BY: Terry DeMio , email@example.com –
Kentucky doctors diagnosed more cases of opioid addiction for people privately insured than did doctors in any other state in the nation last year, a new report finds.
The report, “America’s Opioid Epidemic: Data on the Privately Insured Population,” gives an indication of how the opioid and heroin epidemic affects people who are of all different backgrounds. It was created by Amino, a health-care transparency company that aims to help people find care and estimate the costs of their care.
“This shows that opioid use disorder can really affect anyone,” said Amino data scientist Sohan Murthy. In particular, people who have chronic pain and surgery for back ailments that doesn’t fix the pain are more likely to acquire addiction disease, the research shows.
Across the country, the data shows, there has been a steep increase in opioid addiction disease diagnosis, a public health trend that is tormenting the nation. Six times the number of patients were diagnosed with the disorder in 2016 than in 2012.
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In 2012, doctors diagnosed 241,000 people who had private health insurance with the disease, Amino says. Last year, they diagnosed 1.4 million. In 2015, about 2 million people in the U.S. had a substance use disorder with prescription painkillers and about 591,000 had a heroin use disorder, the American Society of Addiction Medicine noted in a report published last year.
Dr. Will Lopez, a senior medical director in Cigna’s behavioral health business, said the problem of opioid use disorder — which developed in the 1990s after pain became a vital sign and doctors started prescribing more painkillers — has always been an issue for everyone. “From the start of this problem, it went across all economical statuses,” Lopez said.
Like other insurers, Cigna has initiated several programs to help combat the opioid epidemic. One such program sets a goal of dropping its customers’ use of opioids by 25 percent by 2019. The insurance company reported in April a 12 percent reduction so far made possible through a focus on prescribing patterns and on encouraging network providers to use new prescribing rules issued last year by the Centers for Disease Control and Prevention.
Kentucky docs diagnoses of opioid use disorder in 2016
Eastern Kentucky had a serious prescription painkiller problem before heroin came. And Northern Kentucky, with its idyllic, suburban communities, was also hit hard by the heroin epidemic. Now, more than one-in-three residents in the eight-county region have a family member or friend with a heroin problem.
Kentucky doctors’ diagnoses of opioid addiction among the privately insured are topping the nation, the Amino study shows.
“Relative to the population, Kentucky had the highest diagnosis rate,” said Murthy, the Amino data scientist.
Kentucky tallied 23 patients with the disorder per 1,000 residents. By comparison, Ohio had about 12 patients per 1,000 residents diagnosed, the data show, leaving the state the eighth in the nation in that ranking.
The heroin-addiction resurgence in the United States has captured a largely white population, including many women. Most with the disorder live outside large, urban areas, studies show. That’s in contrast to the 1960s.
A Journal of American Medical Association (JAMA) report from July 2014, “The Changing Face of Heroin Use in the United States” shows another difference: Those who started using heroin in the 1960s largely used it as their first opiate drug. Now, though, most report that they had been using prescription painkillers before they moved to heroin.
“We found that heroin use is not simply an inner-city problem among minority populations but now extends to white, middle-class people living outside of large urban areas, and these recent users exhibit the same drug use patterns as those abusing prescription opioids, JAMA researchers concluded.
Treatment with buprenorphine highest in Kentucky
Kentucky was a clear standout, too, in the number of those with the addiction who were treated with a medication called buprenorphine. That’s the generic of Suboxone, although the brand also has the opioid-blocker naloxone in it.
Amino calculated the buprenorphine treatment differently, Murthy said, so the addiction diagnoses don’t correlate equally to the treatment numbers. Buprenorphine is used to curb cravings, prevent withdrawal, stabilize a person’s brain and allow the patient to respond to counseling and function normally in society.
Kentucky had nine of the top 10 counties in the nation for doctors treating a high volume of patients with the medication for opioid use disorder. Boone, Campbell and Kenton were not among them.
Dr. Mina “Mike” Kalfas, a certified addiction expert with a Christ Hospital outpatient office in Northern Kentucky, said the region has too few providers, leaving many who need the medication unable to get it here.
“We don’t have the capacity that we should have,” said Kalfas, who has around 100 buprenorphine patients in his Fort Wright office and works with addiction expert Dr. Michael Fletcher at ICAN in Crestview Hills. That office has the potential to treat 175 patients with the medication. The lack of medication assisted treatment is a problem around the nation, according to experts with the National Center on Addiction and Substance Abuse.
Buprenorphine is one of three FDA-approved medications for treating the disorder. The Substance Abuse Mental Health Administration offers a burprenorphine physician-finder online.
Suicidal tendencies, hep C among other maladies opioid users share
People who have the disorder often suffer from additional health problems, and Amino’s report came as more evidence of that issue.
Patients with opioid addiction last year were eight times more likely than people without addiction to have alcoholism, nearly seven times as likely to have suicidal ideation and more than twice as likely to suffer from depression.The dual diagnoses are common in heroin- or prescription painkiller-addicted patients, addiction experts say. It just makes sense because of what heroin and synthetic opiates do to a user’s brain, said Kalfas.
“The depression, suicidal thoughts, loss of joy, are consequences of chronic opioid use, because they experience a decrease in endorphins over time,” Kalfas said.
There’s a link, too, between heroin and opioid use disorder and hepatitis C, with patients about nine times as likely as others to the bloodborne disease that leads to inflammation of the liver. Without expensive treatment, people can die from the virus.
Northern Kentucky and Greater Cincinnati have soaring hepatitis C cases, with public health officials pointing to a need for more needle exchange sites. Needles and syringe barrels can harbor the virus for several days, and the exchanges provide clean-for-used needles, as well as offer tests for such diseases as hepatitis and HIV and guide people into treatment when they are ready.
Other results of Amino’s data crunch show that those with opioid use disorder are seven times more likely to have experienced failed back syndrome, which causes chronic pain. They’re almost six times as likely as those without the addiction to have chronic pain. When states cracked down on the prescription of addictive painkillers, or opioids, used in an attempt to conquer chronic pain, drug cartels moved heroin into the market, and people who’d been cut off prescriptions along with others who’d been using the drugs sold on the streets started using heroin.
How many were diagnosed with opioid use disorder in your county in 2016?
Boone County: 1,200 (9.6 per 1,000 residents)
Butler County: 1,700 (4.6 per 1,000 residents)
Campbell County: 400 (4.4 per 1,000 residents)
Clermont County: 400 (2.0 per 1,000 residents)
Hamilton County: 4,700 (5.0 per 1,000 residents)
Kenton County: 700 (10.4 per 1,000 residents)
Warren County: 800 (3.6 per 1,000 residents)
Source: The information above was provided by Amino from its report, “America’s opioid epidemic: data on the privately insured population.” “Residents” were based on where patients were treated. They could have been treated in a county that was not where they lived. For Amino’s blog post/analysis see: http://bit.ly/2sOB4lr