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Thirteen states have made progress in battling the deadly opioid epidemic while eight states have notably failed to deal with the crisis, according to a report issued this month by the National Safety Council (NSC). It comes on the heels of a report earlier this year by the Centers for Disease Control (CDC) that found deaths from drug overdoses decreasing in 14 states.
Meanwhile, four congressional committees are considering legislation that would attempt to combat the opioid crisis by fast-tracking development of non-addictive painkillers, restricting the flow of addictive drugs to the United States from other countries and providing more federal aid to the hardest hit states and communities.
A bipartisan omnibus bill to accomplish all of these goals had been crafted by Sen. Lamar Alexander (R-Tenn.), chairman of the committee that deals with health issues, and Sen. Patty Murray (D-Wash.), the committee’s ranking Democrat. Alexander wants Senate action by April 30 and House passage by Memorial Day.
Early this month Alexander saw a distressing and typical consequence of opioid addiction when he visited a children’s hospital in eastern Tennessee. Ten of 30 newborns in the hospital were suffering from withdrawal symptoms caused by exposure to opioids.
The national statistics are grim. According to the CDC, there were 63,632 drug overdose deaths in 2016, the last year for which full figures are available, and 42,249 were attributable to opioids. The opioid death rate increased nearly 29 percent from 2015 to 2016. In a March report the CDC said it continues to rise.
Drug overdoses claim 175 lives a day, 115 of them from opioids. Mike Moore, a former Mississippi attorney general, said the overdose deaths were equivalent to a Boeing 737 crashing every day and killing all passengers aboard. If that happened, “we’d shut the skies down until we figured out the problem,” said Moore, who successfully sued tobacco manufacturers and is now involved in litigation against opioid makers.
The opioid epidemic cost a staggering $1 trillion in the United States from 2001 through 2017, according to the health consultancy Altarum and reduced U.S. life expectancy. The Los Angeles Times reports that the epidemic is also causing a “dangerous shortage [at hospitals] of the powerful pain killers needed by patients in acute pain.”
Opioids are named for opium, a narcotic used for centuries that is made from a poppy-like plant. Morphine and heroin are derived from opium, as are such prescription painkillers as Vicodin, Percocet and OxyContin. The opioids category also includes a handful of synthetic compounds, chiefly methadone and fentanyl.
All of these drugs are addictive. Fentanyl, especially dangerous, is 50-100 times more potent than morphine and has become the prime culprit in overdose deaths, according to the CDC.
The NSC has identified six life-saving actions for states. These include requiring prescriber education, implementing opioid prescription guidelines and doing so in a clinical setting, improving data collection, treating opioid overdoses and providing extended treatment for overdose survivors, many of whom suffer from “opioid use disorder,” a chronic brain disease.
The NSC gave an “improving” rating to 13 states and the District of Columbia which took at least five of these key actions. Nevada and New Mexico have taken all six. The states with five actions are Arizona, Connecticut, Delaware, Georgia, Michigan, New Hampshire, North Carolina, Ohio, Rhode Island, Virginia and West Virginia
Twenty-nine states that took three or four actions were deemed “lagging” by the NSC. Eight states taking one or two actions were described as “failing.” Missouri was the only state taking a single action. The seven states with two actions are Arkansas, Iowa, Kansas, Montana, North Dakota, Oregon and Wyoming.
The NSC measures improvement, not mortality. For deaths, the source is the CDC, which uses “age-adjusted” death rates. Younger populations tend to have more opioid deaths. By adjusting for age, researchers can estimate how many deaths would have occurred if every state had the same age distribution of residents.
The national age-adjusted rate is 13.3, meaning that for every 100,000 Americans, 13.3 died from taking a potent opioid dose. The state with the highest age-adjusted death rate is West Virginia, where 43.4 of every 100,000 people died from opioid misuse. Other states with high death rates, with the number of deaths per 100,000 people in parentheses, are New Hampshire (35.8), Ohio (32.9), Maryland (29.7) and Massachusetts (also 29.7).
In the face of these daunting statistics, some states have reduced opioid death rates with widespread use of the overdose antidote naloxone. Communities need more naloxone, according to the CDC, as well as better access to mental health services and medication-assisted treatment.
Although naloxone is the wonder drug of the opioid crisis, it works better with follow-up intervention.
“Naloxone works well but it’s only the first step,” said Sherry Green former director of the National Alliance for Model State Drug Laws. “Once we save people with naloxone we need to go the next step and give them a chance for recovery.
According to CDC figures, drug overdose deaths declined in 14 states during the twelve months ending in July 2017. Listed in order of the percentage of decline, the states are Wyoming, Utah, Washington, Alaska, Montana, Mississippi, Kansas, Rhode Island, Oregon, California, Tennessee, Massachusetts, Arizona and Hawaii.
But with drug overdose deaths still rising in most states, health officials aren’t doing victory laps.
“If we’re truly at a plateau or inflection point, it would be the best news all year,” Caleb Alexander, an epidemiologist and co-director of Johns Hopkins University’s Center for Drug Safety and Effectiveness told the Pew Charitable Trusts. “But we’re still seeing rates of overdose that are leaps and bounds higher than what we were seeing a decade ago and far beyond any other country in the world.”
These rates could be reduced, health officials say, by following the best practices of the more innovative states. Here are some examples:
Rhode Island has won plaudits for a high level of care for overdose patients in emergency rooms and hospitals. The smallest state in the union has also pioneered in treating addicted jail inmates, greatly reducing the overdose death rate once they are released, according to JAMA Psychiatry.
Vermont uses a “hub and spoke” plan to help patients recovering from opioid use disorder. Nine Regional hubs provide daily support for patients with complex addictions. At over 75 local spokes, doctors, nurses, and counselors offer ongoing opioid use disorder treatment and medical care.
Ohio successfully experimented with a program for pregnant women and mothers struggling with opioid use. Called MOMS (for maternal opiate medical support) it was a two-year initiative that improved maternal and fetal health outcomes.
After opioid overdose deaths increased 74 percent from 2012 to 2016 in Arizona, Gov. Doug Ducey (R) declared a state of emergency and ordered real-time reporting of opioid overdoses. “This allowed immediate dedication of public funds toward fighting the opioid epidemic,” said the NSC.
Massachusetts and Pennsylvania led the way in permitting “non-opioid directives,” which allow patients to prevent treatment with addictive medication. Massachusetts was also the first state to authorize bulk purchases of naloxone.
The Bay State is currently plagued by fentanyl, which Gov. Charlie Baker (R) said is involved in 80 percent of overdose deaths. Baker has joined law enforcement officials in calling for stricter laws to prevent importation of the deadly compound.
In Massachusetts, as elsewhere, police officers are often on the front lines of the crisis. They arrest drug dealers, treat overdose victims and take users to recovery facilities or jail. The work can be dangerous. A police officer in eastern Ohio, and three officers in Baltimore County, Maryland were hospitalized for reportedly ingesting fentanyl through the skin.
President Donald Trump favors the death penalty for drug dealers, and Atty. Gen. Jeff Sessions seeks longer mandatory sentences for drug offenders, reversing Justice Department priorities during the Barack Obama presidency. But a recent report from the Pew Charitable Trusts, reaffirming previous studies, found no correlation between long prison terms for drug offenders and drug overdose deaths.
There is a consensus in the states and among health care officials that the opioid epidemic is a costly public health emergency, one that National Safety Council president Deborah A.P. Hersman calls “the most fatal drug crisis in U.S. history.”
There’s urgent need for federal legislation along the lines of the Alexander-Murray bill to provide states and health agencies with the resources they need to combat this deadly epidemic.