Rise in opiate overdoses and treatment drug prescriptions concerns health officials

11/20/2014 10:52 AM

Kentucky has shown progress after cracking down on prescription drug abuse, but health officials have seen troubling trends as overdose deaths continue to rise and opioid treatment drugs are being prescribed at alarming rates.

Kentucky’s uptick in overdose deaths is partly due to a shift to cheaper, readily available heroin for opiate addicts previously hooked on prescription medication, Audrey Haynes, secretary of the Cabinet for Health and Family Services, told the Interim Joint Committee on Health and Welfare Wednesday.

Heroin overdose deaths in Kentucky increased 207 percent from 42 in 2011 to 129 in 2012, she said. Kentucky ranks highest in patients admitted to hospitals for heroin abuse among surrounding states and the national average, and statistics show more women age 18 to 44 in the state die from drug overdoses than the U.S. average, she said.

The state has also experienced a dramatic 165 percent rise in neonatal abstinence syndrome in newborns from 2008 to 2013, Haynes said.

“Because of the lack of real longitudinal data to this extent on the impact of neonatal abstinence syndrome, I guess we really aren’t sure what we have in store for us for this next generation of children and the impact this may or may not have on their future as far as education goes,” she told lawmakers.

Opiate treatment drugs like buprenorphine, which can be prescribed by general practitioners, have been prescribed and seized by law enforcement in arrests at higher rates, leading some health officials to suspect illegal use.

John Langefeld, medical director for the Department for Medicaid Services, said data show a 241 percent increase in buprenorphine product prescriptions for Medicaid recipients from January 2012 to this May. Medicaid paid $22.5 million for the drugs in 2013 and in the first six months of this year, the bill totals $20 million, he said.

“We anticipate, in fact, that the cost this year alone will more than double what it was last year,” Langefeld said.

Police seizures of buprenorphine products in cases have increased “threefold” since House Bill 1, the so-called “pill mill bill” was enacted in July 2012, he said.

With increased reporting standards to the Kentucky All Schedule Prescription Electronic Reporting system, health officials can track the origin of buprenorphine prescriptions and where those prescriptions are filled. Eight of the top 10 counties where buprenorphine prescriptions are filled for Medicaid recipients are located in southeastern Kentucky, with Pike, Harlan and Floyd counties topping the list, according to cabinet data.

Health officials have also identified another key identifier for potential opioid treatment drug abuse and doctor shopping, as 2,571 patients sought buprenorphine prescriptions from three or more physicians. One patient sought such prescriptions from nine physicians, cabinet data show.

Haynes said the cabinet has worked with the Kentucky Board of Medical Licensure to strengthen prescribing practices for buprenorphine. The drugs should be prescribed and dispensed as stringently as methadone, where patients obtain the drug in highly monitored and regulated clinics, along with improved access to drug treatment, she said.

“We have to look at common, other medication-assisted treatment that the public is paying for oftentimes, which is like suboxone,” Haynes said. “We have to look at those with the same strict protocols as we do with methadone.”


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