Heroin problems outpace Michigan’s solutions

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The Capital News Service
LANSING — As Michigan struggles to keep up with its growing heroin and opioid addictions, only one state intervention might be working.
Traverse City police in April were able to reverse an overdose using naloxone, a drug that can help restore breathing after a heroin or opioid overdose, said Pamela Lynch, consultant and therapist at Northern Lakes Community Mental Health in Traverse City.
This was possible because recent state laws allowed doctors to prescribe the drug to people who can administer it, such as police officers, and not just to those who need it.

In the Traverse City case, police revived a driver who had crashed into a stop sign while overdosing on heroin. Officers who were the first responders on the scene pulled the driver from the car and administered a dose of naloxone.
Lynch said the Traverse City success proves first-responder access to naloxone should be increased.
“Emergency departments, treatment centers should be distributing naloxone,” Lynch said. “It’s a drug that has no potential for abuse.”
Other states have taken steps to help pharmacies distribute naloxone, which Lynch said Michigan should consider as well.
But the overdose-reversal drug attacks just one aspect of a complex and growing problem that advocates say has spread to all areas of the state.
“I don’t think there are any boundaries to this anymore — it’s the kid next door, it could be your kid, it could be my kid,” said Linda Davis, a district judge in Clinton Township and president of Families Against Narcotics.
Among the issues advocates are trying to address: high prescription rates for painkilling opioids, which are similar to heroin and can lead to addiction; contaminated batches of heroin that are leading to accidental overdoses; and a lack of good medical insurance to support addiction treatment.
Advocates are calling for more education for the public and a change in insurance practices, a change in prescription culture, and further legislation to increase the availability of naloxone.
The reason for the continued growth of heroin abuse in the state, Davis said, is the change in culture of medical practice which has turned from pain management to pain elimination, resulting in overprescription.
Pharmaceutical opioids — popular painkillers like oxycodone, morphine and methadone — are chemically similar to heroin and highly addictive, Davis said.
A lot of young people get sports injuries, and these are the first drugs that are written up for them. Vicodin and codone-based drugs like hydrocodone, all share heroin’s addictive quality and often leave the patient with an opioid dependency.
“Those are being used and written by doctors for almost every ailment people have,” Davis said. “There needs to be education on this issue in schools about how dangerous these drugs are, because a lot of kids think they are safe — a doctor wrote the prescription, their parents take them, their grandmother takes them.”
When users can no longer afford the prescription medication, which can cost up to $40 per pill, they turn to the cheaper option of heroin, Davis said.
Kevin McFatridge, director of public relations at the Michigan State Medical Society, said the society has been aware of this issue for 10 years and offers educational opportunities for Michigan physicians on the dangers of opioid medications.
“Clearly, members of the Michigan State Medical Society do not want any patient to be addicted to any form of drug — prescription or recreational,” McFatridge said by email.
For those already addicted, the lack of education comes with even higher stakes. Fentanyl-laced heroin has been known to reappear in batches across the state in a cyclical fashion. Fentanyl is a pharmaceutical opioid, which when mixed with heroin gives the user a more intense high. It is cheaper for the dealers to cut — but also leads to more overdoses.
Davis said there is a batch of fentanyl-laced heroin on Michigan’s streets at the moment.
“There’s a big demand for it. Because there is such a lack of education, people don’t realize how deadly that is,” Davis said. “All they know is, it gets you higher.”
The Michigan Poison Control Center has received calls about fentanyl/heroin since January in nine counties: Antrim, Kalkaska, Grand Traverse, Benzie, Wexford, Missaukee, Mason, Lake and Osceola, according to Department of Health and Human Services public relations officer Jennifer Smith.
Three of the cases arrived at a hospital emergency department in Cadillac on April 10 within three hours, Smith said.
People who realize they have a drug problem and seek care meet obstacles, Lynch said.
For instance, while insurance coverage varies per provider, the majority of health insurance policies cover just 30 or 60 days of treatment such as in-patient stays, Lynch said — despite the fact that most users require ongoing treatment and multiple admissions before they can get clean.
“A lot of kids die because they need treatment and they can’t get it because their insurance has been used up,” she said.
Davis agreed that insurance coverage needs to shift to meet patients’ needs.
“The medical profession sees that this is a disease, yet we limit treatment for this disease,” Davis said. “We hold the addict responsible for the fact that they can’t get well.”
Michigan’s treatment system, Lynch said, has not kept up with current science. Where other states are moving toward substitution therapy — minimizing withdrawal symptoms through less-potent drugs, Michigan has not been very receptive to the technique.
Substitution treatment takes two forms, methadone and suboxone. Suboxone is primarily used for those with lesser addictions. Methadone has been known to cause deaths with users who take too much without waiting for the last dose to clear their system, or who use it in conjunction with something else, but is considered the only option for serious long-term users.
While these treatments are available in Michigan, addicts all too often struggle to access them. Doctors in the state who are certified to administer suboxone are capped at 100 patients by state law.
Lynch said the majority of doctors around the state are maxed out and there has been a push for the cap to be raised — other states, she said, have raised the cap to 300. There is no medical reason for the caps, she said.
In his state of the state address in January, Gov. Rick Snyder outlined plans to introduce a complete package of bills addressing the drug abuse problem in the state by October.
Smith said the state’s Health and Human Services Department has been charged with forming a task force, along with the Michigan State Police and the Department of Licensing and Regulatory Affairs, to address the state’s heroin problem and identify potential barriers to treatment.
“I understand the wheels of legislature move slowly,” Lynch said. “But a lot of people are still dying in Michigan, and a multi-pronged approach is needed.”
CORRECTION: This story has been edited to correctly describe the effects of naloxone, which can restore breathing after a heroin or opioid overdose. It cannot restart a user’s heart, as reported in the original version.

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