By the time President Donald Trump declared the opioid crisis a public health emergency in 2017, abuse had gradually increased for two decades. 

More than 47,600 Americans died from opioid-related overdoses in 2017 alone, according to the National Institute on Drug Abuse, bringing the total number of deaths to more than 700,000 – roughly the population size of Denver – since 1999.

That number continues to climb.

While it took years for lawmakers, government officials and the press to truly grasp the scope of the problem, those on the front lines were seeing ramifications shortly after the introduction of a new wave of opioid painkillers in the late

1990s.

Melanie Brown-Woofter, president and CEO of the Florida Council for Community Mental Health, said the consequences were obvious early on, but were initially overlooked.

“There’s always a canary in the coal mine,” she said. “And our folks on the ground started expecting individuals with addictive behaviors and seeing the overdoses in the hospitals much earlier than it was officially recognized by our state leaders. We had seen this years ago with cocaine, and we saw it with meth. And now we’ve moved into the opioid world.”

Florida wasn’t the only state to recognize and address the problem after it had spiraled.

As the number of deaths increased exponentially with prescription opioid overdoses into the late 2000s, state and local governments took notice and worked to identify solutions.

“When it started making the news, I think it shocked a lot of people, because it was under the radar for a period of time when it was first developing,” said Ken Martin, chairman of Ohio State University Extension.

One of the most important steps, from both Martin and Brown-Woofter’s perspective, was creating a coordinated response on the state level.

Coordinating efforts

and resources

Martin said former Ohio attorney general and current Gov. Mike DeWine created a drug czar to help lead efforts to combat and treat addiction. And Brown-Woofter praised the efforts of Florida Gov. Ron DeSantis in reinstituting that state’s drug czar, which had been cut eight years ago.

“We feel that a coordinated effort that’s led centrally to be able to address this issue is so important,” Brown-Woofter said. “Today, it’s opioids. A few years from now, there may be another product out there. We see it morph over time.”

That recognition prompted federal and state governments to allocate funding for prevention, treatment and recovery – highlighting why these efforts are so vital.

New state and federal funding in Wisconsin, which saw more than 900 opioid overdose deaths in 2017, has encouraged health-care officials to crack down on the crisis. U.S. Sen. Tammy Baldwin, D-Wisconsin, recently announced the state will receive an additional $6.25 million in federal grant funding for opioid abuse prevention, treatment and recovery.

Some recent initiatives include an addiction recovery helpline, funding for inmates leaving jail and public health alerts issued to areas with high numbers of opioid overdoses.

“We’ve continued to see a rise in opioid-related deaths since the early 2000s,” said Paul Krupski, director of opioid initiatives for the Wisconsin Department of Health Services. “We have a three-pronged approach to address the crisis, which, I’d guess, is fairly similar to what a lot of other states are doing. We firmly believe we will eventually get ahead of this.”

The department recently partnered with the University of Wisconsin School of Medicine and Public Health to launch an addiction consultation program, connecting providers in rural areas with addiction specialists for insight and resources.

“It’s creating a high level of patient care locally,” Krupski said.

Because Wisconsin is largely rural, counties are often the first line of defense when addressing substance abuse. The health department has awarded grant funding to more than 25 counties and tribal nations through its Unmet Opioid Treatment Needs program. In the first half of the program’s second year, more than 1,000 residents have received treatment or recovery support services.

Tackling the evolving epidemic

Most states implemented prescription drug monitoring programs after realizing how significant the problem was.

PDMPs are designed to crack down on two major contributing factors to the opioid crisis – patients collecting opioid prescriptions from multiple doctors and unscrupulous doctors who operate “pill mills,” prescribing as many pain pills as

possible.

Many states have also limited the amount of opioid-based medication a patient can be prescribed. Wyoming’s legislature earlier this year limited the amount of opioids for first-time patients to a seven-day supply. Florida insurance companies put a cap on opioid prescriptions, as well, Brown-Woofter said.

Federal prosecutors are also threatening criminal action against those prescribing more pills than average. Wisconsin’s drug monitoring system revealed a 29 percent decrease in the number of prescriptions dispensed from

2015 to 2018.

Some of the county’s largest drug distributors continue to face civil lawsuits in several states, which could lead to billions of dollars in damages. Governments want companies such as Purdue Pharma and Walmart to reimburse them for the cost of combating the epidemic, arguing these companies misled

communities about the risks.

In March, owners of Purdue Pharma, maker of OxyContin, agreed to pay Oklahoma $270 million for the company’s role in the crisis. Oklahoma Attorney General Mike Hunter said the settlement would help establish a national addiction research center at Oklahoma State University and support local efforts.

A survey released by integrated health company Vizient last year reveals what changes hospitals, in particular, are making to lower opioids’ toll on human life.

The survey found that 64 percent of hospitals made new investments in opioid medication management recently. Most common programs included prescriber education,

prescription monitoring, pain management alternatives and safe

disposal of old medications.

What’s next?

Experts in the mental health and substance abuse treatment fields believe there are immediate steps that can help keep more on the path to recovery. More funding for substance abuse treatment, increases in the mental health workforce, and increasing the time government and private insurance will fund rehabilitation stays are all on the

wish list.

“Addiction is a brain disorder. And once you enter into addiction recovery, you’re in recovery for the rest of your life,” Brown-Woofter said. “People don’t choose this. Anything we can do to enhance service provision and increase capacity so anyone who needs it can seek services and keep them in recovery is what we’re interested in.”

Another area could have a significant impact on improving the odds of a sustained recovery for those with an opioid addiction.

“Expanding access to medication-assisted treatment is the most effective way to reduce overdose deaths and curb the opioid crisis,” said Beth Connolly, project director of the substance use prevention and treatment initiative at The Pew

Charitable Trusts.

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