Increase in opioid abuse creates major health crisis

By L. Parsons

The abuse of prescription opioids by Americans of all ages, genders, and socioeconomic statuses has risen dramatically over the last two decades. Alongside those abuse rates, overdose has risen as well, as much as five times what they were in 1999. The Center for Disease Control (CDC) has called the epidemic, “The worst public health crisis in American history.”

Opioid prescription painkillers include codeine, fentanyl, hydrocodone (Lortab, Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), methadone, morphine, and oxycodone (OxyContin). According to the CDC, 115 Americans die every day from overdose related to the use of opioid drugs. Street drugs, like heroin, have contributed to these numbers but according to the CDC prescription opioids are a driving factor in the 16-year increase in opioid overdose deaths.

Despite the fact that the amount of opioids sold to doctors and pharmacies in the U.S. has nearly quadrupled since 1999, the CDC reports that there has not been an overall change in the amount of pain that Americans reported.

Some American counties have reported the number of opioid prescriptions outnumber their population. The Arizona Department of Health Services (AZDHS) named Mohave County as one such county with 204,000 residents and 260,100 prescriptions issued in 2016.

Between June 15, 2017, and Feb. 1 of this year 5,703 opioid and opioid related overdoses occurred in Arizona.

Navajo County Public Health Services Director Jeff Lee said that Navajo County opioid statistics are low compared to the other 14 counties. “However, opioid related illnesses or overdoses were not a required reportable condition until the governor declared a state of emergency on June 5, 2017,” he said, adding that from June to December, the county had 65 reported opioid overdoses.

Lee said the largest number of those overdoses were suffered by citizens under the age of 24. However, of the 17 opioid related fatalities in 2017, the majority were users between the ages of 45 and 54. Lee said those fatalities were opioid related, meaning opioids were considered a contributing factor but not the main cause of death.

Arizona legislators have recognized the trend of the over prescribing of opioids. The Opioid Epidemic Act recently signed by Governor Doug Ducey contains many facets that will continue the state’s efforts to battle this crisis. First, it identifies the need for funding to further treatment for users and identifying gaps in and improving access to treatment. Secondly, it outlines the actions the state has taken to date including putting a stop to “doctor shopping.”

An AZDHS study showed that in 2016, as many as 1,000 Arizonans were in possession of as many as four prescriptions at a time from four different doctors. Doctors are now required to update the prescription drug database before prescribing controlled substances. Since its inception in May 2016, this initiative has helped reduce the number of people being given multiple narcotic prescriptions by multiple doctors.

Forged prescriptions have also been a factor in the crisis. The solution to this problem is to require electronic prescribing (E-prescribing) for drugs that have a high potential for abuse. Also included in Ducey’s plan is a limit on the first refill of an opioid prescription where the state is the payer. It is reported that Arizona’s Health Care Cost Containment System (AHCCCS) is the leading payer of substance abuse treatment in the state.

Other parts of the act are the Good Samaritan provision that encourages people to call 911 for a potential opioid overdose. This means that citizens that call 911 to report a potential overdose will not be charged with drug offenses themselves.

The Angel Initiative was also put into place to help parents afflicted with opioid addiction by allowing citizens to walk into a police precinct, turn in their drugs and request treatment without fear of prosecution. Assistance is also provided to parents to secure safe placement for their child while they are in treatment, in lieu of placing their child in the foster care system.

When asked about what the county has in place to combat this crisis, Lee said, “Continued public education on opioid use and its effects, and the linking of families and users to organizations that distribute Naloxone.”

Other important steps that will take place include, “Continued surveillance of data with our epidemiologist to help direct our education campaigns to the right demographics and the use of data collected to determine if additional strategies need to be introduced.”

The entire Opioid Epidemic Act is available for public view on Governor Ducey’s website, www.azgovernor.gov.