The popular television series Dopethic, based on Beth Macy’s non-fiction book, depicts the complexity of assigning responsibility for the opioid crisis. Several unprotected contributors, such as pharmaceutical companies, federal regulators, and medical professionals, played a real role. Some people misunderstand people through malicious desires. Others try to help, but act on the wrong information.
Legal implications are beginning to reflect this accusation. Recently, Johnson & Johnson and some Native American tribes have reached a tentative $ 150 million settlement on the company’s role in perpetuating the opioid crisis in the community.
Blame and justice are certainly important aspects of organizing. Nevertheless, the crisis continues and we must seek solutions to help millions of Americans affected by drug use. The numbers are staggering and are expected to increase. According to a recent study, 600,000 opioid overdose have died in the United States and Canada since 1999. The number is projected to increase to 1.2 million by 2029.
Nursing schools had two district rotation sites that specifically treated patients with substance use disorders. One was an outpatient program in the wealthy suburbs, and the other was an urban program in which residents were ordered by the court to stay or face legal implications. Both patient populations showed similar physiological and psychological signs and symptoms consistent with the diagnosis of substance use disorder.
The story of its impact on life was devastating. Established career damage, loss of college scholarships, collapse of relationships. Some patients relied on selling family heirloom to pay for opioids, while others sold sex. At that time, it was clear to me that the existence of this condition was indiscriminate and widespread and needed to be part of my primary care practice.
The need for intervention is clear, but treatment barriers continue to exist. Substance use disorder is a medical condition and many patients require medication to treat this disorder. Opioids affect receptors in the brain that can block pain and suppress breathing. This is why it is important to use drugs that act on these same receptors. Drugs such as naloxone block these receptors, so opioids are ineffective and can reverse active overdose.
Efforts have been made to make naloxone accessible to the general public in order to increase the response rate to overdose. Some schools are considering keeping it handy and training teachers and staff to reduce time to respond to potential overdose. Monitored drug consumption sites rely on this drug to reduce harm to people who use opioids.
Other drugs, such as svoxone, a combination of buprenorphine and naloxone, not only protect against respiratory depression, but also help reduce opioid cravings. Although Suboxone has a proven track record as a safe and effective drug, not everyone can prescribe it due to substance use disorders due to strict legal restrictions.
As a family nurse practitioner in Chicago, one of the clinics I work in provides primary care to help patients manage conditions such as high blood pressure, depression, and substance use disorders. The clinic offers routine care and screening, including Papanicolaou stain specimens, blood draws, and drug therapy for substance use disorders.
There are no atypical services in primary care on this list, but unfortunately the treatment of substance use disorders falls into another category and is not included in other matters that are routinely managed in the primary care setting. There is a tendency. This contributes to the stigma of people with substance use disorders and can cause fragmentary care.
Physicians, nurse practitioners, and physician assistants can prescribe buprenorphine with a Drug Administration (DEA) registration, but until recently, if they were using buprenorphine to treat patients with substance use disorders, this A special exemption was needed for the drug.
No exemption is required for other regulated substances containing opioids such as hydromorphone, oxycodone and morphine. This exemption requires additional education and limits the number of patients the provider can treat on a time basis. Currently, healthcare providers with an exemption period of less than one year can treat 100 patients. After a year, that number could grow to 275 patients.
This may sound good, but in a 2020 report published by the US Department of Health and Human Services (HHS), 40% of US counties did not have an exempted provider. More than 1,000 counties were considered highly in need of buprenorphine service, and 56% were not fully competent.
To address this, HHS passed new guidelines in April 2021 to allow most non-exempt healthcare providers to prescribe buprenorphine to 30 patients. This is a step in the right direction, but there are ongoing calls to completely remove the waiver barrier.
The Senate introduced a 2021 mainstream addiction treatment in February last year. It has been approved by those who propose to remove the exemption and advocate increased access to treatment. The American College of Medical Toxicology, American Foundation for Suicide Prevention, National Council for Behavioral Health, and other organizations have signed endorsements, but the bill has not been passed.
Indeed, the opioid crisis is complex and multifaceted. There are clear legislative changes that politicians can make to improve and even save the lives of millions of people. It’s time to break the barriers so that fewer Americans die from opioid overdose.
Dr. Amanda Ramonica Wire is a family nurse and instructor at Rush University and a public voice fellow for the OpEd project.
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