** Summarize the following paragraphs in ONE PARAGRAPH please.**
Just as my deadline approached for the editorial for this issue, Time magazine for March 5, 2018 arrived at my home. In this historic issue, entirely devoted to the topic of the opioid epidemic in the United States, riveting black and white photographs by James Nachtwey depict what is happening in my country. It is difficult for me to find words to describe the emotional impact of these photographs, even though I live in Appalachia, one of the regions with the highest overdose rates and heightened attention by the governor and the media to the crisis. In the disturbing Nachtwey photographs, we see addicts shooting heroin, suffering from withdrawal in jail, and lying at the roadside after overdosing. We see anguished family members overcome with grief beside coffins or tombstones of their children. The photographs put faces with the grim numbers that we see daily in the news media.
Here are the bare facts of the story and some of those numbers:
• Sales of opioids such as OxyContin quadrupled between 1999 and 2014 as physicians began to prescribe them for chronic pain conditions, assured by pharmaceutical companies that they were non-addictive
• A national survey in 2015 revealed that more than 1/3 of American adults used prescription opioids within that year
• 1 in 3 Medicare beneficiaries received opioids in 2016
• Overprescribing contributed to addiction and an unprecedented increase in morbidity and mortality (almost half of opioid overdose deaths attributed to a prescription opioid)
• Unscrupulous “pill mills” began to dispense opioids without medical justification
• Diversion of opioids for illicit use contributed to the widening epidemic (“doctor shoppers” feigned painful conditions in visits to multiple providers, then sold pills to others)
• Many addicts switched to heroin when “pill mills” were shut down and they were unable to obtain the pills to which they had become addicted, and heroin-related overdose deaths tripled
• Fentanyl, 50 times more potent than heroin, is often ingested inadvertently, mixed with other drugs, and fentanyl-related overdoses and deaths have now sharply increased
• By 2014 more Americans had died from drug overdoses than in any previous year on record, with 6 out of 10 overdose deaths attributable to opioids
• In 2016 there were almost as many deaths from drug overdoses (nearly 64,000) as in all of America's recent wars combined
• A plethora of well-intentioned federal and state initiatives, including tougher penalties for drug possession, have been undertaken, yet the epidemic is not waning
Words of drug users accompany some of the photographs in Time. Hear their voices:
“I got in a car accident and was in the hospital for three or four months. At first, I took it for the pain as prescribed…I started to like the buzz so I began taking more than I was supposed to.”
“I had a career in sales…making a lot of money…I always messed around with drinking, pot…then I started up with the OxyContins…It's an amazing feeling, that warm hug from Jesus.”
“Once you're into heroin, it's almost like a relationship with a person that you love. And letting go of that, the thought of never seeing someone I love again—I couldn't imagine giving it up forever.”
“Heroin grabs hold of you, and it won't let you go. It turned me into somebody I never thought I would be.” (“The Opioid Diaries,” 2018).
Other voices, depicting the societal stigma associated with opioid addiction, can be heard in a newspaper report on focus groups conducted in Appalachian communities near my home:
“Opioid addiction is ‘the new leprosy’…not only community members but law enforcement and health care providers were ‘judgmental and contemptuous,’ labeling addicts ‘trash’ and overdose deaths as ‘one more off the street.’”
[The researchers] “interviewed people who had been in recovery for 20 years, and they said they were still viewed in their community as a ‘junkie’ and an addict and they can't get a job.”
(Mattson & Reynolds, cited in Nelson, 2018. January 15)
As the readers of Time and newspapers listen to the voices of users, describing “the buzz,” “warm hug from Jesus,” even heroin being personified as a lover, and hear the pejorative views expressed by their neighbors, labeling the users as “trash,” they may feel paralyzed by the enormity of the problem, asking what can be done and how? But we as psychiatric-mental health nurses have knowledge and perspective–and compassion–beyond that of the general public. We are committed to conveying empathy, respect, and support to clients with substance use disorders. We are aware that many people who abuse substances such as opioids have been physically or sexually abused, and that opioids can physically change brain structure and function. We are also aware that evidence-based treatments do exist.
Medication-assisted treatment (MAT) has demonstrated effectiveness and deserves wider coverage by insurance companies. In a JAMA article, “A New Year's Wish on Opioids,” physician Joshua Sharfstein (2018) made a plea for medication-assisted treatment, decrying the widespread misconception that taking methadone or buprenorphine simply substitutes one addiction for another. Enumerating the benefits of MAT, Sharfstein listed reduction of intense drug craving, crime, transmission of infectious diseases, and overdoses. Some emergency departments are offering buprenorphine therapy right in the emergency department followed by ongoing treatment. This approach shows short-term success. After one year of MAT, 75% of opioid addicts have not relapsed, compared to a success rate of only 20% for abstinence-only approaches (Nelson, January 31, 2018).
However, too few opioid addicts receive the long-term treatment that is essential to prevent relapse. We are all familiar with the discouraging statistics on relapse of individuals with substance use disorders, especially those unable to obtain supportive aftercare, employment, and community acceptance. Stephen Loyd, medical director for Substance Abuse Services for the state of Tennessee, points out that an opioid addict who stays clean for one year has a 10–18% chance of making it to 15 years of sobriety. But an addict who remains engaged in treatment and aftercare for 5 years, has a 65% chance (Loyd, cited in Nelson, January 31, 2018). Loyd, who himself was privileged to receive inpatient treatment and 5 years of aftercare in a special program for addicted physicians, provides personal testimony regarding the persistence of opioid cravings throughout life. Just seeing a picture of a Percocet bottle on the internet recently caused him to tremble with overwhelming craving (after 13 years of being “clean”). In a candid interview with a newspaper reporter, he recounted all of the strategies he had learned to use to cope with craving: snapping rubber bands on his wrists, calling a buddy, reminding himself of all he had to lose if he relapsed. To achieve recovery, all addicts must learn new ways of coping with the powerful impulse to use the drug again.
At this point, how can we as psychiatric-mental health nurses add our voices of compassion, reason, and clinical expertise to the national conversation among professionals, legislators, law enforcement, and the general public? First, we can display commitment to the concept that recovery from substance use disorders is possible and thereby convey a sense of optimism to our patients (Worley, 2017). Worley challenges us to revise some of the language we use—even some of the language I have used earlier in this article—replacing terms such as abstinence and sobriety with “remission” and replacing relapse with “exacerbation.” She reminds us that defining a person by his or her illness, e.g., “addict,” is stigmatizing, even though they may still define themselves that way.
Nurses, with their holistic worldview, understand the importance of helping recovering individuals to find new ways of coping, self-soothing, filling their spiritual emptiness, and finding pleasure in life without substances (Melin, Eklund, & Lindgren, 2017). We also understand the necessity of individual therapy for working through childhood adverse experiences and other severe traumas such as domestic violence. Psychiatric-mental health nurses can effectively promote and/or deliver mindful meditation, yoga, support groups, cognitive-behavioral therapy, motivational interviewing, group and family therapies, and lifestyle interventions such as involvement in meaningful spiritual practices and physical activity (Simonton, Young, & Brown, in press; Cleary & Thomas, 2017; Worley, 2017). I invite your data-based articles about the interventions that you are delivering in facilities and communities across the country. I also invite our international colleagues to offer their perspectives and insights about our uniquely American epidemic. All voices can contribute to scientific advances and greater wisdom.
The paragraph describes the drug addiction or Opioid epidemic in United States brought into attention by a photographer through his photograph. The rate of addiction has greatly increased because of the prescription drugs ,easy availability. The addicted people ready to buy the drug at any cost .The use of heroin ,Fentanyl,pills ,Oxycontin where the chief drugs used to get a state of elation in the victims. The healthcare provider are responsible in appropriate prescription and follow up to prevent addiction.As Psychiatric mental health nurse it is a must to care for these victims also health educate,create awareness to all in preventing the opioid crisis and providing a healthy society.
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