Prevention of prescription opioid misuse and abuse
About the Final Project (due Friday August 3)
The public health topic to be used for the Public Health Policy analysis is
• Prevention of prescription opioid misuse and abuse
You must choose one particular state and develop your Policy Analysis on this topic for a client of your choice at the state level.
I would strongly recommend that you use the outline I posted in Doc Sharing to construct your paper. The outline will help ensure that you include all of the five necessary components of a policy analysis. For clear descriptions and examples of how to fully and properly develop each of the five components, Chapter 14 of the Teitelbaum and Wilensky textbook is the essential resource.
As you read Chapter 14, notice that the purpose of this type of analysis is NOT to evaluate an existing law, regulation or program. The purpose is to propose some alternative policies to address the public health issue (assigned topic above) -- and then to recommend to your client the one of these options that your analysis reveals to be the most feasible and effective.
Be sure that all material has proper attribution (citations and references – fully APA compliant) and that your paper is formatted according to APA style guidelines.
Your paper should have no fewer than 12 and no more than 15 pages (excluding cover and reference pages.)
( this is the Guidelines)
It is very important that you recognize that the Policy Analysis (as described in Chapter 14 of Teitelbaum and Wilensky, 2017), is distinct and different from an ordinary research paper. It must not be simply an in depth description and assessment of a program, law, regulation, etc. that is currently in place. (You will receive little credit if you approach your final project this way.)
The purpose of the Policy Analysis is to propose NEW policies or substantive changes to existing policy -- and then do the research and analysis to be identify the best choice among the various options you are proposing.
To be able to complete the Policy Analysis for your final project, you will have to have determined the following:
• Who is the client for whom you are doing this analysis and what kinds of policies are within the purview and authority of that client?
• What is the specific objective the client wants to achieve and who is the target population?
• Which stakeholders will be the important interest groups that will take a position on your proposed policies?
• Will you want to propose options to change an existing policy – or to establish a new one?
You will need to have made these decisions in order to be able to develop three different policy options and select the best one for potential implementation.
Use this outline for your paper to ensure you clearly include and fully address all of the required elements.
POLICY ANALYSIS OUTLINE
I Problem Statement (1 sentence)
Clearly express your Problem Statement – as described and illustrated in Chapter 14 of Teitelbaum and Wilensky text. Be sure your problem statement identifies your client and the target population.
II Background (2 - 3 pages)
Describe the public health issue – focusing on those aspects that could be addressed by a new or changed public policy. Include some description of previous policy initiatives addressing this issue. (See Chapter 14 of Teitelbaum and Wilensky, 2017)
III Landscape (3 - 4 pages)
Describe stakeholders and interest groups who might support or oppose your proposed policies in light of economic, political, legal factors and other relevant factors. (See Chapter 14 of Teitelbaum and Wilensky, 2017)
IV Options (2 - 3 pages)
Propose at least three different and distinct policies (laws, regulations, legal decisions, etc.) that might effectively address the public health issues. Be sure all policies are within the purview and authority of your chosen client. Include a discussion of the pros and cons of each policy in light of factors you identified in your background and landscape section. (See Chapter 14 of Teitelbaum and Wilensky, 2017)
V Recommendation (1 – 2 pages)
Select one of the policy options you proposed and explain why it is superior to the others in terms of effectiveness and feasibility. (See Chapter 14 of Teitelbaum and Wilensky, 2017)
VI References (On separate page)
Prevention of Prescription Opioid Misuse and Abuse
Student’s Name
Institutional Affiliation
Prevention of Prescription Opioid Misuse and Abuse
Problem Statement
There is a tremendous need for the Florida Department of Health to have a policy meant for limiting the amount of opioid prescribed to patients to avoid its misuse or abuse.
Background
Opioids are a category of drugs that are meant to relieve pain. Drugs that fall under this category include; heroin, legally prescribed pain relievers such as morphine, codeine, hydrocodone, oxycodone, and synthetic opioids like fentanyl (NIDA, 2018). The main issues that result from opioid use in Florida are
Abuse and misuse of opioids prescribed for medical purposes
Deaths resulting from an overdose of opioid drugs
Addiction to the opioid drugs
Doctor shopping
In 2017, Florida was among the six states that declared opioid abuse a public health emergency (NIDA, 2018). This came after the state experienced a gradual increase in the number of deaths related to opioid overdose from 2013 to 2016. The number of deaths related to an opioid overdose in 2016 was 2,798, which was significantly higher as compared to 2013, which was 200 (NIDA, 2018). This would mean that for every 100,000 individuals, 14.4 would die of an opioid overdose. Compared to the national death rate of 13.3 deaths per 100,000 individuals, that of Florida is higher (NIDA, 2018). A high number of the deaths are also associated with synthetic opioids and heroin, as Florida recorded 1,390, and 952 deaths in 2016 that were related to fentanyl and heroin respectively (PDMP, 2017). The main reason for opioid abuse and misuse in Florida is the highest prescription rates. Healthcare providers in the county prescribed 69.6 opioid drugs for every 100 patients, which is equivalent to 13.6 million prescriptions (NIDA, 2018). The high prescriptions have resulted in more addiction and drug abuse, which has also resulted in a high number of deaths.
To combat the issue of opioid-related deaths, the Florida Department of Health, the Florida Department of Criminal Justice, and the county government of Florida have set up various programs and policies. The state of Florida addressed pill mills in 2010. According to the pill mill law, pill mills; unregistered clinics, which prescribed and dispensed prescription drugs were required to register with the state of Florida and were required to adhere to the following;
The clinics were required to have a physician owner who would oversee all operations of the clinic
The clinic was expected to have inspection requirements
The pill mills were required to establish requirements for prescribing and dispensing drugs as well as prohibitions for other physicians at the clinics.
The Florida Department of Health implemented the Prescription Drug Monitoring Program (PDMP) in 2011. The program involves gathering data related to prescription drugs dispensed to patients within the state of Florida, using an electronic database (Rutkow, Chang, Daubresse, Webster, Stuart & Alexander, 2015). The registered prescribers in Florida were able to freely access the PDMP database and gain information concerning individuals before prescribing any drugs. The database was also useful in identifying individuals who visited several physicians to collect drugs meant to satisfy their addiction (Rutkow et al., 2015). Aside from that, the state also passed a law that limits the prescription of painkillers to patients over a period of three days. The law limits the prescription of opioid drugs such as fentanyl and OxyContin and other painkillers to three days and seven days for patients with acute pains. However, the limits set do not apply to patients with terminal illness, chronic pain or those who experience trauma (Florida Board of Dentistry, 2018).
Florida has experienced a decrease in the number of control substance prescriptions, mainly because of the policies that have been put in place over the years. An example would be the decrease in the number of deaths caused by alprazolam and oxycodone by 45.1 percent and 70.6 percent, respectively, from 2010 to 2014 (PDMP, 2017). More so, as noted over a ninety-day period, the number of controlled substances prescribed to patients by five or more prescribers and dispensed by five or more pharmacies has also decreased by 69.3 percent (PDMP, 2017). The state of Florida was also the top state to experience a gradual decrease in deaths related to drug poisoning from 2010 to 2013 as stated by the Centers for Disease Control (PDMP, 2017). The number of deaths caused by drug overdose in the period between 2010 and 2012 also decreased by 23 percent. A majority of these deaths were associated with prescribing rates since the decline in prescribing rates also lead to a decline in the number of deaths (Rutkow et al., 2015).
Despite the improvement in prescribing some of the opioid drugs to patients in the state of Florida, the state continues to record high cases of deaths related to fentanyl and heroin abuse. Because of the restrictions to opioid prescription, prescribers have opted for opioid substitutions, which have resulted in severe outcomes. More so, little information is known regarding the effectiveness of the laws on the rate of prescribing the opioids to patients. Therefore, it would be most appropriate for the Florida Department of Health to implement other more effective policies and programs that would combat the issue of opioid prescription misuse and abuse.
Landscape
Among the various stakeholders that have shown interest in the issue, the key stakeholders include
Center for Disease control and prevention
Florida Department of Corrections
Florida District Medical Examiners
Florida Emergency Medical Services Advisory Committee
Office of the Attorney General in Florida
Office of the Governor in Florida
Florida Alcohol and Drug Abuse Association
Purdue Pharma and Endo Pharmaceuticals
These stakeholders play an important part in solving the issue of abuse and misuse of opioids in Florida.
Political Factors
The issue of opioid abuse and misuse has been highly prioritized by the state of Florida. The office of the governor has shown more interest in solving the issue and has worked side by side with the Department of Health to solve the problem of drug abuse. The governor of Florida, Rick Scott, requested the Surgeon General and Secretary of the Department of Health to declare the opioid epidemic a public health emergency across the state (Scott & Philip, 2017). The urgency of the state to declare the epidemic as a public health emergency proves that the issue is a front-burner. Similarly, in 2016, Governor Rick Scott signed into law a needle exchange program that allowed the University of Miami to distribute clean syringes to drug addicts who are more likely to contract HIV and AIDS from the shared needles (Drug Policy Alliance, 2016). Key interest groups such as the members of the Florida Alcohol and Drug Abuse Association are likely to support the change since they are focused on treating and preventing drug addiction (FADAA, 2018). However, Purdue Pharma and Endo Pharmaceuticals are more likely to oppose the change since it would damage their reputation and decrease their sales.
Social Factors
The individuals affected by the problem are patients who require pain-relieving drugs as well as heroin users who abuse the opioids to satisfy their addiction. The opioid drugs are medically prescribed to the patients for treatment, but constant use of the opioids leads to addiction. However, the solving the problem of opioid addiction and misuse can greatly affect individuals who are already addicted since withdrawals can be deadly. The addicted patients might also face stigmatization since communities tend to isolate themselves from drug addicts.
Economic Factors
The issue of opioid abuse and abuse of other drugs leads to drug-related crimes as well as high medical costs associated with the abuse. These crimes disrupt businesses in the state of Florida and therefore lead to lower revenues. Such instances will greatly affect the economy of Florida, which is currently at an average growth rate of 2.9 percent (Bureau of Economic Analysis, 2018). The high addiction rates might result in more funds allocated to programs and rehabilitation centers to help curb the issue of opioid addiction. Some of the individuals addicted to the opioids neglect their family responsibilities and instead use the money to buy the drugs rather than providing for their families. Nonetheless, solving the issue of opioid abuse and misuse will help reduce the use of the drugs and result in less addiction. The fewer the cases of addiction, the fewer cases of drug-related crimes. Also, the cost of healthcare will reduce as fewer individuals will need to undergo treatment for opioid addiction. Opioid manufacturing companies such as Purdue Pharma use deceptive marketing to make high sales of their products, which leads to fewer sales of alternative drugs such as Acetaminophen and Corticosteroids.
Legal Factors
The policies set up by the county government are favorable in combating the issue of drug addiction and opioid distribution in Florida. The law on combating drugs signed by Rick Scott, such as the legislation to combat opioid epidemic are favorable for the administering changes. Also, the changes are in line with the rights to the medical administration, which require healthcare givers to give patients the right drugs, the right dose and at the right time (Hughes & Blegen, 2008). The Florida Department of Corrections can also help enforce the change by taking legal actions on individuals who go against the changes. For patients with chronic illness, the changes such as restriction to opioids can result in a violation of their right to appropriate care. The restriction can, therefore, lead to future litigation as organizations such as the Center for Disease Control might file suit to defend patients with chronic illnesses. Implementing the changes can also lead to future litigations by Purdue Pharma and Endo Pharmaceuticals, who might sue the firm in implementing policies and regulations that only affect their drugs regardless of their ability to solve problems related to pain management.
Options
Despite the regulations and programs set up by the Florida Department of Health to combat the misuse and abuse of prescribed opioid drugs, the state still faces a high number of deaths and abuse. I would, therefore, propose four policies that would be appropriate to address the issue in Florida, some of which are new and others currently exist but need to be changed.
Option 1: Limiting the supply of opioid drugs in Florida
The prescription of opioid drugs from physicians, doctors, or other health care providers serve as the initial source of the drugs that later results in abuse and death. The number of patients visiting a doctor because of pain problems is uncontrollable. However, there are different types of treatments that can be given...