Browsed by
Month: November 2016

Social Determinants of Health

Social Determinants of Health

As far as public health goes, I was always under the impression that as long as people ate their vegetables, visited the doctor for their flu shot come October, and payed their health insurance bills, they’d remain reasonably healthy and be prepared financially for a bad case of pneumonia or a broken ankle. Learning about the social determinants of health and the realities of healthcare inequality in UC105 has called a couple of things to my attention. First, for most Americans, managing health and accessing healthcare is far from this simple. And second, the reason managing health has seemed so simple to me is due in large part to my social identities–they’ve made quality healthcare and health education unconventionally accessible.

Growing up, my family was very close with my maternal grandparents. They lived no more than 15 mins away, and we had lunch at their house after church every weekend. My grandpa is a retired physician and my grandma a retired nurse, so whenever I ran a fever or woke up feeling nauseous as a little kid, all my parents had to do was give them a call. Sure, I went to the doctor’s office for check-ups and the emergency room for a couple broken arms, but sincere medical advice was always just a phone call away, free of charge.

Today, healthcare is available to me at UHS and is covered by my parents’ insurance plan. I am a college student in a healthcare-focused, substance-free learning community, and am thus afforded not only the opportunity to take classes pertaining to health–like UC 105 and my Women’s Health 220 class, for example–but am also surrounded by peers who are passionate about maintaining personal health and promoting it as aspiring health professionals. I am literally on a committee that meets weekly to discuss health and wellness.

Nonetheless, there are times when the university environment, especially outside of HSSP, promotes unhealthy behavior–accumulating intense, academic-derived stress, binge drinking, and skipping out on sleep are normal, almost fashionable practices. All too often, I’ll stroll through Mason Hall and overhear students boasting about the exam they just took on 3 hours of sleep or how they’d just studied for 11 hours straight without leaving their dorm room.

With relatives in healthcare and as a college student in a pre-health learning community, my social identities have affected my health in primarily positive ways. How have your social identities impacted your health?

 

Opioid Epidemic in America

Opioid Epidemic in America

I have previously heard about Opioid before lecture, but couldn’t recall much. I learned from lecture that Opioid abuse is a serious public health issue. Its usage has caused a rise in overdoses and deaths. The number of people who have died from overdose of the prescription opioids has nearly quadrupled in the United States, according to the Centers for Disease Control and Prevention. Addiction is very difficult to stop. Many individuals try to battle the urge, but sometimes help from others is needed in order to get rid of addictions.

People who are prescribed Opioids for pain, the drugs typically do not lead to addiction if people use them as directed. But, for those individuals that have it prescribed to take for a year will develop an addiction disorder.

To mitigate this problem, one can limit the prescribed opioid. There can also be regular monitoring in order to provide opportunities to minimize the risks associated with long-term opioid use by discontinuing of opioids among patients who are not benefiting from it or among those who are engaging in practices that increase the risk of overdose.

Another solution is to educate the patient (and the patient’s family) about overdose risks, the use of an opioid treatment, increased caution in prescribing high opioid doses, and more frequent clinical follow-ups.

The Opiate Epidemic

The Opiate Epidemic

Before having learned about the opioid epidemic in more depth on Thursday, I had only heard of it briefly. I was shocked to hear how far this epidemic has spread in America and how many people are afflicted with addiction to opioids. There are now 3 to 5 hospital emergency calls a day due to overdose instead of a few per month. Also, this epidemic is not one that only effects lower income urban areas, but has started to effect people who live in suburban areas as well. This was surprising to me because most drug epidemics in the past have mostly been confined to inner city areas. While I feel glad that this issue is beginning to receive more attention, it is also sad that it had to spread to middle class suburban areas in order to gain the attention that it needs to provoke change.

Another thing that struck me about this epidemic is that it has been categorized by many as an iatrogenic one. Doctors and other healthcare professionals seem to be abusing the power of these drugs without considering the extremely negative ways that they can impact patients’ lives.

This epidemic can be helped on many different level of the social ecological model. On the public policy level, I think that there could be more regulations put on the prescription of opiates. Doctors should be made to try every means of pain prevention before prescribing opiates to patients due to the extreme risk that comes with taking these drugs. On a community level, people in effected areas can create outreach programs that provide people who are afflicted with opiate addiction in any way they need. These ways could include counseling and also connect them with rehabilitation centers in order to help them get rid of their addictions

The Opioid Epidemic

The Opioid Epidemic

Before class I thought I understood the opioid epidemic because I have known a couple people that have struggled with addiction, but once I left class my view on the epidemic had nearly completely changed. I thought addiction was something that could never affect me or anybody I love and that it only happened to people of a lesser socioeconomic status than myself, but that’s what makes the opioid epidemic so unique and dangerous – it can affect anybody. One could go in for a routine surgery and be prescribed pain medication and six months later have to check into rehab for an addiction to painkillers and thats what makes this specific disease so terrifyingly easy to come across. The one thing that struck me the most was the shear number of prescriptions in the US. I find it a bit unnerving that there are enough prescriptions in Michigan for every citizen to have more than one.

In order to mitigate this issue, I would start with a change in policy. Reserving only the highest pain killer for patients who have clearly demonstrated the highest level of pain. This would decrease the number of prescriptions for medications that have shown high addictive qualities such as Vicodin. Another way to work on solving this problem is by educating the recipients of the prescirption on proper use and disposal of medications. Once given a prescription for an opioid, I think it is really important that a physician go over what to do once the patient is finished with the prescription and how to correctly and safely use the medication.

 

Over-Prescription of Opioids

Over-Prescription of Opioids

Prior to this week’s lecture, my understanding of the opioid epidemic in America was hardly any. Dr. Terri Voepel-Lewis really opened my eyes to how relevant this situation is. We hear stories of celebrities dying due to overdose but there are millions of Americans facing the same issue. The victims in this epidemic are not just the patients that become addicted to the opioids but also families and friends who have to witness their loved ones suffer from addiction.

I was struck by the fact that physicians were considering pain to be a fifth vital sign when it is very hard to measure. How would they know when someone is truly in pain and when someone is just trying to get their hands on narcotics? Dr. Voepel-Lewis mentioned that this has made providers judge their patients which should not be allowed in an unbiased environment. I was also struck by the governments’ position on this situation. They said they would focus on improving the treatments for those who become addicted rather than finding a solution to decrease the level of opioids being prescribed.

If I could do something to try to mitigate this problem, I would start from public policy. As I have mentioned earlier, I believe the government should put some laws and policies to decrease the levels of opioids being prescribed. The government made Vicodin a schedule II controlled substance which has made it more difficult for the opioid to be prescribed and distributed, so there should be more of that being done by the government. However, there should also be institutional factors to help avoid over-prescribing opioids. Hospitals and other providers should monitor who they are prescribing opioids and work with the patient even after their visit to make sure that they do not begin to rely on the drugs. There are of course other ways to fight the epidemic, what other ideas do you have?

Opioid Epidemic

Opioid Epidemic

Personally, I felt like this lecture opened my eyes to the process of how the opioid epidemic began.  I was surprised to see how some of these drugs began as simple pain medications and how WWI sparked morphine addiction in the United States.  Looking at it in hindsight, it is very clear that one thing led to another and it seems crazy how out of hand it has gotten since these drugs (opium, morphine, heroin) were first used as medicine.  I was also very surprised at the idea that hospitals and doctors began using pain as a vital sign.  Again, it is easy for me to judge in hindsight, but pain is different for everybody so I am baffled that they could create a standard based on something that varies for each person.  And it proved to be one of the main reasons why the opioid epidemic has gotten to the point that it is at right now.  What is something that surprised you from this lecture and how has that affected the growing issue of opioid addiction?

SEM stands for The social- ecological model is something that can be used to categorize certain topics of discussion and how each of these models has either helped or hurt the issue at hand.  The social-ecological model consists of 5 different levels. These levels include:

  1. Intrapersonal factors
  2. Interpersonal factors
  3. Organizational factors
  4. Community factors
  5. Public policy

Of these different levels, all of them can be intervened with to try to mitigate the problem of opioid use, but three in particular that would be most effective are public policy, community factors, and organizational factors.  It is necessary to regulate these drugs by federal laws, which makes it more difficult to obtain these drugs in the first place.  However, people who are addicted already are still going to find a way to obtain these drugs so community factors become important because it allows for change on a smaller scale.  Usually people who are effected by opioids aren’t all spread out within an area, they are within a certain community so people within the community that is effected needs some organization to help them.  And lastly is just that-organization.  Without some standards and outlines to guide people, it will be very difficult for people to get the help they need.  What are some ways these different levels of the SEM can help create positive change for this nationwide issue?  Do you believe this is something that needs immediate attention or is it not a priority right now for the United States?

 

Over prescription of Opiods

Over prescription of Opiods

In this lecture, the fact that physicians started to consider pain as a fifth vital sign and treat it so aggressively surprised me. Pain is very different for each person as everyone has a different pain tolerance. I was struck that doctors were prescribing such strong medications for something that is not carefully measured, like blood pressure or temperature. Also, in my experience, when I have gotten sick my doctor will usually prescribe a generic medication and if that does not work will later prescribe something stronger. I thought it was very odd that so many physicians were prescribing incredibly strong and addictive pain medications right off the bat rather than starting with something weaker like Tylenol or ibuprofen.

In order to resolve this problem, I would either intervene on the individual level or the relationship level. First the individual level by understanding the patient’s background to see if he or she will be at a greater risk of becoming addicted to the opioids. If he or she is, I would consider prescribing something else if that is possible, but if not discuss the harmful and addictive effects the drug may have as well as how to deal with effects. I think many patients that became addicted to their pain medications did not know how to deal with the effects and resulted to street drugs to continue achieving the high they were getting. I would also intervene the relationship level by ensuring that the patient will have a support group and that they understand the effects the drugs may have on the patient. I think it is important that the patient has people to turn to in case the drugs have negative effects and that the patient will be able to receive the help the may need from the people around them.

The Shocking Effects of the Opioid Epidemic

The Shocking Effects of the Opioid Epidemic

As someone who had little knowledge related to the opioid epidemic previous to the lecture, much of what Dr.Terri Voepel-Lewis shared was shocking. I recently had a surgical procedure over the summer, and I was prescribed such large amounts of Vicodin and morphine that I ended up with plenty left over. The potential danger of the overload of opioids sitting in my cabinet didn’t cross my mind until lecture. It was frightening to learn how easy it was for many patients to become fatally addicted to these drugs that are commonly prescribed to treat pain. I was especially saddened to learn that the number of babies born with drug addiction has been drastically increasing due to opioid abuse. Since my pain was often measured on a scale from one to ten after my procedure, it was also interesting to learn that in June 2016, the AMA dropped pain as the fifth vital sign.

In February 2016, whitehouse.gov stated that more Americans now die every year from drug overdoses than they do in motor vehicle crashes, and many of the deaths are opioid-related. This fact is a testament of how serious the opioid epidemic is and how it is negatively affecting our country.

I believe initiative in the public policy and organizational levels of the social ecological framework would have the greatest impact on the opioid epidemic. According to lecture, actions by Congress on opioids have been focused on treatment rather than limiting. I personally think it would be more effective if there were more federal regulations on the prescription of opioids and how health professionals assess pain. We also learned in lecture that if one harmful drug decreases in abuse, another will increase. Many over-the-counter drugs are known to be commonly abused. Therefore, on the organizational level, I believe the availability and use of over-the-counter drugs in local pharmacies must be better monitored. Overall, it is way too easy to gain access to dangerous opioids.

In your opinion, who is to blame for the opioid epidemic? How could health care professionals better assess and treat pain to prevent over-prescription of addictive opioids?

Over Prescription of Opioids

Over Prescription of Opioids

Not having had any knowledge about the medical history of opioid use, I was struck right from the beginning at the notion of the opioid epidemic being an iatrogenic. Suddenly, my perception of doctors and medical treatments had changed yet again (the first time was when I learned about health/treatment disparities caused by unconscious biased). What is alarming to me is that this opioid iatrogenic was induced by the misconception that physicians were improving patient health with the treatments that they were prescribing at the time.

By using the socio-ecological model, we can analyze and identify the different factorial levels that contribute to the induction of the epidemic. One level at which we could intervene to try to mitigate this problem is the individual level. This would mean providing patients with knowledge on the history of opioid use and the potential risks that come along with it. This can be mediated in several different ways, whether that be through distributing informational pamphlets in the doctor’s office or conducting group education sessions at the hospital. By making different health resources available to patients, they are able to gain more control over their own bodies.

Another level that can be intervened is the interpersonal level. As portrayed by the post-Civil War opium addiction and the Ann Arbor local who had died due to overdose, people with histories of opioid use/abuse are at a greater risk of abusing the drug. A potential method for reducing this risk is providing the patients who are prescribed large amounts of opium a counselor whom they can speak with regularly about how they are feeling. The counselors would check on the patients regularly and pay attention for any symptoms suggesting overdose/abuse.

Over Prescription of Opioids

Over Prescription of Opioids

What struck me most from this lecture was in the beginning of the lecture when Dr. Terri talked about some of the major historical events involving Opioid use. What blew my mind was when the first documentation in 3200 B.C of Opioid use. I never even knew that documentation like that would exist. I never even knew people could tell what opioids where. Then in 220 A.D opioid was first documented for being used in surgery in China. What is interesting and mind-boggling is that it was not found as an addicting disease till 1914. This is when the first documented mention of the addiction took place. All the time it took and all the addictions that could have occurred in between where never caught. Many people could have died and that is a bit scary that doctors at the time did not notice anything, or even family members.

The four level of social ecological framework are the following: Individual, Relationship, Community, and Societal. I will talk about two levels, Community and Individual, where you could lessen the use of opioids. Community refers to settings such as schools, workplaces, neighborhoods and many other places. A person’s community has an incredible affect on how they can turn out. In this case, growing up in certain neighborhoods can affect their use on opioids. Growing up in a violent neighbor they may be more susceptible to use of opioids. In order to mitigate this problem, there should be more police reinforcement in the area watching out for any deals that can happen. Also there should be buy backs, where the city will offer to buy drugs that have been sitting around or anything like that. As for the “Individual” level, this is a difficult level to mitigate such a problem. Growing up in a family, for example, that only knows drugs and opioids are not much in your favor. If you see your family doing it, you will think it is okay; however, a solution can be catching the addiction early and reaching out for help before it is too late. Get psychological help, rehab, or anything along those lines. It would not be wrong as well to get him within the family or to contact support groups because you can be saving those closest to you, or even your own life.