Stacy Lenze is on the front lines of the opioid addiction epidemic in Honolulu.
As a community health outreach worker, she’s heard frightening stories about people trying to help friends overdosing on narcotics like opioids by injecting them with everything from saltwater to milk.
Lenze is distributing life-saving medication and training people to administer shots of the drug naloxone, which can reverse the effects of heroin or opioid overdoses.
Drug overdose deaths in Hawaii increased by 83 percent from 2006 to 2014, a growth rate more than double the national average of 37 percent, according to the Centers for Disease Control. Prescription opioids and heroin account for the majority of drug deaths, the CDC said.
“There is a huge epidemic throughout the U.S., and Hawaii’s not immune,” said Dr. Tricia Wright of Honolulu who’s working with a nonprofit organization to distribute naloxone. “We’ve lost so many people from opioids.”
Hawaii’s isolation may contribute to its high overdose rate, because the quality of drugs brought onto the islands is inconsistent, Lenze said.
“Somebody might use the same amount that they’ve always used, but it’s a different quality level,” she said.
A joint investigation by The Associated Press and the Center for Public Integrity found that drugmakers that produce opioid painkillers and allied advocacy groups spent more than $880 million on campaign contributions and lobbying over the past decade as they worked to influence state and federal policies. The groups have an array of political interests that include opioid advocacy, and their spending was eight times that of the gun lobby during the same period. By comparison, groups advocating for limits on opioid prescribing spent about $4 million.
The investigation comes as the number of overdose deaths from prescription painkillers has soared, claiming the lives of 165,000 people in the U.S. since 2000. Reporters analyzed campaign finance and lobbying data from 2006 through 2015, reviewed hundreds of documents and conducted more than 150 interviews. The AP and Center for Public Integrity found that drugmakers and allied groups employed an annual average of 1,350 lobbyists in state capitals around the country and contributed to a total of 7,100 candidates for state-level office.
The groups spent far less money in Hawaii than in other states. Contributions to Hawaii candidates from companies that manufacture opioids amounted to less than $40,000 from 2009 to 2014, about 1 percent of the campaign spending that poured into California.
Hawaii lawmakers passed a bill this year that in most cases prevents health care providers from prescribing more than a 30-day supply of opioids. The law, which went into effect July 1, also enables more health care providers to use a database that tracks painkiller prescriptions.
State Sen. Josh Green, an emergency room doctor, introduced several bills aimed at curtailing opioid abuse in recent years despite receiving campaign contributions from Pfizer, which manufactures opioids.
“I’m all in to curtail narcotic medication pills, and I am very aggressive irrespective of what the pharmaceutical industry wants,” he said.
Drug companies say they are committed to solving the problems linked to their painkillers. Purdue Pharma, one of the largest opioid producers by sales, said it does not oppose policies “that improve the way opioids are prescribed” even if they result in lower sales.
It took several years for Hawaii lawmakers to pass legislation to limit opioid prescriptions. In 2013, Green’s bill that would have prohibited health care providers in emergency rooms from prescribing long-acting opioids died. An effort in 2015 to limit the number of times doctors could prescribe opioids also failed.
During that time, several lawmakers who led committees on health and consumer protection were receiving campaign donations from Pfizer and Pharmaceutical Manufacturers of America, a drug trade group. The donations were small and they said Pfizer and the trade group weren’t lobbying against the proposals.
“They have never in my memory lobbied on any of the opioid legislation,” said Sen. Rosalyn Baker, chairwoman of the Commerce, Consumer Protection and Health Committee, who was among those receiving donations.
Pfizer spokeswoman Sharon Castillo said the company wasn’t involved with Hawaii’s proposed opioid legislation. Its legislative priorities in the state included working to increase vaccination rates, among other things, she said in an email.
The company has been educating prescribers on the appropriate use of pain medications, promoting access to opioids manufactured in a way that makes the pills harder to break down and abuse and supporting the use of prescription drug monitoring programs, she said.
A spokeswoman from Pharmaceutical Manufacturers of America said the company doesn’t comment on lobbying. But she emailed a statement saying the group is committed to working with policymakers and providers to combat opioid abuse through mandated education on appropriate prescribing, training and use of databases to prevent abuse, and clinical guidelines for prescribers.
Rep. Della Au Belatti, chairwoman of the House Health Committee and also a donation recipient, said she wasn’t lobbied by the pharmaceutical industry. She said Hawaii is behind states with more aggressive laws, such as those that limit opioid prescriptions to a seven-day supply, but she and others are pushing to catch up.
For example, doctors in Hawaii are required to sign up for a database that tracks painkiller prescriptions, but they’re not required to enter information, an issue that could be addressed with future legislation, Green said.
He said he’s seen teenagers and others suffering from car accidents, head injuries and fatalities because of addictions to painkillers they should have never been taking.
“That’s heart-wrenching, because those are totally preventable tragedies,” Green said.