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7301MED Health Policy and Planning

Question

Answered

Task

commentary posts -300 words each

  • Those not submitting a Primer for the allocated week are instead, required to:
  • Read the all primers posted for the allocated week.
  • Post commentary on all the primers posted (2 posts) in your group for each week 
  • The commentary  needs to reflect positively on the posted primers and demonstrate your academic understanding of the topic.
  • each week  approximately 300 words not including reference.
  • Separate commentary to two primer topics(600 words)
  • Referencing style APA 7th
  • For the each primer one or two reference

Question for the primer

To what extent in your community do you think prescription drugs pose a problem with use and abuse? Support your answer with contemporary and relevant literature (both academic and grey literature). What stakeholders in your community can assist you in understanding the extent of this issue among older adults and people with disabilities? In your answer you should consider:

  • Exploring the use and abuse of prescription drugs in the community and any policies that address this issue.
  • Explaining stakeholder analysis.
  • Identify who are the key stakeholders with regards to this issue and in terms of influence and power.

Student Answer 1 (need to comment with 300 words)

Prescription drug abuse poses a significant and growing problem within communities across Australia.  The Australian Medical Association are calling it a national emergency, however when compared to other health conditions it seems to fly under the radar. This category of drug use is now the second highest in the world after the United States of America, affecting 3-4% of the population. (Cabin Sydney, 2015).  Prescription drugs commonly include benzodiazepines which help to relieve anxiety or aid with sleep, and analgesics which reduce pain.  One of the biggest increases in Australia was around oxycodone, a highly addictive benzodiazepine, from 2002-2009 resulting in a 180% rise amongst the population. (Cabin Sydney, 2015).

The use and subsequent abuse of these drugs is on the health policy planning and strategy agenda of every government across this nation and internationally.  4.5% of Australians 14 years and older have used prescription medications for non-medical purposes at some point in their lives. (Cabin Sydney, 2015). The research and planning that is required to combat an ever-growing issue such as this, needs to involve all relevant stakeholders including governments at all levels, special interest and lobby groups, clinicians, consumers, and others affected or working within the space. (Department of Health, 2017). Once the stakeholders are identified there needs to be an extensive analysis of strengths, weaknesses, power and influence of all those involved to ensure that a community solution focused leadership group and vision is built, ensuring that all stakeholders share a common goal and are working towards it. (Zuckerman, 2000).

The collective group of stakeholders needed to address the growing abuse of prescription drug use in Australia would need to have extensive mapping programs to identify any differences, clashes, hidden or unspoken agendas and understand the power and influence of each individual member of the working group. (Zuckerman, 2000).  One of the important and often ignored issues with growing prescription drug abuse are older Australians and those people with disabilities.  Stakeholder analysis needs to ensure that all aspects of the problem are identified, gaps understood and, are all on the agenda, to be solved. (Mitchell, 1997).

Australia has completed some significant work in understanding and addressing the increased prescription drug use in this country.  The harm currently caused to society by this abuse is only second to alcohol misuse. It appears that the availability of education and the laws surrounding prescription drug abuse haven’t kept up with the increase in its use and the addiction associated with it. (Cabin Sydney, 2015). The extent of this problem is growing each decade, showing that deaths attributed to the use of benzodiazepines rose by 70% between 2009-2018. (Australian Institute of Health and Welfare, 2020). These staggering figures and may others like them, have underpinned the National Drug Strategy (NDS) 2017-2016 in Australia, bringing together all of the key stakeholders who participated in an informed national consultation process throughout 2015, interviews and online surveys were completed, collating feedback from the community and stakeholder forums throughout this period.  This strategy was born from this information.  The NDS’s goals are to:

  • Increase access to effective and affordable treatment
  • Develop and share data around the performance of the strategy and the outcome
  • Reduce adverse consequences
  • Improve national coordination of the message and the prevention techniques
  • Prioritise specific populations-older persons, those with mental health conditions
  • Build the workforce capacity
  • Increase border control therefore decreasing supply opportunities and enforcing legislation(Department of Health, 2017).

This has been a strong overarching strategy across the nation for those individuals tackling the increasing prescription drug use epidemic.  Sub-strategies were also created for Tobacco use, Ice Addiction, Aboriginal and Torres Strait Islander populations as well as a detailed mental health plans and how each of these sections integrated with the national strategy. (Department of Health, 2017).

Stakeholder analysis typically refers to the myriad of tools, structures and techniques used to identify and understand the needs and expectations of major interests inside and outside the project environment. (Smith, 2000). It ensures that all policy makers have a vested interest from the initial planning process and beyond.  This is critical in the war on prescription drug abuse in Australia. The value of strategic planning is more in the actual process than the defined plan itself.  By the time the plan is finalised, it is out of date.  This is intrinsic with drug use with new prescription medications coming onto the market regularly, and a strategy needing to evolve and be fluid to encapsulate this. The evidence-based research in this analysis around prescription drug misuse, would fortify the health policy produced for concise drug protocols. (Greenhalgh, 2017).

The individual influence, power and interest held by each of the parties involved in the analysis needs to be understood to assist in building strong relationships and identify any separate avenues that may be required.  Sull et al (2000) documented that the analysis process “needs to target those in the know, gather objective data, engage all respondents, link to credible research and ensure there is no disconnection”. Working towards an effective strategy to tackle prescription drug abuse is a highly emotive and growing issue, one that the strategist needs to understand from every angle. This is also true for the stakeholders involved. One of the fundamental flaws in stakeholder analysis is groups not knowing enough about each other to have continued meaningful conversation, not enough time or drive to find out more about each other and the reasons behind inclusion in this strategy analysis. (O’Dwyer, 2004). The analysis needs to map out the individuals, agendas, and power held by each, before combining them into a strong relationship-based foundation. (Beckham, 2000).

There are many stakeholders that can provide important information around the extent of the prescription drug issue amongst vulnerable populations such as older people and those living with disabilities in Australia.  The analysis undertaken around the participants involved needs to include as many participants as possible to give a wide and varied understanding of the issue being addressed.  Any subsequent health policy decisions will be stronger because of this intensive and collaborative process. (Department of Health, 2017). The important groups that play an essential role in this process and that require representation in this area are:

  • Individuals with lived experience of prescription drug abuse
  • Families, carers, disability support workers
  • Private health insurance companies
  • Australia Medical Association and other members of the medical community including Doctors, Nurses, and Counsellors working with addiction
  • Organisations working with drug users-Drug Arm, Youth Assist
  • Local, State and Federal Government representatives
  • Specific associations including public health and any other government departments
  • Special interest or lobby groups-those wanting to look at increasing access to prescription drugs
  • Pressure groups-unions and media
  • Communities affected by this issue
  • All those directly or indirectly affected by increasing prescription drug use

All these participants need to be working towards the same goal, even though they

may have differing agendas. (Mitchell, 1997). The influence and power that each of them has, need to be considered.  While some may have more influence by the title or organisation represented, it is foolish not to acknowledge that without each of them, a gap would be evident, one that could not be filled by another. This issue is affecting all population groups. The harmful use of prescription medications is increasing in older people (over 60) and those with disabilities, particularly living with mental health conditions.  Those individuals who are older or have disabilities can be more at risk of addiction and misuse of prescription medication than those without co-morbidities or age, due to increased pain or medication management difficulties experienced. (Department of Health, 2017).

The information gathered by these stakeholders and the evidence-based research undertaken in this space in Australia has formed the national strategies associated with drug misuse, particularly highlighting prescription drugs and its growing influence in society. At the core of this strategy is:

  • the drive to prevent the uptake of drug use at any age and delay its first use all together.
  • Reduce any harmful use
  • Support more people in recovery
  • Base all decisions, including those of policy on evidence-based practice
  • Reduce the access to supply of these prescription drugs
  • International work is continuing to develop an effective, non-addicting pain medication as a public health priority.

In 2016, measures were put into place within the National Strategy for removal of large quantities of paracetamol and aspirin to be placed behind pharmacy counters, brand names for analgesics were removed and only used as examples, access to codeine was restricted and the drug reclassified (Schedule 4).  In 2017, the Australian government announced further funding to implement a national “real time” monitoring system for prescription drugs ensuring instant alerts were available to avoid “Doctor/Pharmacy shopping”.  This ensured that prescriptions were monitored, and increased access identified. (Department of Health, 2017).

The over consumption of prescription medications is a preventable disease and illness in Australia. (AIHW, 2020).   Prescription drug abuse is out of control.  It is now taking as many lives as methamphetamine addiction, yet it is not receiving the same level of national awareness. (Cabin Sydney, 2015). This misuse is at epidemic proportions across a large majority of the nation, affecting more and more of the vulnerable populations in the community. Older people and those living with disabilities such as mental health are abusing and becoming addicted to benzodiazepines and analgesics at alarming rates. The measures that the government through the National Drug Strategy 2017-2016 for example, does not entirely fix the problem, however it goes a long way to coordinating and ensuring a strong committed partnership between all the stakeholders involved now and for the future. (Department of Health, 2017). A large part of this planning, analysis and strategy is to ensure continuing work is done in this space, using evidence-based research and adapting to the every changing landscape of prescription drug use.  The consequences of not continuing to do so is frightening for Australia and all other countries around the world.

Looking forward the following questions from peers

While planning and the foundation strategies have come along way over the last decade, where do you think the gaps still lie? Is there somewhere where more resources need to be targeted in the fight with prescription drug abuse? Could inequity and lack of access be different across the states and therefore be causing more issues themselves?

7301MED Health Policy and Planning

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