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Nebraska Officials Address Opioid Crisis at Conference 10/21/16  10/21/16 9:56:56 AM Printer Friendly VersionPrinter Friendly Version

U.S. Attorney Deborah R. Gilg, District of Nebraska, pauses for a moment with Nebraska Attorney General Doug Peterson at the multidisciplinary conference held in an effort to see the current opioid abuse epidemic as not only a crime issue, but as a public health issue.

A Dose of Reality
Nebraska Officials Address Opioid Crisis at Conference,
Emphasize Collaborative, Comprehensive Approach

Julien R. Fielding
The Daily Record

Opioid abuse is a public health concern; it’s a national epidemic, and everyone has been touched by it, said Dr. Jeffrey P. Gold, Chancellor at the University of Nebraska Medical Center, during his opening remarks last Friday at the conference, “Charting the Road to Recovery: Nebraska’s Response to Opioid Abuse.” The daylong event was held in the Michael F. Sorrell Center for Health Science Education on the UNMC campus.
Although Nebraska hasn’t experienced the same level of devastation, as has Ohio, Delaware, Indiana, or even Wisconsin, we have seen a “dramatic increase” in opioid-related problems. Legislative Bill 471, which was introduced by Sen. Sara Howard of Omaha, will take effect next year to close the loopholes in the state’s prescription drug monitoring program. With that, it’s clear the legal community, law enforcement, and the medical community are being proactive by coming together and looking for solutions.
“This is unprecedented,” said Deborah R. Gilg, U.S. Attorney, District of Nebraska. “We’ve never had such a gathering of law enforcement and the medical community. This was the missing piece needed for battling drug abuse. We need to become educated. More Americans die from drug overdose than from car accidents, and three out of five of these are opioid-related. This touches all of us. We want to get more people into treatment than into jail.”
Fifteen years ago, Gilg said that she believed the answer was to incarcerate; today, she has a very different view. “Once they are released, they come back to our communities. It affects not just individuals but their families. This isn’t just a law enforcement problem, but also one for the community. We have to join forces. I’m encouraged by this conference. We need to have a comprehensive plan.”

Brad Schimel
Wisconsin Attorn U.S. Attorney

Deborah R. Gilg, District of Nebraska, pauses for a moment with Nebraska Attorney General Doug Peterson at the multidisciplinary conference held in an effort to see the current opioid abuse epidemic as not only a crime issue, but as a public health issue. ey General
Douglas J. Peterson, Attorney General, State of Nebraska, agreed. “As we strengthen our prescription drug monitoring program, more people will have to go to the streets to get high. We are in a unique position to work together to stem the increase. I want to look back in five, 10, or 15 years, and say we got ahead of this,” he said.
Before delving into the three topic areas of prevention, legal and law enforcement issues, and treatment issues, the conference gave attendees, a “dose of reality” by screening the sobering FBI/DEA documentary, “Chasing the Dragon: The Life of an Opiate Addict.” Next, Wisconsin Attorney General Brad D. Schimel, who was elected Attorney General in 2014, took to the stage. He explained that “we can’t arrest our way out of this. It’s a problem that has hit every state differently.”
In Wisconsin, opioid addiction has hit very hard. The state ranks second in the nation of pharmacy robberies. “Only Indiana has more. We have more than California (ranked No. 3), Texas, and New York,” he said. “And that’s a crazy crime to commit. You aren’t getting away with it.”
According to the CDC, “more persons died from drug overdoses in the U.S. in 2014, than during any previous year on record. From 2000 to 2014, nearly 500,000 people died from drug overdoses. In 2014, there were approximately one and a half times more drug-overdose deaths than from deaths due to motor vehicle crashes. Opioids, primarily prescription pain relievers (oxycodone and hydrocodone) and heroin, are the main drugs associated with overdose deaths. In 2014, opioids were involved in nearly 29,000 deaths, or 61 percent of all overdose deaths; the rate of opioid overdoses has tripled since 2000.”
If we saw this sharp of an increase in traffic deaths, Schimel said, we would be doing everything and anything to stop it from happening; and yet, when it comes to drugs, we have been less forthcoming. In fact, we only really got “serious” about tackling our opioid addiction problem in recent years, he added.
Part of the problem is that many people believe the myths about prescription drugs more than they do the reality. For instance, many believe that painkillers are safe; that illicit drugs are more dangerous than prescription drugs. That’s simply not true, Schimel said.
“There are more deaths from prescription drugs than there are from heroin and cocaine combined. People aren’t afraid of prescription drugs. Most people get their drugs legally from a doctor. And about 70.8 percent got them or took them from a friend or relative. Young people from all walks of life are affected,” he explained.
Because there isn’t the same stigma attached to prescription drugs, and because they are readily available, young adults will sometimes engage in the “recreational use” of such drugs. Schimel told the audience about “Pharm Parties,” during which those attending throw “multi-colored pills into a bowl” and then take whatever they pull out. It’s a practice known as “Skittling,” and it can prove deadly.

“I’ve met over 500 parents who have buried their kids,” he said. “The opioid epidemic was my No. 1 issue when I became attorney general. The No. 1 cause of accidental death in Wisconsin is drug overdose.”
To make matters “worse,” the DEA has reduced the amount of almost every Schedule II opiate and opioid medication that may be manufactured in the U.S. in 2017 by 25 percent or more; so people will need another source of opiates, he explained.
“We have to be prepared for the coming storm. Once a person can no longer obtain prescribed opioids legally, they may turn to the streets – and street [prescription drugs] are expensive. The average price for OxyContin, for example, is about $1.15 per milligram. Compare that to heroin, which you can buy in some areas for less than a pack of cigarettes.
“Eighty percent of those who start abusing heroin, started on prescription painkillers,” he said.
According to the National Survey on Drug Use and Health, in 2012 nearly 670,000 Americans had used heroin in the previous year. Heroin is becoming more addictive, and more people are dying from it, because it is often “cut” with two very powerful drugs: Fentanyl, which is 80 to 100 times more potent than morphine, and Carfentanil, a synthetic opioid so strong “that just a few granules the size of grains of table salt can be lethal.”
“Every 40 years or so, we have a heroin epidemic in this country,” Schimel said. “But this is new. It has never been so pervasive before.” Heroin no longer comes primarily from Southeast Asia; it’s coming from Central America and Mexico, and it’s coming in in huge waves and in large quantities.
The purity level has also changed. In the 1980s, the purity was about 3 percent to 8 percent. In 2013, the purity was 26 percent. That said, the purity can change from day-to-day, and that, too, can prove deadly. It isn’t uncommon to find heroin with 67 percent purity. Even with that high of purity, the price is still relatively low, and has even dropped over the years. What used to cost $350 per gram can now be purchased at $150 per gram.
 It’s also much “easier” to get the drug into one’s body. Whereas one used to have to inject the drug, it can now be smoked, snorted or injected.
The increasing pervasiveness and ubiquity of opiates means fighting the drug problem has also become more complicated. Law enforcement used to be able to identify “drug houses” through observation, but the advent of the cell phone and internet have created a situation in which drug dealers – who are also not so easily identified anymore – can use one phone for two weeks, then get another phone and so on, essentially moving around and always staying one step ahead of the authorities.
Wisconsin does what it can to get prescription drugs out of the hands of the public. Like most states, they offer a “Take Back” prescription drug day, and it has been successful. In September 2014, they took back 34,000 pounds of prescription medications; in April 2016, they took in 64,247 pounds. The state is now ranked No. 3 in terms of how many prescription drugs it collects.
If the country can’t “arrest its way out of this,” then what can it do? Prevention is key. According to the Office of National Drug Control Policy, 1 in 4 parents (27 percent) believe that prescription and OTC medications are much safer to abuse than street drugs, and many teen-aged females see prescription pills as “cleaner” than other drugs. Considering such concerning statistics, it is vital to make the public aware of the dangers of prescription painkillers, and to offer incentives like drug take-back days or have medical return units available to get pharmaceuticals out of the hands of the people.
Law enforcement and the medical community need to forge partnerships to involve schools, Schimel continued. Instead of firing employees who have a drug problem, they should be offered a chance to get help.
“There is so much stigma attached to treatment; it’s seen as a moral weakness,” he said. And yet, drug treatment is more cost-effective than incarceration, and it can work.
“Drug treatment courts are smart, because people see the immediate consequences for their actions,” he added.
Legislation is also critical. According to the CDC, 36 states have operational Prescription Drug Monitoring Programs that track “the prescription and dispensing of controlled prescription drugs, monitor this information and provide a prescriber or pharmacist with critical information regarding a patient’s controlled-substance prescription history. It also provides information that can help prescribers and pharmacists identify high-risk patients who would benefit from early interventions.” Clearly legislators like State Sen. Sara Howard – who attended the conference – must agree that this kind of legislative intervention is key to winning the war on opioid addiction.
As Schimel pointed out, “We have to solve this as a nation.”
Handouts from the Conference are available at: https://www.unmc.edu/cce/handouts/opioid/index.html.
To watch the FBI documentary, “Chasing the Dragon: The Life of an Opiate Addict,” you may do so online at: https://www.fbi.gov/video-repository/newss-chasing-the-dragon-the-life-of-an-opiate-addict/view.

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