Opioid Dependence in the Prison Environment Essay (Critical Writing)

Introduction

Opioids refer to psychoactive substances that are extracted from poppy plants and can be synthesized in laboratories. These chemicals affect the opioid receptors found in the gastrointestinal tract or peripheral and central nervous systems (Bellum 2014, par. 2). There are proscribed (like heroin) and permissible opioids that are administered to patients who suffer from excruciating pain. Studies show that individuals who are addicted to these substances are at high risk of using heroin. Mainly, there are three categories of opioids, which are natural, synthetic, and semi-synthetic. Natural opiates are mainly obtained from plants and include thebaine, codeine, and morphine (Bellum 2014, par. 3).

Synthetic opioids are prepared in laboratories and comprise methadone, levorphanol, and fentanyl (Bellum 2014, par. 5). Semi-synthetic narcotics are manufactured in labs. Nevertheless, unlike synthetic opioids, these substances are extracted from natural opiates (Bellum 2014, par. 4). They include hydromorphone, heroin, and oxycodone.

Despite the high rate of opioids abuse in prisons, no research has been conducted to identify the factors that contribute to this problem and how they can be resolved. The study titled “Prescription opioids abuse in prison settings: a systematic review of prevalence, practice and treatment response” by Bi-Mohammed et al. (2017) is the first to look into this matter. The objective of this research was to understand the occurrence, trend, and mitigation of the problem associated with the diversion of administered substances in penitentiaries. In this study, I am going to focus on opioid dependence in the prison environment. I will also highlight the significance of this study to areas of addiction and health care. The report will culminate by outline the strengths and weaknesses of this study and its potential academic implications.

The rationale for the Study

Research shows that there exists a connection between imprisonment and opioid-related deaths. In the early 1990s, scientists discovered that there were high numbers of opioid use disorders, drug abuse, and overdose among individuals released from prisons. The rationale for this study is to understand the current state of misuse of prescribed opioids in prisons and measures taken to address the issue of diversion of these drugs. This study will be helpful to the field of addiction as it will highlight the conditions that make it hard for inmates to cease using narcotics after completing their sentences. In the area of healthcare, this research will underscore the importance of providing opioid agonist therapy to people who have left penitentiary.

Structured Critical Review

Anatomy and Physiology

Opioids work by activating the production of dopamine (neurotransmitters) that lead to extreme pleasure in the brain. They connect brain regions that manage feelings like the desire to drink, eat or have sex. Individuals who use prescribed opioids are susceptible to becoming addicted. One requires therapy to rid his/her body of over-reliance on these substances. According to pharmacists, opioid drugs such as morphine have the possibility of causing deep analgesia, tolerance, physical reliance, mood swings, and hedonic effect that might result in neurotic substance abuse—these drugs impact both the lateral and central nervous system.

In the latter, these substances affect varied body parts, among them the spinal cord. On the other hand, in the peripheral system, opioids impact plexus (submucous and myenteric) found on the linings of the gut leading to severe constipation.

Research shows that opioids affect neurons by attacking receptors found on the neuronal cell membranes. There are three primary categories of opioid receptors which are mu, kappa, and delta. Pharmacological investigations have revealed that natural opioid peptide such as b endorphin, reacts mainly with mu receptors. Additionally, enkephalins and dynorphin interact with delta and kappa receptors, respectively. Morphine constitutes naturally occurring opioids; hence it is strongly attracted to mu receptors. The drugs used to counter the impacts of opioids like naloxone block all receptors but are most effective on mu.

Opioids attack neurons in two spots, which are postsynaptic neurons and presynaptic nerve terminal. The postsynaptic reaction of these substances leads to the suppression of neurons. Conversely, the presynaptic interaction results in the prevention of secretion of the neurotransmitter, and this is regarded as opioids’ primary impact on the nervous system. It is important to note that the effect of opioids depends on the number of receptors on a neuron. The nervous system constitutes an assortment of neurons that vary in function, size, shape and chemical composition of the neurotransmitters that they produce. Morphine interacts with mu receptors preventing discharge of acetylcholine and noradrenaline.

Pathophysiology

Unlike the many harmful effects of alcohol, the pathological impacts of opioids are few. Scientists claim that the upshot of these substances mirrors the pharmacological results of their parent drugs. One should know that opioids do not contain metabolites that harm body tissues. The implications of opioids use are sedation, and in serious instances, overdose fatalities and respiratory depression. Another impact is the narrowing of smooth muscle, which results from increased intake of these drugs. Prolonged use of opioids may lead to these muscles getting hypotonic, subjecting a person to the danger of gastroparesis.

Opioids ingestion impairs normal bowel movement, and abuse of both approved and illegal drugs can lead to persistent and occasional severe constipation. An individual who uses opioids may also develop dental problems as these drugs cause dry mouth.

Epidemiology and Statistics

Unauthorized intake of opioids is the third most common type of drug abuse globally. It involves the use of prohibited substances like heroin and the unapproved ingestion of pharmaceutical drugs. Statistics show that about 0.1% of Japanese and 0.5% of Swedish populations have used illegal drugs in the past (Saunders et al. 2016, p. 285). Additionally, states like New Zealand and Australia have recorded under 0.5% cases of opioids abuse (Saunders et al. 2016, p. 285).

The United States and the United Kingdom have witnessed the highest rate of opioids use, with about 0.9% of their people being victims of this problem (Saunders et al. 2016, p. 285). The high number of complications and overdose fatalities attributed to opioids use to make this issue a major global concern. Generally, illegal use of opioids does not weigh heavily on the international burden of disease compared to authorized substances like tobacco and alcohol. Studies show that opioids result in 0.8% of illnesses while alcohol and tobacco contribute to 4% and 6%, respectively (Saunders et al. 2016, p. 285).

Study shows that about 39 million people suffer from opioid-connected problems across the globe. The highest percentage of this population comprises prisoners or individuals who were once incarcerated. In the United States alone, it is estimated that over 200,000 inmates experience opioid-related challenges every year (Bi-Mohammed et al., 2017, p. 3). There is a consensus that the prison environment predisposes people to the dangers of drug addiction.

Research Method

The article’s title is well articulated and in line with the findings and objectives of the specified study. The authors include an abstract that clearly defines the goals, research methodology, findings, and clinical implications of this study. Moreover, this article comprises an introduction that gives a precise account of the challenge of opioids used in prisons across the globe. The introduction concludes by highlighting the reasons that prompted the writers to conduct this study.

The authors used secondary data from peer-reviewed journals to compile this report. This method of data collection is useful, especially if one does not have adequate time to gather primary information. The researchers restricted their search to articles written between 1995 and 2015 to ensure that they collected the latest information. Moreover, they devised an inclusion and exclusion standard that enabled them to narrow down their search. The writers used journals that discussed the nature of misuse of prescribed opioids in penitentiaries and how this problem is handled.

The utilization of the critical appraisal skills program (CASP) framework guaranteed that this study used articles with methodological firmness (Bi-Mohammed et al., 2017, p. 8). It also helped to boost the reliability of the findings. A study by Hedrich et al. (2011, p. 502) reviewed the effectiveness of opioid maintenance treatment (OMT) programs in assisting inmates in ceasing using drugs after they are released. This study was invaluable in reinforcing the knowledge of the challenges associated with the diversion of prescribed drugs.

The findings of the main study revealed differences in the nature of prescribed opioids misuses across various prisons globally. Bi-Mohammed et al. (2017, p. 2) learned that snorting or sniffing was a common method of abuse of buprenorphine in the UK. Cases of diversion of prescribed drugs were common in most prison facilities. Institutional and financial limitations were found to be the major challenges that hindered the capacity of prisons to regulate opioids abuse and address the issue of diversion of prescribed drugs. This study established that prison managers were doing little to deal with the problem of buprenorphine abuse. Additionally, prisoners have devised ways to elude supervisors who administer drugs.

Strengths and Weaknesses

One of the strengths of this study is that it relied on peer-reviewed journals that were up-to-date. The article was written in 2017 and depended on periodicals published between 1995 and 2015. An evaluation of the article’s list of references shows that the majority of the sources used for this report dated between 2011 and 2015, hence they are modern. In spite of the cases of misuse of prescribed opioids in the prison environment being rampant, no research has been conducted to ascertain the cause of this problem or how it can be handled. Therefore, this is the first study to focus on the subject of opioids abuse in prisons and its practice, pervasiveness, and treatment procedures.

This research did not lack some limitations, one of them being the use of limited data. In spite of the researchers accessing 42 journals that discussed opioids dependence in penitentiaries, only ten articles were used for this study (Bi-Mohammed et al., 2017, p. 2).

It made it difficult for the authors to obtain comprehensive findings that could represent the global trend in opioids abuse in prisons. Additionally, failure to use empirical data affected the quality of the findings. Moreover, the researchers did not access journals that discussed the misuse of prescribed opioids, which is a major problem in many prisons. Instead, the findings of this research depended on the ideas that arose from information concerning the various modes of prescription opioid misuse and their connection to the prison environment. Consequently, this study was subject to biases originating from authors’ assumptions.

Possible Practical or Academic Implications

The literature review and findings of this study have opened room for future research in different areas. The study has found that most opioids that are prescribed in penitentiaries are prone to misuse due to the nature of their administration. Therefore, this research highlights the need for further studies to establish the mechanisms that reformatories can use to guarantee the safe intake of prescribed opioids.

This study did not focus on factors that contribute to prisoners abusing prescribed opioids and the group of inmates that is most vulnerable. Consequently, future investigations should concentrate on these areas to enable prison administrators to come up with effective strategies to deal with this menace. Apart from looking for alternative ways of administering opioids, future research should also look for ways of training prison officials in how to handle prescription drugs.

Summary/Conclusion

Opioids refer to naturally occurring and synthetic drugs that are used to relieve pain. These drugs interact with different receptors found in the gastrointestinal tract and the central nervous system. They work by blocking the release of neurotransmitters that aid in the transfer of information from any part of the body to the brain. Abuse of prescribed opioids in prison settings is on the rise due to the state of their administration. Today, over 39 million people suffer from opioid-related complications internationally. In spite of these astonishing figures, no research has been conducted to ascertain the occurrence of opioids abuse in prisons, modes of misuse, and how this problem is addressed.

The study titled “Prescription opioids abuse in prison settings: a systematic review of prevalence, practice and treatment response” by Bi-Mohammed et al. (2017) was analyzed in this report. The writers aimed at establishing the state of opioids abuse and the measures taken to deal with the issue of diversion of prescribed drugs in penitentiaries. The study used ten peer-reviewed journals from renowned online libraries. The findings of this research highlighted the need to conduct further investigations to identify strategies that can be employed to minimize diversion and abuse of prescribed opioids in prisons.

Reference List

Bellum, S 2016, Real teens ask: what are the different types of opioids? Drugs and Health Blog. Web.

Bi-Mohammed, Z, Wright, NM, Hearty, P, King, N & Gavin, H 2017, ‘Prescription opioid abuse in prison settings: a systematic review of prevalence, practice and treatment responses’, Drug and Alcohol dependence, vol. 171, no. 1, pp. 1-32.

Hedrich, D, Alves, P, Farrell, M, Stover, H, Moller, L & Mayet, S 2011, ‘The effectiveness of opioid maintenance treatment in prison settings: a systematic review’, Addiction Review, vol. 107, no. 1, pp. 501-517.

Saunders, JB, Conigrave, KM, Latt, NC, Nutt, DJ, Marshall, EJ, Ling, W & Higuchi, S 2016, Addiction medicine, 2nd edn, Oxford University Press, Oxford.