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An Epidemic

Jul 27, 2016

The opioid pain drug Fentanyl recently made headlines when it was named as the cause of Prince’s death in mid-April. While it is still unclear whether Prince had a prescription for the legal synthetic pain drug, the drug carries high risks and is tightly controlled by the Food and Drug Administration (1). However, much of it is manufactured illegally overseas and in Mexico, and sold on the street.

What many people do not realize is that while Fentanyl is legal with a prescription, it’s 50 to 100 times more potent than street level heroin and is often prescribed to pain patients who have built up a tolerance to other prescription pain medications (4). Many of these people who have built up a high tolerance have also developed prescription pain medication dependence. According to the Center for Disease Control (CDC), for every prescription overdose death, there are 10 admissions for prescription drug abuse, 32 emergency room visits, 130 people who become dependent, and 825 recreational users (3).

Like heroin, morphine, and other opioid drugs, Fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions. When opioid drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation. Fentanyl’s effects resemble those of heroin and include euphoria, drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, unconsciousness, coma, and death (5).

“It just slows your heartbeat down so much and your breathing, you just die,” said Christine Gabig, Forensic Scientist with the Omaha Police Department (2).

The Drug Enforcement Administration reported that in late 2013 and 2014, more than 700 fentanyl-related overdoses were reported in the United States (1). These overdoses are not only happening in coastal and southern states, but here in our Heartland. Nebraska alone has seen 19 Fentanyl overdose fatalities since 2014 (2).

“These numbers could be much higher because the drug doesn’t show up in a typical illicit drug screen,” explains Gabig.

In the late 1990s and 2000s pain management with prescription opioids became big business. In 2010, enough prescription painkillers were prescribed to medicate every adult in America around the-clock for an entire month (3). This over-abundance of prescriptions has led many people down the slippery slope of addiction. Taking a legal prescribed medication for physical pain can quickly spiral into a physical dependency, and a need to deaden any and all pain; including emotional pain.

When individuals are unable to afford or receive a pain prescription from a doctor, they often resort to finding drugs on the street. Heroin use has increased 63% between 2002 and 2013, due to its availability and low cost. According to the CDC, approximately 29 Americans die from heroin overdose every day. Today the average heroin users are white men and women in their late twenties living in suburban areas (6).

In January of 2015, Senator Sarah Howard introduced LB471, which called for all Nebraska pharmacies to enroll in a Prescription Drug Monitoring Program (PDMPs) (7). PDMPs are state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. They are designed to monitor this information for suspected abuse and can give a prescriber or pharmacist critical information regarding a patient’s controlled substance prescription history. It is also used to eliminate “doctor shopping.” The term “doctor shopping” is used to describe a patient who receives several prescriptions from multiple doctors to either support their own habit or to sell illegally. Prior to PDMPs, there was no way to know what other doctors have prescribed the patient. This information can help prescribers and pharmacists identify high-risk patients who would benefit from early interventions (3). Being able to monitor pain prescriptions early on can help prevent later abuse of Fentanyl and heroin, and ultimately reduce overdose deaths.

According to the Center for Disease Control, the people at highest risk for prescription drug overdose include:

People who obtain multiple controlled substance prescriptions from multiple providers—a practice known as “doctor shopping.”
People who take high daily dosages of prescription painkillers and those who misuse multiple abuse-prone prescription drugs.
Low-income people and those living in rural areas.
People on Medicaid are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkillers overdose. One Washington State study found that 45% of people who died from prescription painkiller overdoses were Medicaid enrollees.
People with mental illness and those with a history of substance abuse (3).

In February of 2016, LB471 was passed by a 47-0 vote. Nebraska now joins 48 other states having this important consumer protection tool in place (8). The data base will be up and running by January 2017 (9).

Resources:

Jill Hamilton, Project Coordinator, The Kim Foundation

Jill Hamilton has been the Project Coordinator at The Kim Foundation since 2014. She graduated with a bachelor’s degree in journalism and public relations from The University of Nebraska at Omaha in 2009. Since working at the foundation, she has become an active member of the Nebraska State Suicide Prevention Coalition, Nebraska LOSS Advisory Committee, The Omaha Metro Hoarding Taskforce, The Early Childhood Mental Health Coalition, Nebraska State Conference Planning Committee, is Chair of the Nebraska LOSS Teams Conference Planning Committee, and serves as the Outreach Coordinator for the Metro Area LOSS Team.Jill Hamilton, Project Coordinator, The Kim Foundation
Jill Hamilton has been the Project Coordinator at The Kim Foundation since 2014. She graduated with a bachelor’s degree in journalism and public relations from The University of Nebraska at Omaha in 2009. Since working at the foundation, she has become an active member of the Nebraska State Suicide Prevention Coalition, Nebraska LOSS Advisory Committee, The Omaha Metro Hoarding Taskforce, The Early Childhood Mental Health Coalition, Nebraska State Conference Planning Committee, is Chair of the Nebraska LOSS Teams Conference Planning Committee, and serves as the Outreach Coordinator for the Metro Area LOSS Team.