President Donald Trump on Thursday declared what law enforcement and health leaders have known for years — that opioid drug abuse is a national emergency.
The local concern
“Clearly it’s a full-blown epidemic,” Storm Lake Public Safety Director Mark Prosser told the Pilot-Tribune. “The amount of overdose deaths is rising around the country, and it’s coming at Iowa from both sides. In our area we’re starting to deal with it now. It’s coming — it’s already here.”
Opioids are drugs that act on the nervous system to reduce pain, often seen in prescription medication form. Continued use and abuse can lead to addiction, or worse.
Prosser said that the Storm Lake Police Department has already been in conversations with emergency room officials at the local medical center at how to handle opioid incidents, and officers have been sent for training. Officers are also being equipped with protective gloves to avoid absorption of the drugs in cases they may encounter.
While opioids are investigated in a similar fashion to other types of drug pushing and abuse, it creates unique challenges because it is so readily available, and is used both legally and illegally.
“In several cases, we’ve caught individuals with a huge bag of all kinds of assorted pills they have bought up or stolen — they have no idea what is in there or what effect it could have on a person, and neither do the people who buy the stuff from them,” Prosser said. “In a societal sense, this is incredibly dangerous. It requires only a very small amount to be very serious and possibly fatal. There is a higher rate of death than with many of the other drugs we see.”
In fact, while there were about 3,000 overdose deaths annually at the height of the heroine epidemic in the 1970s, and 5,000 in the late 1980s at the peak of a crack cocaine trend, there were 64,000 drug deaths in the U.S. last year, and University of Pittsburgh researchers project that 300,000 are expected to lose their lives in the next five years.
“In all my years I’ve worked in the substance abuse field, I’ve never had so many patients die,” said longtime treatment expert Joan Hartman, of Illinois-based Chestnut Health Systems.
How the crisis emerged
Like most trends, widespread opioid abuse began on the east and west coast, Prosser notes. Drug trends typically take about 18 months to migrate to the rural Midwest.
The problem has “exploded” in the past two years, and is two-pronged, the local police chief says — with health providers over-prescribing legal pain medications that are then abused, and a market thriving to buy or steal legitimate drugs and resell them for illegal use.
The drug brands are often familiar — morphine, OxyCotin, Robitussin AC, Tylenol with Codeine, Demerol, Percodan or Percocet and others, both synthetic and nonsynthetic. On the street, they may go by such names as “Captain Cody,” “Demmies,” “Schoolboy,” “Miss Emma,” “Murder 8,” “Friend,” “Percs,” “Juice” and “Hillbilly Heroin.”
The drugs were designed to release medication slowly over time, but abusers often crush up pills to snort, or cook them for injection directly into the bloodstream in search of a bigger, faster high.
That can create even more health risks, like lung infections or interference with blood supply that can result in tissue death or even amputation of limbs.
Opioids bind to the areas of the brain that control pain and emotion, driving up levels of the hormone dopamine in the brain’s reward centers, according to health officials, and with enough of the drug, the user can experience intense fleeting euphoria. As the brain becomes used to the feeling, it can take more and more of the drug to get the same high, making users subject to dependence, and eventually, addiction.
While drugs as prescriptions may be abused, the drugs are also coming into the country illegally.
“Drug cartels in Mexico that had been pushing pot or coke are now getting into the heroin business, and cutting it with Fentanyl to create a very toxic substance,” Prosser said, referring to a potent prescription opioid drug intended for end-of-life pain-sparing that is often known by the street names “China Girl” or “China White.”
Money drives the epidemic
Stemming the use of opioids is not easy, because obtaining the drug may be as simple as buying pain pills from a patient who is prescribed them. There is a “huge” market for prescription medications from pushers.
“We’re seeing the stuff being sold all the time, opioid or not. We deal with it constantly,” Prosser said. “We’ve seen it for a few years now.
Attacking the problem
Events for people to safely turn in their unneeded or expired medication, as was held in Storm Lake over the weekend, may help keep opioids out of the wrong hands.
“You don’t want people flushing them on to the water plants, and you really don’t want people throwing them into the garbage either,” Prosser said, noting that the sheriff’s department has accepted medication drop offs, as well as some pharmacies.
He said medical researchers are also working on alternatives for pain treatment in hopes of moving away from opioids.
“This is a wave and a scourge. We’ll see more of it. They are trying to educate folks, but I kind of lump it in with all of the other education efforts,” Prosser said. “It helps to a degree, but as long as there is a market for a drug and a pathway to get it here, there will still be those who abuse it.”
Politics and the crisis
Reactions to Trump’s action Thursday varied. Sen. Edward Markey, D-Mass., noted that the proclamation did not come with any immediate meaningful federal funding.
“America is hemorrhaging lives by the day because of the opioid epidemic, but President Trump offered the country a Band-Aid when we need a tourniquet,” he said.
Chris Christie, who heads up a presidential committee on opioids, praised Trump’s announcement as “bold action.” In many health circles, the attention was welcomed.
More details of a federal program are expected later this week, including expanded use of telemedicine.
“Nobody has seen anything like what’s going on now,” Trump said.
Meanwhile, on the same day the president was declaring the emergency, Iowa Gov. Kim Reynolds outlined her priorities on battling opioid abuse in the state.
Among the strategies is teaming with drug users.
Reynolds wants the state to pass a good Samaritan law similar to those in 36 other states, that would make a drug user immune from prosecution in an incident in which they call 911 to report another user’s overdose. Drug dealers would not be protected.
She also wants to expand “take back” days for medication in all 99 counties, and push for more medicine prescribers to sign up with the state’s prescription monitoring program (only 45 percent now take part) along with creating an automated system to alert doctors and pharmacies when a patient exceeds reasonable prescription dosages in hopes of stemming prescription drug shopping. She also calls for adding codeine cough suppressants to the list of medications subject to the monitoring program.
Reynolds wants expanded use of Naloxone, a medication that blocks and reverses opioid overdose effects, and increase Methadone treatment resources in the rural parts of the state.