Evaluation Of An Epidemiological Problem

Evaluation Of An Epidemiological Problem

Introduction

Opioid addiction is a disorder that is characterized by the insatiable dependence on opioid drugs. The disease is caused by an interaction of lifestyle, environmental, and genetic factors.  The majority of the genes involved in opioid addiction are found in the opioid system of the body which controls addictive and reward behavior as well as pain (Evans & Cahill, 2016). Exogenous and endogenous opioids bind to opioid receptors, which are embedded on the outer membrane of the neurons, triggering chemical changes (inside and outside the neurons) which produce a feeling of pain relief and pleasure (Evans & Cahill, 2016). In essence, opioid drugs cause addiction by triggering the release of endorphins hormones which interact with receptors to produce the feeling of pain relief and pleasure.

The secretion of the endorphins aids in boosting the feeling of pleasure which creates a powerful sense (though temporary) of well-being (Cragg et al., 2017). The alteration of the brain chemistry by the opioids causes drug tolerance which marks the onset of the opioid use disorder.  The major risk factors for opioid addiction include poverty, personality, psychiatric disorders, depression, and history of drug abuse (Cragg et al., 2017). This paper intends to explore the background, surveillance methods, epidemiology, diagnosis, and a possible plan of action for alleviating the epidemic of opioid addiction. The paper further intends to explore the prevalence rate of opioid addiction in Tarrant County compared states (Texas) and national figures. 

Significance of the Paper

This paper will play a crucial role in bridging the information gap on the risk factors, in incidence, diagnosis, symptoms, epidemiology, and the management of opioid addiction.  The paper will further provide comprehensive data on the prevalence of the opioid addition in Tarrant County, the state of Texas, and the whole nation. The comparison data will enable state and local policymakers to adopt the necessary measures to curb and subsequently reduce the prevalence of the addiction in the county.

Background of the Disease

 The current opioid crisis in the United States traces its origin to the institution of pain management in 1995 (Bernard, Chelminski, Ives & Ranapurwala, 2018). The subsequent publishing of the standards for pain management by the Joint Commission (TJC) in the year 2000 paved the way for the loose regulatory scrutiny of the opioid subscribers by both the Drug Enforcement Agency and the Federation of State Medical Boards which led to misuse.

The prescription opioids are traditionally used to alleviate moderate to severe pain caused by injuries, surgical process, or health conditions.  However, the increased liberalization of pain management has led to the increased uptake of opioid therapy in the management of acute pain such as back pain. The prolonged use of prescription opioids exposes users to the risk of addiction (Bernard et al., 2018).  The opioid crisis in the U.S.A is attributed to three classes of opioid drugs which include the prescription opioids, heroin, and fentanyl.

Prescription opioid drugs are mainly employed in the management of acute pain. Heroin refers to an illicit addictive opioid drug which causes death when misused.  The use of heroin in the country is pervasive in all demographics (Saloner et al., 2018). Fentanyl refers to a synthetic opioid which is approved for managing severe pain. The uncontrolled use of the drug increases users risk to addiction and death. Opioid addiction is symptomized by drug cravings, irritability, anxiety, insomnia, tolerance, physical dependence, constipation, increased pain sensitivity, nausea, sweating, itching, depression, and reduced levels of testosterone. The pervasiveness of the opioid addiction in the United States varies from one region to another. Table 1 below shows the prevalence statistics for opioid addiction for Tarrant County, Texas, and the United States.

Region Opioid Prescription/ 100 People Opioid-Related Overdose Deaths/100,000 people
Tarrant County 66.7 4.9
Texas 53.1 5.1
United States 58.7 14.6

 

Table: Prevalence statistics for opioid prescription and opioid-related deaths for Tarrant County, Texas, and the United States in 2017.

Current Surveillance Methods

The misuse of opioid drugs is often accompanied by life-threatening consequences which affect both the patients and the wider society.  As noted earlier, individuals with mental health disorders, chronic pain, and history of substance abuse are susceptible to the risk of opioid addiction (Jones et al., 2018).  The socioeconomic and the health risks associated with the misuse of opioids makes it imperative to adopt approaches that minimize the dangers of diverting, misusing, or abusing opioids while improving the treatment of chronic pain (Jones et al., 2018).

The safety of the opioid therapy in pain relief is made possible through the use of validated screening instruments which provide a rational method for identifying and reporting patients who are faced with the risk of opioid addiction. The screening tools further aid in identifying patients who require extended monitoring or surveillance during and after the therapy session. Currently, the screening for opioid abuse is carried out using a combination of several tools (Jones et al., 2018).  The most popular tools include the risk factor stratification, assessment of comorbid abuse, urine drug testing, and the assessment of aberrant drug-related behaviors.

The stratification of the risk factors utilizes a variety of the screening tools such as the subjective and the objective screening tools to classify patients’ risk of opioid abuse. The stratification approach uses a scaling system to categorize the risk of patients to opioid addiction and the subsequent care required to insulate them from addiction during therapy (Rosic et al., 2017).  The stratification approach categorizes individuals with track record of opioid use disorder as high-risk individuals. As such, the patients are placed under regular urine drug testing and constant monitoring for medication use to insulate them from opioid addiction.

Additionally, the Prescription Monitoring Program report of the patients is reviewed after every two months to update and evaluate their susceptibility to opioid addiction (Rosic et al., 2017).  The assessment of the comorbid abuse analyzes the susceptibility of the patients to substance abuse and recurring mental health problems. The assessment tool considers mental problems such as personality, major mood, and psychotic disorders as risk factors for opioid addiction. Comorbid disorders expose patients to suicidal ideation, physical comorbidity, impaired social functioning, poor response to therapy, low adherence to medication, and acute psychopathological symptoms (Rosic et al., 2017).  The assessment tool allows physicians to establish whether the concurrent psychiatric symptoms exhibited by patients on opioid therapy is substance induced or independent of drugs abuse. 

The information generated from the assessment tool enables physicians to make the right clinical decision when administering opioid therapy to patients (Rosic et al., 2017). Urine drug testing provides a fast and effective method for monitoring patients’ adherence to opioid therapy.  The tool provides physicians with an objective measure of the quantity of opioid present in the urine which is essential for establishing the susceptibility of the patients to opioid addiction. However, the use of the tool does not provide a comprehensive method for assessing patients’ addiction to opioid due to its susceptibility to false-negative and false-positive results.

The assessment of aberrant drug-related behavior allows physicians to pinpoint patient’s behaviors that are suggestive of uncontrolled use of medications (Rosic et al., 2017).  The tool captures behaviors such as an unsanctioned escalation of doses, frequency of emergency pain medication, obsession with medication, and the diversion of medication among others. However, caution is required when assessing the aberrant drug-related behavior of the patients due to etiological differences (Rosic et al., 2017). As such, a differential diagnosis is required to determine the etiologies of the captured aberrant drug-related behaviors.


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Descriptive Epidemiology Analysis

Opioid addiction afflicts millions of people in the country and internationally. The national opioid addiction prevalence statistics indicate that approximately four million Americans are dependent on opioids.  The majority of heroin users (approximately 80%) in the country report prescription pills as their first encounter with opioid drugs. Higgins, Smith, and Matthews (2018) attribute 4.7% of the incidence of opioid (iatrogenic opioid) dependence on the misuse of prescription opioids. The prevalence of opioid addiction among adolescents is estimated to be more than twice the national averages for young adults and older adolescents within the age brackets 18 to 25 years (Higgins, Smith & Matthews, 2018).

However, a higher percentage of overdose-related deaths are registered among adults within the age brackets of 35 years and above.  The epidemic of opioid addiction is prevalent among people of all demographics regardless of their socioeconomic, age, sex, and cultural background.  Studies show that the current wave epidemic is being fuelled by synthetic opioids and herone (Alexander, Kiang & Barbieri, 2018). The cost of managing opioid addiction per patient each year in the United States is estimated to be approximately $20,000. On the other hand, the economic toll of the opioid epidemic runs into billions of dollars considering more than 11 million Americans have opioid use disorder (Alexander et al., 2018). The societal costs of opioid addiction are estimated to be much higher than the economic costs. The societal costs of opioid addiction are categorized into indirect costs and direct costs such as the low productivity. Oderda, Lake, Rudell, Roland, and Masters (2015) observe that the social cost of opioid misuse in the country is approximately $50 billion every year.

People at risk of opioid addiction include individuals with record of mental problems, substance abuse disorder, challenges of physical health, and acute or chronic pain.  The development of a comprehensive plan of action for preventing the occurrence of opioid addiction requires an in-depth knowledge of the characteristics of the population that is susceptible to the disease. Individuals that may aid in developing an opioid addiction preventive plan include those with aberrant drug-related behavior, patients at high risk of opiate relapse, patients reliant on opioid therapy for pain relief, and persons with established drug use disorder.

Screening and Diagnosis

 The diagnostic strategies for opioid addiction depend on several factors such as the physical and the mental health of the patients, the period of opioid abuse, and the type of opioids abused.  The diagnosis of opioids addiction is carried out by assessing the symptoms and signs of opioid addiction. The major symptoms of interest include behavioral, physical, cognitive, and psychosocial symptoms (Wickersham, Azar, Cannon, Altice & Springer, 2015).  Behavioral symptoms include the loss of productivity, long-term dependence on opioids, and drug cravings among others. Physical symptoms relevant to the diagnosis of opioid addiction include pupillary constriction, emotional distress, mental tension, insomnia, drowsiness, and slowed physical movement. The cognitive symptoms include attention deficit, memory loss, impaired judgment, and suicidal ideation.  The psychosocial symptoms include impairment of visual acuity, gastrointestinal problems, injection marks on veins, financial instability, and anoxia. 

Screening for opioid addiction is conducted using a variety of tools which differ on administration time, reliability, method of administration, and validity (Wickersham et al., 2015).  The most common tools include the CAGE-AID Questionnaire, the Composite International Diagnostic Interview, the Mini International Neuropsychiatric Interview, the Structured Clinical Interview for DSM Disorders, and the Severity of Opiate Dependence Questionnaire (Wickersham et al., 2015). The CAGE-AID Questionnaire provides the most optimal results compared to other screening tools.  The screening tool can either be administered by a physician or self-administered (Basu, Ghosh, Hazari & Parakh, 2016). The average time of administrating a screen using the instrument is 1 minute. The short administration period and the ease of administrating a screen make CAGE-AID Questionnaire one of the cheapest instruments for screening opioid addiction. The instrument has sensitivity, specificity, and a positive predictive value of 79.5%, 97.8, and 93% respectively (Basu et al., 2016). The use of the instrument in screening opioid addiction is not bound by any national, state, or professional body guidelines.

Plan of Action

 The prevention of opioid addiction requires a combination of several strategies to alleviate the incidence and the progression of the disease.  The use of evidence-based strategies is taunted as the most effective method for preventing opioid addiction in all demographics. Koh (2017) observes that the use of evidence-based interventions has the potential to ameliorate the opioid crisis in the country.  The researcher advocates the use of community and health professional partnerships to alleviate the misuse of the opioids, addiction, and opioid-related mortality.

Tailoring preventive interventions to schools, families, and the affected communities have the potential to tame the incidence and progression of opioid addiction. Based on the information gathered above, I intend to address the challenges of opioid addiction, once I finish school, by implementing three interventions which include development of partnerships between patients and clinicians, public education, and advocating relevant policy changes at state and federal levels.  The promotion of partnerships between patients and clinicians will be crucial in increasing the participation of the former in their care.

As such, patients will be more likely to disclose their experience with risk factors (such as the history of mental illnesses and substance abuse) for opioid misuse to their physicians which will aid in managing their addiction. Public education will be critical in sensitizing communities about the utility of the primary, secondary, and tertiary preventive measures in alleviating the occurrence and deterioration of opioid addiction. Public education will be conducted in hospital settings and health fairs.  The primary preventive interventions of interest include adherence to opioid prescription and the avoidance of nonmedical use of opioids. The secondary preventive measures that will be advocated for during the public education campaign include regular screenings of patients under opioid therapy and early treatment for new addicts. The tertiary preventive measures of interest include rehabilitative treatment and therapeutic treatment of patients with opioid use disorder. The advocacy of the policy changes at the state and federal level will aid in regulating the prescription of opioid therapy and enhancing information sharing among physicians. 

 Conclusion

Opioid addiction is type of substance abuse disorder with a significant repercussion on the health, social, and the economic wellbeing of the affected patients.  The ongoing opioid crisis in the U.S.A is estimated to have a significant social and economic cost that runs into billions of dollars. The onset of the disease is caused by a combination of environmental, genetic, and lifestyle factors.  The main risk factors of the diseases include psychiatric disorders, drug abuse disorder, young age, and social environments that promote the misuse of drugs. Opioid addiction is symptomized by drug cravings, euphoria, nausea, sweating, and chronic constipation among others.

The monitoring of opioid addiction in the country is carried out using a variety of tools which include the evaluation of the aberrant drug-related behavior, urine drug testing, assessment of comorbid abuse, and risk factor stratification. Individuals at risk of contracting opioid addiction include those with a history of mental problems, substance abuse, chronic pain, and poor physical health. The diagnosis of opioid addiction is conducted by evaluating the signs and symptoms of the disease. The management of opioid addiction can be enhanced by advocating a raft of preventive measures to alleviate the incidence and progression of the disease.

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