Running Head: CASE STUDY 2 PAPER

Case Study 2 Paper

The opioid epidemic is a major issue in the United States of America and is worsening as
time goes on. The epidemic has resulted in rising deaths resulting from opioid overdose, as well
as, increases in disease spread by needles such as; HIV transmission. hepatitis transmission, etc.
The opioid crisis is almost always encountered by emergency services who are called to treat
overdoses where they witness health inequity due to the stigmas that come with drug use (Levy,
2019). There are many strategies to help try and reduce the effects of the opioid epidemic that is
taking place in our country such as; syringe services programs, naloxone distribution, fentanyl
screening and medication assisted treatment. All opioid epidemic strategies tend to be
controversial based on the legality of the issue but evidence based strategies need to be put into
place to make a difference in local communities that are at high-risk and suffering.
Injection drug use is the most common way to contract hepatitis C virus, it also accounts
for over nine percent of HIV diagnoses (Levine et al., 2019). Also, “community-acquired needle-
stick injuries in the U.S. is estimated to be 2000 per year”, this costs the healthcare system $9.8
million (Levine et al., 2019). Syringe services programs are places where drug users can safely
and properly dispose of syringes and needles in exchange for new ones. This was created in
hopes to reduce needle sharing and improper disposal of used syringes. These syringe service
sites have been proven effective, when implemented in Miami, Florida, there was a reported 49%
decrease of syringes found after the program was implemented. There was also a reduced risk of
disease transmission, decrease of improper syringe disposal and an increase of syringes in
circulation without increasing syringes found in public (Levine et al., 2019). There is a certain
stigma of disapproval that comes with syringes services programs, they are not widely accepted
by the community. Therefore, it is hard to establish and receive funding for a syringe services
program with resistance from the community and the idea that they are encouraging drug use
when they are doing the opposite (Jones, 2019). Syringe services programs are very controversial
based on opinion and legality. There is a grey area where jurisdiction lies with drug use and
whether the police department or other enforcement should be involved. In the big picture,
syringe services programs are proven to do more good for the community than harm. The syringe
service program does not condone drug use but makes it safer for those who do use which
increases safety for the community by reducing unsanitary needles, reducing the transmission of
diseases and reducing mortality from said diseases (Jones, 2019).
Naloxone is a medication that reverses the symptoms of an opioid overdose, it works
very quickly to restore normal respiration of an individual. Naloxone distribution is a cost-
effective strategy that reduces the number of overdoses while causing no harm to the community.
In Florida, naloxone is available to the public to purchase with no questions asked. Having
naloxone available allows those who use or those who are in environments where this is an
extreme issue to be able to actively help. Overdose events are often witnessed but are not
reported due to the fear of having legal repercussions taken against them. Offering education on
the Good Samaritans Laws may be beneficial for naloxone distribution to be an effective strategy
(Townsend et al., 2020). Offering naloxone distribution would allow more effective recovery
from overdosing due to the time saved waiting for emergency services to arrive. An unintended
consequence of naloxone distribution is users would be able to treat each other and may not seek
healthcare when needed. This strategy would be more widely accepted due to the decreased rates
in mortality shown and relieving emergency services from being the only people able to give a
user a fighting chance. Therefore, reducing healthcare costs.
Fentanyl has become an increasing issue in United States and is leading to higher rates of
mortality. It has resulted in more overdose deaths than heroin and prescription related deaths in
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CASE STUDY 2 PAPER

the United States (Peiper et al., 2019). Due to fentanyl being so potent and being regularly mixed
with heroin, most drug users do not know when it is being sold to them. Therefore, fentanyl test
strips have been put into place as community outreach to reduce the number of over doses related
to fentanyl. When assessed if fentanyl testing strips would have an effect, it was reported that a
positive test result did alter drug use behavior and increased overdose safety (Peiper et al., 2019).
It would be more effective if paired with another evidence-based strategy to make an effect on
the opioid epidemic than standing alone. Due to drug use being controversial it is unlikely to be
popularly accepted by the whole community. Although, proven to be helpful by increasing the
safety of those who do use and are at risk for overdosing from fentanyl. Some unintended
consequences of fentanyl testing strips would be that the user would not alter their behavior after
a positive testing strip and reduce the amount they normally intake resulting in overdosing
anyways. Overall, if testing strips were paired with syringe services programs it could be more
effective for the user to remain safe and reduce their risk of overdose and having to utilize
emergency services.
Medication assisted treatment for opioid addiction is a 12-step treatment with the use of
medications which vary. It has shown that those who were compliant with treatment had more
favorable outcomes than those who were not compliant (Klein & Seppala, 2019). It also had
been proven to be ineffective long-term, whether the individual was compliant or not during
treatment, 6 months’ post treatment had no correlation (Klein & Seppala, 2019). This method is
only effective if the individual is seeking help to change. An unintended consequence of this
strategy would be if the person would go back to using then they would still be doing so
unsafely, unmonitored and possibly with dangerous substances such as fentanyl. To legally
complete treatment patients would have to be informed and be mentally aware and competent
enough to understand what they are taking part in which may open a roadblock with addressing
mental illness. This strategy is also only helpful to those who can afford treatment, most
insurance does not cover rehabilitation costs and it is costly and consumes long amounts of time
which is not feasible to everyone. As a public health standpoint, this strategy would be most
effective when collaborating with the other strategies to reach a broad population.
All in all, I would recommend a combination of the strategies provided to have the most
effective and beneficial program available to combat the opioid epidemic. Syringe services
programs have been proven to work by making drug use safer for the individual and the
community by reducing improper disposal of syringes, reduced risk of disease transmission
without increasing drug use or syringes found in public. This strategy should be paired with
fentanyl testing strips and naloxone distribution opportunities. The same place where they can
exchange and dispose of syringes, they should have access to the fentanyl testing strips and
naloxone. This would allow a user to be the safest they can possibly be if they choose to use
opioids. It would reduce the mortality rate from overdoses as well as the usage of emergency
services for opioid related incidents. While these locations would be easily accessed, resources
for rehabilitation should be advertised and openly educated about to give those who wish to seek
help the opportunity. These strategies all have their advantages but if they were put together it
would be the best solution to our opioid crisis. The only issue would be the allocation of funding
required to make such a big impact as well as the support needed from the communities on the
controversial issue at hand.
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References
Jones, C. M. (2019). Syringe services programs: An examination of legal, policy, and funding
barriers in the midst of the evolving opioid crisis in the U.S. International Journal of
Drug Policy, 70, 22–32. https://doi-org.dax.lib.unf.edu/10.1016/j.drugpo.2019.04.006

Klein, A. A., & Seppala, M. D. (2019). Medication-assisted treatment for opioid use disorder
within a 12-step based treatment center: Feasibility and initial results. Journal of
Substance Abuse Treatment, 104, 51–63. https://doi-
org.dax.lib.unf.edu/10.1016/j.jsat.2019.06.009

Levine, H., Bartholomew, T. S., Rea-Wilson, V., Onugha, J., Arriola, D. J., Cardenas, G.,
Forrest, D. W., Kral, A. H., Metsch, L. R., Spencer, E., & Tookes, H. (2019). Syringe
disposal among people who inject drugs before and after the implementation of a syringe
services program. Drug and Alcohol Dependence, 202, 13–17. https://doi-
org.dax.lib.unf.edu/10.1016/j.drugalcdep.2019.04.025

Levy, S. (2019). Youth and the opioid epidemic. Pediatrics, 143(2), 1–7.

Peiper, N. C., Clarke, S. D., Vincent, L. B., Ciccarone, D., Kral, A. H., & Zibbell, J. E. (2019).
Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe
services program in the Southeastern United States. International Journal of Drug Policy,
122.

Townsend, T., Blostein, F., Doan, T., Madson-Olson, S., Galecki, P., & Hutton, D. W. (2020).
Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder
and lay distribution in the United States. International Journal of Drug Policy, 75.
https://doi-org.dax.lib.unf.edu/10.1016/j.drugpo.2019.07.031