Introduction
By the year 2018, fentanyl (a synthetic opioid) over-dosage is expected to become one of the leading causes of death among middle-aged adults (especially males) in the US. This provides us with the strong rationale to refer to the concerned issue in terms of a “pandemic” and naturally calls for the creation of the community-based prevention program.
In 2016, there have been registered 64.000 deaths in the US due to drug overdose – a staggering increase by 20% from what accounted for the drug-related mortality rate in 2015. Partially, this situation is reflective of the dramatically amplified recreational popularity of what is commonly termed as the synthetic opioid drugs across the nation – the development that took place throughout the last five years. Among them, the most popular/widespread is fentanyl – the “chemical” analog of heroin, which can be produced and smuggled with comparative ease. As Worley (2017) noted, “Drug deaths involving fentanyl more than doubled from 2015 to 2016… (this accounts for) an epidemic of drug overdoses that is killing people at a faster rate than the H.I.V. epidemic at its peak” (p. 16). As it can be inferred from the chart above, the rise of the concerned drug’s recreational usage has reached nothing short of an exponential momentum, which means that something needs to be done quickly to bring the situation under control. My presentation aims to contribute towards enlightening policymakers as to how they may go about tackling the described issue.
Fentanyl
- Fentanyl’s recreational effects are similar to those of heroin and morphine. However, fentanyl is 100 times more potent than the latter two, which increases the drug’s appeal to both drug traffickers and users.
- Fentanyl is often mixed with heroin and other conventional narcotics and consumed without the would-be affected individuals being aware of it. This significantly expands the population of individuals who can fall victims to the drug in question.
- Fentanyl is a “versatile” narcotic – it can be taken intravenously/as a pill and smoked.
- Fentanyl is much more addictive than heroin, which is why it proves quite impossible for those who have tried this drug even once not to become strongly hooked on it.
- As of today, there are no universally adopted therapies for treating one’s addition to fentanyl on a long-term basis. However, the symptoms of fentanyl overdose can be effectively addressed by mean of administering Naloxone (intravenously) to the affected person.
- The ongoing “fentanyl epidemic” in Canada and the US is likely to attain an additional momentum in the near future. Such an eventual development is predetermined by the sheer measure of the drug’s commercial competitiveness, “Even with declining prices, heroin costs about $65,000 per kilogram wholesale, whereas illicit fentanyl is available at roughly $3,500 per kilogram” (Frank & Pollack, 2017, p. 605).
Destructive Effects
Taking fentanyl serves the purpose of allowing the addict to experience the short-lived sensation of an overwhelming euphoria. This, however, comes at a price of causing the affected individual to become utterly depressed/suicidal after the drug’s recreational effect wears off – hence, the sheer addictiveness of fentanyl. Because the latter alters the metabolic processes in the taker’s body, it is very likely for the concerned individual to end up complaining about having grown extremely weak (in the physical sense of this word), as a result of his or her even short-termed exposure to fentanyl. It is also commonly reported that, in the aftermath of having used recreational fentanyl for some time, one begins to exhibit the signs of mental/behavioral inadequateness – all because fentanyl has a powerful effect on the functioning of the affected person’s neocortex. Specially, people hooked on fentanyl grow to disregard the code of social ethics – something that causes them to pose a danger to the society’s overall well-being. Finally, it must also be noted that the majority of the fentanyl recreational users suffer from the loss of their sense of taste/smell, which adds even more to the intensification of depressive anxieties in these individuals.
Epidemic’s Innate Cause
The main impetus behind the epidemic of fentanyl abuse in the US has to do with the informal institutionalization of neoliberalism, as the country’s de facto ideological policy. The reason for this is apparent – the concerned ideology endorses the continual privatization of the health sector, which in turn strengthens the influence of the pharmaceutical industry on the adoption of healthcare policies in this country. As a result, physicians are encouraged to prescribe patients with as many pain-relieving medications (containing fentanyl) as possible, as the main indication of their professional adequacy – hence, making fentanyl easily accessible by drug dealers. According to Barry (2017), “A primary driver of the fentanyl overdose epidemic is a fourfold increase in prescription opioid sales for pain management that has taken place through the recent decade” (p. 1). The ongoing “war on drugs”, initiated by the US government in the late nineties, contributes even further towards increasing the issue’s severity. After all, this “war” resulted in the reduced availability of heroin in America (due to the destruction of the opium poppy plantations in South America), which naturally causes heroin-addicts to switch to using fentanyl as a cheap alternative.
Systemic Approach to Designing a Prevention Program
When it comes to designing a community prevention program (in our case aimed to address “fentanyl epidemic”), it is important to do this in accordance with the basic provisions of the Systems Theory, as such that helps to explain the fundamental subtleties of the community’s functioning as a thermodynamic system of its own. As Hummelbrunner (2012) outlined it. “Systems theory is a specific way to conceptualize the world around us. In its broadest sense, a system consists of elements linked together in a certain way, i.e. interrelationships that connect parts to form a whole” (p. 396). The theory’s main axiom is that as the society (community) becomes ever more complex, there emerge many new (previously unheard-of) qualities to its functioning. They, however, do not directly derive from what used to be the operational principles of the same society in the past, before it has reached an entirely new level of complexity. What this means is that it would be wrong to assume that a truly effective fentanyl-abuse prevention program can be solely concerned with addressing the issue as such that represents the value of a “thing in itself”, without trying to affect the fentanyl-related discursive climate within the community. Instead, policymakers should consider adopting a systemically sound approach to tackling the problem.
Objectives
The practical implementation of our prevention program is expected to prove beneficial to the community, in the sense of making it less vulnerable to fentanyl, as a whole. The reason for this is that the conceptualization of the above-outlined objectives is reflective of the earlier mentioned systemic aspects of the community’s spatially prolonged existence. In this regard, it must be noted that being closely interdependent, the specified objectives naturally derive from each other. Consequently, this presupposes that it would prove utterly ineffective addressing them in the “one at a time” mode, without much thought given to the fact that the community itself never ceases to undergo a qualitative transformation as policymakers are trying to retain control over its functioning (Pitthayapong et al., 2017). The above-stated implies that there can be hardly any objective criteria for measuring the effectiveness of the program’s implementation phases, especially for as long as the creation of the anti-drug discursive climate within the community is being concerned. However, it will still be possible to evaluate the program’s successfulness objectively, with respect to the would-be obtained statistical data of relevance.
Prevention Program – Philosophy
In full accordance with the systemic outlook on the community’s functioning, my prevention program takes into consideration the fact that the application of the linear cause-effect logic to defining the fluctuating dynamics within the community is hardly justified. In other words, it would prove impossible to curb the rate of fentanyl abuse in our community, without ensuring that the applied effort, in this regard, is circumstantially sound. Hence, the foremost axiomatic premises (as seen above) of the suggested approach to achieving the earlier mentioned objectives. This approach acknowledges that there is much mutual interdependency between the behavioral patterns, exhibited by the society’s members, and the nature of the externally applied stimuli that elicit such behavior in the former (Robinson et al., 2016). The deriving implication is quite evident – a practically valuable prevention program for addressing “fentanyl epidemic” must necessarily be long-termed and feature the elements of centralized (socialist) planning. The logic behind this suggestion is rather apparent, as well – it takes a long time to change one’s existential attitudes by mean of altering the social environment around him or her. This, however, is the only viable approach to improving the narcological situation in just about every community. Following are the sub-sequential phases of the proposed program’s implementation.
Promotion of Physical Culture/Traditional values
As it is shown by many discursively relevant studies, there is a negative correlation between the measure of a person’s willingness to lead a physically active life and the potential likelihood for him or her to become a drug-addict (Kwan at el., 2014). What this implies is that a fair share of the municipal funds should be spent on ensuring that just about every community member has easy access to sporting facilities in the neighborhood. As practice indicates, this most commonly calls for the numerical expansion of the latter – a rather costly (but necessary) communal undertaking. What is even more important – a continual effort must be applied in establishing the ethos of “sport-friendliness” within the community. Accomplishing this particular objective, however, is likely to prove challenging – all due to the ongoing stigmatization of physical culture as something innately Eurocentric/male-chauvinistic. The same applies to the promotion of the so-called “family values” by the community’s authorities – the activity that has long ago proven beneficial, within the context of how the law enforcement agencies go about trying to lower the rate of opioid abuse in the area. After all, the community’s strong affiliation with such values is nowadays commonly interpreted reflective of its members’ endowment with homophobic prejudices.
Safe Drug-Consumption
Nowadays, it becomes increasingly clear to just about everyone that the continual deployment of the retributive strategy for containing the epidemic of opioid abuse in this country can no longer be considered thoroughly valid. The reason for this is that in light of the most recent breakthroughs in the field of neurology, one’s addiction to fentanyl appears to have a strongly defined chemo-electrical quality to it, which in turn implies that the affected person can hardly be held criminally accountable for experiencing it. There is, however, an alternative approach to treating fentanyl-addicts (as opposed to sentencing them to do time in jail) – providing these individuals with different rehabilitative opportunities. One of them would be allowing such persons to take fentanyl under the supervision of the adequately trained staff, with every sub-sequential dose being gradually reduced. This will help to ease up the drug-withdrawal symptoms in the concerned addicts. The implementation of the suggested initiative should also result in reducing the rate of deaths from fentanyl-overdose. The reason for this is that there will be plenty of Naloxone (the medication used to hamper the effects of opioid overdose) available at every “safe consumption” site, as well.
Stigma Reduction
It does not represent any secret that there is a strongly negative public sentiment towards just about anything associated with drug abuse – something that often results in the stereotypization/dehumanization of fentanyl users, as socially dangerous people who are predestined to end up dying from an overdose. Many conservative politicians see it as yet another indication that there is indeed much rationale to the practice of providing fentanyl-addicts with harsh sentences in jail. As Barry pointed out, “Highly stigmatized views about individuals using opioids were associated with greater support for punitive responses to the epidemic” (p. 3). And yet, the very developmental logic of “fentanyl epidemic” presupposes that there can be very little practical worth to such a practice by definition. Quite to the contrary – keeping fentanyl users incarcerated takes up the community’s valuable resources that could have been used for raising public awareness about the drug’s destructive effects (Peian et al., 2015). There is even more to it – the stigmatization of fentanyl-addicts inevitably results in confirming to the affected users that they are nothing but the society’s “burden”. In its turn, this makes it quite impossible for these individuals to address their deadly addiction in a socially responsible manner. Under the auspices of the proposed prevention program, however, the media will be encouraged to refrain from continuing to dehumanize the victims of fentanyl.
Discursive Considerations
There are many reasons to believe that the enactment of the earlier outlined prevention program will result in improving the narcological situation within just about any community. At the same time, however, there appears to be a number of conceptual deficiencies to it, as well. The most prominent of them has to do with the fact that that the proposed program is heavily involved with the discourse of neoliberalism. For example, the suggested decriminalization of fentanyl users correlates well with the neoliberal outlook on healthcare as “paid service” rather than “public good”. And yet, as it was mentioned earlier, the adoption of the concerned ideology by the country’s governmental officials did contribute rather substantially towards creating the objective prerequisites for the outbreak of “fentanyl epidemic” to take place during the recent few years. What this means is that it will only be natural for the proposed prevention program to continue undergoing a conceptual transformation as time goes on. Such a scenario is predetermined by the fact that the very passage of time calls for the adjustments to be continually applied to even the most thought-through social initiatives. In particular, the eventual decline of the neoliberal discourse is most likely to result in the drastic reevaluation of the suggested approaches to addressing the epidemic of fentanyl-abuse in America. The semantic dichotomies contained in this slide are suggestive of what may be such a revaluation’s discursive vector.
Conclusion
Even though the provided suggestions for the enactment of the effective fentanyl-abuse prevention program on a communal level are far from being deemed exhaustive, they fully adhere to the systemic conceptualization of human society as a continually evolving organism – the main indication of their soundness. Apparently, the time has come to admit that it is no longer appropriate to combat fentanyl addiction in individuals by mean of subjecting them to criminal persecution alone. Instead, policymakers must seek the reduction of the fentanyl-overdose rates in a circumstantially sensitive manner while recognizing the systemically multidimensional subtleties of this particular objective and never ceasing to remember the most basic provision of the Systems Theory – “a whole is greater than the sum of its parts”. Evidently enough, “fentanyl epidemic” cannot be addressed outside of what accounts for the phenomenon’s overall social context, which means that the key to finding an effective solution to the problem of fentanyl-abuse in the US is ultimately concerned with reassessing the operational principles of American society, as a whole. I believe that this conclusion resonates well with the line of argumentative reasoning, deployed throughout the presentation’s entirety.
References
Barry, C. (2017). Fentanyl and the evolving opioid epidemic: What strategies should policy makers consider? Psychiatric Services, 2(5), 1-4.
Frank, R., & Pollack, H. (2017). Addressing the fentanyl threat to public health. The New England Journal of Medicine, 376(7), 605-607.
Hummelbrunner, R. (2012) Systems thinking and evaluation. Evaluation, 17(4), 395–403.
Kwan, M., Bobko, S., Faulkner, G., Donnelly, P., & Cairney, J. (2014). Sport participation and alcohol and illicit drug use in adolescents and young adults: A systematic review of longitudinal studies. Addictive Behaviors, 39(3), 497-512.
Peian, L., Peipei, C., Pan, Z., Jiaxi, Y., Yong, W., Na, C., &… Jing, Z. (2015). A COPD health management program in a community-based primary care setting: A randomized controlled trial. Respiratory Care, 60(1), 102-112.
Pitthayapong, S., Thiangtam, W., Powwattana, A., Leelacharas, S., & Waters, C. M. (2017). A community based program for family caregivers for post stroke survivors in Thailand. Asian Nursing Research, 11(2), 150-157.
Robinson, W., Seibold-Simpson, S., Crean, H., & Spruille-White, B. (2016). Randomized Trials of the Teen Outreach Program in Louisiana and Rochester, New York. American Journal of Public Health, 106, S39-S44.
Worley, J. (2017). A primer on heroin and fentanyl. Journal of Psychosocial Nursing & Mental Health Services, 55(6), 16-20.