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Are Opioid Overdose Death Rates Actually Much Worse Than We Think?

Are Opioid Overdose Death Rates Actually Much Worse Than We Think?

Author: Justin Mckibben

It hasn’t even been one week since I wrote about the Center for Disease Control and Prevention (CDC) reporting opioid overdoses increased by 30% in only one year, and already a new story from The Washington Post suggests that these numbers are actually being highly undercounted! So in reality, the increase could be skewed by the fact that the real rates of overdose deaths are tragically misrepresented.

This new study reveals that the government has actually been undercounting opioid overdose deaths by anywhere between 20% and 35%!

So how is this happening? How much worse is the overdose outbreak?

A Closer Look at Coroner Reports

The reason the study says this underreporting is happening is due to how the current numbers are actually determined. In order to estimate national trends in opioid overdose and opioid-related death, the federal Centers for Disease Control and Prevention amasses data from over 3,000 coroner’s offices across the US.

However, the issue is that coroners function independently, so their available resources vary from case to case. The same goes for their reporting practices.

Christopher Ruhm, a professor at the University of Virginia, took a closer look at tracking trends and found that a lot of coroners do not specify the drug when documenting a fatal overdose. Ruhma states that from 1999-2015, of all fatal overdoses 23.1% did not have a drug specified on the death certificate.

The CDC cannot control local coroners, so it is the states and counties responsibility to improve their overdose reporting practices. If we want a more accurate reading of how opioids are harming a community, there has to be efficient documentation.

Unfortunately, the political incentives are not very supportive of accurate reporting. Officials may be concerned that by spending money on better overdose recording, they will have paid for the chance to look like their opioid problem is actually getting worse. The incentive just isn’t there from a political stance. However, that isn’t a good enough reason to botch the records. Communities still deserve to have a comprehensive idea of the issues they are facing.

Tracking Overdose Death Trends

The inference of coroners not including the drug in the report is that there are a lot more overdoses that do not get included in the official figures released at the federal level. There could be thousands of more deaths from opioids that go unaccounted for. To take a shot at tracking trends, Ruhm studied the records of coroners who did record specific drugs for overdose deaths. Based on this tracking, he was able to attribute a “corrected count” of opioid overdoses. In his report, Ruhm states:

“Corrected rates were obtained by using information from death certificate reports where at least one drug category was specified to impute involvement for cases where none was specified.”

There are many elements to how Ruhm came up with her corrections, and I encourage everyone to read the full analysis, which is published by the Society for the Study of Addiction (SSA). The report makes some pretty intense claims about what overdose deaths opioids should account for. For example in 1999 the CDC figures show:

Yet, Ruhm’s corrected count shows 1999 saw:

  • 10,232 overall opioid deaths
  • 3,421 synthetic opioid deaths

In 2015, the CDC figures say:

  • 33,091 overall opioid deaths
  • 19,884 synthetic opioid deaths

But Ruhms count pushes that up to:

  • 39,999 overall opioid deaths
  • 23,857 synthetic opioid deaths

Finally, when we look at the 2016 CDC figure, it said 42,249 opioid overdose deaths nationwide. But the corrected count figure puts 2016 at 49,562 opioid overdose deaths nationwide

What we can take away from Ruhm’s research is simply that the severity of the opioid crisis is being underestimated. From 1999-2015, Ruhm’s corrected counts for overdose deaths were 21% to 35% higher for all opioids. With corrected counts involving heroin and synthetic opioids were 20% to 30% higher.

So when we look at these stats, even if we leave some room for calculation errors, it is still a troubling thought. Since 2009, the leading cause of injury-related death in America has been drug overdoses. For years now, opioids have been public enemy number one concerning drug policy. Everything from prescription painkillers to synthetics being shipped halfway across the world has contributed to this crisis. If all we know about the true devastation of this epidemic is merely our best guess that still doesn’t take it all in, now is truly the time to urge officials and community leaders to take significant steps toward real, lifesaving solutions.

One of the most important resources that we need to take advantage of is providing safe and effective treatment to those who are struggling. Palm Partners Recovery Center has offered innovative and holistic treatment options for over two decades. If you or someone you love is struggling, please call toll-free now. We want to help.

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Opioid Crisis Continues to Get Worse: Overdoses Increase Nationwide

Opioid Crisis Continues to Get Worse: Overdoses Increase NationwideAuthor: Justin Mckibben

These days it is pretty much impossible to In case you missed it, the latest news concerning opioid overdoses in America is not good. Just this week a report was released by the Center for Disease Control and Prevention (CDC) that only reminds us of just how horrific the opioid epidemic is. In most of the country, this crisis continues to get worse.

While we still don’t have a complete picture of the death toll in 2017 concerning opioids, the most up-to-date data shows that overdoses have spiked nationwide. Examining reports from hospital emergency rooms, the report compares the overall increase in opioid overdoses from the third quarter of 2016 up until the third quarter of 2017.

According to this data, opioid overdoses to increase by 30% in only a year.

Rising Overdose Rates by Region

In every age group, with both men and women, opioid overdoses are increasing, according to CDC Director Anne Schuchat. The Midwest has been the hardest hit region in that 12 month period. According to the CDC report:

  • 7% increase in opioid overdoses in the Midwest
  • 3% increase in the West
  • 3% increase in the Northeast
  • 2% increase in the Southwest
  • 14% increase in the Southeast

All this may not come as much of a surprise for many Midwesterners. When you look at the last few years, the opioid crisis has not been kind to these communities. Of the counties with the highest overdose death rates per capita over the last few years, we consistently find some of the top spots going to states like West Virginia, Ohio, and Kentucky.

Needless to say, these devastating figures aren’t exclusive to the Midwest. A few more examples include:

  • 109% increase of opioid overdose in Wisconsin
  • 105% increase in Delaware
  • 6% increase in Pennsylvania
  • 34% increase in Maine

Luckily, not all areas are experiencing record highs. Some states are actually fortunate enough to see a slight decrease in overdoses, including:

  • Massachusetts
  • New Hampshire
  • Rhode Island

Even in Kentucky, which has been a Midwestern state hit pretty hard over the years, the CDC analysis saw a 15% drop.

The CDC report does not specify as to why certain regions are experiencing overdoses differently, but one factor experts say has most likely played a key role is the availability of more potent opioids. The synthetic opioid fentanyl has been making its way onto the streets more and more over the last couple years, and supply of drugs like fentanyl has increased much faster in certain areas, which probably has a lot to do with the difference in overdose rates per region.

Analyzing Opioid Crisis

The recent report was meant to take a closer look at the opioid crisis by analyzing overdose reports in emergency rooms instead of opioid deaths like the CDC had previously focused on. CDC Director Anne Schuchat said these numbers lag behind the emergency room reports, and that the agency wanted “more timely information” to work with.

The data utilized for this analysis came from:

  • Approximately 90 million emergency room visits
  • Reports from July 2016 to September 2017
  • 52 jurisdictions in 45 states
  • 142,577 suspected opioid overdoses

That survey found an increase of 29.7% in opioid overdoses. The research also analyzed:

  • 45 million emergency department visits
  • Reports from July 2016 to September 2017
  • 16 States
  • 119,198 suspected opioid overdoses

This analysis shows a 34.5% increase during the same period, but those increases vary drastically from state to state.

At the end of the day, there are a lot of opinions on how to look at this mountain of information and see a way through it. But many experts are convinced that so far we have been failing those who are suffering the most.  Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University, states:

“It is concerning that 20 years into this epidemic, it is still getting worse. The number of Americans experiencing opioid overdoses is still increasing.”

Jessica Hulsey Nickel, president and chief executive officer of the Addiction Policy Forum, is one of many voices who are advocating for a more compassionate and supportive system. Those like Nickel believe that the key element to changing the opioid crisis is better integration of addiction treatment into a more comprehensive and effective healthcare system. Some, including Nickel, believe even emergency room staff should be better prepared to help get follow-up addiction treatment for people with substance use disorder.

Addiction isn’t going away anytime soon, and perhaps one of the most tragic parts of the problem is that so many people never get the help they need. Too many are afraid to ask for help, and plenty more still don’t know how to get help. Providing safe and effective substance use disorder treatment isn’t just useful, but vital to our future. So taking advantage of these programs and supporting expanded access to addiction treatment should be at the forefront of the conversation if we hope to break this trend and save lives. If you or someone you love is suffering from substance abuse or addiction, please call toll-free now. You are not alone.

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Fentanyl in Philadelphia Causing Severe Overdose Spike

Fentanyl in Philadelphia Causing Severe Overdose Spike

Author: Justin Mckibben

In Philadelphia, there have been nearly 800 fentanyl overdoses this year.

According to figures released by the US Centers for Disease Control and Prevention (CDC) a sharp rise in drug overdose deaths, which many attribute in part to fentanyl, is causing a drop in American life expectancy.

As 2018 begins, many are afraid of what the future may bring concerning more deadly drugs reaching the streets, overdoses, and deaths. One area, in particular, is the streets of Philadelphia. Now, many in the area are pointing out that heroin is no longer the poison most popular on the illicit market. Fentanyl in Philadelphia is now the main ingredient in the drug problem.

How Fentanyl in Philadelphia is Changing the Scene

Patrick Trainor is a special agent with the Philadelphia division of the Drug Enforcement Administration (DEA). Trainor has kept an eye on the Kensington neighborhood for two decades. When talking about the drastic impact the lethal synthetic opioid has brought to the heroin market, he states,

“Fentanyl has drastically changed the landscape… Sixty-four percent of fatals in Philadelphia County are fentanyl-related. There’s no dope out here now, it’s all fentanyl. Even the old timers are scared of it.”

In areas like Emerald Street, AKA Emerald City, even drug users carry Narcan regularly.

Dangers and Death

Even addicts who are now content with using fentanyl are aware of the risks. But many say that compared to heroin, fentanyl’s rush is intense and immediate.

It is painful to use because it burns the vein. Some choose to chance the elevated risk of abscesses by injecting under the skin. This practice is said to reduce the risk of overdose and prolong the high. Yet, overdoses come almost instantaneously. Beyond that, the comedown of fentanyl is said to be abrupt, and the withdrawal period is a long and difficult one.

Tolerance for the drug builds quickly; dependence on the drug is rapid and pretty much unavoidable. Even those revived by Narcan can fall back into overdose due to the immense strength of the drug.

Dealers Choice

A lot of the issues related to fentanyl in Philadelphia can be connected to how it hit the street in the first place. According to interviews with drug users in the Kensington area, when fentanyl first started flooding the market the dealers didn’t know how to handle it, and the users didn’t even know about it. They had no idea about the risks of the drug, and overdoses were everywhere.

But then the dealers caught on when customers started dying all over, and so they changed the way they cut the drug in order to keep their consumers. Trainor himself notes,

 “You’re paying the same for something that’s roughly 100 times more powerful, so why would you buy heroin? The demand is for the most powerful thing they can get. Heroin will never be able to compete with fentanyl. It just can’t.”

There is no wonder why fentanyl in Philadelphia has become the dealers choice, the economics of fentanyl trafficking are easy to understand.

Unlike with heroin, there is no need to wait for the poppy harvest to start production. To yield a kilo of fentanyl, the chemicals one would need cost less than $5,000. At $55,000-$60,000 per kilo delivered, fentanyl is the about the same price as heroin but earns traffickers far more once it is cut and packaged for the street.

Each kilo of fentanyl can be cut out to approximately 330,000 doses, according to Trainor. A single kilo is enough to kill half of the counties residents.

Two factors make fentanyl in Philadelphia such a difficult drug to get ahead of:

  1. No dominant trafficker

With drug problems in the past, a substance coming into any area would probably be controlled by a single, relatively predictable trafficker or trafficking family, but not with fentanyl.

This incredibly powerful and potentially life-threatening drug is coming from China, ordered over the dark web, or coming up from Mexico. It isn’t being shipped in through the typical channels, and thus law enforcement has found it increasingly difficult to track.

  1. It is easy to modify

Fentanyl is a synthetic drug, therefore it is pretty simple to change the formula. Every time traffickers make subtle changes to the chemical ingredients of their batch, the DEA analysts struggle to adapt and catch on before the recipe has been changed again.

Trainor states:

“It used to be just fentanyl but now we’ve noticed eight different analogs in this area and around 40 nationally. Our chemists estimate there could be 200 additional variants.”

One of those variants is Carfentanil. This horrifically hazardous material is a painkiller… for elephants and other large mammals! It is estimated to be up to 10,000 times stronger than morphine. Carfentanil has shown up in other areas in the past, such as Cleveland, Ohio. It is still rare for street consumption, but it has shown up along with fentanyl in Philadelphia medical examiner’s office.

Over the past three years, fentanyl-related deaths across America have increased by 540%. According to the Journal of the American Medical Association, for the first time, the majority of fatal overdoses are fentanyl-related, accounting for nearly all the increases in drug overdose deaths from 2015 to 2016. Part of facing the ongoing opioid epidemic is providing effective and comprehensive addiction treatment opportunities. As more and more people die every day from these insidious substances we have to do all that we can to help fight back. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now. We want to help!

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How Fentanyl Trafficking Packages are Still Getting into the Country

How Fentanyl Trafficking Packages are Still Getting into the Country

Author: Justin Mckibben

Deaths due to drugs like fentanyl and other synthetic opioids continue to rise at a devastating pace in America. Despite the implementation of a special opioid commission to tackle the opioid crisis head-on, and even after the President of the United States issued a public health emergency concerning this ongoing issue, drugs like fentanyl are still finding their way into the country.

So how is it that these dangerous drugs are still getting across our borders?

Mailing Law Loophole

Much of the current flow of fentanyl into America is said to be connected to a major loophole in mail security. As it stands, every day up to one million packages overall get into the US without being screened.

Under the current laws, most international packages must include some general information, such as:

  • Information on the sender
  • The packages destination
  • Contents of the package

These seemingly simple details can, in fact, help authorities track and detect packages containing illicit substances. However, these are not bulletproof methods of detections.

A big part of the problem is a loophole that exists within our current system. According to Alex Wolff, of the bipartisan coalition Americans for Securing All Packages, 

“Due to a loophole in the global postal system, packages sent via private couriers (like UPS or FedEx) are required to have the advance electronic data used by law enforcement to screen and stop dangerous material, while packages shipped via foreign postal services are not.”

Wolff explains that when materials are sent through certain channels from outside the country, they are sent without the necessary security data that law enforcement agencies require in order to screen and stop dangerous packages.

Considering that fentanyl and other synthetic opioids are expected to be produced primarily in China, much of the drug is being shipped through this international loophole right into the United States. Thus, law enforcement is essentially flying blind in their efforts to catch a lot of the drug as it slips into the country.

The STOP Act

In an effort to put an end to this exploitation of the mailing system, the Synthetics Trafficking & Overdose Prevention (STOP) Act was introduced to the Senate and House of Representatives in February of 2017. It is currently listed as H.R. 1057, as introduced by Republican Representative Patrick J. Tiberi of Ohio. This bipartisan and bicameral legislation could be a huge step forward. Sponsors for the bill include:

  • Ohio Republican Senator Rob Portman
  • Wisconsin Republican Senator Ron Johnson
  • New Hampshire Republican Senator Kelly Ayotte

Each of these officials represents a state that has been hit hard by the opioid crisis. Surprisingly, almost a year later there has been no further action by Congress to pursue this bill.

Still, Alex Wolff remains optimistic that Congress will act soon to push the bill forward. Now the STOP Act also has the support of:

  • The National Council of State Legislators
  • Fraternal Order of Police
  • The American Medical Association

To clarify, there are a few other prominent “STOP” Acts in the past, including:

  • TheSober Truth on Preventing Underage Drinking Act (STOP Act) of 2006

This was America’s first comprehensive legislation on underage drinking.

  • The Strengthen Opioid Misuse Prevention (STOP) Act of 2017

This was a law for North Carolina aimed at curbing the misuse and abuse of opioids.

Putting a STOP to Fentanyl Shipping

Whether having tracking information on international packages seems like a big deal or not, most experts take it very seriously. According to former assistant secretary in the Department of Homeland Security Juliette Kayyem, who is a lecturer on international security at the Harvard Kennedy School,

“You have the demand problem, the public health problem of making sure people cannot be addicted, but on the supply-chain issue, one of the loopholes is clearly the postal system,”

True, not very many drug distributors write “fragile fentanyl shipment: Handle with care” on their postage. However, Kayyem says that collecting data from senders, even those who are less likely to be truthful is important for law enforcement to be able to stop drugs like fentanyl from coming into the country. Kayyem states that even if someone from another country is shipping things in and lies about what is in the package, that lie itself becomes a means to get them in the long run.

Should this bill be pushed into action? Is this enough, or should there be a way to impose even more strict regulations on international mailing to put a stop to the exploitation of the mailing system? Is this the best way to curb fentanyl use and overdose?

In the past few years, overdose deaths due to synthetic opioids like fentanyl have skyrocketed. Over 20,145 people died from synthetic opioids other than methadone in 2016. But the opioid crisis isn’t just about preventing the drug from coming into the US. We also need to support effective addiction treatment options. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now.

CALL NOW 1-800-951-6135

Overprescribing Opioids: Four Doctors Prescribe 6 Million Pills in 1 Year

Overprescribing Opioids: Four Doctors Prescribe 6 Million Pills in 1 Year

Author: Justin Mckibben

Despite the fact that over 91 people die every day from an overdose due to prescription drugs, some people still struggle to realize that prescription drug abuse is the driving force behind the current opioid epidemic. According to the American Society of Addiction Medicine (ASAM):

  • 4 out of 5 heroin users started out abusing prescription pain medication
  • 94% of people in treatment for opioid addiction surveyed in 2014 switched to heroin from prescription opioids.

One of the biggest issues is that powerful opioid painkillers are being overprescribed. Whether due to aggressive marketing tactics used by Big Pharma companies or the corrupt ‘pill mills’ where doctors were dishing out excessive prescriptions of potent drugs to be sold on the street, prescription opioids flooded the neighborhoods across the nation, helping create one of the worst addiction outbreaks in American history.

But it wasn’t just the fact that drugs were making it onto the streets. In general, even legitimate opioid prescriptions were astonishingly high. While too many people still think the only problem is heroin or street drugs, the facts show us that opioid painkillers were still largely overprescribed in recent years, which contributed to the current crisis.

Too ‘Legit’ to Quit

According to the National Survey on Drug Use and Health, nearly 92 million U.S. adults in 2015 were taking a legitimately prescribed opioid. That translates to 38% of the adult American population.

There were an estimated 240 million opioid prescriptions in 2015, nearly one for every adult in the general population. Even the Deputy Director of the U.S. National Institute on Drug Abuse, Dr. Wilson Compton, said,

“The proportion of adults who receive these medications in any year seemed startling to me”..”It’s an awful lot of people who take these, mostly for medical purposes, but within that, a significant percentage end up misusing them,”

So while a lot of these prescriptions were going to treating serious conditions, how many ended up on the street or being abused at home because they were overprescribed?

The same NSDUH survey found that 11.5 million people misused prescription opioids they obtained through illicit means. Overall, Dr. Compton states that these results indicate medical professionals are doing a poor job of appropriately prescribing these medications.

The trend didn’t end there. According to a new report, nearly 3 million people who had surgery in 2016 became persistent opioid users, taking the drugs 3-6 months after a procedure. The report also states that due to overprescribing, 3.3 billion pills were left unused by patients, which left them open for diversion or misuse.

Some pain management advocates insist that pain may end up being undertreated due to the rising scrutiny of opioid prescriptions.  Many of these advocates say it is extremely difficult to truly know if opioids are overprescribed because pain is too hard to objectively quantify. Therefore, some patients may actually need more relief resources than others.

Yet, prescribing rates are still, at the very least, questionably high. Especially considering by most estimates that over 50% of opioid pills legitimately prescribed are unused by patients, which suggests significant overprescribing certainly exists.

4 Doctors, 6 Million Pills, 1 Year

One recent case in particular that stands out concerning overprescribing of medications is the story of a small northwestern county in Arizona where 4 doctors prescribed nearly 6 million opioid pills in a 12 month period. The data provided by the Controlled Substances Prescription Monitoring Program did not list the doctors by name, but did give detailed information about the prescriptions.

Out of all 4, the top prescribing doctor is responsible for:

  • More than 20,000 opioid prescriptions
  • Equaling out to over 1.9 million pills
  • That comes to 7,350 pills a day

The second-place prescriber is responsible for:

  • More than 15,000 prescriptions
  • Equaling out to nearly 1.6 million pills

The other two doctors totally a combined 2.4 million pills prescribed.

The four doctors in question are located in Mohave County, which as of 2016 is home to approximately only 205,249 people. That comes out to about a 30 opioid supply for every single person in that county.

Now while pain may be hard to objectively quantify, these numbers are obviously unsettling. Even the executive director of the Arizona Board of Pharmacy, Kam Gandhi, could not explain why or how these four physicians were able to issue so many opioid pills.

A spokesperson for Attorney General Mark Brnovich declined to specify exactly what actions are being taken by his office concerning this development. However, according to AZ Central Doug Skvarla, who directs the Controlled Substances Prescription Monitoring Program, said that information has been passed on to Brnovich’s office for “an open investigation.”

Illicit Use of Prescriptions

There are plenty other issues with opioid prescriptions being taken advantage of all over the United States. Pain management advocates often argue that the problem isn’t about opioid prescriptions; it’s the people that misuse and divert the medications. In other words, that the people abusing opioids frequently don’t have a legitimate prescription. A lot of opioid pills being abused are obtained illicitly.

Many people won’t use their whole prescription. Many will actually give pills to a loved one who doesn’t have their own pain treatment. Or they will sell their remaining pills. Pill mills and ‘doctor shopping’ allowed for the even worse spread of excessive opioid prescriptions. Like in Illinois, where one individual received 73 prescriptions for opioid drugs from 11 different prescribers and filed them at 20 different pharmacies. In some cases, the individual filled prescriptions at multiple pharmacies in one day.

There is absolutely a high demand on the illegal drug market for prescription opioid painkillers. As a former addict who spent over 7 years using, buying and selling opioid medications on the street, I can say there is plenty of ways to get these drugs without a prescription.

However, if we back-track a little bit, how did so many potent medications get onto the streets if there is no overprescribing?

Feeling the Pain

Pain management is absolutely necessary. There must be resources and effective medications available for those suffering from serious medical conditions or recovering from life-altering procedures. There is no denying that we have to provide effective pain relief options for patients who desperately need it. So, of course, this is a difficult conversation to have, because many people can take these medications are directed and be fine when they are gone. Some people require long-term pain treatment, but it does not result in a severe addiction.

Still, the fact is that if these medications weren’t being prescribed more than medically necessary, they would have never flooded the underground drug marketplace as rapidly and as abundantly as they did. Between doctors overprescribing (sometimes for kickbacks), patients working the system and manipulating physicians, and the aggressive marketing tactics of Big Pharma going unchecked, there are plenty of elements at play.

Undoubtedly when we examine the opioid epidemic we cannot ignore any contribution. We have to make efforts to combat the spread of heroin addiction. There has to be an intensive effort to deal with the incredibly deadly synthetic opioids like fentanyl and carfentanil, and people also have to acknowledge their own choices and do their part to move forward. It might be a difficult and painful process, but it is necessary.

Still, overprescribing of opioid medications cannot be ignored. We should explore all options concerning prescription monitoring programs, enforce current regulations of drug distribution, and develop innovations in pain management therapy.

According to one report, even just a 10% reduction in surgery-related opioid prescribing would reduce:

  • The number of excess post-surgical pills available for diversion or misuse by 332 million
  • The annual number of patients who go on to persistent opioid use after surgery by 300,000
  • Annual drug costs by $830 million

Not only can we do better to treat those suffering from chronic and severe pain, but we can do better to make sure these potent and habit-forming medications don’t end up in the wrong place. For those who abuse prescription opioids, or who have found themselves using heroin, we need to provide safe and effective treatment options. Palm Partners Recovery Center has been treating people struggling with drug dependence and substance use disorder for decades, focusing on holistic and comprehensive care. If you or someone you love is struggling, please call toll-free now.

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