Why it’s so hard to break an opioid addiction
The landscape of fatal drug overdoses changed significantly in Kentucky between 2007 and 2016 as illegal diversion of prescription pills declined in some places but abuse of a powerful painkiller called fentanyl shot up in others, a new assessment tool shows.
Some counties in Eastern Kentucky, where abuse of prescription pills has long been a problem, saw big declines in average overdose death rates in the five-year period of 2012-2016 when compared to the 2007-2011 period.
In Johnson County, for instance, 64 people died from drug overdoses between 2007-2011, for an average death rate over the period of 90.2 people per 100,000 people ages 15 through 64, according to the assessment.
The number of deaths in the county dropped to 32 between 2012 and 2016, with a corresponding decline by half in the death rate, according to the assessment released by NORC at the University of Chicago, a non-partisan research organization, and the U.S. Department of Agriculture.
However, even with the drop in deaths in some places, the mortality rate statewide in Kentucky from drug overdoses went up from 29.6 per 100,000 people ages 15 to 64 in 2007-11 to 40.4 in 2012-16.
The rate in Kentucky in 2012-16, at nearly twice the national level of 22.5 deaths per 100,000 people, was the second-worst in the country, behind only neighboring West Virginia at 57.2.
“The continued increase is very, very striking,” said Michael Meit, who headed research on the assessment as co-director of NORC at the University of Chicago Walsh Center for Rural Health Analysis.
The mortality numbers could have been even higher in Kentucky and elsewhere in the nation because studies have shown that overdoses are under-reported, Meit said. It’s also likely that the mortality rate has worsened since 2016, Meit said.
The new assessment tool expands on one focused on Appalachia that was released earlier.
The upswing in deaths in Kentucky was driven by heroin and, increasingly since 2015, by fentanyl, a cheap, far more potent synthetic drug police say is often made in China and then mailed into the U.S. or smuggled in across the Southwest border.
Abuse of the two drugs has been more common in and near urban areas in Kentucky, and that shows up in the new report. Several of those counties had big increases in the overdose death rate between the two periods.
In Campbell County, for example, the death rate spiked from 38.4 per 100,000 in 2007-11 to 80.6 in 2012-16.
Death rates went up significantly in Boone, Kenton, Carroll, Gallatin and Grant counties in Northern Kentucky, and also in Jefferson County.
The rate in Fayette County nearly doubled, from 22.6 per 100,000 in 2007-11 to 40.6 in the next five-year period, according to the report.
The new assessment tool includes information on the relationship between overdose deaths and other factors such as poverty, disability rates and education levels.
The report uses average death rates over five-year periods to increase the number of counties with reliable information.
Researchers could not provide a death rate for counties with fewer than 10 overdose deaths in five years because that information is not public.
The goal of the report is to help policymakers and others figure out ways to tackle the epidemic of abuse and deaths from opioids — painkillers that account for most of the fatal overdoses in the country.
More than 72,000 people died from drug overdoses in 2017, and opioids accounted for 49,000 of the deaths, according to the U.S. Centers for Disease Control and Prevention.
Kentucky recorded an all-time high 1,565 overdose deaths in 2017.
Fentanyl was involved in 52 percent of the deaths, up from 47 percent the year before, according to the Kentucky Office of Drug Control Policy.
Drug traffickers often mix fentanyl with heroin or press it into pills that resemble less potent drugs, so users sometimes don’t know the strength of the dose they are getting. That has been a factor in overdose deaths, police say.
Authorities pointed to a measure that state lawmakers approved in 2012 as one key reason for the decline in overdose death rates in Eastern Kentucky.
The law toughened oversight of prescribing; made it mandatory for the ownership of pain clinics to include a licensed medical practitioner; and allowed for better coordination in investigations between health regulators and police, according to the Office of Drug Control Policy.
One goal was to try to shut down pill mills — clinics where health providers pumped out prescriptions for large amounts of pills, often without conducting real examinations and generally for cash. Many of the pills from those businesses ended up being sold on the black market.
More than 30 pain clinics shut down after the law took effect, most of them in the eastern end of the state, said Van Ingram, head of the Kentucky Office of Drug Control Policy.
“So almost immediately . . . there’s less pills on the street,” Ingram said.
Another factor is that heroin and fentanyl, the drugs driving up deaths in urban areas, aren’t having a similar affect in Eastern Kentucky because drug cartels don’t have the same reach into rural areas.
Wider availability of treatment for substance use disorder, including medication-assisted treatment using buprenorphine, which counters withdrawal symptoms, also has been a factor in the decline, Ingram said.
Clay County Coroner Danny Finley said drug investigations and efforts to boost awareness among prescribers and the public about the dangers of opioids and overprescribing also played a role in the drop in deaths.
The overdose death rate in Clay County dropped from 79.5 per 100,000 people in 2007-11 to 37.1 in 2012-16. (Few counties in Kentucky have a population of 100,000; researchers project a rate per 100,000 people in order to come up with a standard measure.)
“We’re just not prescribing in the numbers that we did in the past,” Finley said.
The number of opioid prescriptions in Kentucky declined from 371 million in 2011 to 284 million in 2017, Ingram said.
Local authorities said the decline in death rates in several Eastern Kentucky counties does not mean less drug abuse; rather, drug abusers appear to be using substances that don’t carry as much risk of death.
Brent Turner, the commonwealth’s attorney for Floyd County, said there’s a problem with illegal trafficking and abuse of methamphetamine and buprenorphine, often known by the trade name Suboxone.
“I sure don’t see it getting any better,” Turner said of drug abuse.
Finley, the Clay County coroner, said meth has become a bigger problem there as well.
“We took care of the opioid epidemic in certain areas, and now our problem is meth,” he said.