HJAR Jul/Aug 2022

the seriousness of the pathology and how aggressively we need to react to treat it based on the degree of severity — mild, moderate, and severe. I used to tell my res- idents, “You do not want to kill a fly with a bazooka.”The DSM-5 stratifies current diag- nostic categories as such: risky substance use, substance use disorder, and, finally, the more complicated to treat and control, addiction. So, yes, we need a pathological behav- ior, and it can be in one of the three stages I mentioned above. But in concern of tak- ing a patient from risky substance use to severe, full-blown addiction ... that would need facilitators and enablers, and that is where money and greed play their roles. Once the aggressive marketing of Oxy- Contin started, and the prescriptions for opioids started to pile up, the demand grew, and one of the alternatives to make money (even to have access to other illicit drugs like cocaine, meth, crack, etc.), was diver- sion — selling the pills on the black market. Due to high demand and the convincing of doctors that the best way to treat pain was to increase the dosages, we went from only having OxyContin in 10, 20, and 40 milli- gram dosages to an off-the-charts dose of 80 mg! Since this opioid epidemic started, diver- sion of these drugs became a widespread practice, and it has been documented that the main source of opioid diversion in the United States is provider overprescribing for acute and postoperative pain. 9 This is the right time to share with you something that happened with one of my ex-patients that totally blew my mind and changed my decision making on how I was prescribing opioids. It is important to men- tion that this event took place in 2015. I entered one of the rooms of the clinic and found a man in his early 40s grimac- ing in pain and barely able to move, stand- ing in one of the corners, resting his hand on the edge of the examination bed. I had read his medical history in the EMR, but this was the first time I saw him. The main diagnosis was chronic pain and lumbar Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement The U.S. is experiencing a catastrophic opioid overdose epidemic. Overdose deaths nationwide increased by nearly 30% in 2020, with more than 92,000 lives lost — an unprec- edented jump from about 71,000 deaths in 2019, according to the Centers for Disease Control and Prevention. Preliminary data from the CDC indicate that overdose deaths reached another record high of more than 107,000 in 2021, an increase of nearly 15%. 1 Overdose deaths also rose alarmingly in Arkansas in the first year of the COVID-19 pandemic, jumping from 388 in 2019 to 546 in 2020, an increase of nearly 41%, according to Kaiser Family Foundation’s (KFF) analysis of CDC data. 2 KFF’s analysis did not include 2021 data. Evidence suggests that a person who has been treated in an emergency department for an overdose is at high risk of dying from another overdose. According to the National Institute on Drug Abuse, a review of Massa- chusetts emergency department records and the state’s death records found that among patients treated in an emergency depart- ment for an overdose between July 2011 and September 2015, about 1 in 20 died within a year of discharge - many of them within two days. 3 A new program created in Arkansas seeks to prevent many such deaths in the state by providing the overdose-reversal drug nalox- one — commonly known by the brand name Narcan — to hospital emergency depart- ments for distribution to at-risk patients and their families. The Arkansas Center for Health Improvement, of which I am president and CEO, is partnering with the state drug direc- tor and the Arkansas Department of Human Services to administer the program. Funding is provided by the federal Substance Abuse and Mental Health Administration through DHS. The ACHI team and our partners joined with officials at Unity Health-White County Medical Center in Searcy to announce the launch of the NaloxHome program at the hospital on May 31. Unity Health was the first hospital to adopt the program, but at this writing, we have many more in the pipeline to join. Here is how our new program works: We provide free naloxone to participating Ar- kansas hospitals to dispense to patients or caregivers of patients who have experienced an overdose or are at risk for an overdose. The hospital dispenses the medication at the time of a patient’s discharge from the emer- gency department at no cost to the patient. The patient is instructed in the use of nalox- one and advised that administration of the drug should be accompanied by a 911 call and an emergency department visit. ACHI provides training to hospital staff members in recognizing patients who are at high risk of overdose and educating pa- tients on naloxone use. The hospitals agree to minimal weekly reporting, which is used to replenish naloxone supplies and evaluate the program’s progress. Arkansas’ response to the opioid crisis has four main components: prevention, treat- ment, recovery, and harm reduction, with the NaloxHome program being part of the latter approach. Laws passed by the Arkansas Gen- eral Assembly to promote harm reduction include Act 651 of 2021, which requires that opioid prescriptions be accompanied by nal- oxone prescriptions in certain situations, and Act 248 of 2017, which allows pharmacists to dispense naloxone under a state protocol in the absence of a doctor’s prescription. How- ever, many individuals may not overcome the stigma to fill naloxone prescriptions, and not all pharmacists in the state are exercising their authority under Act 248 to dispense the ADDRESSING THE OPIOID CRISIS: New Program Aims to Reduce Overdose Deaths in Arkansas HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2022 15