Alaska’s Opioid Epidemic
I remember when OxyContin first hit the streets of Eagle River when I was 18. The terms I knew, in reference to drugs, were words like “dimebag” and “blotter,” and seemingly overnight, our collective vernacular had expanded to include words like “80s,” and “OCs.” I hung out with kids who did hard drugs, but I didn’t touch them myself. At that point in my life, I had never seen or known a real junkie, but something told me to be wary. It seemed to me that the people who fell for Oxys the hardest were the ones with depth and tenderness. I liked those people. But, deep down, I knew some of them weren’t going to make it.
Things changed in my hometown after Oxys arrived. Heritage Court, the inexpensive apartment complex in Eagle River, which had always housed the potheads I bummed around with, went from being stoner central to being something else. My first real indicator that sleepy Eagle River wasn’t all peace and love anymore came when two of the kids that lived upstairs from my best friend got into an altercation with someone on the concrete pad that served as a front porch for the floor-level apartments. I hadn’t been there when the stabbing occurred and didn’t know anything about it until I was headed for my friend’s front door and noticed a large, brown stain on the cement. In my world, up until that point, knives were used for cutting fishing line and making marshmallow sticks.
Over the next five or 10 years, prescription opioids sucker punched almost every family or crowd of friends I knew. I lived in a subdivision adjacent to Ravenwood elementary school that was solidly middle to upper middle class. Kids whose parents had money started leaving state for long stretches of time without explanation (rehab). Lots of others got in trouble with the law. Here and there someone at a party would pass out wasted and never wake up. One girl I knew, who had never touched drugs, was prescribed opioids after a dental procedure. In short order, she went from a sweet, smart, successful person who was rising fast in the military, to spending ten years on and off the streets, suffering one trauma after another. There were times she prayed for death. One of the kids that rode the bus with me robbed a liquor store. I drove a friend to the emergency room after a drug-induced seizure. I learned what an abscess looks like. I discovered that addiction made it possible for one body to house two completely different people.
At the time, everyone I knew who was snorting or shooting pills didn’t really understand what they were risking. I remember people saying things like, “these are basically synthetic heroin.” Which is true. But they came from someone’s doctor, not from the streets. That fact was assurance enough the pills couldn’t be *that* dangerous. Turns out, doctors thought that too. What was happening in my little town was the opposite of an isolated incident.
In the late 90s, Purdue Pharma L.P. rolled out its new, extended-release opioid painkiller, OxyContin. It’s active ingredient is oxycodone, which has been around forever, but because it was intended to last for long stretches of time, the amount of oxycodone in OxyContin was enormous. All it took was one person to figure out that you could crush those pills up and snort them or cook that powder over a spoon, and the nation had a serious problem on its hands.
Purdue started a marketing campaign for OxyContin that the DEA itself described as “unprecedented.” They compiled available data showing which doctors around the country already prescribed the most opioids to their patients and bombarded them with targeted advertising. They held all-expenses-paid conferences at fancy resorts attended by more than 5,000 doctors, nurses and pharmacists between 1996 and 2001. In 2001 alone, they paid out $40 million to their drug sales reps. They offered coupons for free, limited time, seven to thirty day supplies of OxyContin that doctors could give to patients. They handed out stuffed toys and fishing hats. They encouraged the use of OxyContin for long-term management of chronic pain, where previously it had been used mostly for pain management in cancer patients. They justified this by widely disseminating the claim that OxyContin had an addiction risk of less than one percent, even in long-term use.
The studies they referenced in making the claim that addiction was extremely rare were conducted based on temporary treatment of acute pain, like that experienced by burn victims, and had nothing to do with long-term use of the drug. Several studies relating to addiction in patients using opioids long-term already existed, and showed rates of addiction between 12 percent and 45 percent, depending on the study criteria and subpopulation. Purdue decided not to mention those results.
Right around the same time that Purdue was marketing the hell out of it’s new wonder drug, the Centers for Medicaid and Medicare Services made an addition to the list of “vital signs” that doctors should use when assessing a patient’s need for treatment. Before, the four vital signs had been temperature, pulse, breathing rate and blood pressure. Now, the list included pain. Medicare and Medicaid patients are given a survey after being discharged from a hospital which is designed to rank how doctors managed their care. This created a situation in which doctors might not be reimbursed by Medicare or Medicaid for their work if the patient reported that their pain hadn’t been mitigated, now that it was on the list of vital signs. But pain, unlike the other 4 vital signs, is entirely subjective and impossible to objectively measure. This was serious encouragement for doctors who wanted to get paid to make sure that their patient’s pain was eradicated.
When OxyContin began showing up with coupons for free trials and promises that addiction would almost never be an issue, a perfect storm of misinformation and lack of oversight culminated in a ten-fold increase in OxyContin prescriptions, which, in part, lead to an addiction epidemic the likes of which the U.S. has never seen.
Drug overdose is now the leading cause of accidental death in our country, with the majority of those deaths attributed to opioids. In Alaska and nationwide, deaths from opioid overdose have quadrupled since 1999. In the late 2000s, when the FDA and the medical industry finally figured out what was going on and prescriptions for opioids became much harder to come by, good, old-fashioned heroin was readily available to fill the needs of our addicted population; it was cheaper anyway, and easy to obtain. New data from the CDC shows that in 2015, more people died from heroin overdoses than from prescription opioids, or from gun homicides. Those statistics were both drastically opposite only a few years ago.
Coincidentally, in 2015 Forbes Magazine totalled Purdue’s estimated sales at $35 billion since it released OxyContin in 1995, mostly from sales of that specific drug. When Purdue finally got in trouble for misleading doctors and the public about the risks of addiction to OxyContin, they were fined $634 million. You tell me if you’d be sorry for what you did if you got to run off with $34.36 billion. Based on a new marketing campaign that Purdue intends to ramp up in Africa, the Middle East, Latin America, Asia and elsewhere using the same old tricks used here in America, it seems they aren’t. They’re running training seminars, disregarding America’s decrease in OxyContin prescriptions as “opiophobia,” bankrolling public campaigns encouraging people to seek treatment for chronic pain and offering patient discounts for their drugs.
It took America twenty years to take in the scope of opioid addiction and begin scrambling to patch the holes it’s left in our society. What that likely means is that places like rural Latin America and Africa are going to be in real deep shit.
Finally, after everything we’ve been through at the hands of opioid addiction in America—all the people we’ve lost, from all races and socioeconomic backgrounds—efforts to curb the crisis are finally gaining some traction on local, state and federal levels.
Two major federal bills passed overwhelmingly late last year: the Comprehensive Addiction and Recovery Act (CARA), which was co-sponsored by Alaska Senator Dan Sullivan, and the 21st Century Cures Act. CARA provides more resources for education, prevention, treatment and alternatives to incarceration through government grants, and the 21st Century Cures Act provides $1 billion in funding available to the United States and territories for help in dealing with the opioid crisis. The Alaska Department of Health and Human Services submitted its application on Feb. 17 for some of that billion dollars that would fill gaps in funding between Medicaid and existing grants that currently fund our state’s treatment services.
We’ve already received a grant for $4 million that will pay for 5,000 Narcan (Naloxone) kits to be distributed in Alaska this year, through Project HOPE. Narcan can help reverse respiratory depression in the event of an opioid overdose. It comes in the form of nasal spray that absorbs directly into the lining of the nose, so it works whether or not the person is breathing. It’s already available for purchase at pharmacies, but the $150 price tag makes it cost prohibitive for some. Organizations that apply and receive training through Project HOPE can distribute the kits for free. In the past, only trained medical professionals could carry and administer the drug, but given the scale of the problem, our governing bodies have agreed that it doesn’t take a doctor to recognize an overdose and the potential benefits of regular folks having Narcan around far outweigh the risks.
According to Dr. Jay Butler, who heads the Alaska Opioid Policy Task Force, “The big three signs of an opioid overdose are reduced consciousness, slow or absent breathing and pinpoint pupils. You may not always have all three present, but if there’s suspicion of an overdose, there’s not a lot of risk from giving Narcan, so we encourage people to do it if they have the drug available. But it’s important also to call 911 immediately because that person may need further medical attention.”
Governor Walker addressed the opioid epidemic specifically in his most recent state of the state address, listing steps Alaska might take to help mitigate the supply of prescription opioids and heroin. On Feb. 14, he filed a Declaration of Disaster to establish a statewide Overdose Response Program. He cited, among other things, that in 2012 the rate of prescription opioid overdose deaths in Alaska was more than double the national average, our heroin overdose death rate was 50 percent higher than the national average and that between 2009 and 2015 the number of heroin-associated deaths in Alaska more than quadrupled. Issuing a Declaration of Disaster for something other than natural disasters like earthquakes or floods is unorthodox, but it’s hard to argue, with numbers like those, that we aren’t facing a crisis that demands we make creative moves fast.
On Feb. 16, Governor Walker held a press conference and signed Administrative Order 283, which basically requires that our various state departments begin working together to tackle the problem. It tasks our departments with finding and applying for grants and funding for treatment, prevention and elimination of illegal drugs. It requires that the Department of Health and Human Services (DHHS) develop and implement a response strategy for the opioid crisis, that the Department of Corrections (DOC) develop a program to provide medically-assisted treatment to inmates if they want it when they’re about to be released, that DOC coordinate with DHHS to provide detox and follow-up with those people, and that the Department of Public Safety identify heroin pathways into the state and pursue enforcement measures.
On August 4 of last year, Senator Dan Sullivan convened a summit in Palmer attended by medical professionals, federal and state officials and citizens to address the opioid crisis in Alaska after a meeting he’d had with 8 women from Fairbanks, all who had suffered tremendously at the hands of heroin addiction. That summit drew more than 500 attendees and included the U.S. Deputy Secretary of Health and Human Services and the Surgeon General of the United States.
If you grew up like I did, these hefty titles, big dollars and bipartisan political efforts might all seem kind of surreal. I was 16 the first time I ever saw someone snorting cocaine. I was terrified. I couldn’t get a ride away from that house fast enough. But Oxys? Just little pills with the letters “OC” on one side, almost as frequently available at parties as weed. They came from some medicine cabinet somewhere, distributed by some doctor, packaged in one of those little, plastic orange canisters that meant “medicine.” They weren’t a powder you were just supposed to ingest on faith, assuming it wasn’t bathroom cleaner. Oxys weren’t tied up in a baggie and traded to some dude for cash through the window of a hoopty in a parking lot at night. Turns out they were worse.
I should have been just as terrified of those pills as I was of that cocaine, but I was just a kid. I didn’t know. If there’s one lesson we should have learned by now, it’s that, as a society, we must make sure that kids now aren’t as ignorant as I was; that just because a drug comes in a little orange canister does not mean it doesn’t have the capability to ruin or end your life.