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Responding to the opioid scourge

ALBUQUERQUE, N.M. — Heroin is cheaper, more powerful and more plentiful than ever in New Mexico. And despite new regulations that are credited with some improvements and a lower death toll, the state is awash in prescription painkillers.

So much so, that State Epidemiologist Dr. Michael Landen says that 1.75 million prescriptions for opioids of different types were written for patients in New Mexico

“That’s almost one prescription for every person in the state,” Landen said.

But the news isn’t all bad.

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The number of accidental drug overdoses in New Mexico fell from 540 in 2014 to 492 in 2015 last year – a drop of about 9 percent.

That still puts New Mexico in the higher range of overdose deaths, more than 20 per 100,000 of population, making it the leading cause of injury death in the state. It exceeded fatalities from motor vehicle crashes, homicides and falls.

The 2014 drug overdose fatality total is more than five times the total of people – 91 in 2014 – who were killed in homicides in which a gun was used.

U.S. Attorney Damon Martinez, left, and Dr. Richard Larson will co-host the forum.

U.S. Attorney Damon Martinez, left, and Dr. Richard Larson will co-host the forum.

For decades, New Mexico has been either number one or two in the country for drug overdose death rates and one of the reasons the Journal and KANW radio are sponsoring a two-hour live radio forum on the issue on Wednesday, starting at 7 p.m. with U.S. Attorney Damon Martinez, UNM Health Sciences Vice Chancellor Dr. Richard Larson and many other experts.

Members of families that have been devastated by opioid drugs, along with a recovering addict, will also participate in the forum, which will cover issues ranging from law enforcement’s response to treatment to how to get help for a family member.

Opioid debate

The U.S. is by far the biggest consumer of painkiller opioids.

An international study found that hydrocodone is prescribed predominantly within the United States and that, in 2007, the U.S. consumed 99 percent of the worldwide supply of the drug, which is prescribed for short term pain and chronic pain.listenin

People who die from overdoses of prescription opioids tend to be older than those who die from heroin overdoses, particularly women, and many are receiving medical care for multiple medical problems and have multiple prescriptions.

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Landen says a key to the decrease in drug overdose deaths appears to be a change in October 2014 in the way hydrocodone is prescribed.

“Federal authorities changed hydrocodone from a class three to a class two drug,” Landen said. “A preliminary review of the information indicates this was a key factor in the decrease.”

The classification change meant that doctors could not telephone pharmacies with prescriptions for hydrocodone and patients could not get refills for the drug – requiring an office visit for each new prescription.

According to Landen, that change led to a decrease in prescriptions for the drug and a decrease in deaths.

The change was not without controversy and continues to draw complaints from patients with chronic pain who require monthly prescriptions.

Many people writing questions to the experts who will participate in Wednesday’s forum objected to the changes in obtaining hydrocodone for their legitimate medical needs.

Despite those complaints, tighter regulations on prescription opioid medications keep coming.

The Center for Disease Control recently issued tougher guidelines for prescribing opioid medications for non-cancer patients that included a warning that doctors and other prescribers take extreme care in prescribing opioids to patients who also have prescriptions for benzodiazepine – which is used to treat insomnia, anxiety and other medical problems under a number of commercial brand names.

Heroin concerns

Overdose deaths caused by prescription opioids have surpassed overdose deaths from illegal drugs for years, in New Mexico and nationally.

But in recent years law enforcement officials have become concerned that the availability of cheap and relatively pure Mexican heroin could increase the number of overdose deaths among heroin addicts.

Normally overdose deaths among heroin addicts tend to occur among new users and users who haven’t used the drug for some time, either because they were clean of the drug or in prison.

In one recently indicted federal case, undercover narcotics agents repeatedly paid $150 for four grams of heroin. A few years ago, $150 was enough for just one gram.

At the current price, the expectation that the heroin would be of poor quality wasn’t true. In fact, one of the drug dealers was indicted for selling the heroin that led directly to an overdose death.

In addition, narcotics agents are keeping an eye out for heroin laced with illegally produced Fentanyl from China.

Fentanyl in a liquid form (instead of the normally prescribed extended-release patches) is causing a spate of overdose deaths in New England and the Middle Atlantic states.

Fentanyl was listed as a factor in the performer Prince’s recent death, but it hasn’t been determined how he obtained the drug.

 

Public forum participants

Hector Balderas, NM Attorney General

Dr. Snehal R. Bhatt, UNM Psychiatric Center, medical director of addictions and substance abuse programs, including Milagro Program

Michelle Brooks, parent of two young adults in recovery, volunteer with Healing Addiction in our Community (HAC)

Michel Disco, assistant dean for External Programs at UNM’s College of Pharmacy, and faculty adviser for Generation Rx, a program in which pharmacy students and others talk to young people about the danger of drugs

Lou Duran, prevention specialist/event coordinator, HAC

Dr. Dion Gallant, medical director for Primary Care Services, Presbyterian Healthcare Services

Diane G. Gibson, Albuquerque city councilor, District 7

Brittany Haggard, chairperson of Generation Rx, a student at UNM’s College of Pharmacy, and a prevention and education presenter for the Heroin Opioid Prevention and Education (HOPE) Initiative

Maggie Hart Stebbins, Bernalillo County commissioner, District 3

Shammara H. Henderson, Smart on Crime Assistant U.S. Attorney and prevention and education presenter for the HOPE Initiative

Katrina Hotrum, director of the Department of Substance Abuse and Treatment Program (DSAP) for Bernalillo County

Dr. Steven Jenkusky, Greater Albuquerque Medical Association (GAMA)

Dr. Joanna G. Katzman, director of UNM’s Pain Center

Dr. Christopher Manetta, medical director for Behavorial Health, Presbyterian Healthcare Services

Ava McGuire, an addict in recovery and community advocate

Nicole Perea, former chairperson  of Generation Rx, a student at UNM’s College of Pharmacy and a prevention and education presenter for the HOPE Initiative

Lisa Simpson, Bernalillo County Public Safety Division, technical adviser on jail population management and developing alternatives to incarceration

Dr. Steven A. Seifert, professor at UNM School of Medicine and medical director of New Mexico Poison Center

Dr. Mauricio Tohen, UNM Health Sciences Center, chairman of Psychiatry Department

Sean Waite, DEA Assistant Special Agent in Charge

Dr. William Wiese, co-chairman, Bernalillo County Opioid Accountability Initiative

Jennifer Weiss-Burke, executive director of HAC and Serenity Mesa


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