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Opioids: America’s public health emergency

How doctors, pharmacists, consumers can help

With nearly 3 million Americans addicted to opioids, including prescription painkillers, heroin and fentanyl, and with death rates soaring from overdoses, President Trump recently declared the opioid epidemic to be a national public health emergency.

Ken Hale, clinical professor of pharmacy at Ohio State, has been a vanguard in educating people about this crisis.

In 2007, he founded Generation Rx, a national program to prevent misuse of prescription medications. Hale, also associate director of the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery, shares his insights and ways to address the opioid problem.

What surprises you the most about this opioid epidemic?

I’m shocked that heroin has become so common. When I was young, I never knew anyone who used heroin. Now it’s become part of every socioeconomic group, every race, every ethnicity, every age. This has clearly affected overdose death rates.

Drug overdose is the leading cause of accidental death in our country for people of any age. And for people under 50, it’s the leading cause of death. To me, that’s shocking. We should be up in arms.

The problem is particularly bad in Ohio. Last year, Ohio had 4,149 deaths from overdoses, up 36 percent from year before.

How did we get to this point, where millions are addicted to opioids? Or in which 52,000 Americans died of drug overdoses in 2015?

A perfect storm exists around this epidemic. The first front is our drug-taking culture. Half of the U.S. population is taking at least one prescription medication, and a fair number are using more than one each day. We seek quick fixes for our health concerns, and the United States is one of only two countries in the world which permit direct-to-consumer ads for prescription drugs. These phenomena tend to normalize the use of prescription drugs.  If we look at opioids, we are less than 5 percent of the world’s population; yet we consume 80 percent of the world’s opioid medications.

The second front in the storm is easy access to prescription drugs. Overprescribing is part of the problem. We’ll fill about 5 billion prescriptions in the United States this year. While opioid prescribing is going down, it’s still staggering. A lot of medication is out there, and 70 percent of people who misuse these drugs get them from family members or friends.

Third are misperceptions about safety and legality. Maybe we think that since a doctor gave us this prescription, it must be safe. Maybe we think if a pharmacist dispensed it, and our government approved it, it is non-addictive. Maybe we think it’s legal to give it to somebody else. All those things can be false. A drug like OxyContin is very similar to heroin. Heroin raises big red flags in our mind, but when we think of OxyContin or Percocet, those red flags may not go up when, in truth, they are very similar in chemical structure.

Opioids

Infographic Description: An epidemic in the heartland

Summary: Ohio consistently ranks among the states with the highest death rates due to drug overdoses and with significant increases year over year. The opioid crisis has claimed the lives of more than 17,000 Ohioans since 2003. Picture: Next to this summary is a picture that shows the steady increase of deaths due to drug overdoses year over year. Data shows more than 2,000 deaths in 2013; about 2,500 deaths in 2014; a little less than 3,500 deaths in 2015; and more than 4,000 deaths in 2016. The sources for this information were the Centers for Disease Control and Prevention and The Columbus Dispatch.

When did this perfect storm start brewing?

In the 1990s there was a strong push to treat pain more aggressively, and in 1995 the American Pain Society pushed pain as the fifth vital sign. Just as doctors check your pulse, blood pressure and temperature, they check your pain. We started seeing pain medications being used more liberally instead of just for cancer pain or post-surgery pain.

At the same time, questionable pieces of literature were used to convince prescribers that we should use these medications more aggressively.

Another factor was the arrival of black tar heroin from Mexico, which had a new delivery model. In the past, heroin was handled by drug cartels, and there was gang violence associated with it. With black tar heroin, the dealers are very customer service oriented and nonviolent. They deliver drugs to your house, like pizza.

Many people have died of overdoses of heroin and fentanyl. What is the link between the abuse of prescription painkillers and using heroin and fentanyl?

About 75 percent of heroin users first misused a prescription pain medication. So we know that misuse of these drugs is the gateway to the heroin and fentanyl problem. If people can’t get the prescription drugs legally or can’t afford them on the black market, they turn to heroin and fentanyl, which are cheaper. We need to close the gate to keep people from starting the misuse of prescription drugs.

We need to tighten the faucet so these drugs aren’t so accessible, and we need to educate people. Prescription drugs can help you, and we’re living longer and healthier lives because of these drugs, but medication can cause harm, especially if misused.

In 2007, I worked with Dr. Nicole Kwiek and other faculty members and students in the College of Pharmacy to create Generation Rx, an educational program that provides free resources for people of all ages about the dangers of misusing prescription drugs. We joined forces with the Cardinal Health Foundation in 2009, and that put wings behind our work. You can go to our website and download a variety of free, ready-to-use materials to take action against prescription drug misuse.

We’ve also teamed up with the American Pharmacists Association’s Academy of Student Pharmacists. More than 100 colleges of pharmacy across the nation now use our resources. The estimated reach from that alone has been over 37 million people since 2010.

We emphasize several key messages:

  • Only use prescriptions medications as the doctor prescribes.
  • Never share your medications with others or use someone else’s prescription drugs.
  • Be sure you store them in locked spaces and dispose of them safely when no longer needed.
  • And model safe medication practices. What others see you doing matters.

This year we are working with Kroger pharmacies to pilot a patient education program in southeastern Ohio, and we are working with schools, which are mandated to provide opioid safety education but often they don’t have the resources or background to do it. We are partnering with OSU Extension, Kroger pharmacists and Cardinal Health in this important work.

Opiods
President Trump recently declared the opioid epidemic a public health emergency. How will that make a difference?

It’s an important step. We need to marshal everything at our command toward fighting this epidemic. The president’s action should help elevate the attention and resources focused on this problem.

But I am concerned that the administration may emphasize law enforcement at the expense of prevention, treatment and recovery resources. All of these things, and more, are sorely needed. We clearly can’t just arrest our way out of this epidemic.

In May Ohio Attorney General Mike DeWine filed a lawsuit against five prescription opioid manufacturers alleging that they engaged in fraudulent marketing of opioids, and several other states have done the same. What is your reaction to this?

I think the pharmaceutical companies do have culpability, in the ways they have marketed these drugs.  Those are the places with deep pockets, but there’s culpability in other pockets as well. Healthcare professionals have culpability in overprescribing, and then there are consumers, in how they misuse these medications. I’m not blaming the victim, but we need to do a better job of educating people about “safe medication practices for life” (the Generation Rx tagline).