Alabama Forms a Council to Counter Their State’s Opioid Epidemic

During the later half of this decade, Alabama was deemed as having the highest rate of opioid prescribing. As a result, the governor Kay Ivey established the Alabama Opioid Overdose and Addiction Council to head the state’s efforts in reducing opioid abuse. The council is made up of six sub-committees: Data, Prescriber-Dispenser, Rescue (Naloxone), Treatment-Recovery, Prevention-Education, Law Enforcement.

On the last day of 2018, the Alabama Opioid Overdose and addiction council released their annual report, featuring their extensive recommended action plan. The plan has five overarching objectives: prevention, intervention, treatment, community response, and workforce. Out of these, they strongly suggested focusing on the prevention and community efforts initially.

Additionally, this report also identified some treatment and recovery support options. The council promoted the My Smart Dose and Courage for All media campaigns, which deal with misuse education and aid, respectively. The report also mentions a 24-hours-a-day helpline of which the council desires to increase statewide awareness.

Click to access FINAL-Alabama-Opioid-Overdose-and-Addiction-Council-Report-to-Governor-2018-Read-only.pdf


Massachusetts’ Community-Centered Approach Finds Success Against Opioids

In 2007, the Substance Abuse and Mental Health Services Administration (SAMHSA) granted Massachusetts federal funding to address opioid overdoses. The state’s Bureau of Substance Abuse Services (BSAS) then divided up the funds among fifteen communities to develop innovative programs to fight the opioid crisis. This strategy was dubbed the Massachusetts Collaborative for Action, Leadership, and Learning (MassCALL II).

In Quincy, Massachusetts, the police department began their efforts by adjusting their policy. Instead of arresting those in overdose situations for drug possession, they now allow for them to call for help without being charged. In addition, officers have been trained in identifying and dealing with opioid overdose, and all police vehicles have been equipped with nasal Narcan. The city’s opioid overdose deaths dropped by 66% in a matter of months.

Similarly, in Revere, Massachusetts, the fire department has received training regarding the application of nasal Narcan, and they carry nasal Narcan on all their vehicles as well. Since this implementation, they have saved more than 90 lives.

Bedford, Massachusetts has taken a more faith-related plan of attack. They have utilized their religious leaders to educate their community about opioid addiction and treatment options while also reducing some surrounding stigma.

Closely akin to Bedford’s efforts, the South Bay House of Corrections is focused on teaching as well. The Roxbury-Jamaica Plain Substance Abuse Coalition provides the inmates with intervention in the form of five classes and a graduation ceremony. The classes focus on inmate experiences with opioids and the police as the inmates help teach each other. As of now, there have been hundreds of graduates from this program.

Slightly differing, the Saint Anne’s Hospital has taken a consultation plan of attack. They named their model the Screening Brief Intervention Referral to Treatment (SBIRT). Within this system, they gauge a patient’s involvement in dangerous actions, explain the good and bad aspects of it, and then help set up a plan to change their risky behavior.

Lastly, a group called Learn to Cope works across the state providing counseling. This program assists in supporting, guiding, and educating those with children o siblings suffering from addiction. Several parents within the organization are certified to train others on the application of Narcan, and 16 parents have saved their children from overdose using Narcan as of 2011.

With a rather community-oriented approach to tackling the opioid epidemic, Massachusetts has clearly already made groundbreaking progress. With evidence to support their method, perhaps other places across the world should look to Massachusetts to model their own plans.

Ohio’s Prevention and Education Strategies

The state of Ohio has recently put forth a considerable amount of effort in recent years. Governor’s Cabinet Opiate Action Team has prompted critical actions in attempt to prevent overdose deaths in Ohio. This includes the adopting laws that expand the access of naloxone (an opioid overdose reversal drug), strengthening the oversight of prescription drugs, requiring youth drug prevention curriculum in schools, developing guidelines for prescribing, closing pill mills, provisioning grant support and implementing tool-kits to local communities, investing for the integration of Ohio’s prescription drug monitoring program with electronic medical records and pharmacy systems across the state, and a focusing on public health and youth prevention campaigns.

Three departments within Ohio have been working together to address this issue. The Department of Public Safety of Ohio is the forefront of the 5 Minutes for Life educational campaign. Within this, ‘Ohio State Troopers, Ohio National Guard, or local law enforcement speak with student leaders about responsible decision-making and encouraging their peers to live a drug-free lifestyle.” The Department of Education has passed legislation which requires local school districts to cover the dangers of prescription opioid abuse within their health curriculum. This plays a fundamental role in Ohio’s Start Talking! Initiative, which gives parents and educators tips for talking to the youth about drugs. Lastly, Ohio’s Department of Mental Health and Addiction Services “leads the state’s Strategic Prevention Framework to guide communities in developing initiatives to reduce alcohol and drug abuse among teens and young adults.”

In addition to these action by the state government, there are many cases where young people directed prevention and education strategies throughout Ohio. Groups such as Prevention Action Alliance and Ohio Youth-Led Prevention Network are youth-led groups that took initiative amidst the opioid crisis. Additionally, young leaders from the Ohio 4-H Healthy Living Program created the display, “What’s in your medicine cabinet?” to raise awareness about the misuse of opioids and prescription drugs.,-Don’t-Forget-Our-Youth.aspx

The Opioid Crisis Seems to be Getting Better, but the Death Rate Still Continues to Rise

The opioid crisis and the misuse of prescription drugs are prevalent throughout adolescents. According to the Health and Human Services, 3.6 percent of adolescents ages 12-17 reported misusing opioids in 2016 and the percentage for older young adults were twice as high.

This percentage has decrease over the last couple of years. According to the Monitoring the Future National Survey Results, 1975-2018, the misuse of pain medication, excluding heroin, decreased from a peak of 9.5 in 2004 to 3.4 percent in 2018 among grade 12 respondents. More specifically, the “past-year misuse of Vicodin decreased from a peak of 10.5 percent in 2003 to 1.7 percent in 2018 and Oxycontin misuse has decreased from the peak rate of 5.5 percent in 2005 to 2.3 percent in 2018.”

Additionally, this national survey showed that students in the 12th grade believe that opioids are harder to obtain than in the past. In 2010, 54 percent of 12th grade respondents believed that these drugs were easily attainable, as compared to only 32.5 percent in 2018.

It may seem that the situation in the opioid crisis is becoming under control. However, the student death rates from overdose are increasing. In 2015, 4,235 adolescents between the ages 15 to 24 died from a drug-related overdose and over half of these were derivable to opioids. In addition, a larger population face health consequences from the misuse of opioids. The Centers for Disease Control and Prevention (CDC) estimates that for every young adult overdose death, “there are 119 emergency room visits and 22 treatment admissions.”

Click to access mtf-overview2018.pdf

Adolescents are Neurologically More Vulnerable to Opioids than Adults

According to studies in 2019, adolescents are developmentally wired to pursue highly stimulating behaviors to garner a large neurologic reward”. Unlike natural rewards such as eating food, opioids prompt a direct receptor binding of the signaling in the reward center. This is a psychoactive and forceful type of stimulation. As a result, the initiation of substance use peak during adolescence and early adulthood.

This type of risky behavior is more likely to be deterred in adults because of their development of the prefrontal cortex. This part of the brain is responsible for functions such as impulse control, self monitoring, and error correction. However, seeing that the prefrontal cortex does not mature fully until the age of 25 (approximately), the risky behaviors are less likely to be discouraged because of their insufficient development. This ultimately leaves the brain’s reward center vulnerable to changes that result in addiction.

Along with neurological vulnerabilities, physiologic vulnerabilities for opioids are intensified by environmental factors, such as availability, promotion, and cultural messaging.

Click to access peds.2018-2752.full.pdf

A Solution to the Youth Opioid Epidemic is Urgent

At 2014, the prescription rate of opioids increased by threefold since 1999. This exponential growth means that there is an increasing number of substances available to the public.

According to a national survey, youth and young adults state that it is easy to obtain and share opioids. Specifically, 32.7% of the respondents say that prescription opioids are easy to acquire and 49.5% of them state that they could do so within 24 hours.

As the availability of opioids aggravate the psychological vulnerabilities of substance use, the youth become increasingly susceptible to using these substances. However, programs designed for adolescents are absent.

Amidst the growing availability of opioids, programs that helps specifically the youth is vital and urgent in effectively step toward to solving the adolescent opioid epidemic.

Click to access peds.2018-2752.full.pdf

Teen Opioid Use Linked to Parental Use

Recent studies have shown that teens have a higher risk of addiction to opioids if their parents struggle with the problem. This study shows similarity to the use of alcohol, cigarettes, and marijuana among teens in relation to their parents’ use of those substances.

Further analysis shows that 8% of teens who did not have parent that abused opioids compared with 14% of teens with parents that abused opioids.






Public Health Crisis of American Indians

As African Americans lack representation within the medical field American Indians and Alaska Natives have even less representation.

Only 62 American Indian or Alaska Native students have graduated from the University of Wisconsin of Medicine and Public Health within the past 37 years out of 5,481 graduates.

The low number of American Indian/Alaska Natives graduates can be attributed in part due to internalized learned behavior from boarding school experiences passed from one generation to the next. It can also be attributed to lack of representation of physicians to serve as role models to other American Indian/Alaska Natives. Even so, sometimes American Indians/Alaska Native do not have access to physician care so they do not view that as a feasible attainment for them.

This not only impacts the number of American Indian/Alaska Natives physicians but the knowledge and way to treat American Indians/Alaska Natives is not very well understood.  A large majority of Americans lack knowledge of key health issues that impact their community the most and the best way to address such issues.