TUPELO • While the overall rates of opioid prescriptions are going down, local and state professionals say those numbers only address part of the issue of dealing with the crisis of opioid addiction.
In 2018, there was a 15.8 percent decrease in opioid prescriptions dispensed from the previous year, according to the April 2019 Mississippi Opioid and Heroin Data Collaborative Provisional Data Report. However, there was a 22.1 percent increase in the number of opioid-related deaths in 2018 versus 2017.
The Centers for Disease Control and Prevention reported that the 2017 overall rate of opioid prescriptions was 58.7 prescriptions per 100 people, but the Mississippi rate was higher than that at 92.9 prescriptions per 100 people. The Lee County rate was 112.6 per 100 people.
Prescribing rates may remain high in areas such as Lee County because of the large amount of healthcare concentrated in the area, said Dr. Stephen Pannel, the medical director at the Oxford Treatment Center in Lafayette County. Since areas of Mississippi are rural, many may travel into the county for healthcare and opioid prescriptions.
“With North Mississippi Medical Center, the large clinical staff and physicians staff, there is a large amount of healthcare in that county, and you have lots of patients traveling into that county from outside counties,” Pannel said.
Pannel’s work mainly is managing patients that come in for detox from drugs. He said the majority of his admissions are now opioid related, and some patients come with dependence on multiple chemicals rather than just an addiction to one drug. However, of those who come in with opioid addictions, most are the kind who buy heroin off the street rather than through prescription pills. Pannel said most of the people he treats for opioid addictions have not had a doctor’s prescription in years.
“Opioid prescribing rates and prescriptions ... are just the tip of the iceberg. I think what people don’t realize is what that looks like five to six years later, and that’s kind of what I deal with,” Pannel said.
Opioid prescribing rates hit Southeastern states, such as Mississippi, Alabama, Tennessee and Arkansas especially hard: in 2017, each of these states had more than 90 prescriptions per 100 people, according to the CDC. Pannel suggests it is due to factors such as lower education and rural areas that make patients vulnerable to healthcare access. Because there are a small amount of providers covering large numbers of people, Pannel said there are trends where a large number of patients seeing the same provider begin to receive similar treatment.
Opioid-related hospital stays and ER visits increased by 26.2% and 50.7%, respectively, from 2014 to 2017. Initiatives such as Stand Up, Mississippi seek to discourage those trends by focusing on education, prevention and treatment policies and partnerships around treating opioid addiction.
Current efforts include spreading information on opioids to people with a high risk for taking opioids after being hurt on the job, said Davy Trewolla, the state opioid coordinator for the Bureau of Behavioral Health Services/Addictive Services. Trewolla said his job is working with the Mississippi Workers’ Compensation Commission to educate employers on how to help people get treated and to cover different areas of prevention and treatment.
“We’re helping employers as far as educating them on how to recognize it in their employees should they suffer from opioid addiction and how to get them treatment (rather than) get rid of them,” Trewolla said.
Despite this education work, there were 180 opioid-related deaths in Mississippi in 2017, according to the 2019 report on drug overdose deaths in Mississippi from the Mississippi State Department. That is due to the current solutions focusing more on one side of the opioid issue rather than on treatment, said Clint Crawford, the director of addiction services at Lifecore Health Group. Many of his patients deal with illegal drugs, and as prescription rates go down, Crawford said he sees an increase in the use of illegal drugs.
“I think the problem that we have is we need better treatment, longer term treatment, things like that, to help people get off of drugs. It’s sort of like sticking your fingers in a hole in a dam. You get one plugged, another one pops up, and that’s kind of what’s happening. That’s kind of what we’re seeing: We’re just seeing a rise in illegal drug use,” Crawford said.
Much of the funding is going toward research when it should be going toward treatment, said Crawford. He describes the opioid prescription rates and opioid addiction rates as two separate problems. Some barriers to properly treating the opioid crisis include addiction treatment being aimed for 30 to 90 days rather for the recommended six months to a year of rehabilitation. Much of the funding is going toward research when it should be going towards treatment, said Crawford.
“It addresses a lot of facets that can contribute to addiction, but you don’t hear a whole lot about treating addiction, and that’s where we need the solution. That’s where the solution meets the problem,” Crawford said.