TOPEKA — The opioid crisis is poised to become a Kansas problem, and leaders across the state must consider what can be done to address it now.
Sharp increases in deaths from opioid drug overdoses, including heroin, are hitting much of the country. Although Kansas has yet to see a strong impact, a Tuesday symposium about the opioid crisis organized by the Kansas Health Institute brought state and industry leaders together with one message: It’s coming.
“I don’t think we’re quite to the place yet where we recognize how bad this is going to be when it gets here,” said panelist Ed Klumpp, former Topeka Police Department chief and currently lobbying for the Kansas Association of Chiefs of Police. “But it’s coming. You could say the edge of the hurricane is hitting us right now, and the eye is on the way.”
Bob St. Peter, KHI president and CEO, agreed.
“The question for us is what can Kansas do, what will Kansas do to prepare and respond to what we know is coming,” he said. “We clearly already have a problem in our state, but is there something we can do to dampen that peak, that spike, that we know has been seen in so many other communities across the country.”
In 2015, 38,000 people died from motor vehicle accidents, 36,000 from guns and 52,000 from drug overdoses, St. Peter said.
Keynote speaker Dr. Andrew Kolodny is a leading national expert on the prescription opioid and heroin crisis. When he first began talking on the subject, it was necessary to convince people there was an epidemic, he said. That talk is no longer necessary.
“Each year for the past 20 years, we’ve set a new record for deaths from drug overdoses in the United States,” he said. “Next year, we will break that record.”
Until 2010, the increase in deaths was driven by prescription opioids, such as oxycodone, Kolodny said. But since 2010, deaths from those drugs have flattened out, and deaths from heroin began going up “very rapidly,” he said.
That didn’t occur, as commonly thought, because there was a “crackdown” on prescription painkillers; instead, it can be attributed at least in part to the increased practice of mixing fentanyl, a strong opioid pain medication, with other drugs. There hasn’t, in fact, Kolodny said, been a crackdown on using painkillers.
“We are still massively over-prescribing opioids,” he said.
Kolodny, in walking through a brief history of opioids or “how we got into this mess,” said prescription opioids are made from opium, typically using the same process used to make heroin.
“When you talk about opioid pain medicines, we’re essentially talking about heroin pills,” he said, adding that by making that statement, he’s not saying don’t prescribe opioids. They remain an important medicine for pain management.
But much needs to be done to address the multitude of ways people become addicted, Kolodny said. That can occur from recreational use, using prescribed drugs, or, as he said might be the most common, a brief medical exposure, followed by recreational use.
Opioid addiction is strongly affecting young people in their 20s and people older than 45 or 50, Kolodny said, who also pointed out demographics are showing significant differences in opioid use among racial groups.
“To say that the epidemic is disproportionately white is an understatement,” he said. “It’s really striking how white the epidemic is.”
Another primary issue is the connection between opioid deaths and opioid sales. On a chart Kolodny showed, the sales and deaths trended upward at about the same pace. The CDC message to the medical community is the epidemic might not be able to be controlled until sales, or prescriptions, are controlled, Kolodny said.
According to the Centers for Disease Control, 82 to 95 opioid prescriptions are written per 100 people in Kansas. Other states, primarily in the east but also including Oklahoma, range 96 to 143 prescriptions per 100 people.
In the U.S., Kolodny said, approximately 5 percent of the world’s population is consuming about 80 percent of the world’s oxycodone and about 90 percent of the world’s hydrocodone.
“The most consistent explanation for geographical differences that we see in our opioid crisis is that the opioid crisis is worst where doctors prescribe most aggressively,” he said.
In two panels, the KHI symposium also heard from Kansas leaders who talked about prescribing, treatment, regulation and enforcement, sharing programs already in place that are addressing the crisis and also needs.
St. Peter said he hopes the symposium gave attendees a broad look at the issue, but more importantly, started conversations.
“The people that could address the issue in our state were in this room today. I hope that they got educated about the issues, and understand the urgency and can come together collectively to do something,” he said. “That’s what we were trying to get done.”