Arizonans Bought More Than 1.7 Billion Opioid Pain Pills In 6 Years
LAUREN GILGER: The Drug Enforcement Administration tracks every single pain pill sold in the United States, and now The Washington Post has sifted through those nearly 380 million transactions and published a searchable database that puts the opioid crisis into perspective. Here in Arizona, more than 1.7 billion pills were sold between 2006 and 2012. In Mojave County, that added up to 74 pills per person, per year. So, we talked with someone who could put these massive numbers into perspective a little bit. Nick Stavros is the CEO of Community Medical Services, which operates 16 opioid treatment centers throughout Arizona, and I asked him first, do these numbers surprise you at all?
NICK STAVROS: No, not in the least bit. There's been a lot of reports and studies that have come out over the last few years that have looked at, predominantly, the marketing tactics of some of the pharmaceutical companies. And they've actually shown that where opioid pain relievers were more heavily marketed, you could find higher overdose death rates from opioids. And so the data that came out, I mean it's good it's getting this publicity because I think it's putting more of a spotlight on the epidemic, but I think to most of us it's not surprising at all.
GILGER: So in your work, when you see people who come in for treatment, right; I wonder if you can give us a sense of just where we are now? You've done this for many years. Have you seen, sort of, all of… the national and local efforts that have brought attention to like you say, the opioid crisis have any impact? Are you seeing those numbers start to go down?
STAVROS: Yeah not, I mean obviously not as much as we'd hope but you know... there's obviously a lot of progress being made in a lot of different states. And so in Arizona in particular, you know even though they've shown that there's been a decrease in overdose death rates over the last year nationally, Arizona is 1 of 18 states where there's actually been an increase in overdose death rates, and so much-much more needs to be done.
GILGER: What kind of challenges are you still seeing, in terms of why they're ending up there?
STAVROS: Yeah, I think the, I mean the biggest problem is actually highlighted by this report. And it is that 1 in 20, approximately 1 in 20 Americans are on high doses of long term opioids for chronic pain. That's a big number. The research says that about 34% of people on high doses of opioids for chronic pain, say they are addicted to their medication. And so, we know that there's a lot of people who have what's called, opioid use disorder, that's the diagnosis. But that number is severely underestimated because when you look at the amount of people throughout the country who are on opioids for chronic pain, they're not being diagnosed as having an opioid use disorder, so they're not getting into treatment. So, the question we in the treatment community ask ourselves a lot is, what can we be doing to get people into treatment, to help navigate them into treatment. It's a great example in Arizona where we've done a lot to cut back on prescribing, in fact, prescriptions have gone down pretty dramatically over the last few years. Yet, overdose death rates from opioids has gone up. Which means that when we clamp down and create a more restrictive environment, yeah, it stops people from getting prescriptions for opioids but then they turn to heroin or fentanyl on the street which is much cheaper, yet much more dangerous. So, you see this increase in overdose death rates, and so that's something that I think we all need to do a better job of, is not just clamping down on the prescribing but actually navigating people into treatment. Because we're more and more so, seeing people getting kicked out of pain management clinics, getting cut off by their primary care physician and coming into treatment after they had turned to heroin on the street or something like that. How nice would it be if we could actually navigate them into treatment prior to them turning to an illicit opioid?
GILGER: How would that work? Would that be something that physicians would need to be looking for?
STAVROS: Mm hmm. It's really-really hard because it takes the entire system working together. So let me give you an example, we worked with a pain management clinic in Tucson where the doctor was identifying patients who he thought had an unhealthy relationship with their medication. And he'd say, hey I want you to go talk to a clinician and a physician at Community Medical Services, and they'd come over to us and we'd have the conversation with them, like, hey you know your doctors said that he thinks you might have an unhealthy relationship with your medication, let's talk about treating you. And I think 7 out of 10 times their reaction is, wait, you're calling me a drug addict? Right, because there's a stigma against being addicted to the medication or being dependent on it. And so then when we say, we want to help you, we want to treat you. They say, I'm, don't call me a drug addict, you know, I don't want, I don't need your treatment and I don't want your treatment. And then all they have to do is go find a prescriber that's willing to prescribe, right? So it's really easy for everything to break down if you have a couple prescribers who are outside of the standard of care or if you have payers that are not paying attention... to the utilization of their patients. It just takes a couple stakeholders in that scenario to make the whole entire thing fall apart.
GILGER: I want to ask you a little bit about how the chain of sale works, I guess, right? So, The Washington Post is looking at pills sold in various states, to various pharmacies. So here, it was Walgreens and Humana, essentially, got the vast majority of the pills that were then prescribed to patients. What role does a pharmacy have in this?
STAVROS: Yeah, well the chain, so the chain you're talking about, it goes from the manufacturer of the medication to the distributor of the medication to the retailer of the medication, which is the pharmacy, to the prescriber, which is the physician, and to the patient ultimately. So, if you look at that entire continuum, there's a lot of areas in there where things could break down but there's also a ton of regulatory oversight of that whole chain to try to prevent things from breaking down.
STAVROS: I do think that pharmacies and the pharmaceutical companies, everybody in that chain, actually has some responsibility for ensuring that opioids are not being illicitly diverted. I mean in Arizona there's a case in Mojave where there was four prescribers, in particular, prescribing something like enough opioids for every resident in the county to take, you know, four times a day for a week. I mean just exorbitant amounts, right? I think most people say that's suspicious, why didn't nobody in the chain report that. So, maybe sometimes they do. But I think one of the concerns is that, that's not happening frequently enough.
GILGER: All right, that's Nick Stavros the CEO of Community Medical Services. Nick, thank you for coming in.
STAVROS: Thank you for having me.