Danielle McLaughlin: Opioid addiction America's indiscriminate killer
OPINION: Synthetic narcotics up to 50 times stronger than morphine are killing Americans in ever-increasing numbers.
This week in Centreville, Ohio, a couple was 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 nine 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 his wife Courtney, 36 and 34 respectively, 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 ground zero in America's opioid crisis. In 2014, it had the most opioid overdose deaths in the country, despite being the seventh-largest state, far behind population behemoths such as California, Texas, and New York.
Here in New York City, opioid abuse is also major public health problem. Deaths due to opioid overdose are three times the city's murder rate. And this number has skyrocketed in recent years due to Fentanyl – the drug that killed the Halyes – now one of a suite of illicit drugs easily available on the street. Before 2015, this synthetic opioid was involved in less than 5 per cent of overdose deaths in New York City. A year later, nearly 90 per cent percent of fatal opioid overdoses involved heroin or Fentanyl.
If Fentanyl is the skyrocket in this grisly new reality, prescription opioids are the milk bottle from which it launched. In the US, overdose deaths of opioid 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 to prevent misuse and addiction.
Although New Zealand has a relatively small problem with opioid addiction, it's worth noting a study in The Lancet published 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 to Denise Paone, Senior Director of Research and Surveillance at the New York City Department of Health and Mental Hygiene. I asked Paone 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". Paone's 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; that if an opioid is warranted, it should only be prescribed for acute pain for three days; to use the lowest possible effective dose; and to be wary of simultaneously prescribing drugs that would make fatal opioid overdose more likely.
In New Zealand, 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 City'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 of 54 per cent in hospital opioid prescriptions.
Although opioid addiction is a fairly stable public health issue at this moment, increased opioid prescriptions are a feature of New Zealand's healthcare landscape. To avoid a nightmarish escalation, it's worth bearing in mind Denise Paone's parting word to me. America's opioid epidemic doesn't discriminate by age or socioeconomic status, she explained, "it's risky drugs, not risky people".
Follow Danielle on Twitter: @MsDMcLaughlin
- Sunday Star Times