Opioid overdose deaths doubled over past 16 years
by Chris Sugidono
Maui District Health Officer Dr. Lorrin Pang sees firsthand how bad the opioid pain reliever epidemic has become.
“Some of my students are asking me for prescriptions,” Pang said Friday. “It’s so normative they’re not shame in asking me.”
Opioid overdose deaths have more than doubled in Hawaii from 25 in 2000 to 59 in 2016, according to the death certificate database of the state Department of Health. Total drug overdose deaths also have more than doubled, from 67 to 172 in the same period.
Opioid pain relievers have contributed to about 40 percent of drug overdose deaths statewide over the past decade. This includes substances such as OxyContin, fentanyl and other synthetics, but excludes heroin.
“At one point 10 years ago, it was really crystal meth,” Pang said. “Ice has gone down a little bit, but the opioids really went up.”
Hawaii health care providers are now scrambling to reduce deaths and addiction rates and have elicited the help of Native Hawaiian healers. Community health centers are seeking to gain insurance coverage for Native Hawaiian healing treatments in the next couple of weeks.
Hawaii’s drug overdoses surpassed motor vehicle traffic crashes as the leading cause of fatal injuries in 2008. While motor vehicle deaths have trended downward, overdoses have continued to climb.
Nine out of 10 poisoning deaths were attributed to drugs and medications from 2010 to 2014. All of the victims were 14 years old or older and most — 87 percent — were between the ages of 25 and 64.
The average number of annual opioid overdose deaths in Maui County was 26 during that period, making up 18 percent of all the opioid overdose deaths in Hawaii. The county averaged the highest annual rate of opioid overdose deaths per 100,000 residents in Hawaii at 17.5.
This month, Gov. David Ige introduced a $10 million initiative to fight opioid addiction that includes distributing 20,000 opioid overdose rescue kits. The state Legislature has enacted a bill to better control opioid prescriptions in response to the growing epidemic.
Nationwide, the epidemic has worsened, with drug overdoses experiencing the largest annual jump ever recorded, according to The New York Times. Preliminary data show that drug overdoses are now the leading cause of death among Americans under 50.
“I think we’re at least as bad as (the rest of) the U.S.,” Pang said. “For every one legitimate use of (opioid painkillers) there’s three or four illegitimate uses.”
Pang said that the opioid crisis began about 15 years ago as doctors began prescribing the painkillers. He said that the number of prescriptions is now four or five times higher.
“I’m not saying these people didn’t have pain to start with, but I don’t think we have more pain than what we had 15 years ago,” he said.
William “Pili” McGrath, supervising attorney for the public defender’s office, said that opioids are selling for $40 to $50 per pill on the street. He said that one prescription could be worth about $1,500.
“What’s happening is someone is getting it from the doctor and selling it,” McGrath said.
Pang said he began to see opioid addiction about three years ago at Malama I Ke Ola Health Center. The federally qualified health center is owned and operated through public-private partnerships to service the homeless, poor and underserved in Wailuku and Lahaina.
Pang, who serves as vice president of the clinic and has been on the board for 10 years, said he has watched opioid addiction grow and it reached a point where doctors had to turn away patients if they were using painkillers or had a history of use. He said doctors had so many other patients that they were forced to turn their focus on people not addicted to opioids.
“I couldn’t believe it on behalf of myself and the board,” he said. “I called the federal people and asked if that is an OK policy and they said yes. Within a few months, though, they reversed that decision.
“In fairness, doctors were being overloaded and didn’t have time to take care of the diabetes and hypertension the patient came in for because at the same time you would be dealing with substance abuse addiction,” he continued. “They’re scared to treat until you get them off these substances and then they can clearly see what they’re dealing with.”
Officials with the health center could not be reached Friday.
Treating opioid-addicted patients is difficult, especially ones with mental health issues because doctors cannot make an accurate diagnosis, Pang said. He said that the clinic’s medical director is very aware and sympathetic to the issue and is working on solutions.
One solution could be Native Hawaiian healers, which community health centers have reached out to for alternative ways to treat pain and help wean addicts off of opioids.
Hamakua-Kohala Health on the Big Island has submitted a proposal to insurance company Hawaii Medical Service Association for Native Hawaiian healing to be included in health coverage. If it is accepted, other clinics statewide would be able to make the same request.
“It’s gonna be huge,” said Irene Carpenter, chief executive officer of Hamakua-Kohala Health. “We’re saying to the insurance companies to step up. It’s time you recognize you’re in Hawaii where you have a whole other population that needs to be addressed.”
There are 11 community health centers in the state and about 45 percent of all patients are Native Hawaiian, Carpenter said. She said that covering healers under insurance would improve care for Native Hawaiians and encourage them to visit clinics.
“A lot of Hawaiians get no primary care and we know a big part of the population has massive substance abuse problems,” she said. “Opioid substance abuse came up as a massive problem (on the Big Island) and I’m sure it’s exactly the same on Maui. There’s just not enough resources.”
Maui and the Big Island lead the state in opioid poisoning death rates.
The Big Island clinic, which has sites in Kohala and Honokaa, recently received a two-year grant of close to $1 million to begin creating a Native Hawaiian healer network. Several Maui healers have already signed on and Carpenter continues to collaborate with CEOs at other clinics.
Carpenter is hopeful that insurance companies will grant coverage, just like it did for chiropractors and acupuncturists. She said she is going to offer training from healers to HMSA officials so they understand the practice and its benefits.
“They might be a little more willing to fund it and have respect for it,” she said.
She is confident that healers can reduce long-term medical costs such as frequent trips to the doctor or emergency room, coupled with better care. She said healers will be carefully selected by the network to ensure quality care.
“We’re going to make sure we’re not adding people to the list who have a couple tribal tattoos and a six-week massage class,” Carpenter said.
Pang said healers provide social follow-up care for patients, similar to Alcoholics Anonymous meetings, which works very well for addicts.
He said that herbs and plants have yet to be discussed and will need to be researched further. Native plants and remedies have been used to treat major diseases such as malaria. In 2015, a Chinese pharmaceutical chemist was awarded the Nobel Prize after using herbs employed in traditional medicine to develop an anti-malaria medicine.
“It (herb) became the lead agent treating malaria because all of the other drugs failed so that approach is not to be dismissed,” Pang said. “I think Hawaiians have a lot to offer. Even if it’s not a drug, their methods of handling pain is quite impressive.”
* Chris Sugidono can be reached at firstname.lastname@example.org.