Ali Safawi: An epidemic mismanaged

Saturday, May 26, 2018 - 10:38am

In 2016, it was estimated that opioid overdoses killed more Americans than the Vietnam and Iraq wars combined.

To understand just how large of a problem opioids are in Michigan, one of the hardest-hit states in the country, you can go to the Michigan-OPEN website which keeps track of roughly how many opioid-related deaths occur each day. At the time of writing this column, the number stands at 115.

With hundreds of Michiganders dying of opioid overdose every week, you would think the state and local governments would have a pretty good handle on addressing this devastating public health crisis. While there are some effective government interventions available to help Michiganders struggling with opioid addiction, these efforts are not enough and the patchwork of policies and institutions  to address opioid addiction is a mess to navigate.

I have an internship at Workit Health this summer, a telehealth program that provides treatment for opioid addiction. Recently, our clinical operations manager and I sought to find a source of free naloxone kits for patients. Naloxone (brand name: Narcan) can reverse an opioid overdose and save someone’s life. It is available without a prescription at places like CVS Pharmacy; however, the cost of a Narcan kit for someone without health insurance is almost $100. In the emergency situation of an overdose, forcing a person’s friends or family to fork over $100 they may not have is both impractical and cruel. Access to free or reduced-cost naloxone kits is not only benevolent, but it also makes fiscal sense. According to a White House-commissioned report, the estimated cost of overdose deaths in 2015 was $431.7 billion. That comes out to be about $30,000 per death by overdose shouldered by taxpayers. But what did we find when we went in search of free affordable naloxone kits for those at incredible risk for death by overdose? A lot of headache and no naloxone.

First, we called the Washtenaw County Health Department and the Washtenaw County Sheriff’s Office. They told us there was a service to provide a free naloxone kit to those who survived an overdose but not for people who have yet to overdose. So much for prevention.

Then, we called our state representative’s office to see if their constituent services desk knew about the resource. The person on the line did not know any places to find free or reduced-cost naloxone kits but said they would look into it for us and call back. The staffer called back soon after, giving us two numbers we could call. We were excited to be on the right track— that is, until we called both numbers. They were disconnected.

If people with years of public health experience had to spend over an hour chasing leads just to end up empty-handed, imagine the obstacles someone struggling with opioid addiction would face trying to find help in Michigan.

Whether you think the government should provide free or reduced-cost naloxone kits or not, I hope we can all agree that the red tape and hurdles to accessing information, let alone goods and services, are ridiculous.

Last summer, I experienced another side of Michigan’s attempts to combat opioid addiction as a pharmacy technician at an independent pharmacy in Detroit. Towards the end of my time there, Michigan State Police raided the clinic of doctor Mohammad Durrani in Dearborn because he prescribed more than 500,000 pain pills between January and August 2017. The bust spooked the physician in the clinic attached to the pharmacy in which I worked. In a panic, the physician began to only write prescriptions for a seven-day supply of opioids and a referral to a pain management specialist regardless of circumstance. This physician had no real reason to be afraid of law enforcement or of losing his license, but his patients suffered, as they lamented to us at the pharmacy, because of their provider’s unnecessary, but understandable, panic.

I—and many people more educated and experienced in addiction care—worry that coming down hard on prescribers of opioids, either through the law or naturally within society, will limit  the flow of pain pills to patients who might genuinely need them (e.g. cancer patients) and risks needless suffering for patients. This may also push people from pain pills to heroin, which is much cheaper and easily accessible illicitly. Yes, opioids have been over-prescribed (there are more opioid prescriptions in Michigan than people). However, indiscriminately restricting access to opioids is not the answer. Medicine has come a long way in recognizing how to safely use pain pills and patients who need them should not be denied pain relief.

Finally, it is critical that government policy addresses treating patients addicted to pain pills or heroin as well as preventing deaths by overdose and addiction itself. Per Bridge magazine, Michigan is in the bottom 10 states for the ratio of the number of clinicians who can prescribe buprenorphine, a drug used to detox and treat someone with opioid addiction, and the number of deaths by overdose. Physicians, nurse practitioners and physician’s assistants can earn a waiver from the federal Drug Enforcement Agency under the Drug Addiction Treatment Act of 2000 to prescribe buprenorphine, commonly known as “bupe.” Why the waiver? Well, bupe is technically an opioid itself, and under the Harrison Act of 1914, it is illegal to prescribe opioids to opioid addicts. While the federal government should make it easier for clinicians to prescribe bupe, state and local governments should do more to encourage clinicians to earn the DATA 2000 waiver, especially in areas hard-hit by the opioid epidemic.

Michigan communities have been devastated by addiction to pain pills and heroin. At the very least, state government should create a central, well-advertised directory for Michiganders looking to locate resources like affordable naloxone kits. State policymakers should also explore policy to encourage more clinicians to treat addiction with buprenorphine and ensure that clinicians who are prescribing opioids properly are not afraid of arrest or loss of license.