GEAmerican Governments In previous years, people used to really get worried about car crashes, plane crashes, gun violence, and HIV. Nowadays, more people are killed by drug overdoses. According to the national institute on drug abuse, every day, about 130 people in the United States die after overdosing on opioids. The addiction to opioids is a very dangerous and serious national crisis that touch public health as well as social and the quality of living standards in an economy. The question that get asked all the time is “what exactly is the opioid epidemic? Is it about prescription drugs or heroin?” The answer would be that it’s a combination of both problems. Opioids were being recommended to treat chronic pain, but people didn’t realize the problems associated with the usage of opioids in the long term which the most important point would be getting addicted to the medication. When people get hooked up on these medications and can’t get them from their providers anymore, people substitute it with extremely strong and toxic drugs like heroin.
When these companies launched years ago, they announced that these medications won't be addicting to the consumer. This false announcement made doctors prescribe these medications crazily. People start misusing them by not following the prescription instructions which lead to many death cases due to addiction. Opioids overdose rate began to increase. Because prescription opioids are similar to, and act on the same brain systems affected by, heroin and morphine, they present a permanent abuse and an addiction, particularly if they are used for non-medical purposes. The most dangerous part is that people start getting creative by crushing the pills and inhaling them, or taking them via snorting or injecting the powder, or combining the pills with alcohol or other drugs. Also, some people didn’t take them exactly as prescribed (e.g., taking more pills at once, or taking them more frequently or combining them with medications for which they are not being properly controlled); and it is possible for a small number of people to become addicted even when they take them as prescribed. It is estimated that more than 100 million people suffer from chronic pain in this country, and for some of them, opioid therapy may be necessary for their case. So now we have two arguments. Some people believe that these control medications are necessary and should have less regulations on them. The others believe that opioids shouldn’t be prescribed to begin with and can be substituted by non-addicting pain killers. President Trump stated in his first State of the Union speech in 2018 that his administration “is committed to fighting the drug epidemic and helping get treatment for those in need.” Unfortunately, the President hasn’t delivered on his promise to seriously confront the opioid epidemic. Now opioids are the deadliest drug overdose crisis in the US history. A $3 billion dollars was given by the President toward the crisis. This money is primarily for addiction treatment, which remains in short supply in the US. According to the 2016 Surgeon General’s addiction report, only about 10 percent of people with a substance use disorder get specialty treatment — in large part due to a lack of access to care. People argue that the US needed to invest in more money for the crisis so we can narrow that gap and eventually try to get rid of it. President Trump and Congress also passed the Support for Patients and Communities Act, which takes some positive steps to increase access to addiction treatment, scale back the over prescription of opioid painkillers. This act is very important because it helps many people that don’t have access to the addiction treatment center or can’t afford to be in one. Looking at a study that was done in 2017, the east coast seems to have higher rates of death from opioid overdoses; West Virginia, Ohio, Kentucky, Pennsylvania, Oklahoma. The opioid prescribing rates in 2012 shows that the east coast have higher rates compared to the rest of the US. Michigan, Indiana, Ohio, Kentucky, West Virginia and more states. Recently, we are seeing a lot of states suing big companies that manufacture the control substances. On March 26, 2019 Purdue Pharma, the maker of OxyContin agreed to pay $270 million to avoid state court trial. On top of that they are funding a national center for opioid addiction and research in Oklahoma City. A total of 1600 law suits were made against that company because of the way they advertised for the medication which was very wrong and misleading. Most presidential candidates aren’t talking much about the opioid epidemic. Elizabeth Warren want to fight the opioid epidemic and put serious resources toward ending the crisis. Some of her ideas are more research toward alternative painkillers. I believe that this crisis needs more attention and work put into it so it can be reduced/ eliminated. With the help of our new presidential candidates, I hope they will shine the light on this epidemic so we can have healthier, happier population.
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JBAmerican Governments With two hundred thousand cases per year in the U.S., the opioid crisis is at epidemic level and continues to affect the lives of not only overdose victims, but also their people around them. “Opioids are a class of drugs that include illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as Oxycodone, Hydrocodone, codeine, morphine and many others” (National Institute on Drug Abuse, n.d.). Fentanyl is the leading killer of Americans among opioids and more often than not, addiction begins with a prescription. The number of Americans addicted to opioids continues to increase and will continue unless a solution is found. “More than 115 people in America die every day due to accidental misuse or abuse of opioids—that’s one person every 12 minutes” (National Institute on Drug Abuse, n.d.), so at a minimum, there are 41,975 deaths a year due to the opioid epidemic in America.
An interesting question about this epidemic is how did it begin? In the 1990’s a large amount of pharmaceutical companies were marketing for their new opioid pills. A few of which promoted their pills as non-addictive, such as OxyContin. What these companies didn’t market was the fast that their drugs were chemically similar to heroin, which is one of the most addictive substances on Earth. “And during that 1999-2016 timeframe, overdose deaths from heroin increased 7 times. And deaths from synthetic opioids like Fentanyl increased almost 21 times” (National Institute on Drug Abuse, n.d.). These drugs have steadily been affecting the country in higher and higher rates each year as is spreads from the Midwest to now the east stated Mathew Kiang, ScD, of the Stanford University School of Medicine. “Eight states—Connecticut, Illinois, Indiana, Massachusetts, Maryland, Maine, New Hampshire, and Ohio – had opioid-related mortality rates that at least doubled every 3 years” and “Florida and Pennsylvania – had opioid-related mortality rates that at least doubled every 2 years”; the mortality rates in the east are mostly caused by synthetic opioids like Fentanyl (George, 2019). In the last midterm election 58 bills were passed by law makers which added new funding to treatment and more payment options for addicts. Love him or hate him, president Donald Trump helped fight the epidemic by signing a package of bills nick named the Support for Patients and Communities Act. “The Support for Patients and Communities Act is a big breakthrough that will boost access to addiction treatment and many other interventions to mitigate the opioid epidemic, from law enforcement efforts against illicit drugs to combating the over prescription of opioids” (Lopez, 2018). “Importantly, this bill will increase access to long-term treatment and recovery while also helping the flow of deadly synthetic drugs like fentanyl from being shipped into the Unites States throughout own Postal Service” said Sen. Rob Portman (R-OH) after the Senate vote. Many of the bills will make a difference in prevention of addiction, limiting illegal opioid distribution and rehabilitation. In the fight for prevention, one bill gives seniors more education on the different options they have when it comes to prescriptions so that they can be informed about the opiate and no-opiate painkiller options they have. To fight illegal distribution, another bill gives more power to the Postal Service in an effort to prevent drug trafficking through international mail. For rehabilitation, another bill added new recovery centers and treatment programs but aside from bills, congress also directed the National Institute of Health to develop new non-addictive painkilling drugs to prescribe to people instead of prescribed opiates. Congress even passed a bill that “would put a patient’s addiction history on their medical records” which it’s authors argue that “it will prevent relapses by giving doctors more information about their patient’s history” (Carberry, n.d.). Some other significant things that the Support for Patients and Communities Act does are it “lifts restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs, expands an existing program that attempts to get more first responders, such as police and firefighters, to carry and use naloxone, a medication that reverses opioid overdoses, allows federal agencies to pursue more research projects related to addiction and pain, attempts to improve coordination between different federal agencies to stop illicit drugs like fentanyl at the border, and increases penalties for drug manufacturers and distributor related to the overprescribing of opioids”. However, though these are positive bills in the fight against the opioid epidemic, the government is not actually providing “a significant increase in spending at all. Even though it authorizes some relatively small grant programs, the actual funding for those will be decided later on by congress’s appropriation process” (Lopez, 2018). Without a doubt, the opioid epidemic will certainly be a big topic in the 2020 election. The Big ShroomAmerican Governments Drug legalization has been quite the hot topic in America these last few years, though most of it has been about the recreational use of marijuana popping up on states ballots like the flowers of the coming spring. However, despite the rampant weed press, it would only be a matter of time until other illicit substances were brought to the debate table. And that day is today. Colorado, one of the first states to legalize marijuana recreationally, has turned its eye to the clinical use of psilocybin, better known as magic mushrooms. Magic mushrooms, or shrooms, were banned by the Nixon administration during their war on drugs through the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Peters 2013). Since then, it has remained federally illegal, classified as a schedule 1 drug.
Schedule classification is handed out at the federal level. Different drugs and chemicals are rated into five categories dependent upon factors like drug abuse potential, long/short term harm, and accepted medical use. These categories are called schedules with schedule V meaning they have a low potential for abuse, little physical harm, and high medical use. Meanwhile, schedule I drugs are the other extreme meaning high potential abuse, high chance of physical harm, and no medical potential what so ever (https://www.dea.gov/drug-scheduling). Many people in society are content with the federal scheduling, and for good reason. It provides a level of protection from potentially hazardous substances and gives a strong case for proper criminalization. After all, it’s better to have some entity out there identifying what is dangerous for us as opposed to no entity at all, right? However, many states have taken issue with the current classification. On one end, the scheduling seems quite backwards. For example, drugs like meth, cocaine, oxycontin, fentanyl, and Adderall are all classified as schedule II. This means they can be, and are, used as prescription drugs. This has led to 218,000 overdose deaths since 1999 by just oxycontin (and similar opioids https://www.cdc.gov/drugoverdose/data/prescribing.html). Meanwhile drugs like marijuana, LSD, psilocybin, and ecstasy are classified as a schedule I drug meaning there is a very high chance of long term harm and death. However, these drugs have staggering lower death rates rating from 0 to the teens per year per drug (https://www.cdc.gov/drugoverdose.html). Discrepancies like these have lead many states to draft and follow drug codes of their own with disregard for DEA Scheduling. And, surprisingly they may even have a case to set their own laws. Drug regulation may be a vast overreach of federal power as there is no place in the constitution where substance authority was directly handed to them. And to this point, the jury is still out on it. It feels like this authority might one day come down to a Supreme Court decision. The states have used/ are using medical classification as a pathway for recreational marijuana. It would be very interesting to see if other substances will follow suit. I wonder just how far they can press their luck before the DEA comes knocking down their door. So why would Colorado advocate for a substance that the federal government would deem more dangerous to society than meth? Well, for medical purposes of course! You see since the banning, there has been a shocking low amount of research done on the drug to really understand its effects. The drug was, more or less, locked away in a vault, far from society, and also far from researchers. This has made the gleaning of empirical evidence difficult on both sides of the argument. However, there has been a reemergence of research recently out of the University of Texas and John Hopkins University with compelling results. Early studies show psilocybin having positive effects for smokers trying to quit, those with depression, and even though terminally ill with death anxiety. Science has yet to reach a verdict on the subject with such few studies done, but the Colorado citizens believe in the early research enough (and perhaps their own personal experience) to petition for the ballot. Perhaps they are trying to seize an opportunity as this last election may have given them a way to circumvent the federal criminal standing. President Trump, love him or hate him, has delegated the responsibility of regulating substances to the state regardless of what the DEA says. Trump has done little to stop the proliferation of the green fever (marijuana) sweeping the nation, and it appears the clinical use of psilocybin may follow suit. After all, the man has a lot on his plate. I can’t blame him for overlooking the occasional mushroom. "Mad Hatter"American Governments Over one-third of people in the United States have experienced pain in the last three months. Of those, 25.3 million experience pain daily. Many of these people turn to opioids as a fast and effective way to relieve their pain. And with doctors readily prescribing opioids, more and more Americans have become addicted to their effects. The United States is facing an opioid epidemic due to the negligence of big pharmaco in the late 1990s. Pharmaceutical companies assured doctors and patients that they wouldn’t become addicted to opioid pain relievers. This caused a sharp increase in their rate of prescription, in fact, rates have quadrupled. In 2017 an estimated 47,600 people died from opioid overdose, 11.4 million misused prescription opioids. Of those prescribed, 21-29% of people misuse their prescription and 8-12% will develop opioid disorder (Public Affairs). The majority of the 11.4 million that misused opioids report doing so to relieve physical pain. However, a large portion report using them to get high (11.7%) or to relax and relieve tension (10.9%) (Lipari, R., 2017). Recently, a lawsuit against a large manufacturer of opioids was settled for $270 million for the deaths and societal damage this misinformation has caused (Hoffman, J., 2019 ). In 2016 the CDC released prescribing guidelines to prevent the overprescribing from doctors. Included in their guidelines is to turn to use physical therapy as a means to prevent and treat pain symptoms especially for musculoskeletal pain such as low back pain and osteoarthritis (MoveForwardPT, 2018). This is a call for doctors to recognize the role of physical therapists in the opioid epidemic.
Additionally, the opioid crisis is merely a symptom of a larger problem that needs to be addressed: the apparent lack of holistic and preventative care due to the holes in access to affordable healthcare. In the United States, health coverage is attained through your employer, purchasing it yourself, or government programs. There are typically three different categories of insurance that vary cost and in freedom to choose your healthcare provider. In general, from highest cost and most freedom, to least expensive but least freedom to choose, the three plans are: fee-for-service plans, health maintenance organizations (HMOs), and preferred provider organizations (PPOs). For people with disabilities, government aid is an option in the form of Medicaid and Medicare. Each type of insurance will cover either a certain dollar amount or percentage of specified medical expenses. Not all doctors, medications, treatments, therapies, or medical equipment are covered. Furthermore, to obtain physical therapy sessions, many insurance policies require a provider to confirm that physical therapy is medically necessary. This places the responsibility on the doctor, rather than the physical therapist, to judge when physical therapy is necessary or not. This highlights the importance of educating prescribers when opioids versus physical therapy are warranted. It also signifies the priority of educating patients of their options when faced with injuries. Election Impact: There are two levels of government we must look at to observe how recent elections have impacted this issue: the federal level and the state level. The federal government has the power to give funding and grants whereas the states can regulate who prescribes it and pass legislations. The midterm elections in November 2018 passed multiple bills in hopes to have an effect on the opioid epidemic. To help current addicts, funding for new treatment programs, new recovery centers, and different payment options for patients were all addressed in the bills. Additionally, Congress guided the National Institute of Health to develop alternative non addictive painkillers. (Walden, & Greg., 2018.) The Affordable Care Act was passed in 2010 and came into effect in 2014. It aimed to address the overarching problem of accessible and affordable healthcare. It roughly halved the amount of uninsured individuals due to the expansion of Medicaid eligibility. However, not much has been done to expand this act any further and, in fact, Medicare access has been declining. (Healthcare.gov) In California, Jerry Brown passed Senate Bill No. 1109 in September 2018. This bill focused on prevention via educating the public about precautions and dangers of opioid use. Additionally, it requires prescribers to participate in continuing medical education in order to maintain updated information regarding risks and alternatives to opioid prescription. (Caiola, S.) Conclusion: The overarching problem of the opioid crisis appears to be rooted in American’s access to healthcare. If healthcare were more readily available and affordable, patients would likely be able to receive the care they need, when they need it. This would prevent injuries from getting too severe and likely needing opioid prescriptions as chronic injuries increase the risk of long term opioid usage. Additionally, the quality of healthcare needs to be improved. This is being addressed by government by requiring providers to receive continuing education of the dangers of opioids and the addiction crisis and the encouragement to use physical therapy as a means of long term pain relief and injury prevention. "Rebekah A"CA Politics California is one of many states that have seen a statistically significant increase in deaths by drug overdose within the last three years (CDC). Nationwide, a staggering 200 people a day are dying of drug overdose. Prescription and non-prescription opioids are to blame for this high number. Opioids are a class of drugs that include prescription pills, heroin, and a synthetic opioid called Fentanyl. In prescription form, Opioid pills are prescribed to treat severe pain. The problem is that the pills are also made illegally and over-prescribed by doctors, sometimes intentionally. They are highly addictive. Authorities suspect that the surfacing of Fentanyl in California has caused an increase in Opioid-related drug overdoses. Fentanyl is an Opioid that is also treated for severe pain. What makes it different from others is that it is made synthetically in labs by drug traffickers who mix Fentanyl with other drugs such as Heroin, Cocaine, Methamphetamine, and MDMA, drugs that are commonly bought and sold on the streets of California cities. Fentanyl is drastically more lethal than heroin, at any dose and has been found in other drugs at alarming levels recently. Fentanyl primarily comes into California from Mexico via the San Diego border. Fentanyl seizures increased by 135 percent during 2017. Overall, drug seizures at the San Diego border increased from 8,900 pounds in 2010 to nearly 82,000 pounds in 2018, marking epidemic levels. In 2017, drug overdose became the leading cause of death in the United States, surpassing car accidents, HIV, and gun violence (DEA 2018 National Drug Threat Assessment).
Executive Action In 2017, President Trump declared the Opioid crisis a national emergency and vowed to grant funds and resources to states in order to effectively put the epidemic to an end. By executive order, he established the President's Commission on Combating Drug Addiction and the Opioid Crisis. The three parts of the commission focus on and allocate funds to prevention, treatment, and enforcement. To carry out this plan, the DOJ is requesting a budget of approximately 300 million dollars. The breakdown of the money would be 40 million dollars to increase DEA agents that target drug trafficking organizations, 7 million for research on Fentanyl seizures, 3 million for the enforcement of law and safety against drugs, and 254 million to set up High Intensity Drug Trafficking Programs in areas that need it the most such as Los Angeles. If this budget is passed, the federal government will make great strides in the efforts to stall the rising Opioid crisis in California’s inner cities and greater rural areas as well. President Trump has stated, numerous times, that illegal drugs enter the U.S. via open ports of entry that California shares with Mexico. The President posits this fact in support of his proposed border wall at the South West Border between San Diego and Mexico. It is true that cartels get drug shipments into California via ports of entry. However, it is highly debatable whether Mexican cartels ever circumvent legal ports of entry to get their drugs into California. According to the DEA, these shipments of drugs usually come directly through legal ports of entry in all types of vehicles, including personal vehicles. With that being said, at the executive level, the Opioid and drug epidemic has been erroneously linked to the Border Wall, another hot topic in California. Perhaps some of the drugs do enter the state via illegal ports of entry but most come straight through the legal ports. If this is definitely the case, then it would be helpful to invest in drug trafficking enforcement at the border’s legal ports of entry. State and Local Impacts In 2018, California Governor Brown vetoed a bill that would enable the City of San Francisco to offer safe drug consumption programs for adults. This bill would have decreased drug users in the streets of San Francisco by providing a particular space for them to safely and hygienically consume their own drugs. Moreover, the bill would have made opportunities for health and safety education available to drug abusers. The streets of San Francisco have become increasingly trashed with the needles of drug users that abuse heroin, creating a concern for public health and safety. The city has a few model safe-injection clinics set up and newly-elected SF Mayor Breed has made it her priority to get real clinics set up as soon as possible. Of course, the problem is that workers in these clinics could be federally prosecuted since the city doesn’t have the approval to operate safe injection sites. Ultimately, safe injection sites would provide San Franciscans with a more sanitary city and are projected to drastically decrease drug abuse, according to medical examiners in support of the bill. Mayor Breed says that the fight for safe injection sites is not over. In fact, in 2019, the bill has been re-authored by Senator Scott and Stockton Assemblywoman Eggman. If it clears the senate and assembly, newly-elected California Governor Newsom will have the final say in whether Mayor Breed can go forward with the operation of these safe injection sites. In areas such as Los Angeles and the Inland Empire, the Opioid epidemic is not a hot topic in its local elections. One possible reason why is because California has not been hit by the epidemic as badly as other states. However, according to the DEA, the epidemic is quickly spreading to California, attempting to make Cali its next victim. This could mean that the 2020 election may include the Opioid epidemic as a hot topic. The evidence of the spreading epidemic is the mass importation of Fentanyl into California (via the Mexico and SD border), the drug that has devastated other states and sparked increases in California’s death by drug overdose rates. The connection between Fentanyl and California cities (particularly L.A.) will be analyzed in the next blog post. Local and federal institutions have teamed up to ameliorate the crisis. The next post will focus on the specific local institutions that are involved in countering the crisis. These institutions include the DEA Fusion Task Force in L.A., Opioid crisis coalitions that aim to limit the prescriptions of Opioids in the Inland Empire, and several city attorney’s class action lawsuit with Big Pharma companies over the emergence and enablement of the crisis. |
AuthorUndergraduate student generated content. Blog posting and updating done by Kristina Flores Victor, Assistant Professor of Political Science at CSUS Archives
March 2020
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