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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-

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