The Opioid Epidemic in Kentucky & The Suboxone Solution

Wednesday, July 10, 2019 | By Chris Clancy

the opioid epidemic in kentucky

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From prescription painkillers such as OxyContin and Vicodin to illicit opioids like heroin and opium, people of all walks of life are using, abusing, and becoming addicted to opioids. Opioid addiction is easily the epidemic of the decade, as no other drug has plagued the American public the way that opioids have.

The New York Times reported that at least 59,000 people died of drug overdoses in 2016, up 19 percent from the approximately 52,000 reported in 2015, amounting to the “largest annual jump ever recorded” in the U.S.

“The death count is the latest consequence of an escalating public health crisis: opioid addiction,” said the newspaper, adding that drug overdoses had become the leading cause of death among Americans under 50.

According to the Centers for Disease Control and Prevention, Kentucky is one of the top five deadliest states for drug overdoses, along with Pennsylvania, Ohio, West Virginia, and New Hampshire. The vast majority of overdose deaths across the U.S. involve opioids, including prescription painkillers, synthetic opioids like fentanyl, or heroin.

What are Opioids?

Sometimes called narcotics, opioids are medications prescribed by doctors to treat severe or chronic pain. They work by attaching to proteins in the brain called opioid receptors, which block pain messages from the body to the brain and can stimulate the reward centers of the brain, leading to feelings of euphoria.

Some of the types of prescribed opioids include codeine, fentanyl, hydrocodone, oxycodone, oxymorphone, and morphine. Heroin, meanwhile, is an illegal opioid drug made from the opium poppy plant.

Opioids and Overdose Deaths in the Bluegrass State

According to figures by the CDC and Prevention and the National Center for Health Statistics—Kentucky saw 1,565 drug overdose deaths in 2017. This represents a 10.3 percent increase from the 1,419 drug overdose deaths in 2016 and marks the fourth year in a row of increase in drug overdose deaths in Kentucky. 

Of the 1,566 drug overdose deaths in Kentucky in 2017, 1,160 involved opioids. Put another way, opioid-related overdose deaths make up three-quarters of all drug overdose deaths in the Bluegrass State. By contrast, methamphetamine accounted for 360 overdose deaths.

People who abuse prescription opioids run the significant risk of turning to heroin since in some communities it is easier to obtain than a new opioid prescription and it’s cheaper. For instance, an 80-milligram OxyContin pill costs anywhere from $60 to $100 on the street, while heroin costs about $9 per dose.

The data suggests as much: While the most commonly prescribed opioid painkiller—hydrocodone—has declined over the past couple of years, Kentucky has seen an uptick in drug overdose deaths involving heroin. Nearly half of the overdoses reported in Kentucky could be attributed to the synthetic opioid fentanyl, either by itself or in combination with illicitly obtained heroin. Fentanyl, a schedule II prescription drug that is mostly used during anesthesia or to manage pain after surgery, is 50 to 100 times stronger than morphine. Because of this potency, the risk of overdose by fentanyl is considerable.

When Did The Opioid Epidemic Start?     

We are currently living through our second opioid addiction crisis. The first epidemic occurred in the late 1800s, as the consumption of opioids—mostly commercially available patent medicines taken by middle-aged women and soldiers with chronic pain—rose nearly 550 percent between the mid-1840s and the mid-1890s, with nearly 500 opium addicts per 100,000 people at its height. 

This epidemic was ended by effective public health initiatives that solved the problem of painful abdominal issues like dysentery, the development of alternative painkillers like aspirin, and stricter regulations for prescribing doctors. Opioids did not again approach public threat levels until after the Vietnam War, when heroin saw increased use among inner-city populations.

The second, current opioid epidemic was put into motion in 1985, when the medical study, Chronic Use of Opioid Analgesics in Non-Malignant Pain: Report of 38 Cases, suggested that opioid pain relievers (OPR) could be prescribed safely on a long-term basis to patients with chronic, non-cancer pain. 

Despite the report’s low-quality evidence and problematic conclusions, it was regularly cited to support the prescribing of opioids. In fact, long-term clinical trials demonstrating the safety of OPRs have never been conducted.

The epidemic began in earnest in the late 1990s, when Purdue Pharma began funding more than 20,000 pain-related educational programs through either sponsorship or financial grants to encourage the use of opioids. Purdue also lent financial support to such powerful voices as the American Pain Society, the American Academy of Pain Medicine, and the Federation of State Medical Boards for their enthusiastic endorsement of opioids to treat pain.

Appalachia: Epicenter of an Epidemic

Kentucky’s experience with opioid use began earlier than in many states. In 2000, fewer than 10 counties in the U.S. had seen 20-plus deaths by overdose per 100,000 people; four of these counties were in Kentucky. By 2014, more than half of Kentucky’s 64 counties had overdose death rates of 20 or more among every 100,000 people.

Most of these opioid-ravaged counties are located in the eastern part of the state, also known as Central Appalachia. Central Appalachia quickly earned a reputation as the epicenter of the country’s opioid epidemic for a number of reasons.

The injuries suffered by coal miners and the physical demands placed on workers in the logging and trucking industries in Appalachia led to a strong demand for chronic pain treatments. (U.S. Department of Labor statistics for 2014 ranked Kentucky among 19 states with a recordable injury rate significantly higher than the national average.)

Another reason is that the region’s economic misfortunes have led to increasing unemployment numbers.

A third reason stems from the lax prescribing practices among doctors in the state, which led to communities getting flooded with illegal narcotics. They also led to the creation of “pill mills,” or operations in which doctors, clinics, or pharmacies prescribe opioids without a legitimate medical purpose. This threat was so specific to Appalachia that opioids became known as “hillbilly heroin.”

The rise of opioids in Appalachia was so swift that it has made methamphetamine—

once known as a scourge to thousands of people in the area—seem like a forgotten killer.

But while methamphetamine may have been left behind in Kentucky and surrounding states since the rise of opioids, it has surged in the Northwest and California. According to the National Institute on Drug Abuse, overdose deaths involving meth have skyrocketed from 1,378 in 2007 to 10,333 in 2017.

Solutions to the Opioid Epidemic; Kentucky Fights Back

Over the past two decades, lawmakers in Kentucky have passed measures to crack down on the opioid epidemic, and substance abuse in general. In 1998, the Bluegrass State became one of the first states to launch a prescription drug monitoring program, the Kentucky All Schedule Prescription Electronic Reporting (KASPER) System. KASPER monitors the medical use of controlled substances, including opioid painkillers. However, it was not until 2012 that lawmakers passed a bill requiring providers to use the KASPER system.

Since Kentucky expanded its Medicaid program under the 2010 Patient Protection and Affordable Care Act (ACA), resulting in roughly half a million new Medicaid enrollees, evidence suggests that access to substance abuse treatment has increased in Kentucky. 

In 2015, Kentucky passed Senate Bill 192, which funds substance use treatment programs and authorized the expanded use of naloxone, which treats opioid overdoses.

Buprenorphine Comes Along

Perhaps the best weapon against opioid addiction is contained in buprenorphine, a partial opioid agonist that can help people reduce or quit their use of opiates, such as pain relievers like morphine and heroin.

Approved in 2002 by the Food and Drug Administration (FDA) for clinical use, buprenorphine is the latest advance in Medication-Assisted Treatment (MAT). Used in combination with counseling and behavioral therapies, it provides a safe, effective, and comprehensive approach to the treatment of opioid addiction.

Under its KASPER system, Kentucky reports on a quarterly basis the number of buprenorphine doses dispensed. Since 2013, the number of buprenorphine doses dispensed has increased 73 percent, from around 2 million to 3.5 million. Part of this increase can be attributed to the fact that buprenorphine, which is covered under Kentucky’s Medicaid program, may be replacing methadone as the primary medication for opioid addiction.

Buprenorphine is the first medication to treat opioid dependency that can be prescribed or dispensed in a physician’s office, significantly increasing access.

As of 2019, the FDA has approved the following buprenorphine products:

  • Bunavail (buprenorphine and naloxone) buccal film
  • Suboxone (buprenorphine and naloxone) film
  • Zubsolv (buprenorphine and naloxone) sublingual tablets
  • Buprenorphine-containing transmucosal products for opioid dependency

Suboxone is the most common formulation of buprenorphine.

How Buprenorphine Works

An opioid partial agonist, buprenorphine has unique pharmacological properties that diminish the effects of a person’s physical dependency to opioids, reducing withdrawal symptoms and cravings. 

Like opioids, it produces effects such as euphoria or respiratory depression. However, these effects are weaker than those of full opiates such as heroin and methadone. Suboxone, in particular, both reduces the symptoms of withdrawal and prevents the feelings of euphoria that come with taking opioids.

Buprenorphine’s opioid effects increase with each dose until at moderate doses they level off, even with further dose increases. This “ceiling effect” lowers the risk of misuse, dependency, and side effects. Also, because of buprenorphine’s long-acting agent, many patients may not have to take it every day.

Unfortunately, buprenorphine’s side effects are similar to those of opioids:

  • Nausea, vomiting, and constipation
  • Muscle aches and cramps
  • Inability to sleep
  • Distress and irritability
  • Fever

JourneyPure and Suboxone

In late 2018, JourneyPure began allowing residential patients to take Suboxone as part of its Medication-Assisted Treatment (MAT) program. This was done upon the recommendation of Dr. Stephen Loyd, medical director for JourneyPure’s Middle Tennessee programs.

Since then, JourneyPure has made Suboxone available at all of its facilities, from its residential treatment centers like JourneyPure Bowling Green to its partial hospitalization (PHP) and outpatient programs.

When enrolled in our Suboxone treatment program, clients will see Suboxone in their everyday routines. We administer the drug to ensure it is taken as prescribed, which minimizes the risk of missing a dose.

As clients continue to take Suboxone, they will notice that their withdrawal symptoms are not unbearable and that their cravings can be managed. Since their complete attention will not be wrapped up in the physical components of ending opioid use, they can start to work with our therapists to identify, understand, and address the components of their addiction and its underlying causes. Through this combination of medication and therapy, clients are poised to succeed in their mission to get sober and stay that way.

Professional Suboxone Treatment is Just a Call Away

There is nothing to be ashamed of when you reach out for help. Opioid addiction is a scary disease that can turn you into someone that you do not even recognize. Do not let that continue. By calling our Suboxone treatment in Bowling Green, you can take back your life.

Get the Help You Deserve.

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