State and local leaders are trying many things to stop the unrelenting spread of the opioid crisis. But while their defense becomes more aggressive, a report released Monday claims that the state is failing in its fight.

The report authored by the National Safety Council ranked Arkansas as one of eight states to receive a “failing” grade.

The grade is based on progress made in six categories: mandating prescriber education; implementing opioid prescribing guidelines; integrating prescription drug monitoring programs into clinical settings; improving data collection and sharing; treating overdoses; and increasing availability of treatment programs.

Arkansas received the poor rating for only meeting the standard in only two of those categories: implementing prescription drug monitoring programs, and treating overdoses.

“I plan on talking to the National Safety Council to see who they talked to about getting their data, because I know they didn’t talk to my office,” said Kirk Lane, Drug Director for the State of Arkansas.

Lane said he agreed with the premise of the report, and believed those six areas are keys to reducing the threat of opioid abuse. His qualm was with the conclusion it drew

“It’s not really reflective of what we’ve got going on right now,” he explained, given that the report used data reflective of December 2017. “Some of our grants kicked off in January that deal with some of these issues.”

Lane said the key to stopping opioid abuse is getting doctors to stop prescribing them. Arkansas ranks second-worst in the nation for the rate of opioid prescriptions. In 2016, that number was 114 per 100 residents. “2017—although it’s unofficial yet,” he stated, “is going to come out to about 108. So, it’s still too high, because the national average is 66.5.”

The prescription rate is not related only to abuse of pain medication, but also to heroin use. Lane said four out of five heroin users turn to the drug after using prescription pain pills.

“So, it’s obvious to the cartels and the people that supply heroin and other illicit drugs—fentanyl— [to bring them] into a community or into a state that’s very opioid-dependent,” he said. “It’s just a perfect storm.”

Lane explained that several factors could lead Arkansas to a rapid improvement in rankings like these and progress in stopping the threat of opioids. The Arkansas State Medical Board is considering amendments to two regulations: one mandates opioid education as part of a doctor’s continuing education requirement, and the other sets prescription guidelines, based on recommendations by the Centers for Disease Control. Lane said prescription guidelines have been debated for a couple years, with no success.

“Change is hard,” he mentioned. “And our prescribing community can’t agree on what guidelines they feel they need to prescribe at. I think it’s the lack of prescriber education, the lack of [being] willing to accept responsibility, and to try to move forward and to try to do a better job.”

To improve data collection, Lane is asking for assistance from county coroners. Part of the problem is that some may not include opioids as a cause of death when they caused the medical condition that caused the person to die. “And we need to have a uniformed reporting that is—in my opinion—needs to be real-time, and not two years behind,” he added. “For example, right now, we still don’t have the mortality rate for 2017, and so we’re trying to affect problems in 2018 with 2016 data. So, what’s hard about that is, you can’t see real-time where you need to put programs in, where you need to put law enforcement effort in, where you need to put education in.”

The Arkansas State Medical Board will meet again on Thursday, April 5, and could approve the two amended regulations. Lane said that would lead to a slow, but significant, impact in the number of opioid pills both used, and abused.

“I think we could be six out of six by the end of the year if we just have the perseverance to, you know, make the good decisions and stick with them,” he stated, referring to the report.

“I think the big thing is getting buy-in. And I think the hardest thing is trying to change the past. And change is hard to do. People get set in their ways, and then you try to find best practices, and then you have to get them into place and you have to get them going, you know. And these things are not easy to do just overnight, with the flick of a switch. You have to get buy-in, you have to have information, you have to have data to get them into place.”