opioid epidemic by Joyce Li https://padlet.com/joli231805/t2axwlx2qiyzy3wz en-us 2023-02-28 12:38:10 UTC 2023-04-27 19:58:42 UTC hello@padlet.com introduction joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497888300 Opioids provide therapeutic pain relief to millions of Americans. At the same time, there is a rising concern for the skyrocketing rates of addiction and overdose deaths. Opioid-related overdose deaths rose from 21,089 in 2010 to 80,411 in 2021 (“Drug Overdose Death Rates” 2023). The states with the highest rise in deaths are predominately rural—Kentucky, West (Hancock and Mennenga 2017). The unique infrastructural, socioeconomic, and social dynamics within rural communities highlight the elaborate societal causes behind opioid abuse and death. ]]> 2023-02-28 12:46:43 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497888300 History joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497888722 Before the epidemic, opioids were "mainly for short-term uses such as pain relief after surgery or for people with advanced cancer or other terminal conditions" (DeWeerdt 2019). What followed would change that.]]> 2023-02-28 12:47:01 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497888722 Late 1980s joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497891234 Medical associations begin increasingly recognize pain as a problem requiring adequate treatment, the “fifth vital sign" (DeWeerdt 2019). A warning issued in 1989 proclaims that “to allow a patient to experience unbearable pain or suffering is unethical medical practice." Small, poorly designed studies and extrapolations of studies beyond their intent minimize the dangers of opioids (Dayer et al. 2019).

]]> 2023-02-28 12:49:08 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497891234 Mid-1990s joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497891493 New products released, including OxyContin, a sustained-release formulation of oxycodone, manufactured by Purdue Pharma. Heavy promotion by pharmaceutical companies—lobbying lawmakers, visiting individual doctors, sponsoring pain medication courses—boosts the sales of opioids. Companies emphasize opioids' “safety, efficacy and low potential for addiction of prescription opioids" (DeWeerdt 2019).

]]> 2023-02-28 12:49:22 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497891493 Three Waves joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497894809
  • mid-1990s to 2010: prescription opioids — patient privacy laws and lack of US states allows for legitimate clinical prescriptions for opioids to be diverted from the legal to illegal market (Alexander, Kruszewski, and Webster 2012)
  • 2010-2013: heroin — prescription guidelines retooled, supply of heroin increases and price drops
  • 2013 onwards: fentanyl — heroin dealers cut products with fentanyl as it becomes cheaper, more available, and more potent (DeWeerdt 2019)


    • ]]>     2023-02-28 12:52:05 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497894809     Unique impacts on rural communities joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497896200 Contrary to popular belief, the opioid epidemic is not disproportionately rural. Rural areas vary significantly across the US in their rates of drug mortality
    these factors make addressing the epidemic in rural areas especially difficult (Rigg, Monnat, and Chavez 2018).
    However, the largest increases in opioid-related mortality rates are in heavily rural states such as Kentucky, West Virginia, Alaska, and Oklahoma. This can be attributed to significantly lower Emergency Medical Service (EMS) response times due to lower population densities (Hancock and Mennenga 2017).
    ]]>     2023-02-28 12:53:08 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497896200     joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497897307 2023-02-28 12:54:07 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497897307 joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497897987 2023-02-28 12:54:41 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497897987 infrastructural factors joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497899444 Rural areas are less likely to have as as many
    • addiction treatment services and providers
    • detox centers 
    • medication-assisted treatments (MATs), such as buprenorphine and methadone 
    • drug prevention programs
    • drug treatment courts 
    • harm reduction programs
    as densely populated urban areas (Rigg, Monnat, and Chavez 2018).

    Scarcity in resources exists "even where state-level policy and economic environments permitted a range of harm reduction services. Local decision makers often are unable to raise revenue from general funds or property tax levies to supplement the basic services supported by state and federal funds and may lack infrastructure necessary to compete for special initiatives managed by states, creating disadvantaged policy environments.” 

    Further, a limited public transit system prevents rural residents from accessing resources in nearby urban areas (Jenkins and Hagan 2020).

    ]]>     2023-02-28 12:55:58 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497899444     Socioeconomic factors joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497900481
  • homelessness/marginal housing without homeless outreach programs of urban areas (Jenkins and Hagan 2020)
  • financial difficulties can “increase risk of substance use, in part through distress, hopelessness, and lack of control” 
  • poverty is especially high in specific rural areas like “central Appalachia, the Delta South, the Rio Grande Valley, and Native-American reservations” 
  • manual labor jobs lead to more workers at risk for disability/chronic pain, and being subsequently prescribed opioids
  • fewer and lower-wage employment as jobs are automated away (Rigg, Monnat, and Chavez 2018)


    • ]]>     2023-02-28 12:56:49 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497900481     Social factors joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497901336
  • “larger and stronger kinship and peer networks” may enable the selling and sharing of prescription opioids (Rigg, Monnat, and Chavez 2018)
  • tendency for social identities to become fixed may exacerbate stigma and prevent recovery 
  • stigmatization of providers who offer MAT, as the “labeling of [MOUD/MAT] as replacement of one addiction with another and the belief that needle exchange fosters drug use have stigmatized and often blocked these services in rural communities” (Jenkins and Hagan 2020)

    • ]]>     2023-02-28 12:57:30 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497901336     Solutions & the future joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497910325
  • future solutions should focus on harnessing social micro environments to reduce drug-related harms and collaborating with residents to foster support for evidence-based responses to opioids (Jenkins and Hagan 2020)
  • telehealth can expand rural access to drug treatment (Rigg, Monnat, and Chavez 2018)
  • school-based prevention programs 
  • medical education on correct opioid prescribing 
  • public transportation
  • expand availability of MAT
  • expand availability of outpatient mental health and recovery programs (Hancock and Mennenga 2017)
  • expand availability of Naloxone, a medication that reverses overdoses
    • Most importantly, the US cannot recover from the opioid epidemic without addressing the root economic causes behind addiction. The opioid epidemic has been characterized as a "uniquely American problem" (Jenkins and Hagan 2020). A broken and oftentimes nonexistent social safety net, for-profit private pharmaceutical companies, and an economy adjusting to the impacts of automation has enabled the growth of the epidemic. 

    What would the United States look like if everyone could access medical treatment, regardless of their financial status or geographic location? What if there was a robust social safety net, supporting the unemployed? 

    Hundreds of thousands of people have already fallen victim to the opioid epidemic. How many more, until the United States fundamentally reshapes its society to support the most vulnerable of us?
    ]]>     2023-02-28 13:04:40 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497910325     The Opioid Epidemic, Rural Communities, and a Failing System joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497912880 2023-02-28 13:06:36 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497912880 i know it's supposed to be footnotes but i can't rly do that in padlet :( so it's author-date instead joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497927982 2023-02-28 13:18:22 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497927982 Bibliography joli231805 https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497946648 Alexander, G. Caleb, Stefan P. Kruszewski, and Daniel W. Webster. 2012. “Rethinking Opioid Prescribing to Protect Patient Safety and Public Health.” JAMA 308 (18): 1865. https://doi.org/10.1001/jama.2012.14282.
    Dayer, Lindsey E., Jacob T. Painter, Kelsey McCain, Jarrod King, Julia Cullen, and Howell R. Foster. 2019. “A Recent History of Opioid Use in the US: Three Decades of Change.” Substance Use & Misuse 54 (2): 331–39. https://doi.org/10.1080/10826084.2018.1517175.
    DeWeerdt, Sarah. 2019. “Tracing the US Opioid Crisis to Its Roots.” Nature 573 (7773): S10–12. https://doi.org/10.1038/d41586-019-02686-2.
    “Drug Overdose Death Rates.” 2023. National Institute on Drug Abuse. February 9, 2023. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates.
    Hancock, Christine, and Heidi Mennenga. 2017. “Treating the Rural Opioid Epidemic.” National Rural Health Association.
    Jenkins, Richard A., and Holly Hagan. 2020. “What Is a Rural Opioid Risk and Policy Environment?” The International Journal on Drug Policy 85 (November): 102606. https://doi.org/10.1016/j.drugpo.2019.11.014.
    Rigg, Khary K., Shannon M. Monnat, and Melody N. Chavez. 2018. “Opioid-Related Mortality in Rural America: Geographic Heterogeneity and Intervention Strategies.” International Journal of Drug Policy 57 (July): 119–29. https://doi.org/10.1016/j.drugpo.2018.04.011.
    “Understanding the Opioid Overdose Epidemic | Opioids | CDC.” 2022. October 7, 2022. https://www.cdc.gov/opioids/basics/epidemic.html.

    ]]>     2023-02-28 13:31:50 UTC https://padlet.com/joli231805/t2axwlx2qiyzy3wz/wish/2497946648