Journal of Student Research 2019

Journal of Student Research 118 by doctors to illegal/illicit substances like heroin containing the synthetic opioid fentanyl. The wide variety of ways opioids manifest means the epidemic is all encompassing; children to the elderly are overprescribed and addicted to pain medications, some turning to illicit sources like fentanyl and heroin. Wisconsin is not an anomaly in the rise of opioid users and addiction. Last year the national Department of Health and Human Services dedicated a webpage with the title of “opioid epidemic”; legitimizing the ongoing problem at a national level (Affairs (ASPA), 2017). However, when finding alternatives to legal opioid medications prescribed, hope comes in the form of a plant. According to a study published by CBS, marijuana could be a solution for opioid addicts (“Could marijuana,” 2016). With the mainstream media publicizing credible scientific studies about marijuana, there is a feasible solution to a current opioid epidemic. As more research is revealed, the effectiveness of marijuana as a form of pain management, specifically for people who are recovering from opioid addiction, becomes increasingly complicated. A systematic review of thousands of studies surrounding effectiveness of cannibas use during opioid addiction treatment found a variety of results. Some studies found that cannibas helped to sustain members in recovery programs when used as a pain management technique, while other studies found it increased the risk of needle-sharing and other high-risk behavior (Smith, Ravven, & Boyd, 2015). Apart from the studies of the effectiveness of cannibas in treating opioid addiction, the study also correlates people who use opioids are more likely to use cannibas than the average American. When treating opioid users, cannibas becomes a salient component in treatment, which makes looking at cannibas laws and regulations also essential. However, there is one additional restraint to incorporating cannibas in opioid treatment: marijuana, along with heroin, is classified as the most illegal and dangerous drugs under the Drug Enforcement Administration’s class one schedule (“Drug Scheduling,” n.d.). There is thus not a simple solution to this complex health crisis. Operating on several levels—judicial, health, and economic—attempting to treat a large-scale epidemic like the opioid crisis seems impossible, but this study attempts to shed light on potential policy intervention that could deal with growing opioid and injection crises through the goal of increasing health and wellbeing for Americans. To obtain a full understanding of the history of opioids and marijuana within US policy, I will first share background information to set the epidemic and its potential solutions in a larger frame. Next, I will discuss solution guidelines and introduce potential policy solutions to provide alternative pain management options for opioid users with the ultimate goal of decreasing opioid deaths.

A Case Study of California’s Syringe Exchange Programs on Illicit Opioid Use Background Knowledge To understand the complexity of the current crisis, further explanation must be given to the different levels of classification that opioids fall into and the problems that arise due to conflicting classifications. The main trend in creating opioid addiction is the widespread use of licit/legal opioid prescription medications for pain management. In 2016, the Center for Disease Control (CDC) published a ‘Guideline for Prescribing Opioids for Chronic Pain’ which focuses on patients “who endure chronic pain outside of active cancer treatment, palliative care, and end-of-life care” (“CDC Guideline,” 2018). They state that more than 11.5 million Americans over the age of 12 reported misusing prescription opioids in 2016. While the widespread practice of opioid prescription for pain management has become more monitored, prescriptions can still lead to misuse and abuse. Some listed side effects of these drugs include increased tolerance, physical dependence, and increased sensitivity to pain (“Prescription Opioids,” 2018). These practices have also given rise to an increase in use of illicit or illegal opioids like heroin and fentanyl. The CDC states that, between 2010 and 2017, the rate of heroin-related overdose deaths increased by 400%, similar to trends of increasing prescriptions of opioid medications followed by gatekeeping practices to monitor prescription misuse (Hedegaard, 2018). Other synthetic illicit opioids like fentanyl have also become popular substitutes for licit opioid medications. In 2017 synthetic opioid deaths were the leading cause of all opioid deaths, greater than heroin overdoses and opioid prescriptions (Scholl, 2019). As the medical community continues to gain knowledge about the side affects and problems associated with opioid pain management, solutions must also be made to deal with the illegal opioids that are used in response to a decrease in prescription practices. However, opioids are not the only pain management alternative that is also deemed highly illegal. As previously mentioned, The Drug Enforcement Administration created drug scheduling under the Controlled Substances Act of 1970, classifying drugs on a scale of toxicity and addiction levels (Kohl, 2010). Since then marijuana and heroin have been classified criminally with having, “no currently accepted medical use and a high potential for abuse”(“Drug Scheduling,” n.d.). This classification has created long-term problems for the Department of Health and Human Services, the agency that often deals with both substances and their users. As scientists have published studies claiming the effectiveness of marijuana at combatting addiction and pain management in users, the Department of Health and Human Services attempts to use this knowledge in practice. Yet, they must also work around the initial classification of criminality when treating patients. This struggle of drug and health classifications is a great barrier to treating the opioid epidemic. As long as a potential solution— marijuana—remains classified with heroin and other illicit opioids, there can be no official, widescale use or treatment within the United States to an alternative for

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