Indiana has experienced a rise in the opioid epidemic, with solutions being touted such as increased use of medically assisted treatment paired with counseling and increased family support, according to speakers Friday at the inaugural West Central Indiana Drug Symposium.
Known as Indiana’s Drug Czar, Jim McClelland is the state executive director of Drug Prevention, Treatment and Enforcement. He spoke at the symposium, which was at Ivy Tech Community College and hosted by Harsha Behavioral Center.
McClelland said Indiana ranks 11th highest in the nation in opioid prescriptions, which is better than its previous ranking of ninth highest.
However, an oversupply of opioid prescriptions as well as an illicit use of opioids is the primary cause of the opioid epidemic, he said.
“The overall impact of drug overdose deaths in this country has been enough to lower the average lifespan of Americans for two consecutive years,” McClelland said. “That’s not happening in any other developed country in the world. This is serious ... as we always expect the average lifespan will continue to go up. But, in this country for the last two years, it has dropped a bit, and it is primarily a result of this epidemic,” he said of opioid usage.
Last year, Indiana experienced a 35-percent increase in the number of fatal opioid overdoses, McClelland said, and the state had the 15th highest drug overdose rate in the nation.
From 2011 to 2016, Indiana experienced a 46-percent increase in fatal opioid overdoses, Pam Pontones, Indiana deputy state health commissioner and state epidemiologist, said. And opioid emergency room visits increased 70 percent in the Midwest, between July 2016 and September 2017, she said.
The largest age group in Indiana impacted from opioid drug deaths are people aged 30 to 39, with nearly 450 deaths in 2016, Pontones said.
However, people aged 20 to 29 and people aged 50 to 59, also show significant deaths, with each age group having nearly 350 deaths in the state in 2016, Pontones said, with those aged 40-49 years old having nearly 300 deaths in 2016.
A national opioid epidemic started in the mid-1990s, when doctors routinely prescribed medications based on pain as a fifth vital sign, Pontones said, plus the nation experienced aggressive opioid drug marketing, with drugs marketed “as not being addictive but were very much so,” she said.
To help address the problem, McClelland said the Indiana General Assembly this session approved adding nine more opioid treatment facilities and two mobile crisis treatment teams to work in 14 counties. State Sen. Jon Ford, R-Terre Haute, said that means most Hoosiers will be within an hour’s drive of a treatment facility.
Brandon George, director of the Indiana Addiction Issues Coalition, said medically assisted treatment is needed, as it decreases fatalities about 53 percent. However, only 20 to 31 percent of the time is that treatment offered nationwide, said Dave McIntyre, clinical addictions counselor at Valley Professionals Community Health Center.
Heidi Decker, director of the Vigo County office of the Indiana Department of Child Services, said four years ago the agency had 20 family case managers in Vigo County, but now has 65, as a result of substance abuse.
Indiana State Police Sgt. Chris Wright said police used to watch anhydrous ammonia tanks — as ammonia is used to produce methamphetamine — but now residences are being broken into to obtain opioid pills from medicine cabinets.
High risk, but treatable
Dr. Ahsan Mahmood, chief medical officer at Hamilton Center in Terre Haute, said he sees one national concern as not focusing on “concurrent disorders. We have done a disservice to separate mental health and addiction. I think that is one of our biggest oversights in the mental health profession. You cannot separate disorders,” such as bipolar disorders, depression disorders and schizophrenia, Mahmood said.
McClelland said holistic wrap-around services are needed for best opioid treatment, as are strong family and social connections.
”We need for everyone to understand, that regardless of the path that leads to someone to becoming addicted to opioids, once that happens you have a chronic disease that affected the structure of the brain,” McClelland said. “The longer you are on it, the more the brain needs changing. Fortunately, opioid use disorder is treatable and recovery is possible, but the treatment can take a long time and the risk of relapse is high,” McClelland said.
The state distributes Naloxone, a medication designed to rapidly reverse opioid overdose, to 49 county health departments and to 106 rural first responders in another 39 counties, Pontones said. Police, firefighter and emergency medical personnel in Indiana are protected under state law to use and administer the medication, she said.