Opiate addiction rampant in Carroll County

A local mother and grandmother came into the office of the Eureka Springs Independent recently and said after pain with from toothaches and back surgeries, her daughter became addicted to opiate painkillers. Recently that addiction nearly cost the daughter her life as her liver was failing.

“She was in horrible pain and the doctor told her she had three months to live,” the mother said. “We were having a prayer circle around her hospital bed when the nurse came in and said they had found a liver for her to have a transplant. That was a miracle right there.”

The woman requested to remain anonymous to protect her family’s privacy. But she wanted to tell her daughter’s story in the hope that even one person reading the story might realize how dangerous it is to take opiates regularly.

“Maybe that will bring somebody to their senses,” she said. “Maybe someone will listen and realize they shouldn’t be using these drugs. The doctors are a lot to blame as far as I’m concerned because they kept giving her prescription after prescription. People think addiction isn’t going to happen to them. There are some, once they get hooked, they are hooked for life.”

This family’s story is not unique. Arkansas has one of the highest rates of prescriptions for opiates in the country. According to the Centers for Disease Control and Prevention (CDC), nationwide overdose deaths involving prescription opioids have quadrupled since 1999. During those years more than 165,000 people have died in the U.S. from overdoses related to prescription opioids.

Opioids are a class of legal prescription pain relievers including oxycodone, hydrocodone, codeine, morphine, fentanyl and others. Heroin is an illegal opioid.

If you think the problem is worse in big cities, think again.

“We found out our state is one of the top prescribers of opioids,” Denise Robertson, P.D., administrator of the Arkansas Prescription Monitoring Program (PMP), said. “Nationally and in Arkansas, drug overdoses are the leading cause of accidental deaths. They are killing more people than car wrecks right now.”

The PMP program requires each dispenser to electronically submit information regarding each prescription dispensed for a controlled substance. The law setting up the PMP also contains strict provisions regarding patient privacy.

Carroll County has one of the highest rates of opiate prescriptions in the state. Robertson recommended looking at the Prescription Monitoring Program’s website: www.arkansaspmp.com/, where on the 2015 county map Carroll and Madison Counties are “red counties,” with the highest rates of prescriptions for oxycodone. In Carroll, Conway, Crawford, Madison, Marion, Sharp and Perry counties, the amount of oxycodone dispensed was approximately two times higher than the state average.

In the 2015 red counties there were enough prescriptions for oxycodone to give 23 to 32 pills to every person in the county.

“That is how bad it is,” Robertson said.

And in counties like Carroll that share a border with Missouri, which doesn’t have a PMP, the problem could be worse. That is because many people, now aware their opiate usage is being tracked by the state, are getting prescriptions in Arkansas and having them filled in Missouri.

“When you border a state without PMP, you don’t know how much prescription abuse is going back and forth,” Robertson said. “Missouri is the only state left in the U.S. without a PMP. For the past several years, it has been shot down in their legislature.”

Arkansas shares PMP data with neighboring states including Mississippi, Louisiana, Oklahoma and soon, Texas. Robertson said where PMP data is shared, the amount of cross border trafficking reduces considerably.

Even though Missouri has refused to establish a PMP, several counties and St. Louis have decided to start PMPs that will share data with Arkansas.

“Sometimes people who are addicted to painkillers want to be caught,” Robertson said. She said they hear from people detected as frequent users of painkillers who were relieved as they now could seek help.

“We are hearing how wonderful the PMP program is not just from the physician prescribers, but from patients themselves,” she said. “They will say, ‘This saved me,’ or ‘This saved my son.’”

Robertson said the program allows healthcare providers to give support to people addicted through no fault of their own. They went to a doctor for pain, got a prescription, and ended up after a year addicted to pain meds. She said it is important to deal with people addicted to painkillers in a sensitive manner.

“One of the goals of the PMP is to enhance patient care when this type of thing is identified,” Robertson said.

The Arkansas PMP now has about 8,000 registered users including pharmacists, doctors, nurses and law enforcement. The program works by looking at how many prescriptions for controlled substances have been given in a three-month period. That allows detection of people who might be “doctor shopping,” or getting the same prescription from multiple doctors.

Robertson said in 2013 they identified 76 recipients who were doctor shopping. This past year it was down to 18.

Many people don’t realize that often it isn’t the painkiller alone that causes an overdose death. Some forms of oxycodone painkillers also contain Tylenol, which in higher doses harms the liver. If people get addicted and start taking several pills at one time, the liver can be damaged by the Tylenol.

“There are more side effects as you add medication,” Robertson said.

Opiates depress the central nervous system and respiration. If people add alcohol, muscle relaxants, and/or other drugs including benzodiazepines like Valium or Zanax, it can be trouble.

“Lots of time with the toxicology on overdose deaths, it is not just one thing,” Robertson said. “It is a mixture of things. You also have problems with mixing legal prescriptions with illegal drugs like heroin, meth, cocaine, and the illegal fentanyl.”

One issue is that when people are addicted to prescription opiates and their supply it cut off, they often turn to illegal drugs.

“In the early 2000s, people started switching over from heroin to prescription drugs because they were cheaper and easy to get,” Robertson said. “Now we are pulling back on prescription drugs, we are seeing overdoses in pockets around the nation from use of illegal drugs like heroin. Fentanyl powder is being used to taint the heroin, and it is killing people.”

Robertson’s advice to parents is to pay attention to what your kids are doing, who they are hanging out with, and changes in behavior. If you have leftover pain pills, don’t leave them where your children can find them.

There has been some concern that the crackdown on pain pills could lead to people not receiving them who really need them. Robertson recommends if you do take painkillers, make sure you work with your doctor to manage proper use of them.

“People need to take charge of their health,” Robertson said. “No one has said you can prescribe an opioid. But it needs to be prescribed in a patient-appropriate manner and then that patient needs to be followed the whole time. If you are given a painkiller, question it. For those people who are already addicted to it, start a conversation with your doctor about how you can get off of it. Ask, ‘What are my options?’ You have to start the conversation and not be afraid to ask.”