Currently, Alabama tops all other states in prescribing painkillers, with an average of 143 painkiller prescriptions per 100 people, according to the Centers for Disease Control and Prevention. “Alabama craves opiates,” says Danny Molloy with the Addiction Prevention Coalition in Birmingham.
Right now, heroin—an opiate—rules Birmingham’s streets. Deaths from heroin overdose in Jefferson County skyrocketed from just 12 in 2010 to 123 in 2014. In 2015, the heroin death toll dropped to 97. But death from opiates overall, including heroin, climbed to 138.
“That’s important to know because fentanyl is in our heroin drug stream now,” Morris says. “Fentanyl, a prescription synthetic opiate analgesic, is being used to cut heroin because the drug cartels want to make the best drug out there, and fentanyl is 30 to 50 times more potent than heroin.”
Molloy says the medical community can make an impact on the opiate crisis in Birmingham by focusing on problems with prescription drugs. In just one year, local deaths from prescription opiates more than doubled, from 32 in 2014 to 74 last year.
Pill mills, where doctors are hired to write prescriptions for dealers to sell on the street, may be common knowledge among physicians. Even “doc shopping” may be on the radar of most practices, where patients move from one doctor to the next, claiming symptoms that may score them a prescription. But physicians may not be paying enough attention to painkillers and teens.
“A lot of heroin use starts from a child using prescription narcotics,” says Sandor Cheka, executive director of the Addiction Prevention Coalition. Teens playing sports get injured and are prescribed a painkiller. “That becomes a release for them,” he says. “That narcotic translates to escaping their reality, particularly when their identity is tied to a sport that they might no longer be able to play.”
The teens often think that painkillers are safe because they have been prescribed. And parents may not understand the potency. “15 years ago, I was prescribed 200 mg of Advil when I had a soccer injury,” Molloy says. “Now we’re prescribing these children Vicodin and Lortab, both opioid-based narcotics.”
“The problem is that you’re priming the pump, especially with children under 18,” Cheka says. A 14-year-old has a 47 percent likelihood of becoming an addict if given a narcotic. If addiction runs in the family, that shoots to 70 percent. “You’re now giving a 14-year-old a 50/50 shot of being an addict,” Cheka says. “We do need to give medication, but we should investigate what we give and how it’s prescribed.”
According to the national Pride Survey of high school students asking about their non-medical use of drugs, almost one-third will use a prescription opiate drug that year. “Over 60 percent of children who start opiates get the drug originally from friends or family,” Molloy says.
“We need a conversation about pain management at the doctor level,” Cheka says. He would like to see one-week prescriptions for pain medications instead of the more common four weeks. “It only takes 21 days of a chemical in the body for you to become dependent on it. And ironically, the first sign of withdraw for opiates is lower-back pain, which is what a lot of people are being prescribed narcotics for.”
Emergency rooms are a prime source of opiate prescriptions. In Wilkes County, North Carolina, the community began what they called Project Lazarus. Along with other measures, Cheka says ERs and urgent care physicians in the county began prescribing only two to five days of opiate pain medications. After that, the prescription had to come from a primary care physician. “It was a triple-figure percentage reduction,” Cheka says. “They went from the county with the highest number of overdose deaths in the state to the smallest in a year-and-a-half.”
It helped to put the Wilkes County primary care physicians in the loop. 70 percent of the county’s prescribers were registered with the state’s prescription drug monitoring program, compared to a statewide average of only 26 percent three years before.
Alabama also has a prescription drug monitoring program (PDMP). “The problem is that not all doctors have to use it,” Molloy says. “It’s available, but not being used.” The system would alert physicians if a patient had been prescribed the same or a similar drug in the last 30 days. It’s not connected to any EHR systems, requiring a separate log-in and search.
Cheka says the number of drug opiate deaths in Birmingham should be a wakeup call. “The medical community is part of the pathway to heroin,” he says. “What are we doing and what can we do better? Some prescriptions are valid and we need them. But even a 60-year-old with a hip replacement needs their drug usage watched. Are we monitoring them or just writing scripts?”
