Southeast Missouri State University student publication

Response: combating the crisis

Thursday, May 3, 2018

The Opioid Crisis Response Act of 2018, a bipartisan bill currently awaiting approval from the U. S. senate, for the improvement of departmental ability to address the crisis, and its effects on families and communities, by updating care plans and improving data sharing between states.

Missouri became the last state in the union to implement a statewide PDMP in 2017 on executive order from Governor Eric Greitens.

Opioid overdose-related death surpassed the total for traffic deaths in Missouri in 2017, and the year before, 908 Missourians died from opioid overdose.

The executive state cabinet recruited Dr. Randall Williams to be Director of Health and Human Services after his success in the eastern United States. Williams said the administration has made the crisis a priority.

“I think 2017 will be a milestone year in Missouri’s challenge to meet this. Before 2017, to be honest, here to date, we have really not done anything,” Williams said.

In August 2017, Williams put forth a standing order allowing anyone in the state to purchase naloxone, a drug that combats the effects of overdose, without a prescription. That same month, the Good Samaritan law was approved, which protects those who contact emergency services from minor drug and alcohol violations.

But taking a closer look at prescribing habits of physicians in Missouri and holding them accountable with reliable PDMPs, he said, will have the most effect.

“In the year 2017, not a single doctor was disciplined by the Missouri Board of Healing Arts for misusing, abusing or diverting drugs, making us a tremendous outlier in the country,” Williams said.

Medicaid data — which covers 1 million of the 6 million patients in Missouri, and is state funded — Williams said, recently has come under the scrutiny of executive departments, and three additional investigators have been brought on.

“In the last 12 years we have sent out about 8,000 letters out every two months to medicaid doctors saying, ‘You are inappropriately prescribing narcotics,’ and [we’ve] done nothing about them,” he said. “That didn't make any sense.”

Now, Williams said, non-compliance from medicaid providers will result in an investigation form the Bureau of Narcotics and Dangerous Drugs. Physicians with suspicious prescribing activity can have their license revoked.

“We’ve been doing it for a short period of time, but it has already yielded some very active investigations,” he said.

Physicians must identify every patient treated with opioids and their reason for prescribing them.

Because patients of Medicaid are technically patients of the state, Williams said, there is no issue in looking at patient data.

“We just think, very fervently, that to have a robust investigative and disciplinary process is best for everybody,” Williams said. “It’s best for our patients, it’s best for our doctors and best for the profession.”

In addition to investigation of providers, Jefferson City is looking at pharmaceutical companies who have been misleading about addictive qualities.

Missouri Attorney General Joshua Hawley’s lawsuit — a pursuit of charges against three major pharmaceutical manufacturers, for fraudulent misrepresentation — will move forward as ruled April 25, 2018, by a St. Louis Circuit Court.

“This ruling is a major victory in our fight to hold opioid manufacturers responsible for the misrepresentations they’ve made about their drugs,” Hawley said in a press release. “Missouri faces a public-health crisis because of this fraud—today’s win pushes us further forward in holding these manufacturers liable for the damage they have caused.”

Law Enforcement

Missouri State Highway Patrol Sgt. Shawn Griggs, the public information, education and training officer for the department's Drug and Crime Control Division, said law enforcement’s role has shifted in response to a changing epidemic.

“We are not going to arrest our way out of this problem,” Griggs said, “We are focused on a collaborative effort of prevention, education, training, enforcement and treatment.”

He said the dangers of opiates represent a public health concern, and as a result, law enforcement in Missouri is trending beyond enforcement, and toward education. His said officers carry informational brochures, with resources for dealing with substance use disorder.

More than 1,400 Missouri State Highway Patrol employees have been trained in administration of naloxone, and Griggs said some 230 troopers carry the substance.

“It’s about $1 per milligram on the street for prescription painkillers,” Griggs said. “In some places heroin costs much less than that. You become physically dependent and get sick if they don't have it so instead of spending $80 they spend $20 for heroin, because it’s the same thing.”

Griggs said the State Highway Patrol Drug Lab has seen an increase in fentanyl-related cases in recent years — from 49 cases in 2011, to 468 cases in 2017.

He said the dangerous synthetic is created in illegal drug labs.

“We’ve seen that in small amounts in the U. S., but we know that fentanyl is being made clandestinely in other countries and making its way into the U.S.”

While Interstate-55 and I-70 will always play a role in the import of illicit drugs, Griggs said, the dark web, has increased the import of dangerous synthetics.

“We do have officers that are conducting covert and overt narcotics investigations, some of those occur on the internet as well,” Griggs said.

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