Stefanie Gorden

Dr. Beth Huber

Engl 202

July 1, 2018

The American Battle Against Opioids

Almost every American knows someone that has been or is reliant on opioids. Drug

abuse used to be an issue we thought we would worry more about when the time came.

Unfortunately, that time is now. Opioids are taking over our country, and policy makers are

scrambling to find a solution. In 2015, nearly 2.7 million Americans were either dependent on

opioids or addicted to them (Hoban). This number has since increased, which is why we need to

act now to save lives and fight America’s opioid addiction. By the end of this discussion, it is my

hope that you all understand the hold these substances have on our citizens, the dangers of

opioids, and how you can help put an end to this national crisis.

For those of you who do not know exactly what opioids are, the National Institute on

Drug Abuse (NIDA) defines them as, “a class of drugs that include the illegal drug heroin,

synthetic opioids such as fentanyl, and pain relievers available legally by prescription such as

oxycodone, hydrocodone, codeine, morphine, and many others.” Opioids are a type of narcotic

pain medication, used to treat severe or long-lasting pain. According to WebMD.com, these kinds

of drugs bind to receptors in the brain, spinal cord, etc. to reduce feelings of pain. Opioids are

highly addictive, dangerous, and are prescribed by doctors and physicians all over the United

States of America.

For example, a couple of years ago I suffered from severe and chronic headaches for

about six months due to high amounts of stress. I was leaving school early almost every day
because I could not bear to keep my eyes open and would cry because of the pain. Therefore, I

could not focus on my schoolwork and was suffering physically as well as academically. I was

eventually prescribed a narcotic pain reliever called Tramadol by my physician. This drug

belongs to the medicine group of opioid analgesics. Tramadol has a high risk for addiction and

can become habit-forming when taken for extended periods of time (WebMD). I did not

experience opioid addiction, but I would say I depended on Tramadol to not have severe

migraines daily. Luckily, I was aware of these risks, so I looked for alternative ways to reduce

my headaches and stress, and only took the medicine when I needed to. Unfortunately, many

others cannot say the same thing.

In 2015, the NIDA said that just over 33,000 Americans died from opioid overdoses. The

National Center for Health Statistics reported that in 2016 nearly 63,000 lives were claimed by

opioid overdoses, which is more than 140 deaths a day, just in the United States alone (BBC

News). That is a huge uptick in fatality for one year. These numbers increased again by roughly

thirty percent in 2017 (Ducharme). This shows that we are experiencing an overflow of opioid

overdoses. Some news stories have even labeled the crisis the “epidemic of epidemics” because

it is destroying thousands of lives so rapidly.

Opioids are doing more than causing an increase in the number of overdoses. They are

driving down our life expectancy (Santhanam). The average American life expectancy decreased

by 0.1 percent to 78.6 years in 2016 for the second year in a row. The life expectancy in the

United States has not dropped two years in a row since the influenza outbreak in 1963 and has

not dropped at all since the AIDS epidemic in 1993, over two decades ago (Childs). Drug

overdose related deaths were the number one reason behind why Americans are dying at younger
ages, and they are entirely powered by the current opioid crisis. Fatal drug overdoses are the

leading cause of death among Americans aged twenty-five to forty-four (Santhanam).

You might be thinking, “how did this happen?” According to the NIDA, pharmaceutical

companies initially promised that patients would not become addicted to prescription opioid pain

relievers. Suddenly, twenty-one to twenty-nine percent of patients with chronic pain were

abusing their opioid prescriptions (NIDA). This is partly due to the fact that they are so

addictive, and easily accessible. About four to six percent of those that misuse these prescriptions

eventually switch to heroin. However, eighty percent of heroin users initially misused prescribed

opioids (NIDA). You can thank healthcare providers that hand out opioid prescriptions like

candy for this.

There is also a reason for why doctors and physicians were prescribing so many opioids.

Researchers at Harvard University discovered that opioid manufacturers were paying healthcare

providers large amounts of money based on the amount of opioid prescriptions they wrote

(Kessler). “It is unclear whether the payments encourage doctors to prescribe a company’s drug

or if pharmaceutical companies seek out and reward those who are already high prescribers,”

said Harvard University researchers. Either way, there is now one underlying question. Is this in

the best interest of the patient’s health, or the doctor’s wallet?

Hundreds of doctors across the United States were paid six-figures between 2014 and

2015. Those that were not paid quite as much were still paid extra money, at least $25,000

(Kessler). Over 811,000 doctors gave prescriptions to Medicare patients during this one year

period. Out of those doctors, fifty-four percent received payments from opioid manufacturing

companies. Ninety-five percent of those who prescribed the most opioids, the top tenth of one

percent, received payments. Just for perspective, these doctors made nine times more money than
the usual doctor with a normal amount of prescriptions (Kessler). Keep in mind that as a

healthcare provider, it is illegal to prescribe a drug in exchange for rewards by a manufacturer,

whether it be monetary or by other means.

One woman from Greenville, South Carolina, Angela Cantone, experienced this betrayal

by her doctor, Dr. Aathirayen Thiyagarajah, first-hand (Kessler). She suffers from Crohn’s

Disease and faces severe abdominal pain. Dr. Thiyagarajah prescribed her an opioid drug called

Subsys, which is an incredibly strong form of fentanyl, an already extremely potent drug. The

United States Centers for Disease Control and Prevention (CDC) says that Subsys is fifty to one-

hundred times more powerful than morphine. Angela Cantone said that Subsys made her black

out because it put her in a “zombie-like state,” (Kessler). She would wake up in strange places

like the kitchen floor or even outside. Because of the opioid’s side effects, Cantone could not

even look after her own children and feels that she has failed as a mother (Kessler). This shows

that opioids can not only destroy one’s physical health, but their mental well-being also.

The issue is not only how the opioids affected her, but how her doctor handled the

situation which proves that they have encouraged the opioid crisis. When Angela Cantone

expressed these concerns to her doctor, he said it had nothing to do with her prescription. She

suggested trying a non-opioid medication for her pain management, to which Dr. Thiyagarajah

outright refused declaring, “It is Subsys or nothing.” Turns out he had been paid more than

$200,000 by the opioid manufacturer, which is probably why he was forcing this opioid upon

Cantone (Kessler). Two and a half years later, Angela Cantone found herself addicted to Subsys.

Going a day without it meant suffering withdrawal symptoms such as severe vomiting and

diarrhea. She is now suing Dr. Aathirayen Thiyagarajah (Kessler).

 The deeper the investigation of this national issue gets the more questions people have.

What would the rates of opioid addiction be like today if doctors were not accepting money from

drug manufacturers? How many people would be off the streets if they had not been prescribed

an opioid medication in the first place? Most importantly, how many Americans would still be

alive today if none of these payments had occurred? While we cannot change the past destruction

caused by opioids, we can change the future. At least one pharmaceutical company has since

stopped paying doctors for promotional activities for opioids. The manufacturer Purdue Pharma

terminated its speaker programs promoting OxyContin, Butrans, and Hyslinga in November

2016 (Kessler). Encouraging other companies to do the same thing could make a huge difference

in current patient’s dependency and for those that could become addicted if this behavior

continues.

Opioid addiction is ravaging people from every corner of the country; European-

Americans, African-Americans, young people, elder people, wealthy people, and indigent

people. Addicts range from blue collar workers to businessmen and women. One thing all of

these people have in common is that the road to their addiction was paved by opioid

prescriptions meant to manage their pain from accidents or other injuries. Dr. Daniel Sumrok, a

doctor in Tennessee, said that some of his patients are not the usual “TV bums” some might

expect (McKenzie). In fact, many of his patients are people with established careers and families

such as defense attorneys, nurses, teachers, as well as other doctors. Even newborns are being

born addicts because pregnant mothers are also using opioids.

The use of opioids during pregnancy is ever increasing, resulting in children being born

with birth defects and suffering from withdrawal. Babies are more frequently being born with

Neonatal Abstinence Syndrome, a condition likely caused by the mother’s use of prescribed
heavy duty opiate pain-killers during pregnancy (Husaini). Neonatal Abstinence Syndrome

causes a multitude of issues with newborns ranging from a low birth weight or feeding

difficulties to something more severe such as seizures. The chances of the baby developing this

condition rises if opioids are used for extended amounts of time especially close to their delivery

date (Husaini). The exact effects opioid usage has on a fetus are not known yet, but we know that

this issue is becoming increasingly more common. “Studies in animals have taught us that these

types of drugs can alter the development of the central nervous system and maternal attachment,

while an association between prenatal opioid exposure and birth defects has been shown by

epidemiology studies,” says Dr. Volkow (Husaini).

A study revealed that out of approximately 1.1 million Medicaid enrolled women, 21.6

percent filled a prescription for opioids during their pregnancy between the years 2000 and 2007

(Husaini). Then, another study showed that out of about 534,000 privately insured women

between 2005 and 2011, 14.4 percent filled an opioid prescription during their pregnancy.

However, between 2005 and 2011 there was a two percent decline in the number of opioid

prescriptions filled by pregnant women (Husaini). While the progress was small, it was a strong

push in the right direction toward sobriety.

People may ask, “Well why would you not stop taking them?” or “Why would doctors

even prescribe such medications to a pregnant woman?” Dr. Volkow, Director of the National

Institute of Drug Abuse, says that sometimes it is safer for both the mother and the baby to

continue the treatment if she had already been using an opioid medication as her method of

addiction treatment. It is almost like weening them off the drug. If the mother just stopped cold

turkey, her and the fetus could experience severe withdrawal symptoms that could be just as
dangerous to their health during the pregnancy process. Dr. Volkow also said that doctors only

prescribe opioids to pregnant women after careful consideration of their risks and benefits.

While clearly nobody is safe from this opioid crisis, there is a noticeable racial gap.

White people accounted for ninety percent of the fatal opioid overdoses that occurred in the

United States during 2015 (McKenzie). Data from the CDC shows that black people only

accounted for a little over eight percent. The Tennessee Department of Mental Health and

Substance Abuse Services released statistics regarding opioid usage in their area for the year of

2015. Researchers learned from this data that ninety-five percent of 4,071 individuals treated for

prescription opioid abuse in the one state of Tennessee were white. More specifically, out of 839

people treated mainly for heroin addictions, 89.5 percent where white. There was also 1,176

Tennesseans treated for cocaine usage of which sixty-two percent were black, as well were less

than half of those treated for marijuana use (McKenzie).

Reverend White expressed his opinion that “if this had happened in other areas,

communities would have been crying out a long time ago, but since it is claiming more

European-American lives, it is a time of national crisis (McKenzie).” Some people want to help

fight this plague of death sweeping across America, while others are criticizing the steps being

taken because of racial discrepancies. A sociology professor from Georgetown University named

Michael Dyson said that white brothers and sisters are being medicalized and treated like patients

for their traumas that led to addiction, whereas black brothers and sisters are being criminalized

and treated as inmates even though they ended up addicts for the same unfortunate reasons

(McKenzie). However, this racial discrimination might have actually saved the lives of

thousands of African-Americans. Doctor’s under-treat and do not prescribe nearly as many

opioids to black patients for their pain as they do white patients, so their opioid addiction and
overdose rates are much less than European-Americans, which in a twisted way is a positive

thing.

Location also makes a huge difference in who uses what and how often. For instance,

Philadelphia, specifically the Kensington district is run down and flooded with opioid addicts,

mostly heroin users. They have certain parts of the city that drug user’s hangout around called

encampments, which are usually under bridges (Helmore). Many addicts use around

encampments so that they are in plenty of company if something goes wrong, such as an

overdose. Plenty are homeless and not only use in these camps, but also live in them, some for as

many as twenty-five years. Recently, nearby residents have filed complaints with the city, calling

the combination of homelessness and unrestricted drug abuse a public health hazard (Helmore).

For four weeks, the city of Philadelphia cleaned out and permanently closed two of the

most popular underpass encampments during what was called the pilot program. Tents,

mattresses, and other items were removed from the premises, along with the locals that were

living in the debris. Law enforcement and social workers were at the scenes offering help to

those residing in the areas with hopes that some would be willing to go to a rehabilitation center

and seek treatment. Many of the drug users took them up on their offers, but many also said that

they were not ready. One gentleman only known as Jay, cooked up some heroin for him and his

friend while telling reporter, Edward Helmore, that rehabilitation programs are only helpful for

those that want to go, and he is right. One man who was forced to relocate even said that

occasionally he will feel an urge to admit himself into a treatment program, but by the time he

has the resources to do so the urge is gone. Many of the drug addicts also shared that they felt

pressured into accepting drug treatment and detoxes by this city wide intervention (Helmore).
 Philadelphia Health Commissioner, Tom Farley, stated that in 2017 there were 1,200

overdoses in just that city alone (Helmore). This is a three hundred person increase from the year

before making Philadelphia the most severely hit in the United States. Tom Farley even

estimated that for every deadly overdose, there were around eight to ten non-fatal overdoses,

which is ridiculous. I assume the reason for this is that in Philadelphia fentanyl is the most

common drug of choice, and it is extremely dangerous. One local drug user known as Bruce

shared that a “half a nickel bag” worth just five bucks can be fatal. Farley estimates that as many

as 70,000 Philadelphians are addicted to opioids (Helmore). He expressed his dedication to

helping addicts in need, saying that the cities main goal is to keep those who face the sad reality

of addiction alive until they are ready to seek the treatment they need.

Many Philadelphia officials and healthcare providers have made suggestions for solutions

on how to aid those at risk and in need. They considered setting up safe consumption sites so that

they could at least monitor the drug use, but Farley ultimately decided that even though he is for

the idea if it saves lives, state as well as federal regulations make that impossible (Helmore). The

pilot program got about four dozen homeless opioid addicts from the two newly closed

encampments to enroll in some kind of rehabilitation center (Helmore). The city created a policy

known as intensive daily outreach, which started with three hundred homeless individuals that

voluntarily received assessment. The director of Philadelphia’s office of homeless services, Liz

Hersh, said that more people had accessed treatment in the first two weeks of this

program than the previous six months (Helmore). With the help of this intensive daily outreach

policy, the city is almost providing treatment on demand. This is a huge step in the right

direction towards ending addiction because now healthcare providers can take advantage of the

moment a drug abuser wants to seek treatment before that feeling is gone.
 Since the opioid crisis is causing so many problems nationwide such as children being

sent to foster care, overcrowding of jails and other criminal justice systems, and of course death,

three more states other than Pennsylvania have recently decided to actively start fighting

the opioid crisis; Rhode Island, Virginia, and Wisconsin (Rising). In May this year, leaders from

each state met on Capitol Hill to discuss which efforts they have found to be most successful in

their area. The representatives worked together to form a list of the three most important things

to remember when addressing the opioid epidemic. The first lesson is to get personal rather than

political when addressing your community. Wisconsin’s State Representative John Nygren has

endured the struggles of addiction because his own daughter had an opioid use disorder, and he

used his personal experiences to reach the hearts of his citizens (Rising). Often times people will

listen better if you speak from your heart instead of from a textbook, and you will make more of

an impact if you speak from experience instead of just spewing data at everyone.

The second lesson is to stay engaged on the ground. Essentially, this means that

healthcare providers and law enforcement need to work together to be aware of opioid usage in

their communities and how to promote treatment programs for it. For example, Rebecca Boss,

Director of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities

and Hospitals, said that for one particularly opioid crazed town in her area, clinicians and

detectives partner together to identify people who could potentially suffer from a substance use

disorder (SUD) and educate these individuals on the treatments available to them (Rising). This

not only helps keep citizens alive, but it aids in forming a healthy relationship between the public

and law enforcement. Rhode Island also has a program called The Governor’s Overdose

Prevention and Intervention Task Force, that aims to reduce opioid overdose related deaths by

one-third by 2020. The task force plans to do this by having regular meetings with hospitals and
law enforcement agencies to monitor the activity on the ground, such as overdose related

emergency room visits and police confiscations and arrests. This should be an effective measure

since they have the ability to track their progress (Rising).

The third and last piece of advice is to transform the treatment system. Opioid addiction

would be much less of an issue if treatment was more widely available, and if more people knew

how to even get access to such programs. Virginia has an action plan called the “Addiction

Recovery and Treatment Services (ARTS)” program that began in 2017 with the goal of

reducing opioid addiction. Since the start of ARTS, the number of opioid prescriptions per

10,000 Medicaid beneficiaries has decreased by twenty-nine percent, and opioid related

emergency room visits have declined by thirty-one percent as well (Rising). Also, the number of

Medicaid beneficiaries receiving treatment for opioid use disorders has increased by fifty-one

percent. The ARTS program broadened Medicaid coverage for evidence-based treatment

services, raised low reimbursement rates for treatment by fifty to four hundred percent, and made

a payment model with integrated buprenorphine prescribers and behavioral health clinicians

among numerous other things (Rising).

However, some people are trying to point fingers and play the blame game instead of

figure out solutions. While it is essential to understand why and how this issue came about to

truly understand how to fix it, it is also important to not attach a negative stigma to addiction

along the way. The United States Department of Health and Human Services (HHS) and

National Institute of Health (NIH) is also pouring its efforts and resources into five main goals:

improve access to treatment and recovery services, promote use of overdose-reversing drugs,

strengthen our understanding of the crisis through better public health surveillance, provide

support for cutting-edge research on pain and addiction, and finally advance safer practices for
pain management (NIDA). The NIH also met with pharmaceutical companies and academic

research centers in 2017 to discuss more safe, effective, and non-addictive ways for pain

management, more successful ways to treat opioid use disorders, and overdose prevention

techniques.

Addiction happens in more than one way, so recovery happens in more than one way as

well. Treatments must be specialized to fit the individual in need to ensure that they can make a

successful recovery without relapsing. National healthcare agencies are working on more

integrative medicine, which allows for physicians to determine the patient’s needs, whether it be

medication-assisted FDA-approved Methadone or Buprenorphine, psychotherapeutic

intervention, peer support groups and family therapy, or a combination of a few. It is also

important that there are numerous options for therapy because people suffering from chronic

pain are additional factors to the opioid epidemic since they often become dependent on their

legally prescribed drugs. Then, once their initial prescriptions become less effective, they seek

illegal opioids like heroin and fentanyl to get quicker, better and longer pain relief (Hess). This is

why healthcare agencies are desperately trying to substitute opioid medications for non-opioid

medications. NIH grants are being used to discover new biological targets for pain medications

to steer doctors and patients away from opioid medications as a method of pain management

(Hess). Ideally, we would like to find better long-term medications that are less addictive and

safer for our fellow citizens. A program has also been set in motion by the NIH to help improve

the opioid epidemic.

The initiative put in place by the NIH is called “Helping to End Addiction Over the

Long-Term (HEAL).” The United States Congress has promised to provide $500 million in

funds to support the NIH in fighting the opioid crisis (Hess). One of HEAL’s major priorities is
to redesign the medical communities approach to addiction treatment because many are working

with outdated information. For example, Buprenorphine and Methadone are common forms of

addiction treatment, even though they have low long-term success rates. This could be a reason

that previous efforts towards ending opioid addiction have fallen through. Other programs are

still suggesting physicians use these opioid medications as a form of treatment, which could just

stall our progress more. Although, patient’s that receive medication-assisted treatment are fifty

times less likely to die from addiction (Genovese). However, medical communities still need to

re-evaluate the effectiveness of their treatment methods to ensure that doctors are giving their

patients a fighting chance.

HEAL is not only working to expand treatment, but to also improve the formulation of

existing treatments (Hess). These expansion efforts also include developing more overdose

reversing drugs like Naloxone which once administered, immediately blocks the effects of opioid

painkillers, and thus reverses the symptoms of an overdose. Perhaps something that can better

undo the effects of Fentanyl since this dangeorus opioid is becoming more popular among drug

addicts.

The last bit of information I would like to share with you is how opioids have affected

my home, North Carolina. In 2016, an average of five people died every day from drug

overdoses in North Carolina (Childs). There has been a 440 percent increase in fatal drug

overdoses since 1999. The number of drug related deaths literally quadrupled in one state in less

than twenty years. Luckily, the North Carolina Harm Reduction Coalition (NCHRC) has been

hard at work giving first responders in rural communities the tools and training they need to

identify, respond to and reverse opioid overdoses, since rural areas have been hit particularly the

hardest. The NCHRC has proudly contributed to 10,231 successful overdose reversals (Childs).
If one state’s strategy can save over 10,000 irreplaceable lives, imagine what we can do as a

nation.

How many more people need to die before we finally get a grasp on opioids? Healthcare

providers need to do more research and uncover better ways to treat those with injuries and

chronic pain. We as citizens can do our part in ending this opioid crisis by talking to our loved

ones, educating ourselves and the people around us on addiction, and most importantly, protect

ourselves against the dangers of opioid drug use. By urging legislators to provide funding and

physicians to seek better alternatives, we can put up a good fight to get the results we all know

we need to see and take back the lives of those still struggling. We cannot let opioids take over

America any longer.

 Work Cited

Childs, Robert, and Garth Graham. “Working Together to Fight the Opioid Epidemic.” News

Observer. 15 February 2018. http://www.newsobserver.com/opinion/op-

ed/article200404474.html. Accessed 17 June 2018.

Ducharme, Jamie. “Opioid Overdose Rates in America Are Still Increasing.” Time. 6 March

2018. http://time.com/5187886/opioid-overdose-rates/. Accessed 16 June 2018.

Genovese, Michael. “Evidence-Based Solutions to Fight the Opioid Epidemic.” Real Clear

Markets. 14 June 2018. https://www.realclearmarkets.com/articles/2018/06/14/evidence-

based_solutions_to_fight_the_opioid_crisis_103306.html. Accessed 14 June 2018.

Helmore, Edward. “How Philadelphia Closed Homeless “Heroin Camps” Amid US Opioid

Crisis.” The Guardian. 1 June 2018. https://www.theguardian.com/us-

news/2018/jun/01/philadelphia-homeless-heroin-bridge-camps. Accessed 17 June 2018.

Hess, Peter. “Congress Pledged $500M for New Plan to Fight the Opioid Crisis.” Inverse. 12

June 2018. https://www.inverse.com/article/45847-congress-funds-long-term-nih-opioid-

epidemic-strategy. Accessed 13 June 2018.

Hoban, Brennan. “The far-reaching effects of the US opioid crisis.” Brookings. 25 October 2017.

https://www.brookings.edu/blog/brookings-now/2017/10/25/the-far-reaching-effects-of-

the-us-opioid-crisis/. Accessed 20 June 2018.

Husaini, Zara. “The Dangers of Opioid Use During Pregnancy.” Fit Pregnancy.

https://www.fitpregnancy.com/pregnancy/pregnancy-news/dangers-opioid-use-during-

pregnancy. Accessed 14 June 2018.

Kessler, Aaron. “CNN Exclusive: The More Opioids Doctors Prescribe, The More Money They

Make.” CNN News. 12 March 2018.

 https://www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html.

Accessed 15 June 2018.

McKenzie, Kevin. “Opioid Crisis Points to Racial Divide.” USA Today Network. 27 March 2017.

https://www.gosanangelo.com/story/news/2017/03/27/opioid-crisis-points-racial-

divide/99706092/. Accessed 15 June 2018.

“Opioid Crisis: Overdose Rates Jump 30% in One Year.” BBC News. 6 March 2018.

https://www.bbc.com/news/world-us-canada-43305340. Accessed 16 June 2018.

“Opioid (Narcotic) Pain Medications.” WebMD. https://www.webmd.com/pain-

management/guide/narcotic-pain-medications#1. Accessed 20 June 2018.

Rising, Josh. “3 States Take on the Opioid Crisis- and Find Success.” The Pew Charitable

Trusts. 13 June 2018. http://www.pewtrusts.org/en/about/experts/josh-rising. Accessed

13 June 2018.

Santhanam, Laura. “The Opioid Crisis is Driving Down US Life Expectancy, New Data Shows.”

PBS News. 21 December 2017. https://www.pbs.org/newshour/health/the-opioid-crisis-is-

driving-down-u-s-life-expectancy-new-data-shows. Accessed 17 June 2018.

“Tramadol HCL.” WebMD. https://www.webmd.com/drugs/2/drug-4398-5239/tramadol-

oral/tramadol-oral/details. Accessed 21 June 2018.

 Full Annotated Bibliography

Childs, Robert, and Garth Graham. “Working Together to Fight the Opioid Epidemic.” News

Observer. 15 February 2018. http://www.newsobserver.com/opinion/op-

ed/article200404474.html. Accessed 17 June 2018.

The misuse of opioids is claiming tons of lives, even in our home of North Carolina. In

2016, five people a day were dying in North Carolina from drug overdoses. Our overall

life expectancy has declined for the first time since the AIDs epidemic in 1993. The rate

of drug overdose deaths has increased by 440% since 1999. As an effort to combat this

opioid overdose frenzy, the North Carolina Harm Reduction Coalition (NCHRC) gave

first responders around the state tools such as the overdose reversing drug, Naxolone, to

prevent more people from dying. Since then, more than 10,200 overdoses have been

successfully reversed. The Aetna Foundation, an organization that promotes health and

well-being, donated $6 million towards fighting the opioid crisis, $1 million of which

went directly to NCHRC. With these donations, support, and resources we will fight to

save lives against opioid misuse.

This article was written by two highly educated people who are directly involved with

healthcare agencies and organizations. They deal with the data and reality of drug

addiction first-hand, which is why their input is super beneficial to my paper. Neither of

them seems to have any biases, and if they do, they do not let it interfere with their work

with the public. The article was short but had personal stories that make the findings even
 more useful. This work came directly from them and their agency, so the information

could not have been twisted, or misused.

Ducharme, Jamie. “Opioid Overdose Rates in America Are Still Increasing.” Time. 6 March

2018. http://time.com/5187886/opioid-overdose-rates/. Accessed 16 June 2018.

Opioid overdose rates increased across America by 30%. Areas in the Midwest saw a

much steeper increase than other areas of the country. It is mainly about current opioid

overdose trends in different parts of the United States. However, the article doesn’t give

much of a reason as to why. It is believed that hospitals and other healthcare centers

could play a vital role in ending this opioid issue by educating patients on treatments and

services available to them. Emergency department data is more convenient than

government because it is available to policy makers quicker, which means change can be

implemented faster. Overdose rates are increasing rapidly in some areas, so the more

effective policymakers are, the better.

This article has a lot of interesting facts, that were reported by the Centers for Disease

Control (CDC). The article was relatively short but had a lot of statistics, so it was worth

reading. I did not find that much information about the author, but the sources within the

article seem reliable. There were a couple statements that seemed to be opinionated, not

necessarily by the author but by the sources within the text. Overall, I got useful

information from this article.

Genovese, Michael. “Evidence-Based Solutions to Fight the Opioid Epidemic.” Real Clear

Markets. 14 June 2018. https://www.realclearmarkets.com/articles/2018/06/14/evidence-

based_solutions_to_fight_the_opioid_crisis_103306.html. Accessed 14 June 2018.

This article was meant to inform the public about the most effective ways to treat the

opioid epidemic. It gave a few statistics about the death toll opioid addiction has taken on

the United States. Michael Genovese gave his expert opinion on how treatment should be

determined for individuals struggling with opioid abuse. Patients should have a treatment

routine that is specialized to their needs, because not everyone uses the same drug, started

for the same reason, and/or has been using for the same amount of time. The number of

deaths will keep rising if this issue is not resolved, and we cannot count on the

government to do it for us.

Michael Genovese is a renowned doctor who has lots of experience with behavioral

disorders and other health concerns. His findings are trusted and could be valuable to my

paper. I could use some of his findings to strengthen my research. I thought this article

was a little stronger than the other ones I have read because he had a lot of options for

treatment which I think means a higher chance of success.

Helmore, Edward. “How Philadelphia Closed Homeless “Heroin Camps” Amid US Opioid

Crisis.” The Guardian. 1 June 2018. https://www.theguardian.com/us-

news/2018/jun/01/philadelphia-homeless-heroin-bridge-camps. Accessed 17 June 2018.

 Kensington, Philadelphia is one of the worst-hit cities in the country, due to the steep

uptick in fatal overdoses. The city finally shut down two encampments around the area

that were popular among drug users. Although there was not enough funding to shut

down all of them, so policymakers fear the ones who refused treatment will relocate to

the underpasses that are still open. A few people addicted to opioids gave some personal

insight to the issue, saying they are aware they need help, but they are not ready to go to

rehab, detox, receive treatment, etc. However, heroin and other opioids are not as popular

among Philadelphia anymore. Fentanyl is starting to make a bigger appearance, and it

happens to be extremely dangerous. Therefore, city officials are trying so hard to get

people the help they know they need.

The article was medium length which makes for a thoughtful read. It included first-hand

stories from opioid addicts which makes the article that much more reliable. The personal

details also appeal to rhetoric. If I include pieces from this story in my paper, hopefully it

will open the public’s eyes, and perhaps make them want to help. There were more

quotes and references in this article than facts, but those are equally as important in

establishing its credibility and usefulness.

Hess, Peter. “Congress Pledged $500M for New Plan to Fight the Opioid Crisis.” Inverse. 12

June 2018. https://www.inverse.com/article/45847-congress-funds-long-term-nih-opioid-

epidemic-strategy. Accessed 14 June 2018.

This article is discussing a recent action of Congress, which promised to put $500 million

towards a new plan called HEAL, which stands for “Helping to End Addiction over the

Long-Term.” The National Institutes of Health (NIH) designed this plan to counteract the

current opioid epidemic. The two main focuses for the HEAL plan is to improve pain

management, while improving addiction treatments, says an editorial published in the

Journal of the American Medical Association. The editorial also states, Director of the

NIH, Francis Collins, M.D., Ph.D., Director of the National Institute of Neurological

Disorders and Stroke, Walter Koroshetz, M.D., and Director of the National Institute on

Drug Abuse, Nora Volkow, M.D., are working to address the issue regarding low long-

term success rates of treatments for opioid use disorder, such as methadone and

buprenorphine. The hope is to find alternatives to opioid drugs, so they can minimize

opioid addiction, and ultimately terminate the grasp opioids have on America.

I believe this article will be beneficial to my research regarding opioid usage in the

United States because it tells me how the money is supposedly going to be spent. It gives

me an inside scoop on what the first steps towards accomplishing the goal of ending

opioid addiction is. Some incredibly qualified people have been referenced in the article,

which makes me believe the information is accurate. Obviously, this article alone is not

enough information to base my research off of, however it is a good start to obtain a basic

understanding of the topic.

Husaini, Zara. “The Dangers of Opioid Use During Pregnancy.” Fit Pregnancy.

https://www.fitpregnancy.com/pregnancy/pregnancy-news/dangers-opioid-use-during-

pregnancy. Accessed 14 June 2018.

The article explains why some pregnant women are prescribed opioids, why they use

them despite knowing the risks, and what effects it could have on your pregnancy. It goes

into depth about one specific birth defect though, neonatal abstinence syndrome. It is a

series of issues that a baby faces when it has been exposed to opiate drugs during

pregnancy, such as low birth weight, seizures, and feeding difficulties. It also discussed

the trends of pregnant opioid users over time.

I believe this article is a great article to include in my research because there are a lot of

facts and references. It bettered my understanding of why pregnant women use opioids,

and why doctors prescribe them which I think is a question most people have. Therefore,

it is good information to include in my paper because the public will be more informed.

Also, it mentions Nora Volkow, as do many other articles I have used, so she is a credible

source. I have not seen other people cite this article, but since Nora Volkow is so well-

known, I don’t doubt that it has happened or will happen.

Kessler, Aaron, et al. “CNN Exclusive: The More Opioids Doctors Prescribe, The More Money

They Make.” CNN News. 12 March 2018.

https://www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html.

Accessed 15 June 2018.

This CNN article was about a current issue where many doctors are being paid extra

money by opioid pharmaceutical companies. The story was trying to decipher whether

doctors are being paid more to prescribe opioids, or if they are being paid more because

they prescribe high amounts of opioids. It offered a potential reason as to why doctors

prescribe opioids so much, even though so many people are suffering from opioid

addiction. Opioid manufacturers are directly paying doctors and physicians large sums of

money based on certain prescriptions, mainly opioids. A mother discusses her anger with

this issue because she is now addicted to an opioid called Subsys which her doctor

received a lot of money for prescribing to her and refused to give her anything else for

her pain management. Many patients are suing their doctors because they are now

dependent on whatever opioid they were prescribed. Some doctors are facing criminal

charges, while others have just been fired or had their medical privileges stripped.

The article is long and has a lot of good references to use in my paper. The topic was very

interesting, and a little upsetting so I think it was a good read to get my mind going about

opioid use. It was put together by multiple people who are all very accomplished and

intelligent people, so that gives me reason to believe the information is true. Katherine

Grise reported on liberal bias on college campuses which makes me think that maybe her

research was done with a more conservative point of view. The article included two

detailed stories about people’s personal experiences with this issue, which adds to the

credibility of the research. This also makes the article more useful because it adds to the

rhetorical appeal of my paper.

McKenzie, Kevin. “Opioid Crisis Points to Racial Divide.” USA Today Network. 27 March 2017.

https://www.gosanangelo.com/story/news/2017/03/27/opioid-crisis-points-racial-

divide/99706092/. Accessed 15 June 2018.

This article is all about the racial aspect of the opioid crisis. There is somewhat a racial

discrimination taking place as part of this epidemic. Doctors are prescribing more opioids

as a form of treatment to European Americans than they are African Americans.

Therefore, most of the individual’s using opioids are white, specifically about 90%. A lot

of these people also have nice jobs such as attorneys, doctors, etc. It talks about how if

this was more of an issue among African-Americans they would’ve been crying for help

sooner, but since it primarily an issue among white people, it is a public health crisis. The

small number of African-Americans that suffer from addiction are punished for their

actions, but white people are hospitalized and receive medical attention. The article

explains more reasons behind this racial gap and provides some statistics about the opioid

crisis regarding race.

Although I could not find much information about the author, Kevin McKenzie, I still

believe this is a credible source. USA Today publishes many articles about all kinds of

things and is a very well-known news reporting site. Therefore, I think this article is

worth being included in my paper because many people will trust its information. The

article is a good length, so it gives an adequate amount of information. I believe the

article promotes the readers thoughts because race gaps are so common today.
NIH: National Institute on Drug Abuse. “Opioid Overdose Crisis.” Drugabuse.gov. March 2018.

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Accessed 14

June 2018.

This article told about how the NIH/NIDA and HHS plan to fight the opioid crisis that is

claiming tons of lives. It exposed where the issue stemmed from which was unreliable

pharmaceutical companies, and the steps that need to be taken to fix it. Opioids are

widely used as pain medication and are addictive especially when misused. A new

initiative is being put into place called HEAL which will hopefully advance science and

medicine enough to create alternatives to opioids, as well as better treatment options.

This article gave me tons of statistics that I could use in my paper, as well as new ideas to

research. I did not find a specific author, but the NIH/NIDA is approved source. The

director, Nora Volkow is an accomplished scientist, as well are her colleagues. The

organization conducts research on health related topics and supports those they have

found to be accurate. They are constantly advancing and putting forth more work to keep

the public informed. I have heard of, read about, and even used this database numerous

times for all kinds of research so I trust that it can provide me with useful information.

“Opioid Crisis: Overdose Rates Jump 30% in One Year.” BBC News. 6 March 2018.

https://www.bbc.com/news/world-us-canada-43305340. Accessed 16 June 2018.

 The US Midwest region was hit the hardest with opioid overdoses rising by 70% between

June 2016 and September 2017. Middle-aged individuals (35-54) also saw a 36%

increase in opioid cases. Addiction knows no limits. More than 63,000 people lost their

lives to opioid addiction in 2016 alone which is around 140 people each day. This just

goes to show how serious this issue really is. Research shows that those who have

overdosed once are more likely to overdose a second time than someone who never has.

A good way to prevent people from overdosing on opioids and in turn reduce these rates

is to have all emergency personnel equipped with an overdose reversing drug called

Naxolone.

I was not able to find an author for this article, but it was posted on BBC news. BBC

news is a well-known news reporting website that posts on a variety of topics. I have

previously seen other news sites reference them, however I did not see anything talking

about this article. It was a short article but had lots of thought-provoking facts. A lot of

the facts in this article were consistent with those on another site though, so I believe it is

a credible source.

“Opioid (Narcotic) Pain Medications.” WebMD. https://www.webmd.com/pain-

management/guide/narcotic-pain-medications#1. Accessed 20 June 2018.

Some injuries and feelings of pain are able to be treated with over-the-counter

medications like ibuprofen, Tylenol, etc. However, some people experience severe pain that

require something stronger. This is when doctors prescribe an opioid medication. Narcotic pain
medications can have extreme side effects if not taken correctly. Opioids treat moderate to severe

pain by reducing the signals to the brain that make your body feel pain. Some examples of

opioids are codeine, fentanyl, hydrocodone, methadone, morphine, and oxycodone.

It is important to use this information in my paper because it describes what opioids are, how

they are used, and examples of narcotic painkillers. WebMD does not exclude the dangers of

opioid. It adds to the effectiveness of my paper because it helps the reader understand opioids.

WebMD is a trusted site because it has accurate medical information. Therefore, it is credible

and should be used in my paper.

Rising, Josh. “3 States Take on the Opioid Crisis- and Find Success.” The Pew Charitable

Trusts. 13 June 2018. http://www.pewtrusts.org/en/about/experts/josh-rising. Accessed

13 June 2018.

Virginia, Rhode Island, and Wisconsin took a few steps towards their goal of ending the

opioid crisis. These steps include getting personal, rather than political to draw in the

audience, stay engaged on the ground which means to be involved with the community,

and transform the treatment system. The ARTS program has caused a decrease in opioid

related cases seen in emergency room visits since its start in 2017. New policies and

services are being made to help put a stop to opioid addiction.

This article is reliable because the Chief Medical Officer of Virginia Department of

Medical Assistance Services, Dr. Kate Neuhausen, shared some statistics with the author
 regarding progress within the Medicaid program. Also, I trust that the Rhode Island

Governor’s Overdose Prevention and Intervention Task Force is a credible source when it

comes to sharing information about reducing the number of deaths associated with opioid

overdoses. The article also includes some trustworthy data that promotes new ideas

which is good when doing research.

Santhanam, Laura. “The Opioid Crisis is Driving Down US Life Expectancy, New Data Shows.”

PBS News. 21 December 2017. https://www.pbs.org/newshour/health/the-opioid-crisis-is-

driving-down-u-s-life-expectancy-new-data-shows. Accessed 17 June 2018.

America’s life expectancy has decreased over the past few years due to the opioid crisis.

The number did not drop much, but it will continue to drop if this issue is not resolved, or

at least slowed down. The country has seen a decrease in life expectancy twice, decades

ago and then a century ago. Drug overdose is quickly making its way to the top of the list

for most common reason of death in the United States. Researchers fear the opioid crisis

will get more severe before it gets better. A proposed solution is making the treatment

Buprenorphine more available to the public, so those suffering from opioid addiction can

get it easier. Healthcare centers say physicians have the power to help this issue by

changing their prescription trends.

This article was a good length to get lots of information from. It cited the CDC, and other

professional healthcare agencies so the data reports are full of facts, rather than opinions.

There was just one statement from one of the sources in the article that seemed slightly
 opinionated, and perhaps liberal. The author was well-educated, so I trust that her

research is strong. I learned a lot from the statistics. Therefore, this is a good article to

include in my paper because the audience could learn something too.

“Tramadol HCL.” WebMD. https://www.webmd.com/drugs/2/drug-4398-5239/tramadol-

oral/tramadol-oral/details. Accessed 21 June 2018.

Tramadol is an opioid narcotic analgesic medication. It is used to relieve moderate to

severe pain. Its side effects are vomiting, nausea, constipation, dizziness, or headache.

These side effects can be reduced by eating fibrous foods before taking the medication,

drinking water, and exercise. Before taking Tramadol, you should consult your doctor.

Tramadol is addictive and can be life threatening if addiction occurs. If an overdose is to

happen, call 911 and administer Naxolone immediately, if available.

This website is beneficial to my paper because it gives the public endless information on

any drug they look up. It tells you the medicine group of the medication, its uses, side

effects, interactions with other medications, precautions, and what to do in case of

emergencies such as addiction or overdose. It has a lot of valuable and possibly life

saving information. It even has pictures of the medication, so you know exactly what you

are taking. I trust this website because it is a medical site.