TRAVERSE CITY — Residents addicted to opioids here are younger, whiter, better educated, use street drugs, are likely to be employed and are increasingly female, according to health and law enforcement experts who spoke Tuesday at a healthcare forum.
“Since July 2018 we’ve started seeing an increase in fentanyl being put into other drugs,” said Jennilyn Oster, who has worked with the Naval Criminal Investigative Service, the Traverse Narcotics Team and is currently a school resource officer at the Career-Tech Center.
“We’re seeing more of this in crack cocaine, we’re seeing it in meth. We’re still seeing some opioids bought on the black market, but the amount of pills is down. Now we’re seeing a lot more crystal meth.”
A Centers for Disease Control report released Friday showed nationwide, most drug overdose deaths still involve fentanyl and heroin. Meth was the drug most frequently involved in deaths west of the Mississippi, though Oster’s experience shows it is also a problem locally.
Anecdotal evidence that fewer opioid prescription drugs are available for misuse could mean that initiatives to curb excessive prescribing are working, said Dr. James Whelan, medical director of population health for Munson Health Care.
In 2017, the state passed several laws to address opioid abuse.
All prescribers must register with the Michigan Automated Prescription System before prescribing or dispensing a controlled substance to a patient and must provide a more extensive patient education.
Patients must also sign a written consent for acknowledging they’ve received materials about the dangers of opioid misuse.
“The medical community’s contribution to the problem is a stated fact, so we’re not going to focus on that,” Whelan said. “We’re still prescribing opioids throughout our emergency departments but the amount of pills — we’ve decreased prescription rates by over 75 percent.”
Whelan said there is still improvement needed from doctors and used his own healthcare experience as an example of that. Following a recent surgery, he was adamant he did not want narcotic painkillers but was prescribed them anyway.
Dr. Christine Nefcy, Munson’s chief medical officer, added an experience of her own. When her son had his wisdom teeth removed 8 years ago, he was prescribed 50 opioid pills; when her daughter had her wisdom teeth removed in 2018, she was prescribed 30 opioid pills which, Nefcy said, were still too many.
“I had to drive all over town to find a drop-off box (to dispose of the extra pills),” she said. “So now there’s a drop-off box at each one of Munson’s hospitals.”
Munson pharmacies participate in Michigan Open, a project started by a University of Michigan medical student, that polled doctors on the numbers of opioid pills they prescribed for a gall bladder removal, and then polled patients to learn how many of those pills they took.
The average prescribed was 40; the average consumed was four.
During the student’s project no tracking of opiods was required and it’s unknown whether the extras were thrown away in household trash, disposed of in a drop-off box or misued.
“We’re still prescribing 14 when most patients use four,” Whelan said. “So physicians still have some growth to do.”
Oster shared her experiences interviewing every person she arrested for drug use.
“Nobody wakes up in the morning and says, ‘Hey, I’m going to inject myself with heroin and overdose’,” Oster said. “So I started asking, ‘How did you get involved in heroin?’ The story I was hearing over and over was this: ‘I got injured in a car accident. I had surgery. I got hurt playing football.’ The doctor gave me opioids.”
“Eventually, they get to the point where the doctor says no to a refill and it is no longer about the injury, it is about, ‘I do not want to have all the after-effects of coming down from this stuff.’ And part of the nasty effects of opioid addiction is it destroys your body’s ability to create dopamine.”
Meaning, even after someone with opioid use disorder detoxes, they may experience cravings for years.
If opioid pills are not as readily available because regulations on prescribers are taking effect, Oster said heroin, at $220 a gram, is too expensive for some users who move to crystal meth which is about $20 a gram.
“We need to focus on what we can do to help,” Oster said. “As law enforcement, what I transitioned to, instead of trying to stick my finger in the dike, was education. Today, students are aware that these substances are dangerous.”
Whether users get their start with prescription opioids or street drugs, it is people like Christopher Hindbaugh, director of Addiction Treatment Services, who provide recovery care.
And, recoverly experts can do better, too, Hindbaugh said.
“Our system is built to wait for folks to get really sick. We wait for people to become the stereotypes and then we’re here for them. If you look at it from a public health perspective, we do very little, almost nothing, on prevention.”
Hindbaugh said much of accepted theories on treating addiction is a myth, or worse.
“The established idea is, you have to wait until people hit rock bottom before you can help them,” Hindbaugh said. “Many people in this room believe that. It’s a myth. It’s garbage.”
Working toward solutions was the focus of each speaker, and taking addiction treatment out of the periphery of the healthcare field and making it more central, spending more resources on prevention, identifying doctors who are over-prescribers, and educating the public about the dangers of prescription opioids were all discussed.
The healthcare forum was held at the Hagerty Center and was presented by Grand Valley State University and Northwestern Michigan College. It may become a twice yearly event, with a second forum planned for March 20, topic to be determined.