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1. Discussion: Chronic Disease Process of the Obesity
Discussion: Chronic Disease Process of the ObesityORDER HERE FOR ORIGINAL,
PLAGIARISM-FREE PAPERS ON Discussion: Chronic Disease Process of the ObesityAs you
prepare to complete this assessment, you may want to think about other related issues to
deepen your understanding or broaden your viewpoint. You are encouraged to consider the
questions below and discuss them with a fellow learner, a work associate, an interested
friend, or a member of your professional community. Note that these questions are for your
own development and exploration and do not need to be completed or submitted as part of
your assessment.Assessment 1 will be based on an analysis of position papers that are
relevant to a health care issue related to a vulnerable population. Think about your
experience working with vulnerable populations, and the issues related to health care you
have observed for those populations, or reflect on the two Vila Health simulations in the
Resources. Discussion: Chronic Disease Process of the ObesityWhat is the vulnerable
population that most interests you?What is the health issue that is most prevalent or severe
in the population?How does the health issue impact the daily lives of members of the
population?How does the care environment in your chosen context impact both the
population and the level of care related to the health issue?What are the biggest challenges
that you would need to overcome to improve the outcomes for the population related to the
health issue?What is your position on how to best work to improve the care and outcomes
that the population is receiving?What previously published position papers support your
position, or the need to work to improve care and outcomes in general for the
population?How do these position papers support your assertions?How could one or more
of the position papers help you to form a treatment plan?What previously published
position papers contradict your position?What, if any, of these differences would make your
position stronger if you incorporated them?How could you respond to any irreconcilable
differences in such a way as to encourage buy-in for your position from those
opposed?cf_exemplar_msn_fp6026_assessment_1.pdfguide_1.docxUnformatted Attachment
PreviewRunning head: ANALYSIS OF POSITION PAPERS Analysis of Position Papers for
Vulnerable Populations Learner’s Name Capella University Biopsychosocial Concepts for
Advanced Nursing Practice II Analysis of Position Papers for Vulnerable Populations
October, 2018 Copyright ©2018 Capella University. Copy and distribution of this document
are prohibited. 1 ANALYSIS OF POSITION PAPERS 2 Analysis of Position Papers for
Vulnerable Populations As a group, veterans present a complicated, vulnerable population
for the health care industry. Reports show that more than half of the U.S. Department of

2. Veterans Affairs’ primary care patients state that they have pain, several of whom report
chronic pain. Patients suffering from chronic pain often have higher levels of medical
utilization, more disability claims, diminished productivity at work, and a poorer quality of
life compared to patients who do not suffer from chronic pain. Further, it has been observed
that the latter present with higher rates of alcohol and substance use disorders (Lovejoy,
Dobscha, Turk, Weimer, & Morasco, 2016). The need for pain management was advocated
and discussed in the 1980s and 1990s. Groups such as the WHO took a stand on how to
address pain as a health care issue, particularly with reference to how cancer and cancer
treatment affects patient lives. Discussion: Chronic Disease Process of the ObesityIt was
argued that it is unethical for any patient to be dying in pain, even if the treatment hastens
death. This mandate was initially meant for cancer patients with chronic pain; however,
over time, it has been extended to include chronic noncancer pain as well (Sullivan & Howe,
2013). One of the treatments recommended at the time was using opioids to manage pain.
However, studies have since confirmed that a significant link exists between prescription
opioid treatment and opioid addiction (Compton, Jones, & Baldwin, 2016; Kolodny,
Courtwright, Hwang, Kreiner, Eadie, Clark, & Alexander, 2015; Volkow & McLellan, 2016).
Veterans as a population are particularly vulnerable in this situation given that many of
them deal with both physiological pain and psychological issues including post-traumatic
stress disorder and substance abuse disorder (Sullivan & Howe, 2013). It is then necessary
to look for a solution that allows veterans dealing with pain to manage it effectively and,
further, to regulate and control the use of opioids to minimize the risk of addiction as well
as the potentially dangerous side effects of opioid use. Copyright ©2018 Capella University.
Discussion: Chronic Disease Process of the ObesityCopy and distribution of this document
are prohibited. ANALYSIS OF POSITION PAPERS 3 Pain Relief Management and the Opioid
Crisis The guidelines issued by the WHO and the Declaration of Montreal issued by the
International Association for the Study of Pain state that if patients suffer from chronic pain,
it is unethical to let them remain in pain (Sullivan & Howe, 2013). However, there is a line
that separates the management of pain and the abuse of medication. Studies have shown
that opioids do provide significant pain relief in modest doses over a short period of
treatment. However, the long-term efficacy of opioids for pain relief management has not
been proven to be clinically significant (Sehgal, Colson, & Smith, 2013). The management of
pain to improve quality of life and the possibility of medication abuse and addiction are two
sides of the opioid issue. The position that the American Academy of Neurology takes on the
issue reiterates earlier studies that show that the efficacy of opioid medication might not
extend to a long-term prescription of opioids. The current state of opioid prescription
practices has been associated with significant morbidity and high rates of mortality
(Franklin, 2014). On a similar note, The American Osteopathic Academy of Addiction
Medicine (n.d.) issued a public policy statement on the use of naloxone, an opioid antagonist
that blocks opioid receptor activation and, through this, reverses opioid overdoses by
preventing or reversing respiratory arrest. Discussion: Chronic Disease Process of the
ObesityThe American Society of Addiction Medicine (2016) also suggests a similar course of
action in terms of educating individuals on the use of naloxone. It also encourages those
close to the individual experiencing an opioid overdose to educate themselves on how to

3. detect the onset of an overdose. The same association presents the rising statistics
associated with prescription opioids and the necessity of raising awareness about the
dangers associated with opioids and educating people on the treatment of an opioid
overdose. The American Society of Addiction Copyright ©2018 Capella University. Copy and
distribution of this document are prohibited. ANALYSIS OF POSITION PAPERS 4 Medicine
recommends co-prescribing naloxone with opioids for people who might be at risk of
overdose and educating both the patient and those close to the patient on how to properly
use a naloxone kit. Ethical Pain Management versus the Possibility of Addiction The above
papers focus on ensuring that the public and individuals prescribed opioids are made aware
of the dangers associated with the use of opioids. The addictive properties of opioids and
the epidemic of opioid overdoses that has spread over the past few decades are indicators
of the severity of the situation (Kolodny et al., 2015). The other side of the argument is that
opioid treatment is a necessity for many in chronic pain. In Sullivan and Howe’s 2013 study
on opioid therapy for chronic pain, the authors recount the history of the opioid crisis. The
shift toward the use of opioids in the treatment of pain was marked by the WHO issuance of
guidelines for the use of opioids in the context of pain relief for cancer patients in 1985 and
1996. This was eventually extended to noncancer pain as well. The underlying logic at work
was that chronic noncancer pain could be debilitating to the same extent as cancer pain
over longer periods of time and with greater rates of prevalence. Discussion: Chronic
Disease Process of the ObesityThere are two aspects to the counterargument presented by
supporters of opioid treatment. The first is that pain as a symptom or consequence of injury
or illness can lead to inferior quality of life, resulting in psychological difficulties and even
impeding recovery (Manjiani, Paul, Kunnumpurath, Kaye, & Vadivelu, 2014). The second
aspect is that opioid treatment potentially provides a long-term solution for chronic pain.
This claim is made largely as an extension of the efficacy that can be seen in short-term
studies of opioid treatment (Franklin, 2014). Copyright ©2018 Capella University. Copy and
distribution of this document are prohibited. ANALYSIS OF POSITION PAPERS 5 However,
as there exists very little evidence on the long-term efficacy of opioid treatment, it becomes
problematic that opioid treatment is already in practice to relieve chronic noncancer pain.
In the American Academy of Neurology’s position paper on the use of opioids for chronic
noncancer pain, Franklin (2014) analyzes both the rise of opioids as a treatment as well as
the epidemic of addiction and overdose that came about as a result of the advocacy for
opioid treatment. Aside from the dangers of addiction that individuals face, Franklin also
addresses the significant side effects that opioids present when taken over long durations,
including opioid-induced hyperalgesia, immunosuppression, infertility, and hypogonadism.
Newhouse states that opioid drugs were prescribed to over 400,000 veterans for pain relief,
which correlates to approximately 1.7 million opioid prescriptions (as cited in Snow &
Wynn, 2018). The effort to manage the chronic pain that veterans face, however, presents
with its own unique set of complications, particularly because of how widespread the use of
opioid treatment has become. Baser, Xie, Mardekian, Schaaf, Wang, and Joshi state that
veterans are approximately seven times more likely to abuse opioids than civilians (as cited
in Snow & Wynn, 2018).Further, opioids are more likely to be prescribed to individuals who
have a history of substance abuse and mental health issues, and this would result in

4. unfavorable or harmful outcomes such as drug abuse or opioid overdose (Howe & Sullivan,
2014). When considering this with the prevalence of psychological issues and chronic
physiological pain that many veterans present with, it becomes apparent that long-term
treatment with opioids for veterans is not advisable. Kissin found that 35% of veterans who
were admitted to Tuscaloosa Veterans Affairs Medical Center’s acute inpatient psychiatric
unit presented with severe post-traumatic stress disorder symptoms, coupled with issues
such as suicidal ideation and mood disturbances. Kissin Copyright ©2018 Capella
University. Copy and distribution of this document are prohibited. ANALYSIS OF POSITION
PAPERS 6 also found that 25% of these veterans had an underlying case of opioid use
disorder (as cited in Snow & Wynn, 2018). To treat veterans such as these who are
comorbid with chronic pain and behavioral issues, it is necessary to integrate the
psychological and the psychiatric into the model of care to sufficiently address the overall
health of the patient (Snow & Wynn, 2018). Such a model would require physicians,
psychologists, and psychiatrists to simultaneously address the needs of the patient. One of
the issues they might encounter is managing the patient’s prescriptions. Denenberg and
Curtis and Hawkins et al. note that opioids are contraindicated for patients with substance-
abuse issues (as cited in Snow & Wynn, 2018); physicians and mental health specialists
would have to come to some resolution to mediate the patient’s need for pain relief and the
patient’s potential for abuse of his or her medication. Weiss et al. (2014) note that
individuals who present with post-traumatic stress disorder and substance abuse disorder
are likely to use opioids to relieve negative emotional states, aid sleep, or relieve pain.
Discussion: Chronic Disease Process of the ObesityCrowley, Kirschner, Dunn, and Bornstein
(2017) suggest that behavioral health should be taken into consideration while evaluating
the overall health of the individual. The purpose of opioid treatment is to improve the
patient’s quality of life with respect to the reduction of pain. Therefore, there should be a
simultaneous push toward counseling to address the overall health of the individual and not
solely focus on pain. This would involve coordination between counselors and physicians
who specialize in pain management to effectively improve the quality of life for these
patients. Conclusion The management of chronic pain with long-term opioid treatment
involves significant risk and does not have clinically significant evidence to support its use.
Veterans present a complicated population because many of them deal with mental health
issues such as post- Copyright ©2018 Capella University. Copy and distribution of this
document are prohibited. ANALYSIS OF POSITION PAPERS traumatic stress disorder and
substance abuse disorder as well as chronic pain. An analysis of policies of various
institutions and position papers on the use of opioids for pain management brings into
focus the severity of the opioid crisis. Most position papers take the stance that longterm
opioid treatment would not be advisable given the lack of evidence to support it.Further,
the abundance of public policy statements that advocate educating individuals on the use of
naloxone, an opioid antagonist, indicates the severity of the crisis in the present context.
One effective response to the existing crisis might be to simultaneously provide counseling
along with opioid treatment to address the individual’s overall health. The comorbidity of
behavioral issues and chronic pain in veterans indicates that they are a particularly
vulnerable population, with a high risk of addiction and prescription drug misuse.

5. Therefore, to provide efficient, holistic care, it is necessary to evaluate the efficacy of long-
term opioid treatment and the guidelines associated with it. Copyright ©2018 Capella
University. Copy and distribution of this document are prohibited. 7 ANALYSIS OF
POSITION PAPERS 8 References American Society of Addiction Medicine. (2016). Use of
naloxone for the prevention of opioid overdose deaths. Retrieved September 27, 2018, from
https://asam.org/advocacy/find-apolicy-statement/view-policy-statement/public-policy-
statements/2014/08/28/use-ofnaloxone-for-the-prevention-of-drug-overdose-deaths
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. Retrieved from http://floridahealth.gov/statistics-and-data/e-
forcse/newsreports/_documents/NEJM-opioid-heroin-use.pdf Crowley, R., Kirschner, N.,
Dunn, A. S., & Bornstein, S. S. (2017). Health and public policy to facilitate effective
prevention and treatment of substance use disorders involving illicit and prescription
drugs: An American College of Physicians position paper. Annals of Internal Medicine,
166(10), 733–736. http://dx.doi.org/10.7326/M16-2953Franklin, G. M. (2014). Opioids for
chronic noncancer pain: A position paper of the American Academy of Neurology.
Neurology, 83(14), 1277–1284. Retrieved from
https://doi.org/10.1212/WNL.0000000000000839 Howe, C. Q., & Sullivan, M. D. (2014).
The missing ‘P’ in pain management: How the current opioid epidemic highlights the need
for psychiatric services in chronic pain care. General Hospital Psychiatry, 36(1), 99–104.
https://doi.org/10.1016/j.genhosppsych.2013.10.003 Kolodny, A., Courtwright, D. T.,
Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription
opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual
Review of Public Health, 36(1), 559–574. https://doi.org/10.1146/annurev-publhealth-
031914-122957 Copyright ©2018 Capella University. Copy and distribution of this
document are prohibited. ANALYSIS OF POSITION PAPERS 9 Lovejoy, T. I., Dobscha, S. K.,
Turk, D. C., Weimer, M. B., & Morasco, B. J. (2016). Correlates of prescription opioid therapy
in veterans with chronic pain and history of substance use disorder. Journal of
Rehabilitation Research and Development, 53(1), 25–36.
http://dx.doi.org/10.1682/JRRD.2014.10.0230 Manjiani, D., Paul, D. B., Kunnumpurath, S.,
Kaye, A. D., & Vadivelu, N. (2014). Availability and utilization of opioids for pain
management: Global issues. Ochsner Journal, 14(2), 208–215.Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocvie
w%2F1541487990%3Faccountid%3D27965 Sehgal, N., Colson, J., & Smith, H. S. (2013).
Chronic pain treatment with opioid analgesics: Benefits versus harms of long-term therapy.
Expert Review of Neurotherapeutics, 13(11), 1201–1220.
http://dx.doi.org/10.1586/14737175.2013.846517 Snow, R., & Wynn, S. T. (2018).
Managing opioid use disorder and co-occurring posttraumatic stress disorder among
veterans. Journal of Psychosocial Nursing and Mental Health Services, 56(6), 36–42.
http://dx.doi.org/10.3928/02793695-20180212-03 Sullivan, M. D., & Howe, C. Q. (2013).
Opioid therapy for chronic pain in the US: Promises and perils. Pain, 154(Suppl 1), S94–100.
Retrieved from https://ncbi.nlm.nih.gov/pmc/articles/PMC4204477/ The American
Osteopathic Academy of Addiction Medicine. (n.d.). Naloxone public policy statement: The

6. use of naloxone for the prevention of opioid overdose deaths. Retrieved from
https://c.ymcdn.com/sites/www.aoaam.org/resource/resmgr/Docs/AOAAM_NALOXON
E_POLICY_2015.pdf Copyright ©2018 Capella University. Copy and distribution of this
document are prohibited. ANALYSIS OF POSITION PAPERS 10 Volkow, N. D., & McLellan, A.
T. (2016). Opioid abuse in chronic pain — misconceptions and mitigation strategies. The
New England Journal of Medicine, 374(13), 1253–1263. Retrieved from
http://pcpr.pitt.edu/wp-content/uploads/2018/01/Volkow-McLellan2016.pdf Weiss, R. D.,
Potter, J. S., Griffin, M. L., McHugh, R. K., Haller, D., Jacobs, P., Rosen, K. D. (2014). Reasons for
opioid use among patients with dependence on prescription opioids:The role of chronic
pain. Journal of Substance Abuse Treatment, 47(2), 140–145.
http://doi.org/10.1016/j.jsat.2014.03.004 Copyright ©2018 Capella University. Copy and
distribution of this document are prohibited. Develop a 4–6-page position about a specific
health care issue as it relates to a target vulnerable population. Include an analysis of
existing evidence and position papers to help support your position. Your analysis should
also present and respond to one or more opposing viewpoints. Note: Each assessment in
this course builds on the work you completed in the previous assessment. Therefore, you
must complete the assessments in this course in the order in which they are presented.
Position papers are a method to evaluate the most current evidence and policies related to
health care issues. They offer a way for researchers to explore the views of any number of
organizations around a topic. This can help you to develop your own position and approach
to care around a topic or issue. This assessment will focus on analyzing position papers
about an issue related to addiction, chronicity, emotional and mental health, genetics and
genomics, or immunity. Many of these topics are quickly evolving as technology advances,
or as we attempt to push past stigmas. For example, technology advances and DNA
sequencing provide comprehensive information to allow treatment to become more
targeted and effective for the individual.However as a result, nurses must be able to
understand and teach patients about the impact of this information. With this great power
comes concerns that patient conditions are protected in an ethical and compassionate
manner. CONTEXT Position papers are a way for individuals, groups, and organizations to
express their views and intentions toward a specific issue. In health care, many position
papers address specific policies, regulations, or other approaches to care. As a master’s-
prepared nurse, you should feel empowered to express and advocate for your own views on
policy and care matters. This is especially important when it comes to populations you or
your organization cares for that are not receiving the quality, type, or amount of care that
they require. An important skill in creating a position paper or policy proposal is the ability
to analyze and synthesize others’ views about the population or issue of interest to you. By
synthesizing the positive and negative views of an issue, you can become better equipped to
strengthen your own arguments and to respond to opposing views in an informed and
convincing way. QUESTIONS TO CONSIDER As you prepare to complete this assessment,
you may want to think about other related issues to deepen your understanding or broaden
your viewpoint. You are encouraged to consider the questions below and discuss them with
a fellow learner, a work associate, an interested friend, or a member of your professional
community. Note that these questions are for your own development and exploration and

7. do not need to be completed or submitted as part of your assessment. Assessment 1 will be
based on an analysis of position papers that are relevant to a health care issue related to a
vulnerable population.Think about your experience working with vulnerable populations,
and the issues related to health care you have observed for those populations, or reflect on
the two Vila Health simulations in the Resources. What is the vulnerable population that
most interests you? • What is the health issue that is most prevalent or severe in the
population? • How does the health issue impact the daily lives of members of the
population? • How does the care environment in your chosen context impact both the
population and the level of …