The following post was written by Anastasia Zabludvoskaya.

Anastasia Zabludovskaya is a student of International Relations at University of Nottingham, UK. Currently she is taking part in Erasmus exchange programme at Universität Konstanz, Germany.

On October 27th, president Donald Trump has declared a long-awaited national emergency status on opioid crisis within the United States. According to CDC (US Centres for Disease Control and Prevention) data, opioid overdoses had reached its abnormal level in 2011 and has been growing since. However, its roots could be found in the beginning of the 1990s. The crisis has dominated the media for the past month and there are some basic questions that need urgent answers. I would like to explore what challenges the epidemic brings with it and what changes can be made to stop overdoses.

In order to gain a better perspective on the crisis, it is important to note, that Canada faces the same opioid crises that is happening in the US, with a death toll over 5.000 in 2016. The Minister of Health in Canada, declared that the opioid crisis has claimed more lives than the outbreak of AIDS. Yet, the case in Canada has not been picked up by the mainstream media. Recent research shows that it is possible to pinpoint the main risk group of drug users. In Canada, and also the US, most cases of hospitalisations are happening amongst the younger, male population. Also the ratio of overdoses is multiple times higher in smaller counties than in cities. With this data available, the government should be able to direct funds to those hotspots.

The declared emergency status can ease a financial burden of the states. One of the most curious decisions in this sphere, is freedom to use HIV epidemic funds to deal with the opioid crisis. This choice was based on the relationship between two diseases. Preventing opioid overdoses and drugs abuse, would result in decline of HIV.

The main issue lays in overprescribing heavy painkillers. Starting from 1990s the aggressive promotion of a new drug OxyContin, which is highly addictive due to its high amount of narcotic components. The company behind the OxyContin was aware of its risks, however it did not stop an active promotion of the drug. Overprescribing has brought an increase in drug trafficking and the use of much stronger narcotics, such as fentanyl. Prescribing patients OxyContin, even though their conditions may not require the usage of heavy drugs, has helped to create a new group of drug users with very strong addiction among the patients. The Oxycontin can be prescribed to children as young as 14 years olds, which potentially lead to an earlier abuse of narcotics. In order to get a hold on the massive epidemic, the government should be raising awareness on highly addictive medication. At this point a number of patients are relying on heavy painkillers in their day-to-day lives.

One of the urgent interventions would be to transfer the patients to a lighter medication. If the government will not take a stance on this question, more people will be in the risk group. The reality that the US and Canada are facing right now has no glory in it. Ferocity of the epidemic and inability to slow it down present real obstacles to the leaders. Besides modification of the prescription policy, the US should not undermine a potential of mental health services in this matter. As I mentioned earlier, most of the cases happen in rural areas. Getting psychological help where it is needed could make a significant impact on restraining the epidemic from its growth. Despite being hotspots of the crisis, rural areas struggle with providing mental health services. Timing and the quality of psychological support should be considered carefully.

Provision of emergency care has certain complications. Especially in the focus areas, locating possible overdoses is hard, unlike the users´ habits in big cities, rural areas have their own behavioural patterns. Narcotics are used at home in safe environment. The New Yorker article portrays the death of a young man in Ohio, who died of overdose in his own basement and remained there for two days before he was found. Unfortunately, incidents like this happen on regular basis. Finding the most effective solution to prevent similar cases should be prioritised. To increase efficiency of emergency help, the government should consider narrowing down the circle of risk groups: setting up a reliable data base of users that have a history of overdose hospitalisation and establishing a mobility unit, to assist the work of first responders could have a potential impact on reducing fatal outcomes.

This crisis is a cry for help among the entire nation. The United States is losing its entire healthy citizens without realising the consequences. Raising the awareness around the opioid epidemic should be on top of the agenda. Working with the risk group more closely could provide a significant result.

Trump´s declaration of health emergency is crucial, but a delayed start to the national campaign. Opening more funding possibilities for states is a move towards the solution, however there are speculations around how much financing there is actually available. Trump´s administration is known for shifting resources from health care to expand the world´s largest military budget. Donald Trump´s presidential campaign carried a deliberately provoking attitude “America first”, yet the raging epidemic in the country does not seem to occupy president´s mind.

Sources:

https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain