The New York Times has published another of those scary stories about the epidemic in drug overdoses in the United States. Last year, the Times calculates, nearly 60,000 Americans died from overdoses of prescription and illegal drugs. That’s an increase over the previous year of 19 percent, a record. And 2017 looks to be worse.
Because official statistics from the Centers for Disease Control take months to compile, the Times did its own survey by contacting all 50 state health departments and, in the cases where those departments had not yet made their numbers available, selected counties or coroner offices:
The initial data points to large increases in drug overdose deaths in states along the East Coast, particularly Maryland, Florida, Pennsylvania and Maine. In Ohio, which filed a lawsuit last week accusing five drug companies of abetting the opioid epidemic, we estimate overdose deaths increased by more than 25 percent in 2016. [...]
This exponential growth in overdose deaths in 2016 didn't extend to all parts of the country. In some states in the western half of the U.S., our data suggests deaths may have leveled off or even declined. According to Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, and an expert in heroin use in the United States, this geographic variation may reflect a historical divide in the nation’s heroin market between the powdered heroin generally found east of the Mississippi River and the Mexican black tar heroin found to the west. [...]
“This epidemic, it’s got no face,” said Chris Eisele, the president of the Warren County Fire Chiefs’ Association and fire chief of Deerfield Township. The Narcotics Anonymous meetings here are populated by lawyers, accountants, young adults and teenagers who described comfortable middle-class upbringings.
In the 15-year stretch from 1999 to 2014, more than 165,000 people in the United States were counted as having died from overdoses related to opioid pain medication. The Drug Abuse Warning Network estimated that misuse or abuse of narcotic pain relievers were responsible for more than 420,000 emergency department visits in 2011, the most recent year for which we have data. While the leading causes of death—heart disease and cancer—have plummeted, the death rate associated with opioid pain has gone the other direction.
We know that some approaches work to reduce the impact of this disastrous epidemic. But as usual resources are inadequate. And the Trump regime’s proposed budget cuts knocking the CDC down to the level of funding of 20 years ago would exacerbate the situation, if those reductions managed to get through Congress. Among those programs, for instance:
Just one counseling session with a nonjudgmental, trained social worker while they were waiting for emergency care for any sort of medical issue led to lower levels of opioid misuse and overdose risk behaviors six months later, compared to a group of patients who just received a pamphlet on overdose risk.
Amy Bohnert, who has researched the problem after an acquaintance in her 20s died of a heroin overdose in the mid-2000s:
I’ve watched what the city of Baltimore has achieved in the face of an especially bad heroin epidemic, since it’s where I earned my Ph.D. The city government paid for physicians to get the training and licenses needed to prescribe buprenorphine, also called suboxone. That’s a drug that can help heroin users reduce their cravings and avoid withdrawal when quitting use of heroin or other opioids, and it can be given to them by their primary care doctor, unlike methadone. The number of patients treated with methadone or suboxone in Baltimore nearly quadrupled, and the number of heroin overdoses dropped dramatically.
In 2016, the CDC developed the CDC Guidelines for Prescribing Opioids for Chronic Pain, a list of 12 recommendations. Top of the list? “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.”
Key to reducing the overdose toll, Bohnert says, is developing a better response from physicians, particularly in rural areas. In those locales, it’s often difficult find a doctor who will offer “talk therapy” or prescribe non-drug therapy for pain or to prescribe suboxone or methadone. Improving that situation will require a significant educational effort along with funding resources that are not currently available.