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Connie’s Council Corner: A Perfect Storm

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I just recently returned from a National Association of Counties (NACo) conference and attended a workshop on the opioid crisis in our nation. Many of us have read articles and reports on the alarming increase in the use of these drugs and many of us have wondered why this sudden increase is happening and what we doing about it.
One of the speakers at the conference was Sam Quinones, the author of “Dreamland,” a book about the history and causes of the opioid abuse crisis. Opioids are prescribed medications that relieve pain. Medications that fall within this class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine, and related drugs. Quinones talked about the history of these medications and how they came to be so popular with doctors. The medical community first were told that these medicines were not only effective at relieving pain but were also non-addictive. Patients were happy to hear this and doctors were confident that by prescribing these drugs they were helping their patients. Quinones was curious about how the drugs that we now know are highly addictive were once thought to be risk-free. It all started with a letter written Dr. Hershel Jick published in the New England Journal of Medicine in 1980. In it he said that he checked his medical database and found that among the 11,000-plus patients who were given narcotic painkillers in the hospital, only four got addicted. Not a report, not a study, no research involved. Just an anecdotal comment. This letter took on a life of its own and grew in authority. Now we have a crisis throughout our country that was caused by the pharmaceutical industry that did not research the risk of these drugs and promoted them as non-addictive. Some may argue, all to make a buck.
Couple this with what was happening during the previous 10 years or so. The heroin trade was growing in the United States. Originally heroin was coming into the States from Columbia. Then we saw a shift from Columbia to Mexico. It was easier to get, more prevalent, cheaper and more potent.
Today, we know that opioids are addictive. OxyContin is the drug that we most commonly hear about. Doctors continue to prescribe these medications, often multiple times. Drugs that have a propensity for addiction require additional and increasing use to receive the same effect. This results in addiction. The doctors will eventually stop prescribing the medication and the patient will then search for another drug. That drug in heroin. What we are now seeing is a perfect storm. An increasing population that is addicted to opioids along with a cheap, prevalent, and quick supply of heroin.
The overuse of opioids and heroin often result in death. From 1999-2011 we have seen drug poisoning death from opioids increase by 23% and from heroin increase by 110 percent. On the other hand cocaine has decreased 37 percent. The data is especially alarming in recent years. Heroin related death rate jumped 39 percent from 2012 to 2013 – 75 percent of heroin users started with prescription painkillers and 45 percent were using both heroin and prescription painkillers.
Opioid use has multiple impacts on a community such as crime and incarceration, poverty, homelessness, poor work productivity, mental health impacts, infections, overdoses and death. These impacts affect families, neighborhoods, and businesses, with budget impacts to governments and citizens. We can’t ignore it and hope that it goes away.
What do we do? Government leaders at all levels, health professionals, and law enforcement experts are in agreement that the strategy which waged a "war on drugs" has proven a complete disaster. We cannot arrest our way out of this epidemic. Coordinated efforts from federal agencies, state and local agencies, health care insurers, and health care providers are required to address the needs of millions of Americans now struggling with this chronic, life-threatening disease.

The National Institute on Drug Abuse suggests the following recommendations:

  • Educational initiatives delivered in school and community settings (primary prevention.
  • Consistent use of prescription drug monitoring programs.
  • Aggressive law enforcement efforts to address doctor shopping and pill mills.
  • Diverting individuals with substance use disorders to Drug Courts.
  • Implementation of overdose education and naloxone distribution programs to issue naloxone directly to opioid users and potential bystanders. Naloxone is a medication used to block the effects of opioids, especially in overdose.

I would like to add one more: The pharmaceutical companies must have more oversight in the development of drugs and control over the marketing of prescriptions.
The County is working with the Health Department to address the issue by adopting and implementing the above recommendations. We are doing this through a regional approach, with a focus on systems and exploring innovative methods. You can help. Do your own research. Educate yourself and others. Question your doctor when you are prescribed an opioid for pain. Don’t demonize someone who is addicted. It can happen to you, your child, or best friend. Support addiction programs, including support for government funding. It is more cost effective to have these programs than all of the negative impacts that drug use brings to a community. The solution is not solely with government intervention. The solution will also be dependent on community support.

Connie Ladenburg is a member of the Pierce County Council.

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