By Michael Howell
Sapphire Community Health (SCH), the non-profit, federally-qualified health center located in Hamilton, celebrated its second anniversary on Monday, October 23. The clinic is also the recent recipient of a $175,000 grant to institute a new program designed to address the growing opioid epidemic that is sweeping through the nation. Montana is right in the middle of the pack in terms of the impacts of this epidemic on individual states. According to SHC Chief Executive Officer Janet Woodburn, Ravalli County and Hamilton are not immune.
“I’ve been in this field here for long time,” said Woodburn. “We’ve never seen anything like this before.”
Opioids are a class of drugs that include the illicit drug heroin as well as the legal prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others. According to information from the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the U.S., with 52,404 lethal drug overdoses in 2015.
According to the ASAM, opioid addiction is driving the epidemic, with 52,404 lethal drug overdoses in 2015. More than 20,000 of those deaths were related to prescription pain relievers, while 12,990 of those were related to heroin use. The growth trend of this epidemic is alarming. From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate.
The opioid epidemic has had a big impact on special segments of the population. Adolescents, 12 to 17 years old, can be especially susceptible. Studies show that most adolescents who misuse prescription pain relievers are given them for free by a friend or relative. The number of prescriptions issued to adolescents for prescription pain relievers nearly doubled from 1994 to 2007.
Studies also show that chronic pain is one of the most widespread reasons for issuing those prescriptions and that women are more likely to suffer from chronic pain, be prescribed pain relievers, be given higher doses, and use them for longer time periods than men. 48,000 women died of prescription pain reliever overdoses between 1999 and 2010. Prescription pain reliever overdose deaths among women increased more than 400% from 1999 to 2010, compared to 237% among men.
According to information from the National Institute on Drug Abuse, evidence indicates that several factors have contributed to the current epidemic, including a drastic increase in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies, altogether contributing to the broad “environmental availability” of prescription medications in general and opioid analgesics in particular.
The number of prescriptions for opioids has escalated from around 76 million in 1991 to nearly 207 million in 2013, with the United States their biggest consumer globally, accounting for almost 100% of the world total for hydrocodone and 81% for oxycodone.
Statistics compiled and distributed by Resolve Montana show that about one in twenty Montana teens aged 12 to 17 have reported nonmedical use of a prescription pain reliever at least once in the past year. That puts Montana in the middle of the states at 25th in terms of rate of use in the country and very close to the national average. In Montana 5% of teens ages 12-17 reported having used a prescription pain reliever for a nonmedical purpose in the past year. That number rises to about 9.36% among young adults ages 18-25.
According to the 2015 Montana Youth Risk Behavior Study, more than 5% of seventh and eighth graders, and nearly 16% of all Montana high school students, have taken a prescription drug they did not have a prescription for at some point in their lives. That number rises to 19.6% for high school juniors and seniors. Nationally it is estimated that 70% of prescription painkiller abusers get their drugs from a friend or family member, and most get them for free.
Drug poisonings are the third leading cause of injury deaths in Montana, accounting for 1,334 deaths between 2003 and 2014, after motor vehicle accidents and suicides and opioids are the leading cause of substance abuse related deaths in Montana residents. Prescription opioids alone contribute to 43% of these deaths while prescription opioids in combination with other unlisted drugs contribute 34.3% of related deaths, and prescription opioids in combination with other drugs specifically listed contribute to the remaining 22% of deaths.
Woodburn will tell you that the Bitterroot valley has not been spared from this epidemic. She said that the grant money the clinic has received will go towards addressing this epidemic.
“For one thing,” she said, “we are looking for alternatives for treating chronic pain.” She said although prescription pain relievers are a viable response and in some cases perhaps the best treatment for an individual patient, in many cases it may not be necessary. She said sometimes another drug than an addictive opioid could be used, but other alternatives exist as well. Lifestyle changes can bring relief for chronic pain. Movement and exercise can help. They are also able to offer other forms of treatment such as providing psychological help for those whose suffering is related to some sort of trauma maybe recent or even childhood trauma. Sleep disorders can also lead to chronic pain and the use of pain relievers. But sleep disorders can be addressed without the use of drugs. Meditation techniques can go a long way in treating stress as well as sleep disorders and reduce the chronic pain as well.
The clinic hopes to have its new opioid program up and running by the first of the year with Dr. Brett Bender coming on full time to oversee the program. They are also recruiting a mental health professional and a licensed addiction counselor to work in the clinic.
Woodburn said their approach would be to treat the mind and the body together to help make chronic pain more manageable in order to minimize the need for prescription pain relievers. She called the abuse of opioids a “disproportionate issue for the health care community” and that the $175,000 in start-up funds would go a long way in beginning some appropriate response to the epidemic. She said funding at half that amount was promised for the coming years as well. She said, “This is not like facing an incurable cancer, we can fix this. We know what we need to do.”