Introduction
Social Issue
The opioid epidemic is a public health crisis in the United States that has been declared an emergency by the Centers for Disease Control and Prevention (CDC). The crisis is characterized by an unprecedented increase in drug overdoses and deaths due to opioids, primarily prescription painkillers such as oxycodone, hydrocodone, morphine, and fentanyl.
Opioid addiction is a serious problem that began with overprescribing these medications for non-medical purposes. Abuse of these drugs has led to a widespread addiction and overdose epidemic (Rudd et al., 2018). The crisis has caused immense social and economic damage and human suffering. Opioids are one of the deadliest drug epidemics in U.S. history.
Target Population
Opioid addiction affects many demographics, including people from all walks of life. However, the population most affected by the opioid epidemic is likely those with chronic pain. Conditions like arthritis or spinal cord injury often cause chronic pain. According to the CDC, more than one-third of Americans have chronic pain in at least one area of their body. Opioid addiction also affects people from all socioeconomic backgrounds (Rudd et al., 2018).
However, people struggling with opioid addiction are more likely to be poor and have a lower education level (Salmond & Allread, 2019). Additionally, the latter means that opioid addiction can lead to unemployment and financial instability, as well as be connected with increased rates of poverty and homelessness (Rudd et al., 2018). Therefore, the effects of the identified social issue on the communities cannot be overestimated.
Severity and Impact
The risk for addiction increases with the duration of opioid use and the intensity of pain relief. Salmond and Allread (2019) claim that chronic pain patients are at a higher risk of developing opioid addiction. The authors also claim that the opioid epidemic is a public health problem that needs to be addressed. According to their research, about 50% of patients who take opioids for chronic cancer pain end up developing a substance use disorder (Salmond & Allread, 2019, p. 96).
In addition, the article by Salmond and Allread (2019) states that chronic pain patients are six times more likely to abuse prescription opioids than the general population (p. 98). As a result, opioid addiction has become a major public health problem in America. The opioid epidemic has had a heavy impact on rural communities.
According to the USDA, “rural communities have been hit hard by the opioid epidemic, with rates of overdose deaths more than twice the national average.” The article says that “opioid abuse is also a major factor in rising child maltreatment and neglect rates in rural areas.” In addition, it notes that “rural areas also have higher rates of mental health disorders,” which can lead to substance abuse and addiction (United States Department of Agriculture, 2022).
Thus, one may say that the opioid epidemic has had a devastating impact on many communities across the U.S. The CDC estimates that in 2015, out of the total deaths from drug abuse in the United States, opioid deaths accounted for 63.1 per cent (Rudd et al., 2018, p. 1446). This epidemic has had a significant impact on both public health and society as a whole.
Federal Policies
IPRCC
One cannot overestimate the contribution of the CDC to developing effective and influential policies that address healthcare and social issues. Thus, the first federal policy is the creation of the Inter-agency Pain Research Coordinating Committee (IPRCC). The IPRCC is a public-private partnership between the National Institutes of Health (NIH) and the CDC. The IPRCC’s mission is “to enhance pain research efforts and promote collaboration across the government, with the ultimate goals of advancing the fundamental understanding of pain and improving pain-related treatment strategies” (National Institutes of Health, 2022, para. 1).
The IPRCC was first established in 1997 as a policy to help coordinate the efforts of various federal agencies involved in pain research (National Institutes of Health, 2022). The IPRCC is responsible for developing and implementing national policies related to pain research, and its work has been credited with helping to reduce the opioid epidemic. Specifically, the IPRCC has helped to develop guidelines for prescribing opioids, fund research into new treatments for pain, and increase awareness of the dangers associated with opioid abuse among chronic pain patients in the U.S.
The IPRCC is funded through various sources, including grants from the NIH. The funds raised through these grants are then used to support the work of the IPRCC and its various committees (National Institutes of Health, 2022). This funding helps ensure that the Committee has the necessary resources to carry out its important work regarding the control of the opioid epidemic.
One example of using funds in opioid epidemic control among chronic pain patients is research into new treatments for pain. This type of research helps find new ways to treat pain without relying on opioids, a valuable option for those struggling with addiction or abuse. Additionally, funding for opioid crisis awareness campaigns has been used to raise awareness about the dangers associated with opioid abuse and addiction.
The IPRCC was developed by the NIH, a federal agency funded by Congress. Additionally, the policy was developed through collaboration between the Department of Veterans Affairs and the House Committee on Appropriations. Various stakeholders became involved, including the American Pain Society, the Federation of State Medical Boards, and the American Academy of Neurology. Additionally, numerous pharmaceutical companies were involved in developing the guidelines for prescribing opioids. The Committee now has up to seven Federal representatives, including Friedhelm Sandbrink, Walter Koroshetz, Elisabeth Kato, and Rigoberto Roca.
The IPRCC policy is opposed by some groups who feel it is ineffective in addressing the opioid epidemic. They argue that the policy fails to address the root causes of the problem and does not provide sufficient funding for treatment and prevention programs (Gross & Gordon, 2019). One of the groups is the American Civil Liberties Union, which has stated that the policy would infringe on constitutional rights.
Others who oppose the policy include pharmaceutical companies and doctors’ groups. Pharmaceutical companies argue that the policy increases the cost of drugs (MGN, 2016). At the same time, the doctors’ groups claim that it would be too expensive and burdensome to implement and interfere with their ability to provide treatment for patients.
CARA
The second federal policy is the passage of the Comprehensive Addiction and Recovery Act (CARA) in 2016. It is a comprehensive package of legislation that provides funding for opioid addiction treatment, prevention, and research. Specifically, CARA funds programs that address opioid use disorders, interventions to prevent prescription drug abuse, and recovery services. The bill is funded through various sources, including the federal government, state and local governments, private insurance companies, and philanthropic organizations (Congress, 2016).
The federal government provides the majority of the funding for the CARA through the Department of Health and Human Services (HHS). The HHS provides CARA funding through various programs, including the Substance Abuse and Mental Health Services Administration (SAMHSA), the CDC, and the NIH. CARA is designed to help address the opioid epidemic by funding programs targeting addiction treatment and recovery.
CARA policy was founded by politicians, including U.S. Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI), U.S. Representatives Tom MacArthur (R-NJ) and Barbara Lee (D-CA), HHS Secretary Alex Azar, CDC Director Brenda Fitzgerald, and NIH Director Francis Collins (Congress, 2016). The CARA policy was developed through various meetings with these individuals and others, and it was ultimately signed into law by President Donald Trump in October 2018. The stakeholders, including healthcare providers, addiction specialists, state and local officials, and public members, were also involved in its formation.
Various groups actively oppose the CARA policy. Some of these groups include the American Civil Liberties Union (ACLU), immigrant rights advocates, and labor unions. Others have members of the clergy, law enforcement officials, and business owners. The reasons for opposition vary from group to group, but typically center on concerns over the policy’s efficacy and affordability, as well as civil liberties issues.
Policy Frameworks
The 2016 CDC policy framework on prescription opioids for chronic pain includes four main recommendations. They are the following: (1) non-opioid pain management should be tried first; (2) when opioids are used, they should be prescribed at the lowest effective dose; (3) opioids should be combined with other treatments, and (4) providers should closely monitor patients taking opioids (Centers for Disease Control and Prevention, 2016).
Jansson (2018) offers a framework on the use of opioids for pain management and recommends a more nuanced approach to prescribing opioids, considering the individual patient’s current pain levels and other health conditions. It also recommends that opioids be prescribed in lower doses, combined with non-opioid therapies, and monitored closely (Jansson, 2018). While these recommendations differ from the CDC policy framework, they share a common goal of reducing opioid overdoses and improving patient outcomes.
The statistics in the CARA policy framework provide a snapshot of opioid prescribing trends across the United States. The data show increased opioid prescribing over the past few years, with more than 207 million opioid prescriptions dispensed in 2016 (Brennan et al., 2017). The latter is likely due to the growing awareness of the opioid epidemic and efforts by healthcare providers to treat patients with opioids.
Both frameworks recommend a more personalized approach to prescribing opioids as a way to reduce overdose deaths and improve patient outcomes. However, the CARA policy has some key limitations that should be considered when implementing it in the U.S. First, the CARA is limited in its ability to target specific populations or providers who may be contributing to the opioid epidemic. Second, there is no clear evidence that prescribing opioids at lower doses or combining them with other therapies improves patient outcomes (Harris, 2016). Finally, while both frameworks recommend close monitoring of patients taking opioids, there are currently no mechanisms to ensure this monitoring occurs.
There is a need to address policy gaps and deficiencies identified in both frameworks to mitigate opioid overdoses and enhance patient outcomes. One key deficiency is the lack of targeted interventions that specifically address provider or population behavior that may be contributing to the opioid epidemic. The research is unclear on whether lowering opioid doses or adding other treatments truly improves patient outcomes (Harris, 2016). Additionally, the system currently lacks effective mechanisms for the mandatory, close monitoring of all patients prescribed opioids.
The IPRCC has successfully enhanced communication and coordination among pain researchers, thereby improving the quality of pain research. However, it has several limitations, as listed by researchers. First, the IPRCC lacks a clear mandate or objectives (Gross & Gordon, 2019). Second, it is limited in its ability to fund research projects (MGN, 2016). Third, the IPRCC does not have authority over opioid manufacturers or distributors.
The policy framework argues that addressing the policy gaps and deficiencies will improve pain management and reduce the risk of opioid addiction and overdose. The inconsistency in pain treatment across agencies will result in less effective and potentially more hazardous treatments for patients (Gross & Gordon, 2019). The lack of studies investigating non-opioid treatments will limit patient options.
Use of the CDC Evaluation Framework
The CDC is responsible for protecting public health, and to achieve this goal, the CDC relies on a policy process that allows for considering new ideas and proposals. This policy process is divided into five steps: proposal development, review and comment, decision-making, implementation, and evaluation (Centers for Disease Control and Prevention, 2018). Each step is essential in ensuring that policies are effective and efficient.
The CDC (2016) evaluation framework assesses the IPRCC and the CARA policies addressing the opioid epidemic crisis among chronic pain victims. The framework includes six domains: 1) intended effects and outcomes; 2) context and implementation; 3) feasibility and acceptability; 4) equity; 5) costs and benefits; and 6) sustainability.
Table 1 – Policy Comparison
The IPRCC policy offers a more successful and sustainable approach to managing the opioid epidemic for chronic pain sufferers, mainly because it provides a better return on investment. The CARA policy, while suggested for termination, may be stronger in specific areas, such as increasing naloxone availability and funding pain treatment (CADCA, n.d.).
The Policy with the Best Legislative Solution
The policy most likely to support the long-term needs of chronic pain victims is the IPRCC policy. This policy supports rigorous research into the causes and treatments of chronic pain, as well as the development of new, safer pain medications (National Institutes of Health, 2022). It also establishes a national registry for patients with chronic pain, which will help ensure they receive the best possible care (National Institutes of Health, 2022).
The CARA policy, while it does provide some funding for research into chronic pain, does not establish a national registry or help to improve the care of chronic pain patients (Congress, 2016). Thus, it is less likely to support the needs of chronic pain victims in the long run. Overall, the IPRCC policy presents the best legislative solution to help chronic pain victims against the opioid epidemic.
The Role of Social Media
The role of social media in providing information about the opioid epidemic social issue and CARA and IPRCC policies has been crucial in bringing attention to the issue and promoting change. Social media has been used to share personal stories, provide information on resources, and raise awareness of the issue. It has also been used to advocate for policies addressing the opioid epidemic, such as CARA and IPRCC (RNAction, 2016). However, social media has also been used to oppose these policies, which can create a divide in the community and hinder progress.
One recommendation for improving social media campaigns to promote social issues and social policies is to utilize moderated platforms, such as Twitter and Facebook. These platforms are more likely to be used for advocacy than for opposition, which would help ensure that discussions are constructive and positive. Additionally, campaigns should target key demographics with tailored messaging, such as individuals with chronic pain, to ensure that the message is received and understood by those who need it most (Stellefson et al., 2020).
Conclusion
The IPRCC guides how to prescribe opioids safely and encourages patients to seek treatment if they struggle with opioid addiction. It has been argued that the policy does not do enough to address the root causes of the opioid epidemic. One of its benefits is helping to reduce the number of opioid-related deaths. CARA is a policy that was created to address the opioid epidemic. It provides funding for programs that support addiction treatment and recovery, and has been met with various opposition from different groups. The policy has been deemed ineffective and expensive, and it infringes on civil liberties.
The recommendation is to continue the IPRCC policy and potentially stop the CARA policy, as IPRCC is deemed more sustainable due to its superior cost-benefit ratio, even though CARA has a better track record of addressing the opioid epidemic among chronic pain patients. Finally, the use of moderated social media platforms is recommended to enhance campaigns, raise awareness, and facilitate positive change regarding these policies and the related social issues.
References
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