Introduction: According to the US National Archives, during the Vietnam War, there

were 58,220 fatalities from 1956-1976. However, in 1999-2017, there were more than
700,000 opioid overdoses that lead to death. As we can see, this is a very great issue,
In 2017, the number of overdose deaths involving opioids (including prescription opioids
and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than
in 1999. Drug overdose is now the leading cause of accidental death in the United
States, surpassing guns and even car accidents. On average, 130 Americans die every
day from an opioid overdose. Every 24 minutes, there is one opioid-related death. Hello,
my name is, I and my team are on the opposition side of the debate today, we strongly
believe that pharmaceutical companies are not responsible for the opioid crises.

The administration of opioids has been used for centuries as a viable option for pain
management. When administered at appropriate doses, opioids prove effective not only
at eliminating pain but further preventing its recurrence in long-term recovery scenarios.
Physicians have complied with the appropriate management of acute and chronic pain;
however, this short or long-term opioid exposure provides opportunities for long-term
opioid misuse and abuse, leading to addiction of patients who receive an opioid
prescription and/or diversion of this pain medication to other people without prescription.
Several reviews attempted to summarize the epidemiology and management of opioid
misuse, this integrative review seeks to summarize the current literature related with
responsible parties of this opioid abuse crisis and discuss potential associations
between demographics (ethnicity, culture, gender, religion) and opioid accessibility,
abuse and overdose.

Roadmap: As the first speaker in the debate, I will be stating our limitations in the
debate and then be bringing up the 3 points that our team has for the debate for
today. Our second speaker will refute what points that the other team brings up. After
that, he will be strengthening our current points. Our third speaker will be refuting what
our opponents have said and then state the impact of the debate, and then weigh both
sides and show why we should win. Our three points for the debate today are 1, It is
the fault of the people. Our second point is healthcare and hospitals are not doing
much to stop this. Our third point is that the economy was the fuel of the
epidemic.

Limitations: We are limiting this topic to only the United States. Here is why we
are doing that: The US makes up 5% of the population of the world. However, the
US consumes 80% of the prescription opioids. Since the US consumes by far the
most opioids, this topic should only be limited to the USA. It was the companies
fault for starting it, but for it to continue was the fault of people. The doctors
overprescribe these drugs and some people who get their hands on it will start to
sell it leading to more misuse. This misuse includes people crushing the pills to
powder and inhaling it or to make it into a solution and inject it into themselves
for faster effects.

Contention 1: Onto our first point which is it is the fault of the people. Since 1999,
the volume of prescription opioids has increased by a stunning 400%. This is due
to the doctors overprescribing these drugs. Also, according to NIH, opioid-related
deaths have also increased by 400%. This shows the problem. The companies do
not prescribe opioids, they just manufacture it, like they should be doing.
However, it is the doctors that are the people that prescribe it. Doctors
overprescribe opioids, just as they overprescribe antibiotics. But it is generally
well-meaning; they don’t want their patients to experience pain. But then they prescribe
30 or 60 pills when 5 or 20 would have been adequate. The role of these physicians can
best be described as an innocent bystander. They were truly trying to help the patient.
But nevertheless, though good meaning, it still leads to the opioid crisis becoming even
greater. Not only the doctors though, but it is also people who sell these drugs
illegally, who create these drugs by themselves, without the pharmaceutical
companies. Drug dealers are obviously the source of illegal drugs such as heroin
and various forms of fentanyl not available by prescription in the US. These drugs
are not created by pharmaceutical companies. However, data from SAMHSA
indicate that when it comes to prescription opioids, drug dealers play a limited
role in the supply chain. Fewer than 10% are purchased from drug dealers or
other strangers. Approximately 50% of non-medical users of prescription opioids
get them from friends or relatives; 25% get them by prescription from physicians.
Despite the often-cited problem of patients obtaining prescriptions from multiple
prescribers, most receive the prescriptions from one doctor. If pharmaceutical
companies were to blame for the opioid crisis and it would go away if we simply
clamped down on them even harder. The truth is that the fault and remedy are
much more complex, and fixing this scourge takes all of us.

Contention 2: Healthcare was another leading cause of the opioid crisis. Nearly
half a million individuals with opioid use disorders are hospitalized each year in
the United States. While they are in the hospital, medical providers often treat
complications of this disorder, such as bloodstream infections, but rarely directly
address their addiction. That’s like pumping up a flat tire without ever looking for
the nail that caused the problem. Hospitalization is a “teachable moment” for
many people with opioid use disorders — they are in a safe space removed from
environments that may promote drug use and, with an acute medical issue, they
may be reflecting on the consequences of their addiction and open to solutions
to help them enter recovery. But, what these hospitals are doing is not helping
their addiction. The hospitals are just treating the health effects of the drugs, but
they are not stopping the addiction. We need to do a better job building systems
and training health care professionals to adequately treat opioid use disorder in
the hospital and to connect patients with ongoing outpatient treatment and
support. At the vast majority of the 6,000 acute care hospitals in the U.S., patients
with opioid use disorder are typically offered little more than detoxification. In
one large academic hospital, for example, fewer than 10% of patients with heart
infections from intravenous drug use were provided access to drug treatment
programs. This approach isn’t effective. About 80% of people who use heroin
who are provided the only detox in the hospital will return to using the drug
within a month of discharge says NCBI. And up to 30% of hospitalized patients with a
substance use disorder discharge themselves early against medical advice before
completing critical medical treatment. Patients who are offered medications to treat
opioid use disorder do much better. Buprenorphine, an FDA-approved medication for
opioid use disorder, reduces opioid withdrawal symptoms and decreases cravings.
When started in the hospital, buprenorphine increases participation in outpatient
treatment and reduces hospital readmission for opioid-related reasons. This prevents
avoidable deaths and reduces the overall costs of care. Unfortunately, buprenorphine is
rarely used in the hospital setting. Prescribers describe lacking experience or formal
education in treating addiction and using recovery-centered language. Many
hospital-based clinicians and administrators feel that treating addiction is something that
should be left to psychiatrists in the outpatient setting. While ensuring ongoing
outpatient treatment is essential, ignoring this problem in the hospital is a missed
opportunity to intervene.

Contention 3: Onto our third point. Most of the opioid epidemic happened on the
east coast, where the economy is falling right now and leads to lots of
unemployment. Lots of automobile industries have closed. In 2015, Jennifer Silva,
a professor of sociology and anthropology at Bucknell University, began
interviewing people in the coal region of northeastern Pennsylvania. She was
working on a project, which would become the book We’re Still Here, about how
poor and working-class Americans were affected by the collapse of the coal
industry—the major job provider in the region. But what she found out is that this
is connected to the opioid epidemic. Silva’s interviewees might have been
representative of an awful connection between job loss and opioid abuse, a connection
that continues to be bolstered by research. A study published in the journal JAMA
found that counties with automotive assembly plants that closed had, five years
after the closure, 85 percent higher rates of opioid-overdose mortality, relative to
counties where automotive assembly plants remained open. After all, there are a
number of potential connections between joblessness and addiction, says
Atheendar S. Venkataramani, an assistant professor of health policy at the
University of Pennsylvania and the lead author of the study. Losing a job might
mean losing access to health insurance. It could lead to isolation and loneliness,
or a sense that there’s little left to live for. “If you feel like the American dream is no
longer accessible,” Venkataramani says, “then one may also feel that, Well, it’s not
really worth investing in me... because investing in yourself is one way to access the
fruits of the American dream.”