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Prescription opioid abuse rises in NEA
The Jonesboro Sun - 8/20/2017
BY PAT PRATT and STEPHEN SIMPSON | Sun Staff Writers | email@example.com | firstname.lastname@example.org
JONESBORO - The Natural State has seen an unnatural climb in painkiller addiction, recently rising to second in the nation in the number of opioid-based medication prescriptions written, according to the Centers for Disease Control.
With a renewed emphasis on what has become a national epidemic, doctors and law enforcement have offered some thoughts on reasons for, and the extent of, the problem.
How it began
David Wroten, vice president of the Arkansas Medical Society, said there is plenty of blame to go around for the problem's now epidemic status. Data released by the Centers for Disease Control shows Arkansas had the second highest number of opiate-based painkiller prescriptions written per capita in the nation in 2016, second only to Alabama according to the Centers for Disease Control.
Doctors here wrote 114 opioid-based prescriptions per 100 people in 2016, basically a painkiller prescription for every resident in the state. However, Wroten said some of the blame should fall on the federal government itself for regulations that put doctors in a position to face scrutiny if a patient's pain went untreated.
"If you go to where this problem first started, you had the federal government coming out judging hospitals on how well patients were treated for their pain," Wroten said. "They referred to it as the fifth vital sign. Hospitals were required to ask patients on a scale of 1 to 10 how bad was their pain? If the patient's pain was not treated, it was a significant mark against the hospital."
Wroten said in the mid-1990s when the pain scale was becoming commonplace, the pharmaceutical industries also touted many drugs as safe when they in fact possessed highly-addictive qualities. He said prior to that, doctors were much more cautions about who they prescribed the drugs to.
"At the same time you had drug companies across the country telling doctors that the research was that opioids for treatment of pain was perfectly fine," Wroten said. "There was a time when doctors didn't write a whole lot of opioids for prescriptions. Then it was encouraged."
With the proliferation of the drugs, addiction and abuse became inevitable.
"Then people started abusing those drugs, and not using them and selling them," Wroten said. "Taking them for pleasure and getting addicted to them. And that is kind of how the epidemic started. So there is plenty of blame to go around."
Opioids in NEA
While Arkansas now holds the dubious title of No. 2 in the nation for sheer volume of painkiller prescriptions written, Northeast Arkansas during the past decade has been one of the biggest contributors to that moniker.
The CDC reports the number of opiate-based painkiller prescriptions issued has increased in almost every county in Northeast Arkansas. Second Judicial District Drug Task Force Agent Brett Nolen said of those, one pill is king.
"Hydrocodone," Nolen said. "Hydrocodone is the main thing we see here and in the surrounding counties. I don't know about the rest of the state, but hydrocodone is the main thing here."
DTF agents have noticed a slow increase in hydrocodone arrests in the past few years.
"It's obvious that we've got an issue on our hands now," Nolen said. "The arrests have been trending up this year as well. It's easy to get on the streets. A lot of guys that are selling marijuana are also the sellers of prescription narcotics."
Nolen said they have seen large quantity orders of hydrocodone from other countries, but the majority of contact with the pills is in smaller varieties and those are being prescribed locally. He added that the implementation of the Arkansas Prescription Monitoring Program implemented in 2013 to prevent doctor shopping is a step in the right direction.
"Four years ago, you and I could go to four different doctors and four different pharmacies and stock up on prescription medication," Nolen said. "Now you can only get one prescription from one doctor. We've got a ways to go, but we are heading in the right direction."
DTF and other law enforcement agencies know they must walk a tightrope when it comes to drug enforcement. Often when addicts cannot obtain the drugs legally through a physician, they turn to heroin and other substances.
"Hydrocodone leads to oxycodone, which can lead to heroin," Nolen said. "We've got to be careful with how we handle this opioid issue because if we start putting a squeeze on opioids it could turn into something worse. For example, we had a big problem with meth and the government cracked down with Sudafed laws, but people are going to find something to replace it.
"If they couldn't make it, then they will have someone else do it," he said. "Well, now we are flooded with ice."
With one of the highest opioid prescription rates in the state, Craighead County physicians issued 155 opiate-based prescriptions per 100 people in 2016. Capt. Justin Rolland of the Craighead County Sheriff's Office said while methamphetamine is still the No. 1 drug of choice here, illegal opioids are running a close second and are an ever-growing concern.
"What we are seeing mostly are morphine-based, like Oxycontin and things like that." Rolland said. "We are seeing hydrocodone, basically all your potent painkillers - your extended release tablets and capsules. Those are what we are seeing a problem with."
Rolland said the number of illegal pills confiscated on the streets far outweighs opium-based street drugs such as heroin.
"There is no doubt," Rolland said. "There is a whole laundry list of prescriptions. We are definitely seeing more in the pill form than powered or liquid heroin or anything like that."
In the wake of the increased number of opioid-based substances, Rolland said the sheriff's office is currently considering undergoing training in Narcan administration - an overdose reversal drug.
"We are looking at developing a policy and procedure as far as issuing that to our field deputies," Rolland said. "We are absolutely looking at that. One of our lieutenants brought that to my attention two weeks ago, and we are in the process of doing that now."
Clay County saw the biggest increase of NEA counties in the number of opiate prescriptions written in the past decade. In 2006 the rate was 45 prescriptions per 100 people. In 2016, that number skyrocketed to 134 per 100 people.
Poinsett County also saw the most dramatic shifts in the number of prescriptions written during the past decade, according to the CDC data. While in 2006 the number was 60 per 100, those rates increased dramatically to 93 per 100 residents in 2013, 98 per 100 residents in 2015 and 120 per 100 in 2016.
Prescription rates also climbed in Green, Mississippi and Lawrence counties. Lawrence, while showing a slight increase, however, showed much lower rates than any other area in NEA. About 28 prescriptions in 2006 and 34 in 2016.
Since January 2016, Jonesboro police have cataloged 4,332 drug seizure reports. Out of that total, 1,113 the reports were classified as "other," which usually means opioids.
"When it says other drugs, other depressants or other anything, it is most likely a prescription pill/liquid of some sort," Community Outreach and Recruiting Office Cassie Brandon said. "Most of the pills that are being abused are going to Xanax, Klonopin, hydrocodone combinations, codeine combinations, oxycodone combinations, Dilaudid, etc."
According to the CDC, since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Deaths from prescription opioids - drugs like oxycodone, hydrocodone, and methadone - have more than quadrupled since 1999.