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Identify a problem or concern in your state, community, or organization that has the capacity to beadvocated through legislation. Research the issue andcomplete the sections below. For each topic that requires the listing of criteria, a minimum of two criteria should be identified and discussed. Add more rows as is appropriate for the topic/proposal.

In no more than 250 words, describe the problem, who is affected, and the current ramifications. Explain the consequences if the issue continues.

The problem is the opioid epidemic in California state. Opioids include oxycodone, hydrocodone, as well as fentanyl, which are all extremely potent painkiller, which is made to look like other opiates like opium-derived morphine or heroin. The opioid epidemic, additionally known as the opioid crisis, seems to be a name used to explain the excessive usage, misuse, or abuse, as well as an overdose by the group of medications named opiates or opioids. This overuse of opioid drugs can cause serious medical, social, physiological, as well as economic implications; as well as, if not managed properly, it may lead to death. Between 1999 and 2016, it is projected that 453,300 Americans died as a result of opioid abuse. The over-prescription of opioids throughout the 1990s that resulted in the disputed CDC recommendation for providing opioids for persistent pain management was hypothesized to be the source of what the US doctors and surgeons named "The Opioid Crisis". During 2015, California was experiencing a rising opioid epidemic. That same year, about 2,000 individuals died from opiate overdoses, whereas 7,800 individuals were hospitalized in emergency rooms (Aliferis, 2021). Moreover, according to the National Institute on Drug Abuse (NIH, 2020) during 2018, opioids were associated with 45% of drug overdose-related death throughout California, totaling well over 2,400 fatalities. The most significant rise in opioid-related mortality occurred with the use of synthetic opioids apart from methadone, which increased by over 60% from 536 during 2017 to 865 during 2018. Hence, urgent intervention is required to improve the condition.

In no more than 250 words, outline your idea for addressing the issue and explain why legislation is the best course for advocacy.

RNs seem to be having a unique role to assist patients and their families to grasp the risks as well as advantages of various pain treatment choices since they work in a range of direct-care, coordinated care, management, as well as executive roles. Medication-assisted therapy (MAT) could save lives for those who are addicted to opioids (Compton, 2019). To combat dependency, MAT combines FDA-approved pharmaceuticals with counseling and behavior therapy. Nursing professionals licensed registered nurse anesthetists, as well as certified nurse-midwifery, might be able to deliver this essential therapy under the Addiction Treatment Access Improvement Act of 2017 (H.R. 3692) (Library of Congress, 2022). This bill revises the credentials necessary for a professional to deliver, dispense, or recommend narcotic medicines for upkeep or detoxification therapy in an office-based opiate rehab program under the Controlled Substances Act. This raises the maximum number of patients a qualified professional can see if they fulfill specific criteria. A qualified practitioner's maximal patient threshold seems to be the frequency of patients he or she should treat at any given time. This law adds clinical nurse practitioners, registered nurse anesthetists, as well as certified nurse-midwifery to the list of qualified nonphysician professionals. It renders the designation of some nonphysician professionals as qualified practitioners permanent. As a result, this law gives the nurses necessary authority to provide necessary therapy accordingly. Thus, it will help to reduce the opioid epidemic. Therefore, this MAT therapy will provide optimal outcomes compared to other interventions, because here a nurse can perform their duty more freely.

Perform research and compile information for your idea. Present substantive evidence-based findings that support your ideafor addressing the problem (studies, research, and reports). Include any similar legislation introduced or passed in other states.

Evidence 1

Using MAT therapy as per the Addiction Treatment Access Improvement Act of 2017 (Library of Congress, 2022).

Evidence 2

Providing patient education (Costello  & Thompson, 2015) as per the Addiction Treatment Access Improvement Act of 2017.

Stakeholder Support

Discuss the stakeholders who would support the proposed idea and explain why they would be in support.

Stakeholder(s) Supporting 1

Health care administrator to implement MAT in the clinic. They will support it because it improves the quality of care provided to a patient, thus improving the goodwill of the hospital.

Stakeholder(s) Supporting 2

Local authorities to provide additional funds to train nurses regarding MAT therapy. Local authorities will support this because it will improve the local statistics, reducing opioid overuse.

Stakeholder Opposition

Discuss the stakeholders who would oppose the proposed idea. Explain why they would be in opposition and how you would prepare to debate or converse about these considerations.

Stakeholder(s) Opposed 1

Physicians: According to the evidence there is some incidence where physicians do not properly coordinate with the nurse (Elsous, Radwan, & Mohsen, 2017). However, as this act provides a nurse with more authority, the physician's view, in this case, maybe biased. 

Stakeholder(s) Opposed 2

Patient: In this case, as the patient is already addicted to opioid drugs, they might resist the initial intervention made by nurses. Also, they might not be wanted to participate in a counseling session.

Financial Incentives/Costs

In no more than 250 words, summarize the financial impact for the issue and the idea (added costs, cost savings, increased revenue, etc.). Provided support.

The expense of opioid addiction ($471 billion), as well as fatal opioid overdoses ($550 billion) in the United States, was $1,021 billion during 2017. However, per capita combined cost for California was 3rd lowest, having a value of $1,566. According to statistical analysis, Luo, Mengyao, & Florence, (2021) stated in 2017, the expense of opioid use disorder was $36,501.1 million, the expense of fatal opioid overdoses was $25,394.3 million, the combined expense of fatal opioid overdoses, and the opioid use disorder was $61,895.5 million; per capita expense utilization of opioid use disorder was $923, as well as per capita expense of lethal opioid overdoses was $642. Hence, from this data, it can be stated that although the cost was not high, however, it can be managed with the implementation of the MAT program. Fairly et al., (2017) stated discount benefits of 1.02-1.07 quality-adjusted life-years (QALYs) per individual were achieved with MAT. Methadone price $16 000 per QALY acquired when contrasted to no therapies, accompanied by methadone having overdose education and naloxone distribution (OEND) ($22 000/QALY acquired), buprenorphine along with OEND as well as contingency management (CM) ($42 000/QALY attained), as well as buprenorphine having OEND, CM, with psychotherapy ($250 000/QALY obtained). Other therapy options outperformed MAT using naltrexone. As criminal law expenditures were factored in, all kinds of MAT were found to save money when contrasted to no therapy, with lifelong savings ranging from $25 000-$105 000 per individual. Hence, it can be stated that MAT is a good cost-effective approach.

Legislature: Information Needed and Process for Proposal

Discuss the how to advocate for your proposal using legislation. Include the following:

Provide the name and complete contact information for the legislator.

(Please put the name, as we do not have the contact)

Describe the steps for how you would present this to your legislator.

First, I will explain the current condition of opioid overuse and its consequences in California, with providing necessary data. Also, I will discuss the financial impact of opioid overuse. Then, I will explain the MAT using relevant legislation, and how it can be implemented to improve the condition. Also, I will discuss the cost-effectiveness of the MAT program.

Outline the process if your legislator chooses to introduce your idea as a bill to congress.

A one-hour-long educational program will be created for the nurses so they can acquire necessary information regarding the MAT. The nurse will be provided necessary education support from other healthcare professionals including pharmacists and psychologists. Nurses will have improved authority in the decision-making process, as they are the primary caregiver of the patient. Also, the nurses will have improved collaboration and coordination with other professionals to provide better care.

In no more than 250 words, discuss how principles of a Christian worldview lend support to legislative advocacy in health care without bias. Be specific as to how these principles help advocate for inclusiveness and positive health outcomes for all populations, including those more vulnerable, without regard to gender, sexual orientation, culture, race, religion/belief, etc.

Christian advocacy encourages people to see the policymakers as fellow persons rather than targets. One might encourage someone before gently informing them how God calls them to serve those who are most vulnerable. Cuellar De la Cruz & Robinson (2017) mention that Christian healthcare has a long history of doing good deeds motivated by the Christian philosophy that values human rights, solidarity, the collective good, as well as subsidiary. According to this theory, everyone is equal in God’s eye. Hence, the legislation should be the same for everyone irrespective of their culture, gender, vulnerability, and other factors. Therefore, a nurse needs to provide an equal level of care to each of their patients. Integrating worldview awareness through the ethos of the healthcare professional might not only tackle the unconscious bias, which pervades medical society but also assist the modesty, self-awareness, as well as compassion that are required for real behavior change within nurse-patient and policy discussions. It would have to embrace the many moral lineages, which give birth to current concepts of competence and qualities such as humility, self-awareness, as well as respect to do so. A nurse can not overlook the overuse of patients although they might do it willingly. A nurse needs to take the necessary step to improve the condition of their patient, not considering their sex, culture, and any other factor. The ultimate goal will be to advocate for their patients and make legislative changes to reduce the rate of opioid overuse.

References

Aliferis, L. (2021). How CHCF Helped California Respond to the Opioid Epidemic. California Health Care Foundation. Retrieved 13 January 2022, from https://www.chcf.org/blog/how-chcf-helped-california-respond-opioid-epidemic/.

Compton, P. (2019). Acute pain management for patients receiving medication-assisted therapy. AACN advanced critical care, 30(4), 335-342. https://doi.org/10.4037/aacnacc2019328

Costello, M., & Thompson, S. (2015). Preventing opioid misuse and potential abuse: The nurse's role in patient education. Pain Management Nursing, 16(4), 515-519. https://doi.org/10.1016/j.pmn.2014.09.008

Cuellar De la Cruz, Y., & Robinson, S. (2017). Answering the call to accessible quality health care for all using a new model of local community not-for-profit charity clinics: A return to Christ-centered care of the past. The Linacre quarterly, 84(1), 44–56. https://doi.org/10.1080/00243639.2016.1274631

Elsous, A., Radwan, M., & Mohsen, S. (2017). Nurses and Physicians Attitudes toward Nurse-Physician Collaboration: A Survey from Gaza Strip, Palestine. Nursing research and practice, 2017, 7406278. https://doi.org/10.1155/2017/7406278

Fairley, M., Humphreys, K., Joyce, V. R., Bounthavong, M., Trafton, J., Combs, A., ... & Owens, D. K. (2021). Cost-effectiveness of treatments for opioid use disorder. JAMA psychiatry. DOI: 10.1001/jamapsychiatry.2021.0247

Library of Congress. (2022). H.R.3692 - Addiction Treatment Access Improvement Act of 2017. Library of Congress. Retrieved 13 January 2022, from https://www.congress.gov/bill/115th-congress/house-bill/3692.

Luo, F., Li, M., & Florence, C. (2021). State-Level Economic Costs of Opioid Use Disorder and Fatal Opioid Overdose - United States, 2017. MMWR. Morbidity and mortality weekly report, 70(15), 541–546. https://doi.org/10.15585/mmwr.mm7015a1

NIH. (2020). California: Opioid-Involved Deaths and Related Harms. National Institute on Drug Abuse (NIH). Retrieved 13 January 2022, from https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/california-opioid-involved-deaths-related-harms.

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