Nebraska ‘firing on all cyliders’ against opioid addiction, but concern remains focus of federal roundtable

October 30, 2018

The misuse of the potent painkilling opioids in rural Nebraska requires continued proactive attention, though fatal overdoses from the drugs aren’t as prevalent here as in other states, a USDA official said Tuesday.

Opioids are being prescribed at a higher rate here than the national average, said Karl Elmshauser, the USDA’s state director of rural development.

In 2015, prescribers here wrote 1.4 million opioid prescriptions, a rate of 72.8 prescriptions per 100 people, according to the National Institute on Drug Abuse. That compares to a national rate of 70 opioid prescriptions per 100 persons.

And a 2017 CDC report found the number of opioid-overdose deaths in rural parts of the U.S. had surpassed those in urban areas, which underscores the threat to largely rural states like Nebraska, Elmshaeuser said.

“For communities, addiction creates a safety issue on roads, lost productivity in jobs, increased health care demands and a greater need for more emergency response, law enforcement and judicial resources,” Elmshaeuser said during a rountable discussion with local officials at the Robert Denney Federal Building on Tuesday.

Health care and treatment providers, policymakers and law enforcement officers highlighted the progress made and recurring problems seen as the state continues to address an issue declared a national emergency.

Gage County hasn’t had a fatal opioid overdose this year, and meth is still the primary drug of concern there, said Gage County Sheriff’s Deputy Matt Ernst, who investigates drug cases.

But rescue crews there have used the opioid overdose-reversing drug Narcan 25 times in the last year, including in two cases where the drug revived people undergoing a heroin overdose.

The sheriff’s office there has urgently updated its training to identify overdoses, Ernst said.

But other local law enforcement might not have the level of training of police in Omaha or Lincoln, where more overdoses are reported.

In the first nine months of 2018, there have been 84 fatal and nonfatal drug overdoses in Lincoln, Lincoln Police Capt. Chris Peterson said. Forty-five overdoses were opioid-related, eight involved heroin and four involved fentanyl. The remaining overdoses involved methamphetamine, cocaine and other illicit drugs, he said.

Rural law enforcement officers take on fake-prescription cases, often for opioids, daily, said Nebraska State Patrol Investigator Tyler Kroenke.

Many of these cases involve forged paper prescriptions, often referred to as “fake scripts,” for opiates like hydrocodone or oxycodone, he said.

There are so many the State Patrol can’t always police each one, he said, but to address the problem, the agency has begun alerting pharmacies near where the fake scripts have been reported.

Adopting electronic-only prescribing could address the problem, but the costs of implementing the system in rural hospitals, clinics and pharmacies remains a challenge.

Already, the state has implemented a prescription-drug monitoring program that tracks all drugs a patient is taking, but prescribers aren’t required to check it before writing a new prescription.

And law enforcement officials say its impact on reducing doctor shopping might be limited near the state’s borders, because Nebraska’s monitoring program doesn’t share its information with surrounding states.

State Sen. John Kuehn of Heartwell and Kristen Stiffler, an aide to Sen. Merv Riepe of Ralston, said lawmakers may consider prescribing caps on opioids for adults in 2019 as a means of reducing the risk of people having leftover painkillers that could be diverted or abused.

Preventing addiction is the focus of lawmakers who are keen on reducing overdoses, they said.

But any caps would likely include exceptions for palliative care, cancer patients or other special prescribing circumstances, said Stiffler, who is legal counsel for the Legislature’s Health and Human Services Committee.

Kuehn said policymakers continue to move forward on opioid misuse, using the ongoing discussion in the medical, law enforcement and treatment communities.

“Here in Nebraska we’re firing on all cylinders,” Kuehn said.

Still, Nebraskans largely address addiction with punishment, rather than love and support, said Eric Thomalla, a Blue Valley Behavioral Health substance abuse counselor.

Waiting lists at residential treatment centers and costly care to curb addiction remain barriers to those looking to get sober, he said.

“What we see is all of our laws increase without any intervention,” Thomalla said.