Friday Dec 08 2017
Opioid crisis is a local and national problemBy: Randi Swisley
Tiger Woods was arrested in May while under the influence of several drugs, including the opiate painkillers Vicodin and Dilaudid. He had been trying on his own to dull pain from his fourth back surgery which he underwent in April. He says he now realizes it was a mistake to do this without medical assistance.
Tiger is among the 2.6 million opioid addicts in the U.S. With 650,000 prescriptions for opioids filled each day, the epidemic will likely continue. Disturbingly common for young adults originally prescribed opioids for sports injuries, most addicts cannot afford to continue legally feeding their addiction and must resort to the cheaper and easier to acquire option, heroin.
Doctors began prescribing powerful opioid painkillers in the 1990s for short courses to treat things like severe, acute pain or to ease suffering at the end of life. Around the mid-1990s, drug companies began a concerted marketing effort to convince doctors that opioid pills were safe for treating chronic pain. Since then, addiction and deaths associated with prescription opioids have soared.
Three out of every 20 Californians were prescribed opioids in 2016, most commonly in rural areas. Trinity County with an estimated population of 13,628 filled resident prescriptions there for opioids 18,439 times. Other counties with more prescriptions than people include Lake, Shasta, Tuolumne and Del Norte. Last year El Dorado, Placer and Sacramento counties all had prescription rates above the statewide average.
The Center for Disease Control says 6 percent of people who received initial opioid prescriptions for just one day are still on opioids a year later — highlighting the higher risk of addiction compared to other drugs.
Overdose is also a bigger risk with opiates. The powerful painkillers accounted for 80 percent of the 65,000 drug-overdose victims in the 12 months previous to March 2017. The federal Commission on Combating Drug Addiction claims the number of people dying daily from painkillers is equal to the Sept. 11 attacks occurring every three weeks and that drug overdose now kills more people than gun homicides and car crashes combined.
Near Sacramento over a two week period in 2016, 52 people overdosed and 14 ultimately died after taking counterfeit hydrocodone pills laced with fentanyl. California hospitals treat one overdose victim every 45 minutes. In Ohio, a coroner’s office recently had to store corpses in refrigerated trucks for a week because residents were overdosing on opioids faster than their bodies could be processed.
Universities seeing the epidemic hit the college aged particularly hard are taking notice. University of Pittsburgh notes that the number of fatal drug overdoses has doubled every eight years for the past 37 and continuation of that trend would see annual opioids deaths rising to 90,000 per year by 2025. Harvard and Brown University forecast 45,000 to 52,000 deaths in the next two to three years. Pittsburgh’s Public Health Dynamics Lab predicts that heroin and fentanyl deaths alone will reach 72,000 per year by 2025.
At the source, a single pharmaceutical company in Connecticut has made tens of billions of dollars manufacturing OxyContin alone. Aggressive marketing and incentives for doctors result in the average prescription of 22 days, more than three times what the nation’s largest pharmacy benefit manager recommends.
Curbing the eagerness of too many medical providers to write too many prescriptions without fully weighing the consequences is called for. It is time for Big Pharma and doctors to face consequences themselves.
California joined a 2016 lawsuit with 34 other states against two pharmaceutical companies alleged to have blocked competition from Suboxone, a widely used form of buprenorphine that assists in opiate withdrawal symptoms. The Journal of Substance Abuse Treatment suggests that treating people with drugs like buprenorphine results in $153-223 less spending on health care per month than treating addicts without these medicines does.
Opiod addiction is a chronic, relapsing disease of the brain requiring treatment like other chronic diseases do. Overuse of opiates permanently alters brain chemistry to disrupt realistic decision making. Brain function heals with the right care, and rational decision making can be restored if the drug is not used. Use of any drug, including alcohol, triggers the disease out of remission and allows it to take over the brain’s decision making process. The federal Substance Abuse and Mental Health Services Administration (samhsa.gov) outlines a lifetime regimen for the recovery process including six to nine months of intensive inpatient and outpatient medical and mental health care after getting sober initially. Rational decision making can be restored after about a year. After two years of sobriety, many addicts are qualified to professionally assist others in recovery.
The share of opioid and heroin addicts who receive medical treatments remains small, however. According to SAMHSA among those admitted and discharged for opioid-use disorders in 2015, only 35 percent received medication as part of their treatment. Doctors are limited to less than 275 buprenorphine prescriptions per month to treat addiction but can write 1,000 prescriptions a day for opiates that lead to that addiction.
Impact to our communities is becoming more visible. A study by the council of Economic Advisers focusing on things such as earnings, health care, and criminal justice put the economic cost of America’s opioid crisis at $504 billion in 2015, or 2.8 percent of GDP.
Lawsuits in Mississippi, Ohio, Santa Ana and Orange counties in California, and Chicago condemn drug companies for fuelling the opioid epidemic and accuse them of exaggerating the effectiveness of opioid painkillers while downplaying the risk of addiction. The DOJ has alleged that kickbacks were offered to encourage drug prescriptions and the Drug Enforcement Administration has taken action against firms for failing to control suspiciously large orders of drugs. Some drug companies have been found guilty and paid fines but have not slowed down. They are bolstering advertising campaigns outside the U.S. With 40 percent of opiate sales occurring in the U.S., they are looking to expand their market.
With more than 2 million opioid addicts in America, the demand creates supply and just as much as vice versa. The crisis is too far advanced for criminalization to work as a deterrent.
New York Courts noticed that many of those arrested while high on opiates did not live long enough to make their court dates. Drug Court was born as an alternative sentencing program. Placer County Drug Court’s nine- to 18-month program includes successful completion of your jail commitment and six to nine months of outpatient drug treatment.
It is likely you have a loved one who is an addict. They need your help. Understanding how to help is not intuitive or easy. You may find this advice from support groups helpful:
Getting angry only stresses you out and confirms their bad opinion of themselves. They hate themselves enough already. Assuming their responsibilities or covering for them only makes their failure to assume responsibility permanent. Their guilt will increase and you will feel resentful. The nature of their illness prevents them from keeping promises, even though they mean them at the time. They learn to exploit empty threats, so once a decision is made, stick to it. Denial of reality is another symptom of their illness so what they say cannot always be believed. They are likely to lose respect for those they can fool too easily. It is not helpful to let them take advantage you in any way. Love cannot exist for long without the dimension of justice. Trying in any way to spare them the consequences of their drug use may avert or reduce the very crisis that would prompt them to seek help. They can continue to deny that they have an addiction problem as long as someone provides an automatic escape for the consequences of their drug use. Learning, understanding and planning for their recovery is the most helpful. They cannot help themselves alone. They need help from a doctor, therapist, psychiatrist, and other recovering addicts.
A local outpatient facility called Groups is at 800-683-8313 or at firstname.lastname@example.org. More comprehensive services are available at CORR by calling 530-885-1961. Newstart Medical Group in Weimar has weekend hours and can prescribe Suboxone. They can be reached at 530-637-4025. Local hospitals can treat overdose, but are not prepared to assist an addict trying to recover and do not administer Suboxone.
Randi Swisley was born and raised in Auburn. She served as president of the League of Women Voters of Placer County for four years, as chairman of the WAC Municipal Advisory Council, on the Executive Committee of a the Juvenile Justice Commission, on the Auburn Technology Commission, on the Auburn Oversight Committee, and is a happy member of the Sugar Plump Fairies promoting art and music in the Auburn community.