More people are dying annually from overdosing on opioids compared to HIV, car accidents and gun violence. And Missouri is no exception.
“The opioid crisis is the biggest public health emergency of our lifetimes,” said Rachel Winograd, assistant research professor at the Missouri Institute of Mental Health at the University of Missouri-St. Louis.
She said the clear hot-spots of deaths in Missouri are in the St. Louis area.
Winograd joined St. Louis on the Air host Don Marsh on Tuesday along with Dr. Evan Schwarz, director of medical toxicology at Washington University and Amy Tiemeier, associate professor of pharmacy practice at St. Louis College of Pharmacy.
Opioid medication plays a major role in controlling pain, but its abuse made it a public health crisis. Schwarz said the reinforcing capability of opioids is what makes them addictive.
“After you start using them, first you get very euphoric and these great feelings and they make you feel so good,” Schwarz said. “But after a while they kind of hijack the brain and all the brain can think about is getting more of this to try and feel that way again.”
Fentanyl, a strong opioid medication, is causing more deaths than heroin and prescription pain killers. Winograd said the issue is that heroin and illicitly made fentanyl are easier to find than prescription pills.
“That hasn’t always been the case,” Winograd said. “It’s a supply and demand market out there and when things get harder to obtain in one way, people shift and move towards something else.”
Policies can’t keep up
Some people believe part of the problem is that physicians were quick to prescribe opioids. But Winograd said the epidemic has morphed faster than policies can keep up with.
Schwarz said physicians have owned up to the fact that they should have done things differently when it came to prescribing opioids.
“I’d like to think the majority of us now understand that and are looking at ways to change our practices and ways to improve care for the patients,” he said.
But Winograd also warned against overcorrection, when physicians pull back on prescribing opioids, which in turn might cause people to turn to the streets to get illicit medication.
“At this point, don’t react too impulsively and stop prescribing opioids because we’re going to have a bigger mess on our hands, and we’ve seen that happen in other states,” she said.
Pharmacists playing a role
The role of pharmacists is important in the fight against drug overdose, according to practicing pharmacist Tiemeier.
“At that pharmacy counter is a prime time where pharmacists can be educating and really be improving the landscape with regards to this [opioid] issue,” Tiemeier said.
When it comes to pharmaceutical companies, she said they want to strike a balance between providing medication and preventing abuse. There is still a legitimate use and need for patients to take opioid medication for pain prevention.
“They are continuing to look at ways that they can make medications that help to treat patients’ pains but also address the issue and the very real reality that these are being diverted and misused and causing loss of life,” Tiemeier said.
In Missouri, 47 counties signed up to be part of St. Louis County’s Prescription Drug Monitoring Program (PDMP), including St. Louis City. Part of the program is to collect data to identify “problem prescribers” and potentially “problem patients”.
The program recently received the Missouri Opioid State Targeted Response grant and Winograd is the project director.
She said what reduces opioid overdose mortality is maintenance treatment with methadone or buprenorphine, also known as opioid substitution therapies. She also wants to see greater access to Naloxone, an overdose reversal drugs.
Schwarz said physicians sometimes receive pushbacks from recommending other drugs. But he said the aim is not to get people addicted to a different type of opioid.
“That’s not what we’re doing. The medications that we’re using cause them to be just like normal people and they can be fully functional,” he said.
St. Louis on the Air brings you the stories of St. Louis and the people who live, work and create in our region. St. Louis on the Air host Don Marsh and producers Mary Edwards and Alex Heuer give you the information you need to make informed decisions and stay in touch with our diverse and vibrant St. Louis region.