The Policy Making Process

Opioids are preferred for their effectiveness in reducing pain. However, they have a main side effect of addiction due to the high potential of abuses thereby making the users to replace the prescribed drugs with more lethal opioids with no accepted medical uses including heroin or illicit fentanyl (The Council of Economic Advisers, 2017). Data from the Center for Disease Control and Prevention indicated that the approximately 33,000 Americans died from Opioid use in 2015. A study in 2017 indicated that this number might be underestimated. It has been noted that over the last 15 years, the rate of opioid pain relievers has been on the rise. The Center for Disease Control and Prevention (CDC) notes that there has been an unprecedented increase in the opioids consumption that led to the worst drug overdose epidemic in the history of the nation. The magnitude of this problem contributed to CDC placing the opioid overdose prevention in the list of the top five public challenges (Kolodny, Courtwrigh, Hwang, Kreiner, Eadie, Clark, Alexander, 2015).

Overdose mortality is among the main effects of the increased use of opioid pain relievers. The increase in the opioid consumption has largely been connected with the sharp increase in emergency room visits, nonmedical use of opioid, and application of neonatal abstinence syndrome. An analysis of data has indicated that between 997 and 2011 there have been experienced a 900% increase in the individuals seeking treatment for addiction to the use of opioid pain relievers. There have been established a strong correlation between the sales level, opioid overdose deaths, and treatment for opioid addiction. These three elements have been increasing over time.

Addiction refers to the continued taking of a drug irrespective of the negative health outcome associated with the continued use. Opioids are highly addictive due to their property of inducing positive reinforcement and ending of chronic use causes dysphoria which is negative reinforcement. Continuous exposure to opioids causes structural and functional changes in the parts of the brain that mediate affect, impulse, reward, and motivation. Opioid addiction arises out of repeated exposure to opioids and may face both medical and nonmedical users. The problem of opioid addiction is worsened by its relationship to heroin use. A survey by the federal government on Drug Use and Health revealed that 4 out of 5 prevailing heroin users revealed that their opioid use was initiated through the use of opioid pain relievers mortality (Kolodny et al. 2015). A trend in this scenario is that people shift to heroin after becoming addicted to OPRs. The reason attributed to this was that heroine was less expensive in the black market compared to other opioids that were more expensive and more difficult to acquire. This has led to an increased prevalence of opioid addiction is said to be connected to the rise in heroin-related morbidity and mortality (Kolodny et al. 2015).

The economic cost of the opioid epidemic has concentrated mainly on the health care costs where is has been indicated that prescription opioid abuses use more healthcare resources in comparison to their peers with no addiction issues. Other additional costs that have been associated with the opioid epidemic include income foregone from employment and higher cost related to the criminal justice system. In 2013, the estimates cost for prescription opioid overdose, abuse, and dependence were approximately 78.5 billion. 73% of these costs were related to nonfatal consequences, such as healthcare spending, criminal justice costs, loss of productivity and incarceration (The Council of Economic Advisers, 2017). The other 27% was attributed to fatality costs.

Policy Analysis

A key bill that I would propose is the bipartisan bill by the Senate referred to as Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORTP for Patients Communities Act. This bill represents the effort of the Congress in the recent past to deal with epidemic. This Opioid Crisis Response Act of 2018 is an umbrella that covers over 50 legislative initiatives to deal with the opioid crisis. The expanding nature of the opioid epidemic is the United States implies that no short-termed solution can be effective in dealing with the problem and can rather be dealt with long-term solutions. The bill calls for collaboration and coordination of different organs’ effort within the federal, state, and local government level. The bill aims to enhance the capabilities of the Department of Health and Human Services with respect to the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration. The integration of these departments is expected to cause ripple effects in dealing with epidemic and assist the individual states in installing the updates to their plans of safe care, and enhance information sharing amongst different states.

The provisions in this bill covers aspects such as restriction of supply of all the restricted products for use, influencing the prescribing practices through different methods, reducing demand for the opioid by sensitizing the patients, and reduction of harm through provision of naloxone to the opioid overdoes and needle exchange program for those using injection drugs. Other provisions of the bill deal with the description of duties of different organs in the fight against the epidemic.

The National Institute of Health (NIH) is tasked with the responsibilities of carrying out research to find a new non-addictive pain relivers, and carrying out extensive research on pain and its management. The Food and Drug Administration (FDA) is tasked with the responsibilities of addressing any challenges with the new non-addictive medical products developed to manage pain through public meetings and providing guidance documents; using opioid packaging as a means to encourage prescribing behavior and minimize over-prescription; and the development of safe disposal mechanism to prevent the unused opioids from reaching to the wrong hands; enhancing coordination at the border with the Customs Border Protection; and clearly pointing out the post-market responsibilities of FDA. The Substance Abuse and Mental Health Services Administration (SAMHSA) under this Bill would be required to facilitate grant changes to fund the initiatives by states for fighting the opioid crisis, development of comprehensive opioid recovery facilities, promoting recovery housing best practices, enforcing the opioid prescription limits, training of first responders, youth prevention and recovery initiative, and facilitation of the continued care for drug overdose patients. The Centers for Disease Control and Prevention (CDC) in the Bill will be charged with the duties of carrying out operation to curb the epidemic in the states, localities and tribes, gathering data about controlled substances, public and provider education, carrying out public and provider awareness campaigns, prevention of infections related to injection drug use, and adverse childhood experiences data collection. Under this the bill, the Drug Enforcement Administration (DEA) carried out special registration for Telemedicine, oversee disposal of controlled substances by Hospice care leaders, enhancing the medication-assisted treatment, and delivering the controlled substance to administering practitioners.

Stakeholder Engagement and Education

In offering support for the bill and awareness on its provisions, there will be stakeholder meetings and workshops held at state level. These forums will bring on board different prime stakeholders in the opioid crisis. The agencies to be engaged from a federal level include DEA, White House Office of National Drug Control Policy, CDC, CMS, Department of Health and Human Services, Food and Drug Administration, NIH, SAMHSA. Another important category of stakeholders in this Bill making process are the professional associations whose interest may be high but with limited influence. These will include Consumers Union, National Associations of Boards of Pharmacy, America Pharmacist Association, Alliance of Community Health Plans, American Medical Association, American Academy of Family Physicians, Society of Hospital Medicine, American Academy of Pain Medicine, American Society of Addiction Medicine, Emergency medicine physicians, American Dental Association, Pharmacy Quality Alliance, The Joint Commission, State Hospital Associations and Medical Societies. Another category of stakeholders who will be engaged will be representatives from all states. It will also be essential to include the different individualistic health systems and health plans as they are mainly focused on identifying, monitoring and intervening with individual patients and working closely with the physicians to change prescribing practices and pan management strategies (Martin, Laderman, Hyatt & Krueger, 2016).

In the process of stakeholder engagement, it is important to first establish the types of engagement. This will be broken down into four classifications of engagement specific eight different types of engagement. The four classification of the engagement include role action, thinking, making decision, and creating. The eight types of stakeholder engagement, in order of increasing influence and commitment, will include; following instructions, offering reactions, identity impacts, self-generate input, provide advice advocacy, voting, owning the decision-making process, and being responsible for results and the implementation process (Anderson & Anderson, 2010).

Among the methods of engagement that would be used include; focus group where a group of stakeholders would engage in a discussion under the facilitation of a skilled moderator. This offers an opportunity to acquire information about preferences and opinions in a conducive environment. There will be the use of questionnaire to measure the level of opinion, beliefs and attitudes among individuals. It will be important to organize citizen juries that provides an opportunity for the members of the public to raise their opinion thus promote the spirit of deliberative democracy. Another important method to use to engage the stakeholders will be use of conferences and workshops on opioid crisis as the themes and allowing participants who also make up the audience to make presentations (O’Haire, McPheeters, Nakamoto, 2011).

Strategy and Policy Development

There is a need to include the communities in the discussion of developing a bill to manage the opioid crisis. Among the communities touched by the crisis and needs to be involved is the rural communities. The effect of this crisis to the community include ongoing health problems among addicts, increased rates of overdose fatalities, increase in risk of homelessness, and risks of incarceration. Other effects felt are the associated social problems. Involvement of the community will seek to establish a recommendation of the best approaches to be taken in dealing with the crisis. The community will also be an important point of the evaluation process since there may take part in different research initiatives

The legislators from both the Congress and the Senate are essential in the development and adoption of this bill. It is the role of the legislators to discuss the Bill and its provisions at the floor of the house and approve it for adoption. For this reason, it is important to sensitize them about the major implications of this policy. This will give them a deeper understanding on the intended impact of the bill and thereby garner support of approving the bill.

Policy Enactment and Evaluation

Among the federal level entities that will be engaged in implementing this policy include; DEA, White House Office of National Drug Control Policy, CDC, CMS, Department of Health and Human Services, Food and Drug Administration, NIH, SAMHSA. Other important entities who will be engaged in the implementation process for this policy are the physician and dentists making the prescription of the opioid who will need to abide by the rules stipulated under the provisions of this bill. They are expected to register the use of prescription drugs to the state.

In evaluating the effectiveness of the bill, data will be collected from different sources and will be used to establish whether the intended positive impact is being affected. The CDC will be an important source of data. This is mainly because the CDC is mandated to carry out research and gather data about the opioid epidemic. Another source of data for use in the monitoring process will be the prescription drug monitoring program that will seek to establish the trends in the prescription of opioids.

References

Anderson, L. A., & Anderson, D. (2010). Stakeholder Engagement: Opportunities, Types, and Vehicles. Change.

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, 559-574.

Martin, L., Laderman, M., Hyatt, J., & Krueger, J. Addressing the opioid crisis in the United States. IHI Innovation Report. Cambridge, MA: Institute for Healthcare Improvement; 2016.

O’Haire, C., McPheeters, M., Nakamoto, E., LaBrant, L., Most, C., Lee, K., … & Guise, J. M. (2011). Engaging stakeholders to identify and prioritize future research needs.

The Council of Economic Advisers. (2017). The Underestimated Cost of the Opioid Crisis . Executive Office of the President ot the United States of America.