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Idaho, other states should fight painkiller abuse by not treating it as a crime, experts say

Idaho ranks 22nd per capita among states whose doctors write the most prescriptions for painkillers. In Idaho in 2012, prescriptions for painkillers were written at a rate of 86 for every 100 people.
Idaho ranks 22nd per capita among states whose doctors write the most prescriptions for painkillers. In Idaho in 2012, prescriptions for painkillers were written at a rate of 86 for every 100 people. U.S. Centers for Disease Control and Prevention

Addiction should be treated the same as cancer or any other disease if the U.S. wants to halt skyrocketing use of heroin and prescription painkillers, national health experts say.

The stigma attached to people who abuse drugs discourages the general public from helping them and keeps the addicts from seeking help.

“If we don’t change the perception of addiction then we’re not going to get people the treatment that they need,” said Leana Wen, an emergency physician who serves as Baltimore’s health commissioner. “The stigma around addiction is so pervasive, and people believe that it’s a choice — and therefore, if they believe it’s a choice, then if someone ends up in jail or even if they die, then it seems like they deserved it.

“... The evidence is unequivocal that addiction is a chronic brain disease and also that treatment exists and works. We can look around and see thousands, tens of thousands, hundreds of thousands of people who have successfully recovered who are contributing to society, who have regained their lives and their careers.”

Wen and others spoke earlier this month to 20 journalists at a specialized training program on opioid abuse sponsored by the National Press Foundation. It was held in conjunction with the annual conference of the American Society of Addiction Medicine, held in Baltimore.

Opioids are a synthetic form of opium sometimes described as heroin in a pill. They are highly effective for relieving pain but bring a euphoria that carries great potential for misuse and development of an addiction.

Their use and the number of related overdose deaths — every 20 minutes someone in the United States ODs after using a drug such as oxycodone or morphine — have quadrupled since 1998.

165,000Number of Americans who died from opioid overdoses between 1999 and 2014

2,326Idahoans who died from opioid overdoses during the same years

Eighty percent of the world’s prescriptions for opioids come from the United States. In 2013, 249 million opioid prescriptions were written across the country. That’s enough to supply every American adult with a bottle of pills, said Debra Houry, a physician who serves as injury prevention director for the Centers for Disease Control and Prevention.

Less than 5 percent of individuals who receive opioid prescriptions abuse them, but they account for 32 percent of the opioid prescriptions obtained, according to a study by Castlight Health, a health care information company.

In Idaho, 86 prescriptions for painkillers were written in 2012 for every 100 people, a number matched by neighboring Utah and three less than Oregon. Alabama and Tennessee had the highest rates, 143 prescriptions, while California and Hawaii were lowest, at 57 and 52, respectively.

4.3 million Number of Americans 12 or older who improperly used prescription painkillers in 2014.

‘I FELT LIKE A SPACE CADET’

Despite the sharp increase in prescriptions, pain levels Americans report have remained unchanged, Houry said. That suggests the additional drugs are feeding addictions more than easing pain, as evidenced by a Boise man who sought relief for arthritis and Crohn’s disease, a chronic inflammatory condition of the gastrointestinal tract.

The man testified this month in federal court that his doctor, Michael Minas, quickly increased the dosage of oxycodone that he was taking, making him dependent upon the drug. Minas, an Eagle physician, is accused of improperly prescribing large quantities of painkillers to his patients. His jury trial is ongoing in Boise.

The patient, who wasn’t accused of any wrongdoing, said his monthly supply increased from 120 30-milligram pills to 240 within three months. After another five months, he was taking 420 pills per prescription and filling new prescriptions two or three times a month.

“By this time, it wasn’t about the pain. It was about the addiction. It was the worst I had ever felt in my life,” he said, explaining that he was throwing up, experiencing shakes and going to the bathroom every few minutes. “I told him I felt like a space cadet.”

Three out of four recent heroin users reported moving from opioids to much cheaper heroin.

That story shows why Marc Fishman, an assistant professor at the Johns Hopkins University School of Medicine in Maryland and medical director of a treatment center, draws a line between the ill effects of opioid misuse and the person involved.

“We do want to stigmatize the illness, just as we want to stigmatize cancer but not stigmatize the cancer treatment-seeking patient. It’s a funny nuance,” Fishman said.

VERMONT SEES RESULTS

The state of Vermont now places people picked up for drug use or possession of personal amounts of drugs in a treatment program rather than taking them to jail. If they complete the program, they avoid prosecution.

The state has spent tens of millions of dollars to construct new treatment centers, Gov. Peter Shumlin said. The number of people held in jails and prisons has decreased and Shumlin said the cost of treatment is much less than for incarceration.

9 deaths per 100,000 National average of opioid overdose deaths in 2014

13.7 Idaho overdose death rate that year

“This is a very tough stigma to remove,” Shumlin said. “I found that we literally had Vermonters who were turning their heads to opioid addiction on Main Street, pretending they didn’t see it, and then turning their backs on treatment centers on our back streets.”

Police officers became one of Shumlin’s best allies. Numerous police chiefs and officers told him they had lost their sons, daughters or neighbors to drug overdoses.

“We have not declared victory, because as long as they’re passing out painkillers like candy, we’re still signing people up for addiction faster than we can get them into treatment,” Shumlin said. “But I think we’re finally making some progress.”

John Sowell: 208-377-6423, @IDS_Sowell

Reporter John Sowell recently attended the National Press Foundation’s fellowship program and will continue to write about substance abuse issues.

Coming Sunday

Idaho lawmakers have made it easier to get and use a drug that can halt an opioid overdose before it turns fatal. But it’s taken time for pharmacies to stock it and for local law enforcement to adopt it. We check in on the use of naloxone almost one year later.

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