Mississippi ranks 4th in the nation for opioid prescriptions per capita. Most deadly drug overdoses in Mississippi and our nation are a result of opioid drug use and almost half of them are from prescription medications. We also know that heroin and fentanyl are quickly becoming major problems in the State of Mississippi as well. 211 Mississippians died from overdoses in 2016. All of this is colliding to create what many are calling the Mississippi Opioid Epidemic.

As you can see in the image above, Mississippi has an inordinate amount of opioids being prescribed, per capita. across our state versus other states.

Our nation and state are facing a horrible epidemic that is destroying countless lives every day. It is vital that we are knowledgeable of the facts surrounding the epidemic of opioid drug addiction, abuse, and deaths in Mississippi.

The Mississippi Opioid Epidemic is directly tied to our national opioid crisis. As opioid overdose and death rates have risen across the country, Mississippians have not been immune to succumbing to addiction.

Sadly, we refer to people trapped in dependency and addiction to these drugs generally as addicts, criminals, lives, and statistics. In reality, they are much more than that. They are our neighbors, co-workers, friends, and families.

It is our hope that you can gain a small understanding of the problem we face in Mississippi, This article on the Mississippi Opioid Epidemic was written to share what you need to know, and what you can do as a business or individual to help fight this scourge.

How Did Our National Opioid Crisis become a Mississippi Opioid Epidemic?

 

To answer this question, we need to look at the history surrounding this nationwide epidemic and answer a few questions.

What Are Opioids?

What is the gateway to opioid addiction?

Are surgical patients at risk for addiction?

Who is most likely to become addicted to opioids?

Research has shown that surgery patients are at high risk of opioid addiction. Five to six percent of patients, who did not use opioids prior to having surgery, continue to use opioids for longer than normal, ongoing periods following surgical recovery.

The first item I want to bring to your attention is the huge spike in heroin and fentanyl deaths across the nation, and in Mississippi. Heroin and Fentanyl which are highly potent substances are also opioids.

While the rise in the use of heroin and fentanyl is an alarming epidemic, it should be noted that most addicts started their journey to addiction using opioids “recreationally.”

4 out of 5 heroin users started off using opioid-based pain pills. (Editor’s note: This fact is commonly used to point out the dangers and possibility of pain patients becoming addicted to heroin. While it is highly possible and does happen more than it should, this fact needs to be placed in context. The statistic stated above has more to do with teens and young adults who have illicitly experimented with prescription pills that were not prescribed to them by a physician.)

Having put the above statistic in its proper context – businesses, parents, guardians, and educators need to know that our teens and young adults are very susceptible to becoming addicted to opioids and opiates. We will discuss this further a little later, as well as what actions you can take to diminish the impact on your family, students, and business.

Mississippi’s opioid problem is growing year over year, following the same trajectory as the rest of our nation. One only needs to watch or read the news to see how Mississippi is being affected by this epidemic.

Law enforcement in Mississippi are reporting more possession, and intent to distribute arrests each year. First responders are responding to more overdoses in our state than ever before.

Besides the impact on human life and families, the financial impact to our state and nation due to the opioid crisis is becoming a crisis unto itself.

What is the Financial Impact of the Opioid Epidemic in Our Country?

Opioid abuse is said to have an overall financial impact of at least $78.5 billion dollars annually just in the United States.

This economic burden includes:

• Healthcare Costs
• The Criminal Justice System
• Addiction Treatment
• Lost Productivity

The CDC states that from 1999 to 2011 there was a 300% increase in opioid sales to pharmacies and healthcare providers across the United States. The CDC’s statement is based on data from the Drug Enforcement Administration

What are the most commonly prescribed opioid drugs?

1. Codeine and Codeine Combinations: (Vicodin or generic equivalents)
2. Oxycodone with Acetaminophen: (Generic Percocet)
3. Oxycodone HCL: (Generic OxyContin)
4. Acetaminophen with Codeine
5. Morphine Sulfate
6. Fentanyl
7. OxyContin
8. Methadone
9. Hydromorphone HCL: (Generic Dilaudid)
10. Oxymorphone HCL, extended release: (Opana ER)

You can read more in-depth information about this list in MD Magazine’s article, “Top 10 Painkillers in US.”

(Editor’s Note: We would like to thank MD Magazine and Senior Editor Tom Castles for permission to use their image visualizing the top ten opioid prescriptions. While geared towards medical professionals, we recommend you bookmark their homepage for great coverage of medically health-related news.)

Now that we know which opioid painkillers are prescribed the most, let’s look at how opioids work.

How Opioids Work and How They Led to This Epidemic

According to the National Institute on Drug Abuse, “Opioids act by attaching to and activating opioid receptor proteins, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When these drugs attach to their receptors, they inhibit the transmission of pain signals.“

There is no doubt that a genuine need exists for these pain-relieving drugs in many cases. Unfortunately, many patients transition quickly to psychological and physical addiction due to the strength of opioids. Pain is not something a doctor can measure or quantify. Sadly, people can and often lie about their pain to acquire the drugs they are helplessly addicted to.

The biggest problems contributing to the opioid epidemic are people who abuse these drugs, healthcare providers who have turned their offices into “pill mills,” and street-level drug dealers selling heroin and fentanyl.

Over 28,000 people in 2014 died from opioid drug overdoses. In 2016, this number jumped to around 64,000. As you can see, this situation is not just growing but multiplying exponentially.

Unfortunately, this number is increasing every year. We need to consider the consequences of addiction to these deadly drugs.

The U.S. Government Responds to the Opioid Epidemic across the Nation

Changes are being enforced to limit the prescribing of opioid drugs across the country. The practice of physicians overprescribing of opioids must change for the sake of our country.

I, for one, am glad that steps are being taken to make it happen.

On a state by state level, addressing and fighting opiate addiction is a top priority, so much so, that there are simply too many problems and sub-problems to list.

However, let’s take a look at and discuss large programs that have recently been enacted.

Comprehensive Addiction and Recovery Act

In July of 2016, former President Obama signed the “Comprehensive Addiction and Recovery Act”, also known as CARA. This is the first federal legislation addressing addiction in over 40 years.

CARA appropriates over $181 million in federal funding. CARA focuses on a strategy based on six pillars.

1. Prevention
2. Treatment
3. Recovery
4. Law enforcement
5. Criminal justice reform
6. Overdose reversal

Compact to Fight Opioid Addiction

The “Compact to Fight Opioid Addiction” was also enacted in July of 2016 by the NGA (National Governors Association.) This compact was signed by 46 state governors, including Mississippi Governor Phil Bryant. It targets 3 main problem areas.

1. Inappropriate Prescribing Reduction.
2. Improving the nation’s understanding of opioid and addiction.
3. Actions focused on making a pathway for recovery of individuals with opiate addiction.

The DEA Places Limits on Opioid Production

In 2017, The Drug Enforcement Administration placed limits on opioids that are allowed to be manufactured and prescribed. The “established quota” for hydrocodone, for example, is being reduced from 58.4 million grams to 50.3 million grams in 2018.  The DEA’s order is published in the Federal Register.

CDC Guideline for Prescribing Opioids for Chronic Pain

The CDC or Centers for Disease Control and Prevention are working towards alleviating the opioid epidemic. In 2017 they developed and published the “Guideline for Prescribing Opioids for Chronic Pain.” It addresses the proper prescribing practices of opioid pain medication for adult patients in primary care provider situations. It also addresses chronic pain, which lasts longer than 3 months.

Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months) these recommendations do not include cancer treatment, palliative care, or end-of-life care.

The motto is that “safe prescribing saves lives.” This new publication sets a greater standard for providers to be held accountable for when deciding what’s best for their patients’ pain reduction vs. the problem associated with addiction in the long term.

The use of non-opioid therapies along with going with a lower slower dosage and better more frequent patient follow up treatment are the main components of the publication.

S.892 – Opioid Addiction Prevention Act of 2017

Senate Bill 892 (S.892), the Opioid Addiction Prevention Act of 2017, is a bi-partisan bill offered by Senator John McCain (R-AZ) and Senator Kirsten Gillibrand (D-NY).

This is a comprehensive bill that requires provider certification. It also limits terms of prescriptions to seven days, which are non-refillable.

This bill would hope to ensure that a patient would have to participate in weekly follow up visits in order to maintain ongoing access to opioids. The bill also defines acute pain and outlines how physicians may prescribe for it.

The FDA Suggests Children Should Not be Given Codeine or Tramadol

Another recent development was a regulation released by the Food and Drug Administration (FDA) during April 2017. They stated that children between the ages of 12-18 should not be given any medications that contain codeine or tramadol.

Research has been shown that these medications can life-threatening problems with breathing.

As you can see many members of our governing bodies are hearing and responding to the outcry of concerned families and victims of opioid addiction and overdose

Mississippi Government Responds to the Mississippi Opioid Epidemic

Mississippi is ranked 4th in the nation for opioid prescriptions. There are more opioid prescriptions in the state than actual residents.

This fact, by itself, is astronomical. It becomes even more tedious when you realize opioid painkiller prescriptions are so numerous in Mississippi that every resident, from children to adults, could take one pill every day for 2 months and 1 week. Obviously, our state can use a lot in the way of trying to improve these figures.  

In 2016, Mississippi Governor Phil Bryant issued an executive order to create an Opioid and Heroin Study Task Force. They released their recommendations on August 3, 2017.

The Mississippi Board of Licensure has proposed a number of changes to regulate the prescription of painkillers by doctors.

The Mississippi Board of Licensure is fighting against the underlying causes of the Mississippi Opioid Epidemic as well.

Medical licensees with prescription writing authority in Mississippi must use the state’s prescription monitoring program. This allows the prescriber to see which medications a patient has received or is currently prescribed.

Clinics will now be considered Pain Management Clinics if more than 30 percent of their patients receive controlled substances to control chronic, non-cancerous pain. This is a 20 percent reduction from the previous regulation.

Mississippi patients will now be required to be drug tested before receiving a prescription for chronic non-cancer pain.

Opioid prescriptions will be limited to a seven day supply. Under rare circumstances, a 7-day refill may be allowed.

Mississippi Law Enforcement Responds to the Mississippi Opioid Epidemic

Mississippi law enforcement agencies are proactively stepping up to the challenge of the opioid epidemic in Mississippi. Most notably, law enforcement in Mississippi now carries Narcan, an opioid overdose reversal drug.

Unfortunately, The Meridian Star reported in May 2017, it is now coming to light that illegal drug manufacturers are now creating Narcan resistant fentanyl.

Attorney General Jim Hood along with the Mississippi Bureau of Narcotics Director, John Dowdy have been very vocal about the heroin and fentanyl epidemic in the state. They are leading the charge in Mississippi and partnered with various public agencies to host the July 2017 Opioid & Heroin Mississippi Drug Summit.

The Mississippi Drug Summit brought together many people from healthcare workers, counselors, advocates, families of addicts, recovering addicts, first responder, lawmakers, educators treatment center owners, and people working within the judicial system.

Mississippi Group Health highly recommends that all Mississippians get informed about the opioid problem in our state as quickly as possible.

The Mississippi Targeted Opioid Project – mSTOP

Multiple state agencies have joined together to host informational town hall meetings across the state regarding the Mississippi opioid epidemic.

The educational group formed by these agencies is known as the Mississippi Targeted Opioid Project, or mSTOP.

According to their Facebook page: “The Mississippi Targeted Opioid Project (mSTOP) is a coordinated effort by the Governor’s Opioid Task Force, the Mississippi Bureau of Narcotics, the State Pharmacy Board, the Federal Bureau of Investigations and the Mississippi Department of Mental Health. Their mission is to help educate Mississippians on the realities of the opioid epidemic in our state, and to help those dealing with addiction find treatment.”

The MS Targeted Opioid Project is also distributing Narcan to all law enforcement agencies around MS.  If any agency is interested in receiving Narcan, please contact Angela Mallette directly at 601-398-4406 or via email at amallette@msphi.org.

You can find their town hall events by going to their Facebook page. If there have not been any mSTOP meetings in your area, we encourage you to reach out to your locally elected officials. Ask them if and when there may be a public meeting in your area regarding the Mississippi Opioid Epidemic. If they have no plans on hosting one share mSTOP’s contact information with them.

We would like to thank Angela Mallette of MSTOP for verifying the accuracy of the information we published about their organization.

What can your business do to minimize opioid addiction in the workplace?

Know the signs of drug addiction. If you run across employees who are addicted we have some useful information below that might help you handle the situation within your business environment. We have also included information on agencies and programs that are business specific that many business owners in Mississippi do not know about.

What are the most common signs and indicators of drug addiction?

• Unusual Elation or Euphoria
• Sedation or drowsiness
• Confused Behavior
• Constricted or unusually small pupils
• Slow breathing
• Nodding off
• Loss of consciousness
• Frequent constipation

We feel a little bit of knowledge in identifying common opioid medications could be useful so please look at the chart and the list earlier in this article of most common opioid medications out there.

It is important to provide an easy way for your employees to get the assistance they need – easily and confidentially – in order to assist them in conquering their addiction to opioids, other substances, and medications. Mississippi Group Health recommends doing this before it becomes a problem that is out of control. Let your employees know that help is available.

If you are a business owner, we completely understand the need to have healthy, drug-free employees. We know that running your business is your number one priority and you just don’t have the time to deal with an employee that is addicted, and all the baggage it brings that affects your business.

However, we would be remiss if we did not mention that it might be wise in our state to see what your group health insurance plan covers concerning treatment addiction. With the unemployment rate dropping lower and lower, it is getting harder to find well-qualified employees.

Please understand I am not saying you can help every employee. It isn’t going to happen. We, ourselves, are not naïve enough to believe this as a company. What we do believe is there are employees who truly want help and want to conquer their addiction. You know your employees better than we do.

Is it possible that they are salvageable?

Is it possible by going to treatment and getting the help they might become a loyal, lifelong asset and resource to your business in the future?

If all that happened was you helped save one of your employees’ lives, would it be worth it?

The Mississippi Department of Mental Health’s Alcohol and Drug Services offer Employee Assistance Programs Services. Here is a description of their services from their website.

“An employee assistance program (EAP) is a work-site focused program designed to assist organizations in addressing productivity issues and employee clients in identifying and resolving personal concerns including but not limited to marital, family, financial, substance use, legal, emotional, work stress, and other personal issues that may affect job performance.

An EAP is typically a voluntary, confidential service which provides referrals to professional services designed to help employees with personal issues before they reach a critical point.

In addition, EAPs provide a positive and proactive management tool to employers as an alternative to other actions such as firing employees and allows managers to assist employees exhibiting declining job performance to return to a more acceptable level of productivity.

Chapter 7 of the MS State Code (Sections 71-7-1 through 71-7-33), which provides guidelines and procedures for drug testing in Mississippi, cites EAPs as a possible source of assistance in assessment, referral and/or counseling for employees who are found in violation of the testing procedure. In Senate Bill 3167, the MS Legislature charged the Department of Mental Health to consult with and provide technical assistance to other state agencies or concerned parties interested in establishing their own employee assistance programs.

For more information on how your organization can establish an employee assistance program or for consultation and/or technical assistance, please contact the Bureau of Alcohol and Drug Services, Employee Assistance Programs Services, at (601) 359-1288.“

 

Medically-Assisted Treatment, or MAT, for opioid addiction includes the use of methadone or suboxone

These medical treatments have caused a lot of controversy in the medical community with many saying it is simply substituting one bad habit for another. In fact, in 2009 the CDC stated that 30% of all painkiller deaths involving only one painkiller were from methadone. Suboxone, or buprenorphine, is a newer drug but similar in how it works.

Others say that MAT drugs can have a lot of positive effects such as helping a person keep their job, decrease or stop a person’s involvement in crime, avoid risky sexual behavior, and reduce a person’s risk to HIV.

Medical Insurance & Addiction Treatment

When the Affordable Care Act was passed, it included provisions for coverage of alcohol and drug addiction treatment. Under the Affordable Care Act, addiction was no longer considered a pre-existing condition.

With the state of the Affordable Care Act seemingly changing month after month in our current political client, we recommend contacting your medical insurance provider to see what your medical insurance plan covers regarding addiction treatment.

If you or a family member are addicted, and your insurance covers treatment, get treatment. You and your family will be better for it.

What Can Mississippi Families Do to Fight the Mississippi Opioid Epidemic??

For starters, learn to recognize the signs and indicators of drug use and addiction listed above.

Talk with your children about the dangers of drug use and the possible outcomes of addiction. We know this can feel like a heavy thing to talk with children about. It still needs to be addressed.

If you have any unused prescriptions lying around the house, we recommend taking them to a safe and secure dropbox location. By doing so, you can proactively remove the temptation for your family members and guests.

You can find those locations by visiting the links below. (Thank you to all the agencies and personnel who responded to our requests to verify these locations are up and running for prescription drop-offs.)

• MS Dept. of Mental Health
• MS Dept of Public Safety
• MS Walgreens Locations

We also recommend trying to get help for your addicted family member. There are many licensed psychologists, psychiatrists, and clergy in the state who can help counsel your addicted family member.

TREATMENT SHOULD BE THE NUMBER ONE PRIORITY FOR AN ADDICTED FAMILY MEMBER

While looking at treatment options, there are many things to take into consideration.

News reports over the summer of 2017 showed damning evidence of many so-called treatment centers being scams and suffering from an inordinate amount of in-house opioid overdoses.

I don’t say this to paint all treatment centers with a broad brush. I point this out so you can do your research before choosing an addiction treatment center.

Call the Attorney General’s office of the state that the treatment center is located in and ask if they have had any problems with that specific center. Call the sheriff’s office in that county and ask questions as well.

What about all those addiction treatment commercials and advertisements on television and across the internet?

Do your research before you decide on a treatment center. You just might be shocked at what you find out. Many of these so called “treatment facilities” and “rehab centers” are nothing more than out of State call centers that receive a bounty for recommending you to a rehab center that pays the high commissions. In our opinion, this practice borderlines on human trafficking people suffering from addiction with the end result not being curing the problem but pocketing a bounty or commission for the “recommendations.”

How to Make Sure You Are Dealing with Treatment Centers That Truly Help.

We have learned a lot since we first published this article in the fall of 2017. Here’s what we know and want to share with you. While many insurance plans can and do include addiction treatment, call your provider and make sure that your plan covers this situation before admitting yourself or a family member to treatment.

One thing many people do not know about is the power of Counseling for Substance Abuse Treatment, Alcohol and Drug Treatment, Mental Health Services and Outpatient therapy. Some insurance plans cover these services with a counselor or counseling practice. We suggest looking for local to you Licensed Professional Counselors that are trained, qualified and licensed as Substance Abuse Professionals (SAP), Certified Alcohol and Drug Counselors, and Master Addiction Counselors (MAC). Not all counselors or counseling practices specialize in the areas listed here. Make sure to ask if they have any counselors on their staff who match this criteria.

Why is this important? How can this help save you or a family member from a bad experience with a “treatment facility” or “rehab” only looking at their bottom line?

Counselors with the above mentioned credentials can perform Assessments and Referrals that cover Mental Health, Addiction, Alcoholism, Substance Abuse and more. Local Counselors are also plugged in with other local therapists and treatment centers and have the discernment to know which local treatment centers and rehabs are good and have a heart for the communities they serve.

We highly suggest obtaining an Assessment and referral from a counselor that is local to you and established in your community. If you are in North/Northeast Mississippi, we highly recommend Fair Park Counseling, A Blue Cross Blue Shield Preferred Network Provider, for Outpatient Substance Abuse Treatment Services in Tupelo, MS.

Conclusion

We are facing a crossroads in our state that requires action to save the lives of our family members, friends, neighbors, co-workers, and fellow Mississippians.

We have looked at a lot of information concerning the Mississippi Opioid Epidemic. There is no denying the news about the current epidemic of opioid addiction in Mississippi and our nation can be overwhelming.

Mississippi Group Health applauds our state’s government, healthcare specialists, and law enforcement for shining a light on this unprecedented wave of opioid addiction in its many forms.

I hope this article has been useful in educating you on the opioid epidemic that is facing our state and our nation. It is also my prayer that we can see a large reduction of opioid dependency and deaths that occur from addiction. Perhaps, through education focused on facts, founded in love and compassion for our fellow man, and strong bipartisan legislation that can hopefully become a reality one day soon.

If you have any questions regarding healthcare insurance and treating addiction, feel free to contact me. I would be glad to talk with you and see how we can help.