The Tragic Toll from the Epidemic of Opiate Drug Use

This week, I had the privilege to participate in the Ohio 2012 Opiate Summit: Miles Traveled - Miles Ahead, hosted very ably by the Ohio Association of County Behavioral Health Authorities (OACBHA). The headline from this Summit is very clear: Ohio has an epidemic of non-medical use of prescription drugs, principally opiate painkillers, such as Vicodin and Oxycontin, both of which are extremely addictive; this problem has turned deadly from overdosing for many people, including the very young; Ohioans have joined together to craft essential solutions.

The Centers for Disease Control and Prevention (CDC) has characterized this problem as a “national epidemic.” In 2010, according to the federal Office of National Drug Control Policy (ONDCP), 478 million prescriptions were written for controlled substances; in the same year, an estimated 7 million persons engaged in non-medical use of these drugs.

In 2009, these persons accounted for more than 1.2 million emergency room visits, principally for drug overdosing, compared to slightly less than 1 million emergency visits for illicit drug use. In 2008, more than 28 thousand unintentional deaths occurred because of drug overdosing, about 10 persons per 100,000 population. Nationally, drug overdosing is now the number one cause of accidental death, even exceeding deaths from automobile accidents.

This problem is very tragic, and it is very costly. ONDCP estimates that the total national cost of non-medical use of prescription drugs was $55.7 billion in 2007, of which $24.7 billion was spent for direct health care costs.

The epidemic in Ohio has been developing for more than a decade, and accelerating for the past five years. Every day, four Ohioans die from a drug overdose--a tragedy that affects even the very young. It affects the poor in Southeastern Ohio, as well as those who live in the more affluent areas surrounding Columbus. Compared to the US, more than 1 of every 20 deaths due to drug overdosing occurs in Ohio.

Two principal factors drive this epidemic: very permissive prescription practices and broad availability of these opiates. The "pill mills" issue extremely large numbers of opiate prescriptions for pain; emergency rooms issue them freely; and primary care physicians issue them on request. The net effect is that huge numbers of these pills are available everywhere, from local drug dealers to the family medicine cabinet. In a national collection effort conducted last Saturday, more than 276 tons of prescription drugs were turned in voluntarily at local sites! 

At the Summit, Ohio demonstrated that it can lead the way out of this epidemic. All Ohio State offices are collaborating together to seek and implement solutions, from the Office of the Governor, to the State Attorney General, to the Ohio Highway Patrol, to the  State health and rehabilitation agencies. The Summit brought these entities together with county and local program officials, community health advocates, and persons recovering from substance use to identify key next steps in combating the epidemic.

The drivers of this epidemic also point to the solutions: we must reduce the availability of opiate medications, and we must reduce their use. The pill mills must be closed, and physicians must be educated to prescribe non-opiate painkillers. Families must be educated about the importance of a locked medicine cabinet to keep these drugs out of the reach of young children and teens. Prevention education programs must be expanded.

The ultimate tragedy is that these deaths and these severe addictions are entirely preventable. To combat this problem nationally, we must examine and improve our laws and regulations governing the prescription of opiate painkillers. We also must reform our training practices for physicians, so that they appreciate fully the dire effects of these drugs, as well as the availability and effectiveness of appropriate alternatives.

Our national prevention efforts around the non-medical used of prescription drugs must be strengthened and expanded. We must develop and implement specific prevention interventions for our schools, our families, and our communities. The Center for Substance Abuse Prevention at SAMHSA has been forging new paths that show considerable promise in promoting resilience. These efforts must be tested, refined, and implemented broadly. Public health approaches can be employed usefully to multiply the impact of person-level efforts.

Our hats are off to Cheri Walters, the OACBHA Executive Director, and Suzanne Dulaney, the Deputy Executive Director, for their vision and leadership in hosting this landmark Summit. Their work will have important salutary effects not only in Ohio, but nationally as well. We salute them.