Taking on Opioids

Photos by BRITTANY JORAE’ PUSCH-ZUNIGA

The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice.

While the “Opioid Crisis” has taken center stage on a national scale, the impact on Kansas is not as dramatic. In 2015, there were only 150 deaths related to opioid misuse. However, the Kansas Bureau of Investigation saw heroin importation increase 36 percent in that same year.

Topeka may also be ahead of the curve when it comes to opioid misuse prevention. With pharmacies using a statewide prescription drug tracking system, local physicians working to set opioid prescribing and monitoring protocols, and addiction treatment facilities providing programs to keep people drug free, Topeka is taking opioids head on.

The State’s Perspective

The State of Kansas implemented its K-TRACS system in 2011 to minimize prescription drug misuse. This prescription drug monitoring program provides a database of controlled substance prescriptions that have been dispensed by Kansas pharmacies.

The program requires pharmacists to document prescription dispensing data on every written controlled substance prescription and allows both prescribers and pharmacists to check prescription histories to determine, in advance, if patients are acquiring drugs from multiple prescribers or pharmacies. In 2017, there were approximately 8,300 prescribers and 2,700 pharmacists using K-TRACS in Kansas. In addition, K-TRACS is now being integrated into Electronic Health Records (EHR) and pharmacy management systems.

The Prescriber’s Perspective Dr. Eric Voth, vice president of primary care at Stormont Vail Health, has spent his entire career helping people manage pain. While he is concerned about the rising opioid abuse statistics, he is even more concerned that the fervor to crack down on opioid pain reliever prescriptions might result in patients with legitimate pain control management issues not having access to the medication they need.

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“Opioid abuse is a serious problem,” Voth said. “However, the solution has to be more involved than just eliminating these types of prescription pain killers. Many people with chronic pain rely on this type of medication to simply function each day.”

That is why he chairs the Opioid Stewardship Committee that works to develop standards and policy for prescription medication at Stormont Vail Health and is also collaborating with the Centers for Disease Control on establishing national protocols for prescribing and monitoring opioid use.

These policies include following a hierarchy of pain management options that begin with analyzing the history of the patient and signs of addictive behavior; addressing the severity and longevity of the pain; and determining optimal medication options following a predetermined pharmacological ladder. If narcotics are warranted, the quantity of opiates prescribed for acute pain are limited and strict monitoring of the frequency of prescription refills is required. For example, Voth says, emergency room patients at Stormont Vail are limited to a 7-day supply of opioid pain medication for an acute injury.

“One mistake we as doctors have made is prescribing more pills than a patient may use,” Voth said. “Then those narcotics get stored in someone’s medicine cabinet, where it is easy access for adolescents to find and abuse.”

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Voth says he hopes the implementation of clear policies regarding opiate prescriptions will help not only the patients, but also the prescribing doctors.

“Health care providers are expected to be policemen,” Voth said. “That can fly in the face of pain management. That is why having specific policies in place takes some of the regulatory burden off of the doctor.” Voth supports the efforts to prevent prescription opioid abuse both locally and nationwide, but he says the problem is bigger than prescription medicine.

“One major intervention is working societally on drug abuse,” Voth said. “Most people who abuse prescription opiates have already been addicted to other things.”

The Pharmacist’s Perspective While many believe that monitoring of prescription drug use lies with the prescribing physician, it actually makes more sense that it falls to the responsibility of entity dispensing the medication—the pharmacist.It used to be that the local pharmacist maintained a personal connection with customers who filled prescriptions. They knew about their customers’ health history, ongoing problems, and the different medications needed. Pharmacists would help patients determine if they were taking their medication properly and could address signs of misuse before they became a risk. That was before big box pharmacies came onto the scene.

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Now, with a pharmacy on practically every corner, customers no longer maintain a relationship with their pharmacist. Often times, they fill prescriptions at random locations depending on convenience. Mike Conlin, owner of Jayhawk Pharmacy and Patient Supply, says the loss of these relationships has contributed significantly to prescription drug misuse.

“Narcotics have been the standard in pain for a very long time,” Conlin said. “The only thing that has really changed is the massive amount of advertising and marketing for pharmaceuticals and the large chain pharmacies.”

Conlin says he is in favor of stricter regulations and guidelines for prescription pain medications but says sometimes those third-party decision makers don’t have the best perspective about a patient’s needs.

“I personally think that here, locally, opioids are under control,” he said. “The word ‘crisis’ just causes people to be a little more concerned, but compared to other states, we are doing pretty good.”

In 2016, there were 146 opioid-related overdose deaths in Kansas—a rate of 5.1 deaths per 100,000 persons—compared to the national rate of 13.3 deaths per 100,000. Since 2012, the number of deaths related to synthetic opioids and prescription opioids has slowly decreased. According to the Centers for Disease Control, 82 to 95 opioid prescriptions are written per 100 people in Kansas. Other states, primarily in the east but also including Oklahoma, range 96 to 143 prescriptions per 100 people.

This decline is likely a result of the prescription tracking system, K-TRACS, put in place by the State of Kansas.

“Missouri doesn’t have a statewide tracking system,” Conlin said. “Without the type of communication we have here between doctors and pharmacies, the numbers in Missouri are drastically different than they are in Kansas.”

While K-TRACS has cut down on the abuse of prescription opiates in Kansas, it hasn’t stopped it entirely, and addiction is still a problem for many local residents.

The Treatment Center’s Perspective For those who do suffer from addiction, treatment centers such as Valeo Behavioral Health Care in Topeka can literally mean the difference between life and death. Valeo provides a full range of substance abuse treatment services for adults:

— - Assessment —-  Social detoxification — - Inpatient treatment — - Reintegration — - Intensive outpatient treatment — - Continuing care — - Drug testing — Homeless outreach — - Jail treatment program

Brad Sloan, detox manager at Valeo Behavioral Health, says addiction has always been an issue. It is simply the drug of choice that changes. A few years ago, the emphasis was on heroine. Today it is more about prescription opiates.

The problem, according to Sloan, is that we can’t just ban opioids because they are the standard for pain management.

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“These are good medications that do what they are designed to do—reduce pain,” Sloan said. “However, sometimes when people use these medications over long periods of time, they can become dependent on them. And that dependence can lead to addictive behavior.”

Sloan says that once the focus shifts from pain management to a searchfor euphoria, it becomesan addiction. And, oncethe addiction takes hold, it isn’t that big of a jump from prescription pain medicine to heroine.

“People will find a way to get that euphoric feeling they crave,” Sloan said. “It is really an ‘obsession of the mind’ that will keep the body in a place where it thinks it needs to drug to survive.”

Cathy Walker, director of Valeo Recovery Center, says one of the primary reasons opioid addiction is so hard to combat is because of the physical discomfort involved with detoxification.

“When patients go through withdrawal, they actually feel like they are going to die,” Walker said. “For five to seven days, it feels like the worst flu you have ever experienced.”

That is why a tapered approach to detoxification is the best approach for many people suffering from substance use disorders.

That is where Valeo comes in—beginning with safe, medically controlled detox programs and providing longer term inpatient treatment options, followed with ongoing after care to prevent relapses.

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Part of those after care service include connecting patients up with community services to help them stay clean for the long term.

Patrick Eldringhoff, addiction case manager, helps recovering addicts find safe housing in a clean environment to help provide stability. He finds employment referrals, connects them with career counseling and educational services to put them on the road to success.

“I help people discover their dreams and the put them on a path to making those dreams come true,” Eldringhoff said. “In my own experience, when I had those long-term goals in place, it made my recovery tangible. I want to do that for others.”

Eldringhoff is also part of the homeless outreach team that goes out to communities to bring food, clothing and blankets. He says he always goes out with the hope that someone will seek help as a result.

“Whenever Patrick goes out, we place a detox bed on hold, just in case he finds someone who wants to use our services here at Valeo,” Walker said.

The key piece to helping people recover from addiction, Sloan says, is to build relationships and trust so that they understand people really want to help them succeed.

“All it takes is a moment of clarity and someone there willing to help them,” Sloan said. “We are here to walk alongside and facilitate recovery in that moment. That is really what it all comes down to.”

While opioid misuse may not be at crisis level locally, people and businesses are taking an active role to ensure it never reaches that point. Doctors, pharmacists, regulatory agencies, volunteer committees and treatment facilities in Topeka are working toward a common goal: minimizing substance abuse.