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“Our nation is struggling with a prescription drug epidemic and we must take advantage of every tool at our disposal to address this public health and safety crisis.” – R. Gil Kerkilowske, Director, White House Office of National Drug Control Policy

 

Snapshot of the National Opioid Epidemic
Drug overdoses are now the leading cause of death among Americans under 50.  Despite recent declines, opioid prescribing is still high and inconsistent across the US.

Opioid Epidemic in Southern Nevada
Since 2008, more residents of Clark County have died each year from opioid overdoses than firearms or motor vehicle traffic accidents.  In 2012-2014,  the mortality rate from opioid overdoses in Clark County was almost 70% higher than the national rate.

Every hour, a person in Nevada is admitted into a hospital for an opioid related diagnosis.

Every 75 minutes, a person in Nevada visits an ER with an opioid related diagnosis.

From 2013-2015, Clark County deaths due to drug poisoning was 20.7 deaths per 100,000.  About 2/3 of the drug overdoses involved opioids.  The majority of the drug overdoses were unintentional.

Watch our Governor’s Opioid Addiction Public Service Announcement:


 

Risk Factors
Opioid pain relievers, even when legally prescribed, are highly addictive substances putting consumers at risk for addiction. According to the CDC, there are four major risk factors that make someone particularly vulnerable to prescription opioid abuse and overdose, including: Obtaining overlapping prescriptions from multiple providers and pharmacies, taking high daily dosages of prescription pain relievers, having mental illness or a history of alcohol or other substance abuse, or living in rural areas and having low income.

In Clark County and nationwide, fatal opioid poisonings occur more frequently among non-Hispanic whites, men, and adults between the ages of 25-64. In Clark County, 4% of middle school students and 16.5% of high school students in 2015 reported ever taking a prescription drug without a doctor’s permission.  

People addicted to prescription opioids are 40 times more likely to become addicted to heroin.

 

Cost
The opioid epidemic creates substantial burden on health care utilization and expenditures. In Clark County, opioid use and misuse were implicated in over 1,500 emergency visits and 1,700 inpatient hospitalizations annually from 2011-2013. Opioid-related  cost Southern Nevada’s health system about $9.3 million in ED service costs and $92.5 million in inpatient healthcare costs in 2013. That is the equivalent of providing 4,000 people with inpatient treatment at an average priced 28-day drug and alcohol rehab facility (~$25,000/per person).

 

Public Health Interventions and Best Practices
In 2015, the Nevada legislature passed SB459 which requires all prescribers to register with the state prescription drug monitoring program (PMP). It also enacted the Good Samaritan Law and grants immunity for those administering medications (e.g., Naloxone, Narcan) to reverse the life-threatening effects of an opioid overdose.

 

Best Practices

  • Require medical boards to evaluate prescribing behavior when it exceeds an upward limit for a similarly situated specialists, based on Prescription Drug Monitoring data (PMP)
  • Recommend that publicly funded insurance plans (e.g., Medicare, Medicaid) adopt responsible opioid prescribing practices to ensure only those who need opioids are receiving them.
  • Recommend that primary care providers co-prescribe naloxone when prescribing long-term opioid treatment
  • Reduce the price of naloxone for public insurance (e.g., Medicare, Medicaid) in Nevada
  • Recommend that Emergency Medical Services (EMS) and other first responding agencies document and track administration of naloxone across the state

Source: 2017NVLeg_OpioidFactSheet

 

Progress in Clark County

  • Drug courts:  Help divert individuals convicted of low-level drug offenses to  community-based treatment and support services
  • Syringe Exchange Program and Vending Machine pilot program:  Provide people who inject drugs with access to sterile needles and syringes.  Serves as a gateway to services and cars they might not otherwise access.
  • Safe Drug Disposal Events: Provide the opportunity for people to safely and anonymously dispose of any unused or expired prescriptions or over-the-counter medications.  Help prevent misuse abuse of unused prescription medications.  Also, provide the opportunity to educate the general public about the potential for abuse and medications.
  • Formation of Opioid Advisory Council (SNOAC)

 

Approach: Harm Reduction

Harm reduction is a way of preventing disease and promoting health that “meets people where they are” rather than making judgments about where they should be in terms of their personal health and lifestyle

For drug users, harm reduction recognizes that many drug users are either unable or unwilling to stop, do not need treatment, or are not ready for treatment at a specific point in time.

Harm reduction programs focus on limiting the risks and harms associated with unsafe drug use, which is linked to serious adverse health consequences, including HIV transmission, viral hepatitis, and death from overdose.

For example:

  • Access to sterile syringes, medications for opioid dependence such as methadone and buprenorphine, and overdose prevention.
  • Training on topics including: drug related HIV and Hepatitis C, harm reduction, drug-related stigma, and overdose prevention
  • Participate in monthly outreach to people experiencing homelessness as part of a collaborative team to deliver tertiary prevention to PWID through Hepatitis C education and testing, education and distribution of bleach kits.

Source: Southern Nevada Opioid Advisory Council  Speaker’s Bureau 2017