Panel takes on opioid addiction epidemic

April 16, 2018 GMT

Nebraska has made great strides addressing opioid abuse, but there’s always more that can be done, including on the education front.

That was the message of a panel discussion about the opioid epidemic Friday at the YWCA of Adams County. The event was sponsored by the Hastings League of Women Voters.

Panelists were District 38 state Sen. John L. Kuehn of Heartwell; Max Owens, pharmacy manager at Walgreen’s; and Michele Bever, executive director of the South Heartland District Health Department.

Kuehn said the federal response focuses on access to treatment.

“Here in Nebraska, we’re taking a little bit more aggressive of an approach,” he said. “My legislative partners and I, as we sat down and talked about the epidemic, we decided to do what other states have not been able to get through in large part because of opposition from the medical community.”

All three bills had opposition from the medical community in Nebraska.

The Nebraska Legislature decided it was a priority for the state, Kuehn said.

“Eventually, all the medical associations came along,” he said.

Bever said Nebraska’s Prescription Drug Monitoring Program is one of the best in the country. She said it is an effective tool that is used to make a more informed decision for patient care. As of Jan. 1, Nebraska was the first state to require reporting of all dispensed prescription drugs to the PDMP.

Adding all dispensed prescriptions to the PDMP makes it a comprehensive tool. Providers can now see this additional information in the patient’s medication history, making activities like medication review more convenient.

Bever and Kuehn talked about LB931, LB933 and LB934 from the 2018 Nebraska legislative session. All three bills address opioid abuse.

LB931 creates a seven-day duration cap on a prescription for an opiate issued to a person younger than 19 years of age. LB933 requires health practitioners to discuss with patients risks of addiction and overdose when prescribing opiates. LB934 requires customers to display identification to receive prescribed opiates.

Kuehn introduced LB934.

“These are good, forward-thinking legislative actions to help us deal with this problem in Nebraska,” Bever said.

She presented statistics about drug abuse.

In 2016, 128 people in Nebraska died of a drug overdose, and at least 38 of those deaths were opioid-related. In 2015, 149 people died of a drug overdose and at least 54 of those deaths were opioid-related.

Nebraska’s drug overdose death rate has increased over the last decade — 6.9 overdose deaths for every 100,000 people in 2016, up from 3.6 in 2004. The U.S. drug overdose death rate per 100,000 people was 16.3 in 2015, up from 9.3 in 2004.

“It may not seem huge, but it’s impacting people,” she said. “So we need to pay attention to that.”

Kuehn said until 2016 Nebraska did not have a database documenting opioid prescriptions. Until then, Nebraska had been the only state not to require mandatory recording of prescription opiates.

Nebraska was the first state to comprehensively include veterinarians in mandatory reporting.

“That had a little bit of political push-back, but it’s been a really interesting phenomenon over the last two years,” Kuehn said.

As a veterinarian himself, Kuehn has had his truck broken into and had Oxytocin stolen by thieves who thought they were taking Oxycontin, an opioid.

Oxytocin makes the uterus contract.

“So if you’re looking for a fix and inject Oxytocin there is a very unpleasant side effect that is going to happen,” he said.

Pain was added by the medical community in the 1990s as a fifth vital sign, in addition to blood pressure, heart rate, respiratory rate and temperature.

Unlike the other four vital signs, there is not an objective measurement for pain.

This led to what Kuehn called a “really aggressive” prescription of opioid medication for pain.

“That’s where this addiction for so many begins,” he said. “In this rush to combat pain among patients, we have seen a lot of behaviors adopted that defy knowledge.”

He recalled a friend who, after having a cap placed on one of her teeth, received a seven-day prescription of opioids from her dentist to be taken four times a day.

“People are filling these prescriptions, they’re leaving the bottles on the shelf in the medicine cabinet, kids are obtaining them,” he said.

Now, however, the emphasis on treating pain is beginning to change, he said.

Naloxone can reverse the effects of an overdose but only lasts 30-90 minutes.

Kuehn said a bill set for passage in the Legislature next week will allow rural first responders to legally administer Naloxone.

Owens said Naloxone is available at Walgreens as a nasal spray. It has no effect on someone who is not experiencing an opioid overdose.

He said the cost of Naloxone is covered by many health insurance plans.

He estimated the out-of-pocket cost is more than $100, but he thought vouchers were available online to bring the cost down to around $70.

Owens also addressed disposing of old, unused medication.

While medication take-back events are useful, he said, people often are left waiting, with old medication sitting around, for the next medication take-back event.

“It creates a threat of having these medications end up in the wrong hands,” he said.

Pharmacies have receptacles that can take medication. Opioids cannot can’t be accepted unless the pharmacy has a locked metal receptacle.

When taking back medication, pharmacies do not allow needles. The medication must be in the original container, and any liquids should be 4 ounces or less and sealed in plastic bags.

On Friday, Owens handed out take-back bags, which are available for free in all pharmacies in Hastings, that can be filled and mailed for free to be disposed.

Owens said when take-back isn’t an option, the Federal Drug Administration recommends certain medication such as pain medication and pain patches should be flushed because of the immediate threat if it is obtained by a child or other user.

He said the FDA has studied 15 different medications and found negligible environmental effects when the medication is flushed.

Another option is to mix the medication with an unusable substances such as kitty litter or coffee grounds.