Racial Inequalities in Drug Users

Social and health disparities that demonstrates a racial gap among drug abusers

 The use of drugs is a controversial topic in society today. In essence,substance abuse is rightly a public concern and health emergency.However, amid the problems inherent in drug/substance usage, there are economic, health and social inequities and disparities amongst races. The drug enforcement policies are geared to unfairly target minorities as it has produced profoundly unequal outcomes across racial groups. Drug addiction treatments centers are either over crowded or not effective in minority neighborhoods. Effective management of drug abuse for minorities requires decriminalizing substance possession and usage which would involve using policies such as evidenced based treatment centers, strategies, research initiatives and drug prevention programs that are available in white communities.

How did it become a problem, a need, an opportunity?

 Substance abuse including opiate dependence, alcoholism, or abuse of any substance with potentially deleterious psychological and social effects, is a cultural and public health problem affecting many millions of persons, their families, their health and the society as a whole. “Drugs are chemicals that affect the brain by tapping into its communication system and interfering with the way neurons normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter” (NIH, 2018).In the 19^th century, Cocaine, recreational drugs and opium were all popular.However, coming to the close of nineteen century, significant social issues arose as individuals were abusing these aforementioned drugs. By the end of the 19th century, abuse of these drugs was a significant social issue, and public concern was growing. Physicians also used morphine, Cocaine, opium, and opium derivatives for treatment of pain,sedation and analgesia however,many individuals became unexpectedly addicted and dependent on these drugs due to its sedative and addictive properties.As many people discovered how easy and accessible these drugs were, the more dependent and abusive of these drugs for its euphoric effects became rampant. The Harrison Act was passed in 1914 in attempt to regulate the influx of personal drug activities. In the 20^th century because of the growing problems related to drug abuse, federal control of drugs began to take shape. Through taxation efforts, regulations were stipulated with strigent measures. Acts such as those found under The Harrison Narcotics Act of 1914 (Harrison Act; P.L. 63-223), enforced distributors, manufacturers and importers of opium, its derivatives and cocaine, to register with the U.S department of treasury. U.S Treasury in turn will then keep records of transactions and special taxes and tariffs imposed on the distrubutors and manufacturers. Also under the Act, all providers,practitioners were authorized to prescribe cocaine, opium and opium derivatives but the law under the Harrison Act was subject to many interpretations. Many prescribers, practitioners lost their licenses, privileges and went to jail as the treasury viewed ways patient drug maintenance was used beyond medical scope as originally stipulated. Narcotic Division of the Internal Revenue Bureau under the Harrison Act, closed down state and city narcotic centers/clinics and all who were found gulity of certain misdimeanor were sent to federal penitentiaries. Anyone who sold drugs were mandated under the law to register with the Internal Revenue Services and this gave exclusive prescribing privileges to doctors. Even though the Harrison Act curtailed some of the illegal drug activities, it did not eradicate nor prevent drug abuse or drug addiction. Drug problems continued to be on the rise with even new introductions of newer drugs like crack, synthetic drugs and LSD.Drug use impairs thinking and memory, and impacts how a person learns. It affects the abusers’ judgment often leading to bad choices and decisions that often times results in imprisonment or death.

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 People of all races and all walks of life abuse drugs however, the minority communities are the most impacted heavily and criminally. “African Americans and whites use drugs at similar rates, but the imprisonment rate of African Americans for drug charges is almost 6 times that of whites. African Americans represent 12.5% of illicit drug users, but 29% of those arrested for drug offenses and 33% of those incarcerated in state facilities for drug offenses” (NAACP, 2017).When someone has a criminal record it often becomes hard to gain employment. As such, the person cannot provide nor support his or her family while they are in jail and even after they have been released. This leads to a vicious cycle, The repercussions will follow someone for years to come because the strength or purity is impossible to know making the offender more likely to return to their prior criminal activities to support themselves.

 The families are affected financially.Addiction involves money, often massive amounts. When one involves in drug abuse, the act becomes more frequent and compulsive, and they often run out of cash and other resources to purchase their substance of abuse. When this happens, several things go wrong such as job loss, family break ups, abuse, depression, anger or violence which the caregivers, children or family as a whole suffers. Furthermore, default on various bills such as mortgages, rent, car notes and utilities are seen.When a person is unable to provide or contribute financially for their family, undue amounts of sleepness nights, indulging in alcohol, drug usage stress on their significant others, wives/husbands and even children abounds. Therefore, most minorities tend to live in poverty, or in low socio-economical conditions due to financial and family instability. When a parent abuses drugs, alterations in the way they reason, poor judgements, the risks they’ll take, makes them highly prone to aggressive or violent behaviors towards their wards. it is challenging, impossible to raise children when drug abusers fail to exercise proper judgments even for their own care. The children of drug users learn by examples. In addition, there is usually a genetic risk factor especially with regards to the biological chemistry between parents and their children, so children learn by examples thinking indulging in drug usage is normal. Foremost, these children may be more inclined to believe that indulging and abusing—these substances is okay and even acceptable. Other social implications includes motor vehicle deaths, teenage pregnancies, failure/abstenteeism from schools, suicidal/homicidal idealizations, domestic violence, and child abuse.

 Drug abuse causes health diseases including psychiatric disorders and even death. Certain drugs of abuse, like meth, heroin and cocaine amongst others, usually poses risks of potentially serious and deadly transmissible diseases. Hepatitis, primarily C, though B is of concern as well and HIV, are prevalent within certain populations of drug users. The primary pitfall is for injection drug users as they often share dirty needles but the risks also extends to other non needle users. This is largely because addiction lowers ones inhibitions, increases the propensityof risky behaviors and mainly opens an intense urge to obtain, find and use the drugs at all costs, which often times results in having risky sexual affairs.

When a drug abuser contracts any major disease, their partners are at risks as well. Similarly, pregnant women with drug abuse problems also places their unborn fetus at risks as they are either born with AIDS, failure to thrive, various anormalies and even death.

How did it capture the attention of the decision makers?

 Drug addiction has been in the spotlight drawing the attention of Presidents and legislators because of the damage incurred to the lives of so many Americans over the past few decades. According to Centers for Disease Control Prevention (CDC), “the provisional counts of drug overdose deaths has increased from 56,488 in May 2016 to 66,324 of May 2017, 17.4% change” (CDC, 2018). “Abuse of alcohol, and illicit drugs and prescription drugs is costly to our Nation, exacting more than $520.5 billion annually in costs related to crime, lost work productivity and health care”(NIH, 2018).

Identify the major policy makers involved and discuss their position on this issue.

 On October 26th 2018, president Trump announced that the opioid crisis was a public health emergency and this announcement clearly resonates with Former president Ronald Regan’s war on drugs on October fourteen, 1982. Also, former President Nixon who preceded these presidents also acknowledged that drug abuse is a public health issue. However, from my stand point of view, Former President Barack Obama’s strategy regarding drug abuse solution is what holds water. The Affordable Care Act promulgated by President Obama creates avenues for hope for abusers. “The Affordable Care Act (ACA) encourages primary care doctors to incorporate addiction treatment into their practices. It provided grants to several hundred community health centers around the country, many in rural areas, to begin or expand mental health and medication-assisted treatment, which combines counseling and drugs like Suboxone. This is a big improvement from the days when treatment typically was offered through scattered, poorly funded stand-alone clinics. ACA provides opportunities and increased access to public health insurance and encourages service integration. This is particularly critical for underserved populations that face numerous barriers to accessing AHS, resulting in disparities in access to needed services” (Guerrero, Fenwick, Kong, Grella, & D’Aunno, 2018). President Trump and his entire regime are addressing the drug addiction and opioid abuse alongside New Jersey’s Gov. Chris Christie who is chairing Trump’s opiod commission. However the actions outlined by President Trump’s administration does not exactly address the disparities and inequities of minorities:

1. “To expand access to telemedicine services which involves remote prescribing of medicines that are commonly used for mental health treatment and substance abuse.
2. Bureaucratic delays and inefficiencies in the hiring process are halted which allows the Department of Health and Human Services to hasten their steps in making temporary appointments of specialists with the needed tools and talents to respond effectively to our Nation’s ongoing public health crisis.
3. Grants the Department of Labor needed help for workers that are displaced, dislocated due to drug crisis.
4. Resources within HIV/AIDS programs are being provided to help people eligible for those programs receive substance abuse treatment, which is of utmost importance given the connection between HIV transmission and substance abuse usage.
5. Upon assuming his role as a President, Trump’s oval office has spent more than $1 billion in funding either for the allocation or eradicating of drug use and the crisis associated with opiod use.
6. Over $800 million has been allocated to drug prevention programs in Trump’s era for treatment and prevention,
7.  $254 million in funding has been spent in Trump’s era for high-risk communities, law enforcement, and care coordinators” (Trump, 2017).

Discuss nursing’s involvement and how the issue affects nursing.

Nurses provide direct care to subtance abusers and their families in different settings, clinics, hospitals, and drug treatment programs. APNs need to provide equal level of care for patients’ regardless of their race. According to the Centers for Disease Control and Prevention, “emergency room visits involving misuse or abuse of pharmaceuticals more than doubled from 2004 through 2011, while ED visits involving adverse reactions remained level during the past few years after increasing about 80 percent from 2005 through 2009. ED visits involving use of illicit drugs were relatively stable from 2004 through 2009, but increased about 25 percent from 2009 through 2011. The number of drug related adverse reaction emergency room visit in 2004 was 1.2 million and increased to 2.3 million in 2011, illicit drug in 2004 was 900,000 increase to 1.2 million and misuses of abuse of pharmaceuticals use in 2004 was 600,000 increase to 1.4 million” (CDC, 2018). This indicates an increasing problem that nurses face. Patients are the first priority of the nurse. Advanced practice nurses are in the position to advocate for the best interests of the patients and to maintain the patients dignity throughout treatment and care.Advanced practice nurses improve the quality of care the patients are receiving by ensuring the patients are able to understand their health, illnesses, medications and to prevent substance abuse. APNs have the responsibility to the decision making for their patients so as to make appropriate recommendations,actions and support to the patient and their family. APNs need to assist in finding resources for patients that are uninsured by contacting licensed social workers to help with various community outreach programs. APNs need to assist the best treatment programs regardless of the patients’ insurance carrier. APNs have the opportunity to apply evidence-based concepts from research to implement effective strategies that promote optional health which may include skills and comptencies needed to influence health-related policies to empower communities to take action in improving their health. Programs and drug prevention methods in underserved minority communities are another option.

What ethical concerns are related to this issue?

 Minorities usually do not receive the same treatment as their white counterparts. Americans have the rights to be treated equally and fairly and not be judged nor discriminated because of their backgrounds or race. As healthcare providers, reflecting on our own personal biases, being empathetic and treating patients according to their needs is paramount to their care and outcomes. The evolving roles of advanced practice nurses is becoming intertwined with the growing populace. Therefore, discrimination hinders equal treatment of patients and as nurses, we must continue to provide the human touch that is needed so as to prevent health deterioration.. “Research has shown that even when racial/ethnic minorities are insured at levels comparable with non-Hispanic Whites, they tend to receive lower quality of service for the same condition” (Coustasse, Singh, & Trevino, 2018).

Identify options for resolving the issue.

There are various options in resolving this issue. We as nurses must start from the grass root by advocating first at a local level. We can present the need for more advanced high-technology usage, evidence based drug treatment centers that will provide comprehensive treatments that are specially located in the poverty stricken communities. This can be achieved if the nurses join community boards, form nurses forums,cohort with board of the local health institutions and write letters to local legislatures. These creates avenues for APNs to become better advocators in their roles especially when it comes to the vulnerables.

Another option to resolve the issue would be for the government to provide financial incentives for healthcare practitioners such as grants, awards so as to provide centers that would provide education, guidance to curb the rise of drug abuses and also to establish better facilities with high-capacity drug treatment centers.

State your preferred solution and provide a rationale to defend your position.

Although having a good leadership forum including healthcare professionals and community leaders to take better charge of affairs in minority communities is great, however, building advanced and innovative capacity drug programs is a better option largely related to the fact that drugs possess addictive properties and the tendency to see someone or group of persons abusing these substances are high and there will be need for treatment options. Drug abuse, the outpour for its prevention and drug treatment programs are in high demands and relatively inexpensive especially when individuals remain on drugs and have no assistance nor way out. Programs for drug prevention, drug maintenace via substitutes such as methadone and drug treatment programs are in high demand in todays world. “The Affordable Care Act provides an opportunity to expand Addiction Health Services programs by creating various access to public health insurance and encouraging service integration” (Guerrero et al., 2018). Establishing evidence based treatment options,high- capacity drug programs and financial grants to healthcare professionals will help provide higher quality of care and individualized treatment plans in underserved communities. High-capacity drug programs reduces the waiting periods for enrollment in the program. It also provides adjunct treatment such as psychiatric services and HIV testing. High-capacity programs attracts more leadership,infrastructure and workforce training. When combined with contingency management, medication assistant programs,behavorial therapies, motivational interviewing, renowned drug recovery patients, the outcome outweighs the finances spent. Research shows that minorities are retained and complete the drug treatment in High-capacity drug programs than Whites. Improper method towards curbing the use of subsatnces include those that unfortunately group substance users together. Drug abuse treatment is not “one size fits all (NIDA, 2018).

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 The goal of prevention programs should be long-term, individualized, and include refresher sessions to prevent program destruction as time goes on. (NIDA, 2018, Botvin & Griffin, 2018). This would mean having patients stay in the programs as long as they are recovered. Programs should also be enforced for an certain amount of hours (at least 12 hours, according to Tobler et al., 2018). When substance use is rampant within the community, community-based drug prevention programs can be enforced immediately. Again, availability of drug abuse treatment is not “one size fits all.”

Treatment outcomes should depend on the following factors:

References:

• Botvin, G. J., & Griffin, K. W. (2018). Drug abuse prevention curricula in schools. In Z. Sloboda & W. J. Bukoski (Eds.), Handbook of drug abuse prevention: Theory, science, and practice (pp. 45-74). New York: Kluwer Academic/Plenum Publishers. doi:10.1007/0-387-35408-5_3
• Coustasse, A., Singh, K. P., & Trevino, F. M. (2018). Disparities in Access to Healthcare: The Case of a Drug and Alcohol Abuse Detoxification Treatment Program among Minority Groups in a Texas Hospital. Hospital Topics: Research and Perspectives on Healthcare, 85(1), 27-32.
• Criminal Justice Fact Sheet. (2017). In NAACP. Retrieved January 11, 2019.
• Drugs, Brains, and Behavior: The Science of Addiction. (n.d.). In National Instititute of Drug Abuse. Retrieved January 11, 2019.
• Emergency Room Visit for Substance Abuse. (2018). In CDC • National Center for Health Statistics • National Vital Statistics System. Retrieved January 11, 2019
• Guerrero, E. G., Fenwick, K., Kong, Y., Grella, C., & D’Aunno, T. (n.d.). Paths to improving engagement among racial and ethnic minorities in addiction (Master’s thesis).
• PROVISIONAL COUNTS OF DRUG OVERDOSE DEATHS, as of 8/6/2017 (2017, December 11). In CDC • National Center for Health Statistics • National Vital Statistics System. Retrieved January 13, 2019.
• Seeking Drug Abuse Treatment: Know What To Ask. (2018, June 1). In National Instititute of Drug Abuse Advance Addiction Science. Retrieved January 13, 2019.
• Soole, D. W., Mazerolle, L., & Rombouts, S. (2018). Monograph no. 07: School based drug prevention: A systematic review of the effectiveness on illicit drug use: DPMP Monograph Series. Fitzroy: Turning Point Alcohol and Drug Treatment Centre
• Tobler, N. S., Roona, M. R., Ochshorn, P., Marshall, D. G., Streke, A. V., & Stackpole, K. M. (2018). School-based adolescent drug prevention programs: 1998 meta-analysis. The Journal of Primary Prevention, 20(4), 275-336.
• Trends & Statics. (2018, April 1). In National Instititute of Drug Abuse Advance Addiction Science. Retrieved January 14, 2019.
• Trump, P. (2017, October 26). President Donald J. Trump is Taking Action on Drug Addiction and the Opioid Crisis. In The White House.