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Introduction
Substance abuse is a critical public health issue that has reached increasingly high levels in the United States. Approximately 22.5 percent of Americans have experienced some form of substance abuse (SAMHSA, 2018). The rates keep rising as substance abuse is on track to become a major cause of disability on par with physical diseases and leading to other major health defects. The social burden and economic costs of substance abuse are exceeding hundreds of billions of dollars as well as negatively affecting families. This report will investigate the background, impact on personal lives, and cultural perspectives of the critically dangerous opioid epidemic in the United States due to substance abuse of legal medications.
Background
Substance abuse of prescription drugs implies the inappropriate use of medication by taking it for another purpose or dosage than it was originally prescribed. This can include actions such as taking medication for medical complaints such as pain, attempting to feel high, or using someone elses prescription. The primary categories of medication misuse are opioids (pain medication), central nervous system depressants (sedatives), and stimulants. Abusing prescription drugs can have dire consequences, including health-related that result in emergency room visits, overdose, or addiction (National Institute on Drug Abuse, 2018a).
History
The history of prescription drug abuse has existed for over a century in the context of organized medicine. At the turn of the 20th century, the commercial production of opioids and heroin was legal. With many Civil War veterans addicted after being treated with morphine for injuries, the opioids were applauded as a wonder medication to relieve pain. Heroin was in active use as a medication, even for minor purposes such as a cough suppressant.
This lasted until 1924 when doctors realized the highly addictive nature of opioids and heroin became illegal. In the 1970s the United States was experiencing significant issues with illegal drugs, so physicians were avoiding prescribing new medications such as Percocet and Vicodin. However, a new large study published in 1980 concluded that addiction is rare in patients without a history, and very few experienced adverse reactions. This began the trend of treating chronically ill patients with prescription opioids. Despite the ongoing heroin epidemic, by the 1990s pain management was a priority and it was an expectation by patients that physicians address it in their treatment (Moghe, 2016).
The year 1996 saw the introduction of OxyContin to the market, a long-term and popular painkiller. It was followed by heavy marketing and lobbying which led to the number of prescriptions jumping from 3 million to 8 million in a year and eventually reaching 11 million (Moghe, 2016). However, several years later, charges were filed for branding misrepresentation, and the production company had to pay out fines.
Despite, OxyContin representing a minor percentage of prescription opioids, it contributed towards the increase of medications that had a number of negative properties which were popularized without adequate testing. By 2001, the Joint Commission introduced standards for pain assessment and prescription, finally acknowledging the medical risks and addiction side effects of utilizing opioids for pain management.
Pathophysiology
The pathophysiology of pain medications is based on opioid receptors binding to neurons within the nervous and immune systems. The receptors are binding sites for a number of endogenous peptides such as endorphins, dynorphins, and enkephalins. The peptides regulate vital functions include pain, stress, respiration, mood, and motivation. The prescription medications bind opioid receptors and begin to influence many bodily functions, one of which is pain relief and mood alteration.
Most of these are prototypical mu receptor agonists, having the capability to produce a maximal response in the opioid-sensitive systems. Partaking of opioids leads to a euphoric feeling due to a rush in the brain, commonly known as a high. Chronic use leads to addiction and physiologic dependence, as well as higher tolerance levels. Opioid use modifies gray matter within the brain to create patterns of destructive addictive behavior or create excessive withdrawal symptoms when drugs are unavailable (Dixon, 2018).
Current State of the Issue
Despite active measures from federal agencies, health organizations, and public groups ranging from education to some radical methods as controlled drug use facilities, opioid substance abuse has become an epidemic and crisis. The U.S. Department of Health and Human Services declared a state of public health emergency regarding the opioid epidemic. Statistics indicate that 11.4 million people have misused prescription pain medications, with over 42,000 deaths.
Over 2.1 million individuals struggle with an opioid use disorder consistently, many due to the misuse of prescription drugs for the first time. This has led to 886,000 people gradually transition to illicit drug use such as heroin and 19,413 using synthetic opioids, a common occurrence after a prescription becomes unavailable (U.S. Department of Health and Human Services, 2018). Some areas are more affected as well as the Midwestern region saw an increase of opioid overdoses by 70 percent and large urban cities by 54 percent (National Institute on Drug Abuse, 2018b). It is evident the extent of this issue is widespread in the United States.
While historical evidence shows that dishonest marketing practices and inappropriate medical regulation in pain medication prescription contributed to the rise of the epidemic, there are still external and not well-studied factors that influence its growth. Prescription and drug supply may be a causative vector, but the crisis is linked to being fueled by socio-economic issues. Individuals involved in the epidemic are often attempting to escape physical conditions and psychological trauma of socio-economic upheaval that has led to the creation of vulnerable, isolated, and disadvantaged segments of the population.
Furthermore, the health care system is partially responsible for incentivizing to this day, rapid and simplistic solutions to relatively complex physical and mental health needs of the patients (Dasgupta, Beletsky, & Ciccarone, 2018). Offering opioids as potential illusionary answers to multidimensional health and societal problems is causing the crisis and severe structural changes to perspectives on pain management.
Effects of the Problems
The opioid crisis in the United States has had a profound and devastating impact on individuals, families, and whole communities or societies as a whole. It goes beyond fundamental health problems, causing financial and moral costs. Meanwhile, the toll of human deaths is enormous. The crisis is creating tremendous burdens on the economy, health system, and social services. This section of the report will investigate the impacts of the opioid epidemic on individual, familial, and societal factors.
Impact on Individual
At first, prescription drugs have positive effects of relieving pain and even managing stress. Individuals feel euphoria and a sense of calm. However, a gradual dependence begins to form, where an individual feels extreme mood swings and exaggerated or phantom pain (if the prescription was originally for pain management). Furthermore, the increased tolerance for the drug leads to the person requiring higher dosages or more powerful medications. Addiction is very realistic, easy to form, and can occur with anyone, including medical professionals. Short-term effects may include feelings of fatigue and tiredness.
A person displays a lack of care, apathy, and becomes inconsistent in fulfilling commitments. Short-term health issues such as nausea, chest pain, and decreased respiration are possible. Over the long term, there is a high risk that an individual begins to experience psychiatric or substance abuse mental health disorders ranging from major depression to anxiety and post-traumatic stress disorder. There is a possibility of other substance abuses such as alcohol or illicit drugs which may create a risk for additional problems such as HIV (Acadiana Addiction Center, n.d.).
Addiction can affect anyone, regardless of age, status, or profession. The stereotypical perception of opioid addicts as homeless and poverty-stricken individuals does not always hold up. Initially, many people begin to use medications for reasons of pain management and self-care. However, patterns of addiction begin to change a persons behavior, leading to irrational behavior. Any social or moral barriers gradually become degraded as the brain begins to seek another dosage at practically any cost.
Patterns of behavior change toward avoidance, lying, and manipulation. Some extreme cases lead to addicts demonstrating abuse, both verbal and physical. Criminal patterns such as thieving or forging prescriptions are noticeable (The Recovery Village, n.d.). Addicts fail to take responsibility for their behavior because substance abuse is strongly distorting their reality and thought process.
Impact on Family
Substance abuse of any kind inherently impacts the immediate family of the affected individual, causing suffering and destroying relationships. These factors are influenced by the severity of the addiction and situations vary unique to the family structure and values. However, in light of the opioid crisis, anecdotal evidence suggests that substance abuse is a family disease. The complexity and blend of families in modern communities such as single-parent homes, blended families, and multi-generational homes generate different circumstances and impacts on family members. These are difficult to predict, but most often drastically undermine functionality and relationships in family units.
In every family, an individual maintains a certain role that contributes to the functionality of the family, maintaining a level of stability and balance. As new substance abuse behavioral patterns emerge, the dynamic begins to shift. Toxic relationships may form that either enables the addiction or attempt to punish it. It should be noted that certain family-related scenarios may cause substance abuse in the first place, such as unrealistic expectations or hidden anger.
Other family members may be forced to take on additional responsibilities and roles that they are not prepared for or at an inappropriate to assume these position. For example, an older sibling may have to assume parenthood and breadwinner roles if the parent in the family becomes addicted. Overall, these shifting relationships cause a myriad of negative emotions such as blame, guilt, and shame. The tension, adverse health outcomes, and irrationality of addictive behavior may lead to dysfunctional relationships and abuse. Statistics indicate that upward of 50 percent of domestic violence, child abuse, and sexual assault occur in instances of substance or drug misuse (Behavioral Health of the Palm Beaches, n.d.).
Impact on Society
Extensive research has been conducted on the social impact of medication misuse, particularly the opioid epidemic. It is undoubted that the crisis has created a significant economic burden for the country and has overwhelmed the health care system. First, it must be noted the rapidly increasing death toll from substance misuse. Direct overdose deaths have reached 33,000 annually, 63 percent of which were related to opioids. Meanwhile, total costs are estimated to range anywhere from $239.9 billion to $622.1 billion per year (Office of the President of the United States, 2017). A large percentage of this amount consisted of fatality costs. However non-fatality costs include foregone earnings, healthcare costs, and criminal justice expenses.
There are significant negative impacts on the social, health, and economic welfare of communities as opioids disrupt family structures and introduce criminal activity into the neighborhood. The healthcare system is under significant pressure to provide care for numerous adverse events and addiction to prescription drug abuse. Social impacts are incalculable but over decades can add up to trillions in dollars of lost earnings and potential while resulting in millions of ruined lives due to abuse and neglect (Kasarla, 2017). Effectively, the negative impacts discussed in this report, starting from individual factors are inherently intertwined leading to a series of consequences for a society that exceeds all imaginable financial estimates.
Multicultural Aspect
The sociocultural perspective and beliefs can have a significant impact on the approach to substance usage and potential abuse. It influences behaviors and expectations that individuals, families, and whole communities have about prescription drug misuse. Some ethnocultural groups may have had little exposure to such medication while others view it from a perspective that affects their cultural or communal practices. Certain patterns of behavior may be appropriate in culture, and therefore, substance abuse may be enabled or risk factors unnoticed. This section will explore multicultural perspectives on this issue.
White
Caucasians are the primary ethnic or cultural group affected by the opioid epidemic as the majority of drug-related deaths consist of middle-aged white individuals. The crisis had its largest impact on suburban white populations, which were ironically the primary targeted market of pain medications in the 1990s. A large contribution to this was caused by the collapse of the white high-school educated working class and the recent deep economic recession that has led to the growth of opioid drug misuse. The pharmaceutical nature of this substance abuse scenario has created a racialized logic that goes against common social tendencies of minorities becoming most affected by drug misuse.
Instead, the opioid addiction crisis has become referred to as a white problem. This has occurred due to racial factors as well since physicians are less willing to prescribe narcotic medication to non-white patients due to drug-associated stereotypes or a general lack of access to good insurance. As a result, rural and suburban areas, mostly white have seen skyrocketing rates of prescription medication abuse over the last decades (Moran, 2018).
African-American
Substance abuse for legal drugs has historically remained lower for African Americans than other ethnic groups. There are commonly much higher rates for illicit drug use in black communities, driven by the socio-economic disadvantages and struggles that have forced many in this racial group into poverty. Violence and criminality of urban black neighborhoods have limited the opportunities and resources to engage in resolving drug use issues. However, recent trends demonstrate that the opioid crisis is affecting African-American urban families as well. The easy availability of legal prescriptions has made it a product of drug sales in neighborhoods, drastically increasing addiction and overdose statistics. Urban areas such as Washington D.C. have seen 80 percent of opioid deaths being blacks, with overall urban overdose deaths rising by 41 percent (Peñaloza, 2018).
The potency of synthetic opioids such as fentanyl makes it more appealing than the negative connotations and the expense of heroin. This leads to addicts engaging in practices of taking high dosages of these medications without comprehending their danger.
Hispanics
Similar to other racial groups and cultures, the Hispanic/Latino rates of addiction and overdoses for opioid-related abuse are rapidly increasing. Some states have seen surges of doubling rates over a period of three years. Opioid overdose fatalities amongst Hispanics are at 52.5 percent (Bebinger, 2018). Cultural norms discourage any substance use for Latino women, empirically reflecting on lower rates in that segment of the population.
However, the macho culture of men, poor socio-economic conditions, and the prevalence of crime increase the risk of substance abuse and opiate misuse amongst Hispanic males. Cultural and linguistic barriers often prevent Hispanics from receiving proper information on the dangers of substance abuse or having access to adequate healthcare. This may promote behaviors such as self-management of pain utilizing medications but taking wrong dosages. There is a general distrust of the Hispanic community for the government, fearing deportation amongst possible outcomes. Therefore, Hispanics avoid seeking necessary help.
Asian
The Asian community is very diverse and stereotypical represents a model minority that assimilates into the mainstream culture and displays a strong ethic in the context of strong family structural and community groups. However, Asian Americans may also face cultural conflicts and personal substance abuse issues. Statistically, this ethnocultural group demonstrates the lowest levels of substance abuse. There is a strong cultural taboo against addiction, and little familial support for any individual found engaging in such behavior. However, issues such as racial discrimination and acculturation may lead to risk factors for substance abuse. This is further exacerbated by language barriers and lack of education (Sunrise House, n.d.). The opioid epidemic has not significantly influenced the Asian-American community.
However, another type of prescription medication substance abuse has. Stimulant drugs such as Adderall are commonly used to enhance mental performance are popular amongst younger Asian individuals. The family and social pressure to perform well academically and professionally lead to inappropriate use of this type of prescription drug. Many take the medication without a proper diagnosis of ADHD for which Adderall is commonly prescribed. This leads to addictive behaviors amongst young people that could potentially transition into substance abuse of more serious pharmaceutical and illicit drugs.
Conclusion
Legal drug substance abuse is a critical issue in the current day US society. Opioid abuse is a result of and currently is a major behavioral and social systems problem. Patterns of prescription and abuse have increased exponentially, largely due to the commercial drive of pain management medications and the failings of the health care system to adequately regulate or protect the distribution of opioids to the population.
It has significant and far-reaching impacts on individuals and families as well as extensive socio-economic damages the United States society. A number of communities and vulnerable populations in the cultural context are affected by the epidemic as well. It is vital that strong measures are taken through medical practices, public policy, and social interventions to mitigate this crisis and offer critical aid to those who are affected.
References
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Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: No easy fix to its social and economic determinants. American Journal of Public Health, 108(2), 182-186. Web.
Dixon, D. W. (2018). Opioid abuse.
Kasarla, M. (2017). The opioid epidemic and its impact on the health care system. The Hospitalist.
Moghe, S. (2016). Opioid history: From wonder drug to abuse epidemic. CNN.
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