LITTLE ROCK, Ark. (KTHV) — The opioid epidemic is complex, and a local expert believes it will get worse before it gets better.
A new report from the Centers for Disease Control showed that the number of emergency room visits related to opioid overdoses increased by 30 percent between 2016 and 2017. The authors broke that down by age, gender and location, and the results were similar for each subset of the population.
Dr. Brad Martin, a professor of pharmaceutical evaluation and policy at UAMS, has studied opioid use for more than a decade. He said he was not surprised by the CDC’s findings.
“I think it’ll continue to increase,” he said. “I mean, some of our work we’ve done — time-series models, trying to forecast and seeing where it’s gonna peak — and we don’t see the peak hitting for another four to eight years from now.
“Now, we hope our data’s wrong. But when we look at forecasts into the future and try to look at our death rates and some of our opioid use measures, we think it might be a while before we start seeing any decreases in things like ERs, overdoses that either result in a fatality or in an emergency room visit.”
Martin believes the numbers related to overdoses are following the same trend line as the numbers for prescriptions, but lagging by several years.
“In 2012, we hit our peak, nationally,” for opioid prescriptions, he said. “And then it’s been coming down a little bit. Opioid deaths, however, have continued to increase.”
Martin said the risk of opioid addiction increases the longer a patient is exposed to medication. Another risk factor of having more pills in the public sphere for a longer period is that it becomes more likely someone will take the pills illegally, whether that’s an addict looking for a fix, or a teenager who decides to experiment.
“We were starting to hit the — not alarm bells, but some warning bells — back in 2006 and 2007,” he said. “And now, I think, there’s a lot of, a lot more interest in it.”
Martin sees a couple of ways to reduce the number of overdoses, and to help people survive them. First, he recommends that people who use opioids for pain buy naloxone, a drug that can reverse the effects of an overdose.
“Some people might think, like, ‘oh, that can’t happen to me. I don’t want those things.’ But it’s kind of like having a fire extinguisher at home,” he said. “You never plan on having a fire in your house, but you have — most people have a fire extinguisher, just in case.”
He suggested that some doctors and pharmacists will begin offering naloxone to high-risk patients: those who have used opioids for a long time, those who also take muscle relaxers or anti-anxiety medication, or who drink alcohol.
“People that are on high-dose opioids, that should be something that clinicians should be thinking about and offering,” he said.
Another form of help is coming from pharmacy benefit managers, the companies responsible for approving and paying for prescriptions.
“They payers are no longer paying past seven days for initial opioid therapy,” Martin said. “That’s based on CDC guidelines. Some of our data shows that’s a good step in reducing the risk of long-term opioid use, and then later, dependence and abuse.”
The CDC report’s authors wrote that communication between doctors, first responders, and the community about the dangers of opioids and the value of naloxone will be another key factor to stopping the epidemic. Martin mentioned that Arkansas has yearly conferences to bring them all together.
“Here in Arkansas, we’ve done a reasonably good job," he said. "I think we’re going to see more of those activities in the future. But, yes: is it good? Could it be better? Absolutely.”
Martin said one recent step that may not have a significant impact is the series of lawsuits filed by states and municipalities against large pharmaceutical companies. He mentioned that Perdue Pharma — maker of Oxycontin — reduced its sales staff by 50 percent and stopped promoting opioids to doctors because of criticism over its role in the epidemic. But he said, while Purdue is a large company, it is a small player in the opioid manufacturing industry.
“Most of the prescribed opioid use,” he said, “is not branded by any particular — like Perdue Pharma or Pfizer, that both have opioid products — most of them are from generic manufacturers.”
While the report did not give any state-specific data, Arkansas Drug Director Kirk Lane said numbers here will likely mirror the national trends. He does not expect to have data for 2017 until either April or May.
Martin said, while opioid overdoses will eventually decline, they will never disappear because oxycodone, hydrocodone, morphine, and other opioids are effective medications.
“This is one of the biggest challenges that we have, is that these opioids are very effective for acute pain,” he said. “The evidence is not really there for the use of these in chronic pain. But people kind of transition pretty quickly from acute to chronic opioid use, and this is where the efforts are going to be, to kind of look at and evaluate patients on an individual basis, to see which ones might benefit from reducing doses and ultimately getting off of opioids on a long-term basis. But I think there’s a lot of hope.”