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Grown in the fields of Afghanistan and distributed in our pharmacies, hospitals, and even on our local street corners, opioids are narcotics that have been used for ages for both saving and destroying lives.  Today opioids play an important part in healthcare. In varying strengths and derivatives, they are used in our daily lives to treat and manage pain. We use them to treat pain following surgical operations, in palliative care, as treatment in terminal conditions, and even as a cough suppressant.

Prescription Drug Abuse

As with any narcotic, there are clear reasons for and high value associated with its medical use, but accompanying the drug is the ever-present potential for abuse. Given Americans’ broad use of opioids, many of these medications sit around in our cabinets or in other easily-accessible areas, leaving the door wide open for them to be used outside of their intended purpose (what the Drug Enforcement Administration (DEA) calls drug diversion).

Let’s take a look at Exostar’s home state of Virginia:

• In 2014, more people died from opioid overdoses than fatal car accidents. I spend a weekly average of 550 frustrating minutes sharing the road with my fellow commuters; to think that more people have died from opioids than in car accidents is staggering.
• On average, more than 24 people are seen in emergency departments every day due to an overdose. Three of them die from it.

Across the United States, the numbers are scary:

• At least half of all opioid overdose deaths involve a prescription opioid.
• 78 Americans die every day from an opioid overdose.
• 1,000 people are treated in emergency rooms daily for misusing prescription opioids.
• In 2014, almost 2,000,000 Americans abused or were dependent on prescription opioids.

Heroin is Back

The Centers for Disease Control and Prevention (CDC) says that prescription opioids used to treat pain – such as Percocet, OxyContin, and Vicodin – pose the strongest risk factors for heroin addiction. Heroin? Yes. In recent years, heroin has made an ugly comeback. In an effort to curb drug diversion, the DEA has released guidance on how to prescribe Controlled Substances electronically to lockdown prescription drugs. As we go digital in healthcare and make it more difficult to access prescription opioids, abusers are turning to the more easily-accessible street alternative heroin.

• 3 out of 4 heroin abusers began their addiction from prescription opioids.
• Between 2010 and 2014, heroin-related deaths
• According to the DEA, 500kg of heroin was seized at the Southwest border during 2000-2008. In 2013 alone, they seized 2,196 kg (400%).

Enter Fentanyl

Fentanyl was first discovered in the 1960s. No one had even heard of the drug until it burst into the public consciousness when it killed the musician Prince.  Fentanyl is synthetic and very potent.  It’s 50 times more powerful than heroin, nearly 100 times more powerful than morphine – all jammed into a single pill, a patch, and even ingested as a lollipop! It’s supposed to be used in hospitals to treat patients dying from late stage cancer and people are getting high off it instead.

• Only a tenth of a fentanyl is needed to achieve the same high as heroin.
• It’s so potent that .25mg can be a fatal dose.
• Often mixed in with other drugs, many abusers will never know that they are taking a “dirty pill” that contains potentially lethal dosages of fentanyl.
• Furthermore, in the State of Ohio (which leads the nation in Fentanyl confiscations), 92 fentanyl-related unintentional overdoses occurred in 2013. In 2014, preliminary data shows 514 (roughly a 500% increase).

What Can We Do?

I recently received an email from Dr. Marissa Levine (Virginia Department of Health), David Brown (Virginia Department of Health Professions), and Dr. Jack Barber (Virginia Department of Behavioral Health and Departmental Services), outlining Virginia’s collaborative effort to go toe-to-toe with this public health emergency.

• Naloxone (Opioid antagonist) – in a statewide standing order, Virginia wants to make it available to the public, as it temporarily reverses the effects of opiates. Pursuant to an oral, written, or standing order issued by the prescriber, a pharmacist may dispense naloxone for overdose reversal. Individuals may possess and administer naloxone to a person who is experiencing – or is about to experience – a life threatening opiate overdose.
• Prescription Monitoring Program (PMP) – a repository that tracks when and where patients have filled a controlled substance prescription; providers can query the database and get visibility into a patient’s history with prescription drugs. Guidance given by the state is to query every 3-6 months to ensure the adherence to the treatment and look for inconsistencies.
• FDA Black Box Warning – Benzodiazepines and concomitant use of opiates may lead to lethargy, respiratory depression, coma, and even death. Benzodiazepines are typically prescribed to treat neurological and/or psychological conditions (i.e., insomnia, seizure disorders, anxiety, etc.) and depress the central nervous system (CNS depressant) but each has its own unique pharmacology and risks. Stronger labeling will help prevent adverse interactions and outcomes by mixing them with an opioid.

Conclusion

The problem is real and people are dying. Patients would benefit from talking with their healthcare providers about the negative effects of misusing opioids to identify risks. For abusers, we need to help them find treatment and promote the recovery of individuals. Families can ensure that they store and dispose of controlled substances safely and securely to prevent them from falling into the wrong hands. Abusers range from wealthy suburbanites, high profile celebrities, urban youth, to the kids you tuck in at night. No one is immuned. Collaborating to address this public health crisis is the best that we can do. Let’s remember that together as a whole, we are greater than the sum of our parts.

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Serving as Exostar’s Director of Health IT & Life Sciences, Kenny Kong leads Exostar’s Health IT practice. He has consulted and advised some of the world’s largest Health IT and Biopharmaceutical enterprises in establishing digital identities to securely extend trust across traditional enterprise boundaries. His thought leadership supports the development of Federal Health IT Standards and in his tenure, he has worked in all areas of Health IT from Meaningful Use compliance, launching Electronic Prescribing of Controlled Substances (EPCS) nationwide, to co-founding federal programs that bring Health IT to Medically Underserved Areas across the United States.