Discussion: Presidential Agendas – COVID 19 Essays

By Day 3 of Week 1

By Day 6 of Week 1

Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?  

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Working as not only a RN but also as a RT I have seen many years of ups and downs in the health care field with employment and job availability. When I graduated radiology school in 1996 there were not many jobs out there to choose from so I had to just basically take what I could get. When I graduated nursing school in 2006 there were a few more jobs out there to choose from and I feel like that was mostly because of the more demand for nurses than x-ray techs at that time. Now we have a huge problem with shortages in almost all areas of the health care field from nursing, x-ray, physical therapy, administration and even physicians.

For many years now, the health care industry has changed in so many ways from technology advances, new discoveries made, average age for deaths increasing, changes in insurance and government regulations.  Along with these changes have came growth which means more demand for staffing. With that being said, there have always been shortages in staffing especially in the nursing field. 

Today since COVID-19 pandemic started there are even more staffing shortages seem throughout America and this is the time when we need more and more staff to handle the higher volume of patients and higher acuity of care. The past two presidents have tried to make the health care crisis in America better in different ways. President Obama passed the national “Obama Care” plan that enabled all people to have insurance. When President Trump came into office, he stopped the Obama plan and made it the peoples choice to have insurance and not be fined for not having it. 

Which plan is better? Either way, there are still shortages in the funding to help hire the staffing that facilities need. So what’s the answer to this major issue? I see this everyday where I work. Staffing shortages causes over worked employees, nurse to staff ratio increasing, patients holding in the emergency department because there’s not enough staff to be able to fill the beds and patient care and satisfaction decreases. It’s a vicious cycle.   

The goal of the health care reform was to increase access to care for all people. Yet, that did not happen in many states. It can be difficult, at times, to determine if what we hear from politicians is actually what they are following through with behind closed doors. As nurses and based on our code of ethics, it is our mission to provide equitable care to all patients and to work towards ensuring all communities have access to good quality care. While politicians work from a top down approach, what can we do as nurses to work on a bottom up approach and improve care for our patients?

Dr. Mooring

Hi Janie!

I have heard horror stories about nursing homes and long term care facilities. Biden has many plans to provide COVID-19 support and relief for residents, families and health care staff. He is concerned about staffing, PPE, training, accountability and finance (Biden Harris, 2021).

References

Biden Harris. (2021). Biden-Harris plan to make nursing homes and long-term care facilities safe. Retrieved on December 5, 2021, from https://joebiden.com/covid-nursing-homes/

Week 1 Discussion

The opioid crisis has drawn much attention as it has been increasing at alarming rates. According to the Congressional Digest, “greater than 140 people died daily from overdosing on drugs (Congressional Digest, 2018)”. This crisis has been growing for an extended period. President Clinton took a stance and assisted in fighting the opioid crisis. He reported that he knew some people who were personally battling with it. According to the Clinton Foundation, he and the foundation have placed much funding into educating communities on the opioid epidemic and equipping more people to have accessibility to Naloxone ( States News Service, 2017). Even in 2019, “Former President Clinton and his foundation have continued to keep his word on spreading resources to communities to reduce the instance of more Opioid-Related Deaths ( States News Service, 2019)”

Former President Trump has planned and implemented practices to assist in reducing the Opioid Epidemic. According to the MENA report, he authorized funds to the High-Intensity Drug Trafficking Area Program (HIDTA). He approved First Responders’ training to treat those who need treatment from overdoses and other related emergencies (MENA Report 2018).

There has been a known issue with there being an opioid epidemic for a while now. “The Comprehensive Addiction and Recovery Act Bill was created to assist in addressing the problem of the epidemic on more of a comprehensive scale (Milstead, 2016).” At this time, I would continue to provide and bring awareness to this severe issue. One other concern that I would try to address is getting people to help who have been placed in jail for some of the problems now being treated with prescriptions. Naloxone is currently more accessible so that in case of an emergency, it can be administered. I would continue to campaign to bring awareness to the opioid crisis. I would work with Providers to come up with alternatives and adjunct treatment plans. I have personally encountered patients who have increased pain, taken more than prescribed to help treat the pain, and have to “wait” until there is a next available appointment with the provider so that their pain can be reassessed and a new prescription can be generated. Nurses do have a frontline stance on assisting patients in helping with pain management.

References:

In the New Episode of the Clinton Foundation Podcast, President Bill Clinton Addresses the Ongoing Opioid Crisis with Former U.S. Surgeon General Dr. Vivek Murthy and Members of the Clinton Foundation Community. (2019, August 29). States News Service

 Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning. 

 United States: President Trump Signs Cantwell Provisions to Combat Opioid Epidemic Into Law. (2018, October 27). Mena Report. 

WATCH LIVE TODAY AS PRESIDENT BILL CLINTON HOSTS OPIOID SUMMIT AT JOHNS HOPKINS UNIVERSITY. (2017, October 30). States News Service.

https://link.gale.com/apps/doc/A512277775/EAIM?u=minn4020&sid=ebsco&xid=0b781752

 Week 1 Discussion

The opioid crisis has drawn much attention as it has been increasing at alarming rates. According to the Congressional Digest, “greater than 140 people died daily from overdosing on drugs (Congressional Digest, 2018)”. This crisis has been growing for an extended period. President Clinton took a stance and assisted in fighting the opioid crisis. He reported that he knew some people who were personally battling with it. According to the Clinton Foundation, he and the foundation have placed much funding into educating communities on the opioid epidemic and equipping more people to have accessibility to Naloxone ( States News Service, 2017). Even in 2019, “Former President Clinton and his foundation have continued to keep his word on spreading resources to communities to reduce the instance of more Opioid-Related Deaths ( States News Service, 2019)”

Former President Trump has planned and implemented practices to assist in reducing the Opioid Epidemic. According to the MENA report, he authorized funds to the High-Intensity Drug Trafficking Area Program (HIDTA). He approved First Responders’ training to treat those who need treatment from overdoses and other related emergencies (MENA Report 2018).

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There has been a known issue with there being an opioid epidemic for a while now. “The Comprehensive Addiction and Recovery Act Bill was created to assist in addressing the problem of the epidemic on more of a comprehensive scale (Milstead, 2016).” At this time, I would continue to provide and bring awareness to this severe issue. One other concern that I would try to address is getting people to help who have been placed in jail for some of the problems now being treated with prescriptions. Naloxone is currently more accessible so that in case of an emergency, it can be administered. I would continue to campaign to bring awareness to the opioid crisis. I would work with Providers to come up with alternatives and adjunct treatment plans. I have personally encountered patients who have increased pain, taken more than prescribed to help treat the pain, and have to “wait” until there is a next available appointment with the provider so that their pain can be reassessed and a new prescription can be generated. Nurses do have a frontline stance on assisting patients in helping with pain management.

References:

In the New Episode of the Clinton Foundation Podcast, President Bill Clinton Addresses the Ongoing Opioid Crisis with Former U.S. Surgeon General Dr. Vivek Murthy and Members of the Clinton Foundation Community. (2019, August 29). States News Service

 Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning. 

 United States: President Trump Signs Cantwell Provisions to Combat Opioid Epidemic Into Law. (2018, October 27). Mena Report. 

WATCH LIVE TODAY AS PRESIDENT BILL CLINTON HOSTS OPIOID SUMMIT AT JOHNS HOPKINS UNIVERSITY. (2017, October 30). States News Service.

https://link.gale.com/apps/doc/A512277775/EAIM?u=minn4020&sid=ebsco&xid=0b781752

One of the main arguments against government involvement in the opioid crisis is that people make a choice to use opioids and are suffering the consequences. However, as nurses, we cannot judge our patients for their choices. Rather, we must care for them with compassion and must always provide quality care. How can we encourage nurses to look past their personal bias related to opioid use and still provide excellent care? And how can we get lawmakers to devote time, energy and funds to combat the issue?

Dr. Mooring

WE can encourage staff to provide care for the patients as if we want someone to provide care for them.  A suggestion to get lawmakers to devote time, energy and funds includes possibly having them shadow and walk a day in the caregiver’s shoes so that they can get our angle. This may assist in them seeing firsthand our challenges.

Introduction

Certain health topics and situations preceded each other depending on how they affect the country as a whole. One that stands up to me is the opioid crisis. This has become a plague that unfortunately has extended and affected not only the United States but is a world wide dilemma. The thing with this situation is that it doesn’t only affect in the aspect of simply causing the person to become an addict and fall into dependency. We also should take into consideration that is has trickling effects. Such usage causes constant readmission to hospitals, exposes the person to increase organ dysfunction, exposure to other diseases, and the list goes on. This thus becoming a vicious cycle which turns into dependence in the need for healthcare monitoring due to all these trickling secondary effects of the dependence. “Drug overdose in the United States rose 29.4% in 2020 to an estimated 93,331, including 69,710 involving opioids, according to the CDC. This a 5% increase from 2019.” (National Institute on Drug Abuse, N. I. H) (tjordan_drupal. (n.d.).  This is in essence a disappointment because personally I feel like the war against it would be nearly impossible to defeat but keeping it at bay is by all means a start.

Statistics

To compare I chose the Trump administration and the current Biden administration. I feel like keeping the fight against it relevant gives a better comparison. Considering the alarming statistics regarding overdose about 70,000 Americans died related to said overdose. Since the year 2000 there has been 700k death and the federal budget for drug control in 2020 alone was 35 billion. As per the projected numbers the starting age for drug us is usually at 12 years old. The highest use is in males at 22 percent as opposed to the 17 percent in females. The age range of highest use is between the ages of 18-25% at 39% compared to the ages of 26-29 which are at a 34%. 9.7 million or 96.6 % of opioid misusers  use prescription pain relievers. (Bustamante, J. (2021, September 25). Hydrocodone is the most popular prescription opioid with 5.1 million misusers. Hydrocodone gets prescribed at a rate that would medicate every American around the clock. Sitting back and digesting all these statistics simply makes the situation place itself in the limelight and really shows how big of a monster we have.

Trump

During the term of president Trump he secured a 6 billion in funds to combat the opioid epidemic, signed the SUPPORT for patients and communities act which was considered the larges legislative effort to address a drug crisis. The Department of Health and Human services was awarded during his term 9 billions in grants in order to increase prevention, treatment and recovery in the communities. Passed the CRIB Act in order to allow Medicaid to aid mother whose newborns were delivered with Opioid dependence. Decreased the amount of opioid prescription  allowing for drug overdose to fall nationwide in 2018 for the first time in three decades. Aside from addressing the situation in the State itself, he addressed it from outside sources and received commitment from President Xi to schedule fentanyl and its analogues to keep the lethal substance away and brought a 27 percent decrease in heroin production in Mexico.(WHITEHOUSE. (n.d.). 

Biden

For the Biden administration his approach to combat the crisis is to hold pharmaceutical companies, executives, and others responsible in their role. Plans to invest 125 billion in federal investment in order to create a more effective form of prevention, treatment, and recovery. His main focus also lies to stop overprescribing. Like Trump he also plans to continue to stem the flow of fentanyl and heroin from China and Mexico. This by allowing the “DEA to act expeditiously  when a pharmaceutical distributor fails to adequately monitor shipments that could pose as a danger to the vulnerable communities and increase penalties to said companies that fail to stop such shipments.”( Democratic National Committee. (2020, August 3).  Another point in order to stop this issue is to ban drug manufacturers from providing payments or incentives to physicians. They also have a plan proposed in order to terminate the pharmaceutical corporation tax break related to advertisement spending. MAT or Medication Assisted Treatment is also part of the plan and he projects it for it to be fully universal no later than 2025.The point of that program is to have all over the country in every substance abuse facility the availability for FDA approved medications. These were key aspects that stood up for me regarding both of these presidential terms.

Personal View

This isn’t a matter of political parties or our views on it, the situation in simply based on what has been done to oppress such issue. I personally think that both parties have had great ideas and approach to it. In my view and terms I personally think that the biggest contributor for the opioid crisis is within our own country. I understand there’s plenty of other parties like China and Mexico that contribute to the dilemma, however I think that controlling that aspect will take a lot of work. Yet, when it comes to big pharm the situation is different. The biggest instigator in my opinion of our current opioid crisis is big pharm. The lobbying that they do to prescribers by providing incentives in order to provide the medication that they choose is an easy stream and pipeline to  have a patient become addicted to such medication. I think there is too little lack of regulation on big pharm as well as prescribing authority by physicians when it comes to prescribing medications. I  would address that internal situation first and cut the cord between how much influence big pharm places on a physician. If more control would be place on big pharm, I personally feel there would be a decrease on the dependence for medications  that unfortunately are  creating more harm than good. 

Reference

Bustamante, J. (2021, September 25). Substance abuse and addiction statistics [2021]. NCDAS. Retrieved December 1, 2021, from https://drugabusestatistics.org/. 

Democratic National Committee. (2020, August 3). The Biden plan to end the opioid crisis. Joe Biden for President: Official Campaign Website. Retrieved December 1, 2021, from https://joebiden.com/opioidcrisis/. 

National Institute on Drug Abuse, N. I. H. (2021, February 25). Overdose death rates. National Institute on Drug Abuse. Retrieved December 1, 2021, from https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates. 

tjordan_drupal. (n.d.). CDC: Drug overdose deaths up 29.4% in 2020: AHA News. American Hospital Association | AHA News. Retrieved December 1, 2021, from https://www.aha.org/news/headline/2021-07-14-cdc-drug-overdose-deaths-294-2020. 

WHITEHOUSE. (n.d.). Administration Achievements . National Archives and Records Administration. Retrieved December 1, 2021, from https://trumpwhitehouse.archives.gov/issues/healthcare/. 

One of the main arguments against government involvement in the opioid crisis is that people make a choice to use opioids and are suffering the consequences. However, as nurses, we cannot judge our patients for their choices. Rather, we must care for them with compassion and must always provide quality care. How can we encourage nurses to look past their personal bias related to opioid use and still provide excellent care? And how can we get lawmakers to devote time, energy and funds to combat the issue?

Dr. Mooring

Hello Claudia:

Kudos! Your post  compares and contrasts in an excellent manner how the Trump and the Biden administration tries to deal with the opioid crisis. Illicit drug use such as heroin, the increase of illegal use of fentanyl, oxycodone, morphine contributes to a shorter life expectancy of men and women in the United States. To better formulate policies that will target the opioid crisis needs at its core, policymakers are focusing on the factors that contribute to addiction. Prescription of pain management regimen is a subject that has captured the attention of medical and government personnel. Ways to decrease the explicit use of narcotics and instead the prescription of substitutes can help alleviate the amount of narcotic a patient takes. Also, prescribing narcotics for a shorter period of time with doses that are not so close in time can also help decrease the dependence  on such medications. Lack of education is also of great detriment to patient, since many people have heard of the perils of drugs but true information about its many consequences can remain obscure for many. Also, education for prescribers is also important since ways to prevent the overuse of prescription medication is a crucial part of prevention (Singh et al., 2019).

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

In case of of emergency, to reduce things like suicide and gun violence, previous president, Donald Trump believed that those with mental illness should be ‘involuntarily confined’. This coupled with the onset of COVID- which has been drastically affecting our economy and the mental health of many- made the issue of mental health much more shocking and important to address. Mr. Trump, on behalf of the topic had the following to say: “My administration is committed to preventing the tragedy of suicide, ending the opioid crisis, and improving mental and behavioral health. The pandemic has also exacerbated mental and behavioral-health conditions as a result of stress from prolonged lockdown orders, lost employment, and social isolation” (Le, 2020). President Trump also “released an executive order setting pandemic-related mental health needs as a priority, with the goal of preventing suicide, drug-related deaths, and poor behavioral health outcomes” (Nuzum & Abrams, 2020). Similarly, current President Biden has pledged to redouble efforts to existing mental health services including increasing funds, expanding facilities and investing in basic training to lead towards hiring more mental health clinicians, counselors, and educators (Nuzum & Abrams, 2020). The Biden administration, according to Simmons-Duffin and Chatterjee (2021) has also pledged “$85 million dollars in funding for mental health awareness, training, and treatment.” While the things the Biden administration has been doing for this issue have been relatively positive, I believe that the problem lies in the exorbitant prices of the resources available to people. Some people suffering from mental illnesses are unable to pay off the debts that come from clinics, therapy, and medication necessary to help treat them. There are even stories of people having to choose between being able to afford food for the month or going to a single 30-60 minute therapy session, which is absolutely ridiculous. To try and combat this, I would lower the prices or offer discounted or state/federal government funded options for these people, and propose a bill that would make it easier for patients to get necessary (and oftentimes life-dependent) medications with medicaid/medicare or another affordable health insurance and I would as well create a mental health awareness program for both young and old to benefit from as part of their human rights.

Work Cited

Le, D (2020). American Counseling Association: Your passion, Your profession, Our purpose. Retrieved from https://www.counseling.org/news/updates/2020/10/06/president-trump-issues-executive-order-on-behavioral-health#

Nuzum, R & Abrams, M (2020). The Commonwealth Fund: Improving Health Care Quality. Retrieved from https://www.commonwealthfund.org/blog/2020/health-care-2020-presidential-election-mental-health-and-substance-use-disorders

Simmons-Duffin, S & Chatterjee R (2021). Children’s mental health gets millions in funding from the Biden administration. Npr.org. Retrieved from https://www.npr.org/sections/back-to-school-live-updates/2021/08/27/1031493941/childrens-mental-health-gets-millions-in-funding-from-the-biden-administration

Access to mental health services has diminished drastically over the years, yet it seems that funding continues to decrease. We need more inpatient facilities, as well as more outpatient providers to ensure patients have the care they need. What can we as nurses do to ensure our patients have the mental health care they need? How can we advocate for them and get policy makers to increase funds for their care?

Dr. Mooring

Dr. Mooring,

Thank you for your response and I appreciate your great question! To ensure patients are receiving the care they need, I believe that nurses are supposed to provide holistic care, and educate patients on the importance of medication compliance and practicing coping skills, encourage them to participate in groups and therapy. We can also ensure they receive the care they need by establishing good communication skills, providing them with patient-centered care, and creating a relationship with them.

By starting petitions, attending town meetings and emailing policy makers, nurses can make aware the needs of patients regarding mental health. While creating a good nurse-patient relationship and helping them express themselves and their concerns, nurses can propose and advocate for a change in better treatment plans, payment solutions, and options that fit the patient’s needs.

Initial Post:

Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?

            The past several decades health care has been at the forefront of most presidential  agenda’s. Every election for almost as long as I can remember there has been some focus on health care, mostly concerned with the cost of health care and the access to health care.  President Obama presented and passed the Affordable Care Act in 2010 allowing coverage for all Americans. There were several parts of the act that presented to be problematic. President Trump attempted to dismantle the Affordable Care Act on his first day in office by executive order and present other options for Americans in regards to health care coverage. President Biden is attempting to develop a plan to increase available coverage for Americans by decreasing the age from 65 to 60 years old, thereby covering more elderly Americans.

     As I read all of these articles I am perplexed by its complexity. I am certain  that the majority of the American population struggle with obtaining quality health care coverage and certainly are not aware of how to navigate the many pathways to our system. There are so many avenues in our current system that even the educated find it difficult to navigate. Compounding the ambiguity of current health care system, most individuals find that acquiring or accessing our systems to be cumbersome and inefficient. As I have worked in public health and the emergency department, it is a revolving door to the same pitfalls time and time again. Countless people are not educated and/or know how to proceed in getting adequate coverage or do not have the resources to access the system. Although there are defined efforts and strategies to bring this health care to every individual the system has failed to incorporate large portions of our populations. Our inner city populations, our homeless, and our mental health populations are star examples of not insured or under insured populations. Our current Fee for Service model is obviously proving to be ineffective and costly, but could be potentially diverted by implementing a system that is a universal approach or and universal payor source. There are of course more options that can be available but the core of the program is one overseeing entity.

            There are so many theories of how to fix our health care system that even I find all of it overwhelming almost the feeling of defeat before the battle. I believe that as Nurse Practitioners it is our duty to continue to rise in the forefront of the policies that affect our patients and “us” as providers. I would continue to push forward with initiatives to provide better access for our communities by increasing the full scope of practice for NP’s, increase access by modern technology via telehealth or virtual providers. Provide incentives and increased education to providers to serve in our over burden communities (Milstead, Short, 2019). In my readings I have ever so slightly just grazed over the dilemma’s facing our current delivery method of our heath care system as well as the lack of providers to embrace our communities,  but I do believe that “nursing health research can lead to development of knowledge that improves the access, health and patient safety” and prove to provide and deliver improved nursing care and better patient outcomes ( Jones & Mark, 2005).  ACA seeks to reduce the overall health care costs by encouraging and prompting providers to provide wellness programs, healthy active  living models and other various programs to promote maintenance so as not to incur use of specialist, testing services,  increased Er visits and longer hospital stays (Milstead, Short,2019). I believe that with the collaboration of our health care professionals, our politicians and our government to oversee that there is a solution to our chaotic and overburdened system.  

References: 

Jones, C. B., & Mark, B. A. (2005). The intersection of nursing and health services research: Overview of an agenda setting conference. Nursing Outlook, 53, 270‒273.

Short, J.A.M.N. M. (2017). Health Policy and Politics (6th Edition). Jones & Bartlett Learning. https://mbsdirect.vitalsource.com/books/9781284155235

The goal of the health care reform was to increase access to care for all people. Yet, that did not happen in many states. It can be difficult, at times, to determine if what we hear from politicians is actually what they are following through with behind closed doors. As nurses and based on our code of ethics, it is our mission to provide equitable care to all patients and to work towards ensuring all communities have access to good quality care. While politicians work from a top down approach, what can we do as nurses to work on a bottom up approach and improve care for our patients?

Dr. Mooring

First Response:

Dr. Mooring, I believe that we need to start with the basics of ” proper education and training”  for nurses. Educate the nurses to the current barriers in place that are inhibiting the ability to provide or administer appropriate quality care to our patients and educate the nurses on how to achieve the “Triple Aim of Healthcare: 1) better care; 2) better health; and 3) lower healthcare cost ( Hain, 2014).  First and foremost we need to address the barriers to nurses  within the scope of their practice, encourage  professional organizations, networking, policy, education,  and the upward shift to wellness programs, health maintenance and health promotion.

We need to increase our education to our nurses about what services are available to our patients and encourage our patients to own their healthcare. Encourage involvement in programs,  “American Nurses Association (ANA) and its state constituent associations, as well as specialty nursing groups, can provide their members with the tools they need to be successful. The success of these organizations’ efforts in the legislative arena depends in large part on their members’ involvement with and understanding of the importance of an effective legislative presence on behalf of the profession” (Milsteadt, Short, 2019).

Reference:

Hain, D., Fleck, L., (may 31,2014)” Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign” OJIN: The Online Journal of Issues In Nursing Vol.19, No. 2, Manuscript 2.

Short, J.A.M.N. M. (2017). Health Policy and Politics (6th Edition). Jones & Bartlett Learning. https://mbsdirect.vitalsource.com/books/9781284155235

Shapiro, A., Villarroel, R. L., & George, P. (2019). A call to maximize impact of the SUPPORT for patients and communities act through standard inclusion of opioid use disorder treatment curricula in medical schools. Advances in medical education and practice. 2019; 10: 581-583. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683946/

One of the main arguments against government involvement in the opioid crisis is that people make a choice to use opioids and are suffering the consequences. However, as nurses, we cannot judge our patients for their choices. Rather, we must care for them with compassion and must always provide quality care. How can we encourage nurses to look past their personal bias related to opioid use and still provide excellent care? And how can we get lawmakers to devote time, energy and funds to combat the issue?

Dr. Mooring

Response

Hi Dr. Mooring, thank you for your insight and for the questions. As nurses, we should be able to show compassion and empathy for our patients, with these attributes and we should be able to provide care for us patients without any bias. We should be compassionate about our patients no matter what as we sworn our oaths to be nurses. Also, we have to put ourselves in our patients’ shoes; we have to know that, those patients could be us, or any of our family members, so we should care for them just like we would want to be done to us or any of our loved ones. Secondly, with getting our lawmakers on board, what we can do as nurses is to lobby, since opioid addiction is a very serious patient safety. Even though we have the big organizations like ANA at Washington lobbying, we can also start with local and State organizations to get our voices heard.

Absolutely! We should be active on the local level. That’s where real change happens

Hi Yvonne!

In your discussion post, you had an excellent point on the undertreatment of pain in some patients. As a result of the ongoing opioid crisis, chronic pain is often not treated as well as it should be because physicians are hesitant to prescribe medications. Physicians are caught in the middle between adequately managing chronic pain and preventing opioid abuse from occurring (AAFP, 2019). From the nurse’s perspective, it is critical to advocate for the patient whose pain may be undertreated and collaborate with the patient’s healthcare team if a risk for misuse is present. Advocating for these patients is the nurse’s responsibility, as the nurse typically will have more contact with a patient than the physician does.

While saving and treating those already affected by the opioid crisis is just as crucial as preventing opioid abuse from occurring in the first place, prevention will make the most significant impact in ending this epidemic. One primary strategy to prevent opioid abuse is to decrease the rate of prescribed opioids. President Trump implemented a Safer Prescribing Plan that assigned more significant restrictions and monitoring of prescriptions. Amending insurance coverages to include more pain medications with decreased risk for addiction is another prevention strategy (Ghandnoosh & Porter, 2017). Increased monitoring and ending drug trafficking can prevent people from obtaining illegal opioids. Identifying and stopping the source of the problem is imperative in solving this crisis.

References

American Academy of Family Physicians. (2019, December 12). Chronic Pain Management and Opioid Misuse: A Public Health Concern. American Academy of Family Physicians. Retrieved December 2, 2021, from https://www.aafp.org/about/policies/all/chronic-pain-management-opiod-misuse.html.

Ghandnoosh, N., & Porter, N. D. (2017, December 13). Opioids: Treating an Illness, Ending a War. The Sentencing Project. Retrieved December 2, 2021, from https://www.sentencingproject.org/publications/opioids-treating-illness-ending-war/.

Opioid Epidemic Policies

Precious Dixon

Walden University

Population and Advocacy for Improving Health

Dr. Mooring

12/1/2021

The opioid epidemic was declared a public health emergency by the U.S Department of Health and Human Services in 2017 (HHS). Trump’s Administration established a campaign for fighting the opioid crisis, which involved various national departments. The drive took a multiplex approach and included multimedia awareness campaigns, stimulating stricter policies making it harder for criminals to get fentanyl precursors, working with pharmaceutical companies to investigate addiction therapies, and developing anti-addiction vaccines and other measures (DPBH). However, the number of deaths from opioid overdose continued to rise.

Biden Administration took a slightly different approach. Their plan focuses on providing effective prevention treatment and recovery services available to all addicts with the help of a $125 billion federal investment. Biden Office claims that pharmaceutical companies need to be held accountable for contributing to the initiation of the opioid crisis. Arguably, instead of just pouring budget money into various government agencies and departments, there should be an intense focus on giving the medical practitioners the resources for research programs, thus providing practical evidence for implementation in real life. According to chapter 2 of the book by Jeri Milstead and Nancy Short, “By seeking and obtaining a grant from a national organization, nurse leaders can initiate new practices in a health organization” (Milstead & Short, 2019, p.18). Consequently, initiating new practices in health organizations could bring new ways for fighting such multiplex problems as the opioid crisis.

Increasing funding of care coordination programs could contribute to the overall quality of health services. According to the article by Lamb et al., “Expanding funding streams for measure development and testing is essential to improve the state of performance measurement for care coordination” (2015, p.527). Consequently, additional funding of the programs focusing on improving healthcare quality could have an indirect effect on helping battle the opioid crisis.

Although setting a clear national agenda is vital for attacking complex and multi-leveled issues. Still, the extent of the problems like the opioid crisis arguably requires a plan that will maintain a constant course and only require periodic adjustments by the everchanging administration policies. Article by Soelberg et al., discusses the importance of cooperation between federal and state governments in approaches such complex situations. The article suggests that government interventions aimed at more appropriate opioid prescribing, the studies investigating the effect of these interventions should also consider the impact on people suffering from chronic pain (Soelberg et al., 2017, p.1680). Thus, the policymakers should aim to collaborate with agencies and medical practitioners to find the most effective approach.

References

Assistant Secretary of Public Affairs (ASPA). What is the U.S. opioid epidemic? Retrieved

December 1, 2021, from https://www.hhs.gov/opioids/about-the-epidemic/index

.html.

Department of Health and Human Services Nevada Division of Public and Behavioral Health (DPBH). (2017). Background on PH Emergency Declaration Retrieved December 1, 2021, from https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Resources/opioids/Background%20on%20PH%20Emergency%20Declaration.pdf.

Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., … & Peterson, C. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521-530. doi: 10.1016/j.outlook.2015.06.003.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Soelberg, C. D., Brown, R. E., Du Vivier, D., Meyer, J. E., & Ramachandran, B. K. (2017). The US opioid crisis: current federal and state legal issues. Anesthesia & Analgesia, 125(5), 1675-1681. doi: 10.1213/ANE.0000000000002403.

Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level.

How did the current and previous presidents handle the problem?

An essential topic would be prescription drug prices. Just last week, the Build Back Better Act was passed in the U.S. House of Representatives. This bill includes a provision that will allow Medicare to negotiate prices for high-cost prescription drugs. A tax penalty can be imposed on drug companies if prices increase faster than the inflation rate ( The White House, 2021.) insulin prices will decrease with a $35 copay per month. Before president Biden, other former presidents have tried and failed to contain the price of drugs, like insulin. Clinton, Biden, and Obama have all promised to attempt to fight high drug costs. Unfortunately, Clinton and Obama failed, primarily due to the deep pockets of the pharmaceutical industry. The industry spends more than one billion dollars annually on positioning and marketing products to the public ( Diamond and Goldstein, 2021). There is great anticipation that this bill will become law.  The bill will still need to pass through the Senate for final approval (House.gov, 2021). As nurses, we often see patients who must choose between buying necessities (food, utilities, etc.) or paying for prescription medications. This bill may give some relief from high insulin costs for people living with diabetes.

I personally believe that more patients would be compliant with taking their medication, if costs could be controlled. I am hopeful that future Presidents will make prescription drug prices a priority.

References

United States House of Representatives. (2021). The Legislative Process.

https://www.house.gov/the-house-explained/the-legislative-process

The White House. (2021). The build back better framework: President Biden’s plan to rebuild the middle class.

https://www.whitehouse.gov/build-back-better/

Diamond, D., Golsdtein, A. (2021). A bitter pill: Biden suffers familiar defeat on prescription drug prices. The Washington Post.

https://www.washingtonpost.com/health/2021/10/29/biden-medicare-drug-negotiation/

You make very good points and about if costs can be controlled and reduced, we would have  more patients will to take their medications for mental health. Your statement saying that the pharmaceuticals companies have deep pockets is very true, because we have companies who make drugs and sell them over a name brand and a generic brand yet charging people more for one of the identical products. There are also drugs that are very easy and cheap to produce yet are sold for an advertised price sometimes more than 3x the amount it took to manufacture the drugs and acquire the resources. I think the Build Back Better Act is definite a step in the right direct and the evolution of this bill turning into a law would open up many opportunities for family’s without the proper funds to purchase high-priced medications.

Hello Blessing!

Thanks for your post. Medication costs have been a barrier for patients for many years. Many lives could be saved, along with the improvement of quality of life for many people, if medication costs come down. I also believe the build back better act could be a breakthrough in the fight to decrease the costs. I am hopeful that Medicare contracts will continue to be negotiated in the future.

With a price tag of over three hundred billion dollars per year, it is no secret why prescription drug prices are a hot topic of most presidential candidates. Americans are projected to see an increase in that number over the next several years, which is why they want to know how candidates intend on reducing the cost of life-saving medications that have become unaffordable to some(Gavulic, 2021).

The Trump and Biden administrations have many similarities in their approach to decreasing drug cost, for example, both agree that patients show be able to import medications from other countries that offer them at lower prices. Both administrations also called on Congress to allow Medicare to negotiate drug prices(Biden, 2021).  

Biden urges U.S. Congress to take steps to lower prescription drug cost. (2021). www.reuters.com. Retrieved September 1, 2021, from https://www.reuters.com/world/us/biden-urge-congress-lower-prescription-drug-costs-2021-08-12/ 

Gavulic, K. A., & Dusetzina, S. B. (2021). Prescription Drug Priorities under the Biden Administration. Journal of Health Politics, Policy and Law, 46(4), 599-609. https://doi.org/10.1215/03616878-8970810

One of the most overseen population health topics that rise to the level of the presidential agenda is mental health disorders. Approximately 45% of adult Americans report having some form of emotional distress, such as depression or anxiety. In addition, this population is also at higher risk for other comorbidities and problems to include chronic diseases and substance abuse. The concern is that this is an astronomical portion of the population so that federal government intervention is required in the interest of public health as this population accounts for three times more health care spending than their counterparts without mental health disorders (Moreno C, 2021.)

Our Former President Donald Trump did not perceive this as an issue as he worked to repeal the Affordable Care Act (ACA) that provided coverage for the adult population. Yet, Trump sought to increase spending on mental health providers to increase their numbers by 24%, and address suicide among veterans as a unique concern. As a military spouse for many years now, I was astonished to see the changes that came firsthand for the mental health of our current enlisted and former military members. Many new protocols were introduced with our services members in mind after Trump stepped into office. Amidst the Covid-19 pandemic president, Trump also initiated the lifesaving Executive Order (EO) 13594. This EO is called Saving Lives Through Increased Support For Mental and Behavioral Health Needs. Executive Order 13594 reflects the Trump administration’s dedication to preventing the tragedy of suicide, ending the opioid crisis, and helping improve mental and behavioral health. According to the CDC, in June 2020 40% of adults reported increased struggles with mental health and substance abuse since the start of the pandemic. This Executive Order was put in place to help prevent poor behavioral health outcomes, and drug-related deaths, and suicide (Nuzum & Abrams, 2020,)

In opposition to this, President Joe Biden has expressed his devotion to protecting and building the Affordable Care Act to guarantee that mental health services have coverage expansion and protections. In Addition, Biden has focused on giving more to mental health funding and introducing mental health parity laws. Further, the Biden administration has invested in training and hiring more mental health providers to ensure access (Nuzum & Abrams, 2020.)

Personally, I would initiate a true Affordable Care Act in comparison to the ACA that is currently in place. Contrary to the ACA’s name, many middle-income American families don’t view this act as affordable as the name claims. After the age of 26, when young adults are no longer able to be a part of parental insurance policies, this can make receiving and affording mental health services complicated. I know many young adults who are unable to afford the mental health services that they require. Not only would I try to enforce a more affordable plan, but I would also take strides to provide more free mental health services such as more accessible mental health professionals. I know right now a huge growing mental health aid is the ability to reach out to mental health professionals via text, virtual calls, emails, etc. Instead of having to wait for days or even weeks on end to get in contact with your provider, you now can do so right at your fingertips for less severe needs.

References:

Health care in the 2020 presidential election: Mental Health and Substance Use Disorders. Commonwealth Fund. (n.d.). Retrieved December 2, 2021, from https://www.commonwealthfund.org/blog/2020/health-care-2020-presidential-election-mental-health-and-substance-use-disorders.

. Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, Cannon M, Correll CU, Byrne L, Carr S et al: How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet Psychiatry 2020, 7(9):813–824

Access to mental health services has diminished drastically over the years, yet it seems that funding continues to decrease. We need more inpatient facilities, as well as more outpatient providers to ensure patients have the care they need. What can we as nurses do to ensure our patients have the mental health care they need? How can we advocate for them and get policy makers to increase funds for their care?

Dr. Mooring

During these last 2 years, the Covid-19 virus has not been the only thing that has been on the rampage. Covid has also instigated an increase in mental health instability throughout the world as a result of unexpected unemployment, enforced inactivity courtesy of stay-at-home mandate, and inability to keep up with rising medication prices and the failing economy. Marriage crises, mental trauma and death have all been outcomes of this pandemic. Since coming into term, the current president has began working on reversing the mental health issues that stem from the Covid-19 outbreak. Our hope is that his efforts prove to be successful and will have a reduction in the rate of mental health issues in the next year or two.

The goal of the health care reform was to increase access to care for all people. Yet, that did not happen in many states. It can be difficult, at times, to determine if what we hear from politicians is actually what they are following through with behind closed doors. As nurses and based on our code of ethics, it is our mission to provide equitable care to all patients and to work towards ensuring all communities have access to good quality care. While politicians work from a top down approach, what can we do as nurses to work on a bottom up approach and improve care for our patients?

Dr. Mooring

                As nurses, we can all relate to the many times our patients have called us to remind us that it’s almost time for their pain medication. We have worked with many types of patients and can already tell which patients are truly in pain and which one’s are simply addicted. It’s not a judgment call but a wake up call, not just for the care team, but to the whole world.

According to the Centers for Disease Control and Prevention (CDC, 2021), almost 841,000 people have died from a drug overdose since 1999. In the year 2019, in the United States alone, 70,630 people died from some form of overdose (CDC, 2021). We can say the opioid epidemic is sweeping through our neighborhoods, cities and nation taking the lives of people that were introduced to drugs by a prescription or on the street.

Many presidential campaigns and debates have promised help to the States to combat the war on drugs but in the end have not delivered what they promised. In 2010, President Barack Obama introduced the Prescription Drug Abuse Prevention Plan but did not act on it until towards the end of his presidential term (Barlas, 2017).  The Obama administration started the Medication-Assisted Treatment (MAT)  program through the department of Human and Health Services (Barlas, 2017). This program together with the passing of the Patient Protection and Affordable Care Act (PPACA), helped substance abuse treatment become covered under the marketplace insurance plans (Barlas, 2017).

In 2017, President Trump declared that the opioid crisis was a “Public health emergency”. In 2018, the Support for Patients and Communities Act passed in Congress (Congress.gov). This law supported the community more than ever by offering more benefits than before. Title I (Sec. 1001), declares that juveniles that are currently serving in a public institution can not have their Medicaid terminated (Congress.gov). The law supports other factors such as better opioid packaging and increasing the number of patients a doctor can see and treat with MAT.

In the end, every presidency has its own way of trying to fix the opioid epidemic. I believe that certain criteria must be met in order for a physician to prescribe and keep prescribing pain medication. I have had patients with a pain score of 10/10 and a blood pressure of 90/50. I have also had patients with no hypertension history with a blood pressure of 180/105 with a pain score of 7/10. In some situations, I have had patients get out of bed and start walk back and forth in the room just to get their blood pressure high enough to give morphine. It seems like a never ending problem, but it can be fixed if we all work together for the better, not for who can make more money.

References

Barlas S. (2017). U.S. and States Ramp Up Response to Opioid Crisis: Regulatory, Legislative, and Legal Tools Brought to Bear. P & T : a peer-reviewed journal for formulary management, 42(9), 569–592.

H.R.6 – 115th congress (2017-2018): Support for patients … (n.d.). Retrieved December 2, 2021, from https://www.congress.gov/bill/115th-congress/house-bill/6.

Centers for Disease Control and Prevention. (2021, March 3). Drug overdose deaths. Centers for Disease Control and Prevention. Retrieved December 2, 2021, from https://www.cdc.gov/drugoverdose/deaths/index.html.

Claudia, I appreciate your post. I too agree that the opioid crisis is and should be a hot topic. In my state of Georgia, it is estimated that 180,000 residents are currently addicted to opioids. Our state is losing on average four patients per day to overdose deaths(unknown, 2021).

unkown author. information obtained from https://doseofrealityga.org/get-the-facts/dangers/

Claudia, I enjoyed reading your post. From my experience in the emergency department, I have seen the crippling effects of the opioid crisis firsthand, as I’m sure many of us in this profession have. As you said, it is truly a wake-up call. According to the U.S department of health and human services, overdose-related emergency calls are up 40% since the start of the COVID-19 pandemic, and 42 states reported an increase in overdose deaths. This epidemic is crippling our country, and it is time we start to make a proactive change. No matter the administration in office, the opioid crisis always seems to be an important subject. I believe the way to take steps towards ending this epidemic is stricter prescription drug monitoring programs, state prescription laws, and management strategies in insurance programs, such as prior authorization, quantity limits, and drug utilization reviews.

Assistant Secretary of Public Affairs (ASPA). (n.d.). What is the U.S. opioid epidemic? HHS.gov. Retrieved December 4, 2021, from https://www.hhs.gov/opioids/about-the-epidemic/index.html.

Centers for Disease Control and Prevention. (2021, March 17). Understanding the epidemic. Centers for Disease Control and Prevention. Retrieved December 4, 2021, from https://www.cdc.gov/opioids/basics/epidemic.html.

One of the main arguments against government involvement in the opioid crisis is that people make a choice to use opioids and are suffering the consequences. However, as nurses, we cannot judge our patients for their choices. Rather, we must care for them with compassion and must always provide quality care. How can we encourage nurses to look past their personal bias related to opioid use and still provide excellent care? And how can we get lawmakers to devote time, energy and funds to combat the issue?

Dr. Mooring

I think the opioid abuse crisis is a highly debatable issue. Personally, I have know at least 2 different very close relatives who have been addicted to pain medications but not necessarily needed the pain medication to begin with. Ive known a few that actually have needed the medications due to something that happened prior years to cause them a lot of pain. One good example in my opinion is a friend I graduated high school with. While I worked in the emergency room, she would come in frequently with complaints of pain. Of course many of my colleagues would make their bad remarks and not want to give her pain meds but I knew her prior story and why she was there. A few years prior, she was involved in a head on collision with her mother and 3 kids in the care with her. Her mother and 2 of her kids were killed and she was critically injured. She had went through many surgeries since the accident and had basically had her whole left leg rebuild with screws and rods. I knew she was in pain physically but also emotionally so I NEVER thought twice about giving her pain meds.

I just think it is so hard to decide who really needs the medication versus who doesn’t. I do think the whole system that was implemented several years ago to use a connected prescription system with pharmacies has stopped a lot of this misuse along with holding physicians accountable for the frequency and number of pills prescribed. Until there is a more strict enforcement of border patrol and importing there will always be ways of sneaking illegal drugs and meds across into America. There’s never a clear cut answer to who should or should not get medications for pain but as nurses, it is our responsibility to do what is safe and ethical for each patient.

Dr. Mooring,

I recently read an article from one of the pain journals that comes to our office for the providers. I could not find it onlinereference it. I wish I could it had so much information on the opioid crisis and how other countries are trying to combat it, a great read for EVERYONE, but especially nurses because as you mentioned our biases do sometimes get in the way of patient care. One of the topics that stuck out the most to me was how research is being done on testing people for predispositions to addiction. The meat and potatoes of it was that before physicians prescribe opioid narcotics they could do blood test or oral swabs that have the ability to check for the genes that have been linked to those who are at a higher risk for addiction. Another country has made this testing part of pre-adolescent well child checks. Could you imagine the power that information could give to people. Statistics show that most opioid addictions result from prescriptions that were given as the result of an injury or surgery. The risk of prolonged opioid dependence increases if the patient was treated with opioids prior to the injury or surgery(Sabesan et al., n.d.). If you knew prior to taking post-op pain medications for example, that are already highly addictive, that you personally were at an even greater risk of becoming dependent due to genetics, who you take the chance or tough out the pain. I feel many people would choose to forgo Percocet, Lortab, and MS-Contin if they were able to make informed decisions regarding an increased risk of becoming dependent upon them. I also know that not all addicts have the same story and beginning, which is why I also feel that mental health care should be unstigmatized and integrated into a routine yearly health check. People get so offended when health care workers even mention mental health, like we just called them crazy to their face, I wish that people could/would seek out mental wellness without fear of being ostracized. Working in pain clinic we incorporate mental health as part of our treatment plans for our patients. You want pain meds and such from us, you’ll see psych. I have found that most patients are ok with it. Most of our patients are elderly need someone to talk to and it gives them the tools not for fixate on their pain due to loneliness.   Below is a article I found that discusses the link between opioid dependence and genetics.

Ahmed, M., ul Haq, I., Faisal, M., Waseem, D., & Taqi, M. M. (2018). Implication of OPRM1 A118G Polymorphism in Opioids Addicts in Pakistan: In vitro and In silico Analysis. Journal of Molecular Neuroscience, 65(4), 472–479.

Sabesan, V. J., Chatha, K., Goss, L., Ghisa, C., & Gilot, G. (2019). Can patient and fracture factors predict opioid dependence following upper extremity fractures?: a retrospective review. Journal of Orthopaedic Surgery & Research, 14(1), N.PAG. https://doi.org/10.1186/s13018-019-1233-7

Hi Melanie,

In regards to your discussion on testing for predisposition for addictions, I had to be evaluated years ago for a situational depressive issue that I was going through and the physician sent me to be swabbed orally. It was to test for what medications I would be more receptive or “sensitive” to that might work better for me personally. I really never thought about the test for addictions but if they can do it for other things, they should have it narrowed down by now to being able to test for many things. Thanks for the insight!