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The Cost of Michigan's Deadly Epidemic

Monday, July 1, 2019  
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Opioids and the Toll on Communities

Toby Allen was a young man with a good life. He and his wife Heather had two children. He had a good but stressful job in public relations. Toby was well-liked and always willing to help friends and family.

Toby was a good guy, living a normal life when a seemingly harmless game of football with friends resulted in his life taking a painful and eventually tragic turn. Toby suffered a severe foot fracture after being tackled in a pickup game. Heather said the doctor told the couple he had not seen a fracture so severe, and following surgery prescribed what Heather said were “almost unlimited prescriptions of the painkiller Vicodin.”

“Any time he wanted a refill, he would just get it,” said Allen. “That was the beginning of it for him.”

That one prescription was the beginning of a tragic battle with addiction to opioids, one with which Toby struggled for several years. When prescriptions from doctors were no longer available, Toby started getting his supply from drug dealers and eventually started using heroin. The addiction took a toll on the family finances and the Allen’s marriage.

The opioid epidemic cuts across all demographic lines in our communities including the Allen family, Toby, Heather, Emily and Aiden.

Toby eventually entered rehab which seemed to be successful. However, his first post-rehab drug experience involved drugs laced with fentanyl, a powerful recreational drug often mixed with heroin or cocaine. That experience ended Toby’s life and left Heather alone to raise their two children.

The Allen family are the human faces of the opioid epidemic. It is an issue that crosses every demographic line in every community in the country. It impacts friends and neighbors and most of us, including Toby’s friends, have no idea what is happening.

“He would take Vicodin to feel like Superman,” said Heather. “He was high functioning — most people did not know he was using. His co-workers and friends had no idea.”

Toby and Heather Allen, along with their two children Emily and Aiden, are victims of the opioid epidemic, a crisis that claims 115 American lives daily. In 2017 alone, there were more than 70,000 drug overdose deaths, 68% of those involving opioids. More than 28,000 deaths involved synthetic opioids such as fentanyl, more than 15,000 thousand involved heroin and more than 14,000 involved prescription opioids.

Starting in the 1990s with the increase of prescription painkillers, the opioid epidemic has become a modern health crisis. Opioids are a diverse class of moderately strong painkillers, including oxycodone, hydrocodone and a very strong painkiller, fentanyl, which is synthesized to resemble other opiates such as opium derived morphine and heroin.

Prescription painkillers, specifically opioids, can provide relief to people who have had surgery, traumatic injuries or chronic pain, but they can also disrupt and destroy lives when the relief gives way to dependency.

“It impacts all of us. It affects our neighbors, our friends and our colleagues,” said Eric Dimoff, vice president of marketing and communications for the Lansing Regional Chamber of Commerce and friend and former colleague of Toby. “It is a public health threat that transcends all demographics.”

A 2015 report from the Michigan Prescription Drug and Opioid Abuse Task Force concluded: Prescription drug abuse has reached epidemic proportions. The increased availability of prescription drugs, coupled with general misperceptions regarding the safety of physician-prescribed medications, has led to exponential growth of drug users and drug abusers. In Michigan, the number of drug overdose deaths – a majority of which are from prescription drugs – has tripled since 1999.

In addition to the often-tragic human toll, the opioid epidemic has greatly impacted multiple communities in society, especially health care, law enforcement and the business community. All those sectors share in the responsibility for getting the opioid crisis under control.

In health care, opioid painkillers have been identified as one of the primary reasons for the tragic increase in prescription drug overdose deaths. In 2016, Michigan health care providers wrote 11 million prescriptions for opioid drugs, enough to give every resident a bottle of more than 80 pills. The 2015 Michigan Task Force report stated that opioid painkillers are “being prescribed in the United States at an unprecedented rate.”

Dr. Susan Maples, a Holt-based dentist has been outspoken on the opioid issue. In a recent Lansing Regional Chamber Entrepreneur Connect podcast, Dr. Maples said medical professionals need to assume more responsibility for prescribing alternatives to opioids when it comes to pain management.

“We have to get out of the business of prescribing opioids,” said Dr. Maples. “Advil and Tylenol are often quite effective without the central nervous system euphoric affect.”

The burden the opioid epidemic has put on police departments and other first responders is unprecedented. Local forces are having to divert time and money to combat the consequences that accompany addiction, including violence, petty crimes and child neglect. With rising overdose rates, police often are the first responders to witness and intervene. In fact, it’s not unusual for medical responders to wait for police to arrive before entering an area they deem unsafe — the drug trade is dangerous and first responders know it.

“We spend an inordinate amount of time responding to crimes associated with addiction,” said Ingham County Sheriff Scott Wriggelsworth. “It is interwoven into just about everything we do in law enforcement.”

Wriggelsworth noted county sheriffs have an additional problem in that jails are filled with addicts who often become quite ill when going through withdrawal during their incarceration.

“We have 440 beds in our facility and 70% are filled with inmates with substance abuse and/or mental health issues,” said Wriggelsworth. “We have to deal with all of that which is very taxing.”

Another fallout is the desperation that addicts feel that causes them to do just about anything to secure drugs, including home invasion, theft and other crimes even against loved ones.

“It literally changes who people become,” said Wriggelsworth. “They victimize people they ordinarily would not victimize.”

Emergent BioSolutions in Lansing has joined the front lines in the opioid wars. Through its acquisition of Adapt Pharma last year, Emergent now owns NARCAN Nasal Spray, the first and only nasal form of naloxone for use in opioid overdose emergency. Narcan launched in February of 2016 and is now the leading community use form of Naloxone.

“Broader availability of naloxone among those using illicit or prescription opioids and their friends and family can be a lifesaving opportunity,” said Emergent’s executive vice president for business operations, Adam Havey during an appearance before the Lansing Economic Club in March. “We believe that NARCAN Nasal Spray is an important part of the fight against the opioid epidemic and we look to drive awareness, expand availability and maintain affordability of this important product.” 

Michigan hospitals are helping fight this deadly epidemic by working with lawmakers, state departments, physicians and the public to raise awareness and improve clinical processes. The Michigan Health and Hospital Association (MHA) has worked with hospitals to educate patients, improve patient outcomes and reduce health care costs associated with opioid use, and has received national recognition for its Pain Management Collaborative in 2016.

“We need to create better resources and capacity for provider education on new drugs, alternative treatments to opioids, substance use disorder and opioid tapering,” said MHA CEO Brian Peters. “Clinicians often don’t have enough time to educate their patients, let alone stay up-to-date in a rapidly changing environment themselves, all while new regulations that impact their practice are put into place. The constant pressure is contributing to the provider burnout epidemic, which is a whole other critical issue facing health care providers.”

Insurance companies including Blue Cross Blue Shield of Michigan (BCBSM) have adopted aggressive strategies to combat opioid abuse. Key examples of the Blues work in these areas, include:

  • Prevention - BCBSM is working with physicians to limit the quantity and day supply of addictive substances (except for those who have a cancer diagnosis or are terminally ill)
  • Treatment - using real-time hospital discharge data, the BCBSM pharmacy team works with their behavioral health experts to engage members in treatment following an opioid or heroin overdose. They have worked on removing barriers to addiction treatment by providing access to medication-assisted treatment
  • Fraud Detection - A Controlled Substance Workgroup of doctors, behavioral health specialists, case managers, pharmacists and corporate investigators reviews claims of members with behavior reflecting opioid misuse or abuse to coordinate treatment referrals and ongoing case management
The Blues point to the inroads being achieved in recent years citing a 33% decline in the number of opioid pills dispensed between 2012 and 2017, a 65% reduction in longacting oxycodone and oxymorphone use and a 51% reduction in fentanyl products dispensed in the same time period.

“We attribute that success to the work of our opioid task force, providers, stakeholders and community partners across the state,” said Pam Yager, manager of social mission at Blue Cross Blue Shield of Michigan. “Together, we’re taking a comprehensive approach to solve the opioid crisis by addressing prevention, fraud detection and abuse, advocacy/awareness and, of course, treatment.”

In 2017, the Michigan legislature adopted a 10-bill package aimed at reducing Michigan’s rapidly growing opioid addiction by requiring doctors and the state to better track and control the flow of opioid-based prescription drugs. Included in the package are bills that collectively require doctors to use a new online prescription tracking state database, set up a legitimate doctor-patient relationship and limit the number of pills dispensed in a given seven-day period.

Despite the success seen thus far in efforts combatting the opioid epidemic, there’s still work to be done.

“The opioid crisis has brought to light a critical problem we’re facing as a state and nation when it comes to patient and community access to behavioral health care education and services, particularly for senior citizens, children and teens,” said Peters. “We need to re-evaluate our health care policies and funding structures to support the time it takes for providers to truly engage with patients and their families and educate them on the risk of opioids. In addition, we need to address the shortage of behavioral health care services in our communities and ensure patients and their families have access to the care they need, when and where they need it.”

If you or someone you know needs help with substance abuse, please call the national substance abuse and mental health services administration hotline at 1-800-662-HELP. They can put you in touch with local resources:

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