Health care, emergency responders and others examine opioid misuse
BRIDGEPORT — Opioids have been known about for centuries. People have used them since they began looking at ways to decrease pain.
Over the years, doctors have learned that opioids block the receptors in the brain where the brain feels pain and discomfort. One of the side effects of such medication is euphoria. The brain likes the way it feels and when that feeling goes away, there is a withdrawal.
“In some instances, there is a craving to get to that part again,” said Lisa Scheppers, chief medical officer at Regional West Health Services, during a recent panel on the dangers of opioids. “That’s when we get to the misuse or overuse.”
Panhandle organizations met on Sept. 21 for a panel to discuss the issue of opioids in the Panhandle and how they can help in their response. The Panhandle Prevention Coalition knows that, by partnering with law enforcement and fire departments to increase the availability of naloxone across the Panhandle, lives will be saved.
For many years, addictions, such as opioid addiction, were seen as a shortfall in a person’s moral character. Today, it is seen as a chronic illness. In the late 20th century, those in the medical field were taught opioids were good medications with no side effects. When someone was in pain, an opioid was prescribed because the view was that a patient shouldn’t be in pain. One of the results was an increase in prescriptions by providers.
RWHS staff have worked with the Panhandle Public Health District to focus on education and determine what the data was showing. Providers were educated on the effects of opioids. Nebraska changed how pain is treated and data began to be collected to determine how much medication was being prescribed. Armed with that information, agencies across the Panhandle began working together to respond to what was a growing problem in western Nebraska.
One measure to make sure patients are not over-prescribed opioids, includes the use of a contract patients sign when receiving pain medication.
“It heightens awareness that this is a serious thing you are doing,” said Kim Engel, director of PPHD, “There’s an increased awareness from the patient and provider side so people understand what might happen.”
Timothy Kotschwar, pharmacist at the Alliance Community Pharmacy, was trained in the 1980s when it was commonly taught that pain was being under-treated. Pain treatment needed to be more aggressive.
“It was beat into our heads that you can’t over-prescribe opioids if they (patients) have true pain,” Kotschwar said.
Kotschwar was in school right after barbiturates were determined to be bad and benzodiazepines were considered better than what had come before. In the 1990s, medications, such as oxycontin, took off. Representatives for drug makers made trips to visit doctors with offers that were hard to refuse.
“They pushed hard to get their drugs on the market and pushed that they were safer than what they really were,” Kotschwar said.
Magazine and television ads were everywhere.
“All of a sudden, people were being bombarded with ads,” Kotschwar said. “Their message was ‘Hey, if you have pain, go talk to your doctor.’”
The medical field changed, too. Mid-level practitioners were now able to prescribe opioids on a long-term basis. While we only see the opioid epidemic as something recent, Kotschwar said he has seen a steady increase from 1990 to 2016. The spike in deaths from 2012 to 2016 was when the general public took notice.
Today, new computer systems, such as the prescription drug monitoring program (PDMP), are online and health care professionals can see who is purchasing these drugs and how often.
“PDMP allows a doctor to get on the computer and see if a person is receiving multiple prescriptions,” Kotschwar said.
Nebraska began its program in 2017, but other states, such as Arizona, have had a system in place for two decades. The system has some minor annoyances that Kotschwar hopes can be fixed in the future. He would like it to be more user-friendly and be able to communicate with neighboring states.
There have been several positive changes to how opioid addiction is dealt with. This summer, the law changed, particularly toward how many pills can be prescribed to youth. Tabi Prochazka, health promotions coordinator with PPHD, has spoken with pharmacies to stock Narcan for people to purchase should they, or someone they live with, be addicted to or taking a prescribed opioid. Kotschwar encourages patients to have Narcan in their home for safety reasons. He dispensed 20 Narcan kits in August. It is being taken so seriously that Kotschwar is seeing some providers prescribing Narcan when they write the prescription for an opioid medication.
Meanwhile, the Nebraska State Patrol is seeing a shift in oxycontin use to fentanyl. Representatives from NSP Wing Task Force on the panel said they are also seeing an increase in heroin. This is due partly to the use of PDMP systems where doctor shopping is becoming more difficult, but not impossible. For example, the system may not show a flag that something is wrong even though a person may have purchased 300 pills yesterday and another 90 pills today. There is still a human factor that needs to recognize this is not normal.
Many first responders and law enforcement are already carrying Narcan/Naloxone. Prochazka is working to make sure all parties who may come across an overdose patient will have it.
“My priority by March 2019 is all law enforcement, first responders carry it and all schools have it,” Prochazka said.
Morrill County Sheriff Milo Cardenas said all of his deputies carry it because they don’t know what they will come across on duty.
“When we started noticing it last year and the year before, I bought one for each of my deputies,” Cardenas said. “It’s just a safety issue for all of us.”
For more information on the opioid state-targeted response efforts, visit http://www.pphd.org/Pages/opioid_response.htm.
Agencies working to address opioids in the Panhandle