Editor’s Note: This story is the second in a series of stories to be featured in the Herald, delving into the opioid epidemic and its impacts in Uinta County. Upcoming stories in the series will look at what is being done to combat the epidemic, warning signs of addiction, opioid alternatives, information for family members and more.
EVANSTON — On Monday, Aug. 26, a judge ordered Johnson & Johnson to pay the state of Oklahoma $572 million in damages for the drugmaker’s role in the state’s opioid crisis. Fellow pharmaceutical manufacturing company Purdue Pharma is reportedly negotiating a multibillion-dollar settlement with roughly 2,000 plaintiffs. Nearly all 50 states, including Wyoming, have filed suit against drug manufacturers for what have been labeled deceptive business practices, including allegedly overstating the benefits of their products while simultaneously downplaying the risks of addiction.
When it comes to the opioid crisis, there seems to be plenty of blame to go around. Some, as shown by the lawsuits, blame the manufacturers and/or distributors of the drugs. Others blame doctors for writing prescriptions or pharmacies for filling those prescriptions. Some point the blame at the federal Drug Enforcement Administration for issuing unclear guidelines of what constitutes a suspicious order that should be reported and for continually raising the annual limits on how many opioids could be manufactured as the epidemic gained momentum.
Still others point to the “Pain as the Fifth Vital Sign” movement that in many ways transformed the practice of medicine in the late 1990s, or customer satisfaction surveys used by the Centers for Medicare and Medicaid Services that specifically based provider performance at least in part on pain control.
In a multi-faceted and complex problem, perhaps the only thing that’s crystal clear is that the opioid epidemic has ravaged communities nationwide, with hundreds of thousands of deaths now attributed to opioids, including more than 45,000 in 2017 alone. According to the Centers for Disease Control, 69 Wyoming deaths in 2017 were officially attributed to drug overdose. At a recent Recover Wyoming workshop held in Evanston, however, presenters cautioned that number may be inaccurate due to multiple factors, including the lack of a cohesive reporting tool to track overdose deaths, insufficient training for coroners to absolutely determine an overdose was the cause of death, and even coroner reluctance to list overdose as the official cause of death on a certificate.
Overall, Wyoming opioid prescribing rates are higher than the national average, according to Recover Wyoming, with a U.S. average of 66.5 per 100 persons and a Wyoming average of 71.1 per 100 persons. Here in Uinta County, that average was 100.2 per 100 persons, according to the CDC — meaning there were more opioid prescriptions written in 2017 than there are people in Uinta County. This rate is the highest in the entire state.
In fact, more opioid prescriptions have been written than people in the county for the past several years; 105.4 in 2016, 104.7 in 2015, 112.4 in 2014, 107 in 2013 and 100.2 in 2012. One must go back to 2011 to find a year that finally dips below 100, with only 84.1 that year. Every other year back through 2006 shows a prescription rate in the 90s.
Matt Martineau, with the Wyoming Board of Pharmacy which maintains the state Prescription Drug Monitoring Program database, said it’s important not to jump to conclusions when looking at prescribing rate numbers.
“It’s just a number,” he said. “What does that number mean? It’s hard to necessarily know why it’s high. It could be a high number of cancer patients or surgeries. There are lots of things it could be and it’s not necessarily nefarious.”
It’s problematic, however, to account for this high prescription rate. When an attempt is made to determine what sets Uinta County apart from the rest of the state, the impulse appears to be to attribute the higher rate to the Wyoming State Hospital. Indeed, a Wyoming Survey and Analysis Center (WYSAC) report on opioid use from March 2018 makes that correlation, reading, “Uinta County prescribes more opioids than the population in that county. However, the Wyoming State Hospital, which provides quality active treatment for a variety of mental disorders, is located in Uinta County.”
However, further investigation reveals the Wyoming State Hospital does not account for the high numbers. Kim Deti, public information officer for the Wyoming Department of Health (WDH), said, “We don’t have exact counts of opioid prescriptions made to WSH patients over the last several years. However, we are confident in saying the numbers are quite low. For example, over the last two years there have been an estimated two patients discharged from the hospital with opioid prescriptions and so far this year we have had one patient with an opioid prescription while being served at the facility.”
Deti further said the WDH is working with partners to develop a better and more complete picture of opioid use everywhere in the state, acknowledging “there are some gaps in the available data.”
What then could account for the consistently high opioid prescribing rate in Uinta County? Jill Bass, CNS, APRN, at the Southwest Wyoming Pain Clinic in Evanston, said it could have something to do with the types of jobs that are common in the area, including mining and working in the oil and gas industries, that may result in serious injuries and severe, long-term pain.
Economic factors may be in play as well, as people who have experienced injuries may find themselves facing loss of income due to either injury or lay-offs, resulting in depression that may compound pain symptoms and result in increased doctor visits and prescriptions.
Due to patient privacy concerns and legislation and other factors, it is not known if there are abnormally high numbers of cancer or surgical patients on opioids in the county. It is also not known if there are particular providers whose prescriptions account for a particularly large proportion of the county’s high numbers.
Ultimately, as with the overarching crisis itself, the reasons behind the high opioid prescription rates in Uinta County are multi-faceted and complex. It is next to impossible to point to one factor as the culprit.
However, the data related to opioid use are alarming. According to Recover Wyoming, between 20-30% of patients who are prescribed opioid medications misuse them. Approximately 80% of people who use heroin first misused prescription opioids.
Jared Bingham, clinical director at High Country Behavioral Health, said some of the clients treated for addiction became addicted following surgery or injury. Many have misused opioids by diversion — using medication prescribed for someone else. Some have even resorted to intentionally injuring themselves so they can visit a physician to get more opioids.
“Anybody is vulnerable,” said Bingham. “Painkillers can be a great blessing, but many people innocently become addicted. You can end up with good parents, moms, church-going people who wind up doing totally out of character things.”