Everyone at Corban Gunn, Attorney at Law is dedicated to helping our local and nationwide communities build strong foundations that will lead to a brighter future. As part of that dedication, we decided to start a scholarship in 2017. The Spring 2018 submission period just came to a close, and we were truly humbled by the amount of applications we received as well as the overall quality of every essay. Thank you to everyone who applied!
We’re happy to announce that we’ve chosen a winner. Congratulations to Rebecca Carlson of Graham, NC!
Rebecca is attending her first year of graduate school at George Washington University Milken Institute School of Public Health.
Spring 2018’s essay topic was on the heroin epidemic and how we, as a nation, might take steps to seek a solution to the crisis. Rebecca’s essay was well-articulated and thoughtful.
Here’s her essay:
“To say that heroin use in the United States has become a problem over the last decade is an understatement. With the rise in heroin use and overdose deaths in the US over the last 10 years, it has become an epidemic requiring a multidisciplinary approach and cooperation between various local and national government agencies to combat. There is a role for community members, physicians, local law enforcement, public health agencies, drug addiction rehabilitation centers, U.S. Drug Enforcement Agency (DEA), and lawmakers in fighting the heroin epidemic. Below I propose a three-tiered approach to prevent addiction to heroin based on public health levels of prevention. The goal is to reduce the prevalence of addiction and overdose and improve treatment of heroin overdose to reduce fatality to fight the heroin epidemic.
Heroin use has increased among most demographics. According to the CDC, heroin use has increased among males and females, young and middle-aged adults, and all income levels in the United States. Deaths from overdose have also increased 4 times from what they were in 2010, according to the CDC, with males age 25-44 having the highest heroin overdose death rate at 13.2 per 100,000 individuals. Furthermore, past misuse of opioid prescriptions is the greatest risk factor for starting heroin. Not only is heroin use and overdose deaths on the rise, opioid prescription rates, deaths from opioids, and addiction to prescription opioids have all been on the rise in the past decade according to the CDC. Prescription opioids include natural opioids (morphine and codeine, as well as the semisynthetic oxycodone, hydrocodone, hydromorphone, and oxymorphone) and synthetic opioids (fentanyl and tramadol).
I said previously that combatting the heroin epidemic will require a three-tiered approach to interventions with primary, secondary and tertiary levels of interventions. Primary interventions should be focused on identifying at-risk populations and preventing heroin addiction. Secondary interventions should be focused on individuals already addicted to heroin and treat their addiction. Tertiary interventions should focus on the treatment of heroin overdoses. Using these three levels of prevention to fight the heroin epidemic will allow for state and local communities to assess their greatest need and focus on the interventions that meet their need saving time and resources. For example, a community currently experiencing a high rate of heroin overdoses and deaths would be best to focus on interventions to treat overdoses and prevent overdose deaths. This approach allows for a nationwide intervention to combat the heroin epidemic that also considers the varying needs of individual communities.
My plan for primary interventions involves identifying people at risk of developing an addiction to opioids before they use heroin for the first time and changing how opioids are prescribed. Being one of the most addictive illicit drugs, the pathway from prescription opioid abuse to heroin use is important to target when designing interventions. This is why it is vital to identify at-risk populations before they become addicted to heroin. People who are taking prescribed opioids to manage non-cancer pain and have a family history of addiction are at risk of developing an addiction to prescription opioids and heroin. However, it is not enough to simply identify individuals at risk of using heroin and developing a heroin addiction, communication between opioid prescribers also needs to be changed.
One of the loopholes that people seeking prescription opioids exploit is the lack of communication between medical providers. Another is the ability to use a family member’s or friend’s prescription. I’m proposing three actions to take nationwide to reduce access to opioids. The first is to develop a nationwide system for medical providers to record opioid prescriptions and use for patients. If a doctor knows before prescribing opioids that their patient was recently written a prescription they’ll be less likely to write another one. Second, policies need to be implemented at pharmacies to prevent a person from filling an opioid prescription written for a friend or family member. Third, medical providers should be encouraged to use alternative methods of pain management for their most at-risk patients. That is, patients with a genetic predisposition to developing addiction and chronic pain requiring some sort of pain management. These three actions will help to reduce the number of individuals that become addicted to prescription opioids and thus they will be less likely to start using heroin.
Secondary interventions involve expanding access to drug rehabilitation services, especially in populations with a high rate of heroin use. Expanding access to drug rehabilitation services by starting addiction programs at local community health centers, bringing addiction specialists to rural areas, and expanding telemedicine will make it possible to treat more heroin addicts. Telemedicine is a way to virtually bring doctors to rural areas and reduce costs as the alternative is to fund a physical clinical practice in these communities. It is also necessary to recognize the stigmas associated with heroin use and seeking treatment. These stigmas can be a barrier for many individuals to getting the medical and psychological care needed to overcome their addiction. Therefore, anything that can feasibly be done to reduce this stigma should be incorporated into the implementation of secondary interventions. A virtual heroin addiction recovery program with medical providers and psychologists is an alternative to drug rehabilitation centers that can eliminate some of those barriers. A person seeking treatment will not have to reveal their addiction to family and friends like they would if going to a drug addiction treatment program. It’s not enough to simply expand access to addiction treatment if people are discouraged from seeking treatment due to the stigma surrounding heroin addiction.
Lastly, the tertiary interventions involve improving treatment for people overdosing on heroin. The use of naloxone is integral to saving the lives of people who have overdosed on heroin and works immediately to prevent the action of opioids. Furthermore, because of the way naloxone works to block opioid receptors in the brain it poses a very little risk, even if the person is not having an opioid overdose. In a matter of minutes, the person will begin to breathe normally and be easier to wake. Given the risk of permanent brain damage that can result from an overdose due to lack of oxygen in a matter of minutes, it is imperative to distribute naloxone to the general public as well as to emergency services. However, naloxone is not always available for use by the general public due to local and state laws. I’m proposing that naloxone programs that distribute the medication and provide training on how to identify an overdose and treat with naloxone be implemented throughout the nation, with a focus on populations with high rates of heroin overdoses.
The heroin epidemic is a serious public health issue that has captured the attention of the nation. It seems every day there is a national news report on a consequence of heroin use, from the unconscious parents photographed in their car with a young child after using heroin, to the couple lying unconscious on a city sidewalk. It is a problem that can no longer be ignored because of the rising rate of heroin use and overdose deaths. There are three stages of interventions to implement nationwide to fight this epidemic. They include preventing addiction, expanding access to heroin addiction treatment, and allowing the general public to administer naloxone under Good Samaritan laws. Dividing interventions into these three focus areas will allow for the strategic implementation of interventions based on populations’ current heroin use and heroin-related overdoses and criminal activity.”
For more information on the next scholarship period which will be for Fall 2018, please see our law firm’s scholarship page. Congratulations again, Rebecca! Good luck in all your future endeavors.