Amanda Thomas phe-340 (2)

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7-2 Final Project Submission: Analysis and Recommendations Paper Amanda Thomas June 15, 2023 Phe-340 7-2 Final Project Submission: Analysis and Recommendations Paper

1 Prescription Drug Abuse/ Overdose is the progressively expanding pharmaceutical supply in America. It influences the existence of numerous individuals, mainly youths. Desomorphine is abused for its opioid-like effects. Desomorphine abuse inevitably leads to tolerance, addiction, and dependence like any other opiate. Regrettably, it has become a popular and cheaper substitute for heroin among the drug abuse community, especially among young Russian adults who rampantly increased their consumption in 2009. The drug is synthesized illicitly from codeine by abusers and is administered intravenously, which only exacerbates the dangerous consequences of its abuse. Prescription pharmaceutical misuse is when people would take medicine inaccurately. Drug Abuse is a title given to consuming narcotics, a usual issue. Daily use of drugs is self-destructive. It guides one to being an addict and affects conduct adjustment. Addiction unusually affects the mind. It can drive one to further well-being difficulties such as kidney malfunction and heart complications. Prescription Drug Abuse has set off a national health crisis since most people are dependent on narcotics depending on nationwide financed health insurance benefits organizations. Many individuals rely on the drug pharmaceutical and will someday begin abusing heroin. Investigators propose that 80% of beginner heroin drug abusers use some prescription pharmaceutical. " They stated that eventually prescription medication got expensive, so they opted of heroin."(Keck School of Medicine of USC,2020). Factors The opioid epidemic in the United States is a critical concern that demands immediate attention. The streets known as "Krokodil" and "Crocodil" are infamous for the highly potent drug desomorphine. This derivative of morphine is about ten times stronger than its predecessor, with

2 rapid onset and short-lived effects similar to opiates. However, desomorphine abuse has been a severe problem since 2002, causing long-term damage to the skin, including greenish discoloration and scaly textures caused by damaged blood vessels, thrombosis, and soft tissues surrounding injection sites. Although clinical studies suggest that desomorphine could be an alternative to morphine for pain management, it should be noted that the drug has potent respiratory depressant effects that do not diminish over time and can lead to addiction. The rampant misuse of these drugs is risking the lives of those taking them and making it harder for those with legitimate medical needs to access these prescriptions. Moreover, grave concerns exist about people abusing opioids like the synthetic Krokodil, taking excessive doses, and using them in social settings. We must address these issues with utmost urgency to ensure the safety and well-being of our citizens. "It has been a very public problem across the United States with an increase 64.6% opioid usage." ( Haegerich et al.,2018). In terms of behavior, those who consistently use drugs may experience significant physical and mental health issues due to their substance abuse. " There can be mood changes, getting into trouble financial hardship, change of behavorial, overall and losing interest in activities." ( American Society of Anesthesiologists,2012). The various effects of these factors can significantly impact the lives of individuals, including the user, their family, and friends, as well as medical professionals and caretakers in the community. These effects may require significant lifestyle changes. State-sponsored Programs or Interventions " The first state-affiliated program that came to mind was PDMP, a statewide electronic database that tracks all controlled substance prescriptions."( CDC,2021). " This system allows communication between states to keep track of opioid prescriptions, which helps prevent patients

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3 or addicts from doctor shopping."(CDC, 2021). Effective management of drug-related issues is achieved through implementing laws and regulations. Narcan is widely recognized as the most effective preventive measure to prevent fatal drug poisoning and is readily available to all community members. Additionally, it is essential to note that the federal government rigorously regulates pharmaceuticals to guarantee their safe and responsible usage while under supervision. "The Controlled Substances Act (CSA) was enacted in 1970 which regulates the manufacturing, distribution, prescribing and dispensing of a controlled substance." (DEA,2021). Efficacy It is crucial to closely monitor the consumption of Krokadil opioids, especially given the alarming decrease in the cost of drug distribution. It is concerning to note that between 2012 and 2019, the distribution cost of opioids reached its lowest point in 144 years. Urgent measures must be taken to tackle the problem and avoid additional damage to people and society. "The data was at 467 prescriptions per 100 persons which totaled more than 153 million opioid prescriptions." ( CDC,2020). It is important to note that drug distribution costs vary from country to country. As a result, it is becoming increasingly clear that individuals struggling with addiction require additional medical attention to address substance abuse. Disparity Improving the prescription process, reducing the likelihood of opioid use, preventing abuse, and providing effective addiction treatment are the most effective ways to prevent opioid overdose deaths. Identifying an opioid overdose can be challenging, but these preventative measures must be taken seriously to save lives." Women as well as black and hispanic populations, have faced longstanding health disparities in patient access to opioid treatments like buprenophine." (Mayo Clinic study, 2022). Recent investigations have shown that the use of heroin and illegal fentanyl

4 has led to severe discrepancies in overdose deaths within black communities. This is a concerning trend that requires immediate attention. Reducing the Disparity A common issue regarding the use of narcotics is how people with severe pain can obtain them. Many health problems can cause significant and debilitating pain. Those who suffer from such conditions require medication to manage their pain but may have difficulty accepting it due to the current drug crisis. Physicians are closely monitoring their prescriptions for controlled substances and are less likely to authorize them. "It's almost as if doctor's are hesitant to prescribe opioid drugs or could even have their own biases thinkinh that individuals are just opioid seeking." ( Dekker& Paulson,2005). Behavioral Factor It is imperative to note that individuals struggling with opioid addiction may inadvertently use powerful narcotics like Krokodil, unaware that even a couple of uses can result in addiction. Despite being a highly addictive opioid derivative of codeine with sedative and analgesic effects, Krokodil is hardly discussed in Outbreak as the DEA acknowledges it as an issue prevalent only in other countries, not the US. " Opioid addiction and abuse in the United States has become a prolonger epidemic, endangering public hea lth, economic output, and national security, making opioids very accessible to get." (Cfr.org.) Moreover, "Prescription pain medications and opioid abuse and increase in heroin use in the United States is under scrutiny." (Nida.Nih.gov) states that opioid addiction often begins with prescription pain relief, leading to abuse and dependence. "The narcotic drug krokodil is a semi-synthetic drug used as a cheap alternative to heroin. Its active ingredient, desomorphine, is a highly addictive and destructive drug mainly used in Russia

5 and Eastern. Europe." (PubMed.Ncbi.Nlm.Nih explains that Krokodil), a semi-synthetic drug primarily used in Russia and Eastern Europe as a cheap alternative to heroin, contains the highly addictive and destructive drug desomorphine. "Krokodil is more effective than heroin, and someone can be addicted after one or two uses by this time unusual lacerations and lesions have began to appear on their body." (According to Addictive Addiction Unbiased Guides to Addiction and Mental Health in 2018). Social Cognitive Theory "The theory behind the intervention plan, is the Social Cognitive Theory(SCT), the construst of vicarious learning, self-efficacy, positive or negative reinforcements, and self-control." (Edburg,2013). Each individual is diverse, and this idea must be categorized for each individual, but the foundation will stay similar. Vicarious Learning Both teenagers and adults in health services must be educated about the dangers of KroKadil, an opioid commonly referred to as "the crocodile." This drug can potentially cause severe tissue and muscle damage, resulting in painful lesions and even zombie-like rotting flesh. Despite its affordability and lack of prescription requirements, individuals must be aware of the fatal consequences and harm it can cause, including eventual death. By disseminating information and photographs that highlight these dangers and the fact that you can quickly get them, we can effectively prevent the use of KroKadil. Strengths of Using Cognitive Theory KroKadil is a dangerous drug that can cause severe damage to tissue and muscles, leading to painful lesions and a zombie-like appearance. Both teens and adults in health services need to learn about the fatal consequences and see photographs of tissue death and gangrene. By

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6 spreading awareness throughout the United States, individuals may be deterred from using KroKadil when they know the harm it can cause and the potential for severe injury or death. Weakness of Social Cognitive Theory Using the SCT (Self-Change Toolkit) in addiction treatment may present a possible drawback. The individual struggling with addiction may need to be open to receiving feedback or engaging in the intervention. This is a common issue in any intervention, as people's attitudes and behaviors vary greatly. Therefore, a personalized approach may be necessary to increase the chances of success. Recognizing that every individual is unique and may require a tailored approach to achieve the desired outcome is essential. Additionally, it is important to be flexible and willing to switch to a different method if the current one does not improve. This adaptive approach can help ensure that the individual's needs are being met and that their recovery journey is progressing positively. Community Invention Plan To eradicate the peril of KroKodil usage in communities nationwide, we must educate individuals at institutions catering to drug users, such as community health departments, local detoxification centers, and recovery facilities. It is crucial to remember that KroKodil is less expensive than heroin and any other opioid drug and more widely accessible, but its use is far more hazardous than heroin. "Although it will have specific references to Krokodil and its effect on the body, the aspects of illicit drugs manufactured in unsanitary settings can result in necrosis gangrene severe damage to the organs." ( Addictive Addiction Unbiased Guides to Addiction and Mental Health,2018). " The community action plan will be show videos of the damage Krokodil does the body starting at first time usage." ( Haskin, A, Kim N., & Aguh 2016, April). Both videos and photos will be made available at recovery facilities, detox centers, and family doctor offices, as well as with clinical psychologists. " The videos are graphic but will help the opioid epidemic." ( CNN, 2013; Newsbreaker,2016). Educating children about the dangers of drugs is imperative to assist those struggling with addiction. The communities nearby have the resources to deliver prompt interventions and comprehensive assessments, including medical examinations, to ensure the best possible outcomes.

7 State Intervention Strategies Syringe exchange programs, or S.E.P.s, are a highly effective strategy to prevent the spread of illnesses in multiple countries. These programs provide a diverse range of materials, such as clean needles, contraceptives, cleansing swabs, bleaching agents, and other supplies to ensure the safety of individuals. "The S.E.P.s offer education and counseling to drug users."(Centers for Disease Control and Prevention [C.D.C.], 2018pp 1488-1491). " The results of the S.E.P.s indicate they are showing a decline in H.I.V. and Hepatitis C cases and are cost-effective." (C.D.C.,2018). It is crucial to highlight that the reported cost of S.E.P.s by the borough is $160,000, translating to nearly $20 per customer throughout their lifetime. Although this amount may appear steep, it is essential to consider that the average price of one H.I.V./Aids inpatient medication is approximately $120,000. Furthermore, it is worth noting that 38 states provide approximately 185 schedules, albeit the civil funding for S.E.P.s may vary from the national arrangement. "The S.E.P.s show they have reduced risky behaviors in drug users by 80%."( ACLU 100 years(2020, February 9). Integrating a KroKodil education approach into S.E.P.s has the potential to reduce heroin use significantly. This cost-effective mediation strategy should be implemented for optimal efficiency. "The intervention plan recommended will educate and rise awareness to users at the S.E.P.s that Krokodil could possibly be bought as heroin." ( Haskin, A.,Kim N.,& Aguh, ( 2016,April). The curriculum would donate brochures and watch recordings for patients to look at despite delays in line. " The videos show real effects from the use of Krokodil." ( Newsbreaker,(CNN,2013). It is highly recommended that individuals view pictures and brief videos of Krokodil victims to prevent falling ill. This will enable them to exercise caution when purchasing illegal drugs, as they should be aware of the possibility of combining Krokodil with their preferred drugs. By having a deeper understanding of the hazards associated with Krokodil, people will be less likely to indulge in this drug. Recommended Plan to Reduce the Health Disparity To combat the issue, we can make Naloxone training readily available to family members and caregivers of substance abusers. The training sessions can be held at recreational centers or syringe exchange programs, where the target audience can easily access them. It would be beneficial for substance abusers to receive regular training and carry Naloxone with them at all

8 times. In West Virginia, the Cabell-Huntington health department offers an open Naloxone training program as part of their Harm Reduction Programs, which is accessible to everyone through their syringe exchange projects. This is especially helpful for the state's rural areas and larger towns. "After a short quiz is passed, the participants leave with a test and two red cartridges." ( Cabell-Hungtinton Health Department (2019)). The Cabell-Huntington Health Department's Naloxone trainer has eliminated over 500 unused supplies and disposed of more than 479 used cassettes. " The returned cartridges resulted in reviving the overdose victim or keeping them stable until emergency medical services arrived." ( Cabell- Huntington Health Department 2019). Implementing these curricula nationwide has the potential to decrease instances of overdose due to excessive amounts of narcotics. KroKodil Use and Overall Opioid Epidemic To effectively combat the opioid crisis, it is imperative to educate healthcare providers on the Krokodil narcotic and equip them with the necessary tools to identify and treat individuals struggling with substance abuse. This entails critical care workers receiving proper certification through rigorous training. The government must provide the required funding for the implementation of this strategy. Furthermore, it is recommended that education on the dangers of opioid use begins at an early age, with health awareness programs for students in grades three and four in institutional settings. " The local police will include Krokodil within the Drug Abuse Resistance Education (D.A.R.E.) program." (Paul, T., Ellis, S., & Savelle, T. (2020). Police officers must not be held in higher regard than teachers. To effectively combat substance abuse, every country must establish a training program that empowers citizens to educate their families and friends on substance use warning signs. Furthermore, the availability of free Naloxone training courses must be increased, especially in rural areas. A comprehensive social media campaign and other forms of public outreach will be swiftly implemented to promote this vital strategy. Reflection There is a growing concern about using Krokodil, a dangerous drug causing severe health problems for users in the United States. Those who use the drug often hide the extent of their injuries from medical staff, which can lead to further complications. Krokodil is known for its

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9 ability to cause severe damage to the skin and underlying tissues, earning it the nickname "flesh- eating" opioid. This serious issue needs to be addressed by healthcare professionals and law enforcement. " The opioid epidemic was bad without this newer drug." (CNN 2013, October 11). Reducing the consumption of narcotics in the United States requires a closely aligned approach with the educational curriculum. Early education on the dangers of narcotics is critical and should commence during the early school years. The dissemination of knowledge through compelling visual aids such as photographs and films, alongside the strategy, can yield highly effective outcomes in the fight against this epidemic. References Krinke, C and Scott, M (2018). Adolescent Prescription and Counter-Drug Abuse Retrieved from file:// Users/beeton/Downloads/yf1857.pdf Nida, (2021). April 13 What is the scope of prescription drug misuse? Retrieved from https//www.drugabuse.gov/publicaions/research-reports/misuse-prescription-drugs/what-scape- Prescription-drugs-misuse on 2021 September 6 Keek School of Medicine of USC (2020). Prescription Drug Addiction and Overdose. A public Health fight retrieved from https://mphdegree.usc.edu/blog/prescription-drug addiction-and overdose-a-public-health-fight/ Substance abuse and Mental Health Services Administration (2021) Rise in prescription Drug Misuse and abuse Impacting Teens Retrieved from https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/rise-prescription- drug-misuse-abuse-impacting-teens American Society of Anesthesiologists (2021). Opioid Abuse. Retrieved from Opioid Abuse: Statistics, Signs & Symptoms - Made for This Moment (asahq.org) CDC (2021) Prescription Drug Monitoring Programs (PDMPs) (2021). Retrieved from

10 Prescription Drug Monitoring Programs (PDMPs) (cdc.gov) CDC (2021) Prescription Drug Monitoring Programs (PDMPs) (2021). Retrieved from Prescription Drug Monitoring Programs (PDMPs) (cdc.gov) DEA (202U.S. Opioid Dispensing Rate Maps | Drug Overdose | CDC Injury .. . 1). Drug Scheduling. Retrieved from Drug Scheduling (dea.gov) Dekker, A & Paulson, M. (2005, June). Healthcare Disparities in Pain Management. Retrieved from Healthcare Disparities in Pain Management | The Journal of the American Osteopathic Association (jaoa.org) Haegerich,T; Noonan, R; Rudd, R; & Seth, P. (2018. April.) Quantifying the Epidemic of Prescription Opioid Overdose. Retrieved fro m Quantifying the Epidemic of Prescription Opioid Overdose Deaths (nih.gov) Georgia Department of Public Health (2021). Georgia’s Opioid Response. Retrieved from Georgia's Opioid Response | Georgia Department of Public Health NIDA.( 2020, July 22). Drug Addiction Treatment in the United States. Retrieved from https:/ /www.drugabuse.gov/publications/principles-drug-addiction-treatment- researchbased-guide-third-edition/drug-addiction-treatment-in-united-states on 2021, March 14 Mayo Clinic Study 2022 , https://patientengagementhit.com https://www.cfr.org/backgrounder/fentanyl-and-us-opioid-epidemic

11 https://pubmed.ncbi.nlm.nih.gov/31705099/ NIDA. (2018, June 6). Understanding Drug Use and Addiction Drug Facts. Retrieved from https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction on 2023, May 27 https://link.springer.com/article/10.3758/s13415-019-00710-6#Sec2 Jacobson, M. L., Wulf, H. A., Browne, C. A., & Lucki, I. (2018). Opioid modulation of cognitive impairment in depression. In S. O’Mara (Ed.), Progress in brain research (1st ed., Vol. 239, pp. 1–48). Amsterdam: Elsevier B.V. Return to ref 2018 in the article. Addictive Addiction: UInbiased Guides to Addiction and Mental Health. (2018). Krokodil Addiction: The Horrors, the Withdrawals, the Problems (2018 WARNING). Retrieved January 24, 2020, from Addictive Addiction: https://addictiveaddiction.com/krokodil/ Drug Enforcement Administration (DEA). ACLU 100 years. (2020, February 9). Fact Sheet on Needle Exchange Programs. Retrieved February 6, 2020, from Needle Exchange Programs Promote Public Safety: https://www.aclu.org/fact-sheet/needle-exchange-programs-promote-public-safety Cabell-Huntington Health Department. (2019). Harm Reduction Program. Retrieved February 11, 2020, from Cabell-Huntington Health Department: https://cabellhealth.org/clinicalservices/harm-reduction/ Carney, T., Myers, B., Louw, J., & Okwundu, C. (2016, January). Brief school‐based Interventions and behavioral outcomes for substance‐using adolescents. Retrieved February 6, 2020, from Cochrane Database of Systematic Reviews - Intervention: https://doi.org/10.1002/14651858.CD008969.pub3 Center for Disease Control and Prevention [CDC]. (2010, November 19). Syringe Exchange Programs --- United States. Morbidity and Mortality Weekly Report (MMWR), 59(45), 1488-1491. Atlanta, Georgia, United States. Retrieved February 6, 2020, from Morbidity And Mortality Weekly Report (MMWR): https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5945a4.htm/Syringe-Exchange Programs- United-States-2008

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12 CNN. (2013, October 11). Krokodil crosses over to U.S. from Russia. Retrieved February 5, 2020, from https://youtu.be/-xF1ejbShZ8 Drug Enforcement Administration (DEA). (2019). DESOMORPHINE (Dihydrodesoxymorphine; dihydrodesoxymorphine-D; Street Name: Krokodil, Crocodil). Diversion Control Division | Drug & Chemical Evaluation Section. Retrieved January 14, 2019, from https://www.deadiversion.usdoj.gov/drug_chem_info/desomorphine.pd Escribano, A., Dalae, M. D., & Monfort, M. (2017, July 13). Desomorphine, Krokodil: Current State and Social Perception. Journal of Drug Abuse, 23(2 (3)). Retrieved January 30, 2017, from http://drugabuse.imedpub.com/desomorphine-krokodil-current-state-andsocial- perception.php?aid=20101 Haskin, A., Kim, N., & Aguh, C. (2016, April). A new drug with a nasty bite: A case of krokodil induced skin necrosis in an intravenous drug user. JAAD Case Reports, 2(2), 174-176. doi:10.1016/j.jdcr.2016.02.007 National Institute on Drug Abuse [NIH]. (2018). Opioid Overdose Reversal with Naloxone (Narcan, Evzio). National Institute on Drug Abuse [NIH]. Retrieved February 10, 2020, From https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone narcan-evzio Newsbreaker. (2016). Flesh-Eating Drug Krokodil Spreads East; Shows Up in Chicago. Chicago, Illinois, United States. Retrieved from https://youtu.be/XisElqFj23w Zhang, X. M. (2018). Naloxone Access for Emergency Medical Technicians: An Evaluation of a Training program in rural communities. Addictive Behaviors (86), 79-85. Retrieved February 10, 2020, from https://doi-org.ezproxy.snhu.edu/10.1016/j.addbeh.2018.03.004 https://www.deadiversion.usdoj.gov/drug_chem_info/desomorphine.pdf

Amanda Thomas phe-340 (2)

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