Aminu Alibe

19 January 2018
Independent Research II G/T
Final Annotated Bibliography

Alderks, C. E. (n.d.). Trends in the Use of Methadone, Buprenorphine, and Extended-Release

Naltrexone at Substance Abuse Treatment Facilities: 2003-2015 (Update). ​SAMHSA​.
Retrieved from Pubmed database. (Accession No. 29200242)

This article was written for the Substance Abuse and Mental Health Services
Administration about updated trends in the use of MAT services. The SAMHSA regulates all
opioid treatment programs and uses methadone, buprenorphine, and extended-release naltrexone
to treat opioid addiction. Methadone must be administered at a treatment clinic unless someone
has been on a long-term program, because of this it requires daily visits to an opioid treatment
program. Physicians with specialized training can prescribe buprenorphine, but buprenorphine
may not be appropriate for all individuals. Extended-release naltrexone can be prescribed my
anyone who is qualified to prescribe medicine. According to the article, in 2015 2.4 million
people in the United States were addicted to an opioid. People continue taking opioids because of
how intense withdrawal symptoms can be. There is still an unmet need for medication-assisted
treatment, though some of that need has been met in recent years.
This article is helpful because it provides an insight into how medications can be used to
treat opioid addiction and also how successful these programs have been. Further research into
medication-assisted treatment will be helpful to the research because it provides an avenue for
people to recover from opioid addiction.

Barlas, S. (2017). U.S. and States Ramp Up Response to Opioid Crisis: Regulatory, Legislative,
and Legal Tools Brought to Bear. ​Pharmacy & Therapeutics​, ​42​(9), 569-571,592.
Retrieved from Pubmed database. (Accession No. 28890643)
 This article is written by Stephen Barlas, a freelance reporter that covers political issues
in Washington D.C. He notes how the federal and state governments have improved their
response to the opioid crisis, but there is still a significant amount of progress that needs to be
made. The opioid crisis has potentially affected health policy in the U.S. Congress, when a July
effort to repeal the Patient Protection and Affordable Care Act by Republicans failed, partly
because of concerns about the impact of Medicaid spending on addiction services. The Justice
Department and state governments have sued doctors for improper opioid prescribing practices,
and in some cases have arrested them. The author notes how a synthetic opioid, fentanyl, has
increased the problem of the opioid crisis. Fentanyl largely comes into the country from China
through the U.S. Postal Service. USPS has increased their participation with the U.S. Customs
and Border Protection, senator Rob Portman (R-OH) notes that this is a welcome improvement,
but not enough. All 50 states now have a system to identify individuals that may abuse opioids,
based on how many opioid prescriptions they have had in the past. Drug companies like Purdue
Pharma, Teva Pharmaceutical Industries, Johnson & Johnson, and Endo Pharmaceuticals have
seen lawsuits as a result of increased state activity.
This article is helpful because it identifies strategies both federal and state governments
have taken to mitigate the opioid crisis. Also, it identifies how effective those strategies have
been and identifies what might need to happen in the future. Ideas discussed in the article will be
helpful for further research.
Barnett, M. L., Olenski, A. R., & Jena, A. B. (2017). Opioid-Prescribing Patterns of Emergency
Physicians and Risk of Long-Term Use. ​The New England Journal of Medicine​, ​376​,
663-673. https://doi.org/10.1056/NEJMsa1610524

This article was written and published in the New England Journal of Medicine and
discusses the correlation between overprescription of opioids and long-term addiction among the
elderly Medicare population. Many scholars attribute overprescription of opioids in the late
twentieth century as a major contributor to today’s opioid crisis. In fact, opioid prescriptions are
so prevalent that every American in 2010 could have five milligrams of hydrocodone every four
hours for a month. To effectively conduct research, the authors categorized different prescribers
into four quartiles: high-intensity, low-intensity, and two middle quartiles. The results from the
middle two quartiles were not included in the results so the results would be more apparent.
High-intensity prescribers are prescribers that prescribed more opioids to emergency room
patients, while low-intensity prescribers did not prescribe as many opioids in the same hospital
emergency room. The researchers found that patients who were prescribed opioids by
high-intensity prescribers were more likely to develop a long-term opioid addiction twelve
months after the emergency room visit. This statistic disproves society’s perception that opioid
addiction results from a chance exposure to prescription opioids. Instead, addiction correlates to
overprescription.
This article is useful because overprescription is a significant factor in today’s opioid
crisis. The references cited in this article will provide different sources to research
overprescription.

Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between Nonmedical
Prescription-Opioid Use and Heroin Use. ​The New England Journal of Medicine​, ​374​(2),
154-163. https://doi.org/10.1056/NEJMra1508490
 This article was written by Dan L. Longo. Longo analyzes the correlation between
prescription opioid abuse and heroin use. As many states begin cracking down on “pill mills”
(clinics that overprescribe opioids when they are not needed), policy entrepreneurs speculate the
shift from prescription opioids to heroin. However, the author notes the lack of clear evidence to
support this although many studies found a baseline relationship between heroin use and opioid
use. They note the similarities between opioids and heroin, such as the stimulation of the brain’s
G-protein receptors and an increase in dopamine levels, which provides the high. As many
prescription opioid users develop tolerance, they tend to consider heroin because it is cheap,
reliable, and less restrictive (prescription opioids have a slow release mechanism that deters
abuse). Overall, the author finds the transition rate from prescription opioids to heroin low. Only
3.6% of prescription drug abusers used heroin within five years of their drug addiction.
This article is useful because it addresses the transition rate between prescription-drug
abusers to heroin, which remains low despite the intensity of the opioid crisis nationwide.
Finally, the article provides references to further studies concerning the correlation between
prescribed opioids and heroin.
Cottrell, G. (2018, January 7). Postal Service: We’re fighting opioid crisis. Retrieved January 9,
2018, from USA Today website:
https://www.usatoday.com/story/opinion/2018/01/07/postal-service-fighting-opioid-crisis
-editorials-debates/109251​7​64/

This article was written by Guy Cottrell, the Chief Inspector of the U.S. Postal Service,
about the Post Office’s response to the opioid crisis. He notes that the Postal Inspection Service’s
international parcel seizures increased 375 percent and domestic parcel seizures increased by 800
percent. The increased success of the Post Office in seizing parcels containing illegal opioids is
because of a successful partnership with Customs and Border Protection. Since the Post Office
does not have relationships with international customers, they are more able to require customers
to provide information before accepting packages. This information can then be used to identify
potentially illegal parcels. Three years ago, the Post Office received almost no electronic data but
today 40 percent of the packages they recieve have data.
This article is helpful because it was written by a high-ranking employee about the Post
Office’s response to the opioid crisis. His knowledge about what has improved further can help
the research identify what other actions the U.S. government should take to mitigate the opioid
crisis. This article can also lead to further research on the STOP Act, which Cottrell mentions.

Davis, P. (2018, January 2). Anne Arundel Looks to 2018 to Turn Tide on Opioid Crisis.
Retrieved January 3, 2018, from
https://www.nbcwashington.com/news/local/Anne-Arundel-looks-to-2018-to-turn-tide-on
-opioid-crisis-467696983.html
 This article was written by Phil Davis for NBC Washington about Anne Arundel
County’s response to the opioid crisis in 2018. Anne Arundel County is one Maryland county
that was extremely impacted by the opioid crisis in the year 2017. In 2017, 152 people died from
overdoses and 1,062 people overdosed by December 27. The prevalence of fentanyl in opioids
has worsened the impact of the opioid crisis because of its lethality. In 2018, Anne Arundel
County will try to invest more in education and recovery initiatives to prevent people from
overdosing and help people recover from overdoses. The county will also target some programs
to their homeless population. The county is considering reinstating the Drug Abuse Resistance
Education program, which might be controversial because some say it has not had an impact on
the amount of overdoses. The county is also pursuing litigation against the prescription opioid
industry for their part in the opioid crisis. Overall, Anne Arundel County looks to use 2018 to
turn the tide against opioid addiction and reduce the amount of people who overdose and people
who die as a result of overdose.
This article was useful because it demonstrates the response of a Maryland county to the
opioid crisis and the new strategies they are trying to prevent the opioid crisis from worsening.
This article also highlights the resources they might need to be successful.

Dews, F. (2017, September 7). How the opioid epidemic has affected the U.S. labor force,
county-by-county. Retrieved November 30, 2017, from Brookings website:
https://www.brookings.edu/blog/brookings-now/2017/09/07/how-the-opioid-epidemic-ha
s-affected-the-u-s-labor-force-county-by-county/

This article was published by Fred Drews for Brookings Now. It concerns a study
Brookings completed about the correlation between the opioid epidemic and declining
participation in the U.S. labor force. Participation in the U.S. labor force has been steadily
declining in the 2000s. According to the article, Princeton economist Alan Krueger believes the
increase in opioid prescriptions from 1999 to 2015 could account for 20 percent decline in men’s
labor force participation and a 25 percent decline in women’s labor force participation. His
research indicates that a 10 percent increase in the amount of opioids prescribed in a county is
attributed with a 1 percent increase of people taking opioids on a daily basis. Importantly,
Krueger found a decrease in labor force participation in every county where more opioids were
prescribed. This impact has been felt stronger in counties in poorer southern state.
This article is helpful because it correlates the opioid epidemic to the U.S. economy and
participation in the U.S. labor force. This demonstrates another aspect of how the United States
is affected by the opioid crisis. In the future, research will be conducted to look at the opioid
crisis from an economic perspective.

Drug Enforcement Agency Strategic Intelligence Section. (2016, July). ​Counterfeit Prescription
Pills Containing Fentanyls: A Global Threat​ (Research Report No.
DEA-DCT-DIB-021-16) (DEA Strategic Intelligence Section, Author). Retrieved from
https://content.govdelivery.com/attachments/USDOJDEA/2016/07/22/file_attachments/5
90360/fentanyl%2Bpills%2Breport.pdf
 This report was prepared by the Drug Enforcement Agency Strategic Intelligence Section
regarding the supply increase of fentanyl in the United States and Canada. Fentanyl is a synthetic
opioid that is extremely lethal in small quantities. It is mixed in with other illegal narcotics, such
as heroin, because of its cheap price. Approximately two milligrams of fentanyl is lethal, and this
quantity can be accidentally absorbed through skin contact or inhaled. There are many reports of
police officers and federal agents accidentally overdosing on fentanyl solely by handling it. An
example is a customs officer who handled a freight shipment containing fentanyl. By the end of
2006, the amount of fentanyl exhibits in the National Forensic Laboratory Information System
(NFLIS) reached a new high of 1,594. This was considered the worst fentanyl crisis in the United
States, but by 2007, fentanyl numbers dropped off. However in 2013, the DEA reports the
number of Fentanyl Exhibits in NFLIS skyrocketed to 7,864. China is considered a major
exporter of fentanyl to the United States. Traffickers use a combination of freight forwarders and
multiple transferals of custody to make it harder for customs officials to track it.
This report is useful because it highlights the growing impact fentanyl has on the opioid
crisis. It highlights the fears the DEA has on fentanyl hampering progress law enforcement has
made in stopping the opioid crisis. New information from this report and can be used for future
research.

Fairbairn, N., Coffin, P. O., & Walley, A. Y. (2017). Naloxone for heroin, prescription opioid,
and illicitly made fentanyl overdoses: Challenges and innovations responding to a
dynamic epidemic. ​International Journal of Drug Policy​, ​46​, 172-179.
https://doi.org/10.1016/j.drugpo.2017.06.005

This article was written for the International Journal of Drug Policy and comments on the
importance of naloxone to respond to the opioid crisis. Naloxone is a drug that prevents
overdoses by kicking out opioid proteins that is binded to a person’s brain. Naloxone can be
introduced into the body intramuscularly or intranasally. Many first responders use the
intramuscular version of naloxone, which can automatically inject naloxone after being held over
an appropriate muscle. An important factor that contributes to an overdose is the fluctuation of
heroin’s potency, so many addicts learn to test the potency of heroin. Naloxone programs have
been successful to prevent heroin overdose deaths in Scotland, Massachusetts, and communities
across the United States. This is because heroin takes 20 to 30 minutes before killing a heroin
user. The heroin crisis is increasingly becoming a fentanyl one because it is easier to create and
transport in bulk. With the increasing prevalence of fentanyl, naloxone programs reflect less
success because fentanyl can kill a user within minutes. This is not enough time for first
responders to be dispatched and respond to an overdose.
This article was helpful because it provides information about the effectiveness of
naloxone in mitigating the opioid crisis not only in the United States, but around the world. The
references cited in the article can be used for further research.
Fentanyl: The Next Wave of the Opioid Crisis: Hearings before the Committee on Energy and
Commerce Subcommittee on Oversight and Investigations​, 115th Cong., 1st Sess. (2017)
(testimony of Debra Houry, M.D., Director, National Center for Injury Prevention and
Control, Centers for Disease Control and Prevention). Retrieved from
https://www.hhs.gov/about/agencies/asl/testimony/2017-03/fentanyl-next-wave-opioid-cr
isis.html?language=es

This testimony is by Director Debra Houry, M.D., to the Committee on Energy and
Commerce concerning the state of the current opioid crisis. She discusses what the Centers for
Disease Control and Prevention is working on to mitigate the opioid crisis. The CDC is focusing
on surveillance, improving opioid prescribing policies for treating pain, and distributing
naloxone to local first responders. Concerning surveillance, the CDC is implementing a database
to report overdoses. This will then be used to predict high-risk opioid communities. The Director
also emphasizes the need for improving how physicians prescribe opioids. Data suggests that
patients who receive opioids from high-intensity prescribers, are at an increased risk of
developing a long-term opioid addiction. Finally, naloxone is an essential drug in treating people
who overdosed on opioids. The drug is injected in a person’s bloodstream and clears the
receptors opioids bind to, saving the person’s life. The director also emphasized the
destructiveness of synthetic opioids, such as fentanyl. These opioids are more dangerous because
of their high potency and how little is needed to overdose.
This testimony was helpful because it provided more information on the state of the
current opioid crisis, and the increased risk posed by synthetic opioids. The references cited in
the article can be used in further research.

Gurman, S. (2018, January 1). Authorities Are Cracking Down on Opioid-Peddling Doctors.
Retrieved January 2, 2018, from ​http://time.com/5083313/opioid-crisis-doctors/

This article was written by Sadie Gurman about the federal government’s new response
to the opioid crisis. The government is now utilizing data-driven analytics to prosecute doctors
who overprescribe opioids to people who do not need them. This is in an effort to stop so called
“pill mills,” places addicts go to obtain legal prescriptions. The article focuses on one doctor that
was charged by the Justice Department, Dr. Andrzej Zielke. His prescribing pattern of
oxycodone led to one dying. The Justice Department is using prescription drug databases,
Medicaid and Medicare figures, and coroners’ records to identify doctors who overprescribe
opioids. Rather than prosecutors having to rely on informants and limited data, now analysts in
Washington can quickly identify these doctors, which will help to reduce the amount of doctors
who overprescribe while deterring doctors from overprescribing. However, another aspect to this
is that law-abiding doctors might be scared to prescribe opioids. However, a large amount of
opioid prescriptions is not the only thing that raises suspicions, if the physician is a dentist, a
psychiatrist, or or a gynecologist the government can identify their prescribing patterns as
abnormal and suspicious.
This article was helpful because it explains what the federal government is now trying to
do to mitigate the opioid crisis. Using data analytics is something new that the government can
now do. This can lead to further research such as how effective data analytics is.
Hearings before the Senate Caucus on International Narcotics Control​, 113th Cong., 2d Sess.
(2014) (testimony of Nora D. Volkow, M.D., Director, National Institute of Drug Abuse).
Retrieved from
https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/
americas-addiction-to-opioids-heroin-prescription-drug-abuse

This testimony was given by the Director of the National Institute of Drug Abuse, Dr.
Nora. D. Volkow, to the Senate Caucus on International Narcotics Control. Dr. Volkow
discusses the increasingly problematic nature of America’s drug epidemic, which she attributes
to the substantial increase of prescribed opioids, the changing American culture that places less
taboo on using opioids, and the economic profits gained by pharmaceutical companies. The
written testimony notes the dramatic extent of how many people abuse opioids worldwide.
Throughout the world in 2013, physicians wrote nearly 207 million prescriptions for opioids
such as hydrocodone and oxycodone, of which the United States consumed nearly 100 percent of
the world’s hydrocodone and 81 percent of oxycodone. Another scary statistic describes the
increase in the nonmedical use of opioid analgesics, which rose from 144,600 in 2004 to 305,900
in 2008. Finally, the Director notes the increased danger of crushing pills and snorting them
because it destroys the slow-release system implemented in opioid pills, which can increase the
risk of overdose. Many Americans genuinely need opioids to deal with pain and reduce
suffering, but a balance must be struck between prescribing opioids and not.
This written testimony is helpful to research the opioid crisis because it provides an
in-depth background of factors which aggravated the current situation, and topics covered can
provide more topics from research. Finally, the testimony provides useful information and
statistics about the extent of the opioid crisis.

Irwin, A., Jozaghi, E., Weir, B. W., Allen, S. T., Lindsay, A., & Sherman, S. G. (2017).
Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a
hypothetical supervised injection facility. ​Harm Reduction Journal​.
https://doi.org/10.1186/s12954-017-0153-2

This article is a cost-benefit analysis of opening supervised injection facilities in

Baltimore. Heroin overdose deaths increased from 192 to 260 in 2014-2015. The authors
attribute the increase of deaths to the use of fentanyl in heroin. Supervised injection facilities are
locations where heroin users can go to inject previously obtained heroin under supervision from
medical professionals. The thought behind these facilities is that users will be provided with
clean needles and safe injecting education, which would reduce diseases. Medical professionals
can monitor the users and prevent heroin overdoses. Staff can also convince users to seek
medical rehabilitation. A total supervised injection sites would have a benefit of $7.7 million and
a total cost of $1.79 million. This creates a cost-benefit ratio of $4.35:1. Despite the potential
benefits of a supervised injection facility, the authors acknowledge the political and social
limitations of implementing injection sites in any city. People are uncomfortable with the idea of
an injection site. They believe having a government-sanctioned location where heroin users can
use heroin enables them rather than treating them. Furthermore, a supervised injection facility
might become the subject of federal scrutiny or potential legal action.
This article was helpful to understand a potential idea for mitigating the opioid crisis in
large cities. References cited in this article can be used for further research. A potential limitation
of this article is this might only work in large cities, not rural areas.

Magill, K. (2017, August 25). Howard community members brainstorm opioid epidemic
strategies at workshop. Retrieved November 1, 2017, from Baltimore Sun website:
http://www.baltimoresun.com/news/maryland/howard/ph-ho-cf-opioid-workshop-0831-st
ory.html

This article was written by Kate Magill for the Baltimore Sun about the opioid crisis in
Howard County. The author discusses a workshop sponsored by the Howard County’s Office of
Emergency Management about the opioid crisis. Many speakers have been personally impacted
from the opioid crisis, whether in the form of loved ones or friends that overdosed. Director of
Policy and Programs Carl DeLorenzo and Health Officer Maura Rossman discussed the awful
statistics of the opioid crisis and the multiple options Howard County has to effectively respond
to the opioid crisis. Recovery homes are facing the problem of overcrowding. Mike Elder, the
owner of Donleigh House, discusses having to send away at least one person a week from his
recovery home.
This article is helpful because it discusses the opioid crisis’ impact on Howard County.
Furthermore, the article will help prepare for an interview with a county councilor regarding
Howard County’s response to Howard County.

Magill, K. (2017, December 12). Howard County, Aetna partner to put naloxone in county
buildings. Retrieved January 11, 2018, from
http://www.baltimoresun.com/news/maryland/howard/columbia/ph-ho-cf-aetna-partnersh
ip-1214-story.html

This article was written by Kate Magill for the Columbia Flyer and Baltimore Sun about
a donation given by Aetna, a healthcare company, to Howard County. Aetna is the Howard
County government’s official healthcare provider and donated 408 naloxone kits to the
government. These kits will be placed in automatic external defibrillators in every Howard
County government building. According to Howard County Executive Allan Kittleman, the
county also plans to provide every government employee an hour of leave for training on how to
use naloxone. According to the author, the day of the announcement Deputy Sheriff Dave
Manning administered naloxone to someone who overdosed in the hall of the county courthouse.
Also mentioned by Allan Kittleman is the search for Howard County’s first residential detox
center. According to the police department, almost everyday since October 2017 an overdose
happens in Howard County. This has led to county officials making an effective response to the
opioid crisis a priority.
This article is helpful because it provides information on steps the Howard County
government is taking to mitigate the opioid crisis. This is also helpful for further research on the
effectiveness of their methods in reducing the amount of overdoses that occur in the county in
2018.
Maile, S., & Knapp, J. (2017). Fentanyl: Not Just Another White Powder. ​Fire Engineering​,
170​(6), 28-32. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=123397620&site=ehos
t-live

This article was written by Shawne Maile and Jerry Knapp for Fire Engineering journal.
The article discusses the increasingly stark problem first responders in opioid states across the
country are dealing with. Many times when county hazmat teams respond to a white powder
threat, it is a false-flag. However, because of the fentanyl crisis, first responders and hazmat
teams are increasingly responding to dangerous white-powder threats. Fentanyl is an extremely
dangerous opioid that is flooding the U.S. illegal drug market because of its low cost and easy
production. Often produced in China, fentanyl is smuggled through the U.S. through freighters or
the Mexican border. Just minute amounts of fentanyl, sometimes the size of two grains of sand,
can kill a grown man. There are documented cases of police officers accidentally touching
fentanyl and overdosing. When first responders respond to drug overdoses or the police conducts
a drug bust, the author recommends using self-contained breathing apparatus and Level A PPE.
These systems will protect first responders from the dangers of accidentally inhaling or coming
in contact with fentanyl.
This article is interesting and provided more subjects for research. It documents the
increasingly volatile state of the U.S. opioid crisis with the increase in fentanyl. The sources
cited in the article can be used for further research.

McGreal, C. (2016, May 25). How cracking down on America’s painkiller capital led to a heroin
crisis. Retrieved September 18, 2017, from
https://www.theguardian.com/science/2016/may/25/opioid-epidemic-prescription-painkill
ers-heroin-addiction

This article was written by Chris McGreal for The Guardian about the switch from
prescription painkillers to heroin, specifically in Florida. In 1996, Oxycontin was introduced to
the medical market, and pain clinics emerged in Florida. The author describes an infamous one,
“American Pain,” that was run by former strippers and doctors carrying guns. These pain clinics
did not critically solve the medical problems of their patients, but prescribed painkillers for
everything. The doctors had no interest in improving their patients conditions, they only wanted
to sell pills. Florida was known as the “Oxy Express” of America, and when legislators decided
to crack down on prescription painkiller abuse, they did not anticipate the transition away from
prescriptions to heroin without any support infrastructure for people who were already addicted.
The author interviews several of these people. One describes the inevitable shift to heroin addicts
faced. In 2010, the FBI shut down American Pain and other pill mills and their owners were put
on trial. The lack of supply and intense demand facilitated a switch from painkillers to heroin.
While oxycodone deaths dropped 69% from 2010 to 2015, heroin deaths doubled in 2014 alone.
The author notes the need for lawmakers to develop critical support infrastructure while also
addressing the opioid crisis.
This article provides useful background information regarding the switch from painkillers
to heroin and underlines the importance of lawmakers to be fully prepared to deal with the opioid
crisis. The addicts interviewed in the article provided a real-life case study of the opioid crisis’
harmfulness.

Michaels, A. (2017, October 24). Howard County opioid overdose cases increase from 2016,
police say. Retrieved November 1, 2017, from Baltimore Sun website:
http://www.baltimoresun.com/news/maryland/howard/columbia/ph-ho-cf-opioid-overdos
es-20171026-story.html

This article was written by Andrew Michaels for the Baltimore Sun. He writes about the
increase in opioid overdoses from 2016. The Howard County police department report an
increase in both fatal and non-fatal overdoses from all areas of the county. Since the time of the
article, there have been 138 non-fatal overdoses and 43 fatal overdoses. This is up from 133
non-fatal overdoses and 29 fatal overdoses in the entirety of 2016. In non-fatal overdose cases,
Howard County first responders use the drug naloxone (otherwise known as Narcan) to counter
the effects of overdose. When someone overdoses on an opioid, their breathing significantly
decreases. Naloxone counteracts this, saving a person’s life. It is non addictive and essential to
respond to the opioid crisis. The Howard County Health Department tries to inform residents
over 18 about the signs of opioid overdose, how to respond, and prevent one.
This article is helpful because it discusses the impact of the opioid crisis on Howard
County, and the importance of naloxone to first responders. This article will help prepare for an
interview with a Howard County councillor about the county’s response to the crisis.

Saul, J. (2016). China White Lie. ​Newsweek Global​, ​167​(15), 24-25. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=118723446&site=ehos
t-live

This article was written by Josh Saul for Newsweek Global. The article discusses how
fentanyl enters the United States from China. In February, a customs officer spotted a
19-year-old walking by the U.S.-Mexico border. The officer discovered 1,200 fentanyl pills
disguised as oxycodone. The author discusses how this particular example highlights the
staggering amount of fentanyl being smuggled into the U.S. This is particularly scary because of
how lethal fentanyl is. Fentanyl is 100 times stronger than oxycodone, and 25 to 50 times
stronger than heroin. Many people who overdose on fentanyl think they are using heroin or a
prescription pill with a lower lethality dose, which increases the amount of overdoses. The author
acknowledges the growing political pressure both Democrats and Republicans are facing about
the opioid crisis. As more states declared states of emergencies, the crisis was discussed at length
during the 2016 presidential election.
This article is helpful because it highlights the growing trend away from heroin and
oxycodone towards fentanyl in the opioid crisis. The references cited in this article can
contribute to further research.

Smialek, J. (2017, October 26). This Is How the Opioid Crisis is Changing America. Retrieved
December 1, 2017, from Bloomberg website:
https://www.bloomberg.com/news/articles/2017-10-26/as-u-s-opioid-crisis-deepens-and-s
hifts-trump-seeks-solutions
 This article was written by Jeanna Smialek for Bloomberg and discusses how the opioid
crisis is changing America. In areas across the United States, 2017 is already setup to exceed
2015’s opioid overdose levels. According to the article, the opioid crisis kills 91 Americans
every day. 2 million Americans 12 years old or older were addicted to opioids or heroin in 2015.
This affects the U.S. labor force because it takes able-bodied workers out of the workforce. Men
and women’s participation levels have decreased slightly since 2000, and the increased use of
opioids might be attributable to this. However, since 2010, doctors have begun to decrease the
amount of opioid prescriptions in response to the growing opioid crisis and prescription drug
abuse. In 2010, the article lists the 5 states with the highest age-adjusted death rates from opioids
as West Virginia, Nevada, Kentucky, Oklahoma, and Utah. In 2015, the states were West
Virginia, New Hampshire, Ohio, Rhode Island, and Massachusetts. Finally, opioid overdose
deaths are moving toward younger people, which could complicate the response to the opioid
crisis.
This article is helpful because it demonstrates how the opioid crisis impacted America in
general, and not just how it has affected people addicted to opioids and their families. This
research will be helpful because more research can be conducted on the information learned in
this article.