Primary Prevention of Opioid Use Disorder Essay

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My project is focused on the primary prevention of opioid use disorder in Hispanic/Latino patients with limited English proficiency (LEP). As discussed in previous weeks, one of the main risk factors associated with the misuse of opioids for my select population is a lack of access to appropriate care. One evidence based behavior change that would promote health in my selected population would be regular visits to a primary care doctor for preventive care visits (Dept. of Health and Human Services, 2017). Establishing a relationship with a provider during times of wellness allows for clinical rapport and trust to be built; as well as providing an opportunity for education, screening, and early intervention of health issues (American Academy of Family Practice, 2019). In the context of substance abuse prevention, it is essential that chronic pain, depression, anxiety, domestic violence, and substance use be identified early on and treated with appropriate intervention. Primary Prevention of Opioid Use Disorder Essay

One specific culturally sensitive, evidence-based, measurable intervention that could address the health problem for my selected population would be to implement a care coordination program that offers culturally competent, trauma informed care by healthcare professionals that have the linguistic capacity to provide education, screening, brief intervention and referral at an appropriate literacy and health literacy level. The Institute of Medicine (IOM) has identified care coordination as a key strategy to increase the efficacy, safety, and efficiency of today’s complex healthcare system (AHRQ, 2018). Care coordination allows for the identification of patient’s needs as well as their preferences. It provides a platform for additional education, patient advocacy, and intervention while strategically communicating with stakeholders in the patient’s care team (AHRQ, 2018). Care coordination programs can be broad or developed to meet the needs of a specific population; in this case our Hispanic/Latinos with LEP. Measurable outcomes would be how many patients are participants in the care coordination program, number and type of screenings completed, number of positive screenings, number of positive screenings provided with appropriate brief intervention and referral, number of patients linked to primary care preventive services, and number of patients educated on risks associated with opioid use. Primary Prevention of Opioid Use Disorder Essay

Once the intervention of providing a culturally competent and linguistically appropriate care coordination program to our LEP patients is in place, I would expect to see an increase in preventive care visits, an increase in identification of conditions that could place the patient at risk of substance abuse such as depression, anxiety, or untreated chronic pain, and an increase in education including opioid medication indications, risks, benefits, proper administration, and proper disposal. By providing a platform for these patients to receive additional education, screening, and early intervention in a language they understand, we can decrease the impact of risk factors associated with opioid misuse; leading to a healthier community overall.

Question 2:

Research shows that within the homeless population one of the key factors that can promote health with Hepatitis A is improving access to the Hepatitis A vaccine. One way to accomplish the tasked is by promoting education by encouraging the importance of the vaccine. Having a public health nurse outreach to the homeless shelter to offer to counsel and to give information regarding Hepatitis A. The nurse will be able to build report within the community so that the members can feel supported and safe to converse with the nurse. Once a relationship has been created with the nurse and the patients, it is easier to provide education as well as care. Primary Prevention of Opioid Use Disorder Essay

Having a public health nurse going to the homeless shelter twice a week opens many aspects. One of the aspects can help combat Hepatitis through the promotion of proper hand washing for the children of the community through fun classes by the nurse. Classes for the adult population would focus ‘For persons at-risk or infected with hepatitis A through unprotected sexual contact, timely referrals for comprehensive sexual health-related services can assist in preventing cases of other sexually transmitted diseases, including HIV,” Per CDC. Which can improve outcomes and help to find additional support for that homeless shelter.

In conclusion, outgoing outreach is key in improving awareness of hepatitis A within the homeless population. This is what I noticed where there is a need for in the homeless community. Using an evidence-based strategy that has proven to work in the previous community is ideal for research and for fieldwork.

This policy brief explores the U.S. opioid epidemic and advocates for a broader role
for health education in prevention strategies to stem the tide of opioid-related
deaths in the United States. Declared a public health emergency in 2017, the opioid
crisis continues to inflict a damaging mental and physical toll on those addicted;
impacts the lives of children and family members of those affected; negatively
impacts the economy by weakening the workforce; places additional burdens on
the healthcare, criminal justice, and social welfare systems; and challenges the
health of communities. Much of the focus on addressing the opioid epidemic has
centered on initiatives to prevent opioid overdoses, expand addiction treatment
and curtail the availability of illegal and counterfeit opioids. Despite these efforts,
greater measures must be taken to prevent opioid misuse that leads to addiction.
The goal of this policy brief is to illustrate the role of health education specialists
(those who educate people about behaviors that promote wellness) in addressing
the opioid crisis. This brief will outline the role of health education specialists in
coordinated actions and interventions that include one or multiple strategies:
curtail opioid overdose; provide recovery resources to both health providers and
opioid users; and advocate for health policies that improve the health of children,
families, communities, and the economy that are all negatively impacted by the
opioid crisis Primary Prevention of Opioid Use Disorder Essay

BREAKING DOWN THE OPIOID EPIDEMIC: A PREVENTABLE PUBLIC HEALTH
EMERGENCY
Opioid refers broadly to a class of chemicals that inhibit pain receptors in the brain, spinal cord, and digestive
tract that function to reduce the effects of pain. This includes heroin, a highly addictive, illegal substance,
fentanyl, hydrocodone (e.g., Vicodin®), oxycodone (e.g., OxyContin®, Percocet®), methadone and morphine
(CDC, 2017b-c). In addition to relieving pain, opioids provide a feeling of euphoria, making them increasingly
addictive (CDC, 2017b). Repeated use of opioids may lead to opioid tolerance such that a higher dose of the
drug is needed to achieve the same effects. For this reason, the risk for developing dependence is high and the
rate of progression to opioid dependence is far shorter than other classes of drugs (Ridenour et al., 2006;
Volkow, N., & McLellan, A., 2016; Wagner & Anthony, 2002;). As opioid users increase their dosage or progress
to more powerful forms of opiates, their likelihood of overdose and death increases (Mars et al., 2014;
SAMHSA, 2018a).

NOW

Unlike some other forms of addiction, which may be concentrated within population segments, the opioid crisis
affects individuals across all socioeconomic demographics. Where one lives is a determinant of both health status
and health outcomes, and this does not exclude risk for opioid drug dependence. Those who are addicted to
opioids are both young and old, living in both urban and rural environments, and span racial and ethnic groups
(Overdose Lifeline, 2017). However, the population most likely to be affected by opioid dependence are white
men and women, aged 50-54, without a college degree (Social Capital Project, 2017). Opioids are often
misused due to pain, injury, trauma, despair, and age.
While the number of opioid prescriptions has increased over the previous two decades, policies to detect and
prevent opioid abuse have been inconsistent, if not altogether absent in many states and localities. The rise in
opioid prescriptions coupled with inconsistent oversight have dire consequences. Opioid-related deaths have
quadrupled since 1999, doubling in the decade ending in 2015 (WONDER, 2017). In 2016, an estimated 66
percent (42,249 people) of more than 63,600 drug overdose deaths involved opioid use. Problems
associated with opioid misuse – spanning the spectrum from prescription overdose, illegal opioid use, to the
comorbidities associated with opioid misuse – are multi-faceted, evolving, and difficult to solve. In a time when
opioid overdoses and deaths are climbing year after year, high-quality health education by trained health
education specialists is critical to prevent any further opioid addiction and misuse. Primary Prevention of Opioid Use Disorder Essay
OVERVIEW OF OPIOIDS, OVERDOSE, AND OPIOID USE DISORDER (OUD)
THE ESSENTIALS TO UNDERSTANDING OPIOIDS
There are three main types of opioids:
1) Natural opiates, such as morphine, codeine, and thebaine;
2) Semi-synthetic, such as hydromorphone, hydrocodone, oxycodone, and heroin; and
3) Fully synthetic (synthetic), such as fentanyl, pethidine, levorphanol, methadone, tramadol, and
dextropropoxyphene.

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PRESCRIPTION OPIOIDS
Prescription opioids are necessary and appropriate to treat
moderate-to-severe pain and are often prescribed when there
is a medical need for pain relief, including after surgery or
injury, or for pain management with other health conditions such
as cancer. Yet, prescriber behavior has changed noticeably in
the last 40 years to include prescribing opioids for the
treatment of chronic pain, despite the lack of evidence
regarding the long-term effectiveness of opioids for chronic
pain relief (CDC, 2017d). This has resulted in physicians
prescribing opioids more often, for longer durations and at
higher doses than ever before, thereby increasing the risk of
addiction, overdose, and opioid-related mortality. Additionally,
this prescribing behavior has negatively impacted the doctorpatient relationship as patients feel misled with the care
received (CDC, 2017c; King et al., 2014). Primary Prevention of Opioid Use Disorder Essay
In addition to the use of prescription opioids for medical use,
there is potential for misuse of prescription opioids through
legal and illicit means, including: prescription from one or more
physicians or stolen from a health care provider, given, bought,
or stolen from a friend or relative, acquired from a drug dealer
or some other method (SAMHSA, 2017a). In 2016 alone, 11.5
million people misused prescription opioids with 2.1 million people misusing prescription opioids for the first time
(Kochenak, 2017). Additionally, with the exception of marijuana, prescription opioids are the most abused illicit
drug in the United States. According to the 2016 National Survey on Drug Use and Health (NSDUH), 3.3 million
people aged 12 years or older were current misusers of prescription opioids (SAMHSA, 2017a). Altogether, the
medical consequences of prescription opioid misuse are detrimental, considering the potential for addiction,
overdose and other side effects (CDC, 2017c).
POTENTIAL SIDE EFFECTS OF OPIOIDS
• Tolerance (taking more of the medication for the same pain relief)
• Physical dependence (symptoms of withdrawal when the medication is stopped)
• Increased sensitivity to pain
• Constipation
• Nausea, vomiting, and dry mouth
• Sleepiness and dizziness
• Confusion
• Depression
• Low levels of testosterone that can result in lower sex drive, energy, and strength
• Itching and sweating
SOURCE: NATIONAL INSTITUTE ON DRUG ABUSE
Figure 1: Source of Misused Prescription Painkillers

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HEROIN
Heroin is an illegal, highly addictive
opioid made from morphine, a natural
substance derived from opium poppy
plants. Heroin it can be a white or brown
powder, or a black sticky substance
known as black tar heroin (NIH, 2018).
There are multiple ways to use heroin,
including injecting, sniffing, snorting, or
smoking. Like other opioids, heroin influences the brain by binding to and activating specific pleasure receptors.
Heroin affects the user’s heart rate, sleeping, and breathing. Heroin is perceived to be a cheaper, more readily
available alternative to prescription opioids (Lankenau et al., 2012). Primary Prevention of Opioid Use Disorder Essay
Prescription opioid misuse is a risk factor for initiating heroin use, albeit at a low rate (Compton, Jones, &
Baldwin, 2016; Muhuri, 2013). Multiple research projects are exploring the trajectory from opioids to other
types of drugs, and/or methods of use among people aged 30 years and under to better understand
progression from prescription opioids to heroin or cocaine. (Compton et al., 2016; Lankenau et al., 2012).
FENTANYL (PHARMACEUTICAL AND ILLICIT)
Fentanyl is a synthetic opioid with effects that mimic morphine. However, fentanyl may be 50 to 100 times more
potent than morphine (DEA, 2017). Although pharmaceutical grade fentanyl is prescribed to treat severe pain
(typically advanced cancer pain), the current, dangerous trend of fentanyl abuse and related overdose is
primarily fueled by illicit use of the substance.
Illicitly-manufactured fentanyl (IMF) is sold alone or may be mixed with heroin or other substances like cocaine to
mimic pharmaceutical drugs like oxycodone (DEA, 2017). Both IMF and
heroin have become increasingly available in the illicit U.S. drug market
and continue to be mass produced (DEA, 2017; Pezalla, Rosen, Erensen,
Haddox, & Mayne, 2017). Because fentanyl is 30 to 50 times more
potent than heroin, IMF that is adulterated, or “cut,” with other substances
can be deadly. In addition, there are no standard dosages of IMF or
illicit fentanyl-related compounds. According to the Drug Enforcement
Administration (DEA), two milligrams of fentanyl, equivalent to a few
grains of table salt, is considered a fatal dose for more than 95 percent
of the American public. Both the high potency and potential for high
dosage of IMF accelerates the epidemic of opioid-related mortality and further hinders abilities to curb illicit
opioids (DEA, 2017).
OPIOID OVERDOSE DEATHS
Deaths from opioid overdose (i.e. using enough of a drug to produce a life-threatening reaction and sometimes
death) have never been higher than they are today (Hedegaard, 2017). Since the opioid epidemic affects a
broad demographic, opioid overdose deaths continue to increase among men and women, all races, and adults
across the lifespan (2017). The potential for abuse of prescription opioids, heroin, and fentanyl are similar in
that the risk of overdose rises as users build a tolerance to the effects of the drugs and begin to seek higher
SOURCE: DEA SOURCE: DEA
SOURCE: DEA

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doses and/or stronger forms of opioids to achieve the euphoric effects. Inevitably, opioid-dependent individuals
experience withdrawal symptoms (e.g. negative mood, sweating, abdominal cramps, and nausea/vomiting)
during prolonged abstinence (Chang, 2007). To avoid or alleviate these withdrawal symptoms, many opioiddependent individuals continue to use opioids, despite the serious health consequences associated with this
behavior (2007). Primary Prevention of Opioid Use Disorder Essay
Figure 2 shows the top three substances contributing to the rise in opioid overdose deaths over the last few
decades.
OPIOID USE DISORDER (OUD)
Given the highly
addictive nature of
opioids, they are
regulated as controlled
substances (DEA,
2016). The use of
opioids may lead to
the development of
opioid use disorder
(OUD), a primary type
of substance abuse
disorder, which as
defined by the
Diagnostic and
Statistical Manual of
Mental Disorders (DSM5), includes both illicit
and prescribed opioids
(SAMHSA, 2018b). A
substance use disorder
occurs with the
recurrent use of alcohol and/or drugs causing clinically and functionally significant impairment. Furthermore, OUD
diagnosis is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria
(2018b). Symptoms of OUD include the following:
A strong desire for opioids, inability to control or reduce use, continued use despite interference with
major obligations or social functioning, use of larger amounts over time, development of tolerance,
spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after
stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and
insomnia. (SAMHSA, 2018b).
Figure 2: 3 Waves of the Rise in Opioid Overdose Deaths

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COMORBIDITIES & THE COST TO SOCIETY
INFECTIOUS DISEASE
Comorbidities are exacerbated by the opioid crisis, including incidence of Hepatitis B and C, HIV, and other
diseases caused by injecting drugs with infected needles. In addition to risk for addiction and overdose, injection
drug users (IDUs) face the risk of contracting or transmitting viral infections through blood or bodily fluids.
Disease transmission is problematic for both IDUs and the public. Contact with these fluids may easily occur when
people inject opioids and share needles or other drug equipment or have unprotected sex with an infected
partner (NIDA, 2018). Primary Prevention of Opioid Use Disorder Essay
Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are viral infections that cause inflammation of the liver, which
can lead to cirrhosis and result in the loss of liver function altogether. Infection is most likely to spread via sharing
needles and other drug equipment (NIDA, 2018). While increased incidence of Hepatitis infections are extremely
concerning, public health concerns are highest for HIV/AIDS (Human Immunodeficiency Virus and Acquired
Immune Deficiency Syndrome), as these conditions limit and, in progressed cases, terminate the body’s ability to
fight off infection and disease (2018).
To illustrate the magnitude of comorbidities associated with
opioid abuse and addiction, see the map to the right
depicting a 2015 event when the rural town of Austin, Indiana
faced HIV and Hepatitis C outbreaks associated with IDU
(Campo-Flores & McKay, 2016). Indiana’s Austin county (as
well as multiple others marked in red) faced common
situations in which its ‘vulnerabilities,’ including high
unemployment rates, opioid-related overdose deaths, and
illegal use of prescription opioids were exposed which
resulted in heightened susceptibility and instances of HIV and
HVC outbreaks.
Another related issue is that as the opioid crisis amplifies in
mortality and morbidity, its costs reverberate into the
community and economy. In 2015, the estimated cost of the
epidemic was $504 billion (Council of Economic Advisers, 2017). A contributing cost includes opioid-related care,
which continues to burden the capacity of the medical community, including responders and resources to care for
this influx of patients. In 2014 alone, the rate of unintentional, opioid-related poisonings resulted in 53,000
hospitalizations and an estimated 92,262 emergency department (ED) visits. As the rate of these hospital-related
treatments rise, communities are increasingly challenged to keep up with this surge (CDC, 2017a).

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TOLL ON YOUTH & FAMILIES Primary Prevention of Opioid Use Disorder Essay
The national toll of the opioid crisis is evident not only in incidence of infectious
disease, but also in the impact on the health and safety of children, their
families, and the communities in which they live. In fact, opioid misuse and
abuse has many additional repercussions on society, including but not limited to
increases in crime, violence, and disruptions in family, workplace, and
educational environments (NIDA, 2018).
One prominent issue is maternal opioid use and the incidence of opioid
withdrawal syndrome in newborns caused by exposure to opioids, otherwise
known as neonatal abstinence syndrome (NAS), which accounts for the majority
of in utero opioid exposure incidences (Ko, Patrick, Tong, Patel, Lind, &
Barfield, 2016). To detect NAS, the following symptoms may be identified: central nervous system irritability
(e.g., tremors, increased muscle tone, high-pitched crying, and seizures), gastrointestinal dysfunction (e.g., feeding
difficulties), and temperature instability (Hudak, 2012). Postnatal opioid withdrawal is caused due to a variety
of reasons for opioid use, which range from maternal prescription opioid use, nonmedical opioid use, or
medication-assisted treatment (Hudak, 2012; Ko et al., 2016). According to available state data, the incidence
of NAS has skyrocketed (383 percent) between 2000 and 2012– in other words, every 25 minutes a baby is
born suffering from opioid withdrawal (Ko et al., 2016; NIDA, 2015).
It is estimated that 8.7 million children have a parent with a substance
abuse disorder. This home environment can cause children to endure
stressful or traumatic events, otherwise known as adverse childhood
experiences (ACEs), which may last into adulthood (Lipari & Van Horn,
2017). The 1998 ACE Study by Kaiser Permanente and CDC yielded
considerable results in understanding children in families with substance
abuse disorders and drew a powerful correlation between ACEs and its
effect into adulthood (Felitti et al., 1998). This research is important today,
as it aids the nation in addressing the opioid crisis with primary prevention
strategies, as well as screening tools to detect children in need, offering
those children the support they need and the ability to achieve resilience
that otherwise may not be possible (Felitti et al., 1998; Blanch, 2017).
According to Smith and Wilson (2016), primary care physicians or
pediatricians are essential to identify and assess risk in the context of the
parent’s opioid addiction and can therefore intervene to protect the child.
Additionally, schools are a key point of contact for screening as they have
the unique opportunity to connect with families and children who may be at risk, and lessen the impact of ACEs
(Blanch, 2017).
In sum, the task of protecting children in families suffering with opioid addiction begins with prevention and
requires early screening intervention (Blanch, 2017; Felitti et al., 1998; Smith & Wilson, 2016). For reference, the
American Academy of Pediatrics (AAP) has outlined an approach to ‘heal’ children and families suffering from
opioid addiction through: A) establishing policies that prioritize prevention so that these families can remain
together during treatment, B) supplying providers with tools and resources to recognize and assist children and
Babies born exposed to
opioids experience: Primary Prevention of Opioid Use Disorder Essay
• lower birthweight
• respiratory conditions
feeding difficulties
• seizure
• longer hospital stay
Source: NIDA, 2015
Early childhood adversity due
to a parent/caregiver who uses
opioids may range in social,
emotional, physical and
mental health challenges and
lead to:
• multigenerational cycles
of child abuse, neglect
and substance use
• school failure
• increased risk for costly,
preventable diseases like
obesity and heart disease
Source: Lipari & Van Horn, 2017

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their parents affected by trauma to give them the best chance for lifelong health, and C) equipping these
families with knowledge and access to prevention education, treatment services and Medicaid (AAP, n.d.).
TREATMENT FOR OPIOD USE DISORDER & OVERDOSE
In the instance of opioid overdose, harm reduction is the best choice to mitigate the effects of opioids and
prevent death. The CDC (2017a) suggests it is crucial to expand access to evidence-based treatments, including
medication-assisted therapy (MAT) and naloxone (Narcan®).
MEDICATION-ASSISTED TREATMENT (MAT)
Medication-assisted treatment (MAT), an approach that combines medication (methadone, buprenorphine, or
naltrexone) with counseling and behavioral therapies, is effective in treating OUD and preventing repeated
overdose. There is a common misconception associated with MAT; that it is not safe and that it is simply
substituting one drug for another. However, these medications are shown to relieve the withdrawal symptoms and
psychological cravings (effects of opioids) that cause chemical imbalances in the body (SAMHSA, 2018a). Primary Prevention of Opioid Use Disorder Essay
NALOXONE
Naloxone is a medication known as an “opioid antagonist” that is administered via intramuscular, intravenous, or
intranasal routes and acts to block the effects of opioids. This medication can reverse an overdose within minutes
and can be life-saving (SAMHSA, 2018). Sold under brand name Narcan®, among others, this medication is
Food and Drug Administration (FDA)-approved for the immediate treatment of a known or suspected overdose
caused by opioids and can be used on men, women, children, pregnant women, and the elderly. In the instance
of an overdose emergency, naloxone kits are administered by law enforcement agencies, fire departments, first
responders, departments of health, local school districts, colleges and universities, community-based organizations
and are priority for the following populations:
• People who have an immediate, medical need due to overdosing (*greatest need)
• People in treatment or who have recently completed treatment
• People who use and/or are prescribed opioids
• People recently released from jail or prison
• Family members/loved ones of those using opioids
• Law enforcement
RESPONSE OF STATE & FEDERAL LEADERS: IDENTIFYING THE GAPS &
OPPORTUNITIES FOR HEALTH EDUCATION
SUMMARY OF FEDERAL-LEVEL INITIATIVES
The United States has the highest opioid-related death rate in the world, having increased by 140 percent since
2000, with American citizens consuming more opioids than any other country (Rudd, 2016). In response to the
opioid epidemic, the U.S. government has proposed multiple approaches to decrease opioid related deaths.
SAMHSA, CDC, and NIH have all recommended that additional research and access to harm reduction and
treatment be expanded throughout states. Although the epidemic has received the attention of these government
agencies, targeted strategies based in health education are lacking. Looking ahead, this leaves an opportunity Primary Prevention of Opioid Use Disorder Essay

ORDER NOW

Society for Public Health Education | A Nation in Crisis: A Health Education Approach to Preventing Opioid Addiction |10
for health education advocates to recommend that these key stakeholders adapt strong platforms to include
prevention and health education. A brief synopsis of this work follows.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis
The President’s Commission on Combating Drug Addiction and the Opioid Crisis was established through an
executive order on March 29, 2017 to analyze ways to control and treat individuals affected by drug abuse,
addiction, and the opioid crisis (President’s Commission, 2017). The Commission recommends: a mass media
public education campaign on opioids; proper drug disposal and take-back programs (medication boxes),
expanding Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs in schools, changing opioid
prescribing practices, improving data collection, and protecting first responders against highly lethal substances
often combined with opioids. The report also discusses the prospect for federal drug courts in all 93 federal
judicial districts, expanding the use of recovery coaches in hard-hit areas, increasing naloxone training, and for
HHS to create guidelines for recovery support services. The commission also recommends block grant federal
funding for states to work on opioid-related activities, and for the White House Office of National Drug Control
Policy (ONDCP) to establish a system of tracking and accountability for federal-funded activities related to the
opioid crisis. Additionally, the commission offers a variety of programming (President’s Commission, 2017).
In June 2018, the Youth Opioid Prevention Campaign, a partnership of ONDCP, the Truth Initiative, and the Ad
Council, was launched with the purpose of preventing and reducing opioid misuse among youth and young adults,
with a target audience of ages 18 – 24 years and a halo audience of ages 15 – 30 years (President’s
Commission, 2017). Primary Prevention of Opioid Use Disorder Essay
STRATEGIES OF FEDERAL HEALTH AGENCIES
1) The U.S. Department of Health and Human Services (HHS) recommends a 5-point strategy, including:
• Better addiction, prevention, treatment, and recovery services
• Better data
• Better pain management
• Better targeting of overdose reversing drugs
• Better research
2) The National Institutes of Health (NIH), a component of HHS, recommends key strategies for
pharmaceutical companies and academic research centers to discuss:
• Safe, effective, non-addictive strategies to manage chronic pain
• New, innovative medications and technologies to treat opioid use disorders
• Improved overdose prevention and reversal interventions to save lives and support recovery
In 2018, NIH director, Francis S. Collins, M.D., Ph.D. launched the HEAL (Helping to End Addiction Longterm) Initiative to address scientific solutions that span the agency.
3) The Substance Abuse and Mental Health Services Administration (SAMHSA) focuses its efforts on reducing
the impact of mental illness and substance abuse, and in light of the opioid crisis, has amplified its work in:
• Releasing an Opioid Overdose Prevention Toolkit (2018)
• Awarding grants to 50 states, territories, and pacific jurisdictions; the agency has also dedicated funds to
elements of opioid prevention, treatment and recovery, such as: training for MAT, naloxone, pregnant and
postpartum women, first responders and treatment providers (SAMHSA, 2017b)
4) The Centers for Disease Control and Prevention (CDC) focuses on:

Society for Public Health Education | A Nation in Crisis: A Health Education Approach to Preventing Opioid Addiction |11
• Providing states with resources and strategies for improved data collection (see Prescription Drug
Monitoring Programs) Primary Prevention of Opioid Use Disorder Essay
• Collecting and analyzing data on opioid-related overdoses
• Supporting healthcare providers and health systems with data, tools, and guidance; recommendations for
clinicians to improve communications and outcomes between providers and patients is in the Guideline for
Prescribing Opioids for Chronic Pain (Dowell, Haegerich, & Chou, 2016)
• Partnering with public safety officials, including law enforcement
• Raising awareness on consumer safety of prescription opioids
The Surgeon General’s Spotlight on Opioids Report
The Surgeon General, Dr. Jerome A. Adams, issued a report in September of 2018 emphasizing the opioid crisis
and the support required across multiple sectors to end this epidemic (HHS, 2018). The unique ties and resources
that health education specialists have with individuals and their communities were highlighted as vital
opportunities to improve prevention, patient access, and treatment efforts for this epidemic (2018). Health
education specialists can also play a role by developing curricula to educate students on substance use
prevention, which has been identified as an effective component of school-based strategies. Education is a
critical component of harm reduction strategies, which can utilize health education
specialists to organize outreach and education programs as well as provide overdose
prevention education. The Surgeon General also calls on health education specialists to
teach up-to-date information on substance abuse disorder as a medical condition,
implement evidence-based prevention programs and interventions, provide support in
both treatment and recovery, and improve the training of all health care professionals
(HHS, 2018).
SUMMARY OF STATE-LEVEL INITIATIVES
Currently, state-level initiatives focus on secondary intervention, i.e., mandated state-based prescription drug
monitoring programs (PDMPs), naloxone distribution programs, and medication-assisted treatment (MAT) (Pezalla
et al., 2017). A synopsis of PDMP objectives and effectiveness follows.

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Prescription Drug Monitoring Programs (PDMPs)
A PDMP is an electronic database that tracks controlled substance
prescriptions in a state to assure safe prescribing and patient behaviors. Primary Prevention of Opioid Use Disorder Essay
State-based PDMPs allow physicians and other prescribers the ability to
access clinical information about a patient to make better informed treatment
decisions, and ultimately help identify patients at risk of opioid addiction or overdose (CDC, 2017d). Although
the shortfall of PDMPs is that they overlook a major contributor to the opioid epidemic, the control of illicit
opioids, PDMPs are critical to preventing overprescribing and misuse of opioids (Haffajee, Jena, & Weiner,
2015).
In 2017 there were 51 PDMPs in all states except Missouri, plus the District of Columbia
and Territory of Guam (Alexander, Frattaroli, & Gielen, 2015). One barrier to using
PDMPs is that physicians find the process of retrieving information needed from the
database too time consuming or difficult. Optimization of PDMPs, therefore, requires that
states mandate prescriber use of PDMPs to consistently monitor data for treating patients
(PDMP COE, 2014). Some successful comprehensive mandate programs include:*
Kentucky – the first state to mandate comprehensive PDMP use in 2012. Opioid prescriptions decreased by
8.6% the first year after the mandate law was in effect (Warner, Chen, Makuc, Anderson, & Miniño, 2011).
Tennessee – Mandated in 2012, Tennessee saw a 75% drop in patients’ seeing multiple prescribers for the same
drugs in one year (PDMP COE, 2014).
New York – From the mandate going into effect in 2012, the number of patients’ seeing multiple prescribers for
the same drugs decreased 36% in 2013 (PDMP COE, 2014).
SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION

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*Following each mandate, all three states increased PDMP registration, increased use of PDMP by prescribers,
(approximately 10,000 percent in New York), and decreased opioid prescribing, ‘doctor shopping’ for
additional prescriptions, and prescription overdose hospitalizations (heroin treatment admissions rose during the
study period) (PDMP COE, 2014). Primary Prevention of Opioid Use Disorder Essay
Per Alexander, Frattaroli, & Gielen (2015), the recommended actions to achieve comprehensive use of PDMPs
include: A) mandate prescriber PDMP use, B) proactively use PDMP data for enforcement and education
purposes, C) authorize third-party payers to access PDMP data with proper protections, and D) empower
licensing boards for health professions and law enforcement to investigate high-risk prescribers and dispensers.
Massachusetts state legislation, Chapter 55 of the Acts of 2015, gave the Massachusetts Department of Public
Health the ability to collect data to help epidemiologists generate more distinct estimates of trends and the
prevalence of OUD (Bharel, 2019). In doing so, this allows more targeted program interventions and precise
methods to reach individuals most affected by this disease. Barocas et al. analyzed the data from the
Massachusetts databases, where researchers discovered the prevalence of OUD in Massachusetts was 4.60
percent in 2015, which is nearly four times higher than current national prevalence estimates. This shows the
national average is likely underestimated and that states should provide detailed data sets to enable more
accurate prevalence estimates.
In addition to actively using PDMP throughout the United States, since 2015 many states have implemented an
opioid tax. New York, Massachusetts, Pennsylvania, Connecticut, Kentucky, Minnesota, California, and
Washington are among the first states to implement said tax. Many state proposals are intended to finance
treatment or prevention programs (Brill, 2018).
CURRENT & PROPOSED FUNDING
Nearly $4 billion was allocated to address the worsening opioid epidemic in the FY 2018 omnibus, the
largest investment to date – however, these funds are lacking a focus on primary intervention.
The highlights of funding for public health programs include: (H.R. 1625, 2018)
• $1.4 billion to SAMSHA
• $500 million for the NIH for more opioid addiction research
• $350 million to the CDC for opioid overdose prevention, surveillance, and state-based PDMPs Primary Prevention of Opioid Use Disorder Essay
• $415 million for the Health Resources and Services Administration (HRSA) to, among other efforts, improve access
to addiction treatment in rural and other underserved areas
• $100 million to the Administration for Children and Families to help children whose parents misuse drugs
• An additional $299.5 million to the Department of Justice’s (DOJ) anti-opioid grant funding
• An additional $500 million to the Department of Veterans Affairs for mental health programs
State-level public health efforts depend on increased federal funding and grant awards to support ongoing
efforts in their communities.

Society for Public Health Education | A Nation in Crisis: A Health Education Approach to Preventing Opioid Addiction |14
Related Legislation & Funding
The Energy and Commerce Committee has steered multiple pieces of legislation to fund key opioid prevention
initiatives, as well as address other policy recommendations for federal agencies. Key pieces of legislation
include, the Comprehensive Addiction and Recovery Act of 2016, as well as the committee’s work in mediating
other bills for consideration (House Committee on Energy & Commerce, 2018).
COMPREHENSIVE ADDICTION AND RECOVERY ACT OF 2016 (CARA)
The Comprehensive Addiction and Recovery Act of 2016 (CARA) (P.L. 114-198) was signed into law on July 22,
2016 (S.524, 2016). CARA includes a wide variety of measures to combat the opioid epidemic: prevention,
treatment, recovery, grant funding, law enforcement, and criminal justice (ASAM, 2016). CARA expands the
availability of Naloxone® to law enforcement and first responders. It also improves PDMPs to help eliminate
loop-holes in opioid prescriptions. The law works on improving treatment options within the incarcerated
population and guides these individuals along a road to recovery before they are released (S.524, 2016). The
law reduces the number of opioids that are available through prescription (requiring only partial refills for
patients rather than full refills); provides grants for physicians to prescribe reversal medications to opioid users,
safe care plans for addicted babies, and programs for veteran opioid users; creates a new Comprehensive
Opioid Abuse Grant Program, advances in VA opioid management and care, and a study on the Good
Samaritan laws (ASAM, 2016). There are also components of the law that address health education: (S.524,
2016) Primary Prevention of Opioid Use Disorder Essay
• Campaigns to increase education and awareness of opioids for the general public.
• Community-Based Coalition Enhancement Grants to address local drug crises to create prevention
strategies in heavily affected areas.
• Informational materials for parents of youth who may have to take opioids after a sports injury.
21ST CENTURY CURES ACT (“CURES”)
The 21st Century Cures Act (P.L. 114-146) was signed into law on December 13, 2016. Goals of this act include
priorities to update and advance the discovery, development, and delivery of new cures and treatments. Text of
the act outlines projects and state responses to address opioid abuse, including funding for the NIH Innovation
Projects Precision Medicine Initiative (PMI) and Brain Research through Advancing Innovative Neurotechnologies®
(BRAIN) Initiative. Both initiatives are historic efforts that aim to gather data from over a million Americans to
gain a deeper understanding of how individual differences such as lifestyle, environment and biology impact
health (NIH, 2017). Funding will also be appropriated to the FDA to meet the activities outlined in the text, and
funding for HHS grants to states to address the opioid abuse crisis (H.R.34, 2016).
POLICY RECOMMENDATIONS: A CASE FOR HEALTH EDUCATION SPECIALISTS
HOW CAN HEALTH EDUCATION PREVENT OPIOID ADDICTION?
Every day, more than 115 people die from opioid overdose (WONDER, 2017). To understand the opioid crisis
and curb opioid-related morbidity and mortality, health education specialists, public health partners, community
members and their stakeholders must engage in a comprehensive effort to apply health education strategies
(prevention and harm reduction) across all levels of intervention. When working together, all players may better
understand how the crisis began, evolved, and continues to transcend county lines – this is the health education
approach to prevent opioid addiction and ending this epidemic (Chaney, n.d.). Primary Prevention of Opioid Use Disorder Essay

Society for Public Health Education | A Nation in Crisis: A Health Education Approach to Preventing Opioid Addiction |15
Science, Engineering, and Medicine developed a framework of prevention that operationalizes a
multidisciplinary approach, paired with a strategy aimed towards high-risk populations. This framework is
intended for both clinical and community levels, which is categorized in three ways: 1) Universal Interventions:
clinical guidelines of prescribing opioids and recommendations for evidenced-based pain reduction alternatives,
and broad strategies to increase community resilience, quality education, stable housing, sustainable
employment, and justice reform, 2) Selective Interventions: tailoring responses to specific subpopulations and
communities who are at greater risk for drug misuse and addiction, and 3) Indicated Interventions: identify
individuals who are in the early stages of addiction, this requires the engagement of community partners in
mental health, law enforcement, social services, and the medical community (Springer & Phillips, 2007). The
opioid crisis must be viewed as both a clinical and public health crisis in order to properly deploy primary
prevention interventions. Primary Prevention of Opioid Use Disorder Essay

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