Lessons of the opioid addiction epidemic
Blake Fagan, Guest columnist
Mitchell and Yancey County
Opioids, which include Oxycontin, Percocet, Vicodin and morphine, are powerful painkillers. In the past, opioids were mainly used for patients with cancer pain, at the end of life, or after major surgery. But starting about 20 years ago, there was a big push for doctors to prescribe opioids for acute and chronic pain of all types, such as headaches, fibromyalgia, arthritis and back pain.
At the same time, doctors were told, incorrectly, that these medications were not addictive. As a matter of fact, doctors were told that less than 1 percent of patients on long-term opioid therapy became addicted or dependent on the medications. Furthermore, starting patients on these medications, doctors were told, would return them to normal function. They would get their lives back.
But after prescribing opioids to millions of patients for noncancer pain, we have learned the following: These medications ARE addictive. One third of patients prescribed opioids for 2 months or more — just 2 months — become addicted or dependent on the medications.
Moreover, when family members of these patients are polled, they believe that even a larger percentage of patients on long term opioids are addicted or dependent on the medication — 50 percent instead of 33 percent. Less than 25 percent of patients on long-term opioids return to full employment, so they are not the cure-all we were promised.
If you are a young person (younger than 25) and take an opioid for any reason — after a surgery, tooth extraction, etc. — you are 50 percent more likely to become addicted in your lifetime. The young brain should not be exposed to opiates unless absolutely necessary.
Now, pain is very personal and emotional for many people. There are many people whose lives have been changed for the better because of opioid therapy, but the above statistics are sobering.
Furthermore, opioid medications and their cousin, heroin, have led to a surge in overdoses and overdose deaths. Deaths from opioids and heroin now surpass deaths from car wrecks, homicide or suicide in this country. It is a national and local crisis.
Because of evolving understanding of opioid pain medications and the drastic increase in people living with addiction, and overdose deaths, providers are becoming more cautious about prescribing these medications.
E. Blake Fagan is a family physician and the chief education officer at the Mountain Area Health Education Center. He received his medical degree from Vanderbilt University and is a graduate of MAHEC’s Family Medicine Residency Program in Asheville. He is a Western Carolina Medical Society board member.
The community response to opioids
Local information supplied by Jim Haaga, MD
A recent article in this paper explored the reasons for the opioid crisis and the serious potential for addiction with the use of opioids (hydrocodone, oxycodone and others). Medical providers have become acutely aware of the crisis because of the exponential rate of opioid overdoses and overdose deaths in our community.
However, there is hope. Many individuals and organizations in WNC have been responding to this issue for years, but now there are collective, region-wide responses to this crisis. What are some of the actions these coalitions are taking?
In Mitchell and Yancey Counties, meetings have been held for the past eight years as the Mitchell Yancey Substance Abuse Task Force (MYSATF) has developed. This group has worked under the Graham Children’s Health Services, now renamed “Partners Aligned Toward Health” or “PATH”. Currently leading the MYSATF are Jeff Spargo, program coordinator, Schell McCall, director of PATH, and Chairperson, Jessica Farley, RN, of the Toe River Health District.
Prevention of substance abuse is a key goal of the MYSATF. An after-school program in both counties, STAR for middle schoolers in Mitchell, and the Cougar Fit Club for high school students in Yancey County, have been working for several years to give a group of students healthy and constructive habits and lifestyles. Working with the Yancey program since the beginning have been Dan Graham, retired Mountain Heritage counselor and Donna Banks, current MHHS counselor.
A recent grant secured by the task force has enabled the hiring of a new Youth Team Advisor, Terri Leiser, who, along with other task force members are starting projects like Youth-2-Youth, in which a club format will be used by youth to learn teach their friends about the importance of staying “drug free”. A summer youth activity guide is being published also to help in constructive alternatives to boredom or activities that might lead a young person to experiment with drugs. It can be found at www.pathwnc.org.
Mechelle Akers, Burnsville Ingles pharmacist and former chair of the MYSATF has guided many efforts of the task force and encouraged her fellow pharmacists to monitor patients’ opioid use, counsel them and to help keep prescribers aware when they see a potential problem. She also led in many “drug take back days” and establishment of permanent drop off boxes in both counties sheriff’s offices for excess/outdated prescription medications of any kind.
Mental health and substance abuse counselors, through RHA and other practices, work daily with community members who struggle with addiction and related mental health problems.
Faith leaders are now attending the MYSATF meetings and helping to increase awareness in their congregations, letting them know that help is available where needed for themselves and their loved ones.
Sheriff and police department officers in both counties have been extremely involved in attending the meetings of the task force. They have been trained in the use of the potentially life-saving medication Naloxone (Narcan) for use in drug overdoses, where they may often be the first person on the scene. They are working daily to reduce the availability of illicit substances.
In the broader area, the Buncombe County Department of Health and Human Services is leading an effort to build a coalition of providers in Buncombe County, including community clinics and the hospital, to tackle this problem. VAYA Health (formerly Smoky Mountain LME), a regional health organization helping those with behavioral health and intellectual or development disabilities, is leading the effort to build a regional coalition to attack this problem for the 23 westernmost counties.
The physicians and the medical community are re-training themselves to reduce the flow of inappropriate opiates from providers to patients. Over the years, providers have been misinformed about the addictive nature of opioids. Providers are increasingly in agreement that inappropriate opioid prescribing needs to be curtailed. MAHEC is offering online and live in-person educational courses to providers in our communities about appropriate opiate prescribing.
Physicians and the medical community are also working on prevention. We are talking to pharmacists, emergency department providers, and chronic pain and addiction specialists about dispensing naloxone, a medication that reverses the effects of an opioid overdose to patients at risk of overdose. There are safer medications (“medication assisted therapy”, or MAT) available to “de-tox” patients who are addicted to opioids. More providers are being trained in MAT to help stabilize patients in their addiction and get them off of heroin. Furthermore, several organizations have been talking to schools and community groups about the dangers of taking someone else’s medications and the use of illicit drugs.
Patient engagement is key. Locking up medications can keep them out of the hands where they are not needed. Using medication only as prescribed, and safely discarding medication, especially pain medications, when they are no longer needed, is vital. If patients think they need a smaller amount of pain medication than their physician or dentist is prescribing, they can discuss this matter, with the prescriber and ask for a smaller amount. This is especially true if a controlled substance is being prescribed for a young person.
A Substance Abuse Resource Guide for Yancey and Mitchell Counties has been published yearly for the past 5 years and has information on how to obtain treatment. This is available at the Path website, pathwnc.org. This website, as well as a Facebook page has more information, including how to get involved in the local effort.
Jim Haaga, MD is an emergency room doctor at Blue Ridge Regional Hospital in Spruce Pine.