Painkillers: When the good turns to bad – The Times and Democrat

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Opioid abuse and addiction know no geographic and socioeconomic backgrounds.

They are reality in Everytown USA.

Over-prescribing of pain-killing drugs is identified as a key factor in what has become a national crisis.

The U.S. Centers for Disease and Control’s latest Vital Signs shows opioid prescriptions continue to be written at a high rate, with the amount of opioids prescribed per person standing three times higher in 2015 than in 1999. It is a problem that state and local officials say they are also closely monitoring.

The report indicates that while the amount of opioids prescribed in the United States peaked in 2010 and then decreased each year through 2015, the volume of the potentially addictive medications prescribed is still about three times higher than in 1999, when the problem with opioid addiction was in its infancy.

Researchers sorted counties nationwide according to the average amount of opioids prescribed per person. This was measured in morphine milligram equivalents, or MMEs, to account for the fact that the drugs come in a variety of types and dosages.

The picture locally is mixed.

The average per capita amount prescribed in Orangeburg County was 822.7 MMEs in 2010 and 709 in 2015. So the county saw a decrease in the prescribing of opioid painkillers.

The level remained stable in Bamberg County, with the average per capita amount prescribed there going from 776.4 MMEs in 2010 to 736.9 in 2015.

Calhoun County, however, saw an increase in the average per capita amount of prescribed opioid painkillers, going from 0.4 MMEs in 2010 to 39.4 in 2015.

Shelly Kelly, DHEC director of health regulations said, “Opioid abuse and addiction is rightly called an epidemic in our state and across the country.”

The CDC has reported that prescription painkillers were responsible for roughly half of the nation’s 33,000 opioid-related overdose deaths in 2015.

The S.C. Department of Health and Environmental Control reports 512 deaths occurred in South Carolina from a drug overdose with prescription opioid drugs listed on the death certificate in 2015, up 10 percent from 464 in 2014.

While 2016 data is not yet available, DHEC reports there were 508 deaths in the state from drug overdoses involving opioids. In 2015, there were 565 deaths. In both years, opioid overdoses outnumbered murders.

There were six opioid-involved overdose deaths in Orangeburg County in 2015, one death in Bamberg County and none reported in Calhoun County.

Over-prescribing opioids

“I would consider that opioids are overprescribed in general. What has helped in the recent past are the guidelines that have come out from the CDC and the DEA in terms of their recommendations for how to use opioids and having the providers be more aware of their prescribing habits through just that educational process,” said Dr. Monnie Singleton of Singleton Health Center in Orangeburg.

“I think that has helped us to sort of see a slight decrease in the number of prescriptions that are written, but old habits are hard to break. There are lots of physicians who’ve had patients on opioids for long periods of time and it’s hard to get them off of opioids,” Singleton said.

The South Carolina Prescription Monitoring Program (PMP) has been touted by medical and other professionals as helpful in addressing the problem.

DHEC’s Kelly said PMP is a model for other states “in helping physicians track patient’s use of prescription opioids to spot signs of abuse.”

“In 2016, nearly 5 million opioid prescriptions were filled in South Carolina. By using SCRIPTS, we can also exchange information with other states to track prescriptions. Our drug-control officers also work closely with federal, state and local law enforcement to identify prescription drug abuse ‘hot spots’ – geographic locations where there is a pattern of abuse,” Kelly said.

Singleton said, “I think that the prescription monitoring programs that have been put in place have helped, especially in the area of ‘doctor shopping,’ where a patient may come to one doctor and pick up some opioids and go across town or to another city and pick up some more. The program really helps us as providers see if patients are going around getting them from other places.

“So we don’t see as much of that now as we did three years ago. Most all states have prescription-monitoring programs now.”

Wanda Copeland is a certified family nurse practitioner who said the over-prescription of opioids is a reality.

“One of the things that’s a problem is a lot of times health care providers may be giving too much at one time. For instance, there’s a lot of times when these kids — especially the kids — go and have their wisdom teeth pulled and they’re given like 20 pills of an opiate when they don’t really need that,” Copeland said. “They can just use ibuprofen or something.”

She said while she understands doctors want to help alleviate pain, “I wonder if they’re taking the time to fully evaluate the problem,” noting that the state’s PMP has served to curtail the over-prescription of opioids and “has been a great lifesaver for a lot of physicians.”

She said she works in a local doctor’s office twice a week and they rarely prescribe opiates.

Legislative effort

Greenville state Rep. Eric Bedingfield is chairman of the House Opioid Abuse Prevention Study Committee. He said while the PMP has served to help in discourage the over-prescription of narcotic painkillers, that is only one piece of the puzzle.

“We decided as a group of people who wanted to attack this issue that there was no single direction to go to fix it. The study committee is made up of a cross section of members from not only around the state, but all the various committees in the House,” Bedingfield said.

“This is going to have budgetary impacts that we are going to have to pay attention to. When you take the ability of addicted individuals to doctor shop, they just don’t quit using opioids. They move to street-level drugs and then eventually they will hopefully decide to get clean and want to seek out treatment,” he said. That, too, will come at a necessary cost.

“We want to attack the falsified prescription aspect of things and keep those pills from reaching the patient and the street for those who don’t honestly need them, but at the same time we need to also be prepared as a state to deal with the humanitarian aspect that’s going to follow it,” Bedingfield said.

The legislator said the committee has seen that the state’s opioid addiction problem is pervasive and “knows no socioeconomic or racial boundaries.”

“I wouldn’t dare put percentages on this yet, but a lot of the abuse that we see today is a result of people who … have been using prescription opioid pain medication for injuries at some point and time in life,” Bedingfield said.

“That’s the reason we’ve attempted as a committee and as a House to try to approach this thing from a very holistic standpoint, whether that be educating children about the dangers of prescription drugs or educating our future prescribers – be that physicians, orthodontists, orthopedists or nurse practitioners – about noticing the signs of addiction,” he said.

The legislator said he is hopeful that by the time the committee issues a report on its statewide assessment of the opioid addiction problem – which he said will be accompanied by “various pieces of legislaton” in January – the panel will have enough evidence to convince budget writers on the Ways and Means Committee “that we have not only got to be serious about attacking the problem, but we’ve got to be serious about funding the recovery.”

“The government can’t fix it all, the government can’t pay for it all, but we’ve got to make sure that we let people know that the services of organizations who are not governmentally funded but are still doing positive work in our communities are available.

“There are people out there who just aren’t looking to make a dollar off of treatment and recovery, but are seriously concerned with people being able to live and provide for their families and be good citizens,” Bedingfield said.

The General Assembly is hoping to pass legislation next year to help curb the over-prescription of opioids, he said.

“It’s called Prescription Report Cards, and it would take DAODAS’ (S.C. Department of Alcohol and Other Drug Abuse Services) data from the Prescription Monitoring Program. It would issue a little report to every prescribing doctor in the state and say, ‘Here’s how many prescriptions for opioids you wrote this year,’ and try not to judge them, but give them some perspective and a reminder of what they’re doing and how it compares to other doctors around them,” Bedingfield said.

“We hope that it raises some awareness within them that maybe they’re stretching the limits of what they should be prescribing,” he said.

Singleton said pharmaceutical companies are also partly to blame for the rise in opioid addiction.

“The pharmaceutical companies should step up to the plate and own up to their role … in that they heavily marketed these pain pills in the ‘90s when there was an explosion of synthetic opioids coming to the market.

“They were pushing these pain pills onto doctors as better alternatives to the pain medicines that were on the market in that they were less addictive when, in fact, they were just as addictive or maybe more than some of the others that were already on the market,” he said.

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