Dr. Randall Williams, director of the Missouri Department of Health and Senior Services, said the opioid addiction epidemic has been called a modern plague.
"I believe that to be true," he said.
He spoke Thursday at a conference of health care and law-enforcement experts where a federal Drug Enforcement Administration agent said 700 Americans a day fall into opioid addiction.
Missouri's problem runs close to the national average, and although methamphetamines remain the biggest problem in Eastern Jackson County, opioid addiction – often starting with legal painkillers but drifting to heroin and even more potent drugs – is on the rise.
Williams praised Jackson County for efforts such as the prescription drug database that it helped start, aiding doctors trying to screen out patients complaining of pain just to score a prescription for more drugs such as oxycodone.
But he added, "What we're doing isn't getting us to where we need to be."
Speakers outlined a series of challenges: too few addicts seeking and getting treatment, too few sober-living homes for those in recovery, too little education for doctors on pain management, a hospital evaluation system that gives doctors incentives to be aggressive about pain instead of cautious about addiction, and too many gaps in care between the ER, detox and the next stages of treatment.
And one more: As a society, we don't deal well with life's tougher moments, when we should fall back on our own strength and resilience instead of a pill.
"We are a society that doesn't want to deal with pain," said Michael Petersen, chief medical officer of Accenture Opioid Epidemic Solution.
'Huge problem'
Doug Dorley, a public information officer at the DEA's regional office, said this is the worst drug crisis in U.S. history. He said 25 million people – one American out of 13 – abuses drugs.
Although meth remains the most prevalent drug – "It is everywhere," Dorley said – prescription opioids and heroin are rising quickly. Heroin is often made worse with the addition of fentanyl and carfentanil, which make for a higher high and put the user far closer to an overdose.
"There is a huge problem in the Midwest. ... Whatever the national stats are showing, we're seeing," Dorley said.
Here's how potent and deadly fentanyl and carfentanil are: Police have stopped doing field tests of white, powdery substances. Those are sent straight to the lab because the danger to officers is too great should they come into contact with those substances.
"Ninety-one Americans are dying every single day," said Dr. Angeline Stanislaus, chief medical director of adult services of the Missouri Department of Mental Health, citing figures from 2015. She stressed that the crisis "affects all strata of the society."
She said Missouri had 908 opioid deaths in 2016 – up 35 percent in a year – and 377 of those were from heroin.
Prescription opioids such as oxycodone came onto the market 21 years ago, Stanislaus said, initially intended to treat such things as end-stage cancer. Pharmaceutical companies pushed them hard, making the pitch to doctors that they weren't overly addictive, she said.
Also, medical standards have shifted since the recognition of pain management as a separate discipline four decades ago. Now those drugs are prescribed for a wider range of pain, not just end-of-life scenarios.
Speakers on Thursday said it's often hard for a doctor to know if a patient truly needs help for pain or is trying to get a bottle of pills for his own addiction or to sell easily on the streets for four figures.
"There is very real crisis in how to treat patients ..." said Darrin D'Agostino, dean of medicine at the Kansas City University School of Medicine and Bioethics.
Even today, he said, only a handful of medical schools have a curriculum that links care with the management of chronic pain.
"I think this is one of the major gaps," he said.
Speakers also said patient evaluations – literally the emergency-room evaluation form that has patients rate their pain experience by marking somewhere on a scale of happy and sad faces – add to the problem. Those evaluations affect reimbursement rates, and that puts pressure on administrators to nudge doctors to no-pain options despite the risk of addiction.
Williams said today there are 89,000 opioid prescriptions for every 100,000 Missourians.
Tools to help are available. The state has collected many at opioids.mo.gov.
Every state but Missouri has a database that allows doctors to see how many other prescriptions a patient has. Jackson County and other local governments have started their own database. It's up to 48 jurisdictions, said County Executive Frank White Jr., covered 71 percent of Missouri's population.
"This will definitely help with doctor shopping," Stanislaus said.
Three years
Other speakers cited higher death figures than Stanislaus did. Dorley, of the DEA, said nationwide there have been 105 deaths daily this year just from fentanyl, which is still new on the streets.
Petersen said 38 million Americans – one in nine – have substance abuse disorder, and he put the number of opioid deaths at 142 a day, which he said is basically the equivalent of a commercial jet crash every day.
"That's how impactful this is," he said.
Williams and others said there's usually a downward path of about three years from the beginning of addiction to death. A typical pattern is that person becomes addicted to something like oxycodone, starts buying it illegally – $80 a pill – and then moves to heroin at one-fourth the price and a stronger high.
"The truth of the matter is we have time to intervene," Williams said.
But there are gaps, from tracking data to the lack of what Stanislaus called a "warm handoff" of an overdose patient from the ER to detox to rehab.
"Where we lose people are between stops," said Susan Whitmore, president and CEO of First Call.
Nicole Dawsey, prevention education coordinator for a group called NCADA St. Louis, said nine of 10 people needing treatment don't get it.
"That is unacceptable," she said.
Taking steps
Cameron Lindsey, a professor at the UMKC School of Pharmacy, outlined what she said were key messages: Only use prescription meds as directed by a health care professional. Don't share them. Keep them in a safe place, and properly dispose of them when you're done using them. And model good practices along these lines.
She encouraged educators to use resources at generationrx.org, which focuses on safe medicine use.
Also, Stanislaus pointed out that the drug naloxone, which first responders carry to reverse opioid overdoses, can now be purchased in Missouri by anyone, over the counter.
Dorley said education is crucial, starting in early grade school. Kids need to know, he said, that drugs are drugs, whether from a pill or a dirty needle.
Speakers stressed the need for prevention and treatment.
"Arresting people is not going to solve this problem," the DEA's Dorley said.
Treatment takes time and persistence.
"We don't know what's going to work for each person, and we need to individualize it and model it," said Alan Flory, president and CEO of ReDiscover in Lee's Summit.
Several speakers touched on addiction as a societal problem – something in the way we raise children and the messages we send them – that needs deep and long-term attention.
Sgt. Chris Cesena of the Kansas City Police Department drug unit said front-line officers ask users how they got to this point. The typical answer, he said, is that they started using substances just as a matter of coping.
"For some reason," he said, "they're broken."
Williams praised the efforts being made in Jackson County.
"It is clearly a beacon of light for us as we work on this," he said.
But overall, major changes are needed, he said, and he compared it with a wildfire.
"You've got to stop it," he said, "or it will grow."
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