Criscillis
Taylor Criscillis
Professor Skutar
English 2089
7 November 2017
Argument Speech on The Opioid Epidemic and the Changes needed to take Place
It is a pleasure to meet you, my name is Taylor Criscillis and I am a student here
at the University of Cincinnati Blue Ash. I am studying here under pre health professions
and am seeking enrollment into the nursing program here at campus. My dream job is to
become a registered nurse, work in a hospital in the city, and help make a difference in
the individual’s lives that I may encounter in the future. My topic for this speech will be
about the opioid epidemic and how it has impacted society throughout the last few years
and even more so in the daily routine of many today battling an addiction that many may
not know about. This epidemic is at an all time high in the United States and it is truly
heartbreaking to see and hear about as many stories of so many people. Daughters, sons,
mothers, fathers, and even grandparents are facing this addiction all over our country.
Prescription medications are being taken like candy and abused to an entire new level.
There needs to be a change in our healthcare system to slow and help this epidemic come
to a ceasing halt, and that is what I am here to discuss and argue today.
This epidemic is so close to home for me as an individual. Growing up with a
father who struggled very much with addiction to Percocet’s and pain pills that lead to a
deeper and more terrifying addiction of heroin down the road. Years and years of
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watching someone so close to my heart battle a demon that was so powerful and
overwhelming, that at times I felt as if I didn’t even know my dad at all when he was high
on the medication itself. Luckily in his situation he was sober for 2 years before suddenly
passing away in a tragic car accident. This was almost 5 years ago now and I have very
much peace with my father and what happened. I do believe personally that things
happen for a reason and are meant to be. I know that with the opioid epidemic America is
facing today that I’m not sure if my father would’ve survived and stayed sober with how
much these occurrences and overdoses are these days. We are seeing them all over, from
the grocery store parking lots, to people sitting in their cars completely overdosed, and
even so much as people driving in their cars while under the influence of these highly
addictive medications.
In particular, in the United States, there has been a sharp increase in rates of
opioid pain reliever abuse, misuse and overdose during the last decade. Drug overdose—
a majority involving opioid pain relievers—was the leading cause of injury death in 2012,
and among individuals aged 25–64 years drug overdose surpassed motor vehicle traffic
crashes as the leading cause of injury-related death. Opioid pain relievers are involved in
475 000 emergency department visits each year, and the economic costs of non-medical
use of opioid pain relievers were estimated in 2006 at $50 billion in lost productivity,
crime and medical costs (Barry 85). These facts are extremely eye opening and make you
question what can change to end this epidemic? As a student pursuing nursing and
wanting to work in a hospital, these facts are a huge piece of the kind of cases the
emergency department faces. So something that I purpose to argue against might be to
have classes and seminars with other nurses and doctors about precautions to think about
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and know of for when that times comes that your patient is that one. These would educate
the professionals on how to communicate and try to understand and see things from the
patient’s perspective to be able to help and be of more assistance to them.
Recent survey research among physicians has focused largely on issues most
relevant to clinical practice, including knowledge, attitudes, and concerns surrounding
pain management, tamper-resistant medications, and using opioids to treat chronic non-
cancer pain. Hwang and colleagues’ 2014 survey of PCPs found that more than half of
respondents felt that prescription drug abuse was a major problem (Kennedy-Hendricks
61). It is great that physicians are recognizing this growing epidemic and are trying to be
proactive and think of ways and come up with new, creative ideas for their patients
recovery. You also have to keep in mind here that the patients are in a range of ages from
young adults to the older generation and the way that the nurses and physicians handles
each individual will be different. It is vital that they understand those key things and
know how to connect and handle any situation that may come their way. No matter how
overwhelming or horrific the moment could be in that clinical setting.
The state of Ohio has sued five major drug manufacturers for their role in the
opioid epidemic. In the lawsuit filed Wednesday, state Attorney General Mike DeWine
alleges these five companies "helped unleash a health care crisis that has had far-reaching
financial, social, and deadly consequences in the State of Ohio." The lawsuit -- only the
second such suit filed by a state, after Mississippi did so earlier this year -- accuses the
companies of engaging in a sustained marketing campaign to downplay the addiction
risks of the prescription opioid drugs they sell and to exaggerate the benefits of their use
for health problems such as chronic pain. Or, as DeWine's office put it in a press release
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Wednesday, the "lawsuit alleges that the drug companies engaged in fraudulent
marketing regarding the risks and benefits of prescription opioids which fueled Ohio's
opioid epidemic."
"We believe that the evidence will show that these pharmaceutical companies
purposely misled doctors about the dangers connected with pain meds that they produced,
and that they did so for the purpose of increasing sales," DeWine tells NPR's All Things
Considered. "And boy, did they increase sales." In his release Wednesday, DeWine says
he filed the suit in Ross County for a reason: "Southern Ohio was likely the hardest hit
area in the nation by the opioid epidemic."(Dwyer).
This is a case that is here in my home state Ohio, and they are suing the
companies for not being honest to the physicians about the side effects and how highly
addictive these pain medications are. This was not marketed properly and now they are in
a huge lawsuit because of being a big leading cause to why this epidemic has increasingly
grown throughout the last few years. And just because this is one big lawsuit doesn’t
mean that others aren’t under the surface as well in other places. To have these drug
companies do this to physicians and the healthcare market as a whole then they have the
potential to do it to other potential buyers, advertisers, and physicians. The healthcare
system needs to make a change to help end this epidemic by making sure that the
medications and drugs they invest in and sell through our physicians are backed by the
proper dialogue and information. This includes the correct ingredients of these products
and the effects that make arise after use of them. This cant be something that is taken
lightly either, these are people’s lives and well being that we are speaking about and need
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to take the precautionary measures to make sure our medications are safe and not harmful
or propose a threat/ risk to patients.
This leads to people believing that the side effects will help with chronic pain,
inflammation, etc. so they continue to take the medication, but what they aren’t seeing is
that they are highly addictive and that not what all of the side effects and long-term
results of that drug could be. As stated above from an article, these companies are doing
this because it spikes their sales. They are able to lure customers in and when it comes to
medications ….we normally trust the professionals dealing with them. For instance, if
you go to your doctor and you have a normal case for chronic pain and he introduces a
new drug on the market to you, you trust him and try it out. The doctor isn’t aware of the
true side effects this medication could have and neither are you so you continue to take
them. Before you know it, you find yourself addictive to them and start experiencing the
effects that weren’t listed or advertised about that drug in the first place. This needs to
stop.
Primary care providers often face challenges related to undertreated pain and the
need to prescribe opioids for their patients who report severe debilitating pain. However,
there are also ongoing concerns about misuse, abuse, and addiction related to use of
opioids for chronic noncancer pain. Fear of regulatory scrutiny about improper
prescribing practices associated with opioids is also a primary concern. This has resulted
in tension between the need to treat legitimate medical conditions, such as postoperative
pain and failed surgery, while also minimizing the risk of opioid abuse and addiction.
According to provider survey studies (Gilson & Joranson, 2001), more than one-half of
physicians surveyed reported that they are worried about scrutiny and professional
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sanctions (Jamison, Scanlan, Matthews, Jurcik, & Ross, 2016). As a result, there is much
concern about the management of noncancer pain patients with opioids (Asimina
Lazaridou).
After looking deeper into this article you most certainly gain perspective from the
doctors viewpoint. Think about how scary it can be now days when it comes to
prescribing pain medications to patients. You aren’t sure what could happen and you
don’t know the outcome. You have to know where to draw the line and also be able to
see and trust your patients when they come to you for medications like such. You hold
such a liability for these drugs you are prescribing so when the companies like the
situations here in Ohio have faced… you too are also at stake, along with your status and
career. I believe that if our healthcare system changed the way of prescribing these highly
addictive medications that we could see a change in this epidemic. The change could be
finding new ways to treat such diagnosis like pain and your average medications after
surgery.
In the USA, pharmaceutical advertising and prescription practices have
undoubtedly contributed to the current opioid epidemic [9]. With Surgeon General Vivek
Murthy’s recent letter to America’s doctors, the “Turn the Tide” initiative, and the first
ever Surgeon General’s Report on Alcohol, Drugs, and Health [10], opioid-prescribing
practices have become a high-profile issue in the USA [11]. Prescribing guidelines from
the CDC [12] emphasize that opioid prescriptions are to generally be avoided for chronic
non-malignant (i.e., non-cancer) pain, and that if an opioid is deemed necessary,
providers should “start low and go slow” [11]. While this is an excellent starting point, it
is also likely that providers will take many years to fully adapt to the new guidelines and
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that substantial training in pain management and addiction medicine is required
(Devesh Vashishtha).
In 2014, overdose deaths related to prescription opioids and heroin claimed the
lives of more than 28,000 people in the United States, accounting for the majority of total
drug poisoning deaths.1 Prescription opioid-related overdose deaths increased
dramatically after 1999, nearly quadrupling over the next decade.2 These overdose deaths
paralleled a quadrupling of the amount of opioids prescribed, 3 as professional pain
management societies called for and state regulations encouraged more liberal use of
opioids for chronic, noncancer pain.4 Heroin overdose deaths also increased, more than
tripling between 2010 and 2014.1 In some states, certain pain clinics have provided
opioids and other controlled prescriptions to patients in large quantities and without
medical evaluation or justification. Pain clinic laws attempt to decrease inappropriate
prescribing through requirements such as registration of pain clinics with the state,
physician ownership of the clinics, prescribing restrictions, and record-keeping
requirements.
It is possible that mandated use of PDMP data and pain clinic laws reduce the
frequency with which opioids are prescribed or, more specifically, reduce dosages or
amounts of opioids prescribed to individuals at risk for overdose and, in turn, reduce
overdose deaths. At the same time, publications in mainstream media810 and in the
scientific literature11, 12 have advanced the idea that opioid prescribing policies have
unintentionally driven demand for heroin (a drug with similar effects) as people search
for "a cheaper, more accessible high." (Deborah Dowell).
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The information that the article above stated backs up my argument that our
healthcare system here in the United States needs to make some real changes. Changing
the way our treatment facilities are set up would be a good start. Clinics for rehabilitation
services and care are so high in costs these days that only a select few can afford to
actually go to them and stay for the help. We need more clinics like those with an
affordable rate to help get these patients who are addicted to these medications off of our
streets and out of our society into a more stable and controlled environment. Our tax
dollars pay for each police officer and ambulance to carry the drug called arcane to revive
people when they overdose on such drugs. But what if instead of investing so much into
that why not put it towards something like I mentioned above. Building more help clinics.
Safe spots for people who are in crisis and need to resort to… I feel that this would help
our citizens who are in need get the care that they need and get them recovered. I also
think that it will bring more awareness to this issue and cause people to see that it is not a
small matter and it needs to come to an end.
Recently introduced long-acting buprenorphine formulations open up the
possibility of reducing treatment costs and maximizing the use of primary care by
decreasing the frequency of prescriber visits.17 The option of using slow-release
naltrexone also adds to this outlook the potentiality of an opioid antagonist treatment to
prevent relapse without abuse potential or the need to manage opioid withdrawal
symptoms at discontinuation. Naltrexone is not classified as a controlled substance and
can be prescribed in primary care settings by physicians, physician assistants, or nurse
practitioners, but the clinical use has been limited by low patient acceptance and difficult
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transition from opioid agonist therapies.18 Further research on these and other
medications and their combination with behavioral interventions in primary care settings
will be instrumental for informing future efforts at dissemination and expansion of OUD
treatment while understanding the optimal methods for coordination and integration of
care. Other future research venues include, but are not limited to, the recognition of
patient improvement in relation to specific types and intensity of psychosocial services,
and the identification of indicators of quality of care and their measurement. Given the
high comorbidity levels in this population, research on management of OUD with psychi-
atric comorbidity, use of multiple substances, and/or medi- cal complications is also
important to inform and reinforce evidence-based approaches.
Treatment of substance use disorders is an essential health benefit under the
health care reform. Increasing numbers of individuals with OUD are acquiring health
insurance, which should facilitate their access to evidence- based treatments for OUD.
The answer cannot be to push them into the bottleneck of specialty care, not before a long
waiting time and the risk of patients to be lost in the gap between primary care and
specialty treatment. The goal is to offer patient-centered treatment for OUD, including
shared decision-making about medications and evidence-based interventions, and the
primary care environment perhaps looks like the best one to reach it (Mannelli, Paolo).
The US prescription opioid analgesic market has been consistently contracting
since 2011 and continues to shrink in response to changes in public policy and medical
practice, not- withstanding the increasing availability of products designed to deter abuse.
Fewer patients are being prescribed opioids, the amounts prescribed are less, the daily
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doses are less, and there is a national emphasis on non-opioid treatment alternatives.
These data are consistent with other research on the effective- ness of public policy and
the introduction of OADPs (Pezalla, Edmund J).
In conclusion, the opioid epidemic is very real here in the United States. Not only
here but also around the world and in many other countries. I believe that we can make a
difference in the outcome of this epidemic by making changes in our healthcare system
such as changing the way our doctors, physicians, and nurses are trained and educated on
the medications themselves and different treatment methods that can help be customized
to each patient. I think that finding a way to build and create more clinical rehabilitation
centers throughout communities and cities that are affordable for the average American.
With rehabilitation centers like that available to the people, it would bring awareness to
the issue as a whole and also help get treatment to those in need rather than have people
going into half way houses, jail, or even worse… death. More control over the doctors
and clinics that are prescribing these highly addictive medications needs to take place.
We need to be more aware of who we are giving these out too and be cautious of the
effects and their medical records for past medications. Having more control over these
things will help decrease this huge and concerning epidemic here in the United States.
Knowing I will be a part of our health care system in the near future, working with these
types of situations in a hospital setting only urges me more to find new ways that our
health care system could change to better serve our people. This is a huge and rising
epidemic that will take time to defeat… but with the time, patience, and research, as a
healthcare system we can and will put the opioid epidemic to an end.
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Works Cited
Barry, Colleen L., et al. “Understanding Americans’ views on opioid pain relieverabuse.” Addiction, 7 Oct. 2015,onlinelibrary.wiley.com/doi/10.1111/add.13077/abstract.
Dowell , Deborah, et al. “Mandatory provider review and pain clinic laws reduce
the amounts of opioids prescribed and overdose death rates.” PSNet: Patient Safety
Network, psnet.ahrq.gov/resources/resource/30540.
Dwyer, Colin. “Ohio Sues 5 Major Drug Companies For 'Fueling Opioid Epidemic'.”
NPR, NPR, 31 May 2017,
www.npr.org/sections/thetwo-way/2017/05/31/530929307/ohio-sues-5-major-
drug-companies-for-fueling-opioid-epidemic
Fischer, Benedikt, et al. “Non‐ medical use of prescription opioids and prescription
opioid‐related harms: why so markedly higher in North America compared to the rest of
the world?” Addiction, 20 May 2013,
onlinelibrary.wiley.com/doi/10.1111/add.12224/abstract.
Kennedy-Hendricks, Alene, et al. “Primary Care Physicians' Perspectives on the
Prescription
Opioid Epidemic.” Drug and Alcohol Dependence, Elsevier, 21 May 2016,
www.sciencedirect.com/science/article/pii/S0376871616301168
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Lazaridou, Asimina, et al. “Influence of catastrophizing on pain intensity, disability, side
effects, and opioid misuse among pain patients in primary care.” Journal of Applied
BiobehavioralResearch,24Mar.2017,onlinelibrary.wiley.com/doi/10.1111/jabr.12081/full
Mannelli, Paolo, and Li-Tzy Wu. “Primary care for opioid use disorder | SAR.”
Substance Abuse and Rehabilitation, Dove Press, 16 Aug. 2016,
www.dovepress.com/primary-care-for-opioid-use-disorder-peer-reviewed-article-
SAR.
Nelson, MD Lewis S. “Curbing the Opioid Epidemic in the United StatesThe Risk
Evaluation and Mitigation Strategy (REMS).” JAMA, American Medical Association, 1
Aug. 2012, jamanetwork.com/journals/jama/fullarticle/1273026.
Pezalla, Edmund J, et al. “Secular trends in opioid prescribing in the USA | JPR.” Journal
of Pain Research, Dove Press, 14 Feb. 2017, www.dovepress.com/secular-trends-in-
opioid-prescribing-in-the-usa-peer-reviewed-article-JPR.
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Vashishtha, Devesh, et al. “The North American Opioid Epidemic: Current Challenges
and a Call for Treatment as Prevention.” Harm Reduction Journal, BioMed Central, 12
May 2017, harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0135-
4.
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