Every 12 minutes, the death toll of the opioid epidemic increases by one more.
There were 63,632 drug overdose deaths in the United States in 2016, and 42,249 (66.4 percent) of those deaths involved opioids. Those numbers record a 27.9 percent increase for opioid overdoses in one year, and mark the presence of a new epidemic — the deadliest one yet.
Each day, 600 people try heroin for the first time, and 4,000 people begin to abuse painkillers in the United States.
In 2016, Missouri was identified as ground zero for doctor shopping and diversion of prescription pills.
According to the Center for Disease Control and Prevention, for every 100 people in Missouri there are 80 opioid prescriptions. Worldwide, the United States is home to 99 percent of the world’s Vicodin.
“If you look at heat maps of where our oral narcotic prescription are going, it’s Southeast Missouri,” Missouri Department of Health and Senior Services director Randall Williams said.
The great fear of the executive departments, Williams said, is the spread of potent synthetic opiates from metro areas.
“The cartel follows the highway, and St. Louis is the epicenter in the United States,” Williams said. “Two of the three largest seizures of fentanyl ever have been right outside of St. Louis in Illinois. It is the main distribution point for fentanyl in the United States, and Cape Girardeau is not that far away.”
Missouri State Highway Patrol Sgt. Shawn Griggs, the public information, education and training officer for the department's Drug and Crime Control Division, said the State Highway Patrol Drug Lab has seen an increase in fentanyl-related cases in recent years — from 49 cases in 2011, to 468 cases in 2017) and fentanyl was responsible for 80 percent of overdose deaths in 2017.
Griggs said fentanyl is created clandestinely and imported. The dark web, among other methods, allows dealers to acquire synthetics from overseas, cheaply, and sell them at a high price.
Griggs said dealers with the right equipment can press pills to appear virtually identical to prescriptions medications.
“Many times our drug chemists at the crime lab cannot tell that these pills are altered — or created clandestinely,” Griggs said.
Griggs said the availability of illicit opiates on the street makes it easy for a substance use disorder to grow and lead to using intravenous drugs.
“It’s about $1 per milligram on the street for prescription painkillers,” Griggs said. “In some places heroin costs much less than that. You become physically dependent and get sick if they don't have it so instead of spending $80 they spend $20 for heroin, because it’s the same thing.”
Approximately one in seven people prescribed opiates to treat pain will develop substance use disorder in some capacity, according to the Surgeon General’s Report on Alcohol, Drugs and Health.
Eighty percent of heroin users in the United States began by abusing prescription pain pills given to them by a doctor.
Williams said irresponsible prescribing practices plays a large role in today’s epidemic.
Dr. Joe Leckie, a specialist in emergency medicine at Saint Francis Healthcare System in Cape Girardeau Joe Leckie said much of the prescribing practices came from recommendations from the federal government. Leckie said, when he started out in the position, nine years ago, pain once was considered a fifth vital sign, and physicians were expected to treat it quick and early.
“It’s a two way street,” Leckie said. “The government pushed the doctors to treat pain and then the pharmaceutical reps and pharmaceutical companies say, 'Hey, we have this new pain medicine.'”
Leckie said the practice has changed, mainly in the last two years, and physicians are now instructed to avoid opioids whenever possible.
Even with this push, Leckie said, overprescribing is still a large issue across all medical denominations.
Another obstacle Leckie said he has to face in lieu of the epidemic is doctor shopping, where individuals who have substance use disorder for opioids come into the emergency room and demand more medication. Leckie said having a proper prescription drug monitoring program (PDMP) in place in all hospital computer systems would likely have a strong effect to reverse the issue.
However, Missouri is the only state in the country that has not initiated a reactive PDMP program that monitors patients’ prescription history to relay back to doctors.
In 2017, Gov. Eric Greitens signed an executive order to establish a proactive PMDP county-by-county. But the Missouri House of Representatives has been sitting on a bill that will establish the program statewide.
Legislatively, there are several other pending issues on the radar. With a rise in needle-injected opioid usage, particularly heroin, Hepatitis C has spread as needles are shared among users. Since Hepatitis C is covered under Medicaid, it’s costing the state millions of dollars. In 2016, Missouri had 7,500 new cases of Hepatitis C, averaging $84,000 to treat per patient.
House Bill 1620, which instates a safe-needle exchange program in Missouri to limit the outbreak of Hepatitis C among drug users, is currently pending.
The opioid epidemic is spreading fast throughout Missouri, and Southeast Missouri is the most at risk.