Health Policy Issue Paper
APRNs are major advocates for healthcare policy since they have the required clinical expertise and educational background to present the basis of passing legislation on health and health-related issues. APRNs are at the frontline of care and manage different patients with diverse and unique needs. Therefore, they are well-positioned to relate individual experiences on how legislation can impact patients. This paper discusses an issue in healthcare that is directly affected by policy and discusses the current health policy that is relevant to the issue. It also provides the background information relevant to the selected issue and discusses the socio-economic, political, and ethical factors impacting the issue. APRNs influence on health policy safeguards patient safety, promotes access to necessary resources, and increases the quality of care.Health Policy Issue Paper
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Current Healthcare Issue
In recent years, there has been a substantial increase in the frequency of opioid-related deaths and its complications. Between the years 1999-2015, there has been a threefold increase in the number of prescribed opioids for pain relief per person, reaching more than 200 million with a rate of 71 prescriptions of opioids per 100 persons only in the US (Gross & Gordon, 2019). Today, the misuse of opioids has been associated with the utilization of opioid-associated hospital and emergency department, opioid withdrawal among neonates, and death-related overdoses. For instance, in the year 2016 alone, the opioid epidemic had an economic burden of up to $96 billion and led to more than 40,000 overdose deaths (Singh et al 2019). As a result, most policy efforts have shifted towards addressing the opioid epidemic with little attention to the management of chronic pain.Health Policy Issue Paper
Current Policy Effects/Impacts the Issue
On the 22nd of July 2016, the Comprehensive Addiction and Recovery Act (ACARA) was signed into law by President Obama. This act is the most comprehensive that has ever been developed to address the opioid epidemic and comprises of the following six pillars that are the most integral for an effective response to the opioid epidemic: reforms in the criminal justice, prevention, law enforcement, treatment, overdose reversal, and recovery (Whitmore et al., 2018). The same policy authorizes new funding of up to $181 million annually to address the opioid epidemic, that must be accounted for in the regular processes of appropriations. To improve the effectiveness of the CARA Act in addressing the opioid epidemic, senators introduced several changes to CARA Act to include; harsh penalties to manufacturers who divert opioids, introducing a three-day time limit in writing prescriptions for acute pain as recommended by CDC and decreased restrictions on medication-assisted treatment (Whitmore et al., 2018). The CARA Act also purposes the following:
- Expand efforts in education and prevention-targeted towards aging, guardians, teens, and parents to influence treatment and recovery whilst preventing heroin, methamphetamines, and opioids use.
- Expand naloxone availability to first responders and agencies of law enforcement to help save lives in overdose reversals (Whitmore et al., 2018).
- Collaborating with stakeholders in the criminal justice system to expand resources for easy identification and management of incarcerated individuals.
- To strengthen prescription drug monitoring programs (PDMPs) as a strategy of helping states track and monitor diversion of prescription drugs as well as assisting individuals/population at-risk access essential services.Health Policy Issue Paper
Relevant Background Information
In the mid to late 1990s, there was a sharp increase in medical prescriptions for opioids. Shortly thereafter, the non-medical use of opioids began to increase significantly, reaching a peak of more than 2.5 million users in 2002 (Singh et al. 2019). From the year 2012, the number of new non-medical users of opioids started to decrease to approximately 1.8 million but the overall number of people who use opioids for non-medical reasons is still large. Some of the most dramatic consequences of the increasing use of opioids that have drawn the attention of policymakers, the government, healthcare providers, and other stakeholders in the health sector are the effects of opioid-related overdoses and abuse such as neonatal abstinence syndromes, an increase in the rates of ER visits for non-medical use of opioids and an increase in OUD(opioid use disorder) admissions for treatment.
These outcomes have largely been fueled by concentrating efforts at the policy level to address the opioid epidemic associated with the abuse of opioids, diverting funding, and attention from the management of chronic pain. Despite a decrease in opioid prescriptions, patient harm(suicide-related) and deaths from overdoses continue to increase. This illustrates an imbalance in policy between strong controls for prescriptions and weak mental health and pain management (Gross, Gordon, D. B. (2019). While this stands to benefit individuals impacted by OUD (opioid use disorder) in the short term, in the long term, it could delay advances in managing pain thus prolonging the epidemic further.
Social, Economic, Ethical, And Political Factors That Impact the Issue
Social
The availability of opioids in black markets, the ability to obtain non-opioid prescription drugs, and acceptable social attitudes increase the ease of experimenting with opioids (Dasgupta, Beletsky & Ciccarone, 2018). It is for this reason that there is a high rate of opioids use and abuse in urban areas with high unemployment rates, high crime rates, and poor functioning.Health Policy Issue Paper
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Economic
Individuals with low socioeconomic status and low income are at a high risk of abusing opioids. This has been associated with an inadequate income to cover both household and personal expenses especially health insurance coverage. Most Americans are Medicaid enrolled, which covers the basic medical costs (Dasgupta, Beletsky & Ciccarone, 2018). However, those with a low income or inadequate income cannot obtain specialized treatment due to high prescription costs and this has gradually increased the number of people addicted to opioids.
Ethical
Making the most ethical decision is difficult when chronic pain is integrated into the mix of concerns with a client who is addicted or has been abusing opioids. Pain management and Opioid Use Disorder have their ethical issues yet when caring for both patients, an APRN must observe the ethical principles of autonomy, maleficence, and beneficence.
Political
The federal government of the US only legalized the use of opioids for medicinal purposes such as the management of acute and chronic pain, and pain at the end of life care. It also regulates its use and supply yet over the years, it has placed much focus on the regulatory part of management through law enforcement agencies and the criminal justice system.Health Policy Issue Paper
Issue Statement Expressing Personal Position on Political Issue
The gradually growing opioid epidemic in the US intersects two major public health challenges: decreasing pain suffering and containing opioid-use related harms.
Key Stakeholders Impacted by The Identified Issue
The most significant stakeholders who are impacted by the identified issue are nurses and patients. Nurses are at the forefront of addressing this epidemic since they play a major role in assessing patients for pain and determine the essence of relief using pharmacological agents. APRNs whose training prepares them to be responsible and accountable in assessing, diagnosing, and managing patients’ issues also play an integral role in responding to the opioid epidemic through direct care, policy, and advocacy efforts. Patients are also impacted since pain is subjective and inadequate pain management using opioids decreases QoL and patient satisfaction.
Policies to Improve the Identified Issue
The most effective policies to improve the identified issue are that which will weaver together strategies to reduce the supply, prevent addiction, and promote pain treatment. Besides, the FDA should thus shift from using a product-specific approach in decisions surrounding the approval of drugs but incorporate considerations about public health using a complex systems approach to make policy decisions on opioids.
Conclusion
In the last two decades, deaths associated with drug overdoses have increased steadily, propelling unintentional injuries as the 3rd leading cause of deaths in the US. Based on the statistics provided by the CDC, the rates of opioid drug-related deaths tripled between the years 1990-2015. A major goal of policy formulation regarding opioid use should be to decrease suffering from pain and contain the increasing opioid-associated harms.Health Policy Issue Paper
References
Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. American journal of public health, 108(2), 182–186. https://doi.org/10.2105/AJPH.2017.304187
Gross, J., & Gordon, D. B. (2019). The Strengths and Weaknesses of the Current US Policy to Address Pain. American journal of public health, 109(1), 66–72. https://doi.org/10.2105/AJPH.2018.304746
Singh, G. K., Kim, I. E., Girmay, M., Perry, C., Daus, G. P., Vedamuthu, I. P., De Los Reyes, A. A., Ramey, C. T., Martin, E. K., & Allender, M. (2019). Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns. International Journal of MCH and AIDS, 8(2), 89–100. https://doi.org/10.21106/ijma.284
Whitmore, C. C., White, M. N., Buntin, M. B., Fry, C. E., Calamari, K., & Patrick, S. W. (2018). State laws and policies to reduce opioid-related harm: A qualitative assessment of PDMPs and naloxone programs in ten U.S. States. Preventive medicine reports, 13, 249–255. https://doi.org/10.1016/j.pmedr.2018.12.014
Health Policy Issue Paper