Copyright © 2018 Albuquerque Journal
For the third consecutive year, New Mexico saw a decrease in prescription opioid-related deaths, even as opioid deaths rose nationwide.
Nationwide, opioids of all types killed more than 42,000 people in 2016, more than any other year on record, according to the Centers for Disease Control and Prevention. The CDC notes that from 1999 through 2015, opioid overdose deaths quadrupled from 8,050 to 33,091 and accounted for 63 percent of all drug overdose deaths.
Overall, New Mexico had the 15th highest opioid-related overdose death rate in the nation as of 2016. Going back to 2005, New Mexico was among the top 10 worst states for opioid-related overdose deaths, ranking the second highest in the nation in 2012 and in 2008.
According to Kaiser, New Mexico last year experienced 17.5 opioid deaths per 100,000 population. West Virginia led the nation with 43.4 opioid deaths per 100,000, followed by New Hampshire with 35.8 deaths per 100,000.
States with the fewest opioid deaths were Nebraska with 2.4 deaths per 100,000 population, Montana with 4.2 deaths per 100,000 and Texas with 4.9 deaths per 100,000. The nationwide average was 13.3 deaths per 100,000.
While the opioid overdose death rate in New Mexico is decreasing, the state’s non-opioid overdose death rate from legal and illegal compounds remains unchanged.
So what is New Mexico doing that’s reversing the risk of people dying from opioid overdoses?
Dr. Michael Landen, the state epidemiologist and the Department of Health’s epidemiology director, pointed to three factors:
• Fewer opioid prescriptions are being written combined with improved monitoring of those that are written.
• Wider access to drugs that can reverse opioid overdoses.
• And increased availability of outpatient treatment medications for opioid addiction.
New Mexico has seen increased use of its Prescription Monitoring Program, which requires pharmacies to provide data to the state Board of Pharmacy on what controlled substances have been dispensed to a patient. Prescribing doctors are required to check the database to look for red flags, such as overlapping prescriptions, whether a patient has been doctor- or pharmacy-shopping, and what other drugs and in what dosages have been prescribed.
Monitoring of “high-risk prescribing” has been extremely important in situations where people are receiving opioids and benzodiazepines, a class of drugs often used for treating anxiety and sleeplessness, and includes such drugs as Valium, Xanax or Atavan.
“Opioids and benzodiazepines depress the respiratory system, which could lead to a drug overdose, and where alcohol is used, another respiratory depressant, it further raises the risk of overdose and death,” Landen said.
Since March 2016, naloxone, sold under the brand name Narcan, can be dispensed by pharmacists and without a doctor’s prescription. The drug, which can reverse opioid overdoses, is now routinely carried by police officers and other first responders. The drug is commonly dispensed in an injection pen, but it is also available in a nasal mist form.
The New Mexico Department of Health has been distributing naloxone since 2001 through its harm reduction services, and since 2013 through its co-prescription pilot programs.
In 2016, when a statewide standing order was issued, there were 6,551 naloxone doses distributed statewide, 800 reported overdose reversals and 1,458 Medicaid reimbursement claims processed from 124 outpatient pharmacies, according to the DOH.
“We have essentially opened up access to naloxone,” Landen said.
Also contributing to the decrease in opioid overdose deaths is the wider availability of outpatient medication-assisted treatment with such drugs as methadone and buprenorphine, Landen said. These compounds are used to wean people off more dangerous drugs and help manage their addictions.
Cheranne McCracken, the executive director of the New Mexico Board of Pharmacy, said there have been huge changes on several fronts over the past decade. In addition to the availability of naloxone, she cited better practitioner education in pain management, wider public awareness about prescription drug addiction, better integration of health system records and the adoption of the Prescription Monitoring Program.
According to data from the American Medical Association, registration on New Mexico’s Prescription Monitoring Program has steadily increased from 6,199 in 2014 to 11,543 in 2016.
“There’s been a shift in awareness of information about the risks of opioids,” McCracken said. “Fifteen years ago, there was information out there that opioids were not associated with addiction and were just for pain management. There is also increased insurance coverage now for methadone. Years ago, Medicaid didn’t cover it, and they do now.”
Dr. Barbara McAneny, an Albuquerque oncologist and president-elect of the American Medical Association, said physicians in New Mexico have prescribed 8.6 percent fewer opioids from 2013 to 2016, according to the most recent data available, an indication that physicians in this state are heeding the recommendations of the AMA.
Today’s nationwide opioid crisis did not, of course, happen overnight. It began years ago when hospital accrediting organizations “decided that relief of pain needed to be stressed,” McAneny said. “That sent the message to patients that they should be 100 percent pain free, and that led to overtreatment.”
The pharmaceutical industry marketed opioids as non-addictive, “and that reassured physicians that their patients would not get into trouble,” she said.
Because there is a stigma attached to being drug addicted, people who are in chronic pain often do not seek medical assistance and instead buy opioid drugs on the street.
The bottom line is “we need to destigmatize drug addiction so we can treat it like any other disease, and we need to put some resources into the treatment of addiction,” as well as recognize that not every patient can be made 100 percent pain free, McAneny said.
“We do not have enough physicians trained in that (addiction) specialty and need alternative ways of relieving pain other than opioids. That needs to be the focus going forward.”