Currently, the state of Massachusetts is faced with the challenge of dealing with the prevalence of opioid-related overdose and fatalities. This phenomenon may mainly be attributed to the complex interaction that surrounds the pain management and the resultant opioid use disorders or opiate addiction. The advent of this deliberation may be associated to the fact clinicians are often in a dilemma especially in the application of chronic opioid therapy (COT) and the interactions with substance use disorders (SUDs) (Kaasalainen et al., 2007). Moreover, studies propose behavioral symptomatology of chronic pain and addiction are interrelated such that if one disorder is left untreated, the efficacy of treatment in the other is virtually impossible. In essence, the incomplete comprehension this unique interaction coupled with the inadequate management of both conditions culminated in the under-treatment of pain and premature discharge of SUD patients from pain treatment. Consequently, in a bid to realize optimal physical functionality and pain relief, both conditions ought to be considered for treatment (Oliver et al., 2012). The proper management of pain in the population of patients with SUDs is critical since poor administration may result in dire consequences such as compromised medical care, relapse to addiction and the likelihood of grace toxicity as a result of mistaken tolerance or drug addictions (Coulter, 2011). The stigma that is associated with addiction also serves to compound on the pain management techniques to be applied to the faction of patients with SUDs. This occurrence may lead to the discontented interaction between an addict and the healthcare system. Consequently, pain management through the use of opioids raises more questions than answers in the sense that no single solution exists for opioid addiction. In the long run, this predicament has culminated in the disproportionate impact of the opiate epidemic in hospitals, communities and certain residents.
Mapping the Issue
Cultural Beliefs and Biases in Opiate Addiction
Conventionally, opioid analgesics have been widely considered as the ideal solution in pain management modalities in the American society. This phenomenon may be evidenced by the escalation of opioid prescription for the Massachusetts populace with an increment at the rate of 7 percent per annum since the turn of the millennium. In 2015 alone, approximately one in six residents in the state received an opioid prescription with the majority of the individuals averaging three filled prescriptions (Chapman, Kaatz & Carnes, 2013). Additionally, opiate addiction is perhaps the most prevalent drug use disorder in the US as characterized by high rates of drug-related overdoses and admissions into health facilities that are beneficiaries of public funding. When one takes into account the specific substances, non-medical prescription opioid uses demonstrates the highest rate of surge amongst individuals with who are seeking treatment while heroin users are most likely to be admitted into treatment programs. Thus, heroin addiction has predominantly served as the inference for the development of interventions aimed at addressing the issue of opioid dependence where methadone helps as the primary treatment pharmacological intervention. Nonetheless, the proliferation of prescription opioid use has added dynamism to regarding profiling individuals who require treatment and its related options. This occurrence prompted the enactment of the Drug Addiction Treatment Act of 2000 sanctioned an office-based intervention using buprenorphine. As a result, clinicians are now able to prescribe an opioid-based treatment for a patient who is opioid dependent in the standard practice setting (Lawrence et al., 2013). Methadone treatment necessitates the need of a specially licensed program for its administration where daily attendance and monitoring is mandatory during treatment initiation. On the other hand, the availability of buprenorphine presents patients with the option of self-administration through prescriptions which have significantly contributed to the opiate addiction and drug-seeking behaviors.
Social Roles in Opiate Addiction
Despite the fact that the theory of addiction has historically been fixated on individual factors such as biological and cognitive models, contemporary research indicates that social factors also play a significant role. The advent of problematic opiate use may be predominantly attributed to peer influences and nature of family relations which create normative effects on behavioral patterns. Conflicts which may arise within households are likely to augment stress levels prompting individuals to opt for substance use as a scapegoat (Kreek et al., 2012). Additionally, stressors are likely to emanate from diverse environmental factor. For example, children who are drawn from families with a history of substance use or have been subjected to some form of physical and psychological abuse are at a higher risk of developing an opiate addiction. Additionally, the peer domain comprises of an individuals social group including the areas in which one meets up with friends. A researcher at the University of Utah conducted a study which climaxed with the conclusion that peers and friends who use opiates illicitly are the single most significant contributors to the development of SUDs (Volkow, Koob & McLellan, 2016). Further, the findings indicated that peer groups might play a substantial role in an individuals development where such factions may serve as stand-in families for persons lacking in cohesive and stabilized biological families thus proving the potential destructiveness of peer groups characterized with SUDs.
Social Inequalities in Opiate Addiction
The demographics of the state of Massachusetts illustrates a disproportionate balance in addiction problems in the sense that in individuals drawn from a low socio-economic status tend to be more affected than any other group. This implies that families drawn from poor backgrounds fall victims to opiate addiction as a result of factors such as limited access healthcare, employment or lack of education. Moreover, the effects of poverty leave many victims devoid of access to treatment interventions to the cost implications especially regarding detoxification (Galea & Vlahov, 2002). Individuals who have access to public health services have difficulties in the sustainability of resources due to an array of family obligations. As a result, poverty presents a vicious cycle which manifests itself in generations that are raise in lifestyles of high-risk exposure to opiate addiction.
Challenges of Opiate Addiction in Massachusetts
Perhaps a unique aspect of the case of Massachusetts is the fact that the ability of inmates to re-enter the society is being threatened by the proliferation of the opioid crisis. Researchers estimate that the risk of opioid-related fatalities as a result of release from prison is 50 times greater than that of the general public. Equally important is the fact that the threat is immediate since the fatal overdoses that occur during the first month following release are six times higher than other post-incarceration periods. The data collected during the period of 2013 and 2014 indicated that opioid-related overdose was the cause of death with 40% comprising of recently released convicts (Bruehl et al., 2013). Although inmates receive substance use treatment during incarceration, disparities exist as to the duration and how the intervention was conducted. Patients struggling with SUDs are more likely to be discharged early from pain management care which would ultimately culminate in the prevalence of addiction problems due to drug dependency. On the other hand, opioid drugs are the nerve center of chronic pain management and the incorporation of the modalities such as COT augments the risk of relapse to addiction in patients with a history of SUDs due to the susceptibility to drug seeking behavioral patterns. A study conducted in Massachusetts revealed that the presence of multiple subscribers was a risk factor that contributes to a fatal overdose. Although there are legitimate reasons as to why an individual might have numerous prescribers, such a group is at an elevated risk of succumbing to opiate addiction.
The complicated relationship that exists between pain management and opiate addiction has resulted in the development of stigma towards patients with SUDs. This phenomenon has led to a negative attitude directed towards patients who are perceived as portraying dependence or drug-seeking behaviors. Such prejudice has indirectly contributed to disparities in the healthcare system where patients are not accorded adequate care due to the possibility of being discharged early from treatment. Due to the development of drug dependency and addiction problems, the patients are likely to switch from legal opioid use to illegal drugs which further augment the problem of opioid-related deaths. Moreover, individuals who are currently taking opioids often encounter difficulties receiving pain relief when they are hospitalized. Thus, the principle approach denotes that a clinician prevents withdrawal through continued opioid administration, provision of additional analgesic if need be, monitoring of the patients progress to confirm is pain relief is satisfactory and prevent respiratory depression (Milivojevic et al., 2012). Such a process might prove to be complex for a clinician who is lacking in experience as far as pain management of patients with a history of SUDs is concerned. Moreover, handling of patients with SUDs creates legal implications for the attending physicians as they often exercise caution to prevent incidences of a drug overdose which culminates in death and the potential loss of medical license.
The family domain and the development opiate addiction are often connected and as such addicted individuals are encouraged to opt for residential facilities or inpatient services when seeking treatment. Such a measure is aimed at separating the recovering addict from home stressors that may have contributed to the advent of the addiction problems. Co-dependency issues are also common amongst family units which may significantly perpetuate opiate addiction hence family therapy. The inclusion of the next of kin in the treatment intervention of an addict assists in addressing co-dependency issues and enabling the family so that the coping mechanisms of the recovering addict is augmented. For instance, structured control of opioid medication access is essential in decreasing chances of opiate addiction including arranging for the distribution of drugs from someone other than the patient. Moreover, peers may play an instrumental role towards the road.
The struggle to prevent the proliferation of the opioid epidemic in Massachusetts is aimed at protecting future generations. As a result, the percentage of opioid-related deaths when considering different age groups indicates that the young people are at the most significant risk. Statistics from 2013-2014 suggest that opioids account for more than 25% of all the reported deaths between the ages 18-24 years. As for the individuals aged from 25-34, opioid overdose was responsible for nearly 40% of the fatalities reported while in 2015, two out of three individuals who had died from the opioid overdose was younger than 45 years (OFarrell, T. J., & Clements, 2012). Due to such shocking statistics, the state of Massachusetts has sanctioned the mandatory inclusion of opiate addiction in the curriculum of social work students. Such an initiative is aimed at equipping graduates with the proficiencies required for prevention, intervent...
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