Johnson County agencies look to plot course for preventing spread of opioid epidemic locally

Photo by Frankie Leon (via Flickr).
Photo by Frankie Leon (via Flickr).

It’s nearly impossible to take in the national news these days without encountering some story about the growing crisis of opioid misuse in this country. And while the effects of the national epidemic may not be widely apparent here, Johnson County is far from immune to the problem.

“While I wouldn’t say that we’re an epidemic here in Johnson County, Kansas, I think we’re starting to see the trends…that lead us to believe that we’re going to be no different than any other part of the United States,” said Tim DeWeese, director of Johnson County Mental Health.

With that in mind, DeWeese and Johnson County Department of Health and Environment Director Lougene Marsh organized a community discussion this morning that brought together more than 200 medical, public health, law enforcement, judicial and social services professionals to begin formulating a response plan at the local level.

“When you talk to law enforcement, when you talk to the court systems, when you talk to substance abuse providers, we’re beginning to see all of those red flags,” said DeWeese of the indicators of growing opioid misuse. “What we want to do is ask how do we formulate a plan specific to this community to make sure we don’t experience the same thing that people in other parts of the country are experiencing.”

To date, Johnson County has largely avoided the systemic stresses that opioid misuse can put on public agencies. Statistics show that opioid-related court filings have been trending downward in Johnson County since 2012, and that Kansas has a relatively low level of opioid overdose deaths compared to the country and neighboring states. Kansas’s overdose rate is 11.8 per 100,000 residents, compared to 16.3 nationally and 17.9 in Missouri. Still, about 30 people have died in Johnson County every year for the past four years from opioid overdose.

Also of note, Kansas has an above-average number of opioid prescriptions, with between 82.2 and 95 prescriptions per 100 people, a recipe for increased use that can quickly lead to dependence, according to Kimberly Templeton, MD, an orthopedic surgeon at the University of Kansas Hospital. Templeton categorized the national opioid epidemic as the result of a “perfect storm” of variables: a growing belief among the public that pain is avoidable and can be treated, heavy marketing by pharmaceutic companies for new opioid medications, and an increased acceptance for using drugs for purposes other than what they were prescribed for.

Moreover, Templeton told the audience at the Ball Conference Center in Olathe, physicians have been increasingly likely to write new opioid prescriptions since the Centers for Medicare and Medicaid Services began using patient satisfaction surveys as part of the calculation for reimbursement rates hospitals get for patients who use government insurance programs. Because the satisfaction survey patients receive explicitly asks whether their pain was addressed, hospitals have an incentive to write more opioid prescriptions.

Unfortunately, with so many prescriptions in the system “you’re always going to be able to find someone who can give some to you,” Templeton said. Use of prescription medications can slip into opioid dependence that leads people to seek illicit drugs, like heroin or dubiously sourced fentanyl, the purity of which is always suspect.

“They think they know what they’re buying when they get [these drugs] online or on the street,” Templeton said. “They don’t have a clue.”

Organizers said they hoped Thursday’s panel discussion will be the first step in what they hope will be a long-range effort for local agencies to collaborate on preventing opioid misuse here.

“For every $1 we spend in evidence-based prevention practices, we save $64 in [opioid misuse-related] costs,” Marsh said.

Kimberly Templeton, MD, said a "perfect storm" of factors have contributed to the emergence of the national opioid epidemic.
Kimberly Templeton, MD, said a “perfect storm” of factors have contributed to the emergence of the national opioid epidemic.