Rough draft for ENG102 leading up to final project. Seeking guidance on the flow of the essay, shifting from topic to topic, how it all ties in together, and what to include in my closing paragraph (that is missing from this assignment). Assignment must be submitted in MLA format, I did not include my citations page however I do already have it compiled. I have previously showed deficits in the area of it all flowing freely without repeated myself or my information much. This was structured based on a sentence outline I previously created to try and help me stay on track in each paragraph. Please provide specific feedback so I can address what should be fixed! Thanks!  
  
## One More Chance:

  
  
**Fighting To Stay Alive**  
Our nation has seen an exponential increase in opioid related overdoses, an increase that jumped more than 137% since 2000 (Morbidity and Mortality Weekly Report, 2016). It is estimated that more than half a million individuals have died in the United States from drug overdoses in the past eighteen years. The staggering statistics have sent communities scrambling for ways to save lives and stop the increase from rising more. Communities should be focused on ways to decrease the risk of opioid overdose by executing practical harm reduction strategies, allocating proper program funding, providing drug abuse education, and monitoring physician prescribing habits.  
  
**The Effectiveness of Harm Reduction**  
An increasing amount of evidence has suggested that harm reduction has proven effective in minimizing the mortality rates associated with opioid abuse. It has been reported that studies show that supervised injection sites have helped to lower the rate of drug users contracting communicable diseases such as HIV and Hepatitis C. A fifteen-year study of the drug riddled community in Vancouver's impoverished Downtown Eastside revealed that harm reduction in the form of supervised injection sites has not only reduced the spread of disease but has reduced illicit drug use in general. Vancouver opened the country's first supervised injection site in 2003, allowing users to administer their drugs under the watchful eye of trained professionals in a sterile, clean environment. By 2011, the study revealed that fewer people were sharing needles and in turn less were contracting potentially deadly diseases. While overall drug use has declined, the community knows that they must continue to fight to keep programs in place that are helping lower the mortality rate of addicts.  
  
Several studies have revealed that more users are utilizing methadone maintenance therapy to effectively treat their opioid dependence. Methadone is a synthetic analgesic drug that produces a longer lasting effect to allow an addict to dose once daily. It is used as a substitute drug in the treatment of morphine and heroin addiction and minimizes withdrawal symptoms so that addicts are less likely to use. Studies have shown that methadone treatment has been linked with decreases in death rates and has proven to be effective at not only reducing use but decreasing the occurrence of crimes normally associated with abusing drugs as well. An article published by Dan Wagener attributed methadone maintenance programs to communities seeing a decrease in the number of addicts being diagnosed with HIV. The overall health of drug users improved in communities where methadone clinics were made readily available, the number of patients on methadone rose from 12% in 1996 to 54.5% in 2008 (DrugAbuse). Methadone acts as an aid in helping wean the addict off heroin and other opioids frequently abused, treatment can range from a few short months to the addict's lifetime.  
  
Multiple studies support the idea that communities who implement needle exchange programs tend to see lower rates of people sharing needles, which in turn has lowered the risk for the spread of infectious disease. It was the spread of HIV/AIDS amongst the drug injecting population in the 1980's that initially introduced the idea of needle exchange programs as a way to minimize the number of users infected (Commonwealth Department of Health and Ageing 2002). When illicit drugs are prepared for injection they are typically mixed in powdered form with water before being cooked up in a "cooker" or spoon. Often, they will be filtered through a cotton or cigarette filter before being drawn up for injection. The sharing of such paraphernalia has also been associated with further risk for the viral transmission of disease. Needle exchange programs provide users with sterile wipes, cookers, filters, and waters to ensure users are being as safe as possible given the situation (Koester, Booth, and Wiebel 1990). Arguably, programs for needles and syringe exchange are more readily associated with harm reduction than any other type of intervention.  
  
Harm reduction was shown in a fifteen-year study, to reduce the amount of people using drugs. Amongst those that were still using, fewer users were injecting. It is important to note that needle exchange and safe injecting sites are only some of the services offered. Overdose prevention practices, referrals to substance abuse treatment programs, counseling, HIV, hepatitis c, and sexually transmitted disease testing, as well as medical, social, and mental health services.  
  
Overall, the number of drug users who were sharing needles in Vancouver, Canada dropped from almost 40% in 1996 to only 1.7% in 2011 (Darryl Dyck/Canadian Press, 2013). It is thought that harm reduction is far more effective that the actual war on drugs, with statistics that support such a claim.  
  
Necessary Funding Government grants and funding allocation is necessary in helping agencies expand treatment programs to provide recovery related services for addicts in need. It is crucial to train all first responders and medical personnel to effectively administer opioid overdose reversing drugs such as Narcan. Individual states need to adjust their budget to allow for proper funding to support such programs and allow addicts the best chance at recovery. The likelihood of overdose threatens to level communities throughout the nation. With proper funding, programs that offer harm reduction services have been shown to reduce illicit drug use and improve public safety.  
  
The Comprehensive Addiction and Recovery Act (CARA) authorized funding to fight the opioid epidemic through prevention, treatment, recovery, overdose reversal, and other efforts.  
CARA was signed in to law on July 22, 2016 by President Barack Obama. After several years of input from hundreds of addiction advocates, its main objective addresses the full continuum of care from primary prevention to recovery support. This includes significant changes to expand access to addiction treatment services and overdose reversal medications, criminal justice and law enforcement-related provisions. Such laws are crucial in allocating the proper funding, awarding grants to state substance abuse agencies, local governments, or nonprofit organizations or in areas with higher rates or rapid increases in heroin or other opioid use to expand their availability of medication-assisted treatment (American Society of Addiction Medicine).  
  
There are claims that there's a highly successful treatment for opioid treatment but is thought to be held back by stigma. Put that aside, Medication Assisted Treatment (MAT) received an increase in funding for opioid treatment in the fiscal year, 2017's Omnibus Appropriations Bill. Although critics claim that medication assisted treatment is only allowing addicts to trade one substance for another, supporters of this form of treatment acknowledge that scientific evidence overwhelmingly shows that medications such as methadone and Suboxone significantly reduce the risk of relapse. Research supports the claims that MAT is effective in treating opioid addiction, systematic reviews of this research found that MAT can cut the all-cause mortality rate among addiction patients by half or more (Maia Szalavitz).  
  
Dr. Elinore McCance-Katz, Assistant Secretary for Mental Health and Substance Abuse, stated that amid opioid use disorders plaguing our nation, the money from the  
Department of Health and Human Services (HHS) is much needed. HHS awarded $144.1 million in grants to prevent and treat opioid addiction during President Trump's commitment to combat the opioid epidemic. Specific funding will be distributed to 58 recipients, including states, cities, healthcare providers and community organizations; such funding will be awarded over a period of three to five years. "These funds will support and expand prevention, treatment, and recovery services in America's communities," as stated by Dr. Elinore McCance-Katz, he welcomed the idea of funding being allocated to help treat opioid addiction.  
  
Health and Human Services (HHS) have outlined strategies and included a comprehensive framework to help combat the opioid epidemic to better inform the public along with mental health and substance abuse professionals. In 2016, preliminary data from the Center for Disease Control and Prevention (CDC) suggested that the number of drug overdose deaths would most likely exceed 60,000 individuals in that year alone. Improving access to prevention, treatment, and recovery services, including the full range of MAT works by targeting the availability and distribution of overdose-reversing drugs; strengthening public health data and reporting; supporting cutting-edge research on pain and addiction; and advancing the practice of pain management. Those specific awards follow a separate award of $485 million in grants (April 2017) to be used for opioid abuse prevention, treatment, and recovery to be distributed to all 50 states, the District of Columbia, and four U.S. territories.  
  
**Strengthening Education**  
While numerous approaches are important in preventing opioid overdose fatalities, one that should be spotlighted is providing overdose education in our communities to address the concerns we face as a nation. These types of interventions are increasingly important in the harm reduction process. They can help in addressing modifiable risk factors, educate potential risk factors for overdose and empower people who use opioids to engage overdose prevention by recognizing the signs.  
  
Overdose education and nasal naloxone distribution (OEND) programs have been implemented to help lower the fatality rate seen in opioid stricken communities. Since the late 1990's, access to these programs have expanded to serve more than thirty states. Naloxone can be administered to reverse overdoses caused by heroin and other opioid drugs. Unlike other medications, naloxone is something that everyone can and should have in their homes. The program works to distribute naloxone to those individuals who are most likely to witness an overdose. The drug works by rejecting heroin and other opioids from continuing to adhere to the receptors in the brain and in turn reverses the respiratory depression brought on by an overdose.  
  
The effectiveness of OENDs has been shown in various parts of the world, focusing on positive outcomes around knowledge, skills, attitudes and reduced overdose rates (Coffin & Sullivan,2013).  
  
In the state of Ohio, the Department of Mental Health and Addictions Services allocated up to $500,000 per year to promote access to naloxone in every county across the state through OEND programs such as Project DAWN. Project DAWN is a community-based overdose education and naloxone distribution program who distributes Naloxone kits free of charge. These kits are surprisingly cost effective, considering the organization assembles the kits for around $50 in comparisons to the medical cost of a fatal drug overdose averages around $2,980.  
  
Programs as such have the capability of reaching sizable populations of at-risk individuals while facilitating overdose reversals. While this solution may not may not prevent overdose from occurring, it may remove the fatality factor and give addicts a second chance at life.  
  
Overdose Lifeline, Inc. (ODL) is a statewide Indiana non-profit whose dedication is to help individuals, families, and communities affected by the disease through advocacy, education, harm reduction, prevention, resources, and support. ODL has created the only youth prevention awareness program to address the dangers of opioid use and is implemented in more than a dozen states. Volunteers worked alongside lawmakers to allow over the counter naloxone access to those most at risk. Workers trained and distributed more than 15,000 kits to first responders and the public. They used evidence-based practices molded to target individual personalities to reach adolescents throughout the state of Indiana. It is a belief amongst those who support the distribution of naloxone, the underlying long-term goal of decreasing drug use can only be accomplished if the user is still alive. With that in mind, intervening with naloxone during overdoses are the only way to prevent those deaths In an effort to combat opioid misuse, Drug Enforcement Administration (DEA) has joined forces with Discovery Education to create a comprehensive-no cost program. Their mission is to educate students about the significant impact heroin and opioid use has, in hopes of kickstarting the conversations both at home and in the classroom. Since its launch in 2017, Operation Prevention has reached more than two million students nationwide. The classroom resources provide educators with tools meant to engage students and introduce them to the science behind opioids and the impact they have on the brain and body. Providing early education to young students can be key in setting them up for success in the future, to know what to do if someone they know becomes involved in opioid use.  
  
**Safer Prescribing Habits**  
Research conducted from 2002 to 2012 revealed some startling information: that nearly eighty percent of users injecting heroin had previously used opioid pain relievers in a nonmedical fashion (Jones, 2013; Muhuri et al., 2013). Most individuals concurred that if not for their abuse of prescription opioids, their addiction to heroin would never have developed. Due to the now known risks associated with prescription opioids and the likelihood of dependence developing, prescribing techniques are being transformed. Healthcare professionals are improving the way opioids are prescribed through clinical practice guidelines to ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse or overdose on these drugs.  
  
By February 2018, lawmakers proposed new limits on filling opioid prescriptions for Medicare beneficiaries, no doubt the result of the war on the drugs. Government proposals limit the number of pills in an initial prescription for acute pain and could potentially add flags for beneficiaries who use certain drug combinations with other opioid prescribed medications.  
  
Centers for Medicare & Medicaid Services (CMS) deputy administrator and director of the center for Medicare, Demetrios Kouzoukas, believes that these actions will help reduce the oversupply of opioids in our communities. CMS believes that these measures are important to safeguard the health and safety of our nation.  
  
Opioid monitoring systems have successfully been put into place in an effort to end the over prescribing seen across the nation. CMS utilizes a carefully constructed opioid monitoring system that allows beneficiaries access to prescribed opioids by having them go through only select prescribers and select pharmacies. It is argued that opioid users are known to "doctor hop,' as a way of getting multiple prescriptions from multiple doctors without sending red flags. By minimizing the doctors and pharmacies they can see, CMS is hoping to put a stop to doctor hopping lessen the likelihood of overprescribing techniques.  
  
In 2018, Governor Doug Ducey signed an executive order, limiting initial opioid refills to seven days for Arizona adults insured by state funded health insurance plans. Governor Ducey and the supporters of this bill sought to address the state's opioid epidemic, which is linked to more than 812 deaths in 2017. In addition to imposing opioid refill restrictions, Ducey wants to expand the availability of treatment with a $10 million increase in funding for individuals struggling with addiction who can't afford treatment to due lack of insurance coverage. Also included in his proposal is an order to distribute the overdose-reversal drug Nalaxone to county health officials and law enforcement personal. What is most worrisome is the claims that the opioid epidemic was brought on by years of bad prescribing of powerful and highly addictive pain medication. Pharmaceutical companies failed to warn treating physicians of the potential for dependence until the epidemic was already in full swing and left our nation scrambling to fix the problem (Alltucker, K., Nicla, A., The Republic).  
  
State laws, public health guidelines, and the American Medical Association (AMA) standards are hoping that by cutting back the prescribing of pain pills in the United States, it will in turn prevent opioid addiction. The hope remains the same throughout the nation: fewer people will become addicted to opioids and fewer will die from overdoses. For the most part, prescription prescribing rates are dropping. Mostly in part to the prescribing restrictions being put into place by concerned health officials and lawmakers. Despite the overall drop, more than 650,000 prescriptions for painkillers are dispensed on an average day across the nation (Department of Health and Human Services). And while not all doctors seem happy with the presence of government officials having a hand in what they're allowed to do, they acknowledge the severity of the problem at hand and know that something needs to be done about it.  
  
According to medical societies, painkiller prescribing is decreasing as reported to the Centers for Disease Control (CDC). The CDC notes "in about a quarter of U.S. countries, enough opioid prescriptions were dispensed for every person to have one." And while opioid prescribing is being monitored, five states did actually see higher rates in 2016 compared to 2007. Officials also acknowledge that services should be put into place so that patients have a safe way to dispose of leftover medications, as a way of keeping those leftovers out of the hands of those who could abuse them. The CDC reports that from 1999 to 2014, the United States seen the sale of prescription drugs nearly quadruple. And with that, overdose deaths linked to opioids and heroin did just the same. And with only one state left to enact prescribing monitoring, health officials are questioning why Missouri is the last one to jump onboard.  
  
National health and addiction experts believe it is imperative to closely monitor how many prescriptions go out to the public. A one-size-fits-all approach is no longer seen in doctor's offices across the nation, due in part to physicians acknowledging that not all patients experience pain the same way. While some states have passed laws to limit the amount of days in which a prescription can be written for, other states put emphasis on the diagnosis of "acute" pain. Acute pain is described as the pain felt from minor dental work or a sprained ankle. Patients receiving a prescription painkiller for a diagnosis of acute pain, are more likely to see the pharmaceutical restrictions. Officials, lawmakers, and family members of those lost to opioid addiction feel strongly that our nation is headed in the right direction. They are hopeful that with prescribing restrictions in place, we will start seeing a drop in the amount of people dying from opioid abuse.