A Proposal
Problem Description
This project proposal focuses on the problem of the opioid epidemic in the United States. As reported by the U.S. Department of Health and Human Services (2021), “an estimated 10.1 million people aged 12 or older misused opioids” in 2019 (para. 7). Specifically, over 96% of these individuals abused prescription pain relievers (U.S. Department of Health and Human Services, 2021, para. 8). Different social groups seem to be disproportionally affected by this issue. Research shows that veterans are at an increased risk of mortality due to opioid overdose compared to the general population (Midboe et al., 2019). In addition, according to the Substance Abuse and Mental Health Services Administration (2018), survey findings demonstrate that 3.7 million retired soldiers have a mental health problem, a substance use disorder, or both (p. 7). At the same time, veterans are willing to receive treatment, which indicates the importance of implementing an effective policy to resolve the problem.
The existing policies provide a foundation for addressing the opioid mortality problem in veterans. For instance, one of the measures is the implementation of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (2018). Such a policy aims to reduce opioid prescriptions, improve care for female veterans, and support research to prevent drug misuse among retired soldiers. Another alternative is the Veterans Affair’s opioid safety initiative, which is expected to reduce the percentage of veterans dependent on opioid medication use (U.S. Department of Veterans Affairs, 2019). Finally, the Hawaii Opioid Initiative focuses on decreasing the number of retired soldiers with substance use disorders who require professional help (“The Hawaii opioid initiative,” 2017). Overall, current policies need to be supported by effective alternatives for a comprehensive approach to the problem. This proposal aims to outline three policy alternatives to be implemented at the state level to supplement the existing federal initiatives.
Stated Alternatives
The first alternative is to reduce the frequency of opioid prescriptions by providing relevant education and training for Hawaii clinicians to encourage them to utilize alternative treatment methods for veterans in need of pain management. This strategy can help decrease the morbidity rate resulting from opium-based medicine overdose. According to Sandbrink et al. (2020), “opioid prescribing was recognized as an important contributor to the U.S. opioid crisis” (p. 927). At the same time, different pain management options can be used, such as acupuncture, yoga, non-addictive medications, and art or cognitive behavioral therapy (Sandbrink et al., 2020). Reducing the number of opioid prescriptions would mitigate the leading cause of higher morbidity rates among retired soldiers. Therefore, this initiative should focus on organizing and providing training for clinicians at the state level regarding opioid safety and overdose in veterans and explaining other treatment options available for such populations. For instance, the education plan can include lectures or webinars by experts on this subject, access to evidence-based resources on opioid and nonopioid medications, and regular meetings of clinicians to exchange knowledge and discuss relevant issues.
The second policy alternative is to introduce a Hawaii program for identifying and monitoring veterans at an exceptionally high risk of opioid overdose. For instance, a risk assessment tool can be developed to collect and analyze veterans’ data and identify patterns of problematic behavior. Such a measure can include a survey measuring one’s symptoms that might indicate an increased risk of depression, overdose, or suicide. This initiative would allow for early intervention and effective management of the opioid crisis. Associated risk factors that can increase the probability of overdose in veterans include mental health problems, suicidal thoughts and behavior, severe chronic pain, drug or alcohol issues, and others (Sandbrink et al., 2020). Therefore, individuals that fall under these categories should be monitored closely. Based on the risk assessment findings for specific individuals, measures can be suggested to reduce the probability of overdose and suicide events. Implementing this policy alternative would focus on identifying individuals needing close monitoring and additional support to prevent overdose.
The third policy option involves providing veterans with access to self-care programs at a state level that help improve mental health and manage pain through nonpharmacological methods. As noted by Meerwijk et al. (2020), such initiatives can decrease the “risk of long-term adverse outcomes” in veterans with chronic pain (p. 775). Self-care programs should educate patients on the importance of nutrition, exercise, massage, yoga, and psychotherapy and explain self-care strategies to reduce pain and stress in retired soldiers. This initiative can be implemented in healthcare and rehabilitation facilities to raise patients’ awareness about the importance of nonpharmacological treatment for one’s well-being and pain management. Healthcare personnel should be involved in providing access to relevant resources and additional information for veterans. Overall, this policy alternative can help address the problem of opioid overdose by providing the population with knowledge and methods to improve mental and physical health without using medication.
Criteria
The criteria for measuring policy outcomes include political acceptability, cost, and effectiveness, namely, reduced veteran mortality rates and the number of people taking opioids. In this regard, political acceptability will be evaluated based on a favorable perception of the policy among the public in the U.S. political context (Shahab et al., 2019). The cost will be measured by evaluating the total cost of each policy option. Finally, the effectiveness criterion will be assessed with regard to the reduction of opioid overdose deaths in veterans and the number of people taking opioids.
References
Meerwijk, E. L., Larson, M. J., Schmidt, E. M., Adams, R. S., Bauer, M. R., Ritter, G. A., Buckenmaier, C., & Harris, A. H. (2020). Nonpharmacological treatment of army service members with chronic pain is associated with fewer adverse outcomes after transition to the veterans health administration.Journal of General Internal Medicine, 35(3), 775–783. Web.
Midboe, A. M., Byrne, T., Smelson, D., Jasuja, G., McInnes, K., & Troszak, L. K. (2019). The opioid epidemic in veterans who were homeless or unstably housed.Health Affairs, 38(8), 1289–1297. Web.
Sandbrink, F., Oliva, E. M., McMullen, T. L., Aylor, A. R., Harvey, M. A., Christopher, M. L., Cunningham, F., Minegishi, T., Emmendorfer, T., & Perry, J. M. (2020). Opioid prescribing and opioid risk mitigation strategies in the veterans health administration.Journal of General Internal Medicine, 35(3), 927–934. Web.
Shahab, S., Clinch, J. P., & O’Neill, E. (2019). Impact-based planning evaluation: Advancing normative criteria for policy analysis.Environment and Planning B: Urban Analytics and City Science, 46(3), 534–550. Web.
Substance Abuse and Mental Health Services Administration. (2018). 2018 National survey on drug use and health: Veterans. Web.
Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients And Communities Act, Publ. L. No. 115–271 (2018). Web.
The Hawaii opioid initiative: A statewide response. (2017). Web.
U.S. Department of Health and Human Services. (2021). Opioid crisis statistics. Web.
U.S. Department of Veterans Affairs. (2019). Opioid safety initiative. Web.