PA599 Final report. Drug Abuse in the United States.

Drug Abuse in the United States
Student’s Name
Institution
Drug Abuse in the United States
Introduction
The drug abuse issue is a national problem that has affected many Americans and poses a threat to public health. This issue has been declared as an epidemic, especially in relation to opioid overdose, by the Centers for Disease Control and Prevention (CDC). This is because of the consequences of drug abuse, which have not only affected the healthcare system, but also the legal/justice system and the economy in general. For instance, the CDC (2018a) reveals that more than 630,000 Americans have died as a result of a drug overdose between 1999 and 2016. That means that about 37, 000 Americans have died each year, on average, from a drug overdose. According to the National Institute on Drug Abuse (NIDA) (2020a), over 67,300 Americans died in 2018 alone from a drug-abuse related overdose. Over the years, drug abuse among Americans has been increasing at an alarming rate, which is why the issue is a public health concern. Since this issue also falls under the public administration purview, it is necessary for public administrators to identify policies and programs that will address the issue effectively. There are many negative consequences associated with drug abuse, which will be discussed in this paper. This paper aims to identify ways in which the government, especially at the federal level, can curb the drug abuse problem from a public policy perspective. To achieve this, research on the various policies on drug abuse adopted by the state governments will be done. Also, current policy position papers or recommendations by specialty organizations concerned with public health will be examined. The paper will then propose a policy tool that will best address the issue using the information collected from the research. However, before addressing the issue of drug abuse and the policy on drug abuse, it is important to examine the role of public administrators in the development of a national drug abuse policy.
Role of Public Administrators in Curbing the Drug Abuse Issue
Public administration is a complex area that requires a balance between accountability to the public and the maintenance of authority that has been given to public administrators by the public (Deutscher, Walker, & Phillips, 2019). Public administrators work in the interest of the public. A good example is of this challenge in balancing the two is the issue of opioids in relation to pain management and drug abuse. On one hand, a physician, who works in the interest of a patient, has to make a decision on whether to use opioids to treat patients with chronic pain (Deutscher, Walker, & Phillips, 2019). In doing so, they will be helping the patient, which is their responsibility. On the other hand, the doctor has to consider the effects of opioids which are; possible drug addiction and overdose deaths. The physician, who also handles these patients who come in with drug addiction problems or drug poisoning, has to make a difficult choice and whatever decision they make, the safety of those patients is in their hands.
Also, public administrators have the responsibility of enhancing public safety (Deutscher, Walker, & Phillips, 2019). Through this role, public administrators provide support to various government agencies in promoting public safety. Since the issue of drug abuse affects public safety, directly and indirectly, public administrators have a huge role to play in curbing drug abuse. They help in policy development by sharing data with relevant agencies to inform policy, participate in policy formulation, and also in policy implementation. In addition, through public administration, policies that have been implemented can be monitored effectively. Thus, public administrators are accorded the responsibilities of affecting the government's directives. In the case of drug abuse, public administrators can inform, formulate, implement and monitor policies on drug abuse mitigation.
Background of the Drug Abuse Issue
Drug abuse in the U.S. has been a constant thorn since the 1990s. The drug abuse problem has taken hold of Americans in three different waves. According to the CDC (2018a), the first wave occurred in the 1990s, where the number of opioids prescriptions for treating chronic pain increased, resulting in prescription opioids misuse. Consequently, the number of deaths involving opioids overdose hit an all-time high during the 1990s, which is when the issue began to be considered an epidemic. The second wave hit in 2010 where many Americans were hooked on heroin, leading to heroin overdose-related deaths. The third wave occurred in 2013 after synthetic opioids, such as fentanyl, flooded the markets. This led to a significant increase in synthetic opioid overdose-related deaths. One of the key factors that contributed to this rise in use and, eventually, misuse of drugs was what Kertesz and Gordon (2018) refer to as a public policy monopoly. This occurs when a group of agents gains control in deciding what problems should be solved, using what methods, and in what priority. In the issue of drug abuse, the agents involved in the policy monopoly were healthcare regulatory agencies, healthcare providers, the U.S. Food and Drug Administration (FDA), and some pharmaceutical companies (Kertesz & Gordon, 2018). These agents decided that pain management using opioids was paramount and was given priority over other alternatives. This policy is, however, being rectified because new public policies on how to manage pain while still addressing drug abuse have been formulated.
Drug abuse involves the misuse of prescription drugs, as well as illicit drugs. The most commonly used prescription drugs are as follows (NIDA, 2020b):
* Opioids- These are drugs that are used to treat acute pain, although they have increasingly been used to treat chronic pain despite their negative effects when used for a long period (NIDA, 2020b). The drugs also cause the individuals to feel euphoric, the same high experienced by heroin users. These drugs include hydrocodone, oxycodone, codeine, and morphine, among other opioid pain relievers. The consumption of these drugs is quite high, not only among older people who suffer from chronic conditions but also among younger adults and adolescents. In 2017 alone, more than 2 million Americans started misusing pain relievers, which translates to about 5, 480 new drug abusers per day, on average (NIDA, 2020b). This is an alarming increase in the number of people misusing prescription pain killers. According to NIDA (2020b ), over 80% of adults aged 57 to 85 years are on more than one prescription drug which increases their chances of using a prescription pain killer unintentionally. However, young adults and adolescents use prescription drugs for non-medical purposes. They use the pain relievers intentionally to experience the euphoria.
* CNS Depressants- These are drugs that are used in treating sleep disorders and anxiety because they slow down the brain activity (NIDA, 2020b). They include benzodiazepines, barbiturates, and other sleep medication that can tranquilize, hypnotize, or sedate a person. According to NIDA (2020b), over 1.5 million Americans started misusing prescription tranquilizers while over 217,000 started misusing prescription sedatives, in 2017 alone.
* Stimulants- These are drugs that are prescribed to treat depression, narcolepsy, and attention-deficit hyperactivity disorder (ADHD) due to their ability to increase, attention, alertness, and energy levels (NIDA, 2020b). The drugs also bring about a feeling of euphoria, which is why people use them for non-medical reasons. In 2017 alone, over one million Americans started misusing prescription stimulants for non-medical purposes (NIDA, 2020b).
Illicit drugs include drugs that are used illegally, including prescription drugs that are used for non-medical purposes (Office of the Surgeon General, 2016). Some of the illicit drugs covered in this section that falls under the prescription opioids category are discussed under synthetic opioids such as fentanyl. The most commonly used illicit opioids are as follows:
* Heroin- This is an illicit drug that is made from the opium poppy plants (NIDA, 2018). A majority of people using heroin have used prescription opioids in the past. NIDA (2018) indicates that almost 80% of Americans using heroin had misused prescription opioids before switching to heroin. The rate of heroin-related overdose was about 5 deaths per 100,000 Americans in 2018 (CDC, 2020b). Also, about one-third of all opioid-related deaths were as a result of a heroin overdose.
* Synthetic opioids- These are synthetically manufactured opioids that do not include methadone but includes fentanyl. The CDC (2020b) revealed that over two-thirds of all deaths involving opioids were a result of synthetic opioids overdose. Further, the CDC data reveal that over 31,000 Americans died in 2018 alone as a result of a synthetic opioid-related overdose.
* Synthetic cannabinoids- These are drugs whose chemical compounds are similar to those found in marijuana. While they are often marketed by manufacturers as safer than marijuana, they have been linked with violent behavior as well as suicidal thoughts, among other negative effects (NIDA, 2018). They are some of the drugs associated with increased visitations to the emergency departments in American hospitals.
* Cocaine- This is a psycho-stimulant used for recreation purposes. As of 2016, approximately 2% of the American population had reported being presently using cocaine, a statistic that has not changed much over the last 10 years or so (CDC, 2020b). Also, out of every five drug overdoses in 2017, one was as a result of a cocaine overdose.
The federal government has been actively involved in finding solutions that will eventually address the issue and restore public health for all Americans. Part of the focus has been in surveillance where the CDC, a federal government agency, has been monitoring drug-related risks and outcomes every year to assess the progress in the fight against the crisis (CDC, 2018a). Also, the CDC has been doing research to provide data to other stakeholders who are interested in the issue. Another agency that has taken an active role in addressing the issue is the Food and Drug Administration (FDA). Califf, Woodcock, and Ostroff (2016) indicate that the FDA is working towards developing a more stringent policy on how to balance the societal risk of opioid misuse and individual needs for pain management. Due to the nature of the drug abuse issue in terms of the types of drugs abused; many policies have been formulated to address the issue in two major ways. The first group of policies is designed to regulate the prescription of opioids while the second group focuses on preventing the distribution and use of illicit drugs. For instance, calls to create public policies that disrupt and prevent the sale of illicit drugs over the internet, which is how most illicit drugs reach the U.S., have been made and the government, at federal and states level, has made efforts to control international mail and express consignments (Office of the National Drug Control Policy, 2019). Also, laws and regulations have been formulated to control the use of illicit drugs whereby individuals caught in possession of illicit drugs are punished by law. At the prescription drugs category, some of the policy actions include the development of Prescription Drug Monitoring Programs (PDMPs), integration of risk evaluation and mitigation strategies training for all healthcare providers before they can receive licenses for opioid-prescribing practices from the Drug Enforcement Administration (DEA), among others (St. Marie, Arnstein, & Zimmer, 2018). Formulation and implementation of effective policies is the key to addressing the drug abuse issue in the country and preventing all the negative consequences associated with drug abuse.
Consequences of Drug Abuse
As mentioned earlier, drug abuse has had enormous negative consequences on American lives at the health, economic, and justice/legal levels. Also, the effects are not only experienced at individual levels but also the family, workplace, and national levels.
Consequences on Individual Health and the Healthcare System
One of the major consequences of drug abuse is the development of a substance use disorder (SUD). According to the National Institute of Health (NIH) (2015), about 10% of adult Americans have developed a SUD at some point in their life. These statistics do not include adolescents who are also at risk of developing SUD. In 2016 alone, about 18% of Americans aged 12 years and above reported to have used illicit drugs or prescription drugs for non-medical reasons (CDC, 2018a). These are people who face the risk of developing a SUD. Developing a SUD not only occurs to people using illicit drugs, but also to those using opioids as prescribed by healthcare providers, due to the effect that these drugs have on the brain activity. Once people develop a SUD, the chances of overdosing on the drugs increase. Approximately 128 American lives are lost every day as a result of drug overdoses (NIDA, 2020a). Other than the loss of lives, drug abuse has been linked with increased emergency department visits. In 2015, about 547,543 emergency department visits were because of drug-involved poisoning (CDC, 2018a). Also, about 316,900 Americans were hospitalized in the same year for nonfatal drug poisoning. Additionally, drug abuse is associated with risky sexual behaviors which can contribute to the acquisition of sexually transmitted diseases. Recently, there has also been an increase in maternal use of opioids and the use of opioids during pregnancy has led to an increase in neonatal abstinence syndrome (NAS). Every fifteen minutes, approximately, there is a baby born with NAS (NIDA, 2019c). Therefore, drug abuse not only brings suffering to a baby but also increases the costs of healthcare since such babies cannot leave the hospital until they have fully been treated. An increase in emergency department visits and hospitalization has placed a burden on the healthcare system. In addition to the drug-related poisoning treatment that individuals have to receive, some also seek treatment for addiction and SUD. Over 23.1 million Americans aged 12 years and above have received treatment for SUD at any given year, on average (Office of Public Affairs, 2014). Other than increasing the workload for healthcare providers, the treatment of SUD has led to an increase in the cost of healthcare for many Americans.
Consequences on the Justice/Legal System
Drug abuse has been linked to an increase in crime rates since people under the influence of drugs are more likely to engage in risky behaviors. The sale and distribution of illicit drugs are associated with a lot of violence and individuals involved in such businesses are more likely to commit a crime, given that the sale and possession of illicit drugs is a crime by itself. As revealed by the Office of Public Affairs (2014), about 26% of federal prisoners and 32% of state prisoners reveal that at the time of committing a crime, they were high on at least one illicit drug. This shows a connection between drug abuse and crime rate. Also, drug use is higher among Americans who have been arrested for a crime than among the other civilian population. Of arrestees who have been tested for illicit drugs during booking, approximately 63-83% of them have tested positive for one or more illicit drugs (Office of Public Affairs, 2014). Additionally, people with a SUD or any drug addiction are likely to engage in petty crimes such as theft in order to support their addiction. This contributes to an increase in crimes within the country, which then overburdens the justice system as well.
Consequences on the Economy
Loss of life due to drug overdose often translates to the loss of productive individuals who would otherwise help in building the economy. One of the major factors contributing to a heavy economic burden is the loss of productivity associated with premature loss of life due to drug-related overdose (Office of Public Affairs, 2014). Also, drug-related disabilities have affected the productivity of individuals who abuse drugs. Another loss of productivity comes from the withdrawal from legitimate work when a person is seeking treatment or has been incapacitated by their addiction to drugs. In addition to the loss of productivity, the negative effects of drug abuse are felt on the economy through the increased costs of healthcare as well as costs associated with the criminal justice system. The Office of Public Affairs (2014) reveals that the most recent estimates indicate that the economic costs associated with drug abuse were approximately $193 billion by2007. These costs have since gone high, thanks to the increase in the number of Americans seeking treatment for drug addiction. Also, the increase in the number of inmates due to drug-related crimes contributes to high costs in the criminal justice system. Managing prisons, which are flooding with individuals who committed a crime while under the influence, is expensive. The funds dedicated to providing treatment and/or managing prisons due to drug-related crimes can be used to promote other sectors of the economy if the drug abuse issue was addressed effectively.
Consequences of the Environment
Drug abuse also has an effect on the environment. Drug laboratories within the country are a source of toxic chemicals, wastes, and pose the risk of fire and explosions, all of which negatively affect the environment and pose a threat to public safety (Office of Public Affairs, 2014). Also, the cultivation of poppy and marijuana, some of the illicit drugs available in the country, has resulted in the clearing of land, which contributes to deforestation. During cultivation, growers use fertilizers and insecticides in large quantities, which then pollute the air, soil, and sometimes, water. This is dangerous, especially at a time when protecting the environment has been linked to the survival of mankind.
Various State Governments Policies on Drug Abuse
Different state governments have adopted different policy actions to address the issue of drug abuse. Also, different states have different rates of drug abuse with more states being hit harder by the crisis than others. For instance, between 2016 and 2017, Winsconsin and Delaware states had a 109% and 105% increase in drug-related deaths, respectively (Vivolo-Kantor, et al., 2018). Some states have pursued some very controversial policy action to tackle the drug abuse issue. For instance, in the state of Pennsylvania, and specifically the city of Philadephia, the effectiveness of drug safe houses has been explored and the use of the same recommended. In 2017, a committee led by the mayor of Philadephia recommended the use of safe houses as the best policy action in the fight against the opioid crisis (Burris, Anderson, Davis, & Beletsky, 2019). The drug safehouses are facilities that are located strategically within a city where individuals with drug use problems can practice safe consumption. According to Burris, Anderson, Davis, and Beletsky (2019), these facilities are equipped with sterile syringes, swabs, water, medical care services, trained staff to oversee the consumption and referrals to addiction treatment as well as social support programs. Given the nature of this policy, which is to promote safe consumption of illicit drugs in an effort to reduce drug overdose, it received some opposition from the government and the U.S. attorney for the Eastern District of Pennsylvania asked the federal court to declare such a policy as unlawful under the Controlled Substances Act (CSA). However, the judge ruled in support of drug safehouses, positing that they would be an added benefit for public health in the fight against drug overdoses in the country (Burris, Anderson, Davis, & Beletsky, 2019). While the establishment of a drug safe house in Philadephia will be the first in the country to be operated openly, there are many evidence-based results from around the world indicating that this is an effective policy. For instance, it has been revealed that safehouses reduce the risk of drug overdose-related deaths as well as other risky behaviors since the users are doing so with the right equipment and under the observation of trained staff (Burris, Anderson, Davis, & Beletsky, 2019). Further, they promote treatment-seeking behavior since people using these safe houses often receive referrals to SUD treatment facilities. In addition, the safehouses have been not linked with an increase in drug use or even crime, as would be expected due to their permissive nature. Lastly, such a policy intervention allows users to practice safe consumption through the use of sterile syringes, reduces the injection of drugs in public places, and ultimately, reduces syringe littering. Thus, such a public policy intervention also protects the environment and enhances public safety
Another policy approach that has gained much attention in different states is the controlled substance lock-in programs. This policy approach to drug abuse requires patients who are at a high risk of developing a SUD to receive coverage for medication services from the same prescriber and pharmacy (Roberts, et al., 2016). The purpose of such programs is to ensure that patients receiving controlled substance medications are not able to transfer their drugs to other users, which is how people end up accessing prescription drugs for non-medical purposes. Also, this approach ensures that patients are not manipulating their providers into receiving more medication than prescribed. North Carolina is one of the states that have established this policy and has integrated it into its Medicaid program. The earliest enrollees into the lock-in programs were patients with a high and extreme dependency on controlled substances (Roberts, et al., 2016). Forty-five more states have a Medicaid lock-in program in place to regulate the prescription and use of controlled substances.
Other policy actions involve training bystanders on how to use naloxone in the treatment of drug overdose. Naloxone is an FDA-approved drug that can reverse an opioid overdose. One of the states that have been able to implement a policy promoting the use of naloxone is Massachusetts. In Massachusetts, 2912 bystanders were trained on how to use the drug in case of an overdose and as a result, about 327 successful reversals of opioid overdoes have been reported (Wickramatilake, Zur, Mulvaney-Day, Campopiano von Klimo, Selmi, & Harwood, 2017). Other states are focusing on ensuring that naloxone is available and easily accessible to bystanders, emergency departments, and first responders to ensure that as many lives as possible are saved. Also, about 49 states have established prescription drug monitoring programs (PDMP). These programs provide prescribers with opioid prescribing and dispensing data, which allows them to determine whether patients are obtaining multiple prescriptions for opioids, which promotes opioids abuse (Wickramatilake, Zur, Mulvaney-Day, Campopiano von Klimo, Selmi, & Harwood, 2017). This helps prescribers to determine which patients have become too dependent on opioids and who are using more than prescribed, thus reducing opioid prescriptions. For instance, in Ohio, about 41% of prescribers had to change their prescribing decision after looking at the data on the state’s PDMP. Further, of those changes, 61% involved cessation of opioid prescribing for certain patients. This indicates that prescribers were able to determine that these patients were at the brink of becoming addicts and the PDMP gave them the opportunity to save the situation before it was too late. Other states have taken a policy approach to formulate laws and regulations that address the prescription of opioids. For instance, in Florida, laws that require all pain clinics to register with the state, as well as those that prohibit prescribers from directly issuing Schedule II and III drugs from their office, have been established (Wickramatilake, Zur, Mulvaney-Day, Campopiano von Klimo, Selmi, & Harwood, 2017). As a result of these laws, Florida has seen a decline in the number of drug-related deaths. Two years immediately after the laws were put into effect, the number of deaths from drug overdose reduced by 16.7%. These laws continue to be effective not only in Florida but in other states that have applied the same policy action. Additionally, some states, such as Maine, have focused on regulating the milligram morphine equivalents (MME) dosage (Kertesz & Gordon, 2018). It requires that all doses for patients using opioids be reduced to less than 100 MME unless under special circumstances, which should also be reported when the prescription is issued.
Current Federal Policy on Drug Abuse
The drug abuse crisis can be partly attributed to policy failure in the years leading to the third wave of the opioid problem. Kertesz and Gordon (2018) reveal that prior to 2011, there existed a permissive policy that encouraged and even facilitated the increase in opioid prescriptions for patients dealing with chronic pain. The policy was a monopoly that determined that treatment of pain was a priority and that opioids were the best option in treating pain. There were several regulations in place at the federal level that addressed drug abuse in the country, even at that time, such as the Anti-Drug Abuse Act of 1988 (Kominek, 2018). However, after the opioid epidemic, the policy was expanded and it gave the mandate of addressing the heroin and prescription opioid crisis to the Office of the National Drug Control Policy (ONDCP). This agency also offers financial and administrative support to the President’s Commission, which was established to tackle drug addiction and address the opioid crisis. Also, in 2017, a policy was created to allow the United States to use all legal means available in addressing the opioid crisis when President Trump declared the crisis “a national public health emergency under federal law (Kominek, 2018). ” Further, as part of the policy response to the crisis at the federal level, former President Obama signed a law during his tenure to ensure that there are programs that focus on pr...