MYRTLE BEACH, SC (WMBF) - It's taken some 20 years to get to where we are in today's opioid epidemic. While it's an issue nationally, we are feeling it's devastating effects here at home, too.
In a WMBF News investigation, Kaitlin Stansell talked to doctors, lawmakers and patients who all have their own unique ideas about how to fight this battle.
Watch all four parts of the half-hour special, "A State of Crisis," here:
After the special Kaitlin Stansell hosted a live question-and-answer session on Facebook Live with Claudette Parker, an addiction specialist from Trinity Behavioral Care. Watch it below (the session begins at the 6:45 mark):
"We never knew something a doctor gave you could be a drug," said a former addict who wanted to remain anonymous.
A taste of relief from pain can turn into a lifetime of craving.
"We are not the hardest hit state, but that freight train is coming," said Representative Russell Fry who represents Horry County.
The opioid epidemic has touched every level of our society, and it's taking lives and changing the way healthcare providers treat your pain.
"Every single time I take a shift over a few days, I deliver a baby who is dependent on opioids," said Dr. Marla Hardenbergh, an OB/GYN in Dillon County.
However, the increased scrutiny could be forcing some patients who really need this kind of medication to slip through the cracks.
"I don't know what the right course is, but I know this isn't it," Boyd Neeley said. His wife is one of those patients.
More research is being done to look at just how effective opioids really are in treating pain.
Earlier this month, a report was published in the Journal of the American Medical Association.
The study looked at just how well opioids work on chronic pain over a 12-month span.
Researchers looked at patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain. Despite the use of opioids, the study found their pain was not significantly better after one year of use.
Instead, it was the group using nonopioid medication, like acetaminophen, that showed their pain intensity was significantly better.
Adverse medication-related symptoms were significantly more common in the opioid group.
The study concluded that treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months.
Opioids do have their place in healthcare. We talked to one of the doctors in our area who made the list of the top 1000 prescribers of opioids in the Medicare prescription program.
He detailed why it is difficult for doctors to suggest alternative methods of treatment for patients.
"It is really hard as a physician to mandate lifestyle changes when often it's the lifestyle that lead them come to us," Dr. Jeffrey Wilkins said. "Certainly, heavier people, smokers, all have higher rates of chronic pain. That's no question. But when someone comes to you with back pain and says I want you to stop smoking, I want you to lose 30 pounds, and you pat them on the back and leave, that's probably the only time you're going to see that person. You can send them to therapy, but that takes a lot of patient involvement, too…A lot of patients with pain have a locus of control issue. They feel that life is happening to them, and they aren't in control. So, they often don't exert a lot of control…They sort of sit there and wait for you to come in with your magic pen and your magic pad, and you're going to do something to them and it's going to be okay. And that works about as well as you'd expect it to, not very."
At the state level, lawmakers have mandated that prescribers use tools created to make sure the patients they are serving aren't doctor shopping.
Just two years ago, the South Carolina Department of Health and Human Services started requiring providers to verify Medicaid members' controlled substance prescription histories before writing a new prescription. They put strict consequences on doctors for not using this program.
If a doctor fails to consult the South Carolina Reporting and Identification Prescription Tracking system, SCRIPTS, they could lose Medicaid payments. SCRIPTS has become a useful tool to look at prescribing patterns and prescriber and dispenser information.
"There's a lot of evidence that people that are now doing heroin and other drugs started with prescription opioid medications," said Christie Frick, the Director of SC's Prescription Monitoring Program, said. "We think it's taken a while for us to get to this point. There's a lot of things that have happened over the past 20 years that have contributed to the problem. Practitioners and pharmacists were taught pain was under treated in the 90s, pain was the fifth vital sign. So, there were a lot of things that kind of pushed maybe prescribers to put a lot of patients on opioids without all the precautions of addiction and worried about those kinds of situations."
With all the efforts to curb how many prescription pills end up on the streets, there are patients who actually need the medication and say new regulations and laws are keeping them from getting the care they depend on.
During the first part of our series called "Licensed to Pill," we heard from at least two local doctors who said they are fearful of their patients' futures.
"Pain patients who are not addicted and obviously benefit from monitored opioid prescriptions are being involuntarily tapered downward or off their beneficial pain medications," said Dr. Scott Sauer. "They are suffering inhumanely and some are committing suicide."
Dr. Walter Evans echoed those sentiment.
"I have witnessed the devastation in my patients' lives caused by the restrictive and heavy-handed policies of the DEA," Dr. Evans said. "Now, instead of giving these patients narcotic prescriptions which allowed them to lead active lives, I am prescribing wheelchairs and other assistive devices to help them stay out of a nursing home."
A local man shared his wife's struggle with this very consequence of the opioid epidemic.
Boyd Neeley believes the battle against opioids is going in the wrong direction and hurting people who rely on the medications, like his wife Marlana.
"Yea, they're dependent, but they need the medicines," Neeley said. "A lot of people who need them…have legitimate issues, are going to die also. I'm worried about that because my wife has come close to that already. Had it not been for my son and I, she would have. I don't know what the right course is. But I know, this isn't it."
Neeley said his wife has a history of pain and a list of conditions that have left her dependent on opioids to function.
"She's a wonderful woman. She was a nurse for 30 years. She has the biggest heart of anyone I've ever met," Neeley described. "I've been with her for 35 years, and I can tell you she is not an addict. She is a person in pain, and she has anxiety problems."
Neeley said his wife is being labeled as a drug addict by doctors and is unable to get the medication she needs.
"She's been to at least 8 doctors, and she was dropped by her doctor of at least 10 years," Neeley said. "This is the kind of treatment that people are getting, and it's horrendous and people are dying. You don't hear about those people because they aren't the people dying from heroin overdoses. You don't hear about the veterans, the older people, you don't hear about people who were injured, cut back to less than a third of what they were taking."
He sympathized with prescribers though.
"Between the government and the regulations they are putting on the doctors, they feel helpless, scared, they don't want to lose their license," Neeley said. "I understand that, but somebody has got to fix this."
Neeley believes lawmakers are going in the wrong direction with their solutions.
"It's just the biggest effort at reducing something that is really not touching the problem," Neeley said. "They haven't cut back on the heroin overdoses. They have created a whole new black market…Prohibition didn't teach them anything. If people need things, if people want things, they are going to get it."
From the state level to the federal level, the opioid epidemic has been declared a "public health emergency."
It's impacting every tier of our society, and it does not discriminate.
In South Carolina, from 2014 to 2016, the number of opioid-related deaths surpassed the number of homicides.
Those victims were mothers, fathers, professionals, unemployed, young and old. No one demographic has been unaffected.
While no single change in the law will fix this issue, legislators in our state house are trying to do what's in their power to combat the crisis
This January, the South Carolina House of Representatives' Opioid Abuse Prevention Study Committee released its recommendations to combat the opioid epidemic.
They focused on a five-fold approach, addressing access to treatment and services, education and training for prescribers and the public, the criminal justice system, prescription medication access, and community coordination.
"It's such a widespread issue," Representative Russell Fry said. "It affects families all over the place. It affects our crime. It affects our education. It affects the labor participation. The statistics are staggering how widespread this problem is. So, for lawmakers and anyone in government or in a policy making position, it's really important they focus on this issue this year and that we do it right."
Fry believes doctors play a major role in turning this epidemic around.
"They are the keys to the kingdom in this effort, and we really need them on board to help us tackle this issue in South Carolina," Fry said. He calls prescribers the first line of defense.
"When we look at the data on how people start down this path, it's through excess pills. It's pills in their parents' medicine cabinet or their grandparents medicine cabinets. Pills that were not used. Pills that you have two prescriptions for," Fry said. "So, when extra drugs get on the street and sold, that's how the problem starts. It's little by little. It increases the problem, and people become addicted really, very easily on opioids. So, the less pills that you have floating out there, the better we are at properly addressing the problem."
Fry knows the impact of opioids all too well. He represents Horry County, one of the hardest hit areas in South Carolina.
In 2016, the coastal corner of the state claimed the most opioid overdose deaths, 101.
That number was nearly double the next highest in the state, which was Charleston County with 65.
"What we see is a scenario where people believe if a doctor prescribes a drug, it must be safe. The sad reality is, that's not the case," Fry said. "The more we educate people and give them the opportunity to know the dangers and the risks of these drugs, the better we are at properly addressing the overall problem, which is opioid dependence and abuse."
Fry acknowledged that opioids have their place in healthcare, but the committee he contributes to believes a dramatic shift in how we perceive substance use disorders is needed.
"The big thing and the important this is we are starting a conversation on how we can address is. No one is openly hostile to these solutions. They have been at the table working with us. They want to see the changes, too," Fry said. "We are encouraged by that. I hope we can finish that this year with some sound policy."
To Fry, timing is everything in winning the war against this epidemic.
"If we wait, the problem just persists and gets worse," Fry said. "What we have seen is that the longer we hold off, the more it costs the tax payers, the more it costs society, the more families are affected. This is a growing problem whether we want to deal with it or not."
A bill that would enact a statutory limit of five days for initial opioid prescriptions was introduced this legislative session.
It's just one piece of the puzzle lawmakers are working to put together to fix this problem.
Related Link: Click here to read the complete South Carolina House of Representatives Opioid Abuse Prevention Study Committee report, which includes a complete list of recently-enacted, pending, and recommended legislation related to the opioid crisis in our state.
A DOCTOR'S FIGHT
it doesn't matter what field of medicine a doctor specializes in, the opioid epidemic has touched every sector of healthcare.
One local doctor is working on re-educating her fellow prescribers about substance use disorder.
Dr. Marla Hardenbergh is urging them to treat it as a disease rather than a moral failing.
She sees the devastating effects of this crisis first hand as an OB/GYN.
"I am seeing young women, older women, women who are professional and babies die from this disease every month," Dr. Hardenbergh said. "They aren't dying from breast cancer, cervical cancer. They are dying from untreated substance use disorder, in numbers and devastating consequences for this community and families like I have seen nowhere else."
Dr. Hardenbergh likens opioid addiction to a disease, a disorder, that can be screened for and treated.
"Because we are culturally sometimes geared towards seeing substance use disorders as a moral failing and not a medical disease, we are asking the police to be that bridge, sometimes other groups or supports," Dr. Hardenbergh said. "The most effective way to do that is for the healthcare provider to be that bridge."
She has started a non-profit called SAIL Initiative to address substance use disorders by reconfiguring the way healthcare providers address the issue in their clinical practice.
She's also working to provide sober living housing for women recovering from substance use or dependence.
"I see what this epidemic has done to families, to mothers, to babies all throughout that journey and when I know that there is treatment that can release these people from the devastating effect of this deadly disease…to stand by and not make available a bridge between the disease and the treatment is not being of maximum service," Dr. Hardenbergh said. "If I see it and I don't do anything, I'm guilty, too."
Dr. Hardenbergh said the science is there to support her cause.
"Doctors, providers, especially those that were trained when I was, we didn't understand as much about substance use disorders and how it was a disease and had genetic predisposition and exactly what's going on in the brain that creates the phenomenon of craving," Dr. Hardenbergh said. "We understand that now."
She hopes her organization will show doctors what role they play in stemming this epidemic before it takes even more lives.
"Once we spend the time and the money we need to spend on the state and federal level to educate providers about what is the disease, how do you screen for it, how should we be prescribing controlled substances," Dr. Hardenberg said. "If I failed to screen for breast cancer or I gave you the wrong medicine for the wrong amount of time or I failed to send you to a doctor to give you chemotherapy, that would be gross negligence. This is no different."
Dr. Hardenbergh emphasized that alcohol abuse is also a part of this substance use disorder. She believes this is a preventable and treatable disease with the proper intervention from healthcare providers.
AMERICAN MEDICAL ASSOCIATION
Dr. Gerald Harmon has a unique perspective of the opioid epidemic. He is a local doctor, and he is also the board chair of the American Medical Association. He helps direct lawmakers at the federal level in their pursuit of policy to combat this issue. He says science and data have uncovered a lot of changes that need to happen, and the AMA has come up with their own guidelines for beating the opioid problem.
They have 6 recommendations:
- doctors use their state's prescription drug monitoring programs
- have effective education and training
- support for comprehensive care for patients with pain or a substance use disorder
- remove the stigmas surrounding the opioid epidemic
- expand access to Naloxone
- work with patients to safely store and dispose of their prescriptions.
"We need to remove the stigma of pain, the stigma of the substance use disorder patient...appears to be our best bet at addressing this public health crisis," Dr. Harmon said.
He acknowledged the role doctors have played in where we are in this epidemic today, and he believes there's a fine line between fixing the problem and not hurting the people who need this kind of medication.
"To see them suffer and to see their loved ones say Dr. Harmon...can't you do something more...I couldn't prescribe it or if they can't get to it...we have to be careful," Dr. Harmon said. "In our zeal, again, to do the right thing for the majority of Americans…that some of those people don't fall through those cracks."