Ferret out root causes of opioid epidemic

  • Photo

Locals gathered at diners and other venues, I thought, would be abuzz with news of a man who crashed into a parked semi-trailer only moments after injecting heroin. I was wrong.

The crash happened one sunny afternoon in Manchester, N.H., a town I was visiting for a work-related conference. When a 33-year-old man inexplicably drove his Chevy head-on into a parked truck, an eye witness came forward to say the driver had injected heroin before the incident. Both the driver and a 26-year-old male passenger were taken to a hospital with serious injuries, and the driver later was charged with operating while using. The driver of the truck was making a delivery at a nearby business and not present when the crash occurred.

I was gobsmacked by the news, both for the information it provided and what it didn’t. Did the driver actually shoot up heroin in public, in broad daylight, before hopping in his car and driving head-on into a very-hard-to-miss truck? It seems so. Figuring there was more to the story, I kept my ears open while visiting local establishments. But no one was talking about it.

I finally asked a convenience store clerk near the crash site if I’d heard the story correctly.

“Yeah,” he told me matter-of-factly. “Another one bites the dust.”

What I didn’t know at the time is that New Hampshire’s per capita drug overdose death rate is second only to West Virginia. The state also has the highest rate of fentanyl-related overdose deaths per capita. During this past June, the month I visited the Granite State, emergency responders in Manchester attended to 92 such incidents. Responders in Nashua, less than 20 miles south, saw 25 cases that month. In all, seven people died of drug overdoses.

Perhaps most shocking of all, yearly statistics for 2017 are below those of 2016. By this time last year the region had 360 overdose calls. That number was down to about 250 for the current year.

In a “Vital Signs” report on opioids released last week, the Centers for Disease Control and Prevention offers a look at prescribing rates by county. The map shows the correlations between Iowa and New Hampshire, with some very low-rate counties and others very high. Generally speaking, counties with predominantly white populations challenged by diabetes, arthritis or disability typically are those with higher prescribing rates. Toss in geographies with relatively high unemployment or lack of medical insurance and you’ll find counties with the most dense usage.

And, yes, the report indicates the national number of opioid prescriptions between 2010 and 2015 has decreased annually, if only slightly. Meanwhile drug overdoses remain the leading cause of accidental death nationwide, outpacing car accidents.

While opioid prescriptions have decreased in recent years, doctors continue to prescribe the drugs at rates three times higher than they did in 1999.

The U.S. prescription rate is four times higher than rates in Europe.

Prescriptions are measured by morphine milligram equivalents, which uses morphine as a baseline to measure the equivalent prescribed opioid, which may be more powerful. A small number of Iowa’s counties, all in the south-central portion of the state, have opioid prescription rates per person of at least 677 morphine milligram equivalents — some could be as high as 5,543 MMEs per person.

“The bottom line is, we still have too many people getting too many opioid prescriptions for too many days at too high a dosage,” said acting CDC Director Dr. Anne Schuchat.

When I began to dig deeper into the New Hampshire opioid problems, I came across a clip from MSNBC’s “All In With Chris Hayes” show featuring Sen. Maggie Hassan, D-N.H. She was reviewing the measures taken by the Trump administration’s opioid commission, such as deploying medications aimed at preventing overdose deaths. Hayes interrupted, “But drug deaths are continuing to rise.” Hassan paused, but otherwise continued as if nothing out of the ordinary had been announced.

But Hayes was right. As a New York Times report notes, drug deaths in the U.S. are rising faster than ever. Drug overdoses, according to the Times, now is the leading cause of death among Americans under 50. This is despite millions in supposed drug interventions, and ongoing fights about millions more that must be spent.

I remain disconcerted by the nonchalant-ness most people in New Hampshire attributed to the crash specifically and opioid overdoses generally. Even good reporting can lead to a desensitized public. And I’m worried as more stories of opioid addiction, accidents and deaths come to light, the less the public will care.

We appear caught in a cycle in which we say bad things about drugs, and tend to label addicts as medically diseased — a situation that could affect any one of us at any moment. I’m not sure all of that is true, because that narrative — the one that’s led us here and continues to fail us — omits the correlation between opioid addiction and social condition.

There is no mistake that social conditions — unemployment, disability, poverty — all contribute to the opioid epidemic. But rarely do we hear politicians discussing opioid use in such terms.

“Just Say No” didn’t work in the 1980s. It surely isn’t helping us now.

• Comments: @LyndaIowa, (319) 310-1038, lynda.waddington@thegazette.com

Like what you're reading?

We make it easy to stay connected:

to our email newsletters
Download our free apps

Give us feedback

Have you found an error or omission in our reporting? Tell us here.
Do you have a story idea we should look into? Tell us here.