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Houseboat is the first part of a novel-in-progress set in the coastal town of Apollo, Maine during the Opioid Epidemic.

Utilizing a social construction perspective, this study uses a mixed method approach to examine the opioid epidemic. The study begins by identifying the numerous claims-making groups along with conducting a content analysis of the rhetoric and symbols used to legitimize the claims about the opioid epidemic. The data for the content analysis was obtained through a search of the websites, newsrooms, and pressrooms of claims-making groups. Additionally, the study examines and assesses the volume of money that is generated and allocated towards opioid research and prevention in an effort to determine who has more power to influence the policy initiatives. Findings show that the frequency of rhetoric and the number of claims-making groups releasing information about the opioid epidemic increased from 2010-2016. Most of the rhetoric consists of groups proposing resolution strategies and formulating new policies. Only a few claims-makers are making financial contributions towards opioid prevention initiatives and in most cases, it is a very small amount of money.

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America is engulfed in an opioid epidemic. Whether this is depicted through the tens of thousands of lives claimed by the number of drug overdoses each year, the unprecedentedly high and increasing rates of opiate abuse, or the broadening demographic profile of the addict, it is clear that the current issue is one that requires serious attention. As informed by the negative attitudes toward drug addiction that have prevailed since the War on Drugs was declared, it is hypothesized that much of the contemporary predicament is a result of this misinformation that did not resolve, but exacerbated the drug crisis. Despite the concurrent emergence of evidence asserting that addiction is a disease, instead, the idea that drug addiction is a failure prevails. As with many brain diseases, drug addiction displays both pathological alterations in the transmission of signals within the neural circuitries and the morphological defects associated with non-random regions of the brain. The alteration that is observed during opioid tolerance is the desensitization of mu opioid receptors to dopamine, resulting in the need of increased dosage of opiates to achieve the same high. During opioid dependence, key changes that are seen in the locus ceruleus and the mesolimbic reward system increase both the likelihood of an overdose event and withdrawal when an exogenous opioid is present or absent, respectively. There are two models that describe additional changes that occur during the transition from frequent abuse to addiction: (1) the “Changed Set Point Model” and (2) the “Cognitive Deficits Model.” All three variants of the “Changed Set Point Model” portray a shift in the physiological set points of dopamine and glutamate levels in the reward system and regions that control it. The “Cognitive Deficits Model” theorizes that the modifications localized to the prefrontal cortex are responsible for the ultimate transition. Once the abuser is thrust into the addiction cycle, additional changes in the neural networks are observed. These changes are seen in each of the three phases: (1) Binge and Intoxication, (2) Withdrawal and Negative Affect, and (3) Preoccupation and Anticipation. In the first phase, a process called drug-induced neuroplasticity occurs, resulting in the amplification of signals originating from dopaminergic neurons. Next, during Withdrawal and Negative Affect phase, among other changes, the amygdala is shown to be re-wired in such a way that the addict is more sensitive to stress. And finally in the last phase, the changes that occur, secondary to processes similar to drug-induced, are indicated in the prefrontal cortex. The current FDA-approved medication-assisted therapies include methadone, buprenorphine, and naltrexone. The single outstanding abstinence-based treatment is the 12-step program. In the evaluation of medical and non-medical interventions the relative efficacies were measured using the metrics: (1) rates of abstinence achievement, (2) rates of opioid use, and (3) retention in treatment. Individually, all therapies show moderate success when measured against each metric, which further validates the brain disease model for addiction, and also indicates that the future direction of addressing the opioid epidemic should point at combination therapies. What is most imperative now is for there to be more widespread recognition of the brain disease model for addiction.

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The rates of opioid prescription and use have continued to increase over the last few decades. In turn, a greater number of patients suffer from opioid tolerance. Treatment of acute pain is a clinical challenge for these patients. Acute pain can arise from common occurrences like surgical pain and pain resulting from the injury. P-glycoprotein (p-gp) is a transporter at the blood-brain barrier (BBB) associated with a decrease in the analgesic efficacy of morphine. Peripheral inflammatory pain (PIP) is a pain state known to cause a change in p-gp trafficking at the BBB. P-gp traffics from the nucleus to the luminal surface of endothelial cells making up the BBB. This surface where circulating blood interfaces with the endothelial cell is where p-gp will efflux morphine back into circulation. Osmotic minipumps were used as a long-term delivery method in this model of opioid tolerance in female rats. PIP induced p-gp trafficking away from nuclear stores showed a 2-fold increase when animals were exposed to opioids for 6 days. This observation presents a possible relationship between p-gp trafficking and the challenges of treating post-surgical pain in opioid tolerant patients. This could reveal potential strategies for improving pain management in these patients.

Objectives: Explain ideas to achieve meaningful, synergistic partnerships in combating the opioid crisis by leveraging unique areas of healthcare expertise (i.e., medical, payer, pharmacy) in collaboration with other key healthcare and policy experts. Describe innovative, results-driven solutions in development or in the marketplace to address opioid prescribing practices from the unique perspective of providers, pharmacists, health plans, patients and caregivers. Learn about the system breakdowns from patient and family member perspectives. Share possibilities for better integrating the voice and role of individuals living with addiction and caregivers into important solutions combating the opioid crisis. Identify the greatest, most near-term opportunities for improvements or system-wide changes, generally and for PQA.

This paper analyzes the impact of the 2012 legalization of recreational marijuana in Washington State on opioid abuse. Using synthetic control methodology, this paper finds that the legislation prevented 638 overdose deaths and lead to over 3,600 individuals seeking treatment for opioid abuse disorders. Due to the large health, social, and economic impacts of the opioid epidemic, further research should be conducted into ways to reduce the number of opioid prescriptions, the number of opioid overdoses, and opioid abuse generally.

US Foster Care is already known to be an under researched and complex topic, and the literature that is done tends to focus on the need for more investigation to improve this ineffective system. Foster care has even been described as “one huge experiment that has been conducted on children”, at a “cost of untold billions of dollars” (Courtney, 2000). This comment doesn’t seem too far off—there is a consensus that more work needs to be done in the realm of child welfare services, and some studies have even questioned whether removals and placements by foster care are beneficial at all (Doyle, 2006). In order to improve foster care and decisions in treatment (as these decisions have significant impact on children’s safety and well-being), we need to be more effective in using our resources and understanding the needs of the population, and the trends that might be influencing foster care. On that note, research by the US Department of Health and Human Services has shown a clear relationship between parental substance abuse and child abuse, and a study reported by Economic Inquiry (Cunningham, 2013), investigates this in terms of foster care. Cunningham’s study investigates the impact of methamphetamine abuse on admissions in foster care, and reports a significant causal relationship. This interesting report motivated me to investigate this further, and in terms of the recent opioid epidemic in the US. In this study, I adapt Cunningham’s strategies to investigate the effect of the opioid epidemic on US Foster Care, at a more recent time period. Surprisingly, I find different results for the opioid epidemic than the meth shocks, despite many variations of the model to proxy opioid use. My results show a negative relationship from opioid use on foster care admissions, while also confirming Cunningham’s study with a positive relationship with methamphetamine use and foster care at a more recent time period. This study will explain the methods that attain these results, as well as the reasons driving the results in the discussion. While contributing to Cunningham’s study, this study also contributes new research to a topic (the opioid epidemic) frequently mentioned in recent news. This study also considers the impact of this epidemic on individuals it might impact most, and addresses the gap in literature that exists regarding US Foster Care.