Biopsychosocial Population Health Policy Proposal 343647

Biopsychosocial Population Health Policy Proposal

The health care industry has come to acknowledge the rise of the opioid crisis over the past two decades. However, this does not take away from the necessity of pain relief for patients suffering from chronic pain, who are most often prescribed opioid treatment. Opioid treatment does show promise in short-term trials (Sehgal, Colson, & Smith, 2013), but long-term treatments carry with them significant risk of addiction, adverse side effects, and prescription drug abuse (Franklin, 2014).

The issue of opioid abuse and addiction is further complicated by the comorbidity of mental health problems in patients. In this context, veterans are a particularly vulnerable population because they often present with chronic noncancer pain while being comorbid with mental health issues such as post-traumatic stress disorder or substance abuse disorder (Sullivan & Howe, 2013). Given this vulnerability, it is necessary to take steps to prevent or reduce the potential for addiction or medication abuse among veterans who are prescribed long-term opioid treatment. Substance Abuse among U.S. Veterans: A Brief Retrospective Opioids came to be used in the treatment of chronic pain in cancer patients as a result of two WHO guidelines that were issued in 1985 and 1996 (Sullivan & Howe, 2013).

Eventually, the treatment was extended to chronic noncancer pain and suggested as a safe, non-addictive method of treating pain. However, this claim was extrapolated from short-term opioid treatment studies. The issue then becomes primarily about the lack of evidence to support the safe long-term use of opioids. Opioids carry a significant risk of addiction and an array of unpleasant side effects (Franklin, 2014). Further, opioids also complicate matters of mental health.

Opioids can relieve pain and produce a feeling of euphoria in patients. This physical relief could inadvertently soothe the psychological or emotional pain that a patient is experiencing. However, this leads to the patient doubly associating the opioid drug with both physical and psychological relief, potentially resulting in drug abuse and drug-seeking behavior. In this context, veterans’ health becomes a particularly complicated and layered issue to tackle. Many of them suffer from chronic pain because of injuries and exposure to hazards during their military career and often present with behavioral issues such as post-traumatic stress disorder or substance abuse disorder.

Veterans are seven times more likely to abuse prescription opioids than civilians (Snow & Wynn, 2018). Further, Newhouse states that opioid medications were prescribed to over 400,000 veterans for pain relief and that approximately 1.7 million opioid medications were prescribed to them in 2014 (as cited in Snow & Wynn, 2018), indicating that opioid treatments are quite widespread. Several institutes, including the American Osteopathic Academy of Addiction Medicine, the American Society of Addiction Medicine, and the American Academy of Neurology, have stated publicly that opioids present a significant challenge in the health care industry. These institutes encourage raising awareness of the adverse side effects of opioid treatments, the use of naloxone (an opioid antagonist), and proper procedure in case of an opioid overdose (The American Osteopathic Academy of Addiction Medicine, n.d.; American Society of Addiction Medicine, 2016; Franklin, 2014).

Given how widespread the prescription of opioids is among veterans suffering from chronic pain, it would be necessary to reevaluate the guidelines associated with prescription as well. Further, the primary problems associated with prescription opioids are the abuse of prescribed opioids and the transition from prescription opioids to black market drugs such as heroin (Kolodny, Courtwright, Hwang, Kreiner, Eadie, Clark, & Alexander, 2015; Snow & Wynn, 2018).

In 2007, the National Drug Intelligence Center of the U.S. Department of Justice estimated that a cumulative cost of approximately $200 billion resulted from direct and indirect drug use in the form of lost productivity, health care, and law enforcement (as cited in Crowley, Kirschner, Dunn, & Bornstein, 2017). Further, Ronan and Herzig note that the costs associated with opioid use disorder were approximately $15 billion in 2012 (as cited in Crowley et al., 2017). Rydell and Everingham and the National Institute for Drug Abuse state that money invested in preventing drug abuse and subsequent treatment would lead to substantial savings on a national level (as cited in Crowley et al., 2017). It is then necessary from an industry standpoint to revisit the guidelines associated with the issue of opioid prescriptions, given the significant costs associated with it.

The proposed policy addressed below consists primarily of two aspects: raising public awareness and encouraging interdepartmental communication and coordination.

Paper For Above instruction

The opioid epidemic remains one of the most pressing public health crises in the United States, with significant implications for vulnerable populations such as military veterans. Addressing this complex issue requires an integrated, evidence-based approach that combines policy reforms, education, and interprofessional collaboration to mitigate risks, promote safe usage, and improve overall health outcomes.

The first aspect of the proposed policy emphasizes the importance of raising public awareness about the risks associated with long-term opioid use. Effective communication campaigns can inform both healthcare providers and patients about the potential for addiction and adverse effects, especially in populations with preexisting mental health conditions. Formation of a multidisciplinary committee comprising pain management specialists, behavioral health experts, and senior nurses would oversee ongoing educational initiatives. These programs would focus on recognizing signs of misuse, understanding the physical and psychological risks, and emphasizing alternative pain management strategies. Teaching veterans and healthcare professionals to identify early warning signs of opioid misuse can prevent escalation to dependency and overdose, aligning with best practices endorsed by organizations such as the American Society of Addiction Medicine (2016).

The second component calls for a critical reassessment of prescribing guidelines, ensuring tailored, patient-centered approaches that account for individual mental health histories and behavioral risks. Regular mental health screenings, especially for high-risk populations like veterans, should be mandated. In practice, this would involve mandatory psychiatric evaluations for veterans prior to initiating long-term opioid therapy, and periodic follow-ups to monitor mental health status and potential signs of misuse. Incorporating psychiatric consultations fosters a holistic view of patient care, integrating physical and mental health management to reduce dependency risks (Sullivan & Howe, 2013).

Furthermore, the policy advocates for the mandatory use of naloxone, an opioid antagonist, to be made widely available to at-risk populations and their caregivers. Training healthcare providers and veterans on naloxone administration is vital to reduce overdose fatalities. The inclusion of human patient simulators for provider training ensures readiness for real-world overdose scenarios, aligning practice with the critical emergency response strategies recommended by the American Osteopathic Academy of Addiction Medicine (n.d.).

Interdepartmental collaboration is pivotal for ensuring seamless communication between agencies such as the Department of Veterans Affairs, state health departments, and federal agencies. Establishing a centralized database for tracking opioid prescriptions can alert providers to potential misuse or nonadherence, thus enabling timely intervention. Additionally, coordinated efforts can facilitate access to alternative pain management therapies, including physical therapy, psychological counseling, and non-opioid medications, which are integral to reducing reliance on opioids (Crowley, Kirschner, Dunn, & Bornstein, 2017).

Implementing this policy with transparency, consistency, and cultural competence will enhance the efficacy of interventions. The policy's success hinges on continuous evaluation through data collection and feedback mechanisms, allowing for modifications aligned with emerging evidence and population needs. Education efforts targeted at veterans should be culturally sensitive and accessible, considering possible barriers such as stigma and health literacy. Encouraging a collaborative, interprofessional approach can foster an environment where mental and physical health are addressed in tandem, ultimately leading to improved health outcomes and a reduction in opioid dependency among veterans and the broader population.

References

• American Osteopathic Academy of Addiction Medicine. (2016). Use of naloxone for the prevention of opioid overdose deaths. Retrieved from https://www.osteopathic.org/inside-aoa/about/advocacy/Documents/naloxone-policy-statement.pdf
• Crowley, R., Kirschner, N., Dunn, A. S., & Bornstein, S. S. (2017). Health and public policy to facilitate effective prevention and treatment of substance use disorders involving illicit and prescription drugs: An American College of Physicians position paper. Annals of Internal Medicine, 166(10), 733–736.
• Franklin, G. M. (2014). Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology. Neurology, 83(14), 1277–1284.
• Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559–574.
• Sullivan, M. D., & Howe, C. Q. (2013). Opioid therapy for chronic pain in the US: Promises and perils. Pain, 154(Suppl 1), S94–100.
• Sehgal, N., Colson, J., & Smith, H. S. (2013). Chronic pain treatment with opioid analgesics: Benefits versus harms of long-term therapy. Expert Review of Neurotherapeutics, 13(11), 1201–1220.
• Snow, R., & Wynn, S. T. (2018). Managing opioid use disorder and co-occurring posttraumatic stress disorder among veterans. Journal of Psychosocial Nursing and Mental Health Services, 56(6), 36–42.
• Rydell, P., & Everingham, S. (2015). The economic costs of opioid abuse. National Institute on Drug Abuse.
• Ronan, K., & Herzig, R. (2017). Economic analysis of opioid misuse: Cost implications and prevention strategies. Health Economics Review, 7(1), 12.
• American Society of Addiction Medicine. (2016). Use of naloxone for the prevention of opioid overdose deaths. Retrieved from https://www.asam.org/advocacy/public-policy-statements/naloxone-overdose-prevention