Opioids Pose Huge Public Health Threat with No Easy Answer
May 01, 2018
Rural or urban areas, rich or poor people – the opioid problem is hitting America hard. According to the Centers for Disease Control (CDC), opioids are the cause of three out of five drug overdose deaths in the U.S. among adult males and females of all races and age ranges. Nationally, opioid overdose deaths have become such a problem, the epidemic of opioid use/abuse has been declared a public health emergency by the current Administration.
Although anyone can succumb to death by abusing opioids, the most common users of prescription opioids, according to the CDC, are adult females 40 years of age and older. Abusers don’t always get their opioids from a doctor – often those who are abusing get them from a friend or relative for free. Users who take opioids more than 200 days a year are at the highest risk of overdose; these users typically get their drugs in non-conventional ways. Those with the highest risk for an overdose are four times more likely to purchase the drugs from a dealer than legal methods of obtaining the drugs.
Though the CDC’s findings show a higher percentage of older users overall, younger people are beginning to abuse opioids at a higher rate. In Missouri, this trend leans toward younger people abusing opioids on the rise. According to the Missouri Division of Behavioral Health Department of Mental Health, from 1999 to 2014, deaths related to opioid use increased 7.6 times for females and 3.8 times for males (with 5.9 times for Caucasians and 2.6 times for African- Americans). For young adults, the increase for the 25-34 age group was 7.2 times. Deaths in the 35-44 age group increased 3 times, and in the 45-54 age range, use increased 6 times.
While deaths from opioids are on the rise nationwide – especially from heroin, fentanyl and prescription drugs, Missouri and the Midwest are being hit hard by the epidemic. In 2015, 237 deaths in Missouri were associated with opioid use, compared to 74 deaths across the state line in Kansas. Midwestern states Ohio and Illinois are seeing increasingly high numbers – 690 in Ohio in 2015 and 273 in Illinois. In Missouri alone, the abuse of opioids such as oxycodone, codeine and morphine has increased 137 percent. Nearly one-third of hospital visits related to opioid abuse are people who are uninsured – an increase of 268 percent for that population. The largest increase has been in rural areas of Missouri.
Rates of abuse and overdose are rising significantly in rural areas, especially in Missouri. The highest concentration of opioid deaths in Missouri centers around the eastern part of the state – including St. Louis and rural areas within the vicinity. As of November 2017, St. Louis County in Missouri had recorded 175 opioid-related deaths. In the city of St. Louis there were 125 as of that time period. Other areas around St. Louis that had recorded a high number of deaths at that time included Jefferson County with 53 and St. Charles County with 46. Throughout the state, other areas hard hit with high opioid deaths included Jackson County in the Kansas City area with 58 and Greene County in the Springfield area with 46. From 2015 to 2016, according to the CDC, deaths from opioids in Missouri rose 31.8 percent. In St. Louis, a high number of the deaths are related to fentanyl use. Southeast Missouri is seeing deaths due to prescription drugs and the use of narcotics, according to the Missouri Department of Health and Senior Services.
In 2017, the highest levels of use were recorded in the northern part of Missouri, the southeast corner and a large group of southern counties around Springfield. Why are rural areas being hit harder? Medical professionals speculate some reasons include older populations in rural areas, physical jobs in agriculture and manufacturing that can lead to a higher level of workplace injuries, and fewer alternatives to relive the pain, such as services that provide physical therapy or surgery. Economic problems are also a factor. Some towns in rural areas have not recovered from the recession.
One family doctor in southeast Missouri told Former U.S. Agriculture Secretary Tom Vilsack that on July 4, 2016, the hospital in that area had three fireworks injuries and 23 overdoses. This is just one example of the number of people being seen daily for opioid abuse.
Many states have a prescription monitoring program. Several counties in Missouri – including Lafayette – are participating in a Prescription Drug Monitoring Program. In part, the initiative identifies habitual prescribers and users of controlled substances.