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The Opioid Epidemic and State Responses

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August 17th, 2017

According to the National Institute on Drug Abuse and the CDC, in 2015 over 33,000 people died from opioid overdose in the United States, and in 2013 prescription opioid abuse cost the U.S. economy approximately $78.5 billion in costs related to health care, crime, and loss of productivity. Opioid abuse and the related overdose deaths are harming individuals, families, the health care field, the economy, and society as a whole. With the opioid epidemic growing at a rapid pace, President Trump formed The President’s Commission on Combating Drug Addiction and the Opioid Crisis. The commission recently published an interim report that outlined the current status of the opioid crisis in the United States, issued recommendations for the President, and called upon President Trump to declare it a national emergency, which he subsequently did. Additionally, many states have been implementing plans to address the opioid crisis. Some states have even started to place limits on the number of opioid painkillers that doctors can prescribe. West Virginia and Ohio, two of the states with the highest opioid overdose death rates, have been investing in reversing their current growth of opioid abuse and subsequent death.

West Virginia

West Virginia has the highest rate of opioid related overdose deaths, and drug overdose is the top cause of death for people under the age of 45 in the state. Since 2015, West Virginia has sought to address the opioid epidemic through various pieces of legislation, including:

  • West Virginia Code 16-47-4: Also known as the “911 Good Samaritan” law, this legislation protects witnesses of an overdose from arrest when they call 911.
  • West Virginia Code 16-46-3a: Allows pharmacists to dispense and provide education about naloxone.
  • HB 2195: Requires the implementation of opioid prevention/awareness programs into school curriculum.
  • HB 4347: Prioritizes substance abuse treatment for pregnant women.

Collectively, the enactment of West Virginia Codes 16-46-3a and 16-47-4 have been associated with more 911 overdose calls and fewer overdose deaths. The legislature is currently considering other bills to help fight the opioid epidemic. West Virginia also applied for a Medicaid waiver to specifically address substance abuse disorder and decided to use $24 million from their settlement with opioid distributors to expand the availability of treatment for people struggling with addictions.

Huntington, a small city in West Virginia, has been hit hard by the opioid epidemic. According to Pew Charitable Trusts, Huntington’s overdose death rate is 10 times the national rate, which has prompted the city to make several changes to combat the crisis and reduce its harmful effects. In 2014 Huntington opened an Office of Drug Control Policy that coordinates with a coalition of law enforcement, public health leaders, first responders, and local groups to combat opioids. Huntington has emphasized harm reduction by opening the first needle exchange in the state, a center for weaning babies off drugs, and a school program for children with parents who have been arrested for drugs. They are also training drug users how to administer naloxone to prevent overdose deaths. Finally, Huntington has been trying to send drug users to treatment instead of jail. Recovery Point, a 100-bed facility, has a long-term recovery program with a 68 percent sobriety rate for graduates one-year post-program.

Ohio

Although West Virginia has the highest opioid overdose death rate in the U.S., Ohio is not far behind. According to the Ohio Department of Health, Ohio had 3050 overdose deaths in 2015, which gave it the 3rd highest rate of overdose deaths in the U.S. Thus, Ohio has been taking legislative steps to combat the opioid epidemic. Governor Kasich established the Governor’s Cabinet Opiate Action Team (GCOAT) in 2011. Five of the areas that GCOAT has  focused on are: (1) decreasing drug trafficking through law enforcement; (2) preventing youth from using drugs through education programs; (3) ensuring pain medication is available and used appropriately by improving prescribing guidelines, utilizing the Ohio Automated Rx Reporting System (OARRS), decreasing the amount of drugs prescribed, and setting up a drug take back program; (4) helping people get treatment and recover by investing millions of dollars into research and treatment programs; and (5) expanding access to naloxone through Project DAWN and legislation. Additionally, Ohio has spearheaded an Ohio Opioid Technology Challenge. Thus far, 44 organizations, including universities, hospitals, pharmaceutical organizations, and medical device companies, have submitted project proposals to apply for grant funding to create innovative solutions to the opioid crisis.

Although it is too early to determine if long-term success against opioids in Ohio will be achieved, the state is seeing some promising results since the formation of GCOAT in 2011. First, the number of opioid doses dispensed in Ohio have decreased from 782 million in 2011 to 701 million in 2015. Second, prescriber queries of OARRS increased by 9.5 million between 2011 and 2015. Finally, the number of people receiving a prescription from five or more clinicians within one month decreased from 2,205 individuals in 2011 to 720 in 2015.

Other states have also found some success through initiatives like the prescription drug monitoring program (PDMP), which has helped New York and Tennessee decrease the number of individuals seeing multiple providers for prescriptions by 75 percent and 36 percent, respectively. There is no single way to battle the opioid epidemic, but West Virginia and Ohio have demonstrated several key factors that can be applied in other states:

  1. Involve multiple stakeholders in the policy development and decision-making processes to improve the quantity and quality of ideas.
  2. Partner with law enforcement efforts, as it cannot tackle the issue alone.
  3. Invest in prevention and treatment.
  4. Expand access to naloxone to decrease overdose deaths.
  5. Don’t quit; fighting addictions is not easy for an individual or society, but that does not mean states should give up.

By combatting the opioid epidemic, states can improve the health and safety of their citizens and help health care systems focus resources on other aspects of health.

To read more about opioid prescribing practices, visit Opioid Prescribing Practices of Primary Care Physicians and Opioid Prescribing Patterns Among Medicare Beneficiaries by State.

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