Across our state we face a prescription drug abuse epidemic, with 40 percent of Arkansas teens reporting that they have tried prescription drugs. I have made it my mission to bring critical, life-saving prescription drug abuse prevention education to high schools across Arkansas, all at no cost to schools.
Prescription for Life is an interactive course powered by EVERFI that empowers high school students with the skills and knowledge they need to make safe and healthy decisions about prescription drugs, using an evidence-based, public health approach. Video, animations, simulations, and rich interactivity provide a personalized, highly engaging learning experience for students.
With the help of teachers, school district leaders, and home-school networks, we have the opportunity to deliver this cutting-edge program to our youth and secure the safety and wellbeing of Arkansas’ future.
Thank you for taking part in this program to keep Arkansas students safe!
Drugs have inflicted a deep wound on our society and ensnared many people in their web.
-Pope Francis, Vatican Conference on Narcotics, November 2016.
In 2015 alone, more than 52,000 people died of a drug overdose in the United States, the majority of them (more than 33,000) from opioids.i Each day we are losing more than 91 Americans to opioid overdoses – and millions more are struggling with opioid addiction and suffering the consequences.
As a faith-based or community organization you are an instrumental partner in addressing and preventing public health issues. This e-toolkit from the U.S. Department of Health and Human Services Center for Faith-based and Neighborhood Partnerships outlines ways in which you and your community can support prevention efforts and reduce risk, provide support to those in and seeking recovery to save lives and prevent future generations from harm.
Here are a few practical ways your community may consider bringing hope and healing to those in need:
We hope this toolkit is helpful to jump-start or advance your efforts to usher in a culture of compassion toward those struggling with addiction and its often severe consequences. We are grateful for your partnership.
Opiate addiction not only promotes isolation it makes it preferable. Heroin’s isolation needs community response.
Sam Quinones – Author of DREAMLAND
“When I meet a Jewish person who is in active addiction, I do not offer them to go synagogue and pray. The first place I’m going to send them is to the appropriate 12-step group.” – Rabbi Taub
Finding a supportive community is essential to ongoing recovery. The process of recovery is supported through relationships and social networks. Communities can offer to host programs like Alcoholics Anonymous, Narcotics Anonymous, Celebrate Recovery, or other self-help support group. Programs like these help diminish the isolation suffered by those with addiction, connects them to others in recovery, and support those receiving medication-assisted treatment (MAT) as part of their recovery.
* Offer your space for weekly recovery programs and/or self-help support groups for people with addiction or for their families needingsupport.
* Boldly post your recovery program or self-help support group schedule. List them on United Way’s 211, or Drug Abuse.com. Let people know your community is supportive and committed to recovery.
* Drive members of the community who lack access to transportation to treatment and recovery support services programs.
* Be a resource and connect people to the help they need. Create an easy to access resource center or a “wall” on your Facebook page with information that might include:** Local AA or NA Meetings** Local Al-Anon Meetings and Alateen Meetings** Substance Abuse and Mental Health Services Administration (SAMHSA)’s Behavioral Health Treatment Services Locator.
** SAMHSA’s National Helpline (800)-662- HELP (4357) or 1-800-487-4889 (TTY). Free and confidential/help in English and Spanish 24/7.
* When offering public or congregational prayer, particularly prayers for the sick, please pray for people who suffer from addiction/opioid use disorder.
Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs.-National Institute on Drug Abuse
Community members need to understand addiction in order to create a culture of acceptance and support. Once addiction is understood as a chronic disease condition, not a personal failing, stigma and shame can be replaced by compassion and hope.
As a pastor in West Virginia noted, “Churches are not neutral bystanders: what they don’t say is just as important as what they do say.”
Your community can partner with your local public health office, hospitals, community health centers, or nonprofit service organizations to host educational events on:
* Medication-Assisted Treatment (MAT): Encourage discussions and training around evidence based medication- assisted treatment for opioid addiction.
* Pain Management: Being a knowledgeable consumer is important. Know to ask: Is that an opioid? Is it necessary? Are there alternatives such as non-medication pain relief or self-management programs for my pain?
* Adverse Childhood Experiences (ACEs)/Trauma Informed Approaches: Early stressful or traumatic events increase risk for substance abuse, can challenge recovery efforts, and underscore the importance of prevention like supporting youth and strengthening families.
* Safe Drug Disposal: 50.5 percent of those who abused prescription painkillers obtained them from friends or family.x Learning about and promoting safe drug disposal sites can raise awareness and reduce the supply of opioids getting into the wrong hands.
* Good Samaritan Laws: Invite local law enforcement officials to talk about the laws in your state that may protect those providing and calling forhelp.
90 percent of Americans struggling with addiction are not currently getting treatment. Making sure they get it can make a huge difference.
-HHS Secretary Tom Price,M.D.
Being able to refer people to the right treatment at the right time and help navigate systems of care will save lives. Across the country lay leaders in faith and community organizations are being trained to make referrals to treatment, respond in an emergency, and provide on-going support groups for those in recovery and living with addiction.
Your community can partner with local public health offices, treatment facilities, hospitals, community health centers or nonprofit service providers to deliver capacity-building trainings which might include:
* Motivational Interviewing: A counseling approach that seeks to facilitate and strengthen an individual’s motivation to change their drinking or other behavior by aligning the change in behavior with their life goals.
* Emergency Response: Recognizing overdoses symptoms and administering naloxone (an opioid overdose reversing drug that is pulling thousands of Americans from the brink of death.)
* Peer Recovery Models: By sharing their experiences, peers bring hope to people in recovery and promote a sense of belonging within the community.
* Mental Health First Aid: Courses that gives people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis.
Drug addiction makes it hard to function in daily life. It affects how you act with your family, at work, and in the community. It is hard to change so many things at once and not fall back into old habits. Recovery from addiction is a lifelong effort.
The lives of individuals and their families can be dramatically altered and too often destroyed by addiction. Faith and community organizations are poised to support what SAMHSA identifies as the four major dimensions that support a life in recovery :
Health: Overcoming or managing one’s disease(s) or symptoms
Home: Having a stable and safe place to live
Purpose: Conducting meaningful daily activities (job, family caretaking, and resources to participate in society,etc.)
Community: Having relationships and social networks that provide support, friendship, love, and hope
Your community can restore these life-giving essentials by:
* Providing help with employment readiness, housing, transportation, food, clothing, or child care and support for recovering persons and their families as they overcome the consequences of addiction.
* Designating a community leader to connect people to essential services through a created database or United Way 2.1.1.
* Offering life readiness and coaching programs for reentering formerly incarcerated citizens.
* Coaching families on financial management.
Close to 45% of high school seniors use marijuana daily, and 28 percent of youth have tried cigarettes by 12th grade. In addition, alcohol remains the most widely used drug by today’s teenagers. But did you know that prescription medications are some of the most commonly misused drugs by teens, after tobacco, alcohol and marijuana?Communities may also consider targeting some of their efforts on youth not only because the path of experimental substance use may lead to life changing and potentially devastating consequences but also because young people may be suffering in homes where addiction is present.
Exposure to early adversity, including child abuse and neglect, mental illness and substance abuse in the household, can contribute to poorer health outcomes and fewer life opportunities. ACEs have been associated with risky health behaviors, chronic health conditions, mental health problems, and life opportunities that include high school non-completion, unemployment, and poverty. In addition, those with a history of child abuse and neglect are 1.5 times more likely to use illicit drugs in middle adulthood.
Consider offering programs and services that support families and empower youth that:
* Focus on prevention and offer positive parenting programs and programs that support strong relationships and families.
* Offer mentoring programs to support children of parents in active addiction.
* Gather resources, donate clothing items and necessities like cribs and car seats, and provide support for local foster families as they meet the needs of foster children.
* Host a faith-based recovery or support program such as The Landing, or Teen Challenge USA,or similar programs for young people.
* Help ensure that all children and youth have access to safe, stable, nurturing relationships and environments so that all people can reach their full life potential.
No single organization or person can address the multitude of services needed to help people affected by mental health or substance use conditions… the best sources are the people who live, serve, and work in the community and the best results are often seen when they undertake such action together. – SAMHSA One Voice, One CommunityAcross the country treatment professionals, law enforcement, faith communities, service providers, the courts, schools, city and health recreation centers, media, business, policymakers, families and youth leaders are coordinating their efforts to serve those struggling with addiction.
* Lend your organization’s health “assets” to the effort. Whether you have space for a support group to meet, can hold educational forums, coordinate volunteers to help transport people to treatment and recovery support services or help with job interviews, your community’s contribution is an essential piece to the whole effort.
** National Prevention Week, May 13-19, 2018. Annual health observance dedicated to increasing public awareness of, and action around, mental and/or substance use disorders.
LITTLE ROCK – Arkansas Attorney General Leslie Rutledge has joined with three other states and the District of Columbia in filing a lawsuit in federal court alleging that six generic drug makers, including Aurobindo Pharma USA Inc., Citron Pharma LLC, Heritage Pharmaceuticals Inc., Mayne Pharma (USA) Inc., Mylan Pharmaceuticals Inc. and Teva Pharmaceuticals USA Inc., entered into unlawful agreements in order to restrain trade, artificially inflate and manipulate prices and reduce competition throughout the country for two generic drugs.
“The dishonest actions of these drug manufacturers not only disrupts the marketplace but harms patients,” said Attorney General Rutledge. “Arkansans who need access to these life-saving medications deserve an honest deal – something these drug makers failed to do.”
In July 2014, Connecticut initiated an investigation regarding suspicious price increases of certain generic pharmaceuticals. The investigation, which is still ongoing as to a number of additional generic drugs, generic drug companies and key executives, uncovered evidence of a well-coordinated and long-running conspiracy to fix prices and allocate markets for doxycycline hyclate delayed release (an antibiotic) and glyburide (an oral diabetes medication).
Today’s complaint alleges that the defendants routinely coordinated their schemes through direct interaction with their competitors at industry trade shows, customer conferences and other events, as well as through direct email, phone and text message communication. The alleged anticompetitive conduct – including efforts to fix and maintain prices, allocate markets and otherwise thwart competition – caused significant, harmful and continuing effects in the country’s health care system.
The states further allege that the drug companies knew that their conduct was illegal and made efforts to avoid communicating with each other in writing or, in some instances, to delete written communication after becoming aware of the investigation.
The states are asking the court to enjoin the companies from engaging in illegal, anticompetitive behavior and for equitable relief, including substantial financial relief, to address the violations of law and restore competition.
The lawsuit was filed under seal in the U.S. District Court for the District of Connecticut. Portions of the complaint are redacted in order to avoid compromising the ongoing investigation. In addition to Rutledge, the four others filing suit are the District of Columbia, Missouri, New Mexico and Virginia.
Forty other states have filed separately bringing the total number of states involved in litigation against these companies to forty-four.
Arkansas Attorney General Leslie Rutledge announced today at the Arkansas Sheriffs’ Association meeting in Rogers a first-in-the-nation education initiative called “Prescription for Life” featuring a digital platform to be offered at no cost to all high school students in the State to help them understand the dangers of prescription drug misuse and how to prevent abuse.
“Talking about the harmful impact of prescription drug abuse with children and teenagers can no longer be a goal. It has to be a reality,” said Attorney General Rutledge. “Arkansas ranks first in the nation for ages 12 to 17 in misuse of painkillers. Reversing this trend is a top priority of mine. Prescription for Life will be available to every high school student in Arkansas beginning this fall.”
Prescription for Life will come at no cost to participating schools. Using an evidence-based public health approach, the digital course will empower high school students with the skills and knowledge they need to make safe and healthy decisions about prescription drugs. The course will be aligned with the Centers for Disease Control’s National Health Education Standards and State academic standards.
The self-paced modular course will use video, animations, simulations and interactivity to deliver a personalized, self-guided learning experience. The real-life simulations will demonstrate the impact misuse can have on students’ physical and mental health, relationships and future goals while the scenario-based exercises will help students practice how to support other students in their choices regarding the safe use of prescription drugs.
Educator trainings will be hosted to ensure effective classroom integration and pre- and post-assessments will be used to measure changes in students attitudes and behavior. Educators from the Attorney General’s office will conduct teacher in-service trainings in person and through webcasts and give presentations to parent and community groups throughout the State about how to talk with young people about risks associated with opioid use and how to recognize signs that their loved ones are abusing drugs.
Rutledge has been meeting with families in recent weeks who have lost loved ones to prescription drugs or have been deeply affected by this national epidemic. As she has listened to their stories, Rutledge asked them for feedback and shared her vision to make Prescription for Life available in Arkansas’s 298 public high schools. The program will also be offered to homeschool networks and to interested Arkansas parochial and private schools.
Scott Doerhoff, who lost his son, Will, to a prescription drug addiction and overdose last year said, “Initiating drug education in Arkansas high schools will create the opportunity for a new culture of awareness and safety for our kids and educate them on the life threatening risk of not only illegal substance abuse but also illicit prescription drug use which is often and extraneously, thought of as being a ‘safe’ way to use substances. The William Christian Doerhoff Memorial Foundation and Parent Advocacy Group applaud Arkansas Attorney General Leslie Rutledge and her staff for their commitment and leadership in protecting Arkansas children.
“The Arkansas Attorney General’s office and the Drug Enforcement Administration have joined forces to combat a growing epidemic of prescription opioid misuse and heroin use nationwide,” said Assistant Special Agent in Charge Matthew R. Barden. This important initiative is to educate students about the true impacts of opioids and kick-start lifesaving conversations in the home and classroom. DEA is committed to supporting all educational efforts that provide classroom resources and prevention tools to educators and parents that aim to introduce students to the science behind opioids and their impact on the brain and body.”
“Stemming the tide of the prescription drug abuse epidemic begins with education,” said ArkansasSurgeon General Greg Bledsoe. “Our people – particularly our young people – need to be aware of the high risks associated with prescription drug abuse. I applaud the work of Attorney General Rutledge in initiating this important educational project.”
“Education is critical to combatting prescription drug abuse,” Arkansas Department of Education Commissioner Johnny Key said. “This new program will complement the Arkansas School Health Services Initiative’s efforts to educate students about the harmful effects of prescription drug abuse. We welcome opportunities to partner together to find solutions for issues that affect schools, families and communities.”
“Prescription for Life is an innovative training concept designed to prepare our younger generations to keep their selves, friends, and communities safe from substance abuse,” said Arkansas State Drug Director designee and Benton Police Chief Kirk Lane. “Education and community involvement is the key to resolving the issues of substance use disorder.”
The new education curriculum will be added to the Attorney General’s already robust prescription drug abuse prevention initiative. During 2016, more than 330 pounds of prescription drugs were collected at Attorney General Mobile Offices across Arkansas and 145 pounds have been collected since the beginning of 2017. The sixth annual Prescription Drug Abuse Prevention Summit, hosted by Rutledge, is scheduled for Nov. 9 in Hot Springs with over 720 taking advantage of early bird registration.
Drug overdose deaths are on the rise in Arkansas, increasing from 287 in 2015 to 335 in 2016, according to data from the State Crime Lab. More than 40 percent of teenagers in Arkansas have tried prescription drugs and more than half of all teens report that it is easy to obtain prescription drugs from their parents’ or grandparents’ medicine cabinets. The U.S. Department of Health and Human Services reports that between 59,000 and 65,000 people died from drug overdoses in 2016, up from 52,404 in 2015 and double the death rate a decade ago. That is more than the number of deaths from car accidents in 2016. And according to the Centers for Disease Control, the majority of drug overdose deaths – six out of 10 – involve an opioid.
Find more information about the program and how to bring it to schools or other settings at ArkansasAG.gov.
Federal officials today announced charges against more than 400 individuals—including doctors, nurses, and licensed medical professionals—for their roles in fraud schemes involving about $1.3 billion in false Medicare billings.
The coordinated nationwide sweep by more than 1,000 law enforcement personnel—operating as part of the Medicare Fraud Strike Force—is the largest action to date. Of the 412 individuals charged, one in four cases involved opioid-related crimes, underscoring the scope of what federal officials are calling a drug-abuse epidemic that is killing approximately 91 Americans every day.
“It’s obvious to anyone who picks up a newspaper or turns on the news that the nation is in the midst of a crisis,” FBI Acting Director Andrew McCabe said at a July 13 press conference at the U.S. Department of Justice, where he joined Attorney General Jeff Sessions and the heads of the Department of Health and Human Services (HHS) and the Drug Enforcement Agency (DEA) in announcing the charges. “Opioid abuse destroys lives and it devastates families. This week, we arrested once-trusted doctors, pharmacists, and other medical professionals who were corrupted by greed. These people inflicted a special kind of damage.”
Additionally, HHS began suspending 295 providers—including doctors, nurses, and pharmacists—so they can no longer participate in federal health programs like Medicare, Medicaid, and TRICARE, a health insurance program for veterans and the military.
The takedown targeted schemes that billed the federal programs for medically unnecessary prescription drugs. It also focused on medical professionals who unlawfully distributed opioids and other prescription narcotics, thereby contributing to the opioid epidemic.
The charges—which span 41 federal districts—are the culmination of deep dives into the submissions and payment data at the federal health insurance programs, which can reveal trends and anomalies that investigators at the HHS Office of Inspector General (OIG) can then probe and send to federal, state, and local law enforcement partners to further investigate. In addition to more than 300 OIG agents, this year’s Medicare Fraud Strike Force action included 350 FBI personnel from 28 field offices. The FBI’s Health Care Fraud Unit started a Prescription Drug Initiative specifically to go after individuals who overprescribe opioids or seek to profit from illegally selling prescription narcotics.
According to the Government Accountability Office, fraud, waste, and abuse account for more than 10.8 percent of Medicare spending—or $75 billion annually.
“These people inflicted a special kind of damage.”
FBI Acting Director Andrew McCabe
“We will use every tool we have to stop criminals from exploiting the vulnerable people and stealing our hard-earned tax dollars,” said Attorney General Sessions. “We are sending a clear message to criminals across this country: We will find you. We will bring you to justice. And you will pay a very high price for what you have done.”
Officials laid out case examples to illustrate to scope of the alleged crimes, including:
* In Michigan, six physicians were charged with prescribing medically unnecessary controlled substances—some of which were sold on the street—and then billing Medicare for $164 million.
* In Palm Beach, Florida, the owner of an addiction treatment center was charged in a scheme to submit more than $58 million in fraudulent claims—a case that alleges kickbacks of gift cards, plane tickets, and trips to casinos and strip clubs.
* In Houston, a physician and pain management clinic owner who saw 60 to 70 clients a day allegedly issued medically unnecessary prescriptions for hydrocodone in exchange for $300 cash per visit.
“Their recklessness and their greed puts Americans at significant risk of addiction and death,” said Chuck Rosenberg, acting administrator at the DEA, who said four out of five new heroin users started with pain pills and about 600 new users take up heroin every day.
“With great privilege and great authority comes great responsibility to handle and prescribe controlled drugs lawfully, carefully, and thoughtfully,” Rosenberg said. “Where and when practitioners fail in that responsibility, we are going to hold them accountable.”
LITTLE ROCK – Governor Asa Hutchinson has announced Kirk Lane, Chief of Police for the Benton Police Department, as the new Arkansas Drug Director. Chief Lane will replace former Arkansas Drug Director Denny Altes, who resigned in May of this year.
Governor Hutchinson issued the following statement:
“Chief Lane’s extensive experience in law enforcement and his background with the FBI has well-equipped him to serve as the new Arkansas Drug Director. Chief Lane is a dedicated leader who has been a valuable asset to several Arkansas drug and alcohol boards and programs. I am confident that he will continue to do an outstanding job working to further alcohol- and drug-abuse prevention and treatment initiatives of our state.”
Chief Kirk Lane issued the following statement:
“This is a great opportunity to lead people in the same direction to prevent drug abuse and improve the quality of life for all Arkansas. My job is to encourage people to work together to resolve these issues, and I look forward to being a part of the Governor’s team in this effort.”
Chief Lane has served as chief of police for the Benton Police Department since 2009. Prior to serving in that role, Chief Lane spent more than 20 years with the Pulaski County Sheriff’s Office and served as captain of its Criminal Investigations Division for nearly a decade. He is a graduate of the Arkansas Law Enforcement Training Academy and the FBI National Academy.
Chief Lane has also served as a member of the Arkansas Drug and Alcohol Coordinating Council, the Arkansas Gulf Coast HITDA State Board, the Terrorism Task Force, the Arkansas Prescription Drug Advisory Board and the Arkansas Prescription Drug Monitoring Program.
Chief Lane has also received countless awards for his service including the Mayoral Distinguished Medal of Merit for Benton, 2010 Benton Citizen of the Year and the 2012 Marie Interfaith Award.
The U.S. Drug Enforcement Administration today launched CampusDrugPrevention.gov, a new website focused on preventing and addressing college drug use.
“We must talk to folks about the dangers and consequences of drug abuse, and base those conversations on facts and science,” said DEA Acting Administrator Chuck Rosenberg. “With this website, we put valuable information in the hands of higher education leaders who can use it to enlighten, teach, and change the culture.”
This new website is DEA’s latest effort to support drug abuse prevention programs on college campuses and in surrounding communities. The website was created as a one-stop resource for professionals working to prevent drug abuse among college students, including educators, student health centers, and student affairs personnel. In addition, it serves as a useful tool for college students, parents, and others involved in campus communities.
CampusDrugPrevention.gov offers valuable information, including data, news updates, drug scheduling and penalties, publications, research, national and statewide conferences and events, state and local prevention contacts, and resources available from DEA’s federal partners. The website also includes a “Help a Friend” resource to educate and prepare those who plan to talk to their friends or loved ones about drug use concerns.
For more information and to receive updates on campus drug prevention efforts and resources, visit www.CampusDrugPrevention.gov.
*New data compiled from hundreds of health agencies reveals the extent of the drug overdose epidemic last year.
Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.
The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.
Although the data is preliminary, the Times’s best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.
Because drug deaths take a long time to certify, the Centers for Disease Control and Prevention will not be able to calculate final numbers until December. The Times compiled estimates for 2016 from hundreds of state health departments and county coroners and medical examiners. Together they represent data from states and counties that accounted for 76 percent of overdose deaths in 2015. They are a first look at the extent of the drug overdose epidemic last year, a detailed accounting of a modern plague.
The initial data points to large increases in drug overdose deaths in states along the East Coast, particularly Maryland, Florida, Pennsylvania and Maine. In Ohio, which filed a lawsuit last week accusing five drug companies of abetting the opioid epidemic, we estimate overdose deaths increased by more than 25 percent in 2016.
“Heroin is the devil’s drug, man. It is,” Cliff Parker said, sitting on a bench in Grace Park in Akron. Mr. Parker, 24, graduated from high school not too far from here, in nearby Copley, where he was a multisport athlete. In his senior year, he was a varsity wrestler and earned a scholarship to the University of Akron. Like his friends and teammates, he started using prescription painkillers at parties. It was fun, he said. By the time it stopped being fun, it was too late. Pills soon turned to heroin, and his life began slipping away from him.
Mr. Parker’s story is familiar in the Akron area. From a distance, it would be easy to paint Akron — “Rubber Capital of the World” — as a stereotypical example of Rust Belt decay. But that’s far from a complete picture. While manufacturing jobs have declined and the recovery from the 2008 recession has been slow, unemployment in Summit County, where Akron sits, is roughly in line with the United States as a whole. The Goodyear factories have been retooled into technology centers for research and polymer science. The city has begun to rebuild. But deaths from drug overdose here have skyrocketed.
In 2016, Summit County had 312 drug deaths, according to Gary Guenther, the county medical examiner’s chief investigator — a 46 percent increase from 2015 and more than triple the 99 cases that went through the medical examiner’s office just two years before. There were so many last year, Mr. Guenther said, that on three separate occasions the county had to request refrigerated trailers to store the bodies because they’d run out of space in the morgue.
It’s not unique to Akron. Coroners’ offices throughout the state are being overwhelmed.
In some Ohio counties, deaths from heroin have virtually disappeared. Instead, the culprit is fentanyl or one of its many analogs. In Montgomery County, home to Dayton, of the 100 drug overdose deaths recorded in January and February, only three people tested positive for heroin; 99 tested positive for fentanyl or an analog. Fentanyl isn’t new. But over the past three years, it has been popping up in drug seizures across the country.
Most of the time, it’s sold on the street as heroin, or drug traffickers use it to make cheap counterfeit prescription opioids. Fentanyls are showing up in cocaine as well, contributing to an increase in cocaine-related overdoses.
The most deadly of the fentanyl analogs is carfentanil, an elephant tranquilizer 5,000 times stronger than heroin. An amount smaller than a few grains of salt can be a lethal dose.
“July 5th, 2016 — that’s the day carfentanil hit the streets of Akron,” said Capt. Michael Shearer, the commander of the Narcotics Unit for the Akron Police Department. On that day, 17 people overdosed and one person died in a span of nine hours. Over the next six months, the county medical examiner recorded 140 overdose deaths of people testing positive for carfentanil. Just three years earlier, there were fewer than a hundred drug overdose deaths of any kind for the entire year.
This exponential growth in overdose deaths in 2016 didn’t extend to all parts of the country. In some states in the western half of the U.S., our data suggests deaths may have leveled off or even declined. According to Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, and an expert in heroin use in the United States, this geographic variation may reflect a historical divide in the nation’s heroin market between the powdered heroin generally found east of the Mississippi River and the Mexican black tar heroin found to the west.
This divide may have kept deaths down in the West for now, but according to Dr. Ciccarone, there is little evidence of differences in the severity of opioid addiction or heroin use. If drug traffickers begin to shift production and distribution in the West from black tar to powdered heroin in large quantities, fentanyl will most likely come along with it, and deaths will rise.
First responders are finding that, with fentanyl and carfentanil, the overdoses can be so severe that multiple doses of naloxone — the anti-overdose medication that often goes by the brand name Narcan — are needed to pull people out. In Warren County in Ohio, Doyle Burke, the chief investigator at the county coroner’s office, has been watching the number of drug deaths rise as the effectiveness of Narcan falls. “E.M.S. crews are hitting them with 12, 13, 14 hits of Narcan with no effect,” said Mr. Burke, likening a shot of Narcan to “a squirt gun in a house fire.”
Early data from 2017 suggests that drug overdose deaths will continue to rise this year. It’s the only aspect of American health, said Dr. Tom Frieden, the former director of the C.D.C., that is getting significantly worse. Over two million Americans are estimated to be dependent on opioids, and an additional 95 million used prescription painkillers in the past year — more than used tobacco. “This epidemic, it’s got no face,” said Chris Eisele, the president of the Warren County Fire Chiefs’ Association and fire chief of Deerfield Township. The Narcotics Anonymous meetings here are populated by lawyers, accountants, young adults and teenagers who described comfortable middle-class upbringings.
Back in Akron, Mr. Parker has been clean for seven months, though he is still living on the streets. The ground of the park is littered with discarded needles, and many among the homeless here are current or former heroin users. Like most recovering from addiction, Mr. Parker needed several tries to get clean — six, by his count. The severity of opioid withdrawal means users rarely get clean unless they are determined and have treatment readily available. “No one wants their family to find them face down with a needle in their arm,” Mr. Parker said. “But no one stops until they’re ready.”
About the Data
Our count of drug overdoses for 2016 is an estimate. A precise number of drug overdose deaths will not be available until December.
As the chief of the Mortality Statistics Branch of the National Center for Health Statistics at the C.D.C., Robert Anderson oversees the collection and codification of the nation’s mortality data. He noted that toxicology results, which are necessary to assign a cause of death, can take three to six months or longer. “It’s frustrating, because we really do want to track this stuff,” he said, describing how timely data on cause of death would let public health workers allocate resources in the right places.
To come up with our count, we contacted state health departments in all 50 states, in addition to the District of Columbia, asking for their statistics on drug overdose deaths among residents. In states that didn’t have numbers available, we turned to county medical examiners and coroners’ offices. In some cases, partial results were extrapolated through the end of the year to get estimates for 2016.
While noting the difficulty of making predictions, Mr. Anderson reviewed The Times’s estimates and said they seemed reasonable. The overdose death rate reported by the N.C.H.S. provisional estimates for the first half of 2016 would imply a total of 59,779 overdose deaths, if the death rate remains flat through the second half of the year. Based on our reporting, we believe this rate increased.
While the process in each state varies slightly, death certificates are usually first filled out by a coroner, medical examiner or attending physician. These death certificates are then collected by state health departments and sent to the N.C.H.S., which assigns what’s called an ICD-10 code to each death. This code specifies the underlying cause of death, and it’s what determines whether a death is classified as a drug overdose.
Sometimes, the cases are straightforward; other times, it’s not so easy. The people in charge of coding each death — called nosologists — have to differentiate between deaths due to drug overdose and those due to the long-term effects of drug abuse, which get a different code. (There were 2,573 such deaths in 2015.) When alcohol and drugs are both present, they must specify which of the two was the underlying cause. If it’s alcohol, it’s not a “drug overdose” under the commonly used definition. Ideally, every medical examiner, coroner and attending physician would fill out death certificates with perfect consistency, but there are often variations from jurisdiction to jurisdiction that can introduce inconsistencies to the data.
These inconsistencies are part of the reason there is a delay in drug death reporting, and among the reasons we can still only estimate the number of drug overdoses in 2016. Since we compiled our data from state health departments and county coroners and medical examiners directly, the deaths have not yet been assigned ICD-10 codes by the N.C.H.S. — that is, the official underlying cause of death has not yet been categorized. In addition, the mortality data in official statistics focuses on deaths among residents. But county coroners typically count up whichever deaths come through their office, regardless of residency. When there were large discrepancies between the 2015 counts from the C.D.C. and the state or county, we used the percent change from 2015 to calculate our 2016 estimate.
We can say with confidence that drug deaths rose a great deal in 2016, but it is hard to say precisely how many died or in which places drug deaths rose most steeply. Because of the delay associated with toxicology reports and inconsistencies in the reported data, our exact estimate — 62,497 total drug overdose deaths — could vary from the true number by several thousand.
Overdose Free PA; coroners and medical examiners covering Allegheny, Bucks, Dauphin, Delaware, Erie, Lackawanna, Lancaster, Lehigh, Luzerne, Montgomery, Northampton, Philadelphia and York counties
West Virginia Department of Health and Human Resources
Wyoming
96
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In all cases, “cause of death” refers to what the National Center for Health Statistics classifies as the underlying, rather than the immediate, cause of death. Example: For a person who dies from an infection because of H.I.V., while the infection might be the immediate cause of the person’s death, the underlying cause would be H.I.V.
Deaths from car crashes include all deaths caused by motor vehicle accidents according to the N.C.H.S. Deaths from guns include homicides, suicides and accidental deaths from firearms, in addition to firearm deaths of undetermined intent. It excludes firearm deaths caused by legal intervention. Deaths from drug overdoses excludes deaths caused by substance use disorder or withdrawal, which accounted for an additional 2,573 deaths in 2015.
Definitions for causes of death can change slightly with each revision of the International Classification of Diseases. Where applicable, deaths counted under earlier editions of the I.C.D. were adjusted to correct for this.
The call came in at dinnertime: an 11-year-old girl, not breathing.
Pittsburgh paramedics with Medic 8 supposed the girl was choking on her food as they raced to the address in Beechview. But paramedics with Medic 2 got to the home first and sent out an update over the air: The girl showed telltale signs of heroin use. This was an overdose.
What followed was unique only because of the girl’s young age.
The paramedics gave the girl an adult dose of naloxone and revived her. The drug, often known by the trade name Narcan, blocks the effects of opioids, and can save patients from otherwise fatal overdoses, but also plunges patients into immediate physical withdrawal. The girl, like many heroin users, became combative and nonsensical when she was revived. Paramedics sedated her on the way to the hospital, and left her there in stable but critical condition.
This happens, on average, eight times a day in Pittsburgh. The call for an unconscious person, the Narcan, the anger and withdrawal is routine — so routine that it’s easier for paramedics to count days without overdoses than days with them.
The city’s paramedics are on the front line of the opioid epidemic, a growing wave of people abusing opioid drugs. In 2012, paramedics responded to about 900 calls for overdoses in the city; in 2016, it was 2,300. Pittsburgh EMS Chief Robert Farrow expects calls for overdoses to hit 3,000 this year.
The sheer volume takes both a practical and psychological toll on first responders. Paramedics save the same patients so many times that they know their first names, watch fathers perform CPR on sons and listen to children call out for unconscious, overdosing parents.
They see firsthand how addiction wears on family members, and witnessing that pain can be the hardest part of it all.
“It’s a living suicide,” Medic 2 crew chief Stacey Yaras said of addiction.
At 10:34 a.m. on Friday, EMS District Chief Jeff Meyer received a call for a man down, unconscious and not breathing, a suspected overdose.
He flipped on his truck’s red lights and sped to the home on Woodbourne Avenue in Brookline.
“This could be cardiac arrest, this could be dead or this could be a little Narcan goes a long way,” District Chief Meyer said on the way, laying on the horn as he escaped Downtown traffic.
When patients overdose on opioids, their breathing slows, they fall unconscious and then stop breathing altogether. The heart continues to beat for a few minutes, but the body soon runs out of oxygen, which leads to cardiac arrest.
The first step to saving an overdosing patient is to breathe for them.
But when District Chief Meyer reached the home on Woodbourne Avenue, there was no point.
Timothy Buehl, 25, was on the floor, curled up in the fetal position, surrounded by stamp bags. He’d been dead for hours.
District Chief Meyer made the official pronouncement.
A few minutes later on the front porch, the home’s owner, Thomas Alexander, watched a stream of investigators troop in and out: Pittsburgh police officers, detectives, a crime scene photographer. The Allegheny County Medical Examiner’s office was called to remove the body.
“I got up there and he was cold as ice,” Mr. Alexander said. “I reached down and felt his hand to do his pulse and it was freezing. I knew he was dead.”
He stared off, looked down at his hands. The 25-year-old man was just visiting the home, he said.
“He’s not a bad kid, he’s just a bad addict,” Mr. Alexander said. “He couldn’t stop.”
Many can’t.
“I’ve had the same guy overdose three times in three days,” said Jonathan Dalbey, a paramedic with Medic 2. “You go and take care of him one day, and then you take care of them the next. It’s sad because eventually they’re going to die.”
During 2016, 613 people died from overdoses in Allegheny County, compared with 424 in 2015, according to the medical examiner. In 2012, the county saw only 290 overdose deaths.
In Pittsburgh alone, at least 74 people have died from suspected overdoses so far this year, according to police, compared with 130 in all of 2016.
It’s relatively simple for a paramedic to save someone who is overdosing. Ten years ago, a heroin overdose call was a big deal, Mr. Dalbey and his crew chief, Jeff Reim, said.
“Now, it’s like a drill,” Mr. Reim said. “We could do it in our sleep.”
“I think my record is four back to back [overdose calls],” Mr. Dalbey said. “We know when a dealer hits an area because all the sudden you’ll have like eight overdoses within an hour.”
Overdoses are most often dispatched as top priority calls because they usually involve someone who is not breathing, paramedics said. That means a medic unit with an ambulance responds to the scene, as well as an EMS supervisor and rescue truck, a fire truck and multiple police units.
And when those first responders are at a heroin overdose, they can’t be at a car accident, for instance, or at a home where a woman is experiencing chest pain.
That’s true for any call, paramedics said, but overdoses strain the system because they happen simultaneously and frequently across the city.
“You might have four or five overdoses going on at one time, and you have med units out at each of those,” Mr. Dalbey said. “It’s rare that you would have multiple people having heart attacks at the same time. We have a limited number of ambulances, and as call volume goes up, response time goes up.”
Right now, EMS can keep up with overdoses and other medical calls, Chief Farrow said, although that could change if overdoses continue to skyrocket in coming years.
Other first response agencies have already made changes at their departments to adjust to the flood of opioid use. Allegheny County Police added eight detectives to their narcotics unit about a year ago, nearly doubling the unit’s size, Lt. Jeffrey Korczyk said.
Pittsburgh narcotics detectives now investigate overdose deaths, and most of their work these days is spurred by a death, rather than by citizen complaints, as it was in the past, Detective Calvin Kennedy said.
Police officers and firefighters carry naxolone in their vehicles.
For the time being, first responders are coping with the practical demands of the opioid crisis, officials said.
The psychological toll overdoses take on first responders themselves is perhaps more pressing, District Chief Mike Rogers said.
“Trucks we can replace,” he said. “It’s the wear and tear on the people.”
Nine times out of 10, patients saved from an overdose with naloxone aren’t happy to be saved, Mr. Dalbey said. Torn from their high and dumped into withdrawal — which feels like the flu on steroids, every cell hurts — overdose patients often lash out at paramedics, and it’s hard to constantly save patients who berate you afterward, paramedics said.
“You can only get screamed at for so long before you think, ‘Is this really worth it?’” Mr. Dalbey said.
And yet it always is, he and other paramedics said.
“It’s not our job to judge people,” Mr. Reim said. “Everybody deserves to be saved.”
Shelly Bradbury: 412-263-1999, [email protected] or follow on Twitter @ShellyBradbury.
and the District of Columbia in filing a lawsuit in federal court alleging that six generic drug makers, including Aurobindo Pharma USA Inc., Citron Pharma LLC, Heritage Pharmaceuticals Inc., Mayne Pharma (USA) Inc., Mylan Pharmaceuticals Inc. and Teva Pharmaceuticals USA Inc., entered into unlawful agreements in order to restrain trade, artificially inflate and manipulate prices and reduce competition throughout the country for two generic drugs.
understand the dangers of prescription drug misuse and how to prevent abuse.
