Opioids are ‘apex predator’ of social ills

State officials are ramping up efforts to combat a growing dependency on pain medicines that affects about 150,000 Hawaii residents struggling with addiction.

That’s a significant increase from the 50,000 people addicted to opioids a decade ago, said Edward Mersereau, chief for the state Alcohol and Drug Abuse Division, who presented a plan to lawmakers Friday to reduce opioids in the community beginning in January.

Opioids, highly addictive narcotics commonly used to treat pain, are prescribed to roughly 400,000 patients in Hawaii each year. It takes about three weeks for a patient to become dependent on the drug, which can stop a person’s breathing and heart, resulting in death when combined with alcohol and other depressants.

Although Hawaii is the eighth lowest in the nation for opioid mortalities, the state spends millions each year on avoidable medical costs due to addiction. State hospitals in 2016 billed more than $110.7 million in charges for the treatment of 4,017 patients with opioid-related problems, compared with $48.7 million for 2,797 patients in 2010, according to the Hawaii Health Information Corp., a nonprofit that collects health care data for policymaking.

“It’s because we don’t treat addiction like a chronic illness. If we treated addiction like we did diabetes or cancer … then we’d be able to get it under control,” said Mersereau, adding that the costs to society are substantial: “broken families, job loss, homelessness, unemployment, death, health issues, crime. I call it the apex predator of social issues. The idea of the plan is not to just focus on opioids. The idea of the plan is to focus on the disease of addiction. I don’t see any pervasive social issue in the state that’s not caused or made worse by substance abuse.”

There were 58 opioid-related deaths locally in 2016, 37 of which involved prescription painkillers, according to DOH statistics. Fatal overdoses involving opioid pain relievers, including oxycontin, fentanyl and other synthetics, have gone up and down over the past decade, ranging from 47 to 74 deaths per year, Health Department records show.

Lawmakers granted $200,000 last session to the DOH to design the opioid plan with other state agencies and community groups, and the department will seek another $200,000 next legislative session.

The funds will be used to start a law enforcement diversion program that allows officers to refer people suspected of low-level substance abuse crimes to social services agencies for treatment instead of arresting them. State officials are also working on a single, coordinated phone system that will make it easier to find appropriate treatment.

Prescription drug drop boxes within police stations statewide is another initiative in the works.

Officials are starting education campaigns urging greater vigilance among health providers in monitoring prescription drugs in the community. Only about 10 percent of medical providers who are required by the state to sign up for a database drug-monitoring program actually use the program to check how many drugs are prescribed to patients. A law passed last legislative session limits new prescriptions for opioids to seven days.

“It’s a dynamic plan, and it’s going to take all of us to make sure we keep it that way so that it’s not going to sit on a shelf,” said Sen. Roz Baker (D, South Maui-West Maui).

Former Maui Police Chief Gary Yabuta told legislators, “The opioid crisis has already hit here. It’s indiscriminate. It’s hitting our rural districts. There’s armed robberies on Maui, Kauai, Oahu, the Big Island because addicts need to get their opioids.”