That first high for a soon-to-be addict marks the end of life as they knew it, and the beginning of a long road.
For some that road leads to recovery. For others it leads to crime, isolation and even death.
The opioid epidemic sweeping across America has many people to blame and almost anyone can point a finger at a guilty target: pharmaceuticals, pill-mill doctors and lax government.
In the 1990s, pharmaceutical companies repeatedly assured doctors that opioids weren’t addictive — but they lied. Due to the drugmakers’ dishonesty, doctors started prescribing opioids at higher and higher rates, leading to addicted patients and prescription opioid abuse.
In rural, low-income areas, the Center for Disease Control reports that there is a higher chance for opioid abuse and addiction. Rural areas have also surpassed urban areas in drug overdoses.
Rural eastern Idaho fits this profile perfectly. Eastern Idaho is a rural, agricultural area with a low population density that makes it a susceptible environment for opioid addiction, overdose and abuse.
Rural areas tend to be poorer, sicker and older than their urban counterparts, according to the CDC. Rural residents also tend to have less access to health care and get in more accidents, according to the CDC.
And resource access is vital, because often the problem with the opioid epidemic lies with an initial prescription that can get an unsuspecting patient hooked.
Opioids are highly addictive drugs that are commonly used to treat pain after surgeries, or other medical conditions. Making them easy to abuse.
“It’s OK to ask your physician for risk involved with opioids,” said Pamela Rich, health education specialist at Eastern Idaho Public Health. “I think a lot of the time we go into it (the appointment) thinking we don’t have to ask the questions.”
Rich said it’s important to remember opioids are addictive, and doctors are encouraged not to prescribe opioids for more than three days because the likelihood for addiction increases on the fifth day of taking opioids.
About 11.5 million people in the United States misuse an opioid prescription and 116 people die every day from an opioid overdose, according to the U.S. Department of Health and Human Services.
Whitney Cooley, director of pharmacy at Mountain View Hospital, said some of the red flags for opioid abuse are going to multiple pharmacies to fill a prescription, paying in cash at pharmacies and doctor-shopping for prescriptions.
However, Cooley said she thinks there are very few pill-mill doctors, and most doctors want to help patients when they learn someone is addicted.
Recently, there have been added levels of security and guidelines for opioid prescription since the U.S. Department of Health and Human Services declared a public health emergency in 2017.
Cooley said to prevent abuse, the hospital locks up opioids in a med-dispense machine, “we call it a minion because we think it’s funny,” Cooley said, smiling. The pharmacy “minion” is a gray, heavy, industrial-looking machine with thick hard drawers.
The hospital’s staffers also lock up prescription pads, prescription paper and religiously check the Prescription Monitoring Program for each patient’s medications, Cooley said.
The monitoring program has been a lifesaver for providers. It allows doctors and pharmacists to make sure patients who legitimately need opioids for pain are getting them, and helps them spot and stop abuse.
“I think of Bill with cancer, he comes every month for a very large number of OxyContin, Bill goes on vacation and now is somewhere else and needs to fill it because he couldn’t fill earlier it with me,” Cooley said. “He needs it legitimately, but the system has necessarily made it harder for him to do that because you have, Joe, who got a forged pad, comes to you and says ‘I’m from out of state, I have cancer, I need my 300 (pills).’ At that point you didn’t have a lot to go on and (don’t) see any of the (prescription) history.”
Cooley said the monitoring program has made it easier for pharmacists to tell who legitimately needs opioids, and who is an addict in need of help. With the monitoring program, “Bill with cancer” can easily get the pills he needs and “Joe who got a forged pad” can get the help he needs.
Forty-nine states have prescription monitoring programs, the exception being Missouri. In Idaho, from fiscal year 2016 to fiscal year 2017, database use nearly tripled and at the same time prescriptions dropped 2.88 percent, said Alex Adams, executive director of the Idaho State Board of Pharmacy.
In Bonneville County, there are 92.3 opioid prescriptions per 100 people, compared to the statewide average of 77.6 opioid prescriptions per 100 people in 2016, according to the CDC.
Another thing Mountain View Hospital does to combat opioids leaking onto the streets is track where the opioids go, whether it’s to an “end user” — the patient — or back to the manufacturer. Cooley said what the hospital doesn’t use, partially uses or opens, goes back to the manufacturer. Everything has to be accounted for because narcotics is a closed system.
However, the hospital doesn’t have to report the amount of opioids administered to patients in the hospital under acute care because they are under direct supervision of a nurse or doctor, Cooley said.
Doctors will use IV opioids on patients during, and 24 hours after, surgery. After those 24 hours, the doctors will try and ween the patient off the IV and onto oral opioids.
Cooley said it’s important to remember that there are people who legitimately need opioids for pain relief and the few that do abuse opioids muddy the water for the rest.
“I’m thinking of a grandfather who worked really hard his whole life, who had legitimate old age pain, was on a chronic prescription of an opioid, does he need a pain contract to prove that he’s taking his?” Cooley said. “It’s unfortunate that the people abusing it have caused more problems, and that people have allowed the abuse to happen.”
And doctors are catching on. Rich, who educates providers around the community, said she’s noticed a change in the way doctors are prescribing opioids. She said offices are aware of the guidelines and have taken steps to change their policies on how to prescribe opioids.
The end goal is to change “the amount of prescription opioids placed in the hands of the patient,” Rich said.
In 2013, doctors nationwide wrote almost 250 million opioid prescriptions, which is enough for every adult American to have their own bottle of pills, according to the CDC.
Cooley said it’s necessary to reduce the amount of opioids in circulation that end up lying around in people’s cupboards. It’s pretty much common knowledge that almost everyone has a half-empty bottle of opioids in their home, and this can make people a target for addicts, Cooley said.
Addicted people don’t think rationally, and will try to get their fix by breaking into a person’s home for their medication.
But Rich said it’s important to remember “when people have found themselves addicted to opioids, they need help love and support.”
Reporter Isabella Alves can be reached at 208-542-6711 or follow her on Twitter @IsabellaAlves96.