Background
Opioid abuse is one of the most severe and widespread forms of drug addiction. The stages change each other faster than in other cases, the body quickly becomes tolerant to doses — this is the risk of overdose even after several months of use (Otte, 2019). Diagnostic criteria of opioid dependence and its severity (presence of at least three):
- Opioids are used in greater doses or for longer periods of time than intended
- The desire to take opioids persists, or the person repeatedly unsuccessfully tries to quit or limit their use
- Much time is spent getting opioids (including their theft), their use or return to normal after their action
- When doing necessary tasks at work, school, or home, or when opioid usage puts them in risk physically, a person is frequently intoxicated or experiencing withdrawal symptoms
- Social, professional, or recreational activity necessary in the past for a person stops or decreases
- Marked tolerance: the requirement for substantially higher doses to get the intended effects or a visible diminishing of the effects when using lower doses
- Opioids are frequently utilized to stop withdrawal symptoms or their deterioration
At least some of these signs persist for at least a month or are repeated over a more extended period.
Patient-Centered Health Interventions and Timelines
The drug based on methadone is taken by the patient regularly for several months. The supportive therapy program is formed by considering the patient’s state of health, the stages of addiction development, and the level of tolerance to opioids.
Medical treatment. Drugs are selected with caution to exclude undesirable psychoactive effects. Tranquilizers are used to stabilize the mental state and relieve anxiety, aggression, depression, and sedatives. (The period of admission is from 2 to 4 months).
Physical therapy. It gives a restorative effect, helps restore health, and stabilizes mental state. (The treatment period is 2 to 4 months and depends on the patient’s condition).
Group and individual treatment. Working with a psychotherapist aims to form the motivation to overcome addiction, identify the causes that provoked its appearance, solve the patient’s psychological problems, and diagnose and correct mental disorders. With the narcologist, the psychotherapist works with the patient, planning his psychological and social rehabilitation and restoration of work activity (Otte, 2019). Group therapy is used for the gradual rehabilitation of the patient: the exchange of experience, the support of a team of other patients, and communication contribute to the recovery and normalization of the mental state. (Treatment of addiction after withdrawal lasts several months).
Health Care Issues
A person addicted to opioids needs constant drug use in order to maintain a normal state of health. On average, the interval between doses is 6-8 hours (Otte, 2019). Symptoms increase gradually, begin 8 hours after taking the dose, increase by the second or third day to a maximum and remain at this level for up to 10 days. After this manifestation of withdrawal, symptoms begin to weaken. With withdrawal syndrome, they develop:
- anxiety, desire to get a new dose of opioid, aggression, depression, sleep disorders.
- fever, sweating, vomiting, nausea, convulsions, tachycardia, seizures and spasms, severe pain, and disorders of the digestive system.
- when using opioids to relieve pain, there is a fear of withdrawal, the return of pain syndrome.
An Intervention for Each Health Issue and Community Resources
To alleviate the patient’s condition, tranquilizers, antidepressants, neuroleptics, and non-opiate analgesics are used. Additionally, symptomatic treatment and supportive therapy are used. In the severe withdrawal phase, the patient should be under the supervision of doctors. To cleanse the body, the doctor may prescribe hemodialysis, blood substitutes, and other measures. To improve the functioning of the heart, brain, lungs, and kidneys, separate courses of treatment are prescribed since these organs practically lose their functionality in opioid addicts.
The intervention includes general stages consisting of the relief of threatening conditions, stabilization of vital functions, the introduction of opioid antagonists, detoxification, withdrawal syndrome relief, the use of psychotropic drugs, psychotherapy, and rehabilitation if necessary. In this case, the symptoms are general, so the patient should be provided with the right psychological help and support from the family.
The best option is long-term therapy in a specialized rehabilitation center, where a patient with opioid addiction receives symptomatic treatment, psychological help, and support from people who have already managed to get rid of opioid addiction. Psychological support is necessary in this case to remove the patient’s fears about the return of pain.
Ethical Decisions in Designing Patient-Centered Health Interventions and the Practical Effects
In the process of drawing up an intervention plan, various ethical problems will arise regarding the methods of treatment used. Rehabilitation and return to independent life usually take 6-24 months (Opioid abuse: Statistics, signs & symptoms, n.d.). Rehabilitation programs are expensive and place high demands on the patient and medical workers. Experience shows that only patients with high motivation undergo treatment until the end. However, in return, they get a full life, and many of them then participate in treating other drug addicts themselves. Consequently, the ethical side of this process is the question of how much the doctor is responsible for the patient’s motivation. It is necessary to create conditions that can support a person on the way to recovery (Opioid abuse: Statistics, signs & symptoms, n.d.). Some, however, believe that the constant use of methadone legitimizes drug addiction and, in addition, creates a danger of drug distribution. However, using the opportunities, it is necessary to use this drug in exceptional cases when patients cannot cope with their growing addiction independently.
The Ethical Questions
- Is it necessary to use methadone as the main treatment?
- Should a healthcare professional maintain motivation in all possible ways if patients do not want it themselves?
- Are there any risks to worsen the emotional and psychological state of the patient?
Relevant Health Policy Implications
The best chance to enhance health outcomes and reduce spending is to concentrate on clinically high-risk individuals or those with escalating risk. Patients with clinically high risk and high need require at least 90 days of follow-up, far longer than the typical four to six weeks, to ensure they are fully informed and involved in their treatment and remove any obstacles to care (Qin, 2019). Following discharge, patients are most susceptible; thus, their primary care physician should follow up within 24 to 48 hours (Qin, 2019). Providers need to be aware of the specifics of the admission since it serves as a crucial key component of the transitional care plan. The strategy should last for at least four to six weeks and incorporate follow-up visits to ensure the patient knows discharge instructions, can see signs that could call for immediate attention, and shows to follow-up appointments with the primary care physician.
Discussing The Plan with a Patient and Family Member
All family members involved in developing a medical care plan should clearly understand the difference between decisions made on behalf of the patient and for the patient’s benefit. In order to make a decision adequate to the patient’s existing condition, all interested persons should have the most detailed information about the severity of the patient’s condition and prognosis (Kokorelias et al., 2019). At the beginning of the discussion, it is necessary to determine the correctness of the views of family members about the severity of the patient’s condition and the degree of awareness of their prognosis.
In the process of family members making decisions about certain procedures and clarifying the patient’s values, it is also necessary to choose between medical care focused on supportive therapy to ensure maximum comfort and preserve the patient’s self-esteem. Discussing with members family care plan for the patient, the medical professional should know which possible solutions do not contradict the current legislation (Kokorelias et al., 2019). The need to change the plan is determined by the fact that the family’s view of the prognosis may not correspond to a medical professional’s understanding of the situation. Therefore, it is necessary to find the interfering factors and try eliminating them.
The Literature on Evaluation
Strengthening public health is an intersectoral mission that cannot be solved exclusively within the competence of health services. Therefore, not only medical specialists but also representatives of related industries are engaged in the creation of public health tools. The issues addressed include ensuring the quality of the environment and environmental well-being, solving the problem of social services, and training qualified specialists (U. S. Department of Health and Human Services, n.d.). The Healthy People program provides measures to minimize non-communicable diseases, disability, injuries, and premature death (Qin, 2019). The tasks are set to create conditions conducive to healthy behavior and improving the quality of life to improve the health of all social groups. The program contains 355 goals — primary, research, and variables developing during the program (U. S. Department of Health and Human Services, n.d.). They reflect current healthcare trends and are used in teaching sessions for the Healthy People 2030 document.
The project provides for monitoring in the field of a healthy lifestyle. Information technologies are actively involved in implementing the program, and healthcare IT infrastructure is being created. Comparing learning session content with best practices, it is necessary to highlight the impact of medical literacy (Otte, 2019). It is defined as the degree of a person’s ability to receive, transmit, process and understand basic medical information and types of medical care to make the necessary decisions (Otte, 2019). With increased attention to public health, disease prevention, and improving the prognosis of acute and chronic diseases, awareness of the importance of medical literacy in the population is also growing.
To date, researchers and practitioners are using several approaches to improve the medical literacy of patients. Some of these strategies can be called simple (single-component) or complex. The simple ones include adapted literature, graphic materials and illustrations, and video and audio materials (Qin, 2019). An integrated approach is defined as a strategy consisting of several individual components that seem necessary for each specific addiction or patient (Opioid abuse: Statistics, signs & symptoms, n.d.). Such strategies may include a combination of oral motivational conversation with the patient, demonstration of visual printed materials, and subsequent verification of the understanding of the information received.
References
Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family centered care: a scoping review. BMC Health Services Research, 19(1).
Opioid abuse: Statistics, signs & symptoms. (n.d.). Made for This Moment | Anesthesia, Pain Management & Surgery. Web.
Otte, A. (2019, June 4). Prevention of opioid abuse and treatment of opioid addiction: Current status and future possibilities. Annual Review of Biomedical Engineering, 21(1), 61–84.
Qin, F. (2019). The debilitating scope of care coordination under HIPPA. North Carolina Law Review, 98(6), 1396–1423. Web.
U. S. Department of health and human services. (n.d.). Drug and Alcohol Use – Healthy People 2030. health.gov. Web.
