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Colorado makes gains fighting U.S. opioid overdose death rate

By Jean Lotus
Colorado makes gains fighting U.S. opioid overdose death rate
Photo by frolicsomepl/Pixabay

DENVER, June 13 (UPI) -- As the United States grapples with record-breaking numbers of suicides and overdose deaths, a modest drop in overdose fatalities in Colorado in 2018 has doctors cautiously optimistic that a new statewide program to cut down on the over-prescription of opioids is working.

The number of total overdose deaths in Colorado dropped in 2018 by 38 deaths to 974 from 1,012 in 2017, the first drop in overdose deaths since 2010, the Colorado Department of Public Health and Environment said this week.

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Last year, 349 opioid overdose deaths were reported, 24 fewer than the year before despite an increasing population in the state. This was the first decrease in overdose deaths in Colorado in 10 years.

Meanwhile, across the United States, a newly released study by the Commonwealth Fund, a healthcare advocacy group, reported that overdoses and suicides reached a record high in 2017.

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West Virginia, Ohio and Pennsylvania recorded the highest overdose rates that year, the last one for which information from the Centers for Disease Control and Prevention was available.

Colorado officials are pointing toward the state's "Alternatives to Opioids" program, which showed a 36 percent drop in the number of opioid prescription painkillers prescribed in emergency rooms during its pilot program in 2017.

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The project was also rolled out to emergency departments in Michigan, Illinois and Wisconsin in 2018.

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The project's "toolkit" has been shared with the American Hospital Association, which sponsored a pilot program in New Jersey.

Today, more than 100 Colorado emergency departments participate, said Cara Welch, the Colorado Hospital Association's communication director. A sister program called Colorado's CURE has been reaching out to medical practitioners, nurses and pharmacists throughout the state's health system.

"You can't get addicted to opioids if you never get them in the first place," the hospital association's Dr. Darlene Tad-y said. "If we tear that down that gateway to opioids by having our doctors providing alternatives instead, we will prevent so many chronic opioid users down the line.

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The campaign started on the front lines of the overdose epidemic -- in emergency rooms, where doctors witness the exploding health crisis of addiction.

"We see the ravages of this opioid epidemic, the overdoses and the abscesses and complications from IV use," said Dr. Don Stader, an ER doctor and one of the program's developers at Swedish Medical Center near Denver.

More than 7,600 Coloradans end up in emergency rooms every year because of drug overdoses, the hospital association said. About 86 percent of those admissions were due to abuse of prescription painkillers.

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The Colorado team developed a new process for prescribing options for smaller amounts of non-opioid drugs. They were tailored to "pain pathways" for ailments often seen in the ER, including migraine headaches, kidney stones, stomach pain, skeletal muscle pain and fractures and sprains.

For example, a migraine headache might be treated with extra oxygen, a small amount of a steroid and a nausea medication combined with a smaller amount of pain reliever. An added benefit is that "multi-modal pain control" with small amounts also cuts down on potential side effects, such as constipation, nausea and breathing problems that can come with treatment with opioids, doctors said.

The program also recommends two other "pillars" of treatment: treating patients with the "harm reduction" philosophy -- which removes stigma-causing punitive responses to drug abuse disorders -- and setting up post-crisis medical treatment, such as leaving the hospital with a dose of overdose-reversing.

About 50,000 of the 77,000 overdose deaths in the United States each year in recent years are the result of illegal prescription drug use, said Rob Valuck, executive director of the Colorado Consortium of Prescription Drug Abuse Prevention. He believes those are under-reported.

Drug abuse disorders are long-term chronic conditions that can last years before a person is hospitalized for an overdose, Valuck said. "An overdose today can be the result of an addiction that started 10 years ago, like a light-year phenomenon where you see a star 10 years after it explodes."

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Valuck said he's "cautiously optimistic" about the dip in prescription drug overdoses, saying researchers "don't know if it's the beginning of a turnaround or just a blip."

Other factors that may be influencing the drop in deaths include new Colorado law that only a seven-day supply of opioid painkillers may be prescribed after a surgical procedure (with exemptions for people with chronic pain who are prescribed opioids.) Several other states also limit the supply of opioid painkillers.

In the past 20 years, the number of overdose deaths in Colorado has almost tripled from 345 in 1999. The number of overdoses in the U.S. has increased more than 450 percent from fewer than 17,000 per year in 1999 to 77,000 in 2017.

State health department records show other causes of 2018 drug overdose deaths in Colorado included 229 deaths from heroin, 129 deaths from cocaine, 318 deaths from methamphetamine and 102 deaths from fentanyl.

If it takes 10 years to develop a fatal opioid addiction, doctors recognize it's a problem that cannot be solved overnight.

"Treating opioid epidemic is a long game and I hope it has crested and now we're on the downward part of it," Stader said. "In 10 years, we're going to be practicing medicine a lot different than we are now."

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