EDITOR'S NOTE: This is the first installment of a multipart series on opioids, considered to be the fastest-growing abused substance in Garland County by local health officials.
Local drug rehabilitation professionals and emergency medical personnel say they have seen consistent -- if not increasing -- opioid abuse in Garland County.
In late October, President Trump directed the Department of Health and Human Services to declare the opioid crisis a public health emergency nationwide.
In 2015, the latest year for available data, the Centers for Disease Control and Prevention estimated around 40,000 U.S. deaths were due to either common prescription opioids, heroin and fentanyl, or a combination of both. The total number of deaths from the drugs, which has risen consistently, was fewer than 10,000 in 2000.
In 2015, Garland County trailed only Clay County in deaths per 100,000 people due to opioid abuse. CDC cited a rate of 27 deaths per 100,000 people for Garland County that year.
Heroin and "Other Opiates and Synthetics" comprised 60 confirmed cases, or 20 percent, of abused substances for the first quarter of 2017 in Garland County, according to the Alcohol Drug Management Information System. LifeNet Hot Springs General Manager Jason Gartner estimates his medical personnel respond to 35 to 50 opioid abuse cases per month.
Garland County's percentage of opioid abuse eclipses the rate for the rest of Arkansas, where 14 percent of abused substances are either heroin or "Other Opiates and Synthetics." Only Pulaski County had more confirmed cases of opioid abuse in that time period. However, even at 18 percent, Pulaski County's percentage of cases between the two categories was lower than that of Garland County.
'People can justify it'
While the most recent ADMIS numbers were not available, Quapaw House Director Casey Bright maintains that opioids are now the fastest-growing abused substance in the county. Even "semi-prominent figures" in Hot Springs have been treated for opioid abuse, he says.
"It's kind of the attractive thing now," Bright said. "It's somewhat in the realm of alcohol, where it's acceptable to take prescription drugs because people can justify it."
At 51 cases, Garland County led the state of Arkansas with the greatest number cases that cited abuse of "Other Opiates and Synthetics" in the first quarter of 2017. "Other Opiates and Synthetics" includes prescription opioids like hydrocodone, oxycodone and fentanyl, as well as the analogues of such substances.
Bright said such substances are "socially acceptable," as they are often given by doctors to patients.
"If you're using methamphetamine and I find out about it, everyone's like, 'Oh, that's a horrible thing.' You have no justification for using methamphetamine, whereas I have justification for using my prescription drugs," he said. "You're an addict, and I'm not."
An addictive cure
Bright said prescribed opioids are designed to alleviate a patient's pain entirely -- a functional shift from the past.
"There wasn't an understanding that a pill could take away the pain necessarily. There was assistance, but you were gonna go through pain," he said of past medical practices. "Now it's like, 'I want to be completely numb. I don't want to feel any pain whatsoever, and then when it gets better, I'll stop taking it.'"
Over time, the substances, which are highly addictive, condition the human body's opioid receptors to function below equilibrium. This is because the receptors adjust to "the high" the body is receiving from the opioid substances.
When "the high" from the addictive substance passes, the user's body is left in pain. Bright said opioid withdrawals, like their overdoses, can involve respiratory depression and even death.
Bright said people who are addicted to opioids often mistake these withdrawals for their initial diagnosis.
"What they think is fibromyalgia is really a reaction to opiates because they've been taking them for 10 years, 15 years," he said.
High accessibility
Bright said doctors sometimes overprescribe such medicine because they technically have no way of knowing if the patient is actually in pain.
"If I come in and I say, 'My neck hurts, and I can't turn it farther than that,' is a physician gonna say, 'Well, I'm not gonna give you a drug because you're gonna get addicted to it?' No," he said.
The accessibility to such addictive medicines is much higher than their less addictive alternatives. A joint investigation by The New York Times and ProPublica, published Sept. 17, revealed that only about one-third of people covered in the 35.7 million prescription drug plans analyzed by the publications gave access to a less-risky painkilling skin patch, while nearly every plan gave access to common opioids. Most of the plans did not require prior approval to obtaining the opioid prescriptions.
Bright said opioids are often taken with other prescribed medications such as antidepressants and ADHD prescriptions. At that point, he said, all of the drugs taken are technically being abused, as their effects contradict each other.
"That's the problem, is the accessibility to it, and the combination is too accepted," he said. "That's why I think we continue to see it rising, even though we're throwing billions of dollars at it."
Local on 11/12/2017