How prescription opioids are killing Nebraskans and the battle against this abuse

At least 54 Nebraskans died from prescription opioid abuse in 2015. (NET News image)
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May 16, 2017 - 6:45am

Lots of people take prescription opioid painkillers to deal with acute pain. But abuse of these is killing Nebraskans. Mike Tobias talks with Nebraska’s attorney general and a pain physician about the problem and the battle against it. The interviews are from the NET News “Speaking of Nebraska” discussion program.


The words “crisis” and “epidemic” are often used to describe the abuse of opioid prescription painkillers in Nebraska. Almost 150 Nebraskans died of drug overdoses in 2015, the most recent year statistics are available. At least a third of these were opioid-related. An additional 12,000 to 17,000 Nebraskans are believed to be opioid abusers or have opioid dependence issues. Nationally there were more than 20,000 opioid-related deaths, a reason Nebraska attorney general Doug Peterson believes the Nebraska problem may be more significant than what is reflected in statistics.

Watch the full interview on opioid abuse with Attorney General Doug Peterson and Dr. John Massey on the NET News discussion program, "Speaking of Nebraska."

 


(left to right) Attorney General Doug Peterson and Dr. John Massey talk with Mike Tobias of NET News about opioid abuse for NET's "Speaking of Nebraska" program.

Doug Peterson, Nebraska Attorney General: What I hear from law enforcement is the number of autopsies and the number of coroner calls they have are going up. You don't see a spike in auto fatalities or homicides, and the explanation seems to tend towards drug overdose and we suspect most of those are opioid.

Mike Tobias, NET News: Let's go back and talk about what exactly is an opioid painkiller.

Dr. John Massey, Lincoln pain physician and state representative of the American Academy of Pain Medicine: Opioids have been around for 5,000 years. They're derivatives of poppy and they're all either similar to morphine or synthetic analogs of morphine. They're very effective for acute pain treatment and they are something that the world has been familiar with using for many years.

Massey: The number of prescriptions I believe, from 1999 to 2008 increased by 400 percent and then, from 2008 until now, probably an equivalent amount or very similar. So what you have is many, many more people being prescribed these medications. I think data says that 200 million prescriptions for opioids were prescribed in the United States, which has 350 million people. Another number I like to think about is 98 percent of the world's supply of hydrocodone is consumed in the United States.

Tobias: Give me an example of how that dependence, how that abuse plays out?

Massey: It's probably important to realize that people don't set out to fall into this problem, of course. People have a risk associated with a likelihood of developing this problem that's largely genetic and there's a lot of different numbers out there, but somewhere between 12 and 24 percent of people who start with a medication for fully legitimate purposes are at risk of developing a problem with these medications going forward if we aren't careful. What happens then is that people start taking these medications, which are very effective in an acute post-operative case, and they continue, then, as the disease changes and you don't have an acute injury you develop a chronic pain situation, which is neurologically different so these medications lose their effectiveness and we make probably a very big error when we continue to try to get relief from these medications when they're not going to be as successful. So people take more and more of these medications until they develop a problem.

Peterson: I think the typical digression that you see is typically someone may be prescribed the drug for an appropriate basis. The doctor eventually says that we're going to cut this prescription off, it's served its purpose. If the addiction develops they're going to start to look for ways to shop around to try to get it from a prescription method. Eventually, if that gets completely cut off and we've just put into effect this year the Prescription Drug Monitoring Program for that very reason, then typically what happens is that pushes them into the street market. They're looking for people who are actually selling old prescriptions or other drugs and our biggest concern, from a law enforcement perspective, is we can look at other states and see how this digression has worked. Once they are cut off from the prescription, the appropriate method of getting the drug from their physician, then they go to the street.

Massey: The Drug Monitoring Program is one data point that clinicians can use to help them understand what medications patients are taking. But certainly there are many other ways that we can curtail this problem.

Tobias: Are these opioids overprescribed by physicians?

Massey: Well, I think they may be, and there are a lot of reasons for that. I'm a pain physician, I want to make sure that people understand we want to treat pain and that's a big problem as well. I think if there's a missing education point with the healthcare provider community is that these medications are potentially less effective than we have been led to believe or we have felt in the past. So I think that's part of the problem. They're also cheap and they're easy to administer and some of the things that are more beneficial, less risky, are sometimes harder to get to for patients.

Tobias: You (Massey) wrote in a Nebraska Medical Association publication recently, “Pain treatment and avoidance of prescription opioid abuse are not mutually competing goals.” Are you talking about there being other solutions out there?

Massey: Absolutely. I want people to have successful treatment for pain. Under the best of circumstances, chronic pain situations opioids may reduce pain by as little as 30 percent or less. We need to do a better job than that, so if we're just focusing on this and running into problems we're missing the opportunity to help people.

Tobias: What are other solutions?

Peterson: One of the things that I've tried to do from a law enforcement standpoint is to talk to other attorney generals. The Ohio attorney general, the New Hampshire attorney general, the Wisconsin attorney general, and say, "What have you found successful? What has not been successful?" All of them, now, are in a fairly serious crisis situation but they suggested developing the network with the medical community. Also just the community care field, health and human services, to develop some type of both prevention program, law enforcement program and a treatment program. So back in October we had a symposium at the (University of Nebraska Medical Center) and now we have, from that symposium back in October, developed some task force groups working in prevention and we've started the public service announcements in that regard.

Tobias: That’s the “Dose of Reality” campaign.

Peterson: That's the "Dose of Reality," which was gifted to us, in effect, from the Wisconsin Attorney General's Office. Law enforcement, we're trying to get together and be both networked very well with the federal authorities but also talking to some of these other law enforcement agencies in Ohio, for example, and say, "What are some of the effective methods, use of Narcan, things of that nature." And then treatment. Treatment, I think, is one of the biggest challenges but we just recently had one of the task force meet at the Med Center last month and I was very encouraged to see what the treatment looked like. Very encouraged to know that the medical community now, at the Med Center, they're looking at curriculum, dental schools, pharmacy schools, how to make young doctors, young dentists, aware of how to better address the prescribing of these drugs.

Tobias: Obviously a controversial solution but there are some studies out there that would say medical marijuana is one option. Is it?

Massey: I don't believe so. I think that data is not out there that says this is a problem that, as a solution to this problem, we might just be bringing on our next problem. There are certainly people who have that opinion and I think their challenge is that they don't have data to support that.

Peterson: I would say that, Mike, I think that comes from the industry and the advocates for marijuana. That doesn't come from the medical community. It's troublesome that they kind of manipulate because they do isolated, anecdotal stories and I don't think that's good medical evidence.

Tobias: So if somebody has some of these what should they be doing with them?

Peterson: We have drug take back days, but I really think the easiest thing to do is people can go to their cabinets whenever they watch this program and they can take those drugs, they can go down to their pharmacist, the pharmacist will have an envelope available, you throw it in the envelope and it's mailed to a special, designated by the FDA, location, and DEA, where they'll be disposed of. That's really important because one of the things we see is, as this addiction gets cut off by either the prescribers or from the physician, what they'll start doing is people will look to raid cabinets of friends, family members, and that's where a lot of young people get their drugs. So it's very important that you not take it lightly and don't think, "Maybe I'll use it the next time I turn my ankle." Get it into the pharmacy and get it disposed of. (INFO: "How and where to dispose of unwanted prescription painkillers and other drugs")

Tobias: What (else) do you want people to know?

Peterson: I think all Nebraskans to know that talk to your doctor any time you're being prescribed these opiate-based drugs about, "How can we be as cautious as possible?" Also, for young people, understand that this is really dangerous. Don't even think about messing around with, experimenting with pharmaceutical drugs. They can be very deadly. And just, I guess I am encouraged as the medical community in Nebraska is becoming more and more advanced in looking how best to control the flow of pharmaceutical opiate drugs.

Massey: Have meaningful and direct communication with your providers. We want to treat pain and we can do so successfully without unnecessary risk. We just need open and honest communication.

Discussion

 

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