More than 245 million oxycodone and hydrocodone pills were prescribed to patients in Montana between 2006 and 2012. That's about 245 pills for every Montanan — not counting other opioids or illegally distributed opioids, such as fentanyl.
Opioid overdoses killed 100,000 Americans in a six-year period while hundreds of millions of prescriptions were written legally for this type of pain reliever. This data from the federal government released recently through Freedom of Information requests from the Washington Post newspaper opened a window on the opioid epidemic that has already shortened the life expectancy of the U.S. population.
The data allow readers to see how many opioid pills were dispensed in their county. The numbers from the Washington Post analysis are shocking: In some U.S. counties, an average of more than 200 opioid pills per year were dispensed legally for every man, woman and child living in that county.
Putting the numbers in context, Montana has an opioid problem, but the per person volume dispensed between 2006 and 2012 is significantly lower than in regions that have suffered the highest rate of opioid fatalities, places such as West Virginia and Kentucky.
In Montana, the Washington Post research indicates that Yellowstone County had an annual average of 38 pills distributed per person, about the same as Missoula County with 39 pills, but less than Custer County with 43 pills, Flathead County with 51 pills or Lincoln County with 61 pills.
The data only covers the two highest volume prescription opioids: hydrocodone and oxycodone, which accounted for 75 percent of all opioid pills shipped to U.S. pharmacies.
We don't know all the reasons why opioids — so far — have hit other regions harder than Montana. But methamphetamine remains the dominant drug of abuse resulting in crime and child neglect cases statewide. Alcohol and meth are the two most commonly abused drugs with opioids coming in at No. 3 and growing.
In Billings, health care leaders have been working to prevent opioid addiction for several years. Billings Clinic, St. Vincent Healthcare and RiverStone Health formed a task force to collaborate on best practices to prevent "doctor shopping" and over prescribing of opioids while still providing effective pain management. The family practice residency based at RiverStone and the internal medicine residency at Billings Clinic are teaching new doctors how to treat patients' pain with alternatives to opioids where appropriate. The three health care organizations continue to meet regularly to share information about their ongoing efforts, such as offering medication-assisted treatment for addiction.
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Dr. Michael Bush, chief medical officer for St. Vincent, started working in emergency medicine more than 30 years ago. "The biggest change over the years has been the number of people dying from unintentional opioid overdoses," Bush told The Gazette this week. "It's happening in Billings."
Bush changed his practice in recent years as medical literature established that patients can be at risk of opioid addiction even with short-term prescriptions. "If I prescribe opiates for three days and the patient takes them as prescribed, there is a 10 percent chance of addiction, according to national literature," he said.
St. Vincent now has protocols for all doctors and other professional who write prescriptions that generally limit the daily dosage of opioids and limit the prescription to five days, with exceptions for cancer treatment and some chronic conditions.
The new protocols have had an impact. "Year over year, our data shows decreased opioid prescriptions." Bush said. "We definitely are paying a lot more attention to opioids."
Montana has a chance of escaping the worst of the opioid epidemic — if health care providers, law enforcement and the public pay attention to these extremely addictive and lethal drugs. Public policies must:
- Encourage responsible prescribing.
- Make effective addiction treatment readily available.
- Provide emergency medication needed to respond to overdoses.
- Curtail illegal diversion of prescription drugs.
- Educate the public about the risks of opioids, both those prescribed and those illegally obtained.
Meth is tied to much of the crime in Yellowstone County and the majority of child neglect cases. If more people misuse opioids, we will have crime, child neglect and more overdose deaths.