Policy Issue Analysis Worksheet

Analysis CriteriaResponse
Name of person completing the analysis; sphere of government    I will be completing the analysis by assuming the role of policy analyst for the Centers for Disease Control (CDC). This analysis is conducted within the sphere of the US federal government. Evidence-based public health recommendations are either ignored or discounted within this sphere while developing US federal government policy (Malekinejad et al., 2018). A CDC policy analyst can complete this analysis while enhancing the translation of evidence into policy.  
Is their potential bias? Explain your response.      Potential bias in this analysis may originate from the analyst’s predisposition towards making subjective rather than objective policy evaluations. CDC policy analysts are susceptible to decision-making traps, especially when political influence is exercised over the presentation of scientific guidance and practical, evidence-based advice (Benzian et al., 2021). However, an explicit mission to promote evidence-informed and impartial decision-making can mitigate these potential biases.  
What is the issue that requires a policy solution?        The misuse of opioid pain medications is the main global health concern requiring a policy solution. In the US, more than 11 million Americans misused prescription opioids in 2016, and opioid-related deaths have more than quadrupled since 1999 (Blendon & Benson, 2018). The opioid-abuse epidemic requires a policy solution because combating the misuse of prescription pain medications requires putting in place the relevant laws to control the access and use of opioid medications.      
Context: Add evidence for the following perspectives: Social Economic Ethical Political Legal Environmental Cultural                  The social, economic, and cultural perspectives of opioid prescription medications revolve around the societal phenomenon of substance abuse. Collectively, the tripartite perspectives maintain that the substance abuse associated with misusing opioids emanates from various aspects of the social environment. Notable aspects include social interaction, social bonds, social structure, and drug cultures. The ethical perspectives entail the dilemma in prescribing opioids as an obligation for pain management and a responsibility to avoid harming patients. The obligation to provide pain relief needs to be balanced with an equally important duty not to expose patients to the risk of addiction and not create opportunities for addicting others, drug trafficking, and diversion (Quinlan & Cox, 2017). The political and legal perspectives provide evidence for opioid misuse as a growing problem requiring timely and effective solutions. Politicians and lawmakers have given this evidence through their responses to the reports of public health authorities describing an unprecedented increase in morbidity and mortality associated with the use of opioid pain relievers (Kolodny et al., 2015).    
Costs    The societal costs associated with opioid misuse represent the economic and non-economic costs associated with this epidemic. In a recent study, researchers estimated a total economic burden of $78.5 billion, whereby $28.9 billion was attributed to the increased health care and substance abuse treatment costs associated with opioid overdose, abuse, and dependence (Florence et al., 2016). The non-economic costs include addiction, premature deaths, lost productivity and burdening the criminal justice system.

Issue Analysis Part II

Who are the Stakeholders in this policy issue? What is their ‘stake”? What is their value orientation?              Physicians and lawmakers are the main stakeholders in this policy issue. The prescription of opioid medications is the physicians’ stake, while the lawmakers’ stake is to enact the relevant laws to regulate the distribution and prescription of opioids for beneficial uses in pain management. The value orientation of physicians is ethical and professional as they have a primary responsibility to improve and protect public health through opioid prescriptions (Meisenberg et al., 2018). The lawmakers’ value orientation is legal and political based on their duty to create a regulatory framework for preventing and resolving opioid misuse. The lawmakers are likely to oppose this policy since it will threaten their ties with opioid manufacturers and distributors. In the past, these companies have lobbied lawmakers to loosen access to drugs (Lopez, 2019). However, physicians will readily support it because it will support their efforts to make beneficial rather than harmful opioid prescriptions.
What is the health risk(s) addressed by the policy issue?              Addiction and premature death are the two main health risks addressed by the policy issue. Opioid analgesics are widely diverted and improperly used, thus leading to a national epidemic of opioid overdose deaths and addictions (Volkow & McLellan, 2016).
How would the policy impact these risks? Use evidence.                  The policy would mitigate, prevent and possibly eradicate these health risks by reducing inappropriate opioid prescriptions for other uses other than pain management. State policies designed to reduce inappropriate opioid prescriptions have reduced prescribed opioid amounts by 8 percent and prescription opioid overdose death rates by 12 percent (Dowell et al., 2016). Similarly, this policy will have the same effect in that it will forbid any opioid prescriptions that can lead to addiction or early death.
Specify the policy consequences, both intended and unintended, to the best of your ability.                    The intended consequence of this policy is that it will streamline and standardize opioid prescription practices using scientific evidence and legal requirements. These practices will entail preventing rather than treating opioid addiction and balancing the benefits and harms of prescription. An unintended consequence is that it may contribute to increased nonprescription opioid use. The decreased supply of prescription opioids has led to increased use of heroin and synthetic opioids due to their lower costs and higher availability (Sharareh et al., 2019).

Issue Analysis Part III

Specify 2-3 policy options (include ‘do nothing’ options – what happens if things continue as currently happening).                      The development of prescription monitoring programs and the use of physician-patient contracts are the two main policy options. The monitoring programs would entail data collection systems to determine the number of physicians prescribing opioids and the pharmacies where opioids are dispensed (Hahn, 2011). The physician-patient contracts would stipulate the terms of opioid treatment with a special focus on patient compliance with treatment and monitoring. If things continue as currently happening, the do-nothing option will entail better research to improve the current understanding of the underlying mechanisms in opioid misuse.      
Rationale for policy recommendations                          Sustained reductions in prescribing and dispensing opioids are the rationale for the prescription monitoring programs, while the risks associated with prescription opioids are the rationale for the opioid treatment contracts. Once implemented, prescription monitoring programs are associated with more than a 30 percent reduction in the rate of prescribing Schedule II opioids (Bao et al., 2016). The contracts would entail the protocols and tools to use for improving the safety and benefits of opioid prescribing practices. Uncertainty and ambiguity concerning the mechanisms in the misuse of opioid prescriptions would be the rationale for the do-nothing policy recommendation. Under current conditions, the opioid overdose crisis is expected to worsen such that from 2016 to 2025, there will be approximately 700,000 opioid-related deaths (Chen et al., 2019). Better research is thus needed to address this ambiguity and uncertainty of future trends in opioid prescriptions and misuse.
Identify criteria to evaluate policy options – enter on scorecard.       
Put each policy option in the Scorecard to rate your policy and its alternative     

Policy Options Scorecard

Identify your policy and reasonable options including a “Do Nothing” option.

Use this scorecard to rate your policy and the policy options. You can add criteria that you think are appropriate to your particular issue. Code your responses by using pluses and minuses.

Code: ++ strongly positive, + positive, — strongly negative, – negative

Criteria: Evaluate your policy on each of these criteriaPolicyPolicy Option # 1Policy Option # 2Policy Option # 3
Effectiveness   ++++
Protection of rights   +++
Costs   +
Administrative feasibility   +++
Fairness   +++
Evidence-based practice   +++++
Environmental effects   ++++
Power   +++
Cultural considerations   +++
Final Policy Problem Statement:   The misuse of opioid medications is a complex and multifaceted global health challenge requiring pain management through prescriptions as its starting point. For over a decade, prescription opioids have been the primary treatment for chronic pain globally (Webster et al., 2019). However, opioid prescription for pain management is a double-edged sword because it can alleviate chronic pain but also contribute to other health risks such as substance abuse, drug addiction, and premature death. Therefore, policy interventions for preventing the misuse of opioids should guide prescriptions based on their effectiveness and risks as well as benefits and harms.  
Recommended Policy Solution–Identify which of the policy alternatives is the best solution–give rationale.  

I have identified the utilization of physician-patient opioid treatment contracts as the best policy alternative to address the risks and harms of opioid prescriptions. The rationale for this solution is that patients and physicians are the most affected victims of opioid prescriptions, yet they ought to be beneficiaries rather than victims. Despite initiatives to promote evaluation and treatment, physicians are often reluctant to prescribe opioids for patients with chronic pain (Hudson & Wimsatt, 2014). This reluctance may be a cautionary measure and may also be selfish since physicians will not help patients in managing their chronic pain, yet they are in a position to do so. When benefits for pain and function are expected to outweigh risks, opioids should be used for the treatment of chronic pain (Dowell et al., 2016). Accordingly, the opioid treatment contract would ensure that patients and physicians have established treatment goals to maximize the benefits and minimize the risks associated with opioid prescriptions.

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