Arkansas prescription drug crisis worsens, President Trump addresses national opioid epidemic

As President Donald Trump and U.S. healthcare policymakers on Tuesday (Aug. 8) addressed the nation’s growing opioid epidemic, a new study shows the Arkansas prescription drug problem is so serious there are enough pills on the street for each of Arkansas’ almost 3 million citizens to have a full bottle.

A newly released report by the U.S. Centers for Disease Control and Prevention (CDC) shows all but nine of Arkansas’ 75 counties had overall opioid prescribing rates higher than the national average of 66.5 prescriptions per 100 people. As a state, Arkansas has an opioid prescription rate of 114.6 per 100, which is second only to Alabama 2016 average of 121 per 100 people.

The new CDC data released July 26 also shows that several Arkansas counties had prescribing rates exceeding 130 per 100 people, which is double the national average. In Greene County, located in northeast Arkansas north of Jonesboro, 177.8 pills are dispensed per capita. Garland and Sebastian counties have the second and third-highest opioid prescription rate at 176 and 169 pills, respectively.

Four other counties across the state, including Howard, Jackson, Little River and Stone, dispense at least 150 pills for every 100 people. By far, Newton and Cleveland counties have the lowest rate of opioid prescriptions with an average of 0.8 and 1.1 pill dispensed for every 100 citizens. There was no information available for Nevada County in the southwest corner of the state.

ARKANSAS LEGISLATIVE FOCUS
Some of that sobering data was brought to the attention of Arkansas policymakers nearly a month ago when Arkansas Health Department Director Nate Smith gave a presentation to the Joint Interim Committee on Public Health at the State Capitol. According to Smith’s report, “large amounts of opioids are being sold in Arkansas,” enough for every man, woman and child to take 80 pills each over the course of a year. Altogether, 235.9 million pills were sold across Arkansas in 2016, Smith said, citing the most up-to-date data from the CDC.

ADH spokeswoman Marisha DiCarlo said Tuesday that Smith’s presentation to the legislative panel was to inform legislators of the status of opioid use and drug related health problems in Arkansas, highlighted by drug use by demographic group such as age, sex and race were highlighted.

“The Arkansas Department of Health is committed to Identifying high burdened areas, identifying high prescribers of opioids for educational opportunities, and identifying and eliminating doctor shopping,” DiCarlo wrote in response to a Talk Business & Politics inquiry concerning ADH’s response to the growing healthcare epidemic. “This, in turn, supports the current model of drug overdose prevention which includes reducing the number of opioids dispensed, preventing new addiction and treating substance use disorder.”

DiCarlo also said ADH created a new area of focus named the Substance Misuse and Injury Prevention Branch to address the opioid crisis in Arkansas. The new changes were implemented as Gov. Asa Hutchinson signed Act 820 into law during the recent legislative session to strengthen ADH’s ongoing monitoring of prescription medications. The legislation, sponsored by Republican lawmakers Sen. Jeremy Hutchinson of Little Rock and Rep. Kim Hammer of Benton, mandates that prescribers of dispensed opioids enter information on controlled prescription drugs to patients into the state’s Prescription Drug Monitoring Program (PMP) database. The original PMP bill passed in the 2011 only encourages practitioners to monitor the dispensing of opioids and prescription painkillers.

“The PMP gives prescribers access to the patient controlled substance history, which allows for more informed decision making prior to treating with opioids,” DiCarlo said. “Major insurance carriers in Arkansas have taken the initiative to not only require their providers to register with the PMP, but also in limiting the amounts of opioids they will provide coverage for.”

In addition to the legal mandate to now monitor prescription medications, Act 820 says the Health Department must hire a vendor by 2019 to make the PMP database interactive and provide real-time data reporting, if funding and technology are available. The newly enacted legislation further directs that a state licensing board require practitioners to check the PMP database before prescribing opioids or benzodiazepine to first time patients. Some exceptions include before and during surgery, and while a patient is in a healthcare facility, hospice, nursing home, or in other emergency situations.

After Gov. Hutchinson signed the new legislation into law in April, John Kirtley, executive director of the Arkansas State Board of Pharmacy, said the “incredible abundance of opioids like hydrocodone and oxycodone in Arkansas paired with the mistaken belief that prescription drugs are safe and are not addictive has created an unfortunate prescription drug abuse epidemic in this state.”

‘WE WILL WIN’
The serious opioid cloud hanging over Arkansas comes as President Trump on Tuesday received a “major briefing” from U.S. Department of Health and Human Services Secretary Tom Price on the ongoing opioid crisis at his namesake golf clubs in Bedminster, N.J.

“Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities. Everybody is threatened. Drug overdose is now the leading cause of accidental death in the United States, and opioid overdose deaths have nearly quadrupled since 1999. It is a problem the likes of which we have not seen,” said Trump, who just began a 17-day vacation.

Trump said he is confident that by working with health and law enforcement officials, his administration would win the fight against the deadly epidemic.

“So we’re going to do our job. We’re going to get it going. We’ve got a tremendous team of experts and people that want to beat this horrible situation that’s happened to our country – and we will,” the president said. “We will win. We have no alternative. We have to win for our youth. We have to win for our young people. And, frankly, we have to win for a lot of other people, not necessarily young, that are totally addicted and have serious, serious problems.”

New quarterly data released Tuesday by the CDC’s National Center for Health Statistics (NCHS) shows that drug overdose deaths reached an all-time high in the first three quarters of 2016 at 57,900. The NCHS is the principal agency of the U.S. Federal Statistical System which provides statistical information to guide actions and policies to improve the health of the American people.

The NCHS’s data shows that the number of drug overdose deaths are rising faster than originally forecasted. Earlier this year, the CDC reported that more than 52,000 people died from a drug overdose in 2015. Of those, 33,091 (63.1%) involved a prescription or illicit opioid. Since 2000, more than 300,000 Americans have lost their lives to an opioid overdose.

OPIOID ADDICTION COSTS U.S. $78.5 BILLION A YEAR
Also another study on Aug. 1 in the Journal of the American Medical Association (JAMA) estimates that 2 million people in the U.S. have “opioid use disorder,” or are addicted to prescription opioids, accounting for an estimated $78.5 billion in economic costs annually.

“Proven strategies are available to manage chronic pain effectively without opioids, and changing prescribing practices is an important step in addressing the opioid overdose epidemic and its adverse effects on US communities,” the report states.

In Arkansas, 1,067 people died from a drug overdose between 2013-2015, putting Arkansas in the top 20% of states that prescribe the most painkillers per capita. By definition, legal prescriptions for opioid painkillers can be written by doctors to treat moderate to severe pain, but can also have serious risks and side effects. Common types are oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone.

Besides the more common legal opioids, fentanyl is a synthetic opioid pain reliever that is many times more powerful than other oxycodone and hydrocodone and is typically approved for treating severe discomfort, such as advanced cancer pain.

On the illegal side, heroin use has also increased across the U.S. among men and women, most age groups and all income levels. Illegally made and distributed fentanyl has also been on the rise in several states, CDC data shows.