By Melissa Patrick
Kentucky Health News
As national and state reports showed the number of deaths related to opioids may be at a plateau, or declining, President Donald Trump has signed a comprehensive, bipartisan opioid bill that includes both law-enforcement and public-health measures.
"Together we are going to end the scourge of drug addiction in America," Trump said Oct. 24. "We are either going to end it or we are going to make an extremely big dent in this terrible, terrible problem."
The Centers for Disease Control and Prevention's preliminary data shows that the 12 month period ending March 2018, the most recent data compiled, saw a decline of nearly 3 percent in the number of reported overdose deaths, to 68,690, when compared to the 12 month period ending November 2017, when the number of overdose deaths was at its highest ever, 70,780.
The same CDC report shows an even greater drop in Kentucky of 9.2 percent. In the 12-month period ending November 2017, Kentucky reported 1,594 overdose deaths -- also its peak-- and in the 12-month period ending in March of this year, it reported 1,446 deaths.
A preliminary report from the Kentucky Injury Prevention and Research Center also shows a drop in overdose deaths in Kentucky between the last quarter of 2017 and the first quarter of 2018, with declines in deaths involving fentanyl and heroin, but not in the number of deaths involving methamphetamine.
The provisional KIPRC data shows that between the fourth quarter of 2017 and the first quarter of 2018 the total number of overdose deaths dropped from 366 to 344; heroin related overdose deaths dropped from 57 to 44; fentanyl involved overdose deaths dropped from 187 to 180; and methamphetamine involved overdose deaths increased from 79 to 82.
In his prepared remarks for the Oct. 23 Milken Institute healthcare summit, the nation's top health official was cautiously optimistic about the CDC report and referred to the results as a plateau.
"Plateauing at such a high level is hardly an opportunity to declare victory," said Health and Human Services Secretary Alex Azar. "But the concerted efforts of communities across America are beginning to turn the tide."
Paige Winfield Cunningham of The Washington Post lists five measures of the opioid crisis:
1. Overdose deaths: While the new law and the CDC report offer a glimmer of hope, the grim reality is that in 2017 nearly 72,000 people died from an overdose death, and almost 50,000 of them were from opioids. In Kentucky, 1,565 people died from a drug overdose in 2017, an 11.5 percent increase from the prior year.
2. Number of opioid prescriptions: According to the CDC, opioid-prescription rates fell last year to the lowest level in a decade, 58.7 prescriptions per 100 people.
The firm IQVIA reported in August that there has been a 22 percent decrease in opioid prescriptions nationally between 2013 and 2017, but other studies don't show this decrease, Cunningham reports, noting a Mayo Clinic report in August that said little had changed in the past five years on the prescribing front. "Researchers found that while prescriptions seemed to be leveling off, they weren’t decreasing among most groups of patients," she writes.
The CDC report shows the number of opioid prescriptions dispensed in Kentucky is also dropping, but the state's rate is still higher than the national rate at its very highest in 2012 -- 81.3 prescriptions per 100 people. Kentucky's rate in 2017 was 86.9 prescriptions per 100. The peak in Kentucky was in 2011 at 137 per 100.
Between 2011 and 2016, 70 million fewer opioid prescriptions have been dispensed in Kentucky, according to a 2017 state report.
Toward the goal of decreasing opioid prescriptions, Kentucky passed a law in 2017 to limit most painkillers to a three-day supply for acute pain, but it also came with a long list of exemptions.
3. Prescribing rates for drugs that reverse overdoses or that are used in medication-assisted therapies for addiction: Azar said that since January 2017, the number of patients receiving buprenorphine and naltrexone, medications to treat opioid abuse, has increased by 21 percent and 47 percent, respectively. And the number of prescriptions dispensed monthly for naloxone, often sold under the brand name Narcan, has increased 368 percent.
In Kentucky, an Urban Institute analysis found that the number of annual units reimbursed by Medicaid for buprenorphine rose 382 percent from 2011 to 2017, from 2 million units to 9.8 million respectively. During that time, the number of annual naltrexone unites increased 502 percent, and naloxone jumped 709 percent. (The 2017 numbers are projected, meaning that they include data from only the first two quarters of the year, which have been extrapolated to an annual figure.)
The analysis shows the biggest jump in Kentucky's Medicaid reimbursements for all of these drugs happened between 2013 and 2014, when the the state expanded Medicaid to those earning up to 138 percent of the federal poverty level under the Patient Protection and Affordable Care Act. For example, the number of units of buprenorphine rose 108 percent, from 3.2 million units to 6.7 million units.
In 2015, Kentucky permits certified pharmacists to dispense naloxone under a physician-approved protocol. A map on KyStopOverdoses.ky.gov shows more than 372 pharmacies across the state that distribute Narcan and the interactive website allows a person to type in a ZIP code to find the closest location. Naloxone does not require prescription in Kentucky.
Dr. Michelle Lofwall, a University of Kentucky psychiatry professor and part of the College of Medicine Center on Drug and Alcohol Research, told the UK Board of Trustees Oct. 8, at a day-long meeting dedicated to opioids, that the need for medication-assisted treatments remains great.
She said only 20 percent of persons with opioid-use disorder get any sort of specialty addiction treatment and among those, only 37 percent receive these FDA-approved medications. She said the main reasons for this are stigma, discrimination and concerns about diversion of drugs to illegal use.
4. Number of babies born addicted to opioids (neonatal abstinence syndrome): Using its most recent statistics available, the CDC says the incidence of NAS increased about 400 percent nationally from 2000 to 2012.
"By 2012, on average, one NAS-affected infant was born every 25 minutes in the United States," says the CDC.
Kentucky saw a slight drop in the number of reported NAS babies in 2016 to 1257 from 1,354 in 2015, which amounts to about 100 per month, according to a state Department for Public Health report.
5. Fentanyl and heroin deaths: Fentanyl is a synthetic opioid that is at least 50 times stronger than heroin and is often mixed with other drugs. It is a leading cause of overdose deaths.
The provisional CDC data estimated there were more than 27,000 reported synthetic-opioid overdose deaths in the 12 months through September 2017 and nearly 29,000 such deaths in the 12 months through March 2018. Reported heroin-overdose deaths dropped from 15,983 to 14,964.
In Kentucky, fentanyl was involved in 52 percent of the state's 1,565 deaths in 2017, up from 47 percent in 2016, according to the annual Kentucky Office of Drug Control Policy report. About 22 percent of the deaths involved heroin, down from 34 percent in 2016.
Kentucky Health News
As national and state reports showed the number of deaths related to opioids may be at a plateau, or declining, President Donald Trump has signed a comprehensive, bipartisan opioid bill that includes both law-enforcement and public-health measures.
"Together we are going to end the scourge of drug addiction in America," Trump said Oct. 24. "We are either going to end it or we are going to make an extremely big dent in this terrible, terrible problem."
 |
| CDC graphic |
The same CDC report shows an even greater drop in Kentucky of 9.2 percent. In the 12-month period ending November 2017, Kentucky reported 1,594 overdose deaths -- also its peak-- and in the 12-month period ending in March of this year, it reported 1,446 deaths.
 |
| Kentucky Injury Prevention and Research Center graphic |
The provisional KIPRC data shows that between the fourth quarter of 2017 and the first quarter of 2018 the total number of overdose deaths dropped from 366 to 344; heroin related overdose deaths dropped from 57 to 44; fentanyl involved overdose deaths dropped from 187 to 180; and methamphetamine involved overdose deaths increased from 79 to 82.
In his prepared remarks for the Oct. 23 Milken Institute healthcare summit, the nation's top health official was cautiously optimistic about the CDC report and referred to the results as a plateau.
"Plateauing at such a high level is hardly an opportunity to declare victory," said Health and Human Services Secretary Alex Azar. "But the concerted efforts of communities across America are beginning to turn the tide."
Paige Winfield Cunningham of The Washington Post lists five measures of the opioid crisis:
1. Overdose deaths: While the new law and the CDC report offer a glimmer of hope, the grim reality is that in 2017 nearly 72,000 people died from an overdose death, and almost 50,000 of them were from opioids. In Kentucky, 1,565 people died from a drug overdose in 2017, an 11.5 percent increase from the prior year.
2. Number of opioid prescriptions: According to the CDC, opioid-prescription rates fell last year to the lowest level in a decade, 58.7 prescriptions per 100 people.
The firm IQVIA reported in August that there has been a 22 percent decrease in opioid prescriptions nationally between 2013 and 2017, but other studies don't show this decrease, Cunningham reports, noting a Mayo Clinic report in August that said little had changed in the past five years on the prescribing front. "Researchers found that while prescriptions seemed to be leveling off, they weren’t decreasing among most groups of patients," she writes.
 |
| CDC map shows ranges of opioid prescribing by state in 2017 |
Between 2011 and 2016, 70 million fewer opioid prescriptions have been dispensed in Kentucky, according to a 2017 state report.
Toward the goal of decreasing opioid prescriptions, Kentucky passed a law in 2017 to limit most painkillers to a three-day supply for acute pain, but it also came with a long list of exemptions.
3. Prescribing rates for drugs that reverse overdoses or that are used in medication-assisted therapies for addiction: Azar said that since January 2017, the number of patients receiving buprenorphine and naltrexone, medications to treat opioid abuse, has increased by 21 percent and 47 percent, respectively. And the number of prescriptions dispensed monthly for naloxone, often sold under the brand name Narcan, has increased 368 percent.
The analysis shows the biggest jump in Kentucky's Medicaid reimbursements for all of these drugs happened between 2013 and 2014, when the the state expanded Medicaid to those earning up to 138 percent of the federal poverty level under the Patient Protection and Affordable Care Act. For example, the number of units of buprenorphine rose 108 percent, from 3.2 million units to 6.7 million units.
In 2015, Kentucky permits certified pharmacists to dispense naloxone under a physician-approved protocol. A map on KyStopOverdoses.ky.gov shows more than 372 pharmacies across the state that distribute Narcan and the interactive website allows a person to type in a ZIP code to find the closest location. Naloxone does not require prescription in Kentucky.
Dr. Michelle Lofwall, a University of Kentucky psychiatry professor and part of the College of Medicine Center on Drug and Alcohol Research, told the UK Board of Trustees Oct. 8, at a day-long meeting dedicated to opioids, that the need for medication-assisted treatments remains great.
She said only 20 percent of persons with opioid-use disorder get any sort of specialty addiction treatment and among those, only 37 percent receive these FDA-approved medications. She said the main reasons for this are stigma, discrimination and concerns about diversion of drugs to illegal use.
4. Number of babies born addicted to opioids (neonatal abstinence syndrome): Using its most recent statistics available, the CDC says the incidence of NAS increased about 400 percent nationally from 2000 to 2012.
 |
| Kentucky Department of Public Health graphic |
Kentucky saw a slight drop in the number of reported NAS babies in 2016 to 1257 from 1,354 in 2015, which amounts to about 100 per month, according to a state Department for Public Health report.
5. Fentanyl and heroin deaths: Fentanyl is a synthetic opioid that is at least 50 times stronger than heroin and is often mixed with other drugs. It is a leading cause of overdose deaths.
The provisional CDC data estimated there were more than 27,000 reported synthetic-opioid overdose deaths in the 12 months through September 2017 and nearly 29,000 such deaths in the 12 months through March 2018. Reported heroin-overdose deaths dropped from 15,983 to 14,964.
In Kentucky, fentanyl was involved in 52 percent of the state's 1,565 deaths in 2017, up from 47 percent in 2016, according to the annual Kentucky Office of Drug Control Policy report. About 22 percent of the deaths involved heroin, down from 34 percent in 2016.
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