DEMOGRAPHIC ANGLE TO OPIOID PROBLEM

[Note:  This posting is a continuation of a report on the development of a civics unit of study.  This unit is directing students to formulate informed positions on the opioid epidemic.]

As indicated, this blog has been reporting on the opioid epidemic.  If new to this blog, the reader is invited to use the archive feature and review the last half dozen or so postings to become familiar with what has so far been reported.  This treatment is now going to review a list of factoids and insights that help describe and explain this epidemic and its harmful effects on the American public.

          More specifically, the following list of factoids and insights will highlight demographic information.  First are the factoids; they are:

·        American incidence of overdosing mostly affects whites, Native Americans, and working-class residents.[1]  For example, Native Americans have witnessed a 500% upsurge in opioid induced overdose fatalities between the years 1999 and 2015 – this reflects the highest increase of any identifiable demographic group.[2]

·        In the US, rural areas have experienced highest rates – as measured as a percent of the population – of opioid overdoses.  To quote Andrew Sullivan, “[Opioid epidemic] toll in one demographic – mostly white, working-class, and rural – vastly outweighs its impact among urbanites.”[3]

·        Alarmingly, from information gathered since 2006, one-third of all new abusers of prescribed drugs, were teenagers (particularly 12- to 17-year-olds).  A breakdown of this reported fact shows that that abuse outnumbered any illicit drug use with the exception of the use of marijuana.[4]

·        Opioid prescription rates in 2012 (as noted in an earlier posting) varied significantly among the various states of the US.  This is true even though reported incidence of pain does not vary across the US.  To summarize the variance, the highest rate, in Alabama, is roughly three times greater than in the lowest rated state of Hawaii.[5]

·        There is no evidence that differing amounts of opioids leads to better results in pain relief.  This is measured in terms of pain relief or patient satisfaction.[6]

·        Research has discovered that from the years 2000 to 2012, use of a variety of drugs – marijuana or hashish, cocaine or crack, heroin, non-prescribed methadone, among others – as measured by increases in admission for treatment was noticeably observed affecting people 55 and older irrespective of other demographic classifications.[7]

·        Among other findings, categorizing this older population’s admissions are as follows:  among African Americans the rate is 21% to 28%, among females 20% to 24%, among high school graduates 63% to 75%, among the homeless 15% to 19%, among unemployed 77% to 84%, and among those with psychiatric problems 17% to 32% of admissions.[8]

·        Some noted, exceptional incidence of death attributable to opioids among states and communities are as follows:  Palm Beach County, Florida, overdose deaths rose from149 in 2012 to 588 in 2016;[9] Middletown, Ohio saw opiate deaths of 967 in 2016;[10] Pennsylvania death rate due to opioids rose 44% in the year between 2016 and 2017 resulting in Governor Tom Wolf declaring a state of emergency.[11]

·        “The rising death rates for young white adults, ages 25 to 34, make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it.”[12]

In terms of generalizations, the following insights are offered:

·        Among lower levels of opioid abuse among black Americans – as speculated by a physician – are caused by doctors harboring stereotypic beliefs associating blacks with drug abuse and, therefore, these doctors’ reluctance to prescribe the drug to black patients.[13]

·        Researchers hypothesize that the reason doctors from various states prescribe opioids at different rates of frequency is due to a lack of agreement among medical professionals as to the appropriate amounts of medication patients need.[14]  This writer would add that there does not seem to be evidence that this variance is contingent on geographic location.

·        There seems to be a consensus evolving that chief among the reasons for this epidemic are the social, psychological, and physiological problems among users.  Apparently, these types of issues are being found to be the chief factors leading to users among whites as opposed to blacks in the population.[15] 

This concludes this posting’s review of factoids and insights regarding demographic factors and the opioid epidemic.  Apparently, more needs to be learned about how demographic factors are affecting opioid use and misuse.  Next posting will begin looking at government reactions to this crisis.

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[1] Dan Nolan and Chris Amico, “How Bad Is the Opioid Epidemic?” Frontline, February  23, 2016, accessed July 12, 2018, https://www.pbs.org/wgbh/frontline/article/how-bad-is-the-opioid-epidemic/ .

[2] “Native American Overdose Deaths Surge Since Opioid Epidemic,” R and D, March 15, 2018, accessed August 2, 2018, https://www.rdmag.com/news/2018/03/native-american-overdose-deaths-surge-opioid-epidemic .

[3] Andrew Sullivan, “The Opioid Epidemic Is This Generation’s AIDS Crisis,” New York Magazine/Daily Intelligencer, March 16, 2017, accessed August 2, 2018, http://nymag.com/daily/intelligencer/2017/03/the-opioid-epidemic-is-this-generations-aids-crisis.html .

[4] “Prescription for Danger,” Office of National Drug Control – 2008 Policy Report, for example, see https://obamawhitehouse.archives.gov/ondcp/prescription-drug-abuse1 , accessed August 1, 2018.

[5] “Prescribing Data,” Centers for Disease Control and Prevention, n. d., accessed August 2, 2018, https://www.cdc.gov/drugoverdose/data/prescribing.html .

[6] Dan Nolan and Chris Amico, “How Bad Is the Opioid Epidemic?” Frontline.

[7] “Trends in Substance Use Admissions among Older Adults,” BMC Health Services Research, vol. 17, 584, August 22, 2017, accessed August 2, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568321/ .

[8] Ibid.

[9] Jeff Parrott, “Patient Brokering Exacerbates Opioid Crisis in Florida,” South Bend Tribune, April 2, 2017, accessed August 2, 2018, https://www.southbendtribune.com/patient-brokering-exacerbates-opioid-crisis-in-florida/article_b8c68a56-165f-11e7-9c1d-bf6403fa10a5.html .

[10] Emily de La Bruyere, “Middletown, Ohio, a City under Siege:  ‘Everyone I Know Is on Heroin,’” Yahoo News, August 2, 2017, accessed August 2, 2018, https://www.yahoo.com/news/middletown-ohio-city-siege-everyone-know-heroin-155314072.html .

[11] Katie Meyer and Brett Sholtis (WITF), “Gov. Tom Wolf Declares ‘State of Emergency’ in Pa. Opioid Epidemic,” WHFF, January 10, 2018, accessed August 2, 2018, https://whyy.org/segments/video-gov-tom-wolf-declare-state-emergency-pa-opioid-epidemic/ .

[12] Ibid.

[13] Gina Kolata and Sarah Cohne, “Drug Overdoses Propel Rise in Mortality Rates of Young Whites, The New York Times, January 16, 2016, accessed August 2, 2018, https://www.nytimes.com/2016/01/17/science/drug-overdoses-propel-rise-in-mortality-rates-of-young-whites.html .

[14] Dan Nolan and Chris Amico, “How Bad Is the Opioid Epidemic?” Frontline.

[15] “Trends in Substance Use Admissions among Older Adults,” BMC Health Services Research.

A SAMPLE SET OF INSIGHTS AND FACTOIDS

[Note:  This posting is a continuation of a report on the development of a civics unit of study.  This unit is directing students to formulate informed positions on the opioid epidemic.  Presently, this development, in real time, is to share a set of insights (generalizations or principles) and factoids that help describe and explain this epidemic.]

Before sharing insights and factoids associated with the opioid epidemic, a word on the assignment the reader was given in the last posting.  That posting listed the American states according to how many opioid prescriptions, per 100 residents, were issued in 2012.  The assignment was to hypothesize how the information suggest a cause and effect relationship relevant to the abuse of opioids.

          Since the problem, especially early in the development of the epidemic, was over-prescribing the drug, one could hypothesize that in a conservative environment, one that shies away from regulating business activities, over-prescription would be more probable since there would be a reluctance for local government to regulate the selling of this product.

          To test this hypothesis in an off-hand way, the writer checked which of the top 15 states – those that prescribed the drug most readily – voted for the conservative/Republican candidate and those that voted for the liberal/Democratic candidate in the 2016 presidential election.  He also checked the same for the lowest 15 states.  This at best is an informal way to test this hypothetical relationship.

While in terms of number of states voting one way or another is heavily skewed toward Republican candidates (most states are sparsely populated and agricultural – a conservative political landscape), a definite bias probably would indicate that this suggested hypothesis is true.  So, is there such a definite bias?

Of the top 15 listed states, 14 voted for the conservative/Republican candidate and only one voted for the liberal/Democratic candidate.  Of the bottom 15 states, 11 voted for the liberal/Democratic candidate and 4 voted for the conservative/Republican candidate.  Without doing a sophisticated, statistical analysis, this seems like a definite bias. 

But it should be remembered, 2012 was relatively early in the history of this epidemic and states have become more attuned to the problem including the “Trump state,” Florida, which has been noted for its clamping down on prescribing opioids with regulations and prohibiting clinics from prescribing them.

To return to the basic aim of this posting; that is to explain the function of two curricular components useful in developing a unit of study.  The first is the role insights play and the second is the role factoids play.  Insights are generalizations or principles; that is, they identify or highlight some relationship between or among factors.

For example, if one states hot weather causes people to be irritable, then the weather is one factor and dispositional behavior is the other.  If the weather is characterized as being “hot” (say the temperature is over 90 degrees Fahrenheit), that causes or is correlated to people generally behaving in irritable (disposed to being upset) ways.  In turn, such statements can generally be tested to see if they are true.

In terms of using generalizations or principles in argumentation or debate, they can be used to function as warrant statements that justify some observation with some conclusion.  That is the function Stephen Toulmin[1] ascribes these terms in formulating a reasonable argument.  In this simple example, one can argue that since Johnny was playing baseball out in the hot sun, therefore he was bound to get angry when he was called out on a close play.

This might not be a good argument, but it illustrates the role of generalizations and principles play in argumentation.  So, if the aim of a unit of instruction is for students to build arguments, insights are useful if not necessary.  Further, as just shown, factual statements are also useful for they provide statements of observation.  They, in turn, serve as the “since” or “whereas” statements (“since Johnny was playing baseball”) in an argument.

As for insights, here is an initial list taken from previous postings that described some aspect of the opioid epidemic:

·        The beginning stages of an opioid addiction is noted by patients continuing to consume the drug beyond what a doctor prescribes to either minimize pain or to induce euphoric feelings.  This is chemically enhanced since the body builds up a tolerance – meaning the patient must consume more to induce the desired results and/or prevent withdrawal symptoms.[2]

·        Several written accounts claim that among the general population there has been widespread preference for a “pill” solution for medical concerns over behavioral alterations to daily routines such as exercise, change of diet, and efforts to reduce stress.[3]

·        Due to the extensive amount of reported cases of chronic pain among Americans in the late 1990s (c. 100 million), drug companies and the federal government were motivated to incentivize – to “push” – opioid drug prescriptions.[4]

·        Correlated to the increase of opioid prescriptions, there has been significant more people being admitted to medical facilities for drug abuse treatments and more deaths caused by opioid overdoses.  It furthers indicates that initially legitimate – usually clinical – prescribing of the drug has led to or diverted to an illegal distribution system which in turn has meant more misuse, addiction, and death.[5]

·        Due to their popularity, this increase has encouraged producers to increase the strength or potency of prescribed opioids such as with oxycodone (under the brand names OxyContin or Percocet) and hydrocodone (under the brand name Vicodin).[6]

And here are several factoids that can enrich a lesson on opioids and can, therefore, be used as datum statements (i.e., “since” statements):

·        A significant number of Americans reported in the late 1990s (circa 100 million or just under a third of the population) as suffering chronic pain.[7]

·        In the twenty years, from 1991 to 2011, prescriptions for pain (painkillers) tripled in the US.  The reported numbers were 76 million per year in 1991 and 219 million in 2011.  That number increased to 289 million opioid prescriptions in 2016. [8]

·        Strengthened opioids – more potent than morphine – were in 2002 only prescribed to one of every six drug users.  That number jumped to one of every three drug users by 2012.[9]

The next posting will continue reporting relevant insights and factoids that can prove to be useful either in developing a unit of study over the opioid epidemic/crisis or assisting students in formulating a related argument.  The topic will refocus on the demographic factors of this epidemic.

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[1] Stephen Toulmin, The Uses of Argument (London, England:  Cambridge University Press, 1969).

[2] Jacqueline Howard, “Why Opioid Overdose Deaths Seem to Happen in Spurts,” CNN, February 8, 2017, accessed July 2, 2018, https://www.cnn.com/2017/02/08/health/opioids-overdose-deaths-epidemic-explainer/ .

[3] Teresa Carr, Too Many Meds?  America’s Love Affair with Prescription Medication, Consumer Reports, August 3, 2017, accessed July 30, 2018, https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/ AND Jennifer Markert, “Pills for Everything:  The Power of American Pharmacy,” June 2, 2018, accessed July 30, 2018, https://curiousmatic.com/pills-for-everything-the-power-of-american-pharmacy/ AND Victoria Bekiempis, April 9, 2012, accessed July 30, 2018, https://www.theguardian.com/commentisfree/2012/apr/09/america-prescription-drug-addiction .

[4] “America’s Opioid Epidemic Is Worsening,” The Economist, March 6, 2017, accessed July 19, 2018, https://www.economist.com/graphic-detail/2017/03/06/americas-opioid-epidemic-is-worsening .

[5] G. Caleb Alexander, Stefan P. Kruszewski, and Daniel W. Webster, “Rethinking Opioid Prescribing to Protect Patient Safety and Public Health,” Journal of the American Medical Association (JAMA), vol. 308, 1865-1866, see http://www.addictioneducation.co.uk/21.01.2013PsycInfo%20VCrawford[3].pdf , accessed August 3, 2018. 

[6] For example, “Oxycodone Abuse,” DrugAbuse.com, n. d., accessed July 30, 2018, https://drugabuse.com/library/oxycodone-abuse/ .

[7] “America’s Opioid Epidemic Is Worsening,” The Economist.

[8] “Facing Addiction in America,” U. S. Surgeon General (SurgeonGeneral.com), 2016, site page no longer posted, see https://addiction.surgeongeneral.gov/executive-summary .

[9] “America’s Opioid Epidemic Is Worsening,” The Economist.