This is the third in a series on opioids, arguably the largest public health crisis of the early 21st century. The goal is to give context through education and facts to supplement the daily news about overwhelmed neighborhoods, police and emergency rooms battling overdoses. Part 1 can be found here, part 2 here.
As indicated in my first post in this series, my interest in opioids, and by extension, pain management, arose in my work as an analyst in workers’ compensation managed care while studying narcotic prescribing patterns in 2011. Unfortunately today the discussion is widespread and the news is mostly bad. This post gives an overview of the bad news primarily highlighting those pieces which have simply caught my eye. An extensive news review would be too much to cover.
A number of excellent articles have been written over on Stat (as in “urgent” not statistics). Just a few days ago they published Behind the photo: How heroin took over an Ohio town (a reference to a photo released by police of two adults passed out in an SUV with a child in the backseat). The town is East Liverpool, Ohio and “is in that steel country nexus where Ohio, West Virginia, and Pennsylvania meet.” Ohio is also one of the places where fentanyl and then carfentanil (see notes) have been found in heroin, as reported, for example, in the Cincinnati Enquirer in July of this year:
“The synthetic opioid [carfentanil] is 100 times stronger than fentanyl, the analgesic blamed for increasing overdose deaths and 10,000 times stronger than morphine on the streets.”
“Akron police reported 25 overdoses, four of which were fatal, in a recent three-day period, and Columbus reported 10 overdoses in a nine-hour period, two of which were fatal.”
As the graphics in this CNN piece show Ohio and West Virginia are some of the hardest hit areas in a nation that is being hit all over.
This is America on drugs: a visual guide
But these issues and tragedies are not limited to those places overly hurt by the economic issues of the last decade nor are they limited to heroin users. In the greater Sacramento area, where Sharp Statistical Sciences is located, a spate of overdoses and deaths occurred in April 2016 due to pills that were being sold on the street as Norco (name brand for a combination drug of acetaminophen/hydrocodone). Over 50 overdoses and a dozen deaths were attributed to the fentanyl laced pills.
From what I can find, only one arrest was made in connection to the case and the woman was released on a $50,000 bond. Beyond that, I could find nothing further. Except that a few weeks later a bill designed to increase the penalties for fentanyl trafficking was blocked in the California State Assembly.
Two more pieces from Stat. One reporting from Huntington, WV, 26 overdoses in just hours. This left me with an incredible respect for the efforts of law enforcement, first responders and hospital staff. Thankless efforts—one of the stories I read indicated that not a single one of the people revived showed any gratitude for having their life saved.
One other story of the “human interest” variety. This one is appropriately called Dope Sick and is the story of one young man who died of a fentanyl overdose in Toledo, OH. This story shows explicitly that we are literally watching people die.
Finally, a piece from the Fox News website, with an article by Robin Gelburd, President of FAIR Health a non-profit health research organization discussing their study on group health data: Opioid crisis shocker: Medical services for dependence diagnoses spike at over 3,000 percent. The article includes links to FAIR Health’s recent white papers and infographics (Here is a direct link to the infographic: JH_Opioid Infographic v13 FINAL (8_1_16).pdf).
The bad news is not going to end anytime soon. In part 4, our final piece, we look at policy and health system measures being undertaken to address this costly epidemic. What is clear is that no single or even consortium of agencies will solve it. Directly or indirectly this affects all of us and each of us must find whatever action, no matter how small, that we can take.
Carfentanil or carfentanyl (Wildnil) is an analogue of the popular synthetic opioid analgesic fentanyl, and is one of the most potent opioids known (also the most potent opioid used commercially). Carfentanil was first synthesized in 1974 by a team of chemists at Janssen Pharmaceutica which included Paul Janssen. It has a quantitative potency approximately 10,000 times that of morphine and 100 times that of fentanyl, with activity in humans starting at about 1 microgram. It is marketed under the trade name Wildnil as a general anaesthetic agent for large animals. Carfentanil is intended for large-animal use only as its extreme potency makes it inappropriate for use in humans. Currently sufentanil, approximately 10-20 times less potent (500 to 1000 times the efficacy of morphine per weight) than carfentanil, is the maximum strength fentanyl analog for use in humans.
[Emphasis mine. The average grain of sand weights 50 micrograms]
The Opioid Crisis among the Privately Insured, and The Impact of the Opioid Crisis on the Healthcare System—A Study of Privately Billed Services, http://www.fairhealth.org/
FAIR Health Infographic: JH_Opioid Infographic v13 FINAL (8_1_16).pdf
Jesse Sharp is an expert in the analysis of health care data. Passionate about data and the ethics of analysis he writes on topics related to medicine, public health and statistics. More...