Develop a 2-4 page policy proposal that seeks to improve the outcomes for your chosen health care issue and target population. Introduction Competency?1:?Design evidence-based a

Running head: BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 1

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Biopsychosocial Population Health Policy Proposal

Learner’s Name

Capella University

Biopsychosocial Concepts for Advanced Nursing Practice II

Biopsychosocial Population Health Policy Proposal

November, 2018

BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 2

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

Biopsychosocial Population Health Policy Proposal

The health care industry has come to acknowledge the rise of the opioid crisis over the

past two decades. However, this does not take away from the necessity of pain relief for patients

suffering from chronic pain, who are most often prescribed opioid treatment. Opioid treatment

does show promise in short-term trials (Sehgal, Colson, & Smith, 2013), but long-term

treatments carry with them significant risk of addiction, adverse side effects, and prescription

drug abuse (Franklin, 2014). The issue of opioid abuse and addiction is further complicated by

the comorbidity of mental health problems in patients. In this context, veterans are a particularly

vulnerable population because they often present with chronic noncancer pain while being

comorbid with mental health issues such as post-traumatic stress disorder or substance abuse

disorder (Sullivan & Howe, 2013). Given this vulnerability, it is necessary to take steps to

prevent or reduce the potential for addiction or medication abuse among veterans who are

prescribed long-term opioid treatment.

Substance Abuse among U.S. Veterans: A Brief Retrospective

Opioids came to be used in the treatment of chronic pain in cancer patients as a result of

two WHO guidelines that were issued in 1985 and 1996 (Sullivan & Howe, 2013). Eventually,

the treatment was extended to chronic noncancer pain and suggested as a safe, non-addictive

method of treating pain. However, this claim was extrapolated from short-term opioid treatment

studies. The issue then becomes primarily about the lack of evidence to support the safe long-

term use of opioids. Opioids carry a significant risk of addiction and an array of unpleasant side

effects (Franklin, 2014). Further, opioids also complicate matters of mental health. Opioids can

relieve pain and produce a feeling of euphoria in patients. This physical relief could

inadvertently soothe the psychological or emotional pain that a patient is experiencing. However,

BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 3

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this leads to the patient doubly associating the opioid drug with both physical and psychological

relief, potentially resulting in drug abuse and drug-seeking behavior. In this context, veterans’

health becomes a particularly complicated and layered issue to tackle. Many of them suffer from

chronic pain because of injuries and exposure to hazards during their military career and often

present with behavioral issues such as post-traumatic stress disorder or substance abuse disorder.

Veterans are seven times more likely to abuse prescription opioids than civilians (Snow &

Wynn, 2018). Further, Newhouse states that opioid medications were prescribed to over 400,000

veterans for pain relief and that approximately 1.7 million opioid medications were prescribed to

them in 2014 (as cited in Snow & Wynn, 2018), indicating that opioid treatments are quite

widespread.

Several institutes, including the American Osteopathic Academy of Addiction Medicine,

the American Society of Addiction Medicine, and the American Academy of Neurology, have

stated publicly that opioids present a significant challenge in the health care industry. These

institutes encourage raising awareness of the adverse side effects of opioid treatments, the use of

naloxone (an opioid antagonist), and proper procedure in case of an opioid overdose (The

American Osteopathic Academy of Addiction Medicine, n.d.; American Society of Addiction

Medicine, 2016; Franklin, 2014). Given how widespread the prescription of opioids is among

veterans suffering from chronic pain, it would be necessary to reevaluate the guidelines

associated with prescription as well. Further, the primary problems associated with prescription

opioids are the abuse of prescribed opioids and the transition from prescription opioids to black

market drugs such as heroin (Kolodny, Courtwright, Hwang, Kreiner, Eadie, Clark, &

Alexander, 2015; Snow & Wynn, 2018).

BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 4

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In 2007, the National Drug Intelligence Center of the U.S. Department of Justice

estimated that a cumulative cost of approximately $200 billion resulted from direct and indirect

drug use in the form of lost productivity, health care, and law enforcement (as cited in Crowley,

Kirschner, Dunn, & Bornstein, 2017). Further, Ronan and Herzig note that the costs associated

with opioid use disorder were approximately $15 billion in 2012 (as cited in Crowley et al.,

2017). Rydell and Everingham and the National Institute for Drug Abuse state that money

invested in preventing drug abuse and subsequent treatment would lead to substantial savings on

a national level (as cited in Crowley et al., 2017). It is then necessary from an industry standpoint

to revisit the guidelines associated with the issue of opioid prescriptions, given the significant

costs associated with it.

An Interprofessional Approach to Substance Abuse and Health Care for Veterans

The proposed policy addressed below consists primarily of two aspects: raising public

awareness and encouraging interdepartmental communication and coordination. The first aspect

would help individuals learn about the crisis and identify potentially harmful patterns of

behavior, and the second would improve the condition of individuals who have been prescribed

long-term opioid treatment.

Raising Public Awareness

To approach the issue of the opioid crisis, it is important to understand it as a problem of

scale (given how widespread the issue is) and as a problem of understanding among the public

and those receiving opioids. Raising awareness would improve the public’s understanding of the

nature of the opioid crisis and would thereby help individuals recognize how and when opioids

would be helpful. It would also improve the public’s understanding of the potential harm opioid

use might mean for an individual being treated with opioids. A committee would be formed with

BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 5

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physicians who specialize in pain treatment, behavioral health specialists, and senior nurses to

oversee public awareness drives and educational programs to help raise awareness in the

community. The duties of the committee would include ensuring that these drives and programs

are organized effectively and regularly, evaluating the efficacy of holding such programs, and

understanding how to improve outreach. Trained physicians would oversee the educational

programs, while nurses would provide demonstrations of the correct procedure when

administering naloxone. The programs would contain information on how to identify potential

signs of opioid misuse and addiction (such as patients obtaining their prescriptions early or

patients sharing their prescriptions with those who are close to them) and how to approach such

situations. The committee would also work in close association with the closest veterans’ affairs

office to identify and cater to veterans who require opioid treatment for chronic pain, thereby

improving their understanding of the risks involved in prescription opioids and their misuse.

Precautions and Prescriptions

It is important to critically evaluate the current state of how opioids are prescribed and to

whom they are prescribed. Further, it is necessary to address each individual patient’s physical

and behavioral needs together rather than to focus solely on the pain that a patient might

experience. Individuals with behavioral issues are more likely to be prescribed opioids than those

without. However, they are also more likely to become addicted to opioids or misuse them.

Patients who have been prescribed long-term opioid treatment would be required to meet with a

psychiatrist regularly to monitor and evaluate the risk they present for addiction and misuse. The

psychiatrist would then be required to keep the attending physician informed about the state of

the patient’s mental health and whether any further action would be required while still

maintaining the confidentiality of the conversations the patient has had with the psychiatrist.

BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 6

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Further, during the initial diagnosis, physicians would be required to screen patients for histories

of behavioral issues, including post-traumatic stress disorder and substance abuse disorders.

Certain populations such as veterans are likely to be at a higher risk of opioid addiction and

misuse. To improve patient care, it would be necessary for physicians and nurses to sensitize

themselves to these at-risk populations to better serve their health care needs. For example,

veteran populations are known to present with both behavioral issues and chronic pain resulting

from their time in the military; it would be the responsibility of the physicians and the nurses

attending to a patient to familiarize themselves with the context of the patient so as to develop a

nurturing relationship in such a situation. To enable this, human patient simulators will be made

available to health care providers to train them through simulations that would provide

knowledge that can be used in real situations.

BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 7

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References

American Society of Addiction Medicine. (2016). Use of naloxone for the prevention of opioid

overdose deaths. Retrieved September 27, 2018, from https://asam.org/advocacy/find-a-

policy-statement/view-policy-statement/public-policy-statements/2014/08/28/use-of-

naloxone-for-the-prevention-of-drug-overdose-deaths

Crowley, R., Kirschner, N., Dunn, A. S., & Bornstein, S. S. (2017). Health and public policy to

facilitate effective prevention and treatment of substance use disorders involving illicit

and prescription drugs: An American College of Physicians position paper. Annals of

Internal Medicine, 166(10), 733–736. http://dx.doi.org/10.7326/M16-2953

Franklin, G. M. (2014). Opioids for chronic noncancer pain: A position paper of the American

Academy of Neurology. Neurology, 83(14), 1277–1284. Retrieved from

https://doi.org/10.1212/WNL.0000000000000839

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., &

Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health

approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559–

574. https://doi.org/10.1146/annurev-publhealth-031914-122957

Sehgal, N., Colson, J., & Smith, H. S. (2013). Chronic pain treatment with opioid analgesics:

Benefits versus harms of long-term therapy. Expert Review of Neurotherapeutics, 13(11),

1201–1220. http://dx.doi.org/10.1586/14737175.2013.846517

Snow, R., & Wynn, S. T. (2018). Managing opioid use disorder and co-occurring posttraumatic

stress disorder among veterans. Journal of Psychosocial Nursing and Mental Health

Services, 56(6), 36–42. http://dx.doi.org/10.3928/02793695-20180212-03

BIOPSYCHOSOCIAL POPULATION HEALTH POLICY PROPOSAL 8

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Sullivan, M. D., & Howe, C. Q. (2013). Opioid therapy for chronic pain in the US: Promises and

perils. Pain, 154(Suppl 1), S94–100. Retrieved from

https://ncbi.nlm.nih.gov/pmc/articles/PMC4204477/

The American Osteopathic Academy of Addiction Medicine. (n.d.). Naloxone public policy

statement: The use of naloxone for the prevention of opioid overdose deaths. Retrieved

from

https://c.ymcdn.com/sites/www.aoaam.org/resource/resmgr/Docs/AOAAM_NALOXON

E_POLICY_2015.pdf

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Vulnerable Population Health Policy Proposal

Kyla Hoag

NURS-FPX6026: Biopsychosocial Concepts for Advanced Nursing Practice 2

Capella University

Kathryn Sheppard

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Need for Policy

The homeless is an example of a vulnerable population and they face an assortment of

healthcare challenges, both physical and mental. The homeless population is susceptible to many

physical health related problems such as chronic pain, impaired mobility, impaired hearing or

vision, and obesity. “Chronic pain is thought to be common among homeless people, in part due

to frequent injuries and the high prevalence of concurrent health conditions” (Hwang et. al.,

2011, p. 1). For many people with chronic pain, common pain relief methods are ineffective, and

opioids are used an alternative. It is easy for this population to end up addicted to opioids and

other substances because of chronic pain. Homelessness causes a lack of stability, which can lead

to drug addiction. The homeless population often self-medicates with street drugs, and they use

substances to numb the pain and stressors that comes with living on the street. “According to the

National Coalition for the Homeless, substance abuse is more prevalent in people who are

homeless than in those who are not” (Mosel, 2022). It can be challenging for homeless people to

stop using substances because they have smaller support networks. They also typically do not

have easy access to traditional recovery programs, detox centers, and rehab programs. It is then

crucial to look for a solution that will allow the homeless population to effectively manage their

chronic health conditions such as pain or mental health issues, and to most importantly get them

into a safe environment, where they do not have access to substances to continue feeding their

addiction.

Proposed Policy

The proposed policy I will be discussing is an interdisciplinary pain rehabilitation

program. The interdisciplinary approach to institutional and community problems occurs when

members of different disciplines work inter-dependently (as opposed to the term “multi-

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disciplinary,” which describes members of different disciplines who function independently”

(Hamel, 2001, p. 58). An interdisciplinary program is necessary for this population because they

face a variety of issues that make traditional drug rehabilitation programs less efficient. An

interdisciplinary program addresses the contributors to chronic pain which include behavioral,

psychological, and physical aspects. “To effectively serve the homeless population, rehab

programs must do at least three things: provide services that address the needs for employment,

income, and housing; offer access to affordable interventions; and provide long-term care,

treatment, and support” (Smith, 2020). The most effective rehab programs for the homeless

population understand that substance abuse cannot be managed without addressing the needs of

the person as a whole.

Interprofessional Approach

Effective rehab programs for the homeless population should provide patient-centered

services that are multidisciplinary, meaning competent enough to treat various conditions and

coordinate further services. Chronic pain is important to get under control, but most importantly,

the homeless population’s primary concern that needs to be addressed is housing. Substance

abuse often correlates directly with homelessness, therefore, the sooner the patient can find

stable housing, their chances of falling into addiction are drastically reduced. For treatment to be

effective, the homeless must have a stable living situation. Once basic needs are met, problems

with addicted can be focused on. An interprofessional team should be established to help develop

this type of patient’s plan of care. This team should include: a primary care provider, a pain

specialist, nurses, a mental health professional such as a therapist or psychiatrist, and social

services. There needs to be coordination between inpatient and outpatient social services as this

population is ready to transition into the community again.

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Conclusion

Individuals experiencing homelessness face unusual challenges in accessing healthcare.

These challenges include lack of transportation, loss of housing, financial hardships, lack of

insurance, and negative encounters within the health care system. There are many aspects of

being homeless that can cause a person to struggle with drug addiction. However, traditional

rehab programs hardly work for the homeless as they face a wide range of problems, including

mental, behavioral, and physical. I am proposing an interdisciplinary pain rehabilitation program

to help these patients lessen drug use, increase psychological functioning, promote healthy

behaviors, and have a safe place to call home, temporarily.

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References

Hamel, Pauline. (2001). Interdisciplinary perspectives, service learning, and advocacy:

A nontraditional approach to geriatric rehabilitation. Topics in Geriatric Rehabilitation.

17(1):53–70. https://doi.org/10.1097/00013614-200109000-00005

Hwang S., Wilkins E., Chambers C., Estrabillo E., Berends J., MacDonald A. (2011). Chronic

pain among homeless persons: Characteristics, treatment, and barriers to management.

BMC Fam Pract. 12(73), 2-9. https://doi.org/10.1186/1471-2296-12-73

Mosel, S. (2022). Substance abuse & homelessness: statistics & rehab treatment. American

Addictions Center. Retrieved from https://americanaddictioncenters.org/rehab-

guide/homeless

Smith, Johnelle. (2020). Drug And alcohol rehab programs for homeless individuals. Addiction

Resources. Retrieved from

https://www.addictionresource.net/treatment/inpatient/homeless-

individuals/#homelessness-and-addiction

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