Author: mmg5998

Those who battle addiction every day face enough of a struggle in their normal day-to-day lives, so you can just imagine how hard it must be during the current pandemic. While addiction rehabilitation services are certainly essential institutions for those battling opioid addictions, some facilities are currently not operating or are carrying out their programs differently. The rapid changes in rehabilitation approaches caused by the current pandemic is bound to take a toll on the recovery of so many Americans.

Allegra Schorr, the President of the Coalition of Medication-Assisted Treatment (MAT) Providers and Advocates of New York State (COMPA) fears the risk of overdose the 41,000 recovery patients within the 45 recovery organizations she represents. In the state hardest hit by COVID-19, Schorr is conflicted with developing strategies to help reduce the spread of Coronavirus while preventing overdoses for patients using Medical Assisted Treatment. Schorr also worries that without the proper balance to ensure the wellbeing of those with opioid addictions during this time, overdoses could take a toll on hospital systems which are already strained due to Coronavirus. Aside from Medically assisted treatment, COVID-19 has also changed the way in which many residential rehabilitation facilities operate with many residential programs being forced to suspend the acceptance of new patients (CBS News).

In addition to the fear of those with opioid abuse disorder overdosing or relapsing during the pandemic, many fear that addicts who become infected with COVID-19 could face more serious illness. Many of the drugs that are commonly abused cause great damage to the lungs and heart of those who are addicted. With these underlying issues due to years of drug abuse, contraction of COVID-19 could mean death for many individuals regardless of prior health conditions or age. Also with stay-at-home orders active across many states, sterile needles may be inaccessible to many. This causes an additional fear of the possibility of the transmission of diseases such as HIV and Hepatitis. One huge fear that many experts also share is the fear of the lack of healthy coping mechanisms for addicts. During this pandemic, many are facing hard times, millions of people are temporarily out of work or have unfortunately lost their jobs and many are financially struggling. These stressors could cause many in recovery to relapse and drive those who are actively using illegal drugs to the point of overdose. For a population of Americans that is so reliant on a routine of rehabilitation programs for recovery, these tough times cause fear amongst so many (US News & World Report).

Many recovering addicts across the nation are now learning the grave struggles that isolation brings to their recovery. In a recent article by the Washington Post, Randy Albright, a 56-year-old recovering addict from Maryland spoke about the struggles of isolation. In this time of isolation, Albright emphasizes the importance of those in recovery lending a helping hand to one another. Albright has given his phone number to members of the support group which he is a part of and often leads sessions for and has said that he is “determined to see his recovery ‘continuing tomorrow.'” (The Washington Post)

With so many people struggling with an array of issues (mental health, addiction, financial issues, etc.) not only across our nation but worldwide, it is important that we check up on one another during these difficult times. There’s no telling when this pandemic will finally start to wind down but one thing that’s for sure is that our world will be different for quite some time in so many aspects. Check up on one another and lend a helping hand to each other, especially those who are most vulnerable.

SOURCES:

https://www.cbsnews.com/news/how-the-coronavirus-is-hurting-drug-and-alcohol-recovery/

https://www.usnews.com/news/healthiest-communities/articles/2020-04-02/coronavirus-poses-added-dangers-for-drug-users-nora-volkow-says

https://www.washingtonpost.com/health/people-in-addiction-treatment-are-losing-crucial-support-during-coronavirus-pandemic/2020/03/26/5698eae0-6ac6-11ea-abef-020f086a3fab_story.html

 

On my last civic issue blog post I gave a brief introduction to the history of the opioid epidemic. On this big post, one comment that intrigued my interest was one that mentioned the severity of the opioid crisis in rural areas. This led me to do some research into the topic and I was amazed at the information I learned, small rural areas really are some of the hardest areas hit by the opioid crisis. Many people, myself included, often perceive opioid abuse and high rates of addiction as a problem of inner cities, while these are problems that inner cities often face, these problems are very severe in rural areas.

The first question to come to mind in my research was why the opioid crisis is so severe in these rural areas. The Rural Health Information Hub (RHIhub) credits this issue to “limited resources for prevention, treatment, and recovery” in rural areas. RHIhub also mentions that low educational attainment, poverty, unemployment, high-risk behaviors, and isolation are contributing factors to substance abuse in rural America. Since basically all of the factors mentioned, besides isolation, are present in neighborhoods of major cities across the nation, it was still surprising to me that the issue is so severe in the rural setting. The following chart was produced by The Substance Abuse and Mental Health Services Administration (SAMHSA) and included in the RHIhub information on substance abuse in rural America.

Rural and Urban Substance Abuse Rates
(ages 12 and older, unless noted)

	Non-metro	Small metro	Large metro
Alcohol use by youths aged 12-20	37.8%	35.3%	34.3%
Binge alcohol use by youths aged 12 to 17 (in the past month)	5.5%	4.9%	4.7%
Cigarette smoking	28.5%	24.1%	20.5%
Smokeless tobacco use	8.5%	5.0%	3.0%
Marijuana	11.2%	13.2%	15.0%
Illicit drug use	14.2%	17.3%	19.4%
Misuse of Opioids	4.0%	4.4%	4.5%
Cocaine	1.1%	1.8%	2.1%
Crack	0.2%	0.3%	0.4%
Methamphetamine	0.7%	0.6%	0.4%
Source: Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2016 National Survey on Drug Use and Health: Detailed Tables.

Out of the 10 categories of drugs and other substances listed in the chart, it was surprising to see that the percentage of usage decreased in five of these categories as the population ultimately increased. Perhaps the population size has the biggest impact on the severity of the opioid crisis in rural areas?

Additionally, the CDC states that “opioid death rates in rural areas have quadrupled among those 18-25 years old and tripled for females” between 1999 and 2015. Based on this information, the opioid crisis in rural areas has continued to worsen throughout all three stages of the opioid epidemic. The CDC also mentions a list of solutions (attached below) which they believe would help to prevent overdose deaths in rural America.

• Understanding the differences in burden and context of drug use, drug use disorders, and fatal overdose, and identifying how to tailor prevention efforts to local situations between rural and urban areas.
• Teaching healthcare providers about safer opioid prescribing practices and how to treat patients with opioid use disorder (addiction).
• Considering non-opioid pain treatment options, like exercise and physical therapy, cognitive behavioral therapy, or more effective pain medicines (like acetaminophen, ibuprofen, and naproxen). Some of these options may actually work better and have fewer risks and side effects than opioids.
• Supporting training and access to naloxone, a medication that can quickly stop an opioid overdose, for high-risk individuals, families, emergency responders, and law enforcement.
• Increasing access to treatment for opioid use disorder (addiction) through medication-assisted treatment or comprehensive services to reduce infections from injection drug use, like HIV or Hepatitis C.
• Working with public safety to share data, scale up evidence-based strategies, and decrease the illicit drug supply.

I personally believe that “teaching safer opioid prescribing practices” and “increasing access to treatment” in rural areas are the only two provided solutions that truly target the root of the issue. Which of these solutions, if any, do you believe would help to decrease the number of deaths due to opioid overdose in rural America?

While rates of opioid abuse and overdose seem to be decreasing in major cities, there is still much that needs to be done to decrease the impact of this issue nationwide. According to data provided by the USDA, fewer Americas died from drug overdoses in 2018 (67,367) than in the year 2017 (70,237) but data suggests that five particular states (CA, MO, SC, DE, NJ) experienced increased rates overdose deaths from 2017 to 2018. Furthermore, only 14 states (MN, IA, WI, IN, KY, OH, PA, WV, NY, ME, NC, GA, FL, AK), and Washington D.C. recorded a decrease in the rates of overdose deaths. Across the remaining 31 states, rates of drug overdose deaths remained statistically similar from 2017 to 2018.

 

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Sources:

https://www.ruralhealthinfo.org/topics/substance-abuse

Rural America in Crisis: The Changing Opioid Overdose Epidemic

https://www.usda.gov/topics/opioids

For my civic issue blog, I chose to use this as an outlet to discuss the complex issues surrounding the opioid epidemic throughout the semester. I chose this topic because this is an issue that affects millions of people worldwide, whether its individuals, communities, families, etc. I know for my hometown the opioid epidemic has truly become a crisis. Within the past five to six years I can think of about a dozen young people who have passed away due to a drug overdose in my hometown, the most recent being just a week ago. The impact of this issue has become far too wide and we must do something now to help those impacted and reduce these widespread consequences to society. 

According to the National Capital Poison Center, the opioid epidemic has occurred in three waves, the first of which occurred in 1991. The National Capital Poison Center claims that this wave began “when deaths involving opioids began to rise following a sharp increase in the prescribing of opioid and opioid-combination medications for the treatment of pain.” This increase in prescribing of opioid drugs is said to have occurred due to claims made by pharmaceutical companies to prescribers in which they assured them that it was very unlikely for a patient to become addicted to opioids. By the late 1990’s many communities, especially those where opioids were more frequently prescribed began to see abuse of these drugs as well as diversion, or the transfer of drugs from those which it had been prescribed, to others. While this widespread use of opioid drugs by those without prescriptions may have started over 20 years ago, it seems as if it has only gotten worse with time. Today, in so many cities not only across our nation but worldwide, there is an enormous population of people who abuse prescription opioids, many of whom are not prescribed. Additionally, this terrible addiction, which is now medically recognized as a disease, does not discriminate. The population of those who are addicted encompasses a wide variety of races, social classes, occupations, and beliefs.  

The National Capital Poison Center states that the second wave of the epidemic began around 2010 when many addiction-related deaths occurred from heroin abuse. This widespread increase in not only the use of heroin but heroin-related deaths is said to be a result of early efforts to reduce opioid prescribing. This reduction in the prescribing of opioid drugs made them less accessible, causing many to turn to heroin as a cheap, widely available substitute. The National Capital Poison Center goes on to support the point that the disease of addiction is non-discriminatory by stating that “the use of heroin increased in both sexes, the majority of age brackets, and all socioeconomic groups.” While it was apparent to me that heroin abuse has greatly increased in recent years, thus leading to a higher number of overdose-related deaths, I was completely shocked to learn that “deaths due to heroin-related overdose increased by 286% from 2002 to 2013.” Additionally, based on the information presented by The National Capital Poison Center, it seems as if prescription opioid drugs served as a gateway to more lethal drugs such as heroin, as “approximately 80% of heroin users admitted to misusing prescription opioids before turning to heroin.” 

Furthermore, the third wave of the opioid epidemic, which is said to have started in 2013 due to “an increase in deaths related to synthetic opioids like fentanyl.” This period of the opioid epidemic has experienced the largest number of drug-related deaths with over 20,000 deaths from fentanyl and related drugs in 2016. To reduce opioid-related deaths, the US Centers for Disease Control and Prevention has released strict guidelines for prescribers to ensure that opioids are only prescribed when absolutely medically necessary. While the US Government has taken many necessary steps in attempting to reduce the severity of this crisis, actions by pharmaceutical companies have aimed at counteracting these attempts by the government.   

Despite attempts by the government to reduce the severity of this crisis, data from a 2018 survey suggests that the opioid epidemic is still a major problem in the United States today. According to this survey conducted by the U.S. Department of Health and Human Services, two million people were addicted to opioids in 2018, with 130+ opioid-related deaths per day and a total of 47,600 deaths in 2018 from the overuse of opioids. This survey, which is attached below, reveals more daunting facts about the opioid epidemic in the United States highlighting the extreme need for regulations that help to reduce the impact.  

 

Sources: 

https://www.poison.org/articles/opioid-epidemic-history-and-prescribing-patterns-182

https://www.hhs.gov/opioids/about-the-epidemic/index.html