By MARY SELL and CAROLINE BECK, Alabama Daily News
The number of total drug overdose-related deaths in Alabama may have declined in 2018, but still average more than two deaths per day as multiple state agencies battle an opioid epidemic.
Nationwide, total drug-related overdose deaths were down for the first time in decades, according to preliminary data from the Centers for Disease Control and Prevention. The numbers come with a caveat: they could increase when they’re finalized later in the year.
Meanwhile, capturing a complete picture of drug abuse has never been a perfect science.
“I am encouraged by these numbers and believe they are consistent with other sources of data that we have,” Alabama Health Officer Scott Harris told Alabama Daily News. “Nevertheless, we are aware that some big gaps remain in the information that we collect, and it is likely that all states are undercounting to some degree.”
Harris said the department continues to work with coroners, hospitals and medical providers in the state to ensure the most accurate information possible.
“Our efforts are hampered in Alabama by the high costs associated with toxicology studies that can show a definite cause of an overdose death,” Harris said. “These tests are often just not an option for coroners with limited budgets, and so causes of death can be presumed but may not be proven.”
The ADPH doesn’t yet have 2018 drug-related death statistics, but numbers through 2017 shown a growing problem.
- Of the 836 drug-overdose deaths in 2017, 50 percent involved opioids. The number of fentanyl-related deaths are climbing faster than any other drug illicit or prescribed drug, according to a recent ADPH report. Fentanyl was blamed for the most drug deaths in 2017 and 2016. Heroin topped the list in 2015 and 2014. In 2013, it was methadone.
- Harris said some of the fentanyl could be from prescriptions but law enforcement indicates most is a street drug imported from Mexico and China.
- Total drug overdose and opioid overdose rates had climbed in Alabama in recent years to averages of 17.1 and 8.6 per 100,000 people in 2017.
- Escambia, Etowah and Jefferson counties had the highest opioid overdose rates in 2017.
- Opioid-related deaths in 2017 were reported in among males in age ranges as young as 11 to 14 and as old as 75 to 84. The number of deaths is considerably higher among 15-54 year old males. In these age groups, twice as many males died from opioid-related overdose than females.
Harris said there have been attempts to put a price tag on the epidemic’s cost to Alabama, especially because of an ongoing lawsuit agains drugmakers, but solid numbers aren’t yet available.
Still, there are indicators, like the number of children now in foster care.
In 2006, 11.5 percent of children in foster care in Alabama were there because of parental drug abuse. In 2016, it was 37 percent. Last year, the number had jumped to 46 percent, according to the Alabama Department of Human Resources.
Prescriptions decline, but still higher than population
Asked if the opioid epidemic in Alabama is improving, Harris said there are no quick fixes.
“We know that Alabama still has a high-rate of opioid prescriptions,” he said. “They’re better than they were a few years ago.”
The latest CDC numbers still show more prescriptions written in the state than there are people — 107 prescriptions for every 100 residents in 2017.
Harris said there are caveats in that data too. Per the CDC, it doesn’t include mail-order prescriptions and is based off a sample of about 50,000 retail pharmacies, which dispense about 90% of all retail prescriptions. But, Harris said, the numbers are good for spotting trends.
In 2012, Walker County had a prescription rate of 335 per 100 people. By 2017 it was 216. Colbert County had a prescription rate of 186 per 100 residents in 2017, also a decline in recent years.
Prescriptions are often where people first encounter opioids. Lessening them means lessen the chance of addiction, Harris said.
U.S. County Prescribing Rates, 2017. More information available at https://www.cdc.gov/drugoverdose/maps/rxcounty2017.html.
Awareness and education
Alabama Attorney General Steve Marshall’s office is part of the Alabama Opioid Overdose and Addiction Council that last year published details how to tackle the opioid problem.
The council created a four-point action plan which includes prevention, intervention, treatment and recovery and community response.
“We have seen great progress in terms of raising awareness of the problem, and we continue to work to achieve each goal set out in that report,” Marshall told Alabama Daily News.
As a way to combat the state’s opioid abuse problem, Auburn University’s Harrison School of Pharmacy and the Alabama Department of Mental Health have created the Opioid Training Institute that is conducting ongoing training sessions throughout the state this summer to teach community members and health officials about how to fight the epidemic. There is one in Montgomery July 29.
Dr. Brent Fox is an associate professor with the Harrison School of Pharmacy and helped in designing the program that this year is focusing on outreach to leaders in the community.
“For community folks, we really want them to understand the problem,” Fox told Alabama Daily News. “I don’t know that your average community member has a real thorough understanding of what can lead to opioid abuse disorder and what they can do when they think they see it and what kind of resources are available in the state. They just don’t have that understanding yet, so we are trying to get that to community members across the state.”
The program is free to attend and they welcome any community member who wants to be more involved in stopping opioid abuse, especially religious leaders, teachers or school nurses, who have a wide-reaching influence in the community.
Beverly Johnson of the Alabama Department of Mental Health’s prevention and substance abuse division, said the institute is about education for community leaders, school officials and teachers, church leaders and others on knowing the signs and symptom of addiction.
“(And) what resources are available and how to obtain them,” Johnson said.
The ADMH oversees the state’s public substance abuse services delivery system and contracts with community based entities to offer outpatient and residential treatment services.
Using federal grant money, an additional 7,000 people have been reached for opioid treatment services, Johnson said, and the department has increased its medication-assisted treatment providers by 40 percent.
It’s also distributed 11,000 doses of naloxone, an opioid overdose reversal drug.
Fox says that he thinks the case can be made that the country overall is seeing some improvements in the problem with the decline of overall deaths, but that Alabama still has a way to go.
“Generally, Alabama as a state has had the highest rates in prescriptions of opioids out of all the states,” Fox said.
One of the Alabama Opioid Overdose and Addiction Council’s recommendations was improving and modernizing the state’s prescription drug monitoring program.
Lawsuit against drugmakers
Separate from the council’s plan, Marshall said his office continues to work its lawsuit against opioid manufacturers and distributors. Marshall filed a lawsuit last year against Purdue Pharma, one of the largest manufacturers of the opioid pain medications.
Alabama’s complaint states Purdue’s marketing of these drugs contributed to the creation of the opioid epidemic, which has caused a public health and safety crisis.
Currently there are more than 2,000 state, local and tribal governments suing members of the drug industry, according to the Associated Press, making it possibly the most complicated litigation of its kind ever in the U.S.
The drug companies have denied these claims saying they were just filling the needs of patients for pain relief, and that overprescribing doctors and pharmacies are the ones to blame for addicting their customers.
Fox said it’s hard to say why prescription rates in counties differ so much around the state and determining the exact reason why some less populous counties are seeing larger rates in opioid prescriptions than others is hard.
“I think you have to really get into the counties themselves to see what’s really going on and that’s what you almost have to do, get into the community and talk with people and go to the prescribers, go to the pharmacies and figure out what’s going on,” Fox said.
The program is hoping to do just that with upcoming training sessions in Montgomery, Auburn, Dothan and Mobile in the upcoming weeks.
For more on the institute, visit www.AlabamaOTI.org.
Alabama Daily News Reporter Caroline Beck contributed to this report.