Opioid addiction and the need for a PDMP

Tuesday, March 7, 2017

Abuse of prescription opioids is on the rise in Missouri and this area.

Painkillers like Vicodin, Fentanyl, OxyContin as well as codeine and hydrocodone are opioids, a class of drugs which includes heroin.

According to the Missouri Hospital Association, 2.1 million people in the U.S. misuse opiates and "there is growing evidence which links analgesic opioid dependence to eventual heroin use."

According to the Missouri Hospital Association, the number of people seeking treatment at a medical facility related to opioid use/abuse has gone up 137 percent over the past decade.

As relayed in testimony before a committee in the Missouri House by Rep. Holly Rehder, R-Sikeston, over the past 15 years in Missouri, "the number of people dying from an opioid overdose has quadrupled. One reason is that over the same period, the number of opioid prescriptions had quintupled."

That quantifies to more than 1,000 people dying every year from opioids in this state.

At February's meeting of the Nevada Regional Medical Center, Kevin Leeper, Chief Executive Officer, addressed himself to this problem.

After citing national and Missouri statistics Leeper said, "This is not just a St. Louis or a Kansas City problem; it's a problem right here in Vernon County and downstairs in our Emergency Department."

Leeper spoke of the danger in the attitude which says, if drug addicts kill themselves that helps solve the problem.

"Opioid abuse is having a huge impact on ordinary people such as us in this room," said Leeper addressing the board. "Opioids are amazing painkillers, but for some people it only takes one prescription and they're addicted."

Sitting next to Leeper was the board's president, Steve Russ, who himself had succumbed to addiction of opioids but received help to beat the addiction, and now is director of a program -- Celebrate Recovery -- which helps others overcome a wide variety of problems.

Leeper also referred to information board members had received from the Missouri Hospital Association which described a study on newborns and opioid problems due to maternal use during pregnancy.

According to the Hospital Industry Data Institute, Missouri births between 2006 and 2016, saw a 538 percent increase in incidents related to newborns with withdrawal symptoms stemming from maternal drug use.

While Bates County had no reported cases of neonatal abstinence syndrome, Vernon County has a rate of 3.51 NAS births per 1,000 births.

Said Missouri Hospital association President and Chief Executive Officer, Herb Kuhn, "Babies born addicted to powerful drugs suffer withdrawal symptoms similar to adults and require specialized, and often intensive, care."

In a separate interview, Russ said, "Those of us who deal day to day on the front lines of addiction, understand a prescription drug monitoring program is not single handedly going to solve the problem but this is an important piece which could help this situation."

Missouri is the only state which does have such a statewide system which detects when people are "shopping" from provider to provider for prescriptions.

In his Celebrate Recovery program, Russ has counseled people who were flagged by the PDMP in Kansas, early in their addiction, and so were able to receive early help.

"I also know of people who came from Kansas and shop various providers in order to get opioids for themselves and extra to sell to others as a way to get cash," said Russ.

At last Wednesday's study session, Nevada city manager, JD Kehrman, presented information related to the problem and the possibility of the city joining a multi-city and county effort to create a PDMP, led by St. Louis County.

The reason this patchwork approach is being organized is because of a small group of legislators in the Missouri Senate who have, for the past several years, filibustered such a bill until it died.

In a February meeting of the Southwest Missouri Medical Association, district 31, state Sen. Ed Emery was asked if he would join such a filibuster and he said, "Yes."

Opponents cite concerns over access to medical records and a general opposition to a government already intruding itself into people's lives too much already.

Russ himself has testified this session before a committee in the state Senate and another in the state House, relating his experiences in support of a PDMP.

Said Russ, because these concerns have been raised over a number of years, supporters have modified the bill to add numerous protections, such as reducing the time data can be stored, requiring audits and encryption and preventing law enforcement from obtaining warrants based solely on the information.

Besides creation of a PDMP, healthcare providers -- physicians, dentists, pharmacists and others -- are being advised to adopt a new set of best practices with respect to the prescribing of opioids.

These recommendations include an assessment of pain balanced with the risk factors for addiction, use of non-narcotic analgesics, use of short-acting versions, limit prescription to cover 72 hours, use abuse deterrent packaging and have emergency departments refuse to prescribe controlled substance which are claimed to be lost or destroyed.

"But right now, the biggest thing we need is a PDMP," said Leeper.

To date, those counties and cities joining with St. Louis County towards creating a Missouri PDMP include St. Louis city; St. Charles County, Jackson County along with Kansas City and Independence, Cole County and Jefferson City, Greene County and Springfield city; Benton County and Warsaw city; Stoddard County and Bloomfield city; Perry County and Hannibal city; New Madrid County and Cape Girardeau city; Lincoln County and Troy city; and Ste. Genevieve County.

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