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.
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.”
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.
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.
Roughly 5 million Americans have their wisdom teeth removed annually. After these extractions most patients are prescribed opioids to help ease the pain. Studies have shown that young adults are more likely to refill these prescriptions after pain should have subsided from the extractions. If patients filled the first prescription they were more likely to get multiple refills later when compared to patients who did not fill the first prescription. Hydrocodone was the highest prescribed opioid with oxycodone as a close second.
Some dentists feel as though prescribing opioids after wisdom tooth extraction is excessive and unnecessary. Instead they think prescribing NSAIDs such as ibuprofen are just as effective if not better at relieving pain. Other ways to relieve extraction pain are using an ice pack in the affected area or rinsing with warm salt water for several minutes. The ice pack helps numb the area thus reducing pain, and warm salt water aids in reducing bacteria in the mouth which can cause pain.
“Now the Veterans Administration, building on a project started in Boston, is moving to add naloxone kits to the AED cabinets in its buildings across the country, an initiative that could become a model for other healthcare organizations.”
“Vets have nearly twice the risk of overdose, compared with civilians, says Amy Bohnert, an investigator with the VA Ann Arbor Healthcare System, citing 2005 death data. She says it isn’t clear why veterans are more likely to OD, but many do have complex medical conditions.”
This would be a major step in intervention of an acute overdose in a high-risk community. This would save EMS to patient time and increase the positive outcomes in veterans who overdose.