Opioids | St. Louis Public Radio

Opioids

For five years now, the Missouri legislature has considered legislation to create a prescription drug monitoring database that would allow pharmacists and physicians to look at their patient's prescription history for signs of misuse of narcotics. And for five years, Missouri pharmacists like Erica Hopkins have watched those efforts fail with disappointment.


U.S. Sen. Tammy Duckworth, D-Illinois, speaks to reporters on July 10, 2017 about health care legislation following a tour of Chestnut Health Systems in Granite City.
Ryan Delaney | St. Louis Public Radio

The Republican effort to repeal and replace the federal Affordable Care Act could devastate drug treatment clinics by making deep cuts to Medicaid, the government-run insurance for low-income Americans, U.S. Sen. Tammy Duckworth said Monday.

After touring Chestnut Health Systems, an opioid addiction clinic in Granite City, Duckworth told reporters that if Republicans succeed in cutting Medicaid, millions would be hurt, among them those undergoing treatment for opioid addiction. She said Congress needs to protect Medicaid and make sure that medications used to treat addiction are affordable.

Painkiller
Tom Walker | Flickr | http://bit.ly/22McgqC

Last year set a record for the number of drug overdose deaths in the St. Louis region, most of them opioid-related. Gun violence has also long been a problem in St. Louis. Although there’s no evidence to prove the rise in the prevalence of both issues is related, the solution to them is interconnected, advocates say.

Rici Hoffarth | St. Louis Public Radio

The state of Missouri filed suit Wednesday against three major drug companies, alleging they fueled the nation’s opioid epidemic with a campaign of false advertising and fake claims.

On the steps of St. Louis Circuit Court, Missouri Attorney General Josh Hawley said he would seek “hundreds of millions of dollars” in damages against Purdue Pharma L.P., Endo Pharmaceuticals Inc., and Janssen Pharmaceuticals Inc., a subsidiary of Johnson & Johnson.

Missouri state Rep. Cora Faith Walker, D-Ferguson, speaks on a panel held by NAHSE-STL. Affinia Healthcare Chief Operating Officer Kendra Holmes, criminologist Dan Isom, and anti-addiction advocate Howard Weissman join her.
Durrie Bouscaren | St. Louis Public Radio.

Public health experts on a panel in St. Louis Friday admonished Missouri lawmakers for failing to pass a prescription drug monitoring bill during the last legislative session. They also called for more treatment centers.

At least 712 people died after opioid overdoses in the bi-state St. Louis region last year — nearly 200 more than the year before, according to the anti-addiction group NCADA St. Louis. Missouri is the only state without a statewide database.

St. Louis-based Express Scripts has announced a new initiative to combat opioid abuse. June 7, 2017
Illustration by Rici Hoffarth | St. Louis Public Radio

St. Louis-based pharmacy benefits management company Express Scripts is tackling the opioid crisis.
 
The company announced an initiative Wednesday to more than 600 clients gathered in Dallas for an annual Express Scripts conference. The program focuses on limiting exposure to the painkillers and gives patients access to specialty-pharmacists to make sure the drugs are used properly. 

St. Louis Metropolitan Police officers raise their weapons at a preshift meeting 3.23.15
File photo | Katelyn Petrin | St. Louis Public Radio

The interim chief of the St. Louis Metropolitan Police Department asked the city’s Board of Aldermen on Wednesday to find money for hiring more officers and providing better pay. Liberal activists, however, want city leaders to ignore the drumbeats of demands for more officers and instead find funding for social services that could help stem crime.

The request from the police department will be competing with other urgent public safety needs, including funds for the drug Narcan, which reverses opioid overdoses.

Stephen Cummings | Flickr

Updated at 11:27 p.m. April 24 with the council's decisions — Two bills that would have established a drug monitoring database in Jefferson County failed during a Monday night meeting of the County Council.

The council heard two competing bills that would have allowed the county to join the local prescription tracking system set up by St. Louis County. But a disagreement over how long a database could keep Jefferson County data, however, likely derailed the whole process, even though council members appear to agree that the rising rate of opioid-related deaths is unacceptable and a prescription drug monitoring database could help prevent overdoses.

Mike Morrison talks with two staff members at Bridgeway's detox center in St. Louis.
File photo | Camille Phillips | St. Louis Public Radio

Missouri plans to use a new $10 million federal grant to improve access to opioid addiction medication.

A main focus of the grant, announced Wednesday by Republican U.S. Sen. Roy Blunt, will be increasing the number of doctors and nurse practitioners licensed to prescribe buprenorphine, a medication that reduces opioid addiction cravings, according to project manager Rachel Winograd.

St. Louis-based Express Scripts has announced a new initiative to combat opioid abuse. June 7, 2017
Illustration by Rici Hoffarth | St. Louis Public Radio

Missouri will receive $10 million in federal grant money to help combat a growing opioid painkiller crisis, U.S. Sen. Roy Blunt announced Wednesday.

It comes as the Missouri General Assembly is attempting to set up the nation's last prescription drug monitoring program, though the measures have hit several roadblocks.

Lethal doeses of heroin, left, and fentanyl, right. Fentanyl, a synthetic opioid painkiller, is up to 50 times more potent than heroin.
provided by the New Hampshire State Police Forensic Lab

Fentanyl, a synthetic opioid painkiller, made up almost half of drug overdose deaths in parts of the St. Louis region last year, according to county coroners in Missouri and Illinois.

The drug is up to 50 times more powerful than heroin, and inhaling just a few grains can be lethal.

“If I can be blunt, it’s scary as hell,” said Brandon Costerison, a spokesperson for the anti-addiction group NCADA's St. Louis chapter. “And we don’t really have anything to indicate it’s subsiding yet.”

Ed Ferguson, Karin Caito and Howard Weissman discusses the opioid crisis on "St. Louis on the Air" on Wednesday.
Kelly Moffitt | St. Louis Public Radio

The past year, 2016, will set a record for the number of drug overdose deaths in the St. Louis region. While still collecting data, the National Council on Alcoholism and Drug Abuse – St. Louis Area is expecting a total of 630-640 deaths from overdoses in the past year, most of them opioid related and most impacting younger St. Louisans.

In Missouri, doctors do not have a database to see how many prescriptions, particularly opioid medications, a patient has filled recently. Without that information, some doctors say they look for certain behaviors to identify if a patient is pill-seeking.
Carolina Hidalgo | St. Louis Public Radio

Missouri’s second-most populous county is joining a St. Louis-based effort to monitor opioid prescriptions. The program allows doctors to see how many drug prescriptions someone has filled, so they can flag patients who may be abusing opioids.

Jackson County executive Frank White Jr. signed a contract from his seat in Kansas City, finalizing the agreement to join St. Louis County’s program on Tuesday. According to the resolution passed by the county legislature, Jackson County will pay no more than $28,000 a year to participate.

“It allows a doctor to see if a patient has prescriptions through another doctor, so they can make an informed decision about what to prescribe,” said Susan Whitmore, the president of Kansas City-based FirstCall. “At the pharmacy level, it lets them see if a patient has multiple prescriptions for the same drug.”

FDA | file photo

After years of opposition in the Missouri legislature to a statewide program to monitor prescription drugs, St. Louis County is preparing to test its own.

By using a new database, pharmacists in the county will help flag consumers who may be “doctor shopping” for highly addictive opioid-based painkillers. Missouri is the only state in the country without such a system.

Its goal is to take away one of the easiest pathways to opioid addiction, while giving doctors and pharmacists a way to be more vigilant, said Dr. Faisal Khan, St. Louis County's health director.

A needle exchange kit uploaded to Flickr in 2008.
Todd Huffman | Flickr

Needle exchange programs could become easier to operate in Missouri under a bill pre-filed for the state’s 2017 legislative session.

The programs make sure intravenous drug users have access to clean needles to prevent the spread of blood-borne diseases like Hepatitis C and HIV.  

Michael Velardo | Flickr

The nation’s opioid crisis is threatening to undo decades of HIV prevention work, officials from the Centers for Disease Control and Prevention said Tuesday.

In response to a national survey of intravenous drug users in 22 cities, they’re calling for wider distribution of clean needles.  

“The science shows that syringe services programs work,” CDC Director Tom Frieden said. "They save lives, and they save money." 

St. Louis County Officer David Meyer tests pushing the Narcan nasal syringe hard enough to create mist instead of dribbling out.
File Photo | Camille Phillips | St. Louis Public Radio

The St. Louis-based agencies coordinating Missouri’s federal grant to prevent opioid overdose deaths are training their first batch of first responders Monday afternoon.

Officers and EMTs from the Warrenton and Wright City fire protection districts and the Eureka, St. Charles City, Marthasville and Columbia police departments will be taught how to administer the overdose antidote, naloxone, before collecting a supply of the life-saving drug to bring back to their jurisdictions.

St. Louis College of Pharmacy professor Amy Tiemeier demonstrates how to use a medication disposal pouch to promote National Prescription Drug Take-Back Day. (Oct. 20, 2016)
Durrie Bouscaren| St. Louis Public Radio

Police departments, recreation centers and a handful of grocery stores will accept and dispose of unused medications in the St. Louis region as part of a semi-annual National Prescription Drug Take-Back Day on Saturday.

Public health officials recommend that people dispose of unused medications to prevent accidental poisoning or addiction. While flushing pills down the toilet may be effective, it can contaminate the water system. With that in mind, a growing fixture at the take-back days are plastic disposal pouches, filled with a carbon compound. They can hold up to 45 pills, and a once cup of water is added, the mixture breaks down into a substance that is safe for a landfill.

An induction room at SSM Health's new WISH Center.
Provided | Sarah Savat, SSM Health

SSM Health St. Mary’s Hospital in Richmond Heights has a new facility dedicated to caring for pregnant women addicted to heroin and other opioids.

The Women and Infants Substance Help, or WISH Center started two years ago as a half-day weekly clinic. But after referrals and word of mouth built up a three-week waiting list, SSM Health decided to expand.

St. Louis County Police Officer Kathy Poncin practices administering Narcan Thursday, Feb. 18, 2016 while emergency physician David Tan looks on.
Camille Phillips | St. Louis Public Radio file photo

Federal dollars for the prevention of overdose deaths caused by opioids such as heroin and prescription painkillers are being sent to St. Louis area counties in both Missouri and Illinois.

Each state also received one additional federal grant aimed at fighting the national opioid crisis. One will help the Missouri Department of Health better track opioid overdoses. The other will increase access to medication-assisted addiction treatment in Illinois, but the Metro East won’t benefit from that grant.

A kit containing the opioid overdose antidote naloxone.
File Photo | Camille Phillips | St. Louis Public Radio

Updated at 4:16 p.m. Sept. 2 with information from pharmacies — According to a spokesperson with the state department that oversees the Missouri Board of Pharmacy, Missouri pharmacies do not have to wait for final rules from the board before distributing the opioid overdose antidote naloxone without a prescription.

“The new provisions are ‘self-executing’ and do not require a Board rule for implementation.  This means pharmacists with a valid protocol are authorized to dispense naloxone, as of [Aug. 28, 2016],” said Yaryna Klimchak with the Missouri Department of Insurance, Financial Institutions & Professional Registration.

U.S. Secretary of Agriculture, Tom Vilsack, speaks during a visit to NCADA's offices in St. Louis County. He leads a government task force to curb opioid abuse.
Durrie Bouscaren | St. Louis Public Radio

St. Louis County could receive federal funds to establish a regional prescription drug monitoring database, under a new law passed by Congress that President Barack Obama has said he will sign.

The measure allows for local governments, not just states, to apply for federal grants to set up a database to alert physicians when a patient may be receiving too many opioid prescriptions. U.S. Sen. Claire McCaskill said she submitted the language in a motion because Missouri is the only state in the country without a statewide system.

Kelly Moffitt | St. Louis Public Radio

In U.S. medical schools, a total of nine hours is required in pain management training for doctors. That’s 0.3% of total time in medical school and, to compare, veterinarian schools spend more than 500x more time spent learning to treat pain in animals.

That’s according to a study conducted by Johns Hopkins in 2011 and cited by Dr. Michael Bottros, the director of acute pain service at Barnes-Jewish Hospital.

Michael Velardo | Flickr

Gov. Jay Nixon has signed into law legislation to expand access to medication to combat some drug overdoses. 

Naloxone hydrochloride, also known by the brand name Narcan, has been approved by the FDA for use to block overdoses from opioids, which include heroin and prescription drugs, such as oxycodone and hydrocodone.

U.S. Sen. Roy Blunt meets with people Feb. 20 at Washington University's Alzheimer's Research Center in St. Louis.
Jason Rosenbaum | St. Louis Public Radio | file photo

The U.S. senators representing Missouri and Illinois are playing an active role in congressional efforts to combat the opioid epidemic.

Roy Blunt, R-Mo., Claire McCaskill, D-Mo., Dick Durbin, D-Ill. and Mark Kirk, R-Ill., all voted for the popular Comprehensive Addiction Recovery Act known as CARA.

Chad Sabora of the Missouri Network for Opiate Reform & Recovery watches as the St. Louis Board of Aldermen approve the Good Samaritan bill he supported.
Liz Schlemmer | St. Louis Public Radio intern

A bill that aims to reduce fatal heroin overdoses is on its way to Mayor Francis Slay’s desk.

The St. Louis Board of Aldermen approved the so-called Good Samaritan bill. It offers immunity from drug possession charges for those who seek medical help for someone experiencing an overdose.

Individuals could still be arrested for other crimes, or if they have outstanding warrants.

e-MagineArt.com | Flickr

Updated May 31 with bill signing — St. Louis Mayor Francis Slay went to St. Louis County today to sign the bill setting up the city's Prescription Drug Monitoring Program. The bill allows the city and county to work together to form a cohesive system. The mayor and county Executive Steve Stenger are pledging to bring down drug overdoses.

Probuphine works by implanting four bars like this under the skin of the upper arm. The bars release a dose of the opioid addiction medicine buprenorphine for six months.
Braeburn Pharmaceuticals | provided

Updated May 27 with FDA decision and new pricing details — The Food and Drug Administration approved Thursday the buprenorphine implant Probuphine for use treating addictions to prescription painkillers and heroin.

The implant received a lot of attention in the addiction medicine field in anticipation of its approval as a potential game changer in the fight against opioid addiction. It could also have a $5,000 plus price tag every six months.

A kit containing the opioid overdose antidote naloxone.
File Photo | Camille Phillips | St. Louis Public Radio

Missourians working to reduce the impact of the opioid crisis are close to scoring one victory this legislative session: a measure expanding access to the opioid overdose antidote is on its way to the governor’s desk.

But with one day left in the session, another tool many consider vital in the fight against opioids appears out of reach. Missouri is likely to remain the only state in the nation without a prescription drug monitoring database.

Sen. Rob Schaaf, R-St. Joseph
File photo | Jason Rosenbaum I St. Louis Public Radio

A showdown is looming in the Missouri statehouse over an effort to make Missouri the final state in the nation to gain a prescription drug monitoring program.

State Sen. Rob Schaaf, R-St. Joseph, has promised to filibuster House Bill 1892, which would let doctors check a database before giving patients a prescription for opioid painkillers, and require pharmacists to report filling opioid prescriptions within 24 hours.

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