From ‘Oxy’ to heroin, counties fight opioid drug abuse

Tammy Baney had never shared the story of her family’s brush with prescription drug abuse with “total strangers,” as she put it during a workshop at NACo’s recent Western Interstate Region (WIR) conference.

But the Deschutes County, Ore. commissioner was willing to speak out to show a different face of drug abuse.

“Most of us think of prescription drug abuse or drug addicts ... they look like other people,” she said. “They’re those people; they’re people that we don’t know.”

But not always.

Baney’s ex-husband, Kevin — a pilot, musician and successful hotelier — died in 2008 from an accidental prescription opioid drug overdose. His spiraling substance abuse had been a factor in their divorce.

“This is a silent epidemic within our communities that we need to address,” Baney said.

Pharmaceutical opioids include Vicodin (hydrocodone), OxyContin (oxycodone) and Opana (oxymorphone). The Centers for Disease Control and Prevention report that such drugs were involved in more than half of the 38,300 overdose deaths in the United States in 2010, the latest available figures.

Counties large and small are confronting the issue of prescription drug abuse and its links to heroin use. Rural Scott County, Ind. is in the midst of an HIV epidemic linked to shared drug paraphernalia, prompting state officials to authorize needle exchanges for the first time.

In addition to its toll on individuals, opioid drug abuse also has societal costs, according to the U.S. Department of Health and Human Services (HHS), which reports annual medical costs of opioid painkiller abuse at more than $72 billion a year.

How are counties addressing the problem? One approach involves the formation of opioid task forces, bringing together stakeholders such as law enforcement, the medical community and drug treatment experts, according to Susan Weinstein, director of congressional affairs for the National Alliance for Model State Drug Laws (NAMSDL).

Taking a Regional Approach

Three Northern Kentucky counties are doing just that. Boone, Campbell and Kenton counties are jointly funding a Northern Kentucky Office of Drug Control Policy to fight opioid addiction, starting with heroin, said Kris Knochelmann, Kenton County judge-executive. The counties, with a combined population of almost 390,000, sit just south of Cincinnati, Ohio.

“The number of overdoses showing up both at the hospital and that our police and EMS people are having to deal with are on the rise. The most heart-wrenching are the number of infants that are being born addicted,” about 120 at the main local hospital last year,” he said.

The three counties’ Fiscal Courts have approved $120,000 to launch the effort. Kenton and Boone each chipped in $40,000, while less populous Campbell County approved $20,000 plus an equal amount of in-kind services such as office space and IT sup-port. The money will fund two positions: a nurse with legislative and political advocacy experience and a person to coordinate legal, funding and human services issues, Knochelmann said.

Deaths from opioid drug over-doses have risen steadily over the past 20 years, according to HHS, so much so that they currently out number deaths from car crashes in the United States. In Oregon, Baney said, there’s been a 450 percent increase in deaths from prescription drug overdoses in the past 10 years.

From Rx Pills to Cheaper Street Drugs

Prescription opioid abuse also has other consequences. It often can lead to heroin addiction, according to the National Institute on Drug Abuse. It cites recent surveys which showed that increasingly young people are “taking up heroin because it is cheaper and easier to obtain than prescription opioids.

”Pat Herrity, a Fairfax County, Va. supervisor, said two deaths in his community, including one in his neighborhood, brought the problem into focus. “I found out because I knew the people — that they were heroin overdoses, and they weren’t reported as heroin overdoses,” he said.

The Board of Supervisors com-missioned a report late last year on “recent trends and strategies for prevention” of prescription drug and heroin abuse in the county. Its results will be implemented in a Prescription Drug and Heroin Abuse Prevention Strategic Action Plan, currently under development, to address: education and awareness; prescription drug storage, disposal and monitoring; treatment; enforcement; and data and monitoring.

The county has already begun to target storage and disposal by increasing the number of annual prescription drug take-back weeks from two to four. “We want to be able to ... help educate people on the issue overall, and what they can do between events,” said Jesse Ellis, prevention manager, Fairfax County Department of Neighborhood and Community Services.

In addition to take-backs, some counties have permanent drop boxes in secured locations where the public can drop off leftover or outdated prescriptions, according to Margaret Higgins, chair of the Pima County-City of Tucson Com-mission on Addiction, Prevention and Treatment.

Physician, Heal Thyself

Another factor contributing to opioid abuse is over-prescribing of the drugs by physicians, according to Josh Green, M.D., a Hawaii state senator and emergency room doctor who spoke during the WIR workshop along with Baney.

“It’s become a problem and I’m complicit,” he said. “We physicians...we’re pushing a titanic amount of medicine, pain pills into society.”

It’s been several years since he stopped prescribing powerful opioid painkillers such as OxyContin, MS Contin and Fentanyl, but many doctors are “in denial about the scope of the problem.

”To address supply, 49 states, excluding Missouri, have prescription drug monitoring programs (PDMP), according to the National Association of  State Controlled Substances Authorities. These rely on an electronic database of prescribed controlled substances, enabling health care professionals to identify someone who may be “doctor shopping” to obtain multiple opioid prescriptions. Higgins said counties can be a part of the solution by advocating at the state level to improve and modernize their PDMPs.

New laws save lives

While not curbing supply, naloxone access laws and “Good Samaritan” laws — some of which were piloted at the local level before going statewide — are reducing overdose deaths, Weinstein said. Naloxone — administered by injection or a nasal spray — is an antidote that can bring an overdose victim back from the brink of death.

Naloxone access laws provide professional immunity from civil or criminal liability for first responders, prescribers or dispensers, she explained. With many state Legislatures still in session, it’s hard to give an exact count, but as of  the end of  May, 38 states had naloxone access laws, Weinstein said, adding that NAMSDL, which is funded by Congress, is currently drafting a model naloxone access act that all states might use.

“Naloxone access should be widely available. There’s no down-side to it,” she said. “Naloxone has no rewarding properties, so if it gets into the ‘wrong hands’ it can’t be abused; it just doesn’t work.”

Good Samaritan laws extend immunity to those who administer the drug, sometimes extending to laypersons. At least 25 states have enacted them, Weinstein said.

“These naloxone access laws and Good Samaritan laws are fabulous,” she added. “But within the laws there also needs to be follow-up for treatment, because you don’t want people overdosing every day and then getting reversed. “You want them to be assessed for an addiction problem and then put into treatment. It’s really important that any sort of program, law, whatever, has a treatment component in it.”