Many of my state public health peers across the nation have been dealing with an issue I previously thought I would not have to address in Idaho — prescription drug abuse and misuse, specifically with opioid drugs. There were 218 Idahoans who died from drug overdose in 2015. An alarming fact during that same year was that Idaho had one of the highest percentages (36 percent) of drug overdose deaths related to prescription drugs.
Here are some more alarming facts:
▪ In 2013, an Idaho citizen died every 39 hours because of a drug-induced death caused by illicit, prescription or over-the-counter drug use.
▪ In 2015, a survey conducted with Idaho high school students showed nearly 17 percent of respondents reported taking a prescription drug without a physician’s prescription at least once during their lifetime.
▪ Between 2004 and 2013 there were 1,652 drug-induced deaths for Idaho residents. The annual number of drug-induced deaths more than doubled, from 111 deaths in 2004 to 227 deaths in 2013.
▪ During that same time, Idaho’s overall drug-induced death rate increased by 76.7 percent, while the national rate increased by 40 percent, with more than half of the drug-induced deaths being the result of an accidental poisoning.
Nationally, the number of overdose deaths related to prescription drugs exceeds overdose deaths from cocaine, methamphetamine and heroin combined. Perhaps most concerning is that medication overdoses are now the No. 1 cause of accidental death in the United States.
Prescription drug abuse clearly represents a significant problem that affects all socioeconomic groups. Massachusetts, for example, has seen a 350 percent increase in opioid-related deaths since 2000. Some states such as Alaska and Maryland have declared an official state of emergency. Maryland made this declaration after it was faced with a 62 percent increase in deadly overdoses in the first three quarters of 2016. The declaration will help those states make sure they have the resources to combat the issue.
Addiction can affect anyone. The faces of addiction are our colleagues, neighbors, friends, families and children. Their addiction may have started with a trip to the doctor or dentist for something minor for which they were prescribed powerful opioid painkillers. While prescribing painkillers has been a long-standing practice, the potency and number of pills being prescribed has increased over time.
Federal funding for states to address the opioid crisis is at an all-time high. Idaho joins states across the nation that are starting to focus public health efforts to combat prescription opioid abuse. Pharmaceutical companies are reformulating their drugs to make them less prone to abuse, and prescribers are changing their practices.
Unfortunately, there is a downside to the work being done to reduce opioid use and misuse. Because of the more stringent purchasing requirements, lower potency and increased expense of obtaining prescription opioid drugs, many people with addictions are turning to a cheaper, more readily available alternative: heroin. People addicted to prescription opioid drugs are 40 times more likely to become addicted to heroin.
They are also turning to synthetic opioids such as Fentanyl, which is 50-110 times more powerful than morphine.
So, what can be done to combat these worrisome trends? Thankfully, there are some positive changes occurring in Idaho and other states. One such change occurred in 2016, when state law was changed to allow citizens to easily obtain naloxone, a remedy for opioid overdose. Naloxone can temporarily reverse the effects of an opioid overdose until medical help can arrive.
Making it easier to help
Laws are being loosened so that emergency responders have access to naloxone, and people at risk for overdose and their friends or family members can be trained in the administration of the drug and easily obtain it through a pharmacy. (Find a link to learn more about naloxone in this story at IdahoStatesman.com/health-fitness.)
Other actions being taken in Idaho and across the nation include steps to monitor prescriptions for painkillers that might help a provider know if a patient is receiving multiple prescriptions for painkillers from several different doctors. In 2016, Idaho also made it easier for prescribing physicians to work with the prescription drug monitoring program.
Some states have needle exchanges and supervised injection sites, which may decrease the risk of fatal overdose among addicts. States are also working with law enforcement on drug prevention strategies and states are increasing access to addiction treatment, and specifically medication-assisted treatment.
Most importantly, there is a national dialogue about increasing help-seeking behavior and reducing the stigma associated with asking for help for addiction issues. Someone sitting next to you may be battling with addiction, and they need to know that their road to recovery is supported and without shame.
Elke Shaw-Tulloch, master of health sciences, is the state health officer and Division of Public Health administrator with the Idaho Department of Health and Welfare. Find out more about Department of Health and Welfare services at www.healthandwelfare.idaho.gov.
What you can do to help fight opioid addiction
We can all help! I asked my fellow state health official in Alaska, Dr. Jay Butler, who is leading the public health charge on this issue nationally, what he recommends that anyone can do. His response:
▪ If you or someone you know is on long-term opioid therapy or uses heroin or other illicit opioids, obtain naloxone so that you can save a life in the event of overdose.
▪ Learn about addiction and what you can do about the opioid epidemic by visiting: facingaddiction.org.
▪ Do you know someone with a loved one living with addiction? Let them know that you understand that addiction is a chronic health condition like cancer or diabetes, and that you care. Too often, the support of friends is only expressed after a death.
▪ If your provider prescribes an opioid, ask whether it is necessary and whether non-opioid options are available. Many prescriptions may be more than you need — consider discussing with your pharmacist a partial-fill of the amount; the remainder can be filled later if needed.
▪ Do you have leftover opioids in your home? Many people do. Most people who misuse prescription opioids report getting them from a friend or relative. Find out about drug take-back opportunities in your community and other options for drug disposal.
▪ If opioids are needed, keep them locked up between doses.