Dr. Bill Gallea, head of the Emergency Room at St. Peter’s Hospital

Dr. Bill Gallea, head of the Emergency Room at St. Peter’s Hospital in Helena, talks about legislation Wednesday that passed to help increase access to naloxone, a drug used to reverse opioid overdoses and prevent death. His comments came during a press conference announcing the release of a report on opioid prescription rates. 

A new report released by the state health department Wednesday shows that Montana generally decreased its opioid prescription rate by 4% from 2012 to 2017.

The number of opioid deaths also fell from a peak in 2009 of 8.9 deaths per 100,000 people to 2.3 deaths per 100,000 in 2017.

The U.S. and Montana have long struggled with opioid use and abuse. Stigma around the drug stifles many necessary conversations, and what looks like over-prescribing to one doctor can be viewed as a necessary amount by another. The Centers for Disease Control has put out its own recommendations for prescription maximums, and the state for years has studied ways to help those who need pain relief use medications without crossing over into abuse disorders while seeking to keep the drug out of the hands of those to whom it wasn't prescribed.

Montana Gov. Steve Bullock said the decrease documented in the report came because the state got out in front of the issue early, with programs like prescription drug take-back events that started in 2010, increased drug drop-off locations and an expanded Medicaid program that started in 2016 and has extended substance use disorder treatment to more people around the state.

"Here in Montana we refuse to let the complexities or the challenges as an excuse for inaction," Bullock said Wednesday at a press conference. " ...  We really are ahead of the game in the area of prescription drug abuse compared to other states."

Other health care providers at the event cited efforts by health care providers partnering with the state to increase education about opioids, their proper use and how to help patients manage pain and avoid overdoses.

Dr. Bill Gallea, head of the emergency room at St. Peter’s Hospital in Helena, said legislation passed to help increase access to naloxone, a drug used to reverse opioid overdoses and prevent death, has also helped save lives around the state.

In 2019 so far, Gallea said the drug has been administered more than 500 times by first responders, or almost twice a day around the state. He also shared the story of using the drug to save the life of a 6-year-old who ate what he thought was candy but instead was an adult's opioid prescription left in a place the child could access.

Dr. Greg Holzman, the state Medicaid director, said Montana has made huge strides in bucking the national trend on opioid overdoses and over-prescription, but other substance use disorders, such as abuse of alcohol and methamphetamine, still plague the state.

Dr. Marc Mentell, Montana Medical Association president, said the use of heroin and illicit fentanyl are on the rise. Other states have struggled with abuse of those drugs increasing as they have restricted opioid access.

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Holzman said 475 deaths in the state each year are due to alcohol abuse. The number of deaths associated with meth overdose has increased from an average of eight a year in 2012-2014 to an average of 24 a year in 2015-2017. From 2011-2017, the number of meth-related crimes increased by 690%, according to the state health department.

Holzman said opioid prescriptions have dropped here but not at a rate fast enough that it's alarming.

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"This report is encouraging because we're seeing the overall number of opioid prescribing prescriptions going down, (but) not rapidly. And that's probably a good thing because we don't have any unintended consequences," Holzman said.

Mentell said providers in Montana are working slowly with patients on high opioid doses to lower them or to get patients off prescription opioids, because if the drug use is stopped abruptly that doesn't mean the demand goes away, and patients could turn to illicit drugs.

The number of patients on high and super-high doses of opioids also decreased by 35% and 40%, respectively, from 2012-2017.

"Montana health care providers and Montana health care systems are working hard to find that balance between the appropriate prescribing of these medications while simultaneously ensuring their patients are receiving the care that they need," Bullock said.

While a legislative audit released earlier this year raised concerns with the Montana Prescription Drug Registry used to collect data to produce the report, the state health department said Wednesday it was confident in the findings.

Since 2012, the registry has tracked information about controlled substances and Schedule II, III, IV and V drugs dispensed in Montana. All pharmacies holding an active Montana license have been required to report to it since it went into effect.

A bill passed in the 2019 Legislature requires those prescribing opioids to check with the registry to review a patient's previous similar prescriptions.