Meet Johnathan, a 34-year-old male from rural Georgia recently treated for back pain as a result of some extra contractor work he took on over the holidays. We see patients like him every 15 minutes, which doesn’t leave much time to get beyond Johnathan’s chief complaint. He leaves with his first prescription for opioids.
Opioid overdose is now the leading cause of accidental deaths in the United States, surpassing car accidents. The signs we see on the side of the highway have unfortunately yet to be updated; to be most effective, they should be advertising this public health emergency.
Of the 91 Americans taken by opioids every day, Georgia now claims four, or more than twice our share. Deaths from opioid overdoses increased tenfold in Georgia between 1999 and 2015, compared to fourfold nationally, putting us among the nation’s top 10. It’s safe to say our national epidemic has particularly devastated our state during the past two decades.
As medical best practices spread quicker in today’s digital age, medicine has become increasingly standardized with less variability. According to recent data from the Centers for Disease Control and Prevention (CDC), however, opioid prescribing can vary by a factor of six across counties. Opioid use is an anomaly in modern medicine, with some areas lagging far behind others, and our state unfortunately is the picture of that anomaly.
When we examine the areas of highest prevalence to learn why, we see higher prescriptions tied to areas with higher unemployment or populations with diabetes, arthritis, or disability. Unfortunately, we have several of those areas.
We have just as many Georgians as opioid prescriptions in 2017 alone, and approximately 10 percent of those who are prescribed opioids develop an opioid-use disorder. At the moment, we’re being pillaged for our opiates statewide.
In time, our opioid problem gives rise to a heroin problem when opioids become too expensive; 86 percent of heroin users begin as opioid users. Recently, a televised report aired on our “heroin triangle,” based on a 4,000 percent increase in heroin-related deaths inside a geographic location north of Atlanta identified as “The Triangle”. Since then, the triangle has grown from the epicenter of Alpharetta, Roswell, and Johns Creek to include Kennesaw, Acworth, Cartersville, Cumming, Flowery Branch, and Gainesville.
In 1932, groundbreaking research was published demonstrating a link between smoking and cancer, but it took until the 1960s until the scientific consensus was that smoking was, in fact, terrible for us. Historically, it takes decades and a mountain of data to overcome the inertia of status quo in medicine; but, it doesn’t have to be this way. We live in the information age, so no longer should any problems, medical or otherwise, still stem from a lack of information.
Patient Johnathan came back for months to ask for higher doses as the previous ones lost effect after a while. Around this time, our hospital started an opioid stewardship committee, with pharmacists, doctors, and other providers investing time to offer fellow providers the data behind high-dose opioids and prompting conversations about risks to the patient as well as de-escalation techniques. In time, Johnathan was de-escalated and eventually stopped coming in.
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