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High demand for strong opioids, increased hospitalization of newborns, and rising naloxone administration are some usage, addiction, and opioid treatment trends in Mississippi.

USAGE

High Demand for Strong Opioids

  • A study by the Mississippi State Department of Health (MSDH) for the five years from 2012 to 2017 recorded a very alarming number of opioid prescriptions in the state, indicating a high usage within that period.
  • From 2012 to 2017, the number of opioid prescriptions surpassed the number of people living in Mississippi.
  • While there was a decline in the overall number of opioid prescriptions during the study period, the demand for strong opioids such as “oxycodone, morphine, and fentanyl” increased. For example, oxycodone had 190,341 more prescriptions in 2017 than in 2012.
  • Strong opioids such as Fentanyl have been described as the main drivers of the spike in overdose deaths from prescription medications in Mississippi.

Synthetic Opioids

  • In specific ways, the Mississippi opioid epidemic follows national trends, which is evident from the increasing use of synthetic opioids. The cases of overdose deaths due to fentanyl and other synthetic opioids increased tenfold from 2012 in the US, claiming 30,000 lives in 2018 from 3,000 deaths in 2013.
  • Fentanyl is replacing heroin in the market, as it can be acquired at a cheaper rate. The internet aided the increase in demand for Fentanyl and other synthetic opioids. “Online dissemination of new, easier, and more efficient methods of synthesizing these drugs has boosted the rediscovery and manufacture of fentanyl.”
  • E-commerce, anonymous browsing, and other innovations that promote online privacy allow for illicit procurement of these drugs, increasing abuse, addiction, and overdose cases.
  • In Mississippi, deaths due to synthetic opioids increased 4x in the past seven years, constituting 41.7% of the overdose cases recorded in 2017.

ADDICTION

Multi-Drug Addiction

  • There has been a rising trend of multi-drug abuse and addiction in Mississippi, which typically involves the misuse of more than one opioid or, in some cases, the combination of an opioid with non-opioids.
  • In 2016, 11.6% of opioid-related deaths involved the concomitant use of at least two different opioids, and this value increased to 20% in 2017.
  • Similarly, 50.6% of opioid-related overdose deaths in 2016 reported opioids and non-opioid drugs in the abuse case. This value rose to 55.6% the following year, 2017.
  • The rate of opioid-related overdose increased by 125% between 2011 and 2017. Of the 895 opioid-related deaths in 2017, 90.4% were unintentional, including those who were addicted to using such substances. Only 4.8% were deliberate suicides.

Increased Hospitalization of Newborns

  • Opioid use during pregnancy has escalated in recent times, as more pregnant women are presenting with cases of substance abuse disorder (SUD). This trend follows the opioid epidemic facing the general population and has led to some complications with childbirth. Thus, pregnancy has presented an opportunity for healthcare providers to identify and treat women with SUDs.
  • According to a report from the MSDH, there has been a significant increase in the number of newborn children’s hospitalizations due to substance abuse and SUDs from their birth mothers and involving heroin and other prescription drugs.
  • The number of such hospitalizations increased from 113 in 2010 to 689 cases in 2017. There was also a parallel increase in “cases of neonatal abstinence syndrome (NAS), caused by prolonged exposure of the developing child to addictive drugs during pregnancy, leading to withdrawal symptoms at birth.”
  • Each newborn observed a minimum admission period of nine days in the hospital, totaling a cost of $23 million in 2017.

TREATMENT

Increased Opioid Treatment Medications

  • Opioids are mostly prescribed as pain-relievers. However, they are also used for “maintenance during opioid-addiction treatment, cough and diarrhea suppression, management of acute pulmonary edema, and adjunctive therapy in anesthesia.”
  • Since 2012, there has been a sharp increase in the use of opioids as addiction treatment medications in Mississippi, which also indicates a rising number of opioid use disorders (OUDs) in the state.
  • Addiction treatment medications such as Suboxone or generic buprenorphine accounted for 6.4% of all opioid prescriptions in 2017.
  • However, methadone, which can also be used for addiction treatment, was excluded from this category. Instead, it was included as an analgesic, and opioid analgesics constituted the highest category of opioid prescriptions during the study period from 2012 to 2017, conducted by MSDH.
  • As of 2017, methadone, among other opioids, constituted 52% of Mississippi’s drug overdose death cases.

Rising Naloxone Administration

  • Naloxone is a life-saving drug that reverses opioid overdose effects and prevents overdose deaths when administered in time.
  • Naloxone administration has increased significantly in recent years due to the “emergence and growing popularity of highly toxic synthetic opioid substances.”
  • According to data revealed by Emergency Medical Services (EMS), the total number of naloxone administrations by the third quarter of 2018 was 62% more than the 2017 total. Naloxone administrations averaged 143.7 per month in Mississippi during the first three quarters of 2018.
  • Due to the increasing rates of opioid and heroin addictions in the state, the “House Bill 996, passed in Mississippi’s 2017 legislative session, permits the use of standing orders for naloxone at pharmacies across the state. These standing orders allow any individual to request to purchase naloxone at a pharmacy without a doctor’s prescription.”
  • The state’s expansion of naloxone access saved no less than 2,000 lives in 2017.

COMBATIVE MEASURES

Opioid Alternatives Model

  • The drug overdose epidemic ravaging Mississippi is one of great concern, and several strategies have been proposed to address this situation in the state. Among them is the use of opioid alternatives.
  • Opioid painkillers such as hydrocodone, oxycodone, and methadone were among the primary drivers of those drug overdose cases. Currently, more overdose cases are tied to these opioids over heroin and cocaine. Drug overdoses are also killing more people than car accidents in Mississippi.
  • A group of caregivers and physicians from the University of Mississippi Medical Center (UMMC) partnered with “the Department of Psychiatry and Human Behavior to develop a first-time clinical treatment model around the issue of opioid abuse.”
  • This program aims to effectively minimize and manage a patient’s pain beginning with pain relief remedies or medications other than opioids that would protect the patient from addiction.
  • In implementing this model, the group is looking at “acupuncture and other non-medicines, such as physical therapy and occupational therapy.”
  • Patients would receive non-opiate medications such as acetaminophen, ibuprofen, aspirin, muscle relaxers, and selected anti-depressants or anti-convulsants when the need arises.
  • In developing this alternative model, the team focused on both proper anesthesia and pain treatment during surgical procedures and the patient’s post-surgery pain through “Enhanced Recovery After Surgery.” Such an approach calls for a multidisciplinary team of providers to adopt a culture of reducing a patient’s stress response to surgery as a way to help the patient recover more quickly.”
  • Mississippi is also expanding its Medicaid coverage of opioid alternatives.
  • One example of the successful implementation of an opioid alternative model is the 6-month Colorado Opioid Safety Pilot, which achieved a 36% decrease in opioid administration during the pilot year compared to the same period in the previous year.

Prescription Monitoring Program

  • The Mississippi Prescription Monitoring Program (MS PMP) helps to “provide proper pharmaceutical care relating to controlled substances” for practitioners and healthcare providers using an electronic tracking system.
  • Data provided within this system includes the controlled substance drug profile of patients and the information of the prescribing individual and dispensing institution.
  • As such, health care providers and institutions can assess a patient’s opioid usage to identify abuse, misuse, or prior prescriptions. In the same light, “regulatory agencies can identify potential inappropriate use of controlled substance medication.
  • The Mississippi Board of Pharmacy manages this program, and the service is available online 24/7.
  • The state began collecting information as early as 2005. However, it is making improvements to make the system more effective.
  • While the use of the MS PMP is not yet a requirement in the state, Mississippi’s Medical Licensure Board recently proposed new regulations that would make the MS PMP a requirement before a physician prescribes opioid medications.
  • Looking at Maryland physicians utilizing a similar program, prescription drug monitoring programs (PDMP) improved physicians’ comfort level when prescribing opioids by 70%. About 97% of physicians in Wisconsin using the same admitted that the program helped identify patients with drug abuse patterns/inclinations. As a result, 90% of physicians in the state prescribed fewer opioids.
GLENN TREVOR
Glenn is the Lead Operations Research Analyst at The Digital Momentum with experience in research, statistical data analysis and interview techniques. A holder of degree in Economics. A true specialist in quantitative and qualitative research.

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