By JACK WEATHERLY
Mississippi has suffered the impact of the overprescribing and abuse of opioids for relief of pain – which has become a major health and fiscal crisis across the country.
While the world is bracing itself for the possibility of an epidemic of the coronavirus, the opioid crisis has been established for years.
It has done so in a relatively quiet, low-profile way in contrast with the fears and emerging reality of the virus that began in China and is spreading across the globe.
States have banded together against the manufacture and distribution of the highly addictive pain relievers.
Mississippi Attorney General Lynn Fitch is one of many of her counterparts seeking a settlement with major drug distributors and manufacturers.
Fitch, who took office in January, is “actively engaged on the opioid crisis on both a public education/community engagement level and a legal one,” Ray Coleman, director of communications for Fitch said in an email to the Mississippi Business Journal.
“Mississippi is a party to the lawsuits against the distributors and manufacturers of opioids [McKesson Corp., AmerisourceBergen Corp. and Cardinal Health Inc.]. The preliminary settlement proposal of $18 billion with the three distributors continues to be negotiated even now and Mississippi is participating.
“Similarly, negotiations continue with Johnson and Johnson, Purdue, and Mallinckrodt – for which Mississippi and other states recently reached a framework agreement for a $1.6 billion global settlement. The [Attorney] General’s overarching goals remain a settlement that puts money into abatement activities, and does so quickly.”
In 2017, more than 70,000 persons in the United States died from a drug overdose, and 67.8 percent of those deaths involved an opioid.
The Wall Street Journal has reported that opioid-related deaths has reached at least 400,000 in the past 20 years.
Mississippi had one of the highest rates of opioid prescriptions in 2017, standing at 92.9 per 100,000 persons, fourth highest in the nation, according to the National Institute on Drug Abuse. The U.S. rate was 58.7 prescriptions. The death rate for Mississippi from drug overdose – from opioids and other drugs and 14 other states was not available from the institute.
However, the federal Center for Disease Control reports that 185 people died in Mississippi in 2017 from opioid use, a rate of 6.4 per 100,000 people.
The relative good news for Mississippi is the cost.
The Magnolia State ranked ranked 46th at $703 for overall total costs per capita in 2015, according to a report by the American Enterprise Institute citing the White House Council of Economic Advisers (CEA).
Yet the cost for the nation hit a staggering half-trillion dollars that year, according to the CEA.
Since then, the numbers have climbed, the CEA reports.
It estimates the cost at $696 billion in 2018 — or equal to 3.4 percent of nation’s Gross Domestic Product, the value of all the goods and services produced and a key measure of the economic health of the United States — and more than $2.5 trillion for the four-year period from 2015 to 2018.
“These massive costs point to the nationwide economic destruction from America’s very human ‘crisis next door,’” the CEA states.
In 2017, CEA published a report that measured what it considers the full cost of the opioid crisis by including the value of lost lives, as well as increases in health-care and substance abuse treatment costs, increases in criminal justice costs, and reductions in productivity.
“To quantify the loss of life, CEA used a metric known as the valued of statistical life (VSL), which goes beyond lost productivity,” such as when a person misses work because of such an addiction.
The nation is grappling with the possibility of an epidemic of the coronavirus, which is spreading around the world.
But federal and state health officials have long since designated opioids as just that.
The Mississippi Department of Health reports that there were 8,022 opioid-related hospital stays in 2017, the latest year for which data are available. That was a 26.2 percent increase since 2014.
Total charges for opioid-related hospitalizations in Mississippi were $322,408,631, a 72.4 percent increase since 2014.
Most of the costs in 2017 – $208,432,752 – were paid by Medicare and Medicaid. That was up 64.7 percent since 2014.
Caucasians accounted for 78 percent of such cases.
Emergency department visits were up 50.7 percent since 2014, and similarly charges were up 75.3 percent for a total of $23,425,614.
Medicare and Medicaid paid 50.2 percent of all such charges.
And, again, Caucasians accounted for 72.9 percent of all opioid-related visits.
Mississippi has taken steps to address opioid abuse.
The Mississippi Board of Medical Licensure amended rules on opioid prescriptions to make it more difficult to justify them, according to Dr. Kenneth Cleveland, executive director of the board.
“We knew that too many prescriptions were being written for too many dosage units of medicine,” Cleveland said in an interview.
So the board resulted in the amendment of Part 2040 of Title 30 of the board’s Administrative Code to rein in dispensing of controlled drugs such as opioids for chronic long-term pain as well as for tranquilizers such as Valium and Xanax.
Alternative methods of pain management are encouraged – such as physiotherapy or exercise therapy, Cleveland said.
The new rules went into effect on Oct. 29, 2018, and data for the first six months of 2019 suggest that they are working, according to the Mississippi Department of Health.
Opioid prescriptions for the first quarter of 2018 totaled 698,737, compared with 644,649 in the corresponding 2019 period.
Units, or pills, dispensed in those periods reflect the downward trend. The number for the 2018 first quarter was 37,487,485, compared with 33,055,691.
Prescriptions and total units in 2018 totaled 700,136 and 36,325,735. Prescriptions and units in the 2019 period were 646,656 and 32,940,585, a reduction of 7.6 percent and 9.3 percent, respectively.
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