Discussion: Opioid Overdose Epidemic
Discussion: Opioid Overdose Epidemic
Question Description
Part 1: Agenda Comparison Grid
Identify the Population Health concern you selected.
Opioid Overdose Epidemic
Describe the Population Health issue you chose, as well as the factors that contribute to it.
Deaths from drug overdoses have reached an all-time high since 2011, outnumbering deaths from firearms, motor vehicle crashes, suicide, and homicide. In 2017, over 70,000 people died as a result of drug overdoses. Opioids, particularly highly potent synthetic opioids like fentanyl, are the primary cause of these deaths at the moment. When the value of lives lost due to opioid-related overdoses was considered, the economic cost of the opioid crisis alone in 2015 was more than $500 billion (National Drug Control Strategy, 2019).
Opioids are psychoactive substances derived from opium poppy or synthetic analogues of opium poppy. Opioids are primarily
prescribed for pain management, but they have a high potential for abuse due to their addictive nature. Opioids prescribed include Morphine, Oxycodone, Tramadol, Heroin, and Methadone. Carfentanyl is an example of a synthetic opioid that is illegally obtained. People with a history of substance use disorders, those who have been prescribed opioids in high dosages (over 100mg of Morphine daily or equivalent), those who have had multiple prescriptions for opioids and benzodiazepines, and those from lower socioeconomic backgrounds are at a higher risk of opioid overdose. People suffering from mental illnesses are more likely to become addicted to and overdose on opioids. Males are also more likely than females to abuse opioids (Wiss, 2019).
Administration (President Name)
President Donald Trump
President Barack Obama
George W. Bush, President
Describe the current and two previous presidents’ administrative agenda focus on this issue.
President Trump’s drug war strategy focuses primarily on efforts to halt the flow of drugs into the United States, such as through Mexico, by erecting a border wall. Other efforts to control drug influx include convincing China to classify Fentanyl as a controlled substance, which has resulted in tighter controls over Fentanyl export to the United States (CNN Wire, 2020).
President Trump’s drug-control efforts include prevention, treatment, interdiction, international operations, and law enforcement. Several federal agencies are working to address the opioid crisis, including efforts to reduce the supply and demand for illicit drugs, to prevent prescription drug misuse, and to treat substance use disorders (National Drug Control Strategy, 2019).
President Obama’s drug war was centered on prevention and harm reduction. Prevention was primarily accomplished through education and combating the influx of drugs from other countries. Some states’ harm reduction efforts included increased access to Naloxone, an opioid antidote used in overdose reversal treatments. President Obama signed legislation prohibiting law enforcement from taking action against people seeking help for an overdose. He also promoted needle exchange programs, which aimed to prevent the spread of blood-borne diseases such as hepatitis B, hepatitis C, and HIV through needle sharing (Miller, 2016).
President Bush announced a strategy in 2001 that focuses on three primary elements: preventing drug use before it begins, healing drug users, and disrupting the illicit drug market. His focus was on illicit drug use in general, due to statistics that came out at the time stating that drug use by young people had nearly doubled over the previous decade: in 2000, more than half of all 12th graders in the United States had used an illicit drug at least once in their lives before graduation (The White House, 2006).
Determine the financial and other resources allotted to this issue by the current and two previous presidents.
The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT Act) for Patients and Communities was passed by Congress and signed into law by President Trump. The SUPPORT Act allotted approximately $8 billion over five years to combat the opioid epidemic (CNN Wire, 2020). The SUPPORT act promotes the use of prescription drug monitoring programs (PDMPs) to share data across states. It aids in the reduction of doctor-shopping for opiate painkillers (Wiss, 2019).
Federal drug control funding for Fiscal Year 2017 was $28.8 billion, according to President Trump’s fiscal year (FY) 2019 budget, and was used by multiple federal agencies in ongoing efforts to respond to the opioid crisis (National Drug Control Strategy, 2019).
On February 2, 2016, President Obama’s administration issued their response to the prescription opioid abuse and heroin use epidemic: a budget that includes mandatory new measures.
$1.1 billion in funding to help ensure that all Americans who needed treatment could get it (The White House, 2016).
In 2006, the Department of State received authorization to spend $30 million under the Critical Flight Safety Program to purchase and refurbish spray aircraft for Colombia’s aerial eradication of opium poppy seed farms (The White House, 2006).
President Bush empowered states by offering incentives to encourage states to provide a wider array of innovative treatment options by voluntarily using their Substance Abuse Block Grant funds for drug treatment and recovery support service vouchers (The White House, 2006)
Explain how each of the presidential administrations approached the issue.
Under President Trump, China, a major exporter of fentanyl to the US, agreed to classify fentanyl as a controlled substance. The Justice Department has increased the number of prosecutions it has brought against fentanyl traffickers. And the surgeon general
recommended prescribing or co-prescribing Naloxone (a drug designed to reverse an opioid overdose) alongside opioids (CNN Wire, 2020)
President Obama promoted medication-assisted treatment. He signed The Comprehensive Addiction and Recovery Act (CARA in July 2016 which expanded funding for the availability of medication-assisted treatment (MAT) for opioid use disorder (OUD). MAT consists of pharmacotherapy, ideally in conjunction with behavioral health intervention. Medications such as methadone and buprenorphine (Subutex) have proven effective in mitigating the negative side effects associated with OUD (Wiss, 2019).
President Obama’s strategy included advocating for greater access to naloxone, an opiate antidote that reverses the effects of an opiate overdose; endorsing state 911 Good Samaritan laws which provide immunity from arrests to people who call 911 to help someone who is overdosing; strongly supporting the expansion of syringe exchange programs to reduce the spread of HIV/AIDS, hepatitis C and other infectious diseases (States News Service, 2014).
President George W. Bush signed into law the Drug Addiction Treatment Act of 2000 (DATA 2000) that allowed office-based treatment with Schedule III-V drugs indicated for opioid dependence. However, the physician could only treat 30 patients maximum.
In 2006, he signed another law: the H.R. 6344, which raised from 30 to 100 the number of patients a physician could treat for opioid addiction with buprenorphine (Subutex) sublingual tablets or buprenorphine/naloxone (Suboxone) sublingual tablets (LoBuono, 2007).
President Bush supported aerial eradication of opium poppy seed farms in Columbia by spraying to destroy opium poppy cultivation. This was supported by the US State Department’s airwing, and inflicted substantial damage to the Colombian opium poppy cultivation sector, leading to a 68 percent reduction
in cultivation from 2001 to 2004. Upgraded security
screening at US airports also led to increased seizures of
Colombian heroin, from 15 percent of available heroin in
2001 to 23 percent of available heroin in 2002 (The White House, 2006).
References
Abraham, A. J. 1. aabraham@uga. ed., Andrews, C. M. ., Grogan, C. M. ., Pollack, H. A. ., D, A. T., Humphreys, K. N. ., & Friedmann, P. D. . (2017). The Affordable Care Act Transformation of Substance Use Disorder Treatment. American Journal of Public Health, 107(1), 31–32. https://doi-org.ezp.waldenulibrary.org/10.2105/AJP…
David A. Wiss. (2019). A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health. Frontiers in Public Health. https://doi-org.ezp.waldenulibrary.org/10.3389/fpu…
DRUG POLICY: Preliminary Observations on the 2019 National Drug Control Strategy. (2019). GAO Reports, 1.
LoBuono, C. (2007). New law increases access to opioid treatment. Drug Topics, 151(3), 61.
Miller, D. (2016). Attacking the Opioid Crisis with Policies, Education. Capitol Ideas, 59(4), 14–17.
Office of the Press Secretary, T. W. H. (2016). President Obama Proposes $1.1 Billion in New Funding to Address the Prescription Opioid Abuse and Heroin Use Epidemic. Journal of Pain & Palliative Care Pharmacotherapy, 30(2), 134.
President Obama Proposes $1.1 Billion in New Funding to Address the Prescription Opioid Abuse and Heroin Use Epidemic. (2016). States News Service.
White House Releases 2014 National Drug Control Strategy – Steps in Right Direction but Largely Kinder, More Gentle Drug War. (2014). States News Service.
The White House. (2006). National Drug Control Strategy, 2006. In The White House. The White House.
What Trump’s drug policies have meant for America’s opioid epidemic. (2020). CNN Wire.
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Melissa Cable
RE: Discussion – Week 1
COLLAPSE
Identify the Population Health concern you selected.
Mental Health Care Services
Describe the Population Health concern you selected and the factors that contribute to it.
Mental health care services are important to individuals with mental illnesses and their families. Access to these services can prevent mental health crises and mandated inpatient psychiatric hospitalizations. According to the National Alliance on Mental Illness (NAMI), one in five adults will experience some form of mental illness. The average time between onset of symptoms and treatment is eleven years and only 64% of adults with serious mental illness receive treatment in a given year (NAMI, n.d.). These statistics are alarming and indicative of a significant lack of resources.
Administration (President Name)
Donald Trump
(Current President)
Barack Obama
(Previous President)
George W. Bush
(Previous President)
Describe the administrative agenda focus related to this issue for the current and two previous presidents.
-2018: Signed the SUPPORT for Patients and Communities Act which expands substance use services through Medicaid and increases access to evidence-based treatment and follow up care and services (Presidential Proclamation, 2019).
-2019: Signed the executive order, President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS), which established a task force to educate and better understand veteran suicide (Presidential Proclamation, 2019).
-2020: “Healthy Adult Opportunity” was initiated which allows flexibility of Medicaid at the state-level (Healthy Adult, 2020).
-2010: Signed the Patient Protection and Affordable Care Act (ACA) which extended the mandated mental health and substance use coverage to include Medicaid managed care plans and health plans through the marketplace or exchange. This mandate was first introduced in the Paul Wellstone and Pete Domenici Mental Health Parity and Addictions Equity Act of 2008 and was specific to traditional health insurance plans (NAMI, 2016).
-2011: Increased federal funding for housing resources to individuals with mental illnesses or disabilities through signing the Frank Melville Supportive Housing Investment Act of 2010 (NAMI, 2016).
-2013: The National Dialogue on Mental Health was initiated which promotes discussion and awareness of mental illnesses (NAMI, 2016).
-2002: Appointed a committee of mental health experts, the New Freedom Commission on Mental Health, to create recommendations for the improvement of mental health services for all age groups (NAMI, 2016).
-2004: Signed the bill, Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), that provides community resources which can be used in place of incarceration for people with dual diagnosis of mental health illnesses and substance use disorders (NAMI, 2016).
-2008: Signed the bill, the Paul Wellstone and Pete Domenici Mental Health Parity and Addictions Equity Act of 2008, which is a federal mandate that insurance companies cover mental health and substance use treatments equal to their coverage for medical issues (NAMI, 2016).
Identify the allocations of financial and other resources that the current and two previous presidents dedicated to this issue.
-The 2020 President’s budget for the Substance Abuse and Mental Health Services Administration (SAMHSA) is approximately $5.53 billion which is an increase of around $1.4 billion from the 2017 budget. However, this increase includes $923 million in funding to address the opioid epidemic which was not part of past budgets (US Department, n.d.).
-The 2017 President’s budget for SAMHSA was approximately $4.1 billion which was an increase of around $776.1 million from the 2009 budget (US Department, n.d.).
-The 2009 President’s budget for SAMHSA was approximately $3.3 billion was an increase of around $3.7 million from the 2001 budget (US Department, n.d.).
Explain how each of the presidential administrations approached the issue.
President Trump has approached the issue of mental health in several ways. His primary focus appears to be substance use and the opioid epidemic. He has formed expert committees to assess for appropriate resources needed in communities.
President Obama approached the issue of mental health through ensuring individuals receive mental health services through their insurance companies. He also addressed this issue by creating an environment of open communication and awareness of mental health issues.
President George W. Bush approached the issue of mental health through improving services, mandating coverage, and creating alternatives to incarceration for individuals with mental illness/substance use disorders.
References
Healthy Adult Opportunity Fact Sheet. (2020). Retrieved from https://www.cms.gov/newsroom/fact- sheets/healthy-adult-opportunity-fact-sheet
NAMI. (2016). Retrieved from https://www.nami.org?Blogs/NAMI-Blog/February-2016/How-Presidents -Have-Shaped-Mental-Health-Care
NAMI. (n.d.). Retrieved from https://www.nami.org?NAMI/media?NAMI-Media?Infographics/NAMI- Mental_Health-Care-Matters- FINAL.pdf
Presidential Proclamation on National Mental Health Awareness Month. (2019). Retrieved from https://www.whitehouse.gov/presidential- actions/presidential-proclamation-national- mental-health-awareness-month-2019/
The White House. (n.d.). Retrieved from https://www.whitehouse.gov/
U.S. Department of Health and Human Services. (n.d.). HHS.gov. Retrieved from https://www.hhs.gov/
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