To say that opioid use and addiction have reached a crisis level is clearly an understatement. The carnage from opioid addiction, overdose and death, has crippled law enforcement, Child Protective Services, the coroner, the medical profession, EMS and the criminal justice system. The question then becomes, “How did we get here and how can we solve the problem?”
First, we need to change our cultural response to pain, and the medical profession needs to be a part of that change. Overprescribing of opioids by many well-meaning, and not so well-meaning, health care providers is widely blamed for starting the opioid crisis. It is estimated that the office closure of a local “pill mill” doctor who illegally prescribed pain medication created 10,000 addicts who are now in search of a way to satisfy their addiction.
Even when opioids are legally prescribed, there is no generally recognized protocol for how many pills should be prescribed or for what particular procedures.
New Hampshire is one state whose hospitals are suggesting that surgeons limit the prescription of narcotics to a specific number for only certain surgical procedures, and have based these suggestions on surveys of patients who underwent these surgeries. The response so far has been extremely encouraging. There has been a 53 percent drop in pills prescribed, and patients indicate that they don't even consume all of the pills given. This, combined with a more zealous policing of their own profession, would go a long way to decrease the number of addicted patients.
Next, we need to terminate needle/drug kit giveaway programs because while these programs may curb the spread of disease, they only further drug use, overdose and death. According to the 2016 Indiana Governor's Task Force Report, participants in the Scott County Needle Exchange Program reported injecting drugs more often, with the median injection frequency rising from five to nine times per day. This is an 80 percent increase. It would also imply that the opportunity to overdose increases with participants injecting more drugs, and that more drugs will need to be brought into the community to satisfy these cravings. The mixed message that it is appropriate for the government to hand out objects that are illegal for addicts to possess is completely inappropriate and has not reduced the number of addicts or increased the number of addicts getting treatment.
A recent Journal Gazette article indicates that only 10 percent of giveaway participants in Allen County have asked about substance abuse treatment programs and there is no indicator that they have ever followed through or obtained treatment. As our attorney general, Curtis Hill, has stated, “Needle giveaways only further trap addicts in the vicious cycle of opioid addiction. I don't want another Hoosier to die from their addiction, especially with a needle provided by the state of Indiana.”
Lastly, we need to increase penalties for those who sell poison to our citizens and ensure that addicts have access to rehabilitative treatment, whether sought voluntarily or through a court-supervised program, such as Drug Court. The Indiana legislature has recently passed bills closing loopholes that allowed heroin dealers to avoid the same penalties imposed on other serious felons, and hopefully this legislation will assist law enforcement in curtailing the supply of heroin on the streets.
At the same time we more zealously prosecute dealers, we are in desperate need of treatment options for addicts. The governor's report indicated that there are a total of 88 in-patient beds available for opioid addicts and that only five of the 25 treatment facilities in the state offer treatment for low-income individuals. As Indiana Medicaid does not provide direct reimbursement for residential treatment, I think it becomes clear that we are seriously deficient in what we have to provide to those who need help.
Rehabilitation help needs to be available to everyone, whether they can pay or not, in every community. In 2016 alone, Allen County suffered 804 overdoses and 68 overdose deaths. Unless we adopt a multi-faceted approach to this crisis, our citizens will continue to die at a rate that far surpasses the number of homicide and traffic deaths combined. If we fail to act, we will be complicit in the deaths of hundreds of our friends, family and fellow citizens.
Karen Richards is Allen County prosecutor.