“Show me the numbers,” goes a variation of a popular refrain in business.
But as we report today on the front page, when it comes to drug abuse, there can be a false sense of security when the focus is on the wrong set of numbers.
In this case, it’s the death rate from overdosing on opioids, whether prescription painkillers like Oxycodone and Percocet, or cheaper versions like heroin and fentanyl. In the 15 years leading up to 2014, 165,000 Americans died of prescription-opioid overdoses, a serious and tragic number by itself. But most overdoses don’t kill and many don’t ever result in police contact or emergency room visits.
The result is that by 2015, when there were 33,000 opioid overdoses alone, an estimated 6 million Americans were either addicted to or abusing opioids. Physicians were issuing nearly 220 million painkiller prescriptions, and the majority of former patients now addicted to opioids were getting no treatment at all.
Yet Coconino County, despite the kind of small town, working poor demographic profile that fit other high-abuse areas, was not showing up anywhere near the top in rankings by rate of opioid deaths or reports of overdose. (An overdose can lead to slowed breathing and heart rate to the point of unconsciousness, but not necessarily death.) Annual overdose deaths were counted in the single digits.
But another set of figures told a more troubling story. Physicians in the county were writing painkiller prescriptions at a rate near the top of the national scale, and emergency room visits due to opioids tripled and quadrupled in just five years. Native Americans had even higher rates of increase in ER admissions.
So in recent weeks, the Daily Sun went to the grassroots – former addicts and even a dealer -- to get a sense of local opioid addiction and abuse. Most had been been through recovery programs and some were still under the jurisdiction of the Recovery Court. They all had different backgrounds and paths to addiction, but they were unanimous in warning that the level of opioid abuse in Coconino County was much higher than the official figures indicated.
The reasons for the undercounting include a rural, sparsely populated landscape that allows addicts to escape police detection, aided by fellow addicts who bring them back to consciousness without ever visiting a hospital or getting medical help. National studies show that far fewer than half of those struggling with opioids get any kind of medical help once their initial injury or other sources of pain have been treated, which means they are obtaining their drugs on the black market and under the radar of law enforcement unless caught.
The stories we tell today are not pretty – painkillers and heroin disrupt families and can result in a criminal record that burdens a person’s earning capacity for the rest of their life. And while there is an element of irresponsibility in any compulsive behavior, everyone agreed that it takes very little Oxycodone, heroin or fentanyl to take over the user’s judgment and self-control. Even those who had suffered in jail and lost their families before receiving recovery therapy said that something as common as a toothache was enough to trigger overwhelming cravings for an opioid-based painkiller.
Gov. Ducey has rightly called for more complete and timely reporting of deaths, overdoses and prescriptions. Doctors are now required to reduce the quantity of pills in each prescription and the number written. Pills are harder to grind into more concentrated powder.
But the epidemic is growing, in part because heroin, and now fentanyl, is cheaper and stronger than prescription pills, and those are sold by criminal gangs that are cowing customers into silence. Users also adopt a code of silence and enablement even during medical crises.
DEATHS OF DESPAIR
With the economy improving, there will likely be fewer “deaths of despair,” as some are labeled in Rust Belt cities like Youngstown, Ohio. And recent expansion of Medicaid benefits to the working poor has covered methadone treatment to reduce cravings that can cost between $4,000 and $6,000 a year.
Coconino County has a drug recovery court with room for 80, all of whom must commit to treatment that includes behavioral therapy in exchange for a get-out-of-jail card, some for only the daytime. For those who argue that drug abusers deserve stricter punishment for breaking the law, we’d note that our jails and prisons are already full of inmates who have relapsed without treatment and are two- and three-time offenders. Why not take a chance on non-violent offenders if it heals their pain as well as keeps them out of jail?
Treatment, however, is not cheap. In addition to the cost of the medicines that dull cravings and actually block the effects of opiates on the brain, there is behavioral therapy and supervision. And the larger problem of pain management in our society will take an even bigger investment in nonaddictive medicines and physical therapy. Congress recently approved $45 billion over the next 10 years for treatment of addiction alone, a figure that a Harvard expert estimated would need to be increased fourfold to be effective. That’s a big commitment but it’s also a big – and no longer hidden – problem right here in Coconino County.