Policy background
In the United States, opioid abuse is still a significant public health concern in the country. Understanding opioid prescribing behaviors for children, adolescents, and young adults is crucial for designing focused interventions and policies for this patient population at national and local levels. The opioid crisis is a significant public health concern in the country. Understanding opioid prescribing behaviors for children, adolescents, and young adults is crucial for designing focused interventions and policies for this patient population at national and local levels.
According to many experts, the present opioid addiction pandemic is both the most intractable in the nation's history and the first to affect a significant number of children and adolescents. An initiative to improve public health has been launched throughout the country, including expanding access to addiction treatment. While first established in the 1970s, the treatment infrastructure is woefully inadequate for fulfilling the needs of adolescents and young adults, who are frequently seen in pediatric primary care settings.
Opioid analgesics, in particular, have become increasingly common in drug overdose deaths. Overdose deaths involving opioids in 1999 accounted for 30 percent of all deaths in 2010, compared to nearly 60 percent in 2010. At this point, the number of opioid overdose deaths is outpacing the number of heroin and cocaine overdose deaths. Other than overdose deaths, ER visits and substance treatment admissions for opioid abuse have also increased in recent years.
Individual and family health and well-being are put at risk, communities are torn apart, and resources are drained from the health care system because of substance abuse problems. Those who are detained are more likely to suffer from these conditions than the general population. In 2014, almost a quarter of the 22.5 million Americans who needed drug or alcohol therapy went untreated, compared to 77% of those with hypertension, 73% of those with diabetes, and 71% of those with major depression (Ellis et al. 2019)
Many people believe that instead of over-criminalizing and incarcerating, public policy should support the prevention and treatment of substance use disorders. The federal, state and local governments now support specialist drug courts. Drug courts may help. It will necessitate a coordinated effort from stakeholders in public health, clinical care, public safety, and other areas. Due to the unmet need for effective pain treatment, opioid analgesics are frequently misused and overdosed. Patients' real needs must be considered when developing a prescription medication addiction approach. By collaborating with federal, state, and local partners, HHS has led the fight against prescription drug abuse. These agencies frequently collaborate with HHS on this problem.
Policy landscape
In the 2018 US presidential elections, health care was an essential subject of contention. The opioid issue is one of the top priorities. The opioid crisis is one of the most severe public health concerns of our day, with over 115 overdose deaths each day from prescription and illegal opioid usage. Increased opioid overdose deaths are causing a drop in American life expectancy for the first time in generations. (Fraser et al. 2019) This is an issue of concern for parents as it jeopardizes family continuity due to early deaths among the youths. Public health officials have had a rough time monitoring how to prevent the already escalating death rate amongst teenagers due to opioid overdose. Health officials have advised Americans to keep the overdose-reversing medicine naloxone on hand, and state health departments have issued standing orders to make the drug widely available.
Various legislations have been put forth to ensure funding of the opioid pandemic campaign. One of these legislations is the Comprehensive Addiction Resources Emergency (CARE) Act of 2019which offers $10 billion per year in federal financing to treat the opioid problem. This bill would direct monies to the hardest-hit counties and communities, highlighting the significance of long-term funding equal to the epidemic's severity. At least $125 billion in federal funding for prevention, treatment, and recovery services was proposed by Biden's campaign over ten years, with 60% of that money going to state governments and local communities. This illustrates that the opioid epidemic is a high-priority health concern that requires a multi-pronged approach to get the greatest outcomes. The fight against the opioid epidemic necessitates collaboration amongst disciplines with diverse approaches and cultures. The same as with the medical community, public health authorities must engage the mental health and substance abuse communities. Individuals and communities most harmed by poor social and economic situations must be included (Fraser et al. 2019).
Policy options
Opioid overdose and addiction treatment centers are effective options the government can adopt in tackling the opioid menace. The opioid issue may be tackled uniquely if multiple agencies work together and share a common goal of finding new ways to help those addicted to opioids. However, the referral-in procedure can be perplexing and stressful for those unfamiliar with the facility's scope of what constitutes medically appropriate inpatient addiction treatment. ("Opioid training development: Cultivating nurse competence through education," 2020).
Parents and caregivers can be equipped with evidence-based solutions for managing pain more effectively while reducing the risk of opioid overdose. These methods should allow for symptom treatment at home without putting children, particularly teenagers, at danger of opiate abuse. Unfortunately, research is scarce in this area on a best practice model ("Opioid training development: Cultivating nurse competence through education," 2020).
While overprescribing opioids precipitated the problem, changing pain management prescription procedures is no longer adequate to alleviate the crisis. The active involvement of psychiatrists who are best prepared to handle psychiatric comorbidities is critical in reducing mortality and improving treatment retention. New therapies for OUD, OUD management models that involve health care, and OUD prevention interventions may help resolve the opioid crisis and prevent a recurrence.
Utilization of telemedicine. For those living in rural and underserved areas, the use of telecommunications technology, or "telemedicine," can help improve access to MAT drugs and concomitant therapy in underserved locations. Patients with OUDs can be treated with telemedicine, but it isn't as simple as connecting them to a healthcare provider. As a result, telemedicine cannot be used to combat the opioid epidemic unless it overcomes numerous regulatory, logistical, and quality obstacles. However, despite its considerable potential, there are several impediments to the widespread use of telemedicine for MAT. In 2008, Congress enacted the Ryan Haight Online Pharmacy Consumer Protection Act (Haight Act). For patients being treated at DEA-registered hospitals and clinics, the Haight Act prohibits doctors from remotely prescribing restricted drugs unless they first conduct an in-person examination with the patient or meet a "practice of telemedicine" exception. Lawmakers passed the law in the late 1990s to stop the proliferation of rogue Internet pharmacies that sold controlled medications online.
Policy recommendation
Programs should stock up on naloxone, syringes, safer drug use equipment, PPE, and hand sanitizer in the case of a supply shortage. Cross-training staff and prioritizing vital services can also be done in advance of a labor shortage. Schools should teach kids and their families about the dangers of opioids, prevent them and intervene if someone is abusing them. For this, back-to-school orientations are the best place to convey it. Students suspected of having an opioid use disorder can be evaluated at health centers located within schools.
Collaboration with drug use/mental health providers to develop a clear plan that supports recovery is critical. In the event of a relapse, a care action plan should be swiftly adopted. Medicaid expansion should be done to enroll as many individuals in the program as possible. Many of the neediest people with substance use problems have earnings below 138% of the federal poverty threshold. As of October 2015, an estimated 3 million persons had incomes that qualified them for Medicaid under the ACA, but their states had refused to extend Medicaid eligibility to youngsters (Noyes et al., 2021).
Policies should be enacted to promote safer drug use and reduce barriers to addiction treatment among youngsters (Noyes et al., 2021). To impact policy, policymakers should consult community experts and learn from PWUD. To continue operating in an emergency, policies should define syringe access, OUD medicines, naloxone, and other harm reduction treatments as "essential services." States should request exclusions to allow patients to keep OUD prescriptions longer, cover all OUD meds without prior authorization, and waive counseling and in-person visits.
The US state alcohol and drug agencies should respond comprehensively to the opioid crisis. The government should come up with a variety of evidence-based anti-opioid measures. Upholding and expanding high-quality, evidence-based policies and services should be future public health priorities.
References
Predicting opioid dependence from electronic health records with machine learning. (2019, January 29). Biodata Mining.
Noyes, E., Yeo, E., Yerton, M., Plakas, I., Keyes, S., Obando, A., Gaeta, J. M., Taveras, E. M., & Chatterjee, A. (2021). Harm Reduction for Adolescents and Young Adults During the COVID-19 Pandemic: A Case Study of Community Care in Reach. Public Health Reports, 136(3), 301–308. https://doi.org/10.1177/0033354921999396
Opioid training development: Cultivating nurse competence through education. (2020, June 7). Wiley Online Library.
Opioid overdose and addiction treatment: A collaborative model of compassion, patience, and respect. (2020, May 12). Sigma Theta Tau International.
The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications. (2019, January 16). American Journal of Public Health.