What Should We Do About The Opioid Epidemic? (NIFI Issue Advisory)

The National Issues Forum Institute released the six-page Issue Advisory, What Should We Do About The Opioid Epidemic?, published October 2017. The issue advisory presents three options to use during deliberation on how society can address the rising opioid epidemic that has swept the U.S. The issue advisory is available for free download on NIFI’s site here, as well as, a post-forum questionnaire.

From NIFI…

Drug abuse, a problem the United States has faced for decades, has taken a sharp and lethal turn with the rise of opioids—both legal pain- killers, such as oxycodone and fentanyl, and illegal ones like heroin.

More than 64,000 Americans were killed by drug overdoses in 2016, according to the Centers for Disease Control, and at least two-thirds of those deaths were caused by opioids. That is worse than the peak of the HIV epidemic in 1995 and more than the number of US combat deaths in the entire Vietnam War.

In the last year, doctors wrote more than 236 million prescriptions for opioids, or about one for every American adult. But many patients became addicted to the painkillers as their bodies began to tolerate higher and higher doses. Others, if they could no longer get prescriptions, switched to heroin; then came the even deadlier fentanyl.

Now drug abuse is so widespread it is even affecting productivity–employers say they can’t fill positions because too many applicants fail a drug test. The Federal Reserve reports that opioid addiction may be shrinking the number of job applicants because it is keeping otherwise able-bodied people out of the workforce.

The problem exists in almost every community throughout the United States, though it has hit hardest in the Northeast, the Midwest, and Appalachian regions, where joblessness and poverty have hollowed out many small towns and left families in desperate circumstances. In Cincinnati, Ohio, police estimated that police officers and paramedics spent at least 102 hours tending to overdose patients in just one week. Responding to the crisis is straining the budgets of many small towns and counties.

Doctors and nurses now see the epidemic’s effects on the next generation, a wave of babies born addicted to painkillers or heroin. Sara Murray and Rhonda Edmunds, nurses in Huntington, West Virginia, founded Lily’s Place, a facility for addicted babies and their mothers.

“The devil has come to Huntington,” Murray said on CNN. “We have generational addiction and that’s their normal. It was their mother’s normal. It was their grandmother’s normal. And now, it’s their normal.”

What should we do to relieve the opioid epidemic facing our communities? This issue advisory presents three options for deliberation, along with their drawbacks. Each option offers advantages as well as risks. If we increase enforcement, for example, this may result in many more people in prison. If we reduce the number of prescriptions written, we may increase suffering among people with painful illnesses.

Option 1: Focus on Treatment for All
This option says that, given the rising number of deaths from opioids, we are not devoting enough resources to treatment to make real headway in turning around the epidemic. Addiction is primarily a medical and behavioral problem, and those are the best tools for combating the crisis. Treatment should be available on demand for anyone who wants it. At the same time, the pharmaceutical companies that have profited from making and promoting opioid painkillers need to contribute more to the solution

Option 2: Focus on Enforcement
This option says that our highest priority must be keeping our communities safe and preventing people from becoming addicted in the first place. Strong enforcement measures are needed, including crackdowns and harsher sentences for dealers, distributors, and overprescribing doctors. And we should take tougher measures to cut off the supply of drugs at the source. Addiction to opioids and other hard drugs brings with it crime and other dangers, and closing our eyes to these dangers only makes the problem worse. Mandatory drug testing for more workers is needed. In the long run, a tough approach is the most compassionate.

Option 3: Focus on Individual Choice
This option recognizes that society cannot force treatment on people. We should not continue to waste money on a failed “war on drugs” in any form. Only those who wish to be free of addiction end up recovering. We should be clear that crime will not be tolerated, but if people who use drugs are not harming society or behaving dangerously, they should be tolerated and allowed to use safely, even if they are damaging their own lives. Those who do not or cannot make the decision to get well should not be forced, and communities shouldn’t spend their limited resources trying to force treatment on people.

About NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Follow on Twitter: @NIForums

Resource Link: www.nifi.org/en/issue-guide/issue-advisory-what-should-we-do-about-opioid-epidemic

How Should We Reduce Obesity in America? (NIFI Issue Guide)

The issue guide, How Should We Reduce Obesity in America?, was published on National Issues Forums Institute site in Spring 2017. This issue guide gives three options for participants to deliberate around the issue of obesity in the US. In addition to the issue guide, there is a moderator’s guide and a post-forum questionnaire, all available to download on NIFI’s site here.

From the guide…

Obesity is a health problem that is growing rapidly in the United States and other parts of the world. In this country, it is epidemic. About one in three Americans is obese.

It may be natural for people to gain at least a little weight later in life. But that is no longer the issue. The problem today is that by the time American children reach their teens, nearly one in five is already obese, a condition all too likely to continue into adulthood.

This issue guide asks: How should we reduce obesity in America? It presents three different options for deliberation, each rooted in something held widely valuable and representing a different way of looking at the problem. No one option is the “correct” one, and each option includes drawbacks and trade-offs that we will have to face if we are to make progress on this issue. The options are presented as a starting point for deliberation.

Option One: “Help People Lose Weight”
Take a proactive stance in helping people lose weight— persuasion and education by families and doctors, and the establishment of consequences by employers and insurance companies. Losing weight is a personal decision but it is one that affects all of us.

Option Two: “Improve the Way Our Food Is Produced and Marketed”
Although our food system does a good job of keeping the cost of food low, many of the resulting products are both very unhealthy and very enticing. We need to get better control of our food production system, including how foods are marketed to us, and ensure more equitable access to healthy foods.

Option Three: “Create a Culture of Healthy Living and Eating”
This option would promote overall, lifelong wellness by making sure our children start learning to make better choices as early as possible. This option also calls for reshaping our neighborhoods and buildings to help us get more exercise.

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End of Life: What Should We Do for Those Who Are Dying? (NIFI Issue Guide)

The 23-page issue guide, End of Life: What Should We Do for Those Who Are Dying?, written by National Issues Forums Institute and published on their site on November 2016. This issue guide provides three options for deliberation for participants to explore end-of-life decisions, as people are able to live longer and options for “right to die” become possibilities; what is best for those who are dying? In addition to the issue guide, there is a moderator’s guide and a post-forum questionnaire, all available to download on NIFI’s site here.

From NIFI…

What ought to be done at the end of life is both a personal and public decision. As our population ages, it is becoming a matter of great concern for the entire nation. Diseases that would have been death sentences a few decades ago are now often treatable.

This guide explores end-of-life decisions and examines options and trade-offs inherent in this sensitive and universal issue. Medical advances make it more likely that we will care for relatives in their final days, facing decisions regarding their illnesses or death—as well as our own. Even those who never face such choices will pay for them through tax dollars and the cost of insurance premiums. And as more states consider passing “right-to-die” laws similar to the one that took effect in Oregon in 1997, this debate may become a local one.

Under most circumstances, end-of-life decisions remain difficult and uncomfortable. A Consumer Reports survey found that 86 percent of those polled wanted to die at home. But fewer than half of the respondents over age 65 had living wills detailing their dying wishes, leaving them at the mercy of hospitals and stressed-out families forced to decide on their behalf. In 1990, the US Supreme Court affirmed an individual’s “right to die.” Later, in 1997, the court upheld New York and Washington state laws banning physician-assisted death, leaving it for individual states to decide their legality. These rulings established legal precedence for a national conversation.

This issue guide asks: What should society allow, and support, at the end of life? It presents three different ways of looking at the problem and suggests possible actions appropriate to each.

Option One: “Maintain Quality of Life”
That means when continued efforts to keep terminally ill patients alive a few more days or weeks result in needless pain and suffering, life-support treatment should be discontinued. At that point, caregiving efforts should be devoted to keeping patients comfortable and pain free.

Option Two: “Preserve Life at All Costs”
Do everything we can to prevent death. This means sparing no expense to extend the lives of those who are sick. It should be difficult for doctors to give up on patients, and the end must not be brought about by deliberate medical neglect or intervention. Right-to-die laws must be repealed.

Option Three: “My Right, My Choice”
The freedoms we value so highly in choosing how we live should not be taken away from us at the end of our lives. People should have the right to end their own lives and to enlist their doctors in helping them to die when a terminal illness leaves nothing to look forward to but higher levels of pain and suffering.

Preview the trailer for this issue guide’s starter video above and buy the video and full issue guide on NIFI’s site here.

NIF-Logo2014About NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Follow on Twitter: @NIForums

Resource Link: www.nifi.org/en/issue-guide/end-life

Community Conversations About Mental Health

The 20-page discussion guide, Community Conversations About Mental Health (2013)was sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Dept of Health and Human Services. This guide was prepared for SAMHSA by Abt Associates and its subcontractors, the Deliberative Democracy Consortium and Everyday Democracy. In the guide are instructions for hosting and facilitating community dialogues around mental health issues today and especially for young people; how to identify challenges and what ways to support youth mental health. The beginning of the toolkit includes an Informational Brief section with facts regarding mental health, then there is a Discussion Guide section and finally, a Planning Guide section with facilitator tips.

Below is an excerpt of the guide and it can be found in full for free download, in both English and Spanish at the bottom of the page. To view the original posting on SAMHSA’s site, click here.

From the guide…

us_mental-health_-logoOn January 16, 2013, President Barack Obama directed Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services and Secretary Arne Duncan of the U.S. Department of Education to launch a national conversation on mental health to reduce the shame and secrecy associated with mental illness, encourage people to seek help if they are struggling with mental health problems, and encourage individuals whose friends or family are struggling to connect them to help.

Mental health problems affect nearly every family. Yet as a nation, we have too often struggled to have an open and honest conversation about these issues. Misperceptions, fears of social consequences, discomfort associated with talking about these issues with others, and discrimination all tend to keep people silent. Meanwhile, if they get help, most people with mental illnesses can and do recover and lead happy, productive, and full lives.

This national conversation will give Americans a chance to learn more about mental health issues. People across the nation are planning community conversations to assess how mental health problems affect their communities and to discuss topics related to the mental health of young people. In so doing, they may also decide how they might take steps to improve mental health in their families, schools, and communities. This could include a range of possible steps to establish or improve prevention of mental illnesses, promotion of mental health, public education and awareness, early identification, treatment, crisis response, and recovery supports available in their communities.

Goals and Objectives of the Toolkit for Community Conversations About Mental Health
The Toolkit for Community Conversations About Mental Health is designed to help individuals and organizations who want to organize community conversations achieve three potential objectives:

– Get others talking about mental health to break down misperceptions and promote recovery and healthy communities;
– Find innovative community-based solutions to mental health needs, with a focus on helping young people; and
– Develop clear steps for communities to address their mental health needs in a way that complements existing local activities.

The Toolkit includes:
1. An Information Brief section that provides data and other facts regarding mental health and mental illness and how communities can improve prevention of mental illnesses, promotion of mental health, public education and awareness, early identification, treatment, crisis response, and recovery supports available in their communities.
2. A Discussion Guide section that is intended for use in holding community conversation meetings of 8-12 people each. (In a community forum with more participants, the audience would divide into groups of this size for much of their time together.) It provides discussion questions, sample views, ideas, and an overall structure for dialogue and engagement on mental health issues.
3. A Planning Guide section that describes a variety of ways in which people can facilitate their community conversations and take next steps at the local level to raise awareness about mental health and promote access to mental health services.

Mental health issues in our communities—particularly for our youth—are complex and challenging; but, by coming together and increasing our understanding and raising awareness, we can make a difference.

To download the guide in full click the link below.

About SAMHSA
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Follow on Twitter: @samhsagov

Resource Link [in English]: community_conversations_about_mental_health

Resource Link [in Spanish]: dialogos_comunitarios_acerca_de_la_salud_mental

 

Citizens at Work: An Interim Report [KF A Public Voice 2016]

The 24-page interim report, Citizens at Work, was released by Kettering Foundation at their annual event, A Public Voice 2016 in May 2016. The interim report describes Kettering’s two series of deliberative forums held between 2015-2016. The two series revolved around the issue guides, Health Care: How Can We Reduce Costs and Still Get the Care We Need? and Making Ends Meet: How Should We Spread Prosperity and Improve Opportunity?, which were prepared by Kettering and used for National Issues Forums. Below is more info from Kettering on the report and you can read the original on KF’s site here.

From Kettering…

At A Public Voice 2016, representatives of NIF and other deliberative democracy groups discussed the concerns that have emerged from forums on heath-care and economic security issues. A panel of elected officials and policymakers responded to that discussion.

The interim report is drawn from the work of NIF members and forum participants. To compile the report, researchers from Kettering and Public Agenda attended forums; talked with forum moderators; reviewed questionnaires filled out by forum participants, and analyzed transcripts of forums.

A Public Voice 2016: An Introduction

For more than 30 years, the Kettering Foundation has reported to policymakers and government officials about the characteristics of public thinking on key policy questions. In 2016, the foundation is reporting on citizen deliberations on two separate but important questions:

• How can we reduce costs and still get the health care we need?

• How should we spread prosperity and improve opportunity?

The 2016 citizen deliberations have taken place in public forums around the country, using two issue guides prepared by the Kettering Foundation for the National Issues Forums (NIF): Health Care: How Can We Reduce Costs and Still Get the Care We Need? and Making Ends Meet: How Should We Spread Prosperity and Improve Opportunity?

About 2,800 people from across the country have participated in more than 250 forums on either health care or making ends meet. About 210 of the forums have been in face-to-face meetings. The remainder have taken place online, using a platform called Common Ground for Action, which is designed to reflect what happens in in-person deliberative forums. This platform was developed by Kettering using the same principles used in preparing issue guides.

Download the interim report for free here.

About Kettering Foundation
KF_LogoThe Kettering Foundation is a nonprofit operating foundation rooted in the American tradition of cooperative research. Kettering’s primary research question is, what does it take to make democracy work as it should? Kettering’s research is distinctive because it is conducted from the perspective of citizens and focuses on what people can do collectively to address problems affecting their lives, their communities, and their nation.

Follow on Twitter: @KetteringFdn

Resource Link: www.kettering.org/blogs/apv-2016-interim-report

Mental Illness in America: How Do We Address a Growing Problem? (NIFI Issue Guide)

The 13-page issue guide from National Issues Forums, Mental Illness in America: How Do We Address a Growing Problem?, was published November 2014. The issue guide gives three options for discussion on how mental illness can better be addressed in the US. Below is an excerpt from the guide and it can be downloaded from NIFI’s site here.NIFI_Mental Illness

From the guide…

Many Americans share a sense that something is wrong when it comes to treatment of mental illness. More and more of us are taking medications for depression and other disorders. Meanwhile, dangerous illnesses are going undetected and untreated. What can be done to keep us safer and healthier?

One in five Americans will have mental health problems in any given year. Unaddressed mental illness hurts individuals and their families and results in lost productivity. In rare cases, it can result in violence.

This issue guide presents a framework that asks: How can we reduce the impact of mental illness in America?

The issue guide presents three options for consideration:

Option One: “Put safety first”

This option holds that more preventive action is necessary to deal with mentally ill individuals who are potentially dangerous to themselves or others. We should identify those who need help and intervene where necessary to prevent them from harming themselves and others. These individuals should be sought out and their needs addressed.

Option Two: “Ensure mental health services are available to all who need them”

This option holds that people should be encouraged to take control over their own mental health and be provided the tools to do so. We should make sure that everyone who wishes can get the needed help.

Option Three: “Let people plot their own course”

This option holds that we should not rely on so many medical approaches. We should reduce our dependence on drugs and allow people the freedom to plot their own course to healthy lives. In many cases, simple changes to lifestyle can improve mental health.

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/catalog/product/mental-illness-america-issue-guide-downloadable-pdf

America’s Energy Future: How Can We Take Charge? (NIFI Issue Guide)

The National Issues Forums Institute published the Issue Guide, America’s Energy Future: How Can We Take Charge?, in January 2015. This Issue Guide puts forth three options for deliberation of how America can address its energy consumption and how to deal with it in the future.   

NIFI_USenergyFrom the guide…

Americans depend on easy access to energy. Most of us take it for granted that we will be able to light up a room with the flick of a switch, adjust the temperature of our homes at will, and climb into our cars every morning to go to work, often at distant sites.

We use more energy than any other country. Americans make up only 4.5 percent of the world’s population, yet we consume about 20 percent of the world’s energy production. Collectively, we drive more, heat more, air condition more, and plug in more electronic devices than anyone else. We use 22 percent of the oil consumed in the world each day.

Worldwide energy use is on the upswing as well, and is projected to keep increasing, as rapidly developing countries, such as China, India, and Brazil, become bigger players in the worldwide market for energy supplies, especially oil. And— sooner or later—the world’s available supply of oil will run out.

The Issue Guide presents three options for deliberation:

Option One: “Produce the Energy We Need to Maintain Our Way of Life”
We need to control our own sources of energy so that we do not have to depend on other, possibly unfriendly, countries for our supplies. We have abundant sources of energy in this country and off its shores. We should develop and use them.

Option Two: “Put More Renewables and Clean Energy Sources into the Mix”
Not only is our lavish use of fossil fuels causing untold damage to the environment, but someday we will run out of oil, coal, and natural gas. We need to make the switch to renewable sources of energy, such as wind and sun, as soon as possible.

Option Three: “Find Ways to Use Less Energy”
The most practical way to deal with our current energy problems in not to produce more energy but to use less of it, and to do more with the energy we do use. This will involve both stricter government regulations and changes in our individual lifestyles.

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/issue-guide/americas-energy-future