Curry County is the top opioid prescribing county in Oregon at 1,800 morphine milligram equivalents per person, putting it at 74th of the 3,142 counties, parishes and boroughs in the U.S., according to a report cited by the Oregonian.
Morphine milligram equivalents roughly equate opioid doses to the drug morphine because it is considered the original opioid. Drugs derived from morphine include oxycodone, codeine and fentany, according to the Centers for Disease Control and Prevention (CDC).
And although the prescription rate is dropping, Oregon leads the country in seniors who are hospitalized for opioid abuse, dependence, overdose and adverse effects.
At a recent meeting, Curry County commissioners discussed whether to join other entities in a multi-district lawsuit against opioid manufacturers.
Numerous suits are proposed across the U.S. The suits seek damages, alleging the companies misled regulators, health care professionals and the public about the harmful and addictive nature of opioids and helped create a national epidemic, according to County Attorney John Huttl.
Advanced Health (AH) Prescription Drug Overdose Prevention Coordinator Kate Frame presented an informational meeting about opioid use, abuse and treatment July 25 at the Chetco Community Public Library.
In her report, Frame, who is working with a Substance Abuse and Mental Health Services Administration, said she will gather data over the next two years to target opioid use and abuse in Coos and Curry counties. She will also expand treatment options, decreasing prescription rates and increasing interagency communication.
Specifically, the grant aims to increase education and data sharing, connect partners with resources, raise awareness, increase communication, increase and support community prevention and opioid harm reduction efforts and align efforts with resources to increase the county’s capacity to address the opioid problem.
What we know
Opioid users develop opioid use disorder (OUD) which has a long term recovery period like alcohol addiction. Like recovering alcoholics, people with OUD sometimes relapse, according to Frame.
She said they are unable to benefit from traditional therapies because the withdraw is too intense. They must be weaned off opioids to recover and then can address the causes for their addiction.
Medically assisted treatment (MAT) currently is the best alternative for treatment of opioid addiction, Frame said, and usually includes a daily dose of methadone. Methadone allows medical specialists to wean those suffering from OUD off opiods and avoid relapses due to withdrawal symptoms.
“MAT is gold standard of opioid addiction therapies and has better results than in-patient rehabilitation or recovery,” she added. “For Coos and Curry counties, increasing access to MAT is the number one priority.”
However, federal laws states MAT must be administered by a medical professional who is X-waivered or legally allowed to administer opioids to addicts. They must obtain a waiver from the Drug Enforcement Administration.
Frame’s report indicated only two people in Curry County are x-waivered, and she was unsure if either was currently administering MAT to patients.
“People don’t want to be doing this all alone,” she said. “No one wants to deal with a whole county’s problem alone.”
She recommended a hub-and-spoke model in which providers are centrally located for original treatments and then professionals in communities work to support the extension of those treatments locally.
“If we don’t have MAT out in the communities,” Frame said, “sometimes people who often have jobs and families have to travel an hour or more every day to get one pill, and that’s not realistic.”
AllCare’s Georgia Nowlin said, “We are not like West Virginia yet, but we do have the highest opioid prescribing rate in the state for people over 55 years old.”
West Virginia could be considered the epicenter of the national opioid crisis because it has the highest rate of drug overdose deaths in the entire country, according to the Centers for Disease Control and Prevention.
Ohio also has an overwhelming problem with opioids, according to reporting by CBS.
“We know opioids are being used here to a great degree,” Frame said. “We know that this is happening here but not why.”
To avoid increased opioid use, Frame said she wants to align efforts and make incremental steps to put money into proper initiatives.
Chetco Library Director Julie Retherford suggested Frame use the library directors throughout the county to collect information and to disseminate it.
“We are interconnected and we know what is going on in our communities,” she said.
Retherford recently relocated to Brookings from Ohio, where she said the libraries kept Narcan — a brand named dose of naloxone — on site, and librarians were trained how to use it.
Naloxone reverses the effects of opioids and often saves victims of an overdose.
Ben Cannon of Curry Community Health said Cal–Ore emergency vehicles and Brookings and Gold Beach police vehicles carry naloxone.
Curry County Sheriff John Ward said deputy’s vehicles carry it as well, and the jail has it on hand.
Failures of the system
Frame noted overdose (OD) data for death and overdoses related to opioids is weak in both counties and in Coos county, the medical examiner cannot do toxicology reports, so suspected overdose bodies are sent to Central Point with two police officers who have to wait for the body and bring it back.
The medical examiner for Curry County is in Medford, according to Ward, but there are local Deputy Medical Examiners appointed by the district attorney (DA).
“We go to unattended deaths, investigate and provide DA with findings,” Ward said. “The DA will then authorize the release or not to mortuary. If suspicious, the major-crime team gets called and the DA will the request an autopsy from our county medical examiner.”
When Dr. Chris Amsden asked if data showed how many hospital overdose deaths were from diverted prescriptions, Frame said, “That data doesn’t exist for Coos or Curry county.”
Diverted drugs are those used by someone other than the person for whom they were prescribed.
Amsden noted the focus on supply often scares doctors away from prescribing opioids when they are necessary for pain management, and that might be pushing people into purchasing diverted drugs or other street drugs for pain.
“So what else can we do without focusing all of the attention on the supply, on doctors?” he asked.
Frame said her research should allow a multifaceted approach including suppliers, law enforcement, and health care providers to work together with goals of decreasing opioid prescriptions, keeping the opiate naïve unaware of the drugs, using MAT along with behavioral health and community supports for treatment, and overdose and infection prevention.
•Maximizing the availability of naloxone for overdose prevention
— It immediately reverses an overdose
— Anyone with an opioid prescription, or who has a loved one with a prescription, should have it
— It is available at any pharmacy and you don’t need a prescription
— It is covered by most insurance, and free for people on Medicaid.
•Use local services including the HIV Alliance-Naloxone, HIV and Hep-C testing, and Needle Exchange in Brookings on the fourth Wednesday of every month, 11 a.m.-4 p.m. at Curry Community Health.
•Safe disposal of medications at medication disposal drop boxes at Brookings, Gold Beach and Curry County Sheriff’s departments, and Corner Drug in Gold Beach.
•South Coast Overdose Prevention Facebook page;
•Advanced Health Vimeo Channel: vimeo.com/advancedhealthcco;
•Contact Kate Frame: firstname.lastname@example.org .
Frame concluded by saying those with OUD are not “those people,” not the stereotypes we often see on TV or hear in the community.
“They are us,” she said. “People living in our communities, working and raising kids.”
Reach Boyd C. Allen at email@example.com .s