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A major health care system serving the upper Midwest said this week that the number of opioid pills it prescribes has fallen by almost a quarter as it works to respond to America’s opioid epidemic.

South Dakota-headquartered Sanford Health started analyzing its prescribing last year to direct its response to rising opioid and heroin overdose deaths, said Doug Griffin, who spearheaded the system’s data collection as vice president and medical officer for Sanford in Fargo, North Dakota.

Griffin said the health system learned that the numbers are “staggering”: The system reported prescribing 4.3 million opioid pills in the first quarter of 2016, a figure that doesn’t include cancer patients’ prescriptions. Sanford took steps as a result, including mandating opioid education for providers and using its electronic health record system to alert doctors about safe prescribing habits, Griffin said.

Sanford has since seen a significant reduction in both the number of pills prescribed and prescriptions written. Sanford providers wrote 18 percent fewer prescriptions for opioids in the third quarter of 2017 compared to the first quarter of 2016, amounting to 24 percent, or about 1.25 million, fewer pills prescribed, according to the health system.

The Sioux Falls, South Dakota, region saw a 19 percent reduction in pills prescribed, while the Fargo area experienced a 33 percent drop and the Bemidji, Minnesota, region saw a 37 percent decrease, according to Sanford.

​‘Knowledge has changed’

“The stance that we have taken is clearly opioid overdoses, both illicit and prescription overdoses, are a problem in this country, including in our footprint,” Griffin said. “Like many things in medicine, our knowledge has changed and our focus has shifted on this.”

Allison Suttle, chief medical officer at Sanford, said the system’s end goal is to ensure patients are safe and well-treated and that physicians are educated in how to treat patients’ pain while being “good stewards of the use of opioids.”

“Large health systems can serve as examples,” she said.

South Dakota Department of Health Secretary Kim Malsam-Rysdon said that South Dakota has a low opioid overdose death rate compared to other states, but noted that the state had 38 opioid overdose deaths last year. She said large health systems are on the front lines.

“I think they’re extremely committed to this, and I’m really confident that we’re going to see the changes that we need to see to stay ahead of this epidemic that we’re seeing in other states,” she said.

Avera Health, a Sioux Falls-based health system, sponsored a conference this month with the U.S. Attorney’s Office of South Dakota on the opioid epidemic. Deb Fischer-Clemens, Avera vice president of public policy, said the organization’s responsible prescribing program includes patient contracts, educating providers and patients on opioids and working with its electronic health record to create easy access to the state Prescription Drug Monitoring Program.

Fewer prescriptions, fewer pills

Jay Bhatt, senior vice president and chief medical office for the American Hospital Association, said in a statement that the nation’s hospitals and health systems are working to reduce the number of prescriptions written for opioids and the number of days that many patients take them.

Utah-based Intermountain Healthcare pledged in August to cut by 40 percent the average amount of opioids given per acute pain prescription by the end of next year.
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U.S. Attorney General Jeff Sessions on Friday welcomed President Donald Trump’s declaration of the opioid epidemic as a public health emergency, saying he agreed with Trump that the war on addiction was “winnable.”

Trump on Thursday directed the U.S. Department of Health and Human Services to declare a 90-day public health emergency, but he stopped short of declaring the epidemic a national emergency or asking Congress for additional funds.

Trump’s declaration nonetheless gives states more flexibility to use federal funds, although it will not provide funds specifically for the opioid crisis.

The White House said the administration had allocated more than $1 billion for the opioid epidemic, including $800 million for prevention, treatment, first responders and prescription drug monitoring programs.

‘Make a difference’

Sessions, speaking to law enforcement officials at New York’s John F. Kennedy International Airport, called Trump’s announcement a “rare step” that “will make a difference by getting more help to those who need it.”

“In confronting the worst drug crisis in our history, we need to use every lawful tool we have,” Sessions said. “But if we do, there is hope. I agree with the president — I’m convinced that this is a winnable war.”

In August, the Department of Justice formed the Opioid Abuse and Detection Unit, a pilot program that places prosecutors in so-called opioid “hot spots” and uses data to investigate and prosecute opioid-related health care fraud.

Sessions said the program had begun to produce results.

On Thursday, he announced the first case brought by the program, a 14-count indictment of a Pennsylvania doctor for illegally prescribing and dispensing opioid pills and morphine — “often without an examination.”

On Wednesday, the Justice Department announced that the operator of a now-defunct pain management practice had pleaded guilty of opioid-related fraud in the amount of $750,000.

The doctor admitted prescribing a highly addictive version of the synthetic opioid drug fentanyl in exchange for $188,000 in kickbacks from drug company Insys Therapeutics Inc.

The company’s founder and majority owner, John Kapoor, was arrested Thursday and charged with conspiracy to commit bribery and fraud.

‘Overprescribing’ blamed

“Overprescribing is largely how we got into this crisis,” Sessions said. But he added that the proliferation of illegal fentanyl, which is 50 times as potent as heroin, had made the epidemic “much deadlier.”

Last year, more than 20,000 people died of overdoses involving fentanyl, according to the Centers for Disease Control and Prevention. Overall, deaths from drug overdoses topped 64,000 for the first time, making overdoses the leading cause of death for Americans under age 50.

Fentanyl is available as a Schedule II prescription drug in the United States. But drug seizure data suggest that a large number of the increase in opioid-related deaths is related to illicit fentanyl, often sold on the internet.

In recent years, China has emerged as the No. 1 source of illicit fentanyl in the United States. Earlier this month, federal prosecutors charged two Chinese nationals with illegally distributing large quantities of fentanyl in the United States.

In July, authorities shut down the largest illegal drug marketplace operating on the so-called dark web. The site, AlphaBay, had more than 200,000 drug listings, including fentanyl.

Law enforcement officials vowed to continue to go after illegal fentanyl suppliers.

“As a first step in response to the president’s announcement, the Cyber Crimes Center … will serve as ground zero in our efforts to attack the fentanyl issue where it originates — the dark web,” said Derek Benner, acting executive associate director of Homeland Security Investigations at U.S. Immigration and Customs Enforcement.
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In 2015, 92 million Americans used prescription opioids to alleviate or manage pain, with 11.5 million reporting they misused them. Now more than ever, patients are seeking alternative treatments to avoid using potentially addictive pain pills. VOA’s Elizabeth Cherneff introduces us to a Washington doctor who is helping people manage their pain and combat their addictions.
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Paul Coles’ journey to becoming one of the 2.5 million Americans addicted to prescription opioids began with painkillers prescribed for injuries suffered during an IED attack in Iraq. The physical scars healed, but emotionally Coles suffered. He had Post Traumatic Stress Disorder and couldn’t stop using drugs. 

“It got to the point I would take three times the lethal dose of heroin and cocaine, load it into a syringe and shoot it up, trying to shut my body down,” Coles said. “I would sit there and say, ‘God if you are out there, just kill me.’”

Time after time, he cheated death. But he couldn’t escape the law. Coles found himself handcuffed, arrested and jailed on charges of felony drug possession. Yet what seemed to be a new low would turn into a lifeline.

From the moment Judge Jeri Beth Cohen looked at Coles, she knew he needed help. 

“My feeling is that opioid addiction is a terminal illness: You’re either going to end up in prison or you’re going to end up dead,” Cohen said.

“I’m seeing more and more cases,” she said. “These are young men and women between the age of, I guess, 21-30. It’s a largely Caucasian population,” she added.

​One judge, two courts, one team

Coles’ case is one of hundreds Cohen has seen during the unfolding prescription opioid and heroin epidemic in South Florida. Inside her courtroom, with graphic photos of what drugs can do to the body, she surrounds herself with professional caseworkers on the frontlines of how America’s criminal justice system handles the boom in opioid abuse.

Miami-Dade County launched the nation’s first drug court in 1989. Today there are 3,000 U.S. drug courts serving 136,000 people. But a report by Physicians for Human Rights claims few communities have adequate treatment facilities and the criminal justice objectives of drug courts often overrule the medical need of the patient.

Cohen’s drug court gives people the chance to beat their addictions, stay out of prison while eventually getting their felony drug charge expunged from the record if they complete the year-long program. 

Like Paul Coles 75 percent of Drug Court graduates remain arrest-free at least two years after leaving the program. 

Miami-Dade County launched its first drug court when the community was facing a previous drug crisis. The approach then did not address people’s addictions, rather it was focused on jailing them for criminal conduct.

“There was a crack cocaine epidemic just like we’re looking at this opioid and heroin epidemic right now. People coming into criminal court in large numbers were taking a plea or going to jail, getting out and getting rearrested,” Cohen said.

Today there’s a stream of people in drug court struggling with addiction to a multitude of prescription pain pills and heroin. Cohen, regarded as one of the top drug court judges in the country, uses a holistic approach.

“What I find is if we can get them stabilized on a drug like Methadone or a Suboxone, which blocks a high, then they’re able to start engaging and they’re much more able to focus on getting well.” she said. The goal of the drug court is to get people treatment, steering them away from prison time and hopefully reducing recidivism rates.

“You have to take many variables into account: trauma, untreated mental illness, the chronicity or severity of the drug usage and also what’s going on in the family. If you’re not developing a treatment plan with your treatment team based on an individual’s particular risk and needs, you aren’t going to be successful with that individual,” Cohen said.

The judge bemoans the system’s lack of compassion.

“People are treated really, really poorly,” she said. “In the jails, in the courts, even in treatment they’re treated poorly. If you have money, it’s easier to access care [but] it’s still hard.”

​Zero tolerance

For all her understanding, Cohen shows little tolerance for those not following the rules. She sentences some to community service hours while others go back to jail.

There are frequent drug screenings to make sure people stick with their sobriety. Those who don’t meet the court’s year-long requirements may be returned to a traditional criminal court to face felony drug charges.

“I don’t think that sick people should be in jail. I do the best that I can to help people get well within our system, to divert them out of jail, but yet hold them accountable,” Cohen said “I feel like I do my job and I feel like I do it well.” 

“If you don’t go into the program, that’s fine with me,” Cohen tells a young, opioid-addicted mother, handcuffed and dressed in orange prison suit. “I am not going to keep you here and I am going to have the state dependency court file a termination of parental rights. I will order them to do it,” Cohen stressed.

Family reunions

“The children in my court have been removed from their parents because they have severe and chronic drug addiction and have failed to get into treatment,” the judge said. Her formula is to get parents who are struggling with opioid addiction intensive drug treatment so they can regain custody of their children.

She said 60 percent of the parents who go through the program get their children back.

“It’s getting into true recovery, improving your relationships with your family, your spouse, your children and starting that long life-long journey to recovery,” Cohen said.
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American drug courts are taking a public health approach to help those addicted to prescription opioids and heroin. The goal is long-term recovery and allowing people to have their felony drug charges erased from their records if they complete the program. VOA’s Chris Simkins reports from Miami on how one judge is helping those struggling with opioid abuse.
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More than 10,000 mainly Syrian refugees who escaped fighting in their country are living on five Greek islands. About 2,500 of them are crowded into camps on the island of Samos, even though there is only room for about 800. VOA’s Kevin Enochs reports aid groups say there is a growing mental health crisis among those refugees.
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