Opioids | St. Louis Public Radio

Opioids

Inez Davis, Bill Callahan
DEA St. Louis Division

More often than not, the U.S. Drug Enforcement Administration is associated with tracking drug cartels and arresting traffickers. But the law enforcement agency also ensures physicians and pharmacists are following the law with regard to prescriptions, a role that has become more critical as well as more challenging in recent months.

And in the DEA’s St. Louis Division, the COVID-19 pandemic has prompted more focus on community outreach, even as the opioid crisis continues to ravage the country. Earlier this month, the St. Louis County Department of Health reported a 47% increase in opioid-related deaths among Black men in 2019.

This spring, the division launched the website With You STL in an effort to help connect community members with critical resources for prevention, treatment and recovery. 

St. Louis County Health Department co-director Spring Schmidt (left) and county executive Sam Page address reporters on Sunday, March 8, 2020, regarding Missouri's presumed first case of the new coronavirus.
File Photo | Bill Greenblatt | UPI

The number of black men in St. Louis and St. Louis County who died of opioid drug overdoses increased between 2018 and 2019, even as those deaths declined 7% in the region.

Opioid deaths among black men in St. Louis County went up nearly 50% during that period. Deaths in St. Louis went up 2%.

Public health officials say the greater access white people have to addiction doctors in part explains the disparity. But the fear that some black opioids users have of seeking medical or emergency help also is a factor.

Senate Press availability with Dave Schatz, Caleb Rowden, John Rizzo on Thurs. March, 12, 2020.
Jaclyn Driscoll | St. Louis Public Radio

Legislation creating a statewide prescription drug monitoring program cleared its last major hurdle on Thursday — passing the Missouri Senate 21-10.

The measure has passed in the House for years, but a strong filibuster in the Senate has allowed some of the conservative members to kill the proposal due to privacy concerns. A monitoring program is designed to prevent abuse, especially of opioids. 

The St. Louis County Health Department is distributing free two packs of Narcan nasal spray, which can save people from opioid overdoses.
Sarah Fentem | St. Louis Public Radio

The St. Louis County Health Department is distributing free bottles of an overdose antidote to save people addicted to opioids.

The department announced Monday it is offering naloxone at its health clinic in north St. Louis County and at the Buzz Westfall Justice Center in Clayton. When given to a person who has overdosed on opioids, the medicine can immediately reverse the effects of the overdose.

Granite City Renters Face Eviction Over Drug Overdose 911 Calls During Opioid Epidemic

Jan 29, 2020
On State Street in Granite City, there have been 11 crime-free housing violations for different tenants at the apartment complex over five years, from 2014 to 2018, more repeats than any other rental property. Eight of the violations requiring an eviction
File photo | Derik Holtmann | Belleville News-Democrat

Editor's note: This story was originally published in the Belleville News-Democrat.

GRANITE CITY — A 27-year-old man called 911 to send an ambulance to his home when his girlfriend passed out.

He didn’t know what was wrong but told the dispatcher it could be an overdose.

About a month later, he received a letter saying the city wanted his landlord to evict him.

In Granite City, renters can be kicked out after calling for help for someone overdosing on drugs because of the city’s crime-free housing ordinance. Even if no one is arrested or charged with a crime, the drug use breaks Granite City’s rules for renters.

St. Louis County Council established its own prescription drug monitoring program in 2016 to fill the void left by the absence of an official statewide program. Seventy-five jurisdictions across the state now participate in the program.
Rici Hoffarth | St. Louis Public Radio

Public health officials in St. Louis are expanding their efforts to reduce opioid addiction statewide.

The St. Louis County Department of Public Health unveiled new online resources Wednesday designed to connect doctors with information on opioids, pain management and substance abuse. The toolkit is the latest addition to the county’s prescription drug monitoring program, which was established in the absence of a statewide program. 

Saint Louis University School of Medicine recently was taken off probation by the nation's accrediting body.
Wikimedia Commons

St. Louis University is starting a program to train doctors to treat patients with addictions.

The university’s school of medicine will operate the state’s first addiction medicine fellowship. 

Fellowship doctors will compete rotations at the city’s hospitals, clinics and community health centers. They'll also learn how to treat addiction in pregnant patients and newborns and receive training in telemedicine.

“It’s exciting, because addiction psychiatry has been around since 1991, but addiction medicine now is open to any specialty in medical education,” said Dr. Fred Rottnek, a SLU family medicine professor and director of the fellowship.

Rep. Holly Rehder, R-Sikeston, at a press conference discussing new legislation that would modernize HIV laws in Missouri on Dec. 11, 2019.
Jaclyn Driscoll | St. Louis Public Radio

A bipartisan group of lawmakers is working to change current Missouri law on HIV that they say hasn’t been updated since the 1980s. 

Rep. Holly Rehder, R-Sikeston, said current laws now actually discourage people from being tested. She said if someone knowingly exposes their partner to HIV and they contract the disease, it’s a class A felony. This is the most serious of felony crimes that include murder, rape and forcible kidnapping. 

The opioid prescribing rate in Missouri went up close to 10 percent between 2017 and 2018 within counties participating in the state's drug monitoring program
Sarah Fentem | St. Louis Public Radio

Nearly three people a day died of opioid overdoses in St. Louis last year, according to data released by the National Council on Alcoholism and Drug Abuse.

There were 1,080 people who died of opioids in St. Louis and eight surrounding counties, up 30% from the year before. 

The 2018 count, released this week, marks the 12th consecutive year of rising drug-related fatalities in the region.

St. Louis County jail
File photo

The Buzz Westfall Justice Center in Clayton is sending twice as many inmates to the hospital for medical emergencies as it did in previous years, according to health officials. 

That’s likely because more inmates are coming into jail with drug addictions, said Dr. Emily Doucette, acting co-director of the St. Louis County Department of Public Health. Four in 10 inmates have withdrawal symptoms at their initial booking, said Doucette, whose department provides health care at the jail. 

Additionally, they increasingly have multiple substances, such as alcohol, tranquilizers and opioids, in their system, she said.

Doctoral students in psychology at the University of Missouri will be able to learn how to better treat and prevent addiction thanks to a $1.2 million grant from the federal government.

The funds from the Department of Health and Human Services will pay for 21 new psychology internships in areas that lack health services, more than doubling the department’s current positions.

“This will enable us to give them a little something extra,” said Laura Schopp, chair of the university’s health psychology department. “Any psychologist who is dealing with these chronic health conditions is going to come up against substance use disorders and, particularly, opioid use disorders.”

One out of three Missouri participants in Medicare’s prescription drug program were prescribed opioids last year, more than the national rate of 29%, according to a newly released government report.

About 973,000 Missourians were enrolled in Medicare Part D and 321,000 of them received opioids, the report by the U.S. Department of Health & Human Services’ inspector general finds.

August 29, 2019 Ben Westhoff
Lara Hamdan | St. Louis Public Radio

Fentanyl has become an international scourge. It’s been blamed for a spike in drug overdose deaths in Missouri as well as around the world. It’s both contaminated many recreational drugs and become a substitute for heroin in many American cities. And yet the Chinese factory responsible for manufacturing most of its precursors has received funding and lucrative tax breaks from the Chinese government.

Through years of research, St. Louis journalist Ben Westhoff has become one of the foremost experts into the international fentanyl trade. On Thursday, he joined St. Louis on the Air to talk about his new book, “Fentanyl, Inc.: How Rogue Chemists Are Creating the Deadliest Wave of the Opioid Epidemic.” Westhoff discussed how his investigation followed the drug from its manufacture in China to the streets of St. Louis – and the terrible impact that synthetic, laboratory-made drugs are having on communities around the world.

David Patterson Silver Wolf (at left) and Rachel Winograd joined Monday's talk show.
Evie Hemphill | St. Louis Public Radio

A few weeks ago, the Centers for Disease Control and Prevention released some positive statistics related to the ongoing opioid crisis. While drug overdose deaths in the U.S. had reached record levels in 2017, the nation saw an overall 4.2% decline in 2018.

In Missouri, though, the 2018 outcomes were far less hopeful – despite an influx of $65 million in federal funds aimed at addressing the crisis over the past few years. Provisional data for the state indicates a 16% increase in drug overdose deaths over the course of last year.

On Monday’s St. Louis on the Air, host Sarah Fenske talked with two local experts about where Missouri should go from here in light of the discouraging statistics.

A sign outside the Missouri Network for Opiate Reform and Recovery advertises Narcan, a medication that can reverse an opioid overdose.
File photo |Carolina Hidalgo | St. Louis Public Radio

Since 2016, Missouri has received more than $65 million in federal grants to provide treatment and recovery services to people addicted to opioids.

The money has provided thousands of people with addiction medication, counseling and residential services. But the latest grant cycle expires in September 2020, and addiction treatment providers are uncertain if Congress will approve funding after that. With Missouri’s opioid-related death toll rising each year, advocates say funding for medical treatment is more important than ever.

Donald Hutson is one of hundreds of people who have overdosed while in state prisons since May 2017, according to Missouri Department of Corrections records.
Carolina Hidalgo | St. Louis Public Radio

Destini Hutson spent much of her childhood picturing what life would be like when her dad came home.

Over time, her plans turned to the practical: teach him how to use an iPhone, help him find a job, go to Chick-fil-A together.

“‘It’s a lot that you’re going to have to learn,’” Hutson told her dad, Donald, who went to prison in 1997 when she was still a baby.

Those plans came to a halt last September, when Donald Hutson died of a drug overdose at Missouri Eastern Correctional Center in Pacific. He’s one of more than 430 inmates who have overdosed in state prisons since May 2017, according to internal data from the Missouri Department of Corrections. While there are many ways drugs are smuggled into prisons, DOC employees say internal corruption is a key part of the problem.

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

The number of drug-related deaths increased by 16% last year, as fatal overdoses declined by an estimated 5.1% nationwide, according to the Centers for Disease Control and Prevention.

Missouri is one of 17 states that saw a rise in drug-related deaths last year. In 34 states, the number of deaths declined. Only Delaware had a higher increase over the previous year, at 16.7%.

The emergency department at SSM Health St. Mary's in Clayton is one of several facilities in St. Louis County that County Executive Sam Page would like to have report non-fatal overdoses to the St. Louis County Department of Public Health.
Sarah Fentem | St. Louis Public Radio

County Executive Sam Page plans to ask the County Council to require doctors to report nonfatal overdoses to the health department.

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Many people who overdose on opioids are surviving, thanks to the increased use of the opioid-reversal drug naloxone. Knowing how many people overdose — not just how many die — can help the county understand who needs help the most, Page said.

Health workers and law enforcement are starting to understand addiction and overdoses as a public health, not a criminal, issue, Page said. Other health crises, such as measles or flu epidemics, require physicians to report cases to the government. Overdoses should be no different, he said.

Detective Melody Quinn of the St. Louis County Police Department leads a class outlining the myths and dangers of the sythetic opioid fentanyl, which was involved in the majority of the county's overdose deaths last year.
Sarah Fentem | St. Louis Public Radio

Officials from the St. Louis County Police Department want the public and the region’s law enforcement to know touching the synthetic opioid fentanyl won’t get them high or overdose.

Such myths could put overdose victims at risk, since emergency responders may be hesitant to touch or treat them.

In recent months, several police reports and media outlets have recounted stories of law enforcement officers getting high or sick after responding to overdose victims and getting fentanyl powder on their hands.

Hydrocodone is a common opioid that is prescribed for pain relief
Jonathan Ahl | St. Louis Public Radio

A study of workplace injuries in 27 states, including Missouri and Illinois, shows 68% of injured workers in very rural areas received at least one opioid prescription, while 54% of their urban counterparts received the same amount of prescription.

The study was conducted by the Workers Compensation Research Institute, an independent group that does research for insurance companies, employers and labor unions.

Three veterans filed suit in Illinois' Third Judicial Circuit against Purdue Pharma and more than a dozen pharmaceutical companies, alleging they marketed dangerous painkilling drugs to vets.
David Kovaluk, Brian Heffernan | St. Louis Public Radio

For years after he got out of the Navy, Joel Bishop took morphine twice a day.

He used four or five Percocet in between those doses.

“I lived around that pill bottle. It’s the only reason I had a watch,” Bishop said. “I couldn’t wait until it was time to open that bottle.”

On Friday, Bishop and two other veterans filed suit in Illinois’ Third Judicial Circuit, which includes Madison and Bond counties, against Purdue Pharma and more than a dozen other pharmaceutical companies, alleging they marketed dangerous painkilling drugs to vets.

Missouri Network for Opiate Reform and Recovery Executive Director stands beside the nonprofit's mobile outreach van. The decal on the back window represents the molecule naloxone, a chemical that can reverse and overdose.
File photo | Sarah Fentem | St. Louis Public Radio

A St. Louis nonprofit is sending outreach workers to city streets to dispense life-saving treatment from a newly refurbished ambulance.

The Missouri Network For Opiate Reform and Recovery will use the vehicle to dispense the overdose-reversal drug naloxone to active drug users and those in recovery. It also provides testing for sexually transmitted diseases such as hepatitis C and HIV and information about treatment programs.

The mobile unit extends the nonprofit’s reach beyond its headquarters at 4022 S. Broadway.

David Patterson Silver Wolf is an associate professor at the Brown School at Washington University. He's also chief research officer at the institution's newly launched Community Academic Partnership on Addiction.
Evie Hemphill | St. Louis Public Radio

When David Patterson Silver Wolf refers to the U.S. opioid epidemic as part of a “disease of despair” and “a tough disease to treat,” he’s speaking from experience both professional and personal. He experienced substance-use disorder firsthand after growing up in a troubled home that quickly led him toward drugs and alcohol.

“I was young and I was also suicidal – which, a lot of folks, when we talk about [overdosing], it’s hard to separate out what is an OD and what is just taking of your life,” the Washington University faculty member recalled on Monday’s St. Louis on the Air. “And I was also full of despair. I had no hope, I was a high school dropout … and I couldn’t see a vision forward.”

An activist campaign calls on city officials to shut down St. Louis' medium-security jail, commonly known as the Workhouse.
Carolina Hidalgo | St. Louis Public Radio

The inmate who died at St. Louis' Medium Security Institution (MSI) in August died of an accidental fentanyl overdose, the autopsy report shows.

Louis L. Payton, 48, was the latest inmate to die at the facility known as the Workhouse this year. He was the fifth inmate to die in custody at a city jail this year, according to records St. Louis Public Radio received in August from the city.

Mike Parson
Jason Rosenbaum | St. Louis Public Radio

Missouri Gov. Mike Parson thinks the state is “long overdue” for a statewide prescription-monitoring database for doctors.

Parson, a Republican, said Wednesday he hopes state legislators will pass a bill legalizing such a program next year. Missouri remains the only state without such a database, which proponents say helps cut down on opioids being sold on the street.

Parson made his remarks during a St. Louis stop on a weeklong statewide tour focusing on health issues. He met with state health officials and St. Louis Mayor Lyda Krewson to discuss Missourians’ addiction to opioids. The drugs in 2017 killed 760 people in the St. Louis region alone, and 951 in the entire state. One in every 65 deaths in Missouri that year was due to an opioid overdose, according to the the state’s health department.

A radiologic technologist clears a trauma bay at St. Louis University Hospital's emergency room.
Carolina Hidalgo | St. Louis Public Radio

A coalition of six medical organizations has recommended that hospital doctors take more caution when prescribing opioids for patients with pain.

To cut down on unnecessary prescriptions of addictive painkillers, the Missouri College of Emergency Physicians, the Missouri Hospital Association and other groups want hospital doctors to limit prescriptions, in some cases to a week's supply.

The guidelines, which update a 2015 list that applied only to emergency departments, now include all hospital personnel who prescribe medicine.

Long before Eric Kirkwood of Kansas City, Kansas, had his first sickle cell crisis at age 17, he knew about the pain caused by the disease. His uncle and sister had the genetic disorder, which causes blood cells to clump together and cut off circulation, leaving many patients with pain they describe like being squeezed in a vise.

“I’ve been in so much pain that I’m like ‘Why am I not dying?’” Kirkwood said. “It’s really like torture.”

Rici Hoffarth | St. Louis Public Radio

Residents of the St. Louis region will be able to discard unwanted and expired prescription drugs at dozens of local police departments this Saturday.

The twice-yearly “National Prescription Drug Take Back Day,” which is held in cities across the country, aims to reduce prescription drug abuse. The U.S. Drug Enforcement Administration, which spearheads the program, estimates they have collected more than 9.9 million pounds of prescription drugs since 2010.

Michelle Pattengill, a technician at L&S Pharmacy in Charleston, Mo., holds a bottle of oxycodone, a prescription opioid.
Bram Sable-Smith| Side Effects Public Media

The number of opioid-overdose deaths in St. Louis and surrounding counties continued to rise in 2017, although the increase wasn’t as steep as in previous years.

There were 760 opioid-related fatalities last year in St. Louis, St. Louis County and eight surrounding counties, a 7 percent increase from 2016, according to the St. Louis-based National Council on Alcoholism and Drug Dependence. The year before, the number of deaths jumped nearly 40 percent.

“We have seen a major increase in access to treatment, in access to naloxone, in access to harm-reduction strategies, and that might having an impact in slowing down the increase,” said Brandon Costerison, director of the addiction prevention and education initiative MO-HOPE.

Brandon Costerison, Kathi Arbini and Jeff Lowe discuss the opioid epidemic in St. Louis.
Evie Hemphill | St. Louis Public Radio

Recently released numbers from the Centers for Disease Control and Prevention show that more than 60,000 people died in the United States in 2016 due to a drug overdose. The data show nearly two-thirds of those deaths involved a prescription or illicit opioid.

Further, synthetic opioids such as fentanyl are contributing to the sharp rise in opioid-related deaths.

The problem is stark in the St. Louis area.

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