Sunday, January 22, 2017

Like a Broken (Drug Death) Record

Much has been written about opioids and overdose. If you are involved anywhere in workers' compensation, health care, or insurance you have heard of the American opioid epidemic. My thoughts on opioids are reasonably known from posts like Dying to me don't sound like all that much fun, and What Worthwhile Can You do in 11.2 Minutes. I have touched on formularies in A Florida Formulary, and prescription drug databases in If not, What is the Point. At the end of the day, I think too many Americans are dying from drug overdose. 

I felt that way in 2012 when the overall fatality rate was almost thirty-four thousand (22,134 prescription and 11,641 illicit)(all in this paragraph from I still felt that way when the rate increased in 2013 to almost thirty-eight thousand (22,767 prescription and 14,775 illicit). The sentiment continued and grew when the rate increased in 2014 to over forty-three thousand (25,760 prescription and 17,465 illicit). I wrote about it in 2015: 2015 Injury and Fatality Study is Interesting. A key point in that Study was that overdose death had "more than doubled in the last 14 years."

In 2015, a report concluded that the figures were even higher. That report claimed the total for 2013 "the most recent year for which data is available," the total was not thirty-eight thousand, but 46,471. It noted that this exceeded both the death rate for motor vehicle accidents (35,369) and firearms (33,636). We are approaching the time when overdose will kill more than these two combined (69,005= 35,369 + 33,636). The DEA Administrator was quoted that "drug abuse is ending too many lives while destroying families and communities.” You think? That 2013 total is like wiping out the entire town of Lakeland, Florida (according to one source). 

The American Society of Addiction Medicine says that in 2015, the death rate for drug overdose increased yet again, reaching 55,403! In 2012, they note that enough opioid scripts were written "to give every American adult their own bottle of pills."

There are some voices out there crying out for this to be addressed; kudos to Dori Meinert, Mark Pew, Peter Rousmaniere, Michael Gavin, and a handful of others. This subject is getting attention. But is it getting better?

Then some interesting stories caught my eye. 

In September, police responded to a call in Birmingham, Alabama and found a dead 30 year old male and an unresponsive 35 year old woman. These two overdosed and left their children "ages 7, 3, 2, and 1-month" to fend for themselves. 

In September, Police in Liverpool, Ohio stopped a car for erratic driving. Two adults had overdosed. A four year old was "restrained in a car seat." There was a story in October of a woman overdosed in the front seat of a van, "still holding a syringe in her left hand" in "rural Indiana." Both of these represent children comparatively lucky; they survived the behavior of those who were supposed to care for them. If a fatal vehicle accident had occurred, would those deaths be included as "overdose"? Not likely. 

But, in December, the Washington Post reported that 5 month old Summer Chambers passed in Johnstown, Pennsylvania. She was apparently the third person to die in her household. The District Attorney told a news conference that Summer's young parents apparently died of a drug overdose. The chemical of choice is suspected to be heroin. Summer will not be listed as a fatality of drug overdose, but she was. 

In January, Fox News reported that a ten-month-old was "exposed to fentanyl," which is an artificial opioid drug. This little fighter "had to be revived twice." She was taken by ambulance to one hospital and later airlifted to Tufts in Boston. The mayor of Methuen, Massachusetts said "the opioid epidemic knows no boundaries."

A news story in January caught the attention of the world as it was repeated, tweeted, and re-tweeted. A Florida Trooper happened upon a vehicle at the side of Interstate 4 close to Daytona Beach. Inside were three children from eight months to four years old according to CBS. They were reportedly watching a movie in the still-running vehicle. Their parents were dying beside the car. Presumptive evidence of drug use was found for one parent. Testing is pending, but what else explains two thirty-somethings getting out of the car on the Interstate and dying together?

According to Mothers Against Drunk Driving, the use of pharmaceuticals is staggering. A few points (all italics are direct quote):

About 4,000 drivers are killed each year with drugs in their systems. 

57% of fatally injured drivers had alcohol and/or other drugs in their system – 17% had both. 

Drugs other than alcohol (e.g., marijuana and cocaine) are involved in about 18% of motor vehicle driver deaths. 

More than 22% of drivers tested positive for illegal, prescription, or over-the-counter drugs in blood and/or oral fluid tests. 

In 2013, 9.9 million people (3.8% of the population) reported driving under the influence of illicit drugs. 

Over half of all drivers admitted to a level-1 trauma center for traffic crashes had drugs other than alcohol in their system.

The bottom line is that drugs are directly killing people, lots of people. The 2015 total 55,403 comes out to an overdose death about every 9.5 minutes, all day long. At current growth rates, drug overdose will overtake the combination of cars and guns soon. The rates are high enough today to merit listing in America's top ten. Why is not listed there today, with figures that exceed at least suicide (42,773) and nephritis (48,146). Overdose is closing in on influenza (55,227), diabetes (76,488), and Alzheimer's (93,541). 

The numbers are increasing, dramatically, annually. The probability is that there are other victims involved, through vehicle accidents, neglect or abandonment. And, (the real tradgedy in my opinion) it is likely among the most preventable on the list. 

Michael Gavin, President of Prium, posted Survey Says? We Still Have a Long Way to go on Opioids in December. He has a point, but he may be understating it. We have a long way to go on this entire drug abuse problem. It includes Opioids, but it is deeper and broader than that. People are dying. As we continue this upward spiral of death, I find myself wondering how many will die before we take it seriously. Or perhaps we collectively just do not care? Whose problem is it?

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