An opioid crisis exists in Atlanta, and throughout the United States.
“The opioid crisis is really part of a larger problem that we Americans seem to have: an insatiable appetite for drugs,” said Dr. Gregg Raduka, director, prevention/intervention at the Council on Alcohol and Drugs based in Atlanta. “We’re approximately about 5 percent of the world’s population and we consume about 66 percent of the world’s drugs, according to the CDC.
“We go through various stages with that, in various decades, with various drugs of choice. Right now, it’s prescription drugs. And five years from now it may be something else.”
In April 2016, The Substance Abuse Research Alliance, a program of the Georgia Prevention Project, initiated a study with the goal of assisting the Georgia State Senate Study Committee on Opioids and Heroin in its work. It found that nationally, opioids were involved in 28,470 deaths in 2015. The number of prescriptions written for opioid analgesics has continued to increase. Misuse of prescription opioids, and heroin use, are also on the rise. In 2015, approximately 12.5 million Americans reported misusing pain relievers in the previous year and approximately 914,000 Americans reported use of heroin.
Opioids, primarily prescription pain relievers and heroin, are the main driver of drug overdose deaths. Of the 1,307 drug overdose deaths in 2015 in Georgia, 900, or 68 percent, were due to opioid overdoses, including heroin.
Prescription opioid overdose deaths in Georgia increased tenfold to 549 deaths, or a rate of 5.5 per 100,000 age-adjusted deaths, between 1999 and 2014. Georgia was among the top 11 states ranked by number of prescription opioid overdose deaths.
Access to opioid painkillers for those with legitimate need has suffered due to the opioid abuse problem.
“It’s sad to balance trying to crack down on the abuse of prescription drugs, while at the same time making sure that access is provided for those that need it,” Raduka said.
Dr. Carlton Buchanan, president of the medical staff, medical director and emergency physician at Gwinnett Medical Center, said he would give patients the benefit of the doubt before questioning whether they were a drug-seeker.
“If somebody fools me and gets an extra prescription that they shouldn’t have gotten, that’s a far less thing than me not giving adequate pain medicine to someone who needed it,” Buchanan said. “I would far rather err on that side.”
A handful of strategies have been adopted to address abuse.
“Number one, the prescription drug monitoring policy and the database that the state runs,” Buchanan said. “ER doctors wholeheartedly adopted using that early on. We look at that frequently, because it allows us to look at what other prescriptions patients have been prescribed, and where they come from. We’ve also decreased the amount of medications we’re giving. Typically, you’re now seeing prescriptions of no more than 10 or 12 pills of narcotics.”
Lynn Jackson, administrator, Northside Hospital Forsyth, said there is a “tremendous amount of pressure on healthcare providers as they work to find a way to strike a balance between undertreating acute or chronic pain and overprescribing opioids.”
“Pain is one of the most common reasons people seek medical care,” Jackson said. “Acute pain has been reported as a presenting symptom in over 80 percent of physician visit settings. The health care provider’s evaluation of a patient’s pain level is required to be addressed and reevaluated with prescribed frequency and the goal of alleviating patients’ pain whenever reasonable is a top priority. However, for many providers the emphasis in medical school, when learning about pain, often centered on aggressive use of pharmaceuticals and improving patient satisfaction.”
Raduka noted that the composite medical board “recently came out with regulations that would mandate training for physicians prescribing opioids.”
“That is a step in the right direction,” he said, “to make that kind of training mandatory. And the Medical Association of Georgia, through its foundation, the Medical Association of Georgia Foundation, has a ‘think about it’ campaign, which is trying to reduce prescription drug abuse in general. So, there are some things that are going on that are very worthwhile.”
Opioid abusers spill into the workplace, creating a need for employers to receive training.
“[Employers] need to get all the training they can,” said Raduka, touting the merits of the Council on Alcohol and Drugs’ drug-free workplace program for assistance in dealing with workers “who might be impaired because of taking opioids.”
Jackson said everyone can be a part of the solution.
“I would rather our community be known as one that worked together and made a dent in the tragic cycle of this crisis than one where death statistics continued to spiral out of control,” Jackson said. “Some community stakeholders don’t feel comfortable talking openly about this topic but through forums and summits of learning, with various methods of education pertaining to the opioid crisis, all levels can begin to identify and develop a multi-disciplinary approach to mitigate this crisis. Continuing to educate the public on the dangers of opioid addiction and increasing awareness of the signs and symptoms offers some measure of benefit.”