Introduction
Drug overdose is the leading cause of death for US citizens under the age of 50. Young people today, are more likely to die from a drug overdose than from car accidents or fire accidents. According to the Centers for Disease Control and Prevention (CDC), in 2017, there were 70,237 drug overdose deaths that were reported in the United States (CDC, 2017). The age-adjusted rate of drug overdose deaths in 2017 was 21.7 per 100,000, which was 9.6% higher than the rate that was reported in 2016 (19.8) (CDC, 2017). A point to note is that, approximately 49,000 of the 70,237 deaths were caused by Opioids, whereby, 29,000 people died as a result of overdose from fentanyl, followed by heroine, and other opioid-based drugs. According to the State of Alabama Opioid Action Plan 2017 report, it stated that from 2006 to 2014 there were 5,128 deaths as a result of drug overdose in Alabama (Ivey, 2017). The report findings further indicated that in 2014, the state's death rate per 100,000 was 14.9, and by 2016 it had increased to 15.3 deaths per 100,000 (Ivey, 2017).
The opioid crisis is both a public health and economic crisis, which has had a detrimental impact on the quality of life for the people of Alabama. The reasons for this are the high number of people that are dying from overdose of opioid drugs, and its effect on the health-care, education, and business in the Alabama community. According to the Kaiser Family Foundation 2017 report, there were 422 opioid-related deaths in Alabama in 2017 (KFF, 2019). For the State of Alabama to implement an effective prevention, intervention, and treatment plan to address its opioid crisis, the local authorities will have to implement effective community strategies. It is imperative for the state government, health department and community members to establish awareness campaigns to build cohesive relationship to reduce illegal use, and therefore overdose deaths reported in this state. The state government should also implement policies to reduce the privacy limits on the Alabama Prescription Drug Monitoring Program (Ivey, 2017).
Background and Problem Assessment
Context and Statement of Problem
In 2014, Alabama was ranked number 18 in the nation in number of deaths due to drug overdose. The drug induced death rates in Alabama increased from 5.7% in 2007 to 13.4% in 2013. It was also noted that approximately 2.45% or approximately 91,300 people were reported to be dependent on, or had abused illicit drugs in 2017 (Ivey, 2017). According to the Addiction Campuses (2018), more than 175,000 people were engaged in substance in 2017 through the use of opioid pain relievers for non-medicinal purposes (Alabama Campuses, 2018). In addition to that, approximately 300,000 Alabama residents who are over the age of 17 years suffer from addiction to either, or both painkillers and heroin (Alabama Campuses, 2018). It is also estimated that approximately 30,000 Alabama residents who are over the age of 17 are highly dependent on prescription painkillers and heroin (Alabama Campuses, 2018).
Description of the Problem
In 2016, the State of Alabama reported 343 opioid-related overdose deaths, which translates to a rate of 7.5 deaths per 100, 000 (Ivey, 2017). The opioid-related overdose deaths can be broken down into the following: 157 of the deaths were as a result of synthetic opioids (mainly fentanyl), 126 was attributed to heroin, while 124 was as a result of prescription opioids (Ivey, 2017). The graph below illustrates the rate of Opioid-related overdose deaths in Alabama from 1999 to 2016.
It is clear from the trend in the graph that Opioid-related overdose deaths in Alabama have been steadily increasing from 1999 to 2016, with the 2009-2013 period where there was a decline as indicated in the graph from 4.5- to 3.5- deaths per 100,000 (CDC, 2019). While there were 0.8 deaths per 100,000 in 1999, the figure increased to 7.5 deaths per 100,000 in 2016, which is an indicator that over the years more people have been addicted and abuse opioid-related drugs, leading to more deaths as a result of an overdose. The opioid overdose death rate in 2016 is approximately 7 times that of 1999 (CDC, 2019).
Why has there been an increase in the opioid-related deaths in the State of Alabama? The contributing factor to the increase in opioid deaths in Alabama today can be traced to the rate of prescriptions approximately six years ago. According to the CDC, in 2012, Alabama was ranked as the number one as the highest opioid prescription state in the country with 143.8 prescriptions per 100 residents, which is almost over 7 million prescriptions (CDC, 2017).
In 2013, Alabama physicians wrote 141.1 opioid prescriptions for every 100 persons, which is approximately 6.8 million prescriptions. It was still the highest prescribing rate in the country and almost two-fold greater than the U.S. average rate of 79.3 that year (Ivey, 2017). Although the opioid prescriptions rates have declined by nearly 17 percent from 2013 to 2015 in Alabama resulting to 120.3 opioid prescriptions per 100 persons, or 5.8 million prescriptions, the figure is still way above the average U.S. rate (Ivey, 2017). A majority of the opioid drug addicts began their journey to addiction through the use of physician-prescribed drugs mainly for pain-relieving purposes. Once they are addicted, they use unscrupulous means to acquire these drugs such as prescription fraud, theft and being involved in other crimes to get money to purchase these drugs using illegal channels. In addition to that the resurgence of heroin and synthetic opioid drugs such as fentanyl use and trafficking has led to opioid addiction becoming an epidemic in this state.
Comparison of Opioid and Heroin Use in Alabama US Average
Abuse of prescription opioid painkillers is on the rise in the State of Alabama. According to a 2018 report by Addiction campuses, it illustrated that both children and adults in the State of Alabama are used opioid medications at a higher rate in 2017 than residents in other US states. This can be attributed to the high prescription of opioid-based drugs in the State of Alabama in comparison to other parts, or states in the United States (Alabama State Nurses Association (ASNA), 2018). The table below provides an illustration of the opioid medication abuse in different parts of the US
Region | Age: 12-17 | Age: 18 and Older |
United States | 3.72 | 4.54 |
Southern Region | 3.94 | 4.48 |
Alabama | 5.05 | 5.15 |
(Alabama Campuses, 2018)Prevalence and Scope of the Problem
According to Dr. Scott Harris, the State Health Officer, a majority of the information on the opioid epidemic in the State of Alabama is derived from death certificate data, whereby there is a possibility that they were not prepared by trained medical personnel (Ivey, 2017). Also, there is the possibility that the insurance information on a deceased person may not contain information on their illicit use of opioids. In addition to that, Dr. Harris implied that determining the prevalence and scope of the opioid problem in Alabama may be difficult to assess as the Alabama Prescription Drug Monitoring Program, which tracks the prescriptions that are issued within the state contains strict and privacy-based limits in relation to its use (Ivey, 2017). However, in 2016, the Robert Woods Johnson Foundation utilizing CDC data from 2013 to 2015 identified counties in Alabama that had the highest overdose mortality rates (exceeding the national average of 15.7% per 100,000 persons) (Ivey, 2017). The table below shows the identified counties:
- County County
- Escambia Marshall
- Walker DekalbSt. Clair Blount
- Cullman Etowah
- Cleburne Shelby
- Franklin Baldwin
- Jefferson Morgan
Consequences of the Opioid Addiction and Overdose Problem
The opioid crisis in Alabama will result in a variety of problems in the near future. The Department of Health and Human Services in 2016 found out that approximately three-fourths of all states had recorded a dramatic increase in the number of children in the foster care program. In 92,000 of the cases, parental substance abuse was reported as the primary reason why the children were removed from their homes and placed in foster care (Alabama Campuses, 2018). The possibility of this problem being experienced in Alabama at a high level is possible because it is estimated that approximately 300,000 Alabama residents who are over the age of 17 years suffer from addiction to either, or both opioid painkillers and heroin (Alabama Campuses, 2018).
Increased use among the young population i.e. children and young adults leads to an increase of the number of babies born with Neonatal Abstinence Syndrome (NAS). According to CDC (2014) the number of NAS cases in Alabama increased from 170 in 2010 to 345 in 2013(Alabama Campuses, 2018). In addition to that, the increased use of opioid use has a negative impact on the economy of the state. Alan B. Krueger, the director of Princeton University Survey Research Center analyzed data from 1999 to 2015 on opioid prescriptions and found out that, there was a 20 percent observed decline in labor force participation (LFP) during that period. In addition to that, the misuse of opioid painkillers can lead the addicts to start using heroin or opioid synthetic drugs such as fentanyl, increasing their chances of dying from an overdose due to combination of these drugs (Jones et al., 2018). Also, it leads to increased trafficking of these drugs to ensure that there is easy access, and this can lead to more crime-related incidents whereby criminals are motivated with the need to steal money or valuables that they can use to purchase these drugs.
Solution to the Opioid Addiction Problem
In this paper, it has identified that the main reason for opioid-associated addictions and deaths is the high prescription rates in the State of Alabama, which is ranked first in the nation. It is an indicator that these drugs are easily accessible to the people who have developed an addiction for them. Also, Dr. Harris pointed out that one of the challenges of determining the scope and prevalence of opioid-addiction problem in Alabama is the privacy and limitations placed on the Alabama Prescription Drug Monitoring Program. Therefore, there is the need to implement policies that ensure health care authority members have access to current data on prescription information. They will then be able to use the information to determine the most affected regions by the number of prescriptions and number of people provided these drugs, and they can focus their attention on intervention and treatment plans in the affected regions such as providing the affected people with increased access to medication-assisted treatment (MAT) such as buprenorphine. In addition to that, hospitals in these region will be restricted and monitored in terms of the number of prescription drugs that they can provide to their patients. Vulnerable people in terms of addiction of opioid pain killers should be prescribed with alternative pain killers that are as effective as opioid base drugs in relieving pain but are not as addictive.
Awareness campaigns should be increased in Alabama. The Alabama Health-care Department should introduce social media campaigns, school- and community-based programs to create awareness of opioid pain killers' addiction. People should be informed that just because they are using prescription drugs that were provided by their physicians, it does not mean that they are not addicted. The awareness campaigns should contain information on the symptoms that they should look out for, and intervention facilities in their area of residence. In addition to that, the community members should be provided with communication channels i.e. phone numbers that they can use to report people w...
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