The purpose of current quantitative research is to investigate the reasons and propose solutions to the opioid crisis in the USA. Official medicine commonly prescribes opioid drugs for chronic non-cancer pain treatment. They are dangerous as simultaneously with pain relief provoke euphoria feeling. Moreover, many of them feature short- and long-lasting withdrawals after finishing the treatment. Consequently, withdrawal and bell-being feeling effects often result in opioid abuse, misuse, and overdose, which often become the reasons for opioid-based deaths. Besides, official medicine tends to prescribe opioids for chronic pain treatment, non-medical self-treatment is common among poorer groups of population of the country as well. Absence of proper health care access, high costs of medical services, and cheap price of heroin and fentanyl make self-treatment more affordable for people with low or unstable income. Unfortunately, such practice significantly increases mortality rate from unintentional opioid overdose and greatly influences general opioid statistics of the country. Through discussion of the data about opioid crisis from credible sources, this research highlights the causes of the national issue and identifies possible tactic for its solution.
Opioid crisis, which results in huge number of unintentional deaths from opioid misuse and overdose, has enveloped America. The sources of common abuse and overuse of opioid medicines come either from non-prescribed self-treatment of pain and psychological disorders, or from officially prescribed ones. Current study aims to investigate the reasons of such tendency and identify the gaps in government policies and medical actions to eliminate the problem. The achievement of this goal lies on the grounds of a quantitative method of five credible research articles observation, analysis, and discussion. Such approach helped to present the results and conclusion that the lack of high quality researches, which could indicate all sides of the problem, has entailed poor knowledge of the physicians, patients, and common people about advantages and dangers of opioid drugs. The substantial and fact-grounded multi-side researches of both medically prescribed and self-prescribed opioid treatment for chronic pain among patients over 18 years can provide a reliable base for effective practical government policies and medical practices, which can reduce the crisis rate.
Five credible scientific researches published in 2016-2017, which concern opioid crisis in the USA, are the basis for current research data gathering. They were the results of a random internet search. While choosing five researches among a great number of works, the year of article publication, its credibility, and opioid topic played a crucial role. Quantitative method helped to gather, compare, and analyze the research data. It disclosed the reasons for opioid crisis in the USA and identified researches and policy gaps necessary to eliminate or at least reduce the problem.
Mortality rate from unintentional opioid overdose has risen during last 15 years in the USA. Common physician prescription of opioid treatment for chronic pain, cheap price of illicit heroin and fentanyl, which assist non-medical opioid use, and stress, which stimulates seeking for euphoria feeling, are the main contributor factors to the problem. People who suffer from chronic pain are in depressive mood and have low access to healthcare services, hereby forming a highest risk group of opioid overdose. Government policies and medical actions have tried to stabilize the situation, but in the majority of cases they have concerned only medically prescribed drugs treatment, while non-medical prescription has stayed beyond research and practice. Consequently, it has showed an increase in the opioid misuse and overdose statistics among non-prescribed opioid takers. Such tendency points at the fact that non-medical prescription of opioids needs urgent research, which will help to build a grounded theory for evidence-based medical practices for this category of American population. Medically prescribed opioid treatment, for its part, requires in-depth researches about opioid addictiveness tendencies, alternatives to opioid treatment, strict dosage, and prescription rules for each individual patient. Firstly, such researches will help to formulate an explicit theory about opioid use treatment for physicians. Secondly, they will make it possible to provide patients with detailed education about all danger sides and detailed instructions about safeness of their treatment. Thirdly, they can develop more strategies for opioid abuse prevention. All mentioned above improvements of the opioid crisis theory based on the research will have their direct practical implementation in evidence-based practices.
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Physicians commonly prescribe opioid treatment for chronic pain relief. Apart from analgesic characteristics, the medicines are effective anxiolytics and antidepressants as well. Opioid treatment is dangerous as withdrawal symptoms and dependence may appear even after a short-time medication. Thus, sweating, shaking, diarrhea resolve within days, while dysphonia, insomnia, anxiety – within months. Some of them may manifest themselves during a lifetime (Evans & Cahill, 2017). As a result, craving to omit negative withdrawals and renew the sense of the euphoria appears and leads to drug dependence. The number of people who died in car accidents from opioid treatment counted 17,000 in 2014, while 8,200 died from heroin overdose during the same year (Evans & Cahill, 2017). This statistics divides America population into two groups. The first follows medically prescribed treatments of opioid medicines and the second follows self-treatment measures through buying cheap non-prescribed heroin to relief chronic and severe pain or get better psychological condition (Dahlman, Kral, Wenger, Hakansson, & Novak, 2017).
Opioid crisis has enveloped the USA population becoming widespread and difficult to overcome. Evans and Cahill (2017) assert that the major contributors to the problem are common therapeutic prescription, low price of heroin, and environmental stressors, which lead to the search of relief from anxiety and depression in opioid drugs. As mentioned above, opioid drugs are effective in recent and chronic pain elimination and simultaneously provide a person with the sense of well-being. Official medicine generally uses opioids non-recurrently in emergency service, but the biggest risk factors for opioids misuse, overdose, and abuse are the patients with chronic pain.
Wilder et al. (2016) chose 90 American veterans who suffered from chronic non-cancer pain for their research to establish the level of their knowledge about danger and side effects of opioid treatment. The researchers chose veterans aged 30-59 years old for their study, as they possessed two important features of opioid risk group. The first is chronic pain and the second is prevailing depression state (Wilder et al., 2016; Voon, Karamouzian, & Kerr, 2017). Both of them can contribute much to opioids overdose. Deaths rates in such cases have risen dramatically since 1990s, while unintentional poisoning remains to be the leading contemporary injury resulting in death cases among Americans aged 25-64 years (Wilder et al., 2016). These facts emphasize, that people often overdose and misuse opioid drugs because of the knowledge gap.
The survey of Wilder et al. (2016) confirmed the existence of huge educative gap of the patients with chronic pain. It stays unclear “how frequently physicians warn patients about the risks of overdose when prescribing opioids” (Wilder at al., 2016). Though many educational programs have appeared within last years for people with opioid abuse, the knowledge they provide is not enough to prevent sad consequences of opioid treatment. Consequently, Wilder et al. (2016) insist that not only a patient but also their family members should pass these programs to increase their effectiveness, as the survey showed that 70% of the participants underestimated their opioid risks. Scientists put “optimistic bias” in the ground of such tendency. This is a psychological process, which provides an individual with delusive belief that his/her personal risk for a particular outcome is lower than that of the others in a similar situation. Moreover, the survey indicated that one quarter of 90 veterans misused their medications occasionally at least once and many used considerably more opioid than prescribed (Wilder at al., 2016). Other family members or acquaintances, who used the same treatment or illicit street purchases, were the sources of additional drug doses (Wilder at al., 2016). Such statistics shows that it is important to view both official and non-official aspects of the problem in complex to reach crisis effective solution.
Besides the misuse and overdose findings, the survey pointed at a huge gap in general knowledge of the patients about their treatment. Thus, they did not know that co-usage of benzodiazepines and opioids risks overdose and leads to dose-depended effect. No one indicated the high risk of the opioid overdose after a week or two breaks. Many did not identify sleep apnea and liver diseases as potential risk factors for opioid overdose (Wilder et al., 2016). All these facts pointed at the lack of theoretical education of the patients about their treatment, which lies within the physicians and education programs competencies. Moreover, as a rule, such education is provided for people who have demonstrated abuse or overdose practice, while it should be obligatory for everyone who starts opioid treatment to prevent negative consequences before they emerge.
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The research of Voon et al. (2016) proved the evidence provided by Wilder et al. (2016). It indicated the lack of the research of the problem, which has resulted in a poor theory and non-effective evidence-based medical practices. Scientists compared the reviews of 18 articles published during 2000-2016 years about opioid crisis and chronic non-cancer pain. Their research found many conflicting facts among their data. Such finding pointed at the urgency of the conduction of high-quality primary research of the statistics of both prescribed and non-prescribed opioid use, as it can help to establish strict medical and educative guidelines for safe opioid treatment.
Apart from controversies, Voon et al. researched a few similarities (2016). They can guide medical evidence-based practices and state the following. Both a physician and a patient should prefer weaker opioids for stronger, long-lasting to short-acting. Every patient who starts opioid treatment should receive a treatment agreement, which introduces all benefits and dangers of opioid medication. By the way, current statistics shows that only 47% follow this practice (Voon et al., 2016). Of course, it is better to omit opioid prescription if it is possible, but it is crucial to pay much attention to the risks of overdose for individuals who demonstrate opioid past and present misuse (Voon et al., 2016). People of young age and representatives of Caucasian ethnicity are more likely to misuse opioid, for this reason, the prescription of such kind of treatment for them should pass under special attention with constant check of opioid misuse by urine testing, blood level monitoring, and other drug monitoring programs (Voon et al., 2016). The limitation of maximum day dose of opioid medicines, which is equivalent to 120 mg. per day, helped to reduce opioid connected mortality rate by 50% in Washington (Voon et al., 2016). Consequently, it is rational to implement such maximum dose restriction in all clinical practices. The implementation of further mentioned guidelines in medical practice can help to reduce the harm from dangerous treatment.
Of course, besides researchers, government should respond to the opioid crisis in the country too, as overdose fatalities have increased steadily within last 15 years. In response, in 2015, the US Food and Drug Administration implemented generic immediate and extended-release brands for opioid medicines. The target was to reduce their use and prescription. Besides, the authorities issued various guidelines and strategies for extended-release and long-acting opioid analgesics. All of them concerned prescribed evidence-based medical practices and showed good results. Accordingly, the number of dosing units decreased by 20%, the total number of opioid prescriptions decreased by 16%, fewer patients were prescribed with opioid treatment, daily doses became less, non-opioid alternatives were applied more often (Pezalla, Rosen, Erensen, Haddox, & Mayne, 2017). Unfortunately, such positive impact did not influence another side of the problem. It is non-medical opioid self-treatment, which is very common among poor population. Thereafter, within 2012-2014 years deaths involving heroin and illicit fentanyl increased dramatically and exceeded the positive statistic of official opioid medical practices (Pezalla et al., 2017).
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The reason of such failure is the same as Voon et al. (2016) underlined. It is a poor research of the problem in general and its non-prescribed aspect in particular. Thus, Fischer (Voon et al., 2016) indicated that the percentage of non-prescribed treatments of chronic pain reaches 48-60%, while official medicine indicates only 11% among prescribed treatment (Voon et al., 2016). The difference is huge and explains why the implemented by government policies had so scanty results for average opioid crisis statistics.
Dahlman et al. (2017) interviewed 702 homeless and poor people with a lack of access to health care who experienced opioid use no longer than 24 hours before the questionnaire. One third of them reported that chronic pain was the reason of such action, while 98% of all participants said that they commonly used heroin for self-treatment of moderate and extreme pain (Dahlman et al., 2017). Some tried to treat psychiatric problems with these medicines too, while three quarters of the interview participants showed that they had opioid use disorder practice (Dahlman et al., 2017). Chronic pain and illicit drugs make poor population, which has low access to proper healthcare service, a risk group for opioid overuse and misuse. Only the improvement of government policy and medical actions can provide proper and effective healthcare services, education, and evidence-based opioid treatment medical practices for this group of population. Such practice should help to diminish the statistics of national opioid crisis.
Government policies and medical actions, which try to reduce opioid crisis rate in the USA, demonstrate low effectiveness because of the many gaps in high-quality researches of each aspect and side of the problem. Thus, more researches are necessary to establish strict guidelines for physicians’ treatment prescription. They should include information about alternatives of opioid treatments, strict doses instructions for each age category with the highest dosage restriction. Physicians should be knowledgeable to provide patient with proper and detailed information about his/her individual kind of medicines side effects and dangers. In addition, doctors should predict that a patient can also use non-medically prescribed opioids, thus, all kinds of possible fatal outcomes of medicine mixture should be discussed with a patient and his/her family members beforehand. Extensive research of the issue should also impact the level of physicians’ education about risk groups and opioid abuse prevention strategies for patients who have not showed the opioid abuse yet. To establish substantial and comprehensive theory of opioid crisis management, which will help to provide more effective evidence-based medicine practices, it is crucial to implement a proper in-depth and factual research of non-medical prescription of the opioids and reformation of healthcare service for poor population, which practice such dangerous self-treatment. To conclude, only the progress in research of the problem will provide an objective and many-sided theory, which can serve as an effective base for evidence-based opioid medicine practice. The latter can help significantly to reduce the crisis statistics in the country.