Last week, Dr. Kathryn Beattie of St. Luke’s Children Services recounted her family’s long struggle to find the right care for her 20-year-old son, who died last fall following an overdose. Just two months before Jack Beattie passed away, he and his family had finally been given a diagnosis — bipolar. For Jack, it had a been a long battle with mental health and substance abuse challenges.
Many families in our community have been touched by drug abuse or addiction — as witnessed by the outpouring of response to Dr. Beattie’s story.
Addiction is a powerful, terrible disease, and abuse is a growing epidemic. Far too often, health care providers unintentionally contribute to the problem. This week, Dr. Beattie writes about some of the steps that health care providers and our community can take to help combat addiction.
The United States is experiencing an epidemic of drug overdose deaths. The incidence of death involving any type of opioid overdose increased by more than 300 percent between 1999 and 2015; according to the Centers for Disease Control, more than 52,000 Americans died of an overdose in 2015. That is one death every 10 minute, and of them, 33,000 were related to opioids.
Opioids are a class of drugs that include the illicit drug heroin as well as the prescription pain relievers oxycodone, hydrocodone, codeine, morphine and fentanyl.
Of the 20.5 million Americans 12 or older who had a substance use disorder in 2015, 2 million involved prescription pain relievers (an opioid) and 591,000 had a disorder involving heroin. And because substance abuse is believed to have a genetic component, and the risk of opioid addiction increases with exposure, there are reasons to be extremely concerned about the spread of the problem.
In 2014, more than 240 million prescriptions were written for prescription opioids, more than enough for every American adult to have their own bottle of pills. Four out of five heroin users started out by misusing prescription opioids.
Providers have other options
Health care providers must be part of the solution. Opioids have their place in pain management but are not always required, and research is showing that at times, a nonopioid alternative will provide equivalent or better pain control.
A 2009 study published in the Annals of Emergency Medicine demonstrated that pain relief for patients with a broken arm was better with ibuprofen (the ingredient in Motrin and Advil) than with Tylenol with codeine (an opioid). More recent studies in patients following joint replacement demonstrate a reduced need for opiates with the timely use of acetaminophen (Tylenol) post-operatively. Patients are well-advised to ask their physicians if a nonopioid pain medication may be a better first alternative when pain relief is needed, and medical professionals who prescribe pain medications must limit the use of opioids for their patients.
Mandatory prescriber education, opioid-prescribing guidelines and prescription drug monitoring programs have been implemented in many states to enforce smarter prescribing patterns by providers. In Idaho, we are lagging. The retail distribution of oxycodone per 100,000 people between 2011 and 2015 increased by 27 percent, from 13,394 prescriptions to 17,013 prescriptions, compared with a national decrease of 9.4 percent during that same time period.
The drug-induced mortality rate in Idaho increased 12 percent between 2011 and 2015, going from 12.6 to 14.1 per 100,000 residents. In a February 2016 Statesman article titled, “Idaho faces ‘heroin tsunami’ amid opioid abuse epidemic,” Post Falls Police Chief Scot Haug asserted that heroin had surpassed methamphetamine as the most common drug behind marijuana in his community.
The drug use in our region that precedes the deaths is an alarming harbinger of what is to come; St. Luke’s Community Health Needs Assessments have found that the percentage of people who report using illicit drugs in our area is more than twice as high as Idaho as a whole.
This is not “someone else’s problem.” This is a problem in our communities.
Four in five new heroin users started out misusing prescription painkillers. The rate at which opioid prescriptions are written for adolescents and young adults has doubled in the past 20 years, which is alarming. Even more alarming: Most adolescents who misuse prescription pain relievers are given them for free by a friend or relative, or have taken them from a stash of leftover medication in the medicine cabinet.
St. Luke’s serves as a drop-off point for community members to leave outdated and no-longer-needed prescription drugs to remove them from homes and away from teens. Between January and September 2015, in partnership with the Meridian Police Department, we removed 2,100 pounds of drugs from the Meridian community alone, and we have been awarded a grant from the Office of Drug Policy to extend this program for youth in the rural areas of Fruitland, Payette and Weiser.
April 29 is 2017 National Drug Take-Back Day. Please clean out your medicine cabinets and take unused medications to a local drop-off center. (See the information box.)
At St. Luke’s Children’s, we are addressing drug use/abuse among our preteen/teenage population through our Prescription Drugs: Let’s Talk about It program. This program provides education opportunities in the form of a toolkit, community outreach during school registration and social media.
Adolescents and people with mental disorders are at a greater risk of drug abuse and addiction than the general population. The co-occurrence of chemical dependency/substance abuse disorders and a mental health diagnosis is close to 50 percent, yet most care facilities separate the treatment of the two. This high rate would indicate the need for a comprehensive approach to intervention that identifies and evaluates each disorder for development of a concurrent treatment plan.
In Idaho, we need to increase the availability of medication-assisted treatment facilities for opioid addiction and improve coordination of care for patients with co-occurring disorders.
St. Luke’s and St. Luke’s Children’s look forward to working with our community partners to identify better ways to reduce access to prescription medications, educate our patients to prevent non-medical use of pain relievers and reduce substance abuse, and deliver coordinated substance abuse treatment and mental health care to meet community needs.
Dr. Kathryn Beattie is the executive medical director of St. Luke’s Children’s Services. These articles first appeared on Dr. David Pate’s Prescription for Change blog. Dr. Pate is the president and CEO of St. Luke’s Health System.
This story is the second of three parts. (While the series was originally set as two parts, we’ve now opted to run it in three.) Next week in the Statesman, Dr. Beattie writes about the challenges of treating those struggling with both mental health and substance abuse disorders.
See part 1 of Jack Beattie’s story here as well as more information from the Idaho Department of Health and Welfare about the opioid issue in Idaho here.
National Drug Take-Back Day
April 29 is 2017 National Drug Take-Back Day. Please clean out your medicine cabinets and take unused medications – yours and your pets’ – to a local drop-off center. From 10 a.m. to 2 p.m. Saturday, you can drop off your medication here:
▪ St. Luke’s Medical Center at 520 S. Eagle Road in Meridian.
▪ Ada County Sheriff’s Office at 7200 Barrister Drive in Boise.
▪ Bernie Fisher Park by the watertower at 201 W. Main St. in Kuna.
▪ Fred Meyer at 5425 W. Chinden Blvd. in Garden City.
Learn more and find other Idaho-area collection sites at www.deadiversion.usdoj.gov/drug_disposal/takeback.
Learn more about opioid abuse
▪ The U.S. Department of Health and Human Services has developed fact sheets about the opioid crisis. Find them at hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf.
▪ To learn more about how Idaho stacks up, see the National Safety Council’s “Prescription Nation” report at nsc.org/learn/NSC-Initiatives/Pages/Prescription-Nation-White-Paper.aspx.
▪ Find more information from the Idaho Department of Health and Welfare about opioid addiction in a previous article here.