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Presented in this study is an analysis of the Nevada opioid crisis and how a viable solution can impact its severity. It does so in a public policy environment while synthesizing outside sources to support the presented claims. The scope of this study is to present a problem, cause, solution scenario on how to solve this policy problem. This study also takes into consideration Nevada’s current economic state amid the coronavirus (COVID-19). In addition, this analysis also addresses the history behind the opioid epidemic across the United States and how it is impacting Nevada in present times. The research findings of this study indicate that if inadequate treatment centers is a critical policy problem, and poorly allocated federal funds is the cause of this problem, then the solution is for Nevada to expand federal funds to all opioid treatment centers (OTC) across the state

Booth, Vanessa Marie

English

University of Nevada, Las Vegas Repository

Calvert Undergraduate Research Awards University Libraries Lance and Elena Calvert Award for Undergraduate Research 4-21-2020 Nevada’s Secret Killer: Opioid Deaths Vanessa Marie Booth boothv1@unlv.nevada.edu Follow this and additional works at: https://digitalscholarship.unlv.edu/award  Part of the Health Services Research Commons, Policy Design, Analysis, and Evaluation Commons, Policy History, Theory, and Methods Commons, Public Administration Commons, Public Policy Commons, Social Statistics Commons, and the Urban Studies Commons Repository Citation Booth, V. M. (2020). Nevada’s Secret Killer: Opioid Deaths. 1-15. Available at: https://digitalscholarship.unlv.edu/award/48 This Research Paper is protected by copyright and/or related rights. It has been brought to you by Digital Scholarship@UNLV with permission from the rights-holder(s). You are free to use this Research Paper in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/or on the work itself.  This Research Paper has been accepted for inclusion in Calvert Undergraduate Research Awards by an authorized administrator of Digital Scholarship@UNLV. For more information, please contact digitalscholarship@unlv.edu. 1     Nevada’s Secret Killer: Opioid Deaths    Vanessa Marie Booth UNLV Honors College Brookings Mountain West URST: 101-1001 (Introduction to Public Policy) Dr. Caitlin Saladino April 16, 2020      Nevada’s Secret Killer: Opioid Deaths                      2 Abstract Presented in this study is an analysis of the Nevada opioid crisis and how a viable solution can                  impact its severity. It does so in a public policy environment while synthesizing outside sources               to support the presented claims. The scope of this study is to present a problem, cause, solution                 scenario on how to solve this policy problem. This study also takes into consideration Nevada’s               current economic state amid the coronavirus (COVID-19). In addition, this analysis also            addresses the history behind the opioid epidemic across the United States and how it is impacting                Nevada in present times. The research findings of this study indicate that if inadequate treatment               centers is a critical policy problem, and poorly allocated federal funds is the cause of this                problem, then the solution is for Nevada to expand federal funds to all opioid treatment centers                (OTC) across the state.  Keywords: opioid deaths; substance abuse; Nevada; public policy           Nevada’s Secret Killer: Opioid Deaths                      3 Nevada’s Secret Killer: Opioid Deaths Introduction For the last decade, policymakers, leaders in the medical community, and Nevada            legislators have tried to get a grasp on the severe opioid crisis ravaging intersectional              communities across the state of Nevada. To provide some background information, opioids are             prescription drugs used to treat or alleviate acute or chronic pain (National Institute on Drug               Abuse, n.d.). They are also viewed as a class of drugs that interact with opioid receptors on nerve                  cells in the body and brain. They work to decrease feelings of pain and activate the reward areas                  of the brain. However, among society, these compounds are widely feared due to their association            with abuse, addiction, and adverse effects. The rising number of opioid users is not just an event                 happening in the state of Nevada, but across all of North America. Many ask though, how did                 this even come to be in the last decade? Originally, opioids were only used in severe cases like                  life or death to help treat patients. In the mid-1990’s pharmaceutical companies began             aggressively marketing new forms of opioids such as Oxycontin while claiming that they were              less addictive and could help improve the quality of life for many Americans. This new               concentration of opioids being distributed throughout society resulted in a sharp increase in the              availability of these narcotics.  Despite these events, the use of these drugs resulted in psychological dependence            throughout a variety of users. First starting off at legitimate use, dependent use, and finally               abuse. Some claim that many users then began switching to cheaper and more powerful illicit               opioids that were sold through third parties on the street. Nonetheless, many policy scholars              Nevada’s Secret Killer: Opioid Deaths                      4 today look at the opioid crisis as a multilateral-intersectional problem that can take on a variety                of forms when looking for a viable solution. Purpose The purpose of analyzing this policy problem in this study is to gauge a greater               understanding of the opioid epidemic ravaging Nevada’s healthcare system and families.  This study hopes to shed light on the threat the opioid crisis poses to Nevada’s communities and                 on possible pathways to solutions that can help mitigate its severity. Problem After describing a brief overview of the opioid epidemic’s history, what does this crisis              look like on Nevada soil? According to the live Nevada Opioid Surveillance Dashboard, there              were 11 opioid-involved deaths per 100k in 2018 (Nevada Department of Public and Behavioral              Health, 2018). From this, we can presume that there were approximately 330 deaths in the state                of Nevada during 2018. In addition, a Pew Research study also found that 46% percent of U.S.                 adults have a family member or close friend who suffers from opioid abuse (Pew Research               Center, 2017). Seeing that opioid abuse in Nevada is something extremely common, many             wonder if there is a time when it will ever come to a halt.  In addition to this, because this has been a crisis that has been going on for practically a                  decade, many Nevadans forget that it still exists and is worsening. Only when mainstream deaths               occur do people remember the opioid crisis threat to society. One scenario that has garnered lots                of public attention to the opioid crisis is the Nevada plane crash of March 2019 that killed three                  people. An article in the ​Las Vegas Sun stated, ​“A toxicology test showed the pilot had recently                 used three separate opioid drugs and a sedative that could have contributed to poor decisions,               Nevada’s Secret Killer: Opioid Deaths                      5 including overfilling the plane's fuel tanks by 178 pounds beyond the maximum weight” ​(Las              Vegas Sun, 2019). ​Not long after this, Nevada Attorney General Aaron Ford expanded Nevada’s              opioid lawsuit (Micher, 2019). ​These two scenarios however only shed brief insight on some of               Nevada’s recent involvement in the opioid crisis.  Knowing that many were very upset by the plane crash in 2019 and the increased amount                of opioid deaths across our state, officials have tried to take further measures to get a grip on the                   opioid problem which has failed due to their inability to target an effective solution. When               presented with a policy problem as complex as this one, it’s important to look for an effective                 solution that is both viable and will have the least amount of resistance.  Cause Seeing how opioid abuse is significantly common among Nevadans, it is extremely            important that there are a vast amount of opioid treatment centers (OTP) to treat these patients.                However, some may find it surprising that there are only 15 opioid treatment centers across the                state of Nevada, leaving rural areas with no treatment centers and unaccounted for. This can be                understood however because Nevada is such a large geographical region and although there are              not any treatment centers in the rural areas of Nevada, the opioid use/death rate resulting from                overdoses is significantly lower than compared to Las Vegas, Carson City, and Reno. Yet, the               biggest problem resulting from Nevada’s approach to addressing the ongoing opioid crisis is             Nevada’s underfunded opioid treatment centers. According to a guide published by the Nevada             Division of Public and Behavioral Health, three OTP’s out of the fifteen in the state of Nevada                 receive federal funding from SAPTA through the Federal Block Grant (Division of Public and              Behavioral Health, 2019, p. 21). This makes treatment centers extremely ineffective,           Nevada’s Secret Killer: Opioid Deaths                      6 inaccessible, and unaffordable. In addition, the majority of these facilities have programs that are              covered by public funds like medically assisted treatment (MAT), which combines behavioral            therapy and medications to treat substance abuse. Leaving these treatment centers to be publicly              funded instead of federally funded has resulted in many of them choosing to not prescribe and                host at capacity.  According to a survey from the Nevada Division of Public and Behavioral Health, the              main reasons OTP centers across the state of Nevada are not at prescribing capacity is because                “reimbursement rates are insufficient” (Division of Public and Behavioral Health, 2019, p. 25). If              opioid treatment centers choose to prescribe at full capacity, that means they can provide MAT               programs, narcotics, counseling services, career-building opportunities, and other services to          their patients. These services, if given to every patient seeking treatment, will likely increase              their chance to recover from their current opioid addictions. As claimed by the Brookings              Institute, “Broader access to substance abuse treatment may help individuals manage their            addiction and reduce the negative consequences of opioid use” (Brookings Institute, 2018).            However, that is not the case in Nevada when treatment centers are poorly funded and under                supported. A survey conducted by the Substance Abuse and Mental Health Services            Administration (SAMHSA) found that as many as 90 percent of people who most need drug               rehab or opioid treatment do not receive it (Substance Abuse and Mental Health Services              Administration, 2020). Seeing how many people who don’t receive opioid treatment on a general              spectrum, it’s clear that treatment will successfully minimize the number of opioid deaths             resulting from overdoses.  Nevada’s Secret Killer: Opioid Deaths                      7 While Nevada was awarded $1.68 million in federal grants to support the opioid crisis in               2019, there is a frequent trend of miss-allocating federal funds to opioid treatment centers              (Carson Now, 2019). In order to comprehensively address the epidemic, Nevada must have             adequately funded and supported treatment centers to prevent future overdoses. And although            opioid deaths have started a slow decline in the last two years, there are already predictions of                 higher opioid use due to the coronavirus. According to a U.S. Department of Health and Human                Services study, “poverty and unemployment are highly correlated with opioid use disorder”            (U.S. Department of Health and Human Services, 2018, p.2). Seeing that Nevada will soon see a                sharp increase in opioid cases/overdoses, it’s imperative that our treatment system and federal             funding allocations be readdressed before the opioid crisis worsens.  Solution While the Nevada opioid crisis is a multilateral problem with many different factors, the              timely and viable solution to solve this epidemic is to ensure that all OTP centers in the state of                   Nevada are federally funded rather than publicly funded. It’s clear that after the coronavirus              passes, Nevada’s economic infrastructure may not be up to the task of relying on public funds for                 these office locations. And while this solution alone may not completely solve all of Nevada’s               legislative loopholes in addressing this problem, it will definitely make a lasting impact on              intervening in the opioid addiction process by providing affordable and accessible treatment for             patients of all backgrounds. This solution will also prevent future damage to the opioid crisis as                it will soon see a peek from the coronavirus and open doors for policymakers. It’s imperative                that members of our state legislature and representatives in Congress act quickly to establish this               Nevada’s Secret Killer: Opioid Deaths                      8 allocation of funds as seen by the data I presented earlier which predicts a significant increase in                 opioid-related deaths due to the coronavirus.  Breakdown of Problem/Cause/Solution If inadequate treatment centers is a critical policy problem, and poorly allocated federal             funds is the cause of this problem, then the solution is for Nevada to expand federal funds to all                   OTP centers across the state.  Conclusion/Discussion The Nevada opioid crisis is a multilateral, complex, and intersectional problem.           However, because of its complexities, it deserves to be studied and analyzed in order for               policymakers to improve the lives of people affected by this epidemic whether it be their loved                ones, themselves, or colleagues. The opioid crisis is not immune to anyone and can cause severe                damage to Nevada’s healthcare system, families, and even communities. Seeing that the first step              in saving people from drug overdoses is providing treatment, Nevada must establish proper and              adequate federal funding to support all of its opioid treatment centers. Policy scholars should              also examine the possibility of investing in some rural OTP centers to ensure patients there               receive accessible treatment.        Nevada’s Secret Killer: Opioid Deaths                      9 Annotated Bibliography  Division of Public and Behavioral Health. Nevada Department of Health and Human Services.  (2019, June). ​Opioid state targeted response to the opioid crisis grant program.​ ​Nevada opioid crisis needs assessment.​ Retrieved from  http://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Resources/opioids/DHHS-data/NevadaOpioidCrisisNeedsAssessment061818.pdf  This guide presents information on Nevada opioid treatment centers, breakdown of federal funds, and role opioid abuse plays in Nevada’s healthcare system.   Doleac, Jennifer. (2018, December 7).​ ​Research roundup: What does the  evidence say about how to fight the opioid epidemic? Brookings Institution.   https://www.brookings.edu/blog/up-front/2018/12/07/research-roundup-what-does-the-evidence-say-about-how-to-fight-the-opioid-epidemic/​.  This​ article from the Brookings Institution provides insight on how effective substance abuse treatment is. It also targets discussing how vital it is that there be adequate treatment centers in places with a high number of opioid cases.  Gramlich, John. (2017, October 26). Nearly half of Americans have a family  member or close friend who’s been addicted to drugs.​ ​Pew Research Center​. https://www.pewresearch.org/fact-tank/2017/10/26/nearly-half-of-americans-have-a-family-member-or-close-friend-whos-been-addicted-to-drugs/  Nevada’s Secret Killer: Opioid Deaths                      10 This Pew Research Center study provides statistics and surveys regarding individuals knowing someone who suffers from opioid addiction or substance abuse.   Report: Pilot opioid use a cause in Nevada plane crash​. ​(2019, March 6). ​Las Vegas Sun​. Retrieved from https://lasvegassun.com/news/2019/mar/06/report-pilot-opioid-use-a-cause-in-nevada-plane-cry/​.  This article discusses a plane crash that happened in Nevada and how it was  caused by the pilot overdosing on opioids, leading to poor decisions. This plane crash  killed three people and shed light on the opioid crisis in Nevada.   Micher, Max. (2019, November 13). Nevada tangles with opioid  makers, distributors over documents. ​Las Vegas Review Journal. ​Retrieved from  https://www.reviewjournal.com/news/politics-and-government/nevada/nevada-tangles-wi th-opioid-makers-distributors-over-documents-1891751/ This article from the review journal discusses Nevada Attorney General Aaron Ford expanding the state opioid lawsuit in light of recent events from pharmaceuticals.   Munson, Jeff. (2019, September 23). Nevada awarded $1.68 m planning grant to  increase substance abuse treatment.​ Carson Now​, Retrieved from https://carsonnow.org/story/09/23/2019/nevada-awarded-168m-planning-grant-increase-substance-abuse-treatment  Nevada’s Secret Killer: Opioid Deaths                      11 This article, published by ​Carson Now​, discusses federal funds that were received to help combat the opioid crisis. Other important information in this article is the allocation of those federal funds and increasing more education on how to operate opioid treatment  programs.   National Institute on Drug Abuse. (n.d.). ​Brief description on opioids. ​Retrieved from  https://www.drugabuse.gov/drugs-abuse/opioids   This is a brief description taken from the National Institute on Drug Abuse website discussing what the purpose of opioids are and how they affect the body.   Nevada Department of Public and Behavioral Health. (2018, December 30). ​Nevada opioid  overdose surveillance dashboard. ​Retrieved from ​https://opioid.snhd.org/  This surveillance dashboard, provided by the NDPBH,​ ​displays data about opioid cases, opioid deaths, and hospital visits across the state of Nevada. It is also a live surveillance dashboard where ​previous years’​ statistics on opioid deaths in certain geographical locations in Nevada can be viewed and analyzed.   American Addiction Centers. 2020. ​Rehab success rates and statistics. ​Retrieved from  https://americanaddictioncenters.org/rehab-guide/success-rates-and-statistics​.  This article provides information on substance abuse treatment and discusses a study that provides statistics and coincides with opioid treatment.  Nevada’s Secret Killer: Opioid Deaths                      12 U.S. Department of Health and Human Services. (2018, September 11). ​The opioid crisis and  economic opportunity: Geographic and economic trends​. Retrieved from https://aspe.hhs.gov/system/files/pdf/259261/ASPEEconomicOpportunityOpioidCrisis.pdf​. ​This study from the US Department of Health and Human Services discusses statistics on the correlation between opioid abuse and poverty.                 

Nevada’s Secret Killer: Opioid Deaths

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Nevada’s Secret Killer: Opioid Deaths

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