The Opioid Crisis and Mitigating It Through Youth Education

Introduction

Opioids are a class of drugs which mainly include heroin and other pain medication which include prescription medicine such as morphine, hydrocodone, codeine, and oxycodone. Opioids include both synthetic and semi-synthetic compounds, as well as drugs that are drawn from opium, commonly known as opiates (Knestrick, 2017). Opioids are addictive, and their dispensation and use is highly controlled not only in the US but also in many other countries primarily due to their predisposition to misuse (Zolot, 2017). The common use of opioid pain medication is based on their effectiveness. Patients, however, develop tolerance and require stronger medication, hence the characteristic movement from weaker opioids such as codeine to strong ones such as heroin (Garland, Froeliger, Zeidan, Partin & Howard, 2013). This paper seeks to examine the prevalence of opioid abuse and examine the application of education as a potential solution.

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Prevalence

Green (2017) approached heroin addiction as an epidemic given its spread among peers, noting that it is most prevalent among those who have had experience of physical trauma in which opioid-based pain medication was used. According to Green, Heroin use and abuse of prescription pain medication are connected (Kolodny et al., 2015). Data from the Center for Disease Control (CDC) indicates that heroin use has increased significantly over the last 15 years. The most affected demographic groupings are the non-Hispanic whites and people between the ages of 18 and 25 years. In the period between 2002-2013, heroin use has increased by 114% among non-Hispanic whites and 109% among those in the ages between 18 and 25. There has also been a spike in the number of females who are abusing the drug in within the same period.

The rate of heroin addiction has also doubled from one to 2/1000 people between 2002 and 2013. In the same period, there has been a 286% increase in heroin-related deaths. In the years between 2011 and 2013, 2.6/1000 people reported using opioids within a year before the data collection. Jay and Barkin (2018) note that the 17,087 deaths attributed to the overdose of opioids by the CDC may not be an accurate figure. There are numerous deaths caused by illicit drugs that are toxicologically similar to the prescription ones. The CDC records that at least 61% of drug overdose deaths in 2014 involved opioids. Attempts to use data obtained from death certificate records have been futile due to the inadequacy of the causes of death indicated whereby in cases of drug overdoses (Rose, 2017), the involved drugs are often not specified.

Attempted Interventions

Pain relief is an essential aspect in treatment, and more so in paramedicine. As earlier established, opioids efficiency in main management have led to their use, but while they are effective, patients run the risk of their side effects. Pak, Micalos, Maria, & Lord, (2015) explore the effects of poor pain management which include increased risk of death, escalation of pain, and extreme patient discomfort, among others. In almost all case, patients who require emergency attention first report the existence of pain as the most prominent symptom; hence, pain management is often one of the paramedicine's greatest priorities. The use of opioids as pain medication may thus contribute to the possibility of addiction (Garland & Howard, 2014). For this reason, Pak et al. (2015) explores alternative pain relief procedures that have been proposed and used in various contexts.

Transcutaneous electrical nerve stimulation (TENS) is one of the analgesis which has been proposed for application by paramedics in place of pharmacological interventions. When using this method, a therapeutic effect is induced by using electrical pulses from a mobile device. TENS have been successfully used to relieve pain in numerous cases for at least three decades now. Pak et al., (2015) analyze various studies that prove that indeed TENS have a positive impact on pain and discomfort. However, one main weakness is its application in an emergency setting whereby pharmacological methods are more efficient and will often be preferred.

Acupuncture, acupressure, and electro-acupuncture are therapies that are based on stimulation of certain points on the human body. These methods are components of the large field of alternative medicine and have been used for thousands of years as a traditional way of treating illness. They have their origins in the eastern and Asian parts of the world. Acupuncture involves the insertion of a needle into the acupoint for stimulation while acupressure encompasses the application of pressure using hands to the acupoint. When electricity is passed into the point through the inserted needle, the intervention is referred to as electro-acupuncture.

Warming interventions are interventions in which mild heat is applied on the affected area. While studies indicate that that this intervention may be effective in managing the patients comfort and alleviating pain, this method is only applicable in mild cases. Heat is regulated using an electric blanket or by increasing ambient temperature. Some of the benefits observed when this method is applied include less pain and anxiety and an increase in patients overall mood. This intervention has been suggested as an alternative to pharmacological methods (Pak et al). Aside from warming interventions, there are other physical interventions practiced for pain relief and general increment of patients comfort such as massage, mindfulness-based stress reduction, (Becker, Dorflinger, Edmond, Islam, Heapy, & Fraenkel, 2017) chiropractic, cognitive behavioral therapy (Becker et al, 2017), and osteopathy.

Becker et al (2017) identified several barriers to non-pharmacology based treatment. They include limited access which may result from high transport or treatment costs, among other reasons. Treatment beliefs could also be a barrier, whereby there is a negative perception regarding effectiveness of non-pharmacological interventions especially since most of them stem from alternative medicine practice. Lack of knowledge could also hinder a patient from obtaining non-pharmacological assistance. There is also little social support for alternative medical practice from which most non-pharmacological interventions to drug abuse.

One of the strategies employed in dealing with the opium addiction menace has been the use of anti toxicity medications to prevent death. Naxolone has been one of the most effective of such. However, this measure poses a unique challenge. Victims of drug abuse are hesitant in requesting for emergency care because such a move might lead to arrest and prosecution. Canouse and Compton (2015) found that only between 10% and 56% of the times when a drug user needs emergency help are reported. Only 51% of people called 911 to report an overdose in a 1999-2000 study, even though 89% of people reported having witnessed one. Another study investigated the use of Naxolone cardiopulmonary resuscitation and overdose prevention whereby intravenous drug users were trained in the three aspects and observed for 6 months. After the six months, of all overdoses recorded in which either cardiopulmonary resuscitation or Naxolone treatment was given, the survival rate was 100%. The Drug Enforcement Agency is therefore recommending that law enforcement agencies formulate policies that allow for training which will lead to Naxolone administration.

Student drug testing is another measure that has been carried out by different schools to control and prevent drug use in schools. Terry-McElrath, O'Malley, & Johnston, (2013) carried out a national survey to investigate the impact and effectiveness of student drug testing, and came up with interesting conclusions. While Terry-McElrath et al., (2013) admit that the methodology used in the study may slightly jeopardize the validity of the conclusions, it was clear that student drug testing has an alarming effect. National data for the 12 years ending 2011 collected from 249,975 students from 2,346 middle and high schools indicated that student drug testing had a positive effect on marijuana use deterrence. However, students drug testing led to increased drug use of other drugs. Based on these findings, Terry-McElrath et al., (2013) et al concludes that student drug testing should be approached with caution.

Mitigation Through Youth Education

Kumar, O'Malley, Johnston & Laetz (2013), examined schools from different regions of the US focusing on the drug use prevention programs that are available for middle and high school students. One clear conclusion was that the prevention programs were customized to students needs and differed from school to school. Each school is at liberty to develop and teach whatever approved programs that they feel are of benefit to the students. However, the high level of differentiation hinders any form of comparative appraisal thereby making it impossible to determine which of the programs are most effective. If drug prevention programs are going to work, it is best to have them standardized to facilitate comparison.

The second reality that was prominent in Kumar et al., (2013) study is the inequality that is prevalent among schools. Schools that have a predominantly white population registered more and elaborate drug use prevention programs. However, those that have high populations of African-Americans, Asians and Hispanics had less programs overall. The number and intensity of drug use prevention programs also increased with increase in affluence of the schools. The most common program was Drug Abuse Resistance Education (D.A. R. E.). Ironically, schools are supposed to be safe zones in which students can engage in activities that facilitate their growth and development into responsible and productive adults (Lassi, Salam, Das, Wazny, & Bhutta, 2015). It is necessary that the US institutes policies that require all schools to implement such programs if the drug abuse menace is to be countered. Interestingly, however, student participation in school programs of any nature does not necessarily lead to a decline in drug abuse (Seek & Rao, 2011).

There should also be a deliberate effort to educate students on the nature, use and effects of abuse of different drugs. Lipari (2017) sadly confirms that the substance abuse prevention messages barely get to contexts outside of the school environment. This would indicate that young people who are not within the formal education system are at a much higher risk. However, the media should take up the responsibility of educating all citizens and presenting the correct information.

Computer and online-based drug prevention programs have the potential of significantly reducing alcohol, Tobago and drug addiction among young people according to Champion, Newton, Barrett, & Teesson, (2013). Champion et al., (2013) conducted a study which focused on evaluation and analysis of internet-based or computer-based prevention programs to determine their effectiveness post-intervention. Notably, this is the first study of its kind. The results indicated that these preventive programs are indeed effective.

Champion et al., (2013) positively appraised computer-generated prevention programs for various reasons. First, these programs require less professional intervention and are therefore much more feasible where none is available. They are also significantly less costly to implement compared to conventional drug prevention programs. While the initial development of the program may be costly, the cost is spread over the big feasible audience. They are also easy to monitor, facilitate record keeping and encourage adherence. Two of the evaluated programs reduced the desir...