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The West Virginia Opioid Crisis

The West Virginia opioid crisis has reached a dangerous level of seriousness within our communities in recent years. To understand this level of danger in an attempt to prevent and eradicate this epidemic an understanding of what opioids are, how they affect a person, how addiction begins, and how to recover from such addiction is crucial knowledge. This essay aims to define the West Virginia opioid crisis and its surrounding concerns such as overdose rates, strategies of recovery, treatment methods offered, and the effects of this epidemic on families and communities surrounding victims of addiction in an attempt to prevent and combat this crisis in the years to come.

Opioids include several prescribed and illicit drugs such as hydrocodone, oxycodone, and methadone, heroin, morphine, and fentanyl. Hydrocodone includes medications such as Lorcet, Lortab, and Vicodin that are commonly abused. Oxycodone features painkillers such as OxyContin, Percocet, and Percodan that are also commonly abused (Byrne, Lander, & Ferris, 2009). Opioids are highly addictive substances that are often prescribed for post-surgical pain and chronic pain, but many patients who begin taking these prescriptions are not thoroughly warned of their highly addictive nature.  Opioid addiction can be characterized by the inability to discontinue opiate use and a combination of physiological, behavioral and cognitive behavior with severe intensity in attempts to continue opiate use (Sharma, G., & Kaur, G. 2017). Addiction has a broad spectrum of substances such as alcohol, sex, shopping, and other drugs.

In 2017, research was conducted to reveal that health care providers in West Virginia wrote 81.3 opioid prescriptions for every 100 persons standing among the top ten rates for that year in the United States (National Institute on Drug Abuse, 2019). With more people being prescribed opioids in recent years, it should not be a surprise to our communities that the rate of addiction is rising each year as well. The increasing rates of persons being prescribed opioids have consequently caused these drugs to become increasingly popular in recent years because of their accessibility. Statistics have shown that illegal drugs, tobacco, alcohol, and steroid use in students in grades eight to twelve have decreased over recent years, while the misuse of prescription pain medications such as opioids has increasingly risen (Byrne et al., 2009). The rise of prescription pain killers has had a slow yet dangerous journey into the communities in the United States. Only 15 years ago people initiated the use of opioids over marijuana or cocaine, shedding a light on the steady growth of opioid use until now when an epidemic has swept the country.

As research continues to apprehend a cause of the large number of opioid abusers in the country, many have concluded that other disorders such as mental illness can be correlated to addiction. A number of disorders such as depression, anxiety, post-traumatic stress disorder, and externalizing conditions can be found within patients who are also suffering from substance abuse (Nadai, Little, Mccabe, & Schepis, 2019). With this knowledge, we can begin to understand the trail that leads to addiction in an attempt to prevent a person from consequently becoming an addict due to these circumstances. Many times, a person suffering from chronic mental or physical illness can turn to destructive coping mechanisms. Medical professionals are also a culprit in the cause of these characteristics within persons, as many patients suffering from these illnesses are prescribed addictive substances such as opioids in the name of treatment. The idea that medical professionals are over-prescribing patients has been addressed by multiple researchers.

When examining opioid prescribing data over the last 20 years, there is more than enough evidence to show that medical care providers, specifically surgeons, regularly overprescribe opioids to patients. From 1999 to 2008, the sales of prescription opioids were four times higher than in prior years, which was directly correlated with an increase in opioid-related deaths during the same period. A study done by the Center of Disease Control and Prevention in 2015 showed that there were enough opioids prescribed within that year to medicate every US adult with five milligrams of hydrocodone every four hours for three weeks. (Theisen, Jacobs, Macleod, & Davies, 2018). This study alone identifies the lack of understanding within the medical field of how to appropriately treat patients with acute or severe pain. Medical professionals have a bad habit of overprescribing pain medications “just in case,” due to the difficulty of filling another prescription for opioids and other Schedule II substances. Overprescribing within the medical field can be attributed to at least some, if not many, of the consequent addictions formed within the United States.

The Center for Disease Control and Prevention (2019) found that in 2017 over 70,000 people died from a drug overdose, with 68% of those overdoses involving a prescription or illicit opioid. As more illicit opioids are flooded into the street market, overdoses increase. Opioids such as heroin and fentanyl that are not tested or regulated can have varying potencies that stage a higher risk of overdosing from a smaller amount of the drug. The rate of overdoses in the United States has increased by 27.9% from 2015 to 2016 (Seth et al., 2018). The West Virginia opioid crisis attributes to a large number of these overdoses. West Virginia had a drug overdose death rate of 52 per 100,000 in 2015, which can be characterized as 250% more than the national rate of deaths attributed to drug overdoses, and West Virginia has stood as the highest opioid overdose death rate in the US since 2010. (Warfield, Pollini, Stokes, & Bossarte, 2019). An estimated 2.5 million people are addicted to opioids in the United States (Nguyen & Salinger, 2018). Examining the rates of overdoses within the state is an effective way to fully grasp the large number of West Virginia residents that are currently addicts. Although not every addict has overdosed, therefore we can assume that these numbers are even less than the actual number of victims suffering from addiction.

Recovery is an important stage that addicts hopefully reach within their addiction before an overdose occurs. Many steps within the recovery process are important in becoming sober and staying sober including detox, treatment, and abstinence. Facilities and programs designed for recovery are few and far between in West Virginia, which is a serious problem in our attempt to combat the epidemic. With the number of addicts in our state, there should be a facility for recovery on every corner, but there are only six inpatient facilities located throughout the state of West Virginia (Warfield et al., 2019). Primarily due to insufficient funding, only seventeen counties in West Virginia offer a harm-reduction program, leaving thirty-eight counties without access to services associated with addiction (Pollini, 2019). There are many different treatment methods associated with opioid drug abuse. Medication-assisted treatment includes methadone, buprenorphine and naltrexone, while other treatment plans include 12-step programs, psychosocial interventions, and residential rehabilitation treatment facilities (Nadia et al., 2019). Each of these methods are used to promote opioid abstinence, improve coping mechanisms within addicts, and treat lasting trauma associated with addiction. Treatment facilities and programs can highly impact the rate of recovery. Unfortunately, there is a large deficit in these services and a refusal by policymakers to support these treatment programs due to insufficient funding and stigma associated with lack of empathy and understanding (Pollini, 2019).

Social support is also a large factor in the effectiveness of these treatment options.  Self-help groups such as Alcoholics Anonymous (AA) meetings are a very beneficial tool in the recovery process (Levine, Perkins, & Perkins, 2005, p.333). Many addicts may feel alone in their struggle to become sober, and without a support system such as a family or close group of friends, it can become even harder to begin to recover from addiction. Self-help groups offer a group of people who are struggling with the same problems that an addict may be facing. These meetings can include sharing stories in exchange for support and encouragement, knowledge of coping mechanisms, and the promotion of positive mental health during stressful times. Rewards and celebrations also may be offered for a consecutive amount of time being sober, such as the tokens AA gives out after each month of sobriety. Positive reinforcers such as these are important due to the long process of opioid recovery that often involves increased physical, emotional, legal, financial, and social stress (Borsari & Read, 2019). Social support offered by family, friends, or self-help groups offer a positive alliance with an addict and their recovery process to encourage higher chances of lasting sobriety.

The stigma attached to addicted persons also take a role in the lack of support from surrounding persons. Many debate that drug addiction is a choice, therefore sympathy for a victim of addiction is not granted. This stigma lowers public support for programs focused toward drug-abuse, decreases access to helpful services, and negatively affects the recovery of addicts. (Nguyen et al., 2018) It only takes trying an illicit drug such as opioids one time to become addicted, and a majority of addicts never intended for their drug abuse to escalate so quickly and to impact their lives so heavily. The treatment of addiction as a chronic disease rather than a crime can positively impact the epidemic by promoting awareness and support. Stigmatizing these victims only increases the complexity of these epidemic-related obstacles.

The prevention of opioid abuse is very important in combatting the epidemic now and in the years to come. Prescription drug monitoring programs and other medication-assisted programs have made a positive impact on the opioid crisis, but there is much more to be done in attempts to end the massive opioid epidemic (Strand & Eukel, 2019). There has been struggles in applying effective prevention methods within the medical system due to the lack of information on how to identify the predisposed conditions and behaviors of an individual at risk of addiction. The Opioid Risk Tool (ORT) is a tool used by medical professionals to measure patients prescribed an opioid prescription for opioid misuse, and by using this tool in a population of those on chronic pain medication and individuals who have been exposed to opioid medications, pharmacists have identified a large group of patients who are at an elevated risk of opioid abuse (Webster & Webster, 2005). Tools such as the ORT are an effective way of identifying individuals at risk and warning them of the addictive nature of opioids so that prevention can take place.

Identifying addictive tendencies within the family of an individual is also an effective way of applying prevention before an addiction occurs due to the common occurrence of addiction running from generation to generation. Additive personalities can be identified from an early age by behavior such obsessive and compulsive tendencies, and individuals who present such behavior are at a much higher risk of becoming addicts. The appearance of mental health issues early in life may also point to an individual increased risk of addiction later in life. Studies that were previously discussed show the prevalence of mental disorders in correlation to drug addiction, therefore the identification of these individuals at an early stage of life may save them from resorting to destructive tendencies such as drug abuse when they are presented with stressful life events.

Drug addiction has multiple lasting effects on the family and friends surrounding a victim of substance abuse including feelings of guilt, shame, constant fear and worrying, resentment, mental-health issues, and the repercussions of witnessing traumatic experiences. It can be very destructive to a household when one or more persons within it become deviant in this manner. Often times, the adequate help needed for a victim of drug addiction cannot be provided by the family, therefore the household may blame themselves for the downfall of the victim. Many families experience the tragic loss of a family member due to overdose. An estimated 13.7 million people are living in a household with someone who received or is receiving treatment for drug abuse (Levine, Perkins, & Perkins, 2005, p. 23). Often times, treatment is needed for the people surrounding an addict due to the trauma that can occur when dealing with addiction. Families of addicts can attend self-help groups specifically for persons surrounding victims of drug abuse for comfort and encouragement during these stressful times.

The West Virginia opioid epidemic has also affected many communities negatively. West Virginia’s reputation as a beautiful mountain state has been heavily tainted by the sweeping epidemic. Parks, rivers, and other areas of community growth are littered by hypodermic needles and other drug paraphernalia. Physical environment has a large effect on the well-being of persons within that environment. Many factors can negatively affect an environment, such as the stressors and health of the individuals present (Levine, Perkins, & Perkins, 2005, p. 177-178). The streets of West Virginia are filled with persons who are blatantly under the influence, and this often poses a danger to the surrounding community. The stigma surrounding the opioid crisis in West Virginia has had a lasting effect on the tourism and economy of this state and is negatively impacting the expansion of services that will combat the opioid crisis (Pollini, 2019). An end to this epidemic is crucial in the near future, and the lack of effort by legislature and medical professionals within the state is highly concerning in this attempt. The victims of addiction in West Virginia are in need of our legislators, policy makers, and medical professionals to initiate a singular focus on the eradication of this opioid crisis in the name of our community. Without a sudden change in the approach to this epidemic, West Virginia may not survive the detrimental effects it will continue to make.

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