Lessons learned from opioid crisis
Synthetic narcotics up to 50 times stronger than morphine are killing Americans in everincreasing numbers.
This week in Centreville, Ohio, a couple were found by their four young children, dead in their bedroom. The transcript of the 911 call is heartbreaking. A young boy explains that his parents are ‘‘cold’’ and ‘‘not breathing’’. It sent shivers down this parent’s spine.
Those children, aged 9 to 13, expected a normal spring morning – breakfast and the school bus – but their parents never woke them for school. Instead, airline pilot Brian Halye and wife Courtney had overdosed during the night. Their poison? Heroin laced with Fentanyl, a synthetic opiate 50 times stronger than heroin and 100 times stronger than morphine.
Ohio has been called the ground zero in America’s opioid crisis. In 2014, it had the most overdose deaths in the country, despite being only the seventhlargest state.
Here in New York City, opioid abuse is also a major public health problem. Deaths due to overdose are three times the city’s murder rate. This number has skyrocketed in recent years due to Fentanyl becoming one of a suite of illicit drugs easily available on the street. Before 2015, it was involved in less than 5 per cent of overdose deaths. A year later, nearly 90 per cent of fatal opioid overdoses involved heroin or Fentanyl.
If Fentanyl is the skyrocket in this grisly new reality, prescription opioids are the bottle from which it was launched. In the US, overdose deaths of addicts whose gateway drug was a prescription opioid like Oxycodone or Vicodin have steadily increased over the past 40 years. A few decades ago, less than 5 per cent of addicts got hooked with a prescription opioid. Now it’s closer to 75 per cent.
In light of this, New York City Mayor Bill DeBlasio this month launched HealingNYC, an initiative to curtail the supply of opioids, assist with drug treatment, and prevent misuse and addiction.
Although New Zealand has a relatively small problem with opioid addiction, it’s worth noting a study published in The Lancet last year. It revealed that, worldwide, use of prescription opioids more than doubled between 2001-03 and 2011-13, and that the biggest increases were seen in the US, Europe, Australia and New Zealand.
I spoke this week with Denise Paone, senior director of research and surveillance at the New York City Department of Health and Mental Hygiene. I asked what New York City’s experience with opioids could teach Kiwis.
According to Paone, New York ‘‘wanted to address the opioid issue at a public health level’’, with a focus on addiction prevention. She called it ‘‘stopping new starts’’. Her team set out to target the supply side – all doctors prescribing opioids in the city’s five boroughs.
Paone’s team focused on four key messages with doctors: first, that they didn’t have to start with an opioid prescription for pain; second, that if an opioid is warranted, it should only be prescribed for acute pain for three days; third, to use the lowest possible effective dose; and fourth, to be wary of simultaneously prescribing drugs that would make a fatal opioid overdose more likely.
In New Zealand, Dr Peter Moodie led an opioid prescribing campaign in 2012 for the Capital & Coast District Health Board. The recommendations emanating out of that campaign echo those of New York’s, with the exception of a recommendation on co-prescriptions. In one year, it resulted in a 22 per cent decrease in GP opioid prescriptions and an average drop of 54 per cent in hospital prescriptions.
Although opioid addiction is a fairly stable public health issue at the moment, increased opioid prescriptions are a feature of New Zealand’s healthcare landscape. To avoid a nightmarish escalation, it’s worth bearing in mind Paone’s parting words to me. America’s opioid epidemic doesn’t discriminate by age or socioeconomic status, she said – ‘‘it’s risky drugs, not risky people’’.