Gov. Doug Ducey on Monday declared a state of emergency on opioid overdoses, a measure designed to get the state more information to determine what to do next – including whether to follow the lead of two other states which have sued drug manufacturers.
Christina Corieri, the governor’s health policy advisor, said doctors prescribed – and pharmacies ordered and dispense – more than 431 million opioid pills in Arizona last year. That’s more than 60 pills a year for every man, woman and child in the state.
Yet Dr. Cara Christ, the state health chief, said that the powerful painkiller should be prescribed in most circumstances for “short-term, acute episodes’’ of no more than three days. And that is in cases like having a broken arm or recovering from surgery.
“And you should be able to transition to a non-steroidal anti-inflammatory,’’ like acetaminophen or ibuprofen.
Christ said some of the burden to prevent dependence relies on the patients when a doctor prescribes an opiate. Some of that is to ensure that this drug won’t interact with other prescriptions in ways that could be fatal.
And there’s more.
“You want to make sure you know what should I look out for, what symptoms should I look out for, and what should my family be aware of,’’ Christ said, including having a dosage of naloxone available to counter an overdose.
But that still leaves the question of whether opioids are being overprescribed – and whether any of the blame rests with the manufacturers.
That’s the contention of officials in Mississippi and Ohio who both have filed suit. They accuse five specific manufacturers of misleading doctors about the dangers of their products.
“These drug manufacturers led prescribers to believe that opioids were not addictive, that addiction was an easy thing to overcome, or that addiction could actually be treated by taking even more opioids,’’ said Ohio Attorney General Mike DeWine in filing suit last month.
“They knew they were wrong, but they did it anyway,’’ DeWine said in a press release. “Despite all evidence to the contrary about the addictive nature of these pain medications, they are doing precious little to take responsibility for their actions and tell the public the truth.’’
“It’s not the drug companies,” said Jay Fleming, a Dolan Springs retiree who’s been on pain medication for years following a back injury. “The majority of overdoses are from heroin and illegal fentanyl. These will increase, not decrease, as physicians cut patient doses and patients turn to the street.”
It’s not easy to figure out who is actually in need of pain medication and who is abusing the drugs, said Dr. Michael Valpiani of Better Life Pain Management in Kingman.
“Which is more important – to treat a patient safely or treat a patient in pain? That issue has not been settled,” Valpiani told the Daily Miner.
“Still, doctors are saying we’re undertreating pain and need to pass out more of this drug. Others say we’re passing out too much. The medical board is powerless to do something to stop this. Maybe the state will.”
Most of the guidelines have ended up with exceptions.
“It’s extremely complicated,” Valpiani said. “But remember, your children, your grandchildren and your great-grandchildren are at risk.”
Gubernatorial press aide Daniel Scarpinato was noncommittal about whether Arizona intends to follow suit.
“Yes, we are looking at all the potential policies on this,’’ he said. “But that doesn’t necessarily have to include litigation.’’
At the very least, Scarpinato said his boss wants more information about who is dying from opioid overdoses – an average of two Arizonans a day – and, more to the point, where they are getting the drugs.
“When we’ve got numbers of this degree and an increase of this degree, you need to know more,’’ Scarpinato explained. “Because we want to make sure that whatever policies we’re putting forward actually get to the heart of the issue.’’
Christ said her agency gets some “limited’’ information from death certificates. The health department also gets discharge information from hospitals. But that comes in only once every six months.
The emergency declaration allows Christ to quickly adopt rules that would require daily reporting.
At the very least, she said that will allow both her agency and law enforcement to focus on areas of the state where a problem is emerging. But it will also ultimately provide a clearer picture of who is dying of overdoses and how they got their drugs.
And Corieri said even in cases of people dying from illegal drugs like heroin, there is a definite link with legal prescriptions.
“We know from studies nationwide that four out of five heroin users started by using prescription opiates,’’ she said.
Mohave County claims the top three doctors in the state and four of the top five for Medicare claims involving prescription of hydrocodone acetaminophen, according to ProPublica.
Benjamin Venger of Fort Mohave was No. 1 with 1,976 complaints, followed by Paul Sutera of Bullhead City (1,273) and Marylyce Parker of Bullhead City (1,211). Andres Alvarado of Fort Mohave was No. 5 with 1,154 complaints.
The emergency declaration appears to be part of a bid by the Ducey administration to raise awareness of the issue.
It comes less than a week after his health department put out statistics showing 790 people died in 2016 of opioid-related overdoses. That compares with 454 in 2012.
Of that total, 482 were from prescription drugs, versus 362 four years earlier. The balance are heroin overdoses.
And then there’s that figure a 431 million pills prescribed to Arizonans last year.
“We believe it’s a problem,’’ said Scarpinato.
“We want to attack this on every front possible,’’ he continued. “The governor absolutely believes that when you have that number of pills and opioids in this state and when you’re seeing these numbers and when you’re seeing these deaths, this is an issue we cannot ignore and we will not ignore.’’
The Ohio lawsuit charges that the drug companies violated that state’s consumer fraud laws by disseminating false and misleading statements about the risks and benefits of opioids. That includes marketing in medical journal advertising, and statements made by sales representatives.
DeWine, as that state’s attorney general, wants an injunction to stop what he called “continued deceptions and misrepresentations.’’
He also wants money for consumers who paid for unnecessary opioid prescriptions for chronic pain.
Daily Miner reporter Hubble Ray Smith contributed to this report.