Abstract
The prevalence of opioid abuse has increased dramatically in recent years. This is especially the case in rural segments of the United States. This study examined the depth of opioid abuse among clients of OTs in West Virginia. Results suggest a significant percentage come into contact with clients known to be or suspected of abusing opioids, but lack sufficient training in both recognizing the signs of substance abuse and providing clinical support or assistance.
Primary Author and Speaker: Evan Pivont
Additional Authors and Speakers: Randy McCombie
The prevalence of opioid substance abuse has increased dramatically in recent years, in part from abuse of opioid analgesics as an often over-prescribed treatment of chronic pain, and from unconstrained access to street drugs such as heroin and fentanyl. (CDC, 2018). Beginning in the mid-1990s with a focus on treating pain as the “fifth vital sign”, and development of new and intensely marketed opioid-based pain medications, the number of prescriptions rose from 76 million in 1991to a high of 255 million in 2012, equivalent to 81 prescriptions per 100 Americans. Moreover, prescription dosage rose to current levels of 3X the 1999 figure (Seth, et al., 2018).
OTs practice in a wide variety of settings, and likely come into contact with clients abusing opioid substances. Unfortunately, research on this issue is severely lacking, but is essential to assess the degree to which the crisis impacts OT. Those states having substantial percentages of population living in rural areas present with disproportionately high opioid abuse rates. With just over half of its residents residing in documented rural areas, West Virginia is categorized as the third most rural state in the US. Tragically, WV has witnessed a consistent growth in opioid substance abuse, resulting in a surge in its morbidity/mortality rates and in hospital admissions. Accordingly, WV has been identified as the state with the highest death rate due to opioid abuse (Warfield, et al., 2019).
The purposes of this study were to assess the prevalence of opioid abuse among clients of OTs in WV, the degree to which OTs are educated in regard to identification and treatment of clients abusing opioids, including responding to opioid overdose situations, and to develop recommendations specific to the profession of OT relevant to the problem of opioid abuse, particularly in WV.
The sample design included 500 OTs randomly selected from a total of 732 licensed OTs in WV utilizing a postal survey, focusing on perceptions of opioid substance abuse by clients or client family members, occurrences of opioid substance overdose, and training specific to handling situations of client overdose.
Results were obtained from 191 OTs representing roughly 1/4 of all OTs in WV. Results found that over 80% encountered clients abusing or strongly suspected of abusing opioid substances. Moreover, roughly 1/3 indicated that the problem of opioid abuse among clients is increasing. Of heightened concern was the finding that roughly one-fifth of these therapists experienced a situation of client opioid overdose in their presence. Most acknowledged lacking education and training in regard to emergency overdose response protocol.
Based on the conclusions of this study and nationwide data on opioid substance abuse, it is apparent that OTs, particularly those working in rural segments of the country such as WV, are regularly coming into contact with clients and client family members presenting with symptoms of opioid substance abuse, and lacking knowledge in response to overdose situs.
In support of the Surgeon General’s “Turn the Tide Campaign” calling for healthcare clinicians and academicians to raise awareness about opioid addiction, AOTA committed itself to “developing solutions for the national opioid crisis in a number of ways, including most recently representatives from the West Virginia Occupational Therapy Association providing input to information-gathering efforts by West Virginia’s attorney general” (AOTA, 2016). Consequently, it is imperative for the profession to act as a singular healthcare unit as well as to engage in concert with other healthcare professions in an interprofessional collaborative approach to focus total resolve to end this crisis.
Centers for Disease Control and Prevention (CDC). (2018). Opioid overdose: Understanding the epidemic. Retrieved from: https://www.cdc.gov/drugoverdose/epidemic/index.html
Seth, P., Rudd, R. A., Noonan, R. K., & Haegerich, T. M. (2018). Quantifying the epidemic of prescription opioid overdose deaths. American Journal of Public Health, 108(4), 500-502. doi: 10.2105/AJPH.2017.304265
Warfield, S., Pollini, R., Stokes, C. M., & Bossarte, R. (2019). Opioid-related outcomes in West Virginia, 2008–2016. American Journal of Public Health, 109(2), 303-305. doi: 10.2105/AJPH.2018.304845
American Occupational Therapy Association (AOTA). (2016). Surgeon General calls on health care professionals to combat opioid abuse. Retrieved from: http://www.aota.org/Publications-News/AOTANews/2016/combat-opioid-use-epidemic-surgeon-general.aspx