COVER STORY Arkansas at front line of U.S. opioid epidemic

Story by Wesley Brown Reprinted with permission fromTalk Business & Politics

Editor’s note: Tis is the first in a series of three stories published in Talk Business & Politics magazine in October. Since this story first appeared, President Donald Trump has declared the nation’s opioid crisis a public health emergency (see page 32), and the Pres- ident’s Commission on Combating Drug Addiction and the Opi- oid Crisis has issued its final recommendations for addressing the opioid crisis (see page 33 for a summary of the recommendations). We are sharing this article with our readers so they may have a better understanding of how the epidemic is affecting Arkansas and steps that have been taken thus far to address the issue.

wage that fight in their communities. During a White House briefing in early August with U.S.


Department of Health & Human Services Secretary Tom Price and the President’s Commission on Combating Drug Addic- tion and the Opioid Crisis, Trump announced his intent to make the opioid crisis a national priority, which would bring and influx of federal funds and public health aid to communi- ties in all 50 states to fight the growing health care crisis locally. “Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities ... It is a prob- lem the likes of which we have not seen,” Trump said Aug. 8. Prior to that White House meeting, President Trump issued

and executive order for the Commission on the Opioid Crisis to come up with key recommendations to stem the growing health care crisis. Lef by Gov. Chris Christie of New Jersey, the Com- mission in late July issued an interim report recommending several key actions, including a national emergency declaration. “Our nation is in crisis. Your Executive Order recognized

that fact. Te work of your Commission so far acknowledges the severity of of this national problem,” Christie wrote in the 10-page interim report to Trump. “Te first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency under either the Public Health Service Act or the Stafford Act. With approxi- mately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks.” Despite the recommendations of the Commission and re- cent speeches by Trump highlighting the seriousness of the rising number of deaths from the nation’s growing addiction to opioid painkillers, health care officials are waiting for the president to sign an executive order that will speed up fed- eral funding and services. For example, one of the Commis-


s President Donald Trump considers to formally make the nation’s battle against the growing opioid epidemic a national emergency, Arkansas and other states are now faced with a conundrum of how to

sion’s recommendations would grant Medicaid waivers to all 50 states to apply to open opioid treatment centers to treat thousands of Americans. Other recommendations would mandate medical education training in opioid prescribing to treat pain, enhance federal access to so-called Medication-Assisted Treatment (MAT) that reduces overdoses, and prioritize funding and manpower to help federal, state and local law enforcement officials to de- velop fentanyl detection devices and stem the flow of deadly synthetic opioids through the mail. Another proposal includes a national protocol for dispens- ing naloxone, the fast-acting, FDA-approved nasal spray used to treat drug overdose. According to the Commission, a presi- dential standing order would require the prescribing of nalox- one with all high-risk opioid prescriptions and equip all local law enforcement officials with the potent drug to save lives.

Arkansas Actions But faced with the reality that opioid abuse in Arkansas is

already at the emergency level, state policymakers, healthcare and lawmaker enforcement officials are moving forward with a number of directives. A recent report by the U.S. Centers for Disease Control and

Prevention (CDC) shows all but nine of Arkansas’ 75 coun- ties had overall opioid prescribing rates higher than the na- tional average of 66.5 prescriptions per 100 people. As a state, Arkansas has an opioid prescription rate of 114.6 per 100, second only to Alabama 2016 average of 121 per 100 people. In a recent Joint Interim Committee on Public Health at the

State Capitol, Arkansas Health Department (ADH) Director Nate Smith gave a report to lawmakers that enough opioids are now being sold in Arkansas for every man, woman and child to take 80 pills each over the course of a year. Altogether, 235.9 million pills were sold across Arkansas in 2016, Smith said, citing the most up-to-date data from the CDC. One of the key strategies to emerge in Arkansas to address

the prescription opioid overdose epidemic is the Electronic Prescription Monitoring Program (PMP), the state-run elec- tronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. Between 2012 and 2016, the Substance Abuse and Mental

Health Services Administration within the HHS funded pilot projects in nine states that promoted use of federal PDMPs by registered prescribers and dispensers to inform their clini- cal decisions and allow for intervention at the point of care. Although Arkansas was not one of the original HHS-fund- ed pilot programs, the Arkansas General Assembly did pass


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