The Effects of the Opioid Crisis on Long Island

The Effects of the Opioid Crisis on Long Island Acute and Chronic Pain are serious health conditions that affect a significant proportion of the population. These disorders are usually treated with pain relievers. Acute pain tends to resolve with time without the need to administer strong medications. However, chronic pain persists for a longer period necessitating the use of more effective alternatives. Arthritis and cancer are some of the primary conditions in which individuals experience chronic pain. Studies show that many patients presenting with chronic pain do not respond to common pain relievers.

Clinicians are, thus, forced to prescribe stronger pain relievers to address the health needs of the chronically ill.

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Findings from randomized controlled trials and other health resources have revealed that opioid analgesics are more effective in the management of chronic pain than common pain relievers (Phillips et al., 2017). Professionals have consequently integrated opioid analgesics into treatment plans for those with chronic pain. This move has led to an increase in the rate at which opioid analgesics are prescribed. For instance, data from various health resources show that in 2016 alone, over 60 million people presenting with various forms of chronic pain had at least one prescription for opioid-based pain relievers (Hagemeier, 2018). This number was significantly high considering the country has embraced stringent measures to curb unnecessary prescription of opioids.

Although the use of opioid analgesics has been widely accepted in the treatment of chronic pain, the effectiveness of long-term use of these agents is questionable. Studies have linked continued opioid use to addiction and overdose deaths. Guidelines for prescribing opioids have, subsequently, been developed to enable clinicians and other prescribing officers to be part of the initiatives to avert the crisis. Regrettably, the opioid crisis has progressed to an almost uncontrollable level. The addictive nature of these drugs causes many people to continue using them, even in situations where they are not needed.

Overprescribing and misuse have contributed to the development of the opioid epidemic not only in the United States but also in different parts of the world. The health impact and economic burdens of opioid overuse on individuals, families, and society are well established at the national, state, and local levels. In New York State, for instance, Long Island has been recognized as one of the regions struggling with the opioid crisis. This paper will look at the effects of the opioid crisis on Long Island. Statistics together with the strategies used to manage

this crisis will be addressed. Further, pharmacy restrictions and other potentially effective solutions to this problem will be investigated.

The Opioid Crisis Description and Origin The opioid crisis is the phenomenon typified by an increase in the rate at which opioid medications are prescribed leading to widespread misuse and overdose of both the prescribed pharmacological agents and non-prescription opioids. This crisis evolved into 3 major phases.

The first phase started in the 1990s and continued through 2010. This phase of the crisis was characterized by excessive use of prescribed opioids in the treatment of painful conditions.

During this period, the guidelines for opioid prescription were lax. Furthermore, only a few insurance companies were providing medical cover for chronic pain and other chronic conditions. The prevalence of chronic pain had increased significantly in the 1990s due to obesity, increased survivorship rates following injury and cancer, increased complexity of surgical operations, and greater expectations for pain relief. Pharmaceutical companies realized that this was a golden opportunity to market various opioid products for use in chronic pain management. The move to extensively market opioid analgesics transformed chronic pain into big business (Dasgupta, Beletsky & Ciccarone, 2018). This move was further fueled by the widespread withdrawal of non-opioid analgesics due to their perceived cardiovascular side effects. These factors have doubtlessly sustained a steady rise in the consumption of opioid analgesics over the last three decades. The CDC (2020) noted that the highest rate of dispensed opioid prescriptions in the U.S was attained in 2012. In this year, more than 255 million prescriptions were made at the rate of 81 prescriptions per 100 persons.

The second phase of the crisis, which started around 2010, was characterized by growing concern over the potential health effects of long-term use of opioids analgesics. Professionals noted that although heroin use had remained relatively stable for a long time, it spiked in 2010.

Overdose related deaths were also rising at an alarming rate at the time. Most of those who were using prescription opioids shifted to cheaper alternatives complicating the mater even further.

Consequently, policy developers engaged in the development and implementation of strict regulations on prescribed opioids to bring the crisis to a halt. During this phase, some of the commonly misused prescription drugs were reformulated (Maclean, Mallatt, Ruhm & Simon, 2020). Researchers and health professionals realized that opioid analgesics were highly addictive hence initiated measures to curb further rampant prescribing.

The third phase of the crisis, which started in late 2013 and continues to date, involved a shift to synthetic opioids along with continued enforcement of strict measures to curb the crisis.

Unfortunately, these policies created the base for increased production of counterfeit opioids (Dasgupta, Beletsky & Ciccarone, 2018). The number of death attributable to counterfeit opioids skyrocketed in the United States between 2013 and 2016. Significant regional increases in opioid-related death rates were also reported during this period. The speedy acceleration of the crisis contributed to its description as a national public health problem. Addiction treatment and harm reduction policies were developed and implemented across the continuum to help resolve the crisis (Maclean, Mallatt, Ruhm & Simon, 2020).

Despite these measures have the potential to completely eradicate the opioid crisis, state departments of health have continued to report alarming cases of opioid poisoning. Long Island is one of the regions with a significantly high opioid poisoning spatial cluster (Schoenfeld et al., 2019). Studies show that almost all counties in Long Island have persistently recorded a high rate

of opioid overdose and opioid-related deaths. Drug overdose in New York State rates has increased by approximately 32.4% from 2015 to 2019 (Schoenfeld et al., 2019). Large scale analysis of opioid poisoning related visits revealed that New York City had lower hospital visits that several scattered high-risk regions including Long Island.

Risk Factors for Opioid Crisis Findings from epidemiological studies have identified a variety of factors that increase the risk of opioid abuse not only in Long Island but also in other regions across New York. A major risk factor for opioid use disorder is age. A report by McGraw (2020) noted that women below 65 years of age have a higher propensity to unintentionally overdose opioids than other demographic groups. This variation is attributed to the smaller body size of women as compared to men, as well as their smaller body mass. Apart from age, the race has also been shown to contribute to an increased risk of opioid misuse. Black men, who are advanced in age, are more likely to abuse opioids than their Caucasian counterparts (McGraw, 2020). On the contrary, young white men present with a higher likelihood of abusing opioids than young black men.

Intuitive connections have been made between poor health and socioeconomic factors such as poverty, poor working conditions, and minimal opportunities. Individuals from poor socioeconomic backgrounds suffer disproportionately from chronic pain and other devastating condition that necessitate prescription with opioids (Dasgupta, Beletsky & Ciccarone, 2018).

Social Impact of Opioid Crisis The opioid crisis has had a devastating social impact on the people of Long Island and other parts of New York State. One of the social implications of the crisis is the mistrust of pharmaceutical companies. In the 1990s, pharmaceutical companies engaged in extensive marketing of opioids while promising people that these drugs would not result in addiction.

However, within two decades the devastating consequences of opioid addiction, abuse, and misuse have left many people shattered. Schoenfeld et al., (2019) pointed out that inappropriate use of opioids have led to distress, impairment, and interpersonal problems.

In Long Island and other counties in New York, for instance, opioid abuse has contributed to the death of many people. Families have also been disintegrated due to this epidemic. Members of society tend to dissociate with individuals presenting with a prescription opioid addiction since it is considered a form of substance abuse. Many people do not recognize opioid addiction as a serious health issue that should be addressed promptly. The government has, however, recognized Opioid addiction as a national crisis whose ripple effect on families and children can last for years. Brundage and Levine (2019) pointed out that even if this problem were to be stopped today, it would still impart damage to individuals into the future. This statement is supported by researchers who have further argued that the social implications of the opioid epidemic will take years to correct (Schoenfeld et al., 2019). For instance, reports indicate that children born of parents addicted to opioids experience severe withdrawal symptoms.

Opioid addiction also leads to stigmatization. Society classifies individuals, who develop an addiction to prescription opioids as substance and drug abusers. However, this may not be the case since opioid addiction occurs due to the continued use of prescription pain management medications (Donroe, Socias & Marshall, 2018). Stigma can potentially damage the self-esteem of a person, negatively affect relationships, and hinder those suffering from addiction to seek medical attention. The public does not support substitution therapies, needle exchange programs, and other interventions intended to avert the crisis. Most people believe that these interventions encourage drug use despite evidence showing that they are effective against opioid abuse.

The Health Impact of the Crisis

The health burden related to the opioid crisis has been deteriorating at a disturbing rate.

Consequently, the opioid issue has become a huge concern in the realm of healthcare management, policy, and guidelines. Statistical data from various health resources have painted a grim picture of the opioid burden in Long Island and the entire United States. Haegerich, Jones, Cote, Robinson, and Ross (2019) noted that the opioid crisis has continued to grow irrespective of the strict regulations on prescription opioids. Although health data indicates that opioid prescribing has been on a decline over the last decade, the number of opioid prescriptions dispensed by retail pharmacies is still significantly high (Haegerich, Jones, Cote, Robinson & Ross, 2019). Data shows that the U.S has over the years been experiencing a rise in the number of people visiting the emergency room with opioid poisoning. In Long Island, for instance, statistics show that between 2005 and 2015, the region experienced about a 99% increase in opioid poisoning-related emergencies (Schoenfeld et al., 2019).

Deaths caused by opioid overdose are also high across the state. Reports show that the prevalence of opioid overdose-related death is greater than deaths related to other prescription medications. In 2017, over 17,209 persons died due to opioid overdose in the whole country (Haegerich, Jones, Cote, Robinson & Ross, 2019). On the other hand, it is estimated that in 2018, more than 128 people were dying every day due to opioid addiction and misuse (Maclean, Mallatt, Ruhm & Simon, 2020). In Long Island, as reported by The Fiscal Policy Institute (2019), approximately 3,224 people died in 2017 due to opioid overdose-related complications.

These deaths accounted for approximately 20% of all opioid overdose deaths that occurred in New York that year. This was an increase of about 1543 cases from the 1,681 reported in 2013.

Suffolk County has been identified as one of the worst-hit areas. It is estimated that over 70% of opioid-related death in New York State occurred in this county within the last two years (Fiscal

Policy Institute, 2019). This data has caused Long Island to be identified as one of the high-risk areas in New York State.

Opioid poisoning related deaths are the tip of the iceberg in regards to the total health complications from opioids. Intravenous administration of opioids is a major cause of infections and subsequent hospitalizations. Drug users are increasingly being diagnosed with infections, including methicillin-resistant Staphylococcus aureus. Surveillance data from the CDC’s emerging infections program 2005-2016, as reported by Yadava et al. (2020), revealed that individuals who inject drugs are 16 times more likely to develop infections. In a crucial opioid crisis report, the CDC noted that data on hospitalization due to IV drug use related infections is minimal. A lack of sufficient data makes it hard to determine the exact impact of the opioid epidemic on hospitals Some studies have, however, reported that in the united states, the number of patients hospitalized with IV use infections increased from 301,707 to 6535 between 2002 and 2012 (Yadava et al., 2020).

Economic Crisis The U.S has a significant history relating to the economic implications of the opioid crisis. The total economic burden of this crisis in 2018 was estimated at $500 billion (Maclean, Mallatt, Ruhm & Simon, 2020). Economic studies show that the opioid crisis is fueled by a combination of supply and demand factors. Economic researchers make it clear that despite strict regulations that can potentially address the opioid crisis; their impact is minimal on the root causes of the crisis (Maclean, Mallatt, Ruhm & Simon, 2020). In most cases, strict regulations result in spillover effects typified by the excessive use of other, more harmful substances that are obtained illegally from markets where regulations are less stringent.

Long Island has been persistently experiencing a devastating economic blow due to the opioid crisis. In 2017, for instance, it is estimated that Long Island experienced economic damage of $8.2 billion (Fiscal Policy Institute, 2019). This was approximately 4.5% of Long Island’s GDP. This indicates that the extent of the damage was remarkably high. The Fiscal Policy Institute (2019) also reported that in 2017, Long Island was experiencing economic losses of about $22.4 million every day. Despite this was a drop from $22.7 million in losses in 2016, the losses were still massive.

Although not all people in the region have directly experienced the opioid crisis, residents of Long Island pay for this disaster in one way or another (Fiscal Policy Institute (2019).

Taxpayers, businesses, and consumers are all involved either directly or indirectly in paying for this disaster. Businesses have recorded massive losses due to devastating opioid-related effects.

The opioid epidemic has led to increased healthcare costs for businesses along with decreased productivity. Data shows that individuals within the productive age bracket between 25 and 45 form the largest proportion of those struggling with opioid addiction. Individuals within this bracket use these drugs even in situations where chronic pain has not been diagnosed. The number of deaths related to opioid overdose is also highest in this population. Health data show that approximately 14.2 young persons in every 100,000 die of opioid overdose-related cases. In the entire state of New York, 1,440 young people died due to opioid overdose between 2013 and 2015. This data is disturbing considering opioid poisoning was presumed to be a declining health issue (Yadava et al., 2020). Any disaster targeting the youth has devastating implications on local, state, and national economies.

Albeit poor young people from Long Island and other regions are disproportionately affected by the crisis, people from all backgrounds may also be at risk because of the over-

prescription of these drugs. Statistics have revealed a dramatic increase in the rate of opioid overdose deaths across all ages (Fiscal Policy Institute, 2019). More people are dying from opioid complications regardless of age yet a decrease in the overall share of all opioid deaths has been reported.

Current Management Interventions for the Crisis Due to the worsening opioid endemic in the U.S and the increasing cases of opioidrelated deaths in recent years, federal, state, and local governments have identified combating this problem as a major priority. The New York Department of Health, for instance, has recommended a range of strategic measures to cripple the crisis to its core. These strategies include collecting relevant health data and conducting extensive investigations to better understand the crisis. Analysis of patient-level opioid-related visits to the hospitals is considered a major source of data concerning opioid poisoning (Chen et al. 2018). New York State has, thus, employed a patient to patient based approach to address this problem. The Statewide Planning and Research Cooperative System facilitates the collection of patient-level data on opioid poisoning (Chen et al. 2018). This system is also used in Long Island to achieve similar health objectives. Researchers and policymakers use data from this system to develop measures that can potentially tackle the crisis.

Stringent Pharmacy restrictions have been developed to assist in curbing the opioid scourge. The regulations by the New York State Department of Health (2020) make it clear that initial opioid prescribing should not exceed seven days. This implies that physicians are mandated to prescribe less than a seven-day supply of opioid medications for acute pain. Acute pain refers to any form of pain emanating from diseases, trauma, accidents, or other causes. The 7-day supply regulation is intended to minimize the risk of prolonged use of opioids which

places an individual at the risk of addiction. If acute pain does not revert within seven days, the physician may assess the patient are issue any appropriate renewal, refill or order a new prescription for an opioid analgesic per the existing rules and regulations (New York State Department of Health, 2020).

The Good Samaritan Law has also been passed as a means of addressing the rampant opioid overdose deaths in New York State. People who experience an overdose of any form of medication, have permission to call for emergency help without fear of arrest. This law ensures that emergency medical care is provided to overdose cases subsequently averting the risk of death. The law protects both the person who has overdosed and reports a potential case of overdose regardless of age.

The Bureau of Narcotic Enforcement (BNE) has also been established to enhance public protection by combating the illicit use of prescription controlled substances. The bureau plays an essential role in providing prescriptions to prescribing officers across the state (New York State DoH, 2020). Furthermore, the BNE engages in monitoring and regulation activities for all controlled substances through issuing licenses for all entities that deal with these substances.

Some of the entities that fall under the supervision of BNE are researchers, hospitals, nursing homes, manufacturers, and distributors (New York State DoH, 2020). BNE investigates all suspected cases of opioids diversion, including theft and forgery as well as inappropriate hospital visits. This initiative has brought to an end the era during which physicians wrote down prescriptions on a piece of paper and pulled out bottles of narcotics from cabinets for their patients. Investigators work closely with law enforcement officers at all levels to ensure strict compliance with all prescription opioids rules and regulations. The bureau is also involved in the provision of educational materials to sensitize people to the benefits and potential health

complications of opioid medications. Educational materials are provided to healthcare professionals, educators, and parents.

Health records show that stringent pharmacy regulations are paying off. For instance, opioid prescriptions in Long Island have dropped by over 30% from approximately 1.4 million in 2011 to below 900, 000 (Phillips et al., 2017). The numbers of deaths related to the crisis are also on a decline. However, the anticipated health objectives are far from accomplishment.

Challenges to the Fight against Opioid Crisis The opioid epidemic is one of the serious issues facing the U.S health systems today. All healthcare stakeholders including nurses, physicians, patients, communities, pharmaceutical companies, and distributors have joined forces to identify the best way to handle the crisis. The American Nurses Association, for instance, has developed several helpful resources highlighting best practices to avert the opioid problem. Unfortunately, several factors are threatening to hamper the progress made in addressing the opioid crisis. Carroll, Marshall, Rich, and Green (2017) noted that access to illicit opiates in the region has proven to be a significant hurdle in the fight against opioid use disorder. Some individuals, who develop an addiction to opiates, opt for illicit substances rather than seeking the necessary health assistance. The people, who either use or are exposed to illicit opiates, prefer to keep the whole issue secretive instead of informing authorities for further action. To make matters worse the at-risk population comprises mostly of young, unemployed, and uninsured persons. Therefore, this group is highly unlikely to seek treatment, which they presume to be costly and non-effective (McGraw, 2020).

Another challenge is that the balance between prescription opioid guidelines, opioid abuse disorder, and the health needs of the patients have not been attained. Most of the policies, as highlighted by Hoffman, Terashima, and McCarty (2019), are focused on restricting the use of

opioid agents than supporting the health needs of clients for effective pain medications. In some cases, physicians are faced with critical cases of patients presenting with chronic debilitating pain. In such scenarios, professionals have limited choices other than administering the high effective opioid analgesics.

Limited knowledge of the health effects of opiates on individuals has also contributed to the opioid crisis. Young people use opioid substances for recreational purposes without considering the potential dangers of this practice. To overcome this challenge, providers are required to conduct an extensive assessment of their clients’ health for more understanding and implementation of a practical treatment plan (Hoffman, Terashima & McCarty, 2019).

Individuals, at risk of opioid addiction, are referred to reputable treatment and rehabilitation programs. This intervention is followed by verbal education and implementation of relevant policies.

Proposed Solutions Although the opioid crisis appears to have gotten out of hand, several evidence-based tactics can be employed to address this issue. These practices include restricting the supply of opioid analgesics. This strategy involves regulating the opioid-based substances used in pain management as well as abuse-deterrent medications (Phillips et al., 2017). Another practical strategy is to influence prescribing practices. Influence can be achieved through prescriber education, together with the issuance of prescribing guidelines. Demand reduction can also potentially avert the opioid crisis.

Demand reduction can be achieved through patient education on opioids and opioid use disorder (OUD). Education helps to increase knowledge and access to treatment for the opioid used disorder. Physicians provide their clients with relevant information concerning opioid use

disorder to enhance their ability to make rational decisions (McGraw, 2020). Clients who are informed of their likelihood to abuse or overdose opioids feel motivated to carry on and maintain addiction treatment.

Harm reduction is also a strategic way of tackling the opioid crisis. Individuals presenting with OUD are given naloxone to avoid an opioid overdose. People at risk of OUD are also included in needle exchange programs for further assistance on how to improve their health and avoid injection drugs-related complications (Phillips et al., 2017).

Opiate addiction treatment is also a potentially effective intervention that has been applied in Long Island to assist in the fight against the opioid crisis. Numerous rehabilitation and recovery programs have been set up in the region. These programs employ a detox approach to enable individuals struggling with addiction to recover fully (Clark, 2017). During the detoxification process, individuals are encouraged to avoid further use of the substances to allow the body to sufficiently eliminate the remnants of the toxic compounds before treatment recommences. Unfortunately, the process can result in withdrawal symptoms. Some of the symptoms are so severe that they can cause the death of a person (Qureshi et al., 2020).

Conclusion Opioid abuse has been recognized as a health crisis in the United States. Consequently, rigorous measures, including the development of opioid prescribing rules and regulations, prescriber education, and harm reduction policies have been implemented to curb the community health threat. Regrettably, opioid addiction and opioid overdose have turned out to be major contributors to unintentional injury and death of many people in Long Island and other parts of

the United States. Increased prescribing of opioid medications has led to a rise in the prevalence of unintentional exposure to these substances. Federal, state and local governments have implemented measures to address the opioid crisis at all levels. These interventions are aimed at stemming the rising related morbidity and mortality. Unfortunately, opioid poisoning has deeply rooted effects on society that might take years to address. Excessive prescribing is the biggest risk factor for opioid use disorder. Other risk factors include lax policies, non-compliance with prescription guidelines, and access to illicit opiates. An understanding of the opioid poisoning risk factors is essential for healthcare professionals and policymakers to develop targeted overdose prevention and treatment interventions for their clients.

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