HJAR Jul/Aug 2022

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2022 17 know how to dispose the unused opioids. 13 Once a patient starts to show signs of opi- oid use disorder, the most likely places for them to regain access are pain management clinics. Some of these patients do not really have an organic cause of pain, but they use any pain “excuse” to have access to pre- scribed opioids. This is known as malinger- ing and/or secondary gain. This is where the extremely strict policies of pain medicine clinics come to play: The patients need to be submitted to extremely strict vetting procedures, medical exams, questionnaires, radiographic imaging, pill counts, drug screenings, the signature of a “pain management contract,” etc. One important and life-saving measure was to make it mandatory for any opioid prescriber to also prescribe naloxone if the patient is on 50 MME’s or more (this varies by state). Clinics are now liable for malprac- tice if this is not done! On the same note, first responders and police have started carrying kits with nalox- one to use in case they encounter a patient suffering an overdose event. They use them like EpiPens are used when facing an ana- phylactic reaction. And once it is determined that the patient is the right candidate to receive opioids to treat moderate to severe pain, we, as pain medicine specialists, need to follow the pre- ventive measures to the T. Various prescription monitoring pro- grams in the different states of the coun- try help tremendously to keep track of the number of opioids prescribed, the dates received, dosages, and doctors who sign the prescriptions. In Arkansas, it is called theArkansas Prescription Drug Monitoring program (AR PDMP). This is extremely help- ful in detecting “doctor shopping”practices, comparing the different prescribing prac- tices of doctors, and raising red flags when patients are on dangerous combinations like benzos, Soma, etc. Before COVID, we started to see a plateau in the rate of opioid overdose events thanks to the measures mentioned above to control the opioid epidemic. drug. Policymakers should do more to edu- cate pharmacists about the law. I also urge policymakers to remove any cost-sharing barriers to obtaining this safe and effective medication. States do not have the authority to make naloxone an over-the-counter medication, but the Food and Drug Administration should consider doing so. This would allow naloxone to be included in first aid kits in- stalled alongside defibrillators in public spac- es, potentially saving countless lives. Policymakers should also consider strate- gies to enhance awareness of the growing presence of increasingly powerful synthetic fentanyl in the illicit drug supply. Fentanyl is frequently mixed with drugs such as heroin, laced in illicit marijuana, or manufactured to look like medications such as Xanax, Ad- derall, or Ritalin. As a result, people who use drugs are often unaware that they are taking fentanyl, or in what dose. Fentanyl and similar synthetic opioids are now the most common drugs involved in drug overdose deaths in the U.S. 4 Fentanyl test strips are one strategy that has been shown to make a difference. In a 2018 study published in the International Journal of Drug Policy, 93 young adults in Rhode Island who reported using illicit drugs were asked to use fentanyl test strips, and 31 of them later reported detecting fentanyl in their drugs. Detection of fentanyl was signifi- cantly associated with a positive change in re- ported behavior such as throwing the drugs away, using less, or ensuring another person was present. 5 However, some have raised concerns that if the strips are not deployed strategically, addicted individuals wishing to avoid fentanyl could resell their contaminat- ed supplies to unknowing next victims. Another harm reduction strategy is the es- tablishment of syringe service programs, also known as needle exchange programs. These programs provide people who inject drugs with access to sterile needles and syringes, a safe disposal site for used products, access to vaccinations and testing, and, importantly, referrals to care and treatment. According to the CDC, new users of syringe service pro- grams are five times more likely to enter drug treatment programs and about three times more likely to stop using drugs than people who inject drugs and do not use syringe ser- vice programs. 6 Currently, Arkansas is one of 11 states where syringe service programs are prohibited by law. 7 Harm reduction has its opponents. Some believe that anything short of a zero-toler- ance approach will encourage illicit drug use. Fortunately, that attitude is becoming less common. Recognition that this is a disease with effective treatment and compassion for people struggling with addiction are grow- ing. Clearly, this crisis is affecting every corner of our society: our neighbors, our coworkers, our family members, our friends. I encourage anyone who is struggling or concerned about a loved one to reach out for help. Talk to your primary care provider and visit ARTakeBack. org or NARCANsas.com for information, re- sources, and providers. n REFERENCES 1 Centers for Disease Control and Prevention (CDC). “Vital Statistics Rapid Release: Provisional Drug Overdose Death Counts.” Last reviewed May 11, 2022. https://www.cdc.gov/nchs/nvss/vsrr/drug- overdose-data.htm 2 Kaiser Family Foundation (KFF). “Opioid Overdose Deaths and Opioid Overdose Deaths as a Percent of All Drug Overdose Deaths.” April 19, 2022. https:// www.kff.org/other/state-indicator/opioid-overdose- deaths/?currentTimeframe=1&sortModel=%7B%2 2colId%22:%22Location%22,%22sort%22:%22asc% 22%7D 3 Tobin, S.C. “Many People Treated for Opioid Overdose in Emergency Departments Die Within 1 Year.” April 2, 2020. National Institute on Drug Abuse. 2020. https://nida.nih.gov/news-events/ nida-notes/2020/04/many-people-treated-opioid- overdose-in-emergency-departments-die-within- 1-year 4 National Institute on Drug Abuse. “Fentanyl Drug- Facts.” June 2021. https://nida.nih.gov/publica- tions/drugfacts/fentanyl 5 Krieger, M.S.; Goedel, W.C.; Buxton, J.A.; et al. “Use of rapid fentanyl test strips among young adults who use drugs.” International Journal of Drug Policy 61 (November 2018):52-58. https:// www.sciencedirect.com/science/article/pii/ S0955395918302469?via%3Dihub 6 Centers for Disease Control and Prevention (CDC). “Summary of Information on The Safety and Effec- tiveness of Syringe Service Programs (SSPs).” Last reviewed May 23, 2019. https://www.cdc.gov/ssp/ syringe-services-programs-summary.html 7 amfAR. “Syringe Exchange Program Legality.” Opioid & Health Indicators Database. Accessed May 2022. https://opioid.amfar.org/indicator/SSP_ legality ADDRESSING THE OPIOID CRISIS continued... 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