“THE OPIOID CRISIS IS NOW PART OF URBAN AMERICA AND BIG CITY LIFE”
Mark A. York (July 12, 2018)
(MASS TORT NEXUS MEDIA) According to sources at all levels from police and fire first responders to emergency room physicians across the country and analysts at the CDC, there’s been no slowdown in opiate based medical emergencies in the US over the last 2 years. Emergency response and ER visits for opioid overdoses went way up, with a 30 percent increase in the single year period of June of 2016 to June of 2017, according to the Centers for Disease Control and Prevention. This is now much more common in big city and urban areas of the country that it was just four years ago.
Center for Disease Control’s Acting Director Dr. Anne Schuchat said overall the most dramatic increases were in the Midwest, where emergency visits went up 70 percent in all ages over 25. The affected populations and demographics are comparative to prior medical crisis deaths during historical healthcare pandemics when a disase struck across entire populations, while sparing no particular class of society.
WHY THE HUGE INCREASE IN THE MIDWEST?
ER visits for opioid-related emergencies more than doubled in two states. Wisconsin saw the biggest increase, 109 percent and Delaware saw a 105 percent increase. In Pennsylvania, ER visits were up 81 percent.
“We’re seeing the highest ever death rates in the US,” Schuchat said. She pointed to national statistics that out of 63,000 overdose deaths in 2016, 42,000 of them involved opioids.
“[This] means 115 people die each day from opioid overdose,” she said. This number has been at or above 100 for most of the last 3 years, with no end in sight and with so many different regions affected it may require more grassroots focus and demands made to elected officials to move faster on a long term solution.
There were some decreases reported in the East, with the largest being a 15 percent reduction in Kentucky, which could reflect fluctuation in drug supplies or interventions.
However, hospital visits in cities of all types increased steadily in each quarter by 51 percent. Schuchat emphasized, “Bottom line — no area of the US is exempt from this epidemic.” Looking closer at causation and access to opiates across the country is required. How are unlimited numbers of federally controlled substances still so readily accessible to so many?
US Surgeon General James Adams was also present during the briefing and mentioned how he witnessed first-hand his own young brother’s struggle with opioid addiction.
“Science is clear: Addiction is a chronic disease and not a moral failing,” the doctor said. Adams outlined that a coordinated effort is necessary to prevent opioid addiction. “To successfully combat this epidemic, everyone must play a role,” he noted.
The Surgeon General explained how health departments, along with public safety and law enforcement officials, have to work together to deal with local opioid-related emergencies.
He stressed the need to make naloxone, a life-saving drug that can reverse the effects of an overdose, more accessible in emergency situations.
URBAN AMERICA AND OPIODS
The CDC data shows trends in opioid overdose emergency room
In late 2016 through current medical data from the CDC and hospitals across the country, the opioid epidemic is fast becoming a big city problem.
There was a 54 percent increase in overdoses from July 2016 through September 2017 in the major metro areas of 16 states surveyed by the federal Centers for Disease Control and Prevention — a chunk of the country that includes Chicago, Philadelphia, Milwaukee, Cleveland and Columbus, Ohio.
Nationwide, the scourge that President Donald Trump has vowed to defeat shows no sign of abating, with a 30 percent increase in opioid overdoses reported during that same period, the data released Tuesday shows.
Anne Schuchat, the CDC’s acting director, said the grim new arithmetic, which came from emergency room statistics, confirmed some suspicions. “We’re currently seeing the highest drug overdose death rates ever recorded in the United States,” Schuchat said in a Q&A session with reporters. Asked specifically about the rise in urban opioid overdoses, Schuchat said health officials suspect a “change in the toxicity” of drugs on the street.
Urban heroin dealers have been boosting profits by cutting their drugs with fentanyl, which is 25 to 50 times more powerful. That combination was why Columbus was averaging one fatal overdose per day in the first half of last year.
“The issue of cutting heroin with fentanyl is a very major problem right now,” Schuchat said. “What you are seeing in Columbus is for sure occurring in other
Daniel Raymond, deputy director of the Harm Reduction Coalition, said that initially the opioid overdose rates “were primarily driven by prescription painkillers — they weren’t concentrated in urban areas.”
“But the recent rises are mostly driven by heroin, and particularly fentanyl, and the latter seems particularly prevalent in urban drug markets,” said Raymond, whose organization is based in New York City. “That’s certainly true in places like Ohio and Philadelphia, which are seeing a lot of fentanyl-involved overdose deaths. That doesn’t mean the problems have waned in smaller cities and rural areas, which are also seeing fentanyl, but we are seeing increasing vulnerability in major urban centers.”
The only bright spot — and it’s a dim one at that — was that the CDC found decreases in opioid overdoses in states like West Virginia, New Hampshire and Kentucky that have been leading the nation in the category.
“We hope this is a positive sign,” said Schuchat, who credited leadership, particularly in West Virginia, with taking bold steps to combat the crisis. “But we have to be cautious in the areas that have reported decreases.” Dr. Rahul Gupta, Director of Public Health for West Virginia has been at the forefront of addressing the opioid crisis in not only West Virginia but across the country. Dr. Gupta will be the keynote speaker at the Mass Tort Nexus National “Opioid Crisis Summit, July 20-22, 2018 in Fort Lauderdale, FL where he will be joining other prominent national healthcare and legal speakers on providing solutions to the opioid crisis, see www.opioidcrisissummit.com for attendance information.
“Sometimes places that have had such high rates have no place to go” but down, she added, with West Virginia being one of the states to address the issues pro-actively in all areas.
The new CDC “Vital Signs” report was released a week after Attorney General Jeff Sessions issued a “statement of interest” in support of local governments that are suing the big pharmaceutical makers and distributors, accusing them of swamping many states with prescription painkillers and turning millions of Americans into junkies.
The new CDC numbers come from analysis of emergency room data from 16 states, including some hardest hit by the plague — Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maine, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Pennsylvania, Rhode Island, West Virginia and Wisconsin.
The CDC Research Shows:
- Emergency rooms in half of the states surveyed reported “substantial” increases in opioid overdoses, with mammoth jumps in Wisconsin (109 percent), Delaware (105 percent), Illinois (66 percent), Indiana (35 percent), Maine (34 percent) and North Carolina (31 percent).
- The Midwest, in particular, saw a 70 percent increase in opioid overdoses.
- The only state with a “statistically significant decrease” was Kentucky (15 percent). “The decrease in Kentucky may reflect some fluctuations in drug supply,” Schuchat said.
- “Nonsignificant” decreases of 10 percent or less were reported in Massachusetts, New Hampshire, Rhode Island and West Virginia.
- The highest rate of increases were in large metro areas, which the CDC defines as a population of 1 million or more “and covering a major city.”
- Every demographic group saw a substantial increase in overdose rates, including men (30 percent), women (24 percent), people ages 25 to 34 (31 percent), 35 to 54 (36 percent), and 55 or older (32 percent).
Is Fentanyl The New Crack Cocaine?
The Centers for Disease Control and Prevention issued a Health Alert Network warning about the increased supply of the illicit drugs, which are many times stronger than fentanyl, the prescription painkiller.
“The dramatic rise in the supply of illicitly manufactured fentanyl and fentanyl analogs has been mirrored by an equally dramatic rise in deaths involving synthetic opioids other than methadone, a category which includes fentanyl and fentanyl analogs,” the CDC said in its alert.
Death rates doubled between 2015 and 2016, the CDC said. “More than 55 percent of opioid overdose deaths occurring nationally in the 12 months ending November 2017 involved synthetic opioids, accounting for more than 27,000 overdose deaths,” the CDC said in the health alert, citing preliminary numbers.
That’s up from 20,000 overdose deaths from synthetic opioids in 2016.
Other illicit synthetic opioids include furanylfentanyl and acrylfentanyl. “Finally, drug submissions testing positive for a synthetic illicit opioid known as U-47700, first encountered by the DEA in 2016, increased from 533 submissions in 2016 to 1,087 during January–June, 2017,” the CDC said in the alert, referring to the Drug Enforcement Administration.
What Is Fentanyl?
- Fentanyl, a schedule II prescription narcotic analgesic, is roughly 50-80 times more potent than morphine. This medication is used to manage both pain during surgery and chronic moderate to severe pain for persons who already are physically tolerant to opiates. • However, fentanyl also can be produced in clandestine laboratories in powder form and mixed with or substituted for heroin.
“Ohio alone reported more than 1,700 opioid overdose deaths testing positive for fentanyl analogs during July 2016–June 2017, with more than 1,100 of those deaths involving carfentanil.”
Emergency responders and physicians may not know that people overdosing on the synthetics may need extra care, the CDC said.
For updated information on the opioid crisis and MDL 2804 (Opiate Prescription Litigation USDC Northern District of Ohio, Judge Daniel Polster) subscribe to www.masstortnexus.com/news