The hairstylist-turned-activist estimated that she had made 75 two-hour trips over the past decade from her home in Fenton, on the outskirts of St. Louis, to the state capital, Jefferson City, to convince Republican lawmakers to monitor the way doctors and pharmacists prescribe and deliver controlled care. substances could help save people like her son, Kevin Mullane.
He was a poet and skateboarder who she says turned to drugs after her and her father divorced. He started “shopping” around the age of 17 and was able to get several prescriptions for the pain reliever OxyContin. He died in 2009 at the age of 21 from a heroin overdose.
Addiction amid COVID-19
Had the state implemented a surveillance program, doctors could have detected Mullane’s addiction and Arbini believes his son may still be alive. She said it was embarrassing that it had taken Missouri so long to agree to add one.
“As a parent you stood in front of a train; you would protect your child forever, and if that helps, it helps, ”said Arbini, 61. “It can’t kill more people, I don’t think so. “
But even though Missouri was the isolated outlier, it had not been among the states with the highest opioid overdose death rates. Missouri had an average annual rank of 16th among states from 2010 to 2019, as the country slipped into an opioid epidemic, according to a KHN analysis from the Centers for Disease Control and Prevention. The data compiled by KFF.
Some public health actors now argue that when providers use such surveillance programs to stop prescription opioid abuse, people who are addicted turn to heroin and fentanyl instead. That means Missouri’s new toll could cause more people to overdose and leave the state with buyer’s remorse.
“If we can take advantage of being the last in the country to do so, I hope we have ample opportunity to learn from other people’s mistakes and not repeat them,” said Rachel Winograd, psychologist who directs NoMODeath, a state program to reduce the harm caused by opioid abuse.
Before Missouri’s surveillance program was approved, lawmakers and health and law enforcement officials warned that the absence made it easier for Missouri patients to go to the doctor for medication. individual, or providers to over-prescribe opiates in so-called pill mills.
In 2017, Schaaf agreed to stop obstructing the legislation and support it if it required doctors to check the database for other prescriptions before writing new ones for a patient. This, however, sparked further opposition from the Missouri State Medical Association, was concerned that this requirement could expose doctors to malpractice lawsuits for overdosing patients.
New right does not include such a requirement for prescribers. Pharmacists dispensing controlled substances will be required to enter prescriptions into the database.
Dr. Silvia martins, an epidemiologist at Columbia University who has studied surveillance programs, said it was important to force prescribers to review a patient’s information in the database. “We know the ones that are most effective are the ones where they check it regularly, on a weekly basis, not just on a monthly basis,” she said.
Corn Stephen wood, a nurse practitioner and visiting bioethics researcher on drug addiction at Harvard Law School, said the tool is often punitive because it cuts off access to opioids without offering viable treatment options.
He and his colleagues in the intensive care unit at Carney Hospital in Boston no longer use the Massachusetts surveillance program almost as often as before. Instead, he said, they rely on toxicology screens, signs like injection marks or the patients themselves, who often admit they’re addicted.
“Rather than pulling out a piece of paper and being accusatory, I find it much better to portray myself as a caring provider and sit down and have an honest discussion,” Wood said.
When Kentucky in 2012 became the first state to require prescribers and dispensers to use the system, the number of opioid prescriptions and prescription opioid overdoses initially declined slightly, according to one state. to study.
But the number of opioid overdose deaths – except for a slight drop in 2018 and 2019 – has since steadily increased, according to a KFF analysis CDC data. In 2020, Kentucky was estimated to have the second largest to augment in drug overdose deaths nationwide.
When efforts to establish the statewide Missouri surveillance program failed, St. Louis County established one in 2017 in which 75 local jurisdictions agreed to participate, covering 85% of the state. , according to to the county health department. The county now plans to move its program to the state one, which is expected to launch in 2023.
County department director Dr Faisal Khan said there was no doubt the St. Louis program had “saved lives statewide.” Opioid prescriptions dropped significantly once the county established the monitoring program. In 2016, Missouri had an average of 80.4 opioid prescriptions per 100 people; in 2019, it fell to 58.3 prescriptions, according to at the CDC.
The overall drug overdose death rate in Missouri has increased steadily since 2016, however, with the CDC Reports an initial tally of 1,921 people who died of overdoses of all kinds of drugs in 2020.
Khan recognized that a surveillance program can lead to an increase in overdose deaths in the years immediately following its inception, as people addicted to prescription opioids suddenly can no longer obtain them and instead buy more potent street drugs and containing impurities.
But he said a monitoring program can also help a doctor step in before someone becomes addicted. Doctors who report a patient using the surveillance program should then also be able to easily refer them for treatment, Khan and others said.
“We are absolutely unprepared for this in Missouri,” said Winograd of NoMODeaths. “Substance abuse treatment providers will often tell you that they are at full capacity. “
Uninsured people in rural areas may have to wait five weeks for inpatient or outpatient treatment at state-funded centers, according to PreventEd, a St. Louis-based nonprofit organization dedicated to reducing the harms of alcohol and drug use.
For example, the waiting list for residential treatment in Preferred family health care Clinic in Trenton typically lasts two weeks in the summer and one month in the winter, according to Melanie Tipton, who heads clinical services at the center that primarily serves uninsured clients in rural northern Missouri.
Tipton, who has worked at the clinic for 17 years, said that before the COVID-19 pandemic, people with opioid addiction mainly used prescription pills; now it’s mostly heroin and fentanyl because they’re cheaper. Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine, according to at the National Institute for Drug Abuse Control.
Still, Tipton said her clients continue to find providers who prescribe too many opiates, so she believes a statewide monitoring program could help.
Inez Davis, head of the diversion program for the St. Louis division of the Drug Enforcement Administration, also said in an email that the program would benefit Missouri and neighboring states because “drug buyers and those who commit Prescription frauds now have one less avenue.
Winograd said it was possible that if the state had more prescription opioid pill mills, the overdose death rate would be lower. “I don’t think that’s the answer,” she said. “We need to move in the direction of decriminalization and a regulated drug supply.” Specifically, she would prefer Missouri to decriminalize possession of small amounts of hard drugs, even heroin, and institute regulations to ensure the drugs are safe.
Rep. state Justin hill, a St. Charles Republican and former narcotics detective, opposed the surveillance program legislation over concerns about patient privacy and evidence that the absence of a program did not Missouri’s opioid problem worsened than many other states. He is also concerned that the surveillance program may lead to an increase in overdose deaths.
“I would love to see the people who passed this bill stick to the numbers,” Hill said. “And if we see more overdose deaths, drop the surveillance program and come back to the drawing board.”
This story was produced by KHN (Kaiser Health News), a major operational program of KFF (Kaiser Family Foundation). It has been reproduced with permission.