Increasingly, the use and abuse of opioids have become a pandemic in itself across the United States (Hudak, 2019). As a result, it has been subject to much debate in politics and the public health sector, all with the ultimate goal of addressing this serious issue. Arguably one of the most vulnerable populations who are most susceptible to developing an addiction to opioids is American veterans and military personnel (Hudak, 2019).
Historically, the United States Government has proudly invested billions of dollars into war efforts and has a strong American military ready to defend America both at home and abroad (Hudak, 2019). However, this most often does not extend to taking care of the military after retiring from active service. Each of these individuals has profound medical, psychological, and other health needs deserving of attention and proper funding. Of particular focus for this proposal is the unique needs of military veterans whose underlying conditions put them at an even greater risk of using and abusing dangerous drugs, such as opioids.
Emergent research has begun to highlight the interconnecting concern of military veterans with autism spectrum disorder (ASD) and their reliance on opioids (Grasso et al., 2016; Lindor et al., 2016). ASD is generally described as a neurodevelopmental disorder that exists on a spectrum and is usually characterized by persistent deficits in communication and interactions (Boutot, 2017). Given that no two cases of ASD are similar and a lack of consensus on the causes of ASD, it is therefore challenging for clinicians to ascertain the best course of treatment or therapy to mitigate the undesirable characteristics of ASD (Vatanoglu-Lutz et al., 2014). That said, a holistic approach might be ideally suited (Vatanoglu-Lutz et al., 2014).
This is of particular concern because those with ASD who have not received treatment and are in the military are both likely to experiment with substance use and abuse (Grasso, 2016; Weir, Allison, & Baron-Cohen, 2021). Moreover, one of the foremost health issues associated with the management of ASD among veterans is the preference of taking opioid medication without considering that opioid medication is addictive and has adverse impacts on their health status. According to Grasso et al. (2016), the health implication of opioid medication was the death of over 23,000 veterans due to unintentional overdose. The significance of developing health policy and guidelines for ASD is to provide adequate healthcare support to veterans because most of them live in remote areas where healthcare access is limited. The proposed policy should also ensure frequent follow-up visits, behavioral health treatment, and public health education on ASD treatment. It is also appropriate to have technology incorporated in health care strategies.
Proposed Policy and Guidelines
As Rosland et al. (2013) narrate, the Veterans Health Administration is an oversight body associated with the United States Government, whose general purview is to ensure quality care is offered to all American veterans. It is likely rather unsurprising that one of the foremost challenges experienced is providing veterans with a high standard of care consistently because of veterans’ diverse needs after arriving back in the United States (Rosland et al., 2013). Fundamentally, the focus should likely be on helping veterans healthily reintegrate into society. However, this is also probably easier said than done, given the complexities inherent to war and living a military lifestyle. This is in addition to the mental health and trauma needs of veterans. After all, as Hester (2017) noted, many veterans experience a lack of access to mental health services to address their pressing psychological concerns. Inevitably, this lack of access to proper services to support their needs results in veterans adjusting maladaptively. In some instances, this can mean abusing substances they perceive as therapeutic when the reality is they are anything but therapeutic (Hester, 2017).
This is an even more acute issue for those with ASD because, as iterated earlier, it is a neurodevelopmental disorder. Combining the realities of military service and the lack of access with the aforementioned common characteristics of ASD only magnifies the concern. Also, some extant research suggests that those with ASD tend to have a predisposition to depression and engage in substance use and abuse (Weinstock, 2019). In turn, this can lead to increased dependency, which further magnifies the health concerns.
Extant research posits that military veterans and those with ASD are two populations with increased vulnerability to engage in behaviors leading to substance abuse (Hester, 2017; Weinstock, 2019). It then follows that a veteran with ASD is placed at an even greater risk. Therefore, it would be prudent and likely ethically proper to develop appropriate healthcare treatment strategies management guidelines for veterans with ASD. Furthermore, given the prevalence of opioid abuse in the United States, strict regulations and guidelines are warranted. Specifically, they should strive to ensure that any possible prescriptions of opioids are strictly regulated, prescribed only if needed and as a temporary solution, and carefully monitored by healthcare professionals (Dowell, Haegerich, & Chou, 2016).
Bridging the Gap
Of course, it is always imperative that any proposals ensure mechanisms are implemented to bridge the gaps that exist between veterans and their ability to access and receive quality healthcare services. This policy proposal is bridging the existing gap in providing veterans adequate care to manage underlying conditions, such as ASD.
One such strategy that has received some consideration in the academic literature on addressing these gaps is incorporating Electronic Health Records (EHR) and Electronic Medical Records (EMR) systems through telemedicine practices. On this, Abbott et al. (2018) suggest that encompassing technology in managing health-related conditions faced by veterans would likely prove beneficial. This primarily alleviates the transportation concerns for some veterans with mobility concerns, but it also allows veterans to receive remote care through hopefully more frequent virtual visits (Abbott et al., 2018). Also, implementing this sort of system essentially creates a secured, shared database for the regulation and careful monitoring of prescriptions given for opioid medications in particular (Abbott et al., 2018).
Implementing this is not without some drawbacks, however. For example, one of the main barriers that might be associated with implementing the Electronic Health Record (EHR) systems and telemedicine is that it might be likely that many of the veterans might encounter difficulties using the technology. In addition, telemedicine might not be suitable for all types of visits, and some in-person appointments might be necessary.
In any event, it is evident that providing quality care to veterans is paramount and ought to be a focus in the United States. Veterans have complex needs that warrant urgent addressing to avoid continued healthcare crises within this vulnerable population (O’Hanlon et al., 2017).
With respect to providing care for veterans with ASD, it stands to reason that there ought to be some measure of inclusivity of responsible prescribing practices. Any prescriptions given to an ASD veteran should be done after consultation with a healthcare team to diligently ensure that it is in the patients’ best interests while being mindful of their neurodevelopmental challenges (Boutot, 2017). In other words, the potential therapeutic benefits should outweigh any potential risks. Although, given the precarious state of veterans and veterans with ASD, clinicians should still arguably strive to find ways to mitigate those risks regardless. As Boutot (2017) points out, those with ASD might still benefit from medical treatment for specific conditions, but they should always be paired with non-medical treatment options. Medical assessment should entail determining ASD factors and their impact on their daily and social lives. ASD treatment should entail safe prescription mechanisms such as short-term opioid medication paired with ASD treatment options.
The Need for this Proposed Policy
It is imperative to examine the necessity of such policies in discussing and evaluating any proposed policies, especially relating to vulnerable populations. Though the prevalence of ASD diagnoses continues to increase globally, it is still a disorder that often goes unnoticed – particularly in adults (Hinbest & Chmiliar, 2021). Consequently, this could be problematic for those with ASD who enter the military and eventually become veterans after retiring from service. Many veterans are likely unwilling to admit their vulnerabilities, including a neurodevelopmental condition such as ASD, as many prefer keeping the issues to themselves (Hudak, 2019). This, in turn, impedes their ability to get access to healthcare services.
Meanwhile, many veterans cannot receive full access to healthcare services because of their locality, while others do not have caregivers to assist them. As a result, veterans are a vulnerable population, thereby necessitating the implementation of a health policy that will improve how veterans receive access to quality care.
Also, opioid medication prescription varies among veterans’ well-being (Xu et al., 2019). Veterans, mainly those in remote areas, rely on opioid medication for ASD medication, resulting in higher addiction and mortality. There continues to be noted inadequate knowledge on ASD treatment in the veteran population. Against this backdrop, it is unclear how, if at all, opioid medication improves the outcome in those with ASD. As a result, further health policy and research on this topic are warranted.
An Interprofessional approach in implementing policy guideline
Deboth and Wendland (2021) described an interprofessional approach to healthcare as one that involves coordinated care of patients across a team of healthcare professionals. That is, there is a healthcare team that works together to improve patient outcomes, which is usually comprised of pharmacists, doctors, nurses, and other practitioners. A vital component of this approach is that it encompasses working together to achieve a common objective in providing the best quality of integrated healthcare services (Deboth & Wendland, 2021).
Veterans can greatly benefit from interprofessional care with the implementation of telemedicine. This is because it would make it more feasible for healthcare centers, nurses, doctors, pharmacists, and other specialists to facilitate delivering high-quality healthcare services (Abbott et al., 2018). Doing so would possibly contribute to better patient outcomes and patient satisfaction. This can be achieved by using remote patient monitoring systems, EHR, EMR, and video conferencing. In addition, according to Johnson & Mahan (2020), healthcare centers can appoint healthcare professionals to be in charge of telemedicine equipment, thereby reducing the prevalence of medical errors.
To conclude, veterans in the United States, including those with autism spectrum disorder (ASD), experience profoundly challenging situations that most Americans would likely find challenging to fathom. Accordingly, it is incumbent on the United States to boldly improve care for these veterans in need to ensure they can have a good quality of life when they return home.
Although there have been some improvements made in addressing the healthcare needs of veterans, it is clear that more needs to be done. Extant research continues to point to crises arising in veteran healthcare, chiefly abusing opioid medication (Hudak, 2019; Xu et al., 2019). Moreover, they also experience barriers to accessing healthcare services, as intimated by O’Hanlon et al. (2017). Finally, those with ASD continue to be unable to adequately manage these conditions, which leads to adverse outcomes.
There are solutions to bridging these gaps and ensuring that these individuals receive quality healthcare in the United States. The implementation of telemedicine options resolves the transportation issue for veterans and is relatively inexpensive, and is also conducive to the interprofessional approach that Deboth and Wendland (2021) outlined.
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