West Virginia Health Commissioner Dr. Rahul Gupta examined the circumstances behind every one of the 887 opioid overdose deaths in his state in 2016, in order to get to the bottom of what remains the nation's highest state opioid overdose death rate.
Gupta (@DrGuptaMD) tells Here & Now's Robin Young the intensity of the crisis in his state highlights the failure of the health care system to prevent the epidemic from getting so out of control.
"There are missed opportunities within our systems, and sometimes we may get a single opportunity when somebody comes to visit a physician or another provider in a clinic to get help," Gupta says. "It was us as a health care system who failed these individuals."
On how the state set out to tackle the crisis
"One of the things that we wanted to find out is [how to] learn from those who have already passed away, and how can we learn just not about their medical diagnosis or what's in their blood, but actually also find out, what were their social conditions like? What would a social autopsy of someone who dies from a drug overdose look like? For example, we found about 71 percent of the decedents actually had Medicaid, yet we found that there was a less likelihood of getting naloxone, which is an antidote for reversing overdose in the field, if EMS was called.
"What we're saying is that stigma issues run wide and probably deeper than we actually estimate [them] to be."
On the risk factors for developing opioid addiction
"One of things we found with regards to men of a certain age, which is 35 to 54 years old, we also found if you were high school-educated or less, and if you were single, working in the blue-collar industry, that's when you have the highest risk. And part of it's because we also found that over half of all decedents had been previously incarcerated as well. So these are all those risk factors, and when you ask about particularly men, I think a lot of that has to do [with] both the workforce, the type of industry, the high risk of injury in the industry, which leads to people getting prescribed for drugs such as opioids. And then finally, developing that opioid use disorder, and whether they transition onto heroin or fentanyl, these are the risk factors."
"How can we learn just not about their medical diagnosis or what's in their blood, but actually also find out, what were their social conditions like? What would a social autopsy of someone who dies from a drug overdose look like?"Rahul Gupta
On how pharmacies contribute to the epidemic
"We also found by the way that decedents were three times more likely to have died if they had three or more prescribers. Similarly, they were more than 70 times likely to have prescriptions that are from four or more pharmacies. So one of the things we're also doing is we're developing more robust data collection systems to make sure that we're monitoring through the state's prescription drug monitoring program the prescriptions, so there is no duplications. And we're limiting the number of pharmacies that people can get medications like opioids filled, so that that will relate to and lead to fewer overdoses and fewer deaths eventually."
On how field work has influenced policy changes
"Just a couple of weeks ago, I was able to see about nine patients, four of which actually have substance use disorder. And two of those, that particular day I was able to refer two medications as a treatment and get them the help. But the other two that day really were not willing to go into treatment. At that point, you have to continue to offer appropriate guidance and counseling to individuals and support with the hope that when they come back next time they will be ready. So it's having that experience on the ground, talking to individuals who are suffering from substance use disorder, I think it's important for someone like me, making policy, that helps me to remain grounded as to the real individuals and humans that we're impacting the lives of by changing those policies."
"This is an epidemic of so many different epidemics. Just addressing a particular substance of use or misuse isn't enough."Rahul Gupta
On the policy changes to combat the crisis
"We were able to not only through a waiver get the ability to fund those facilities but fund for naloxone to be reimbursed, but also warm handoff. So not only do providers get reimbursed for administering naloxone, but they also get [an] additional fee for being able to do a warm handoff to other agencies that actually may mentor those individuals to treatment. And in primary care practice, especially in a rural state like West Virginia, people may not have readily access to treatment. They may have to travel many, many miles to get there. So one of the things we wanted to create is an exemption for those primary care [physicians] to be able to provide medications as a treatment to their patients if they feel they wanted to do so. So we've been able to do that as well. To the question of what still needs to happen, I think one of the aspects is that this is an epidemic of so many different epidemics. Just addressing a particular substance of use or misuse isn’t enough."
On the impact of new policy
"I think we’re certainly making progress. Challenges continue and the epidemic continues to evolve, but I certainly think it's important to learn first from a data analytical standpoint and then be able to transform that into policy. But then also step back and look at the larger picture as to what are those pieces missing in our society? How do we develop hope into communities, and to be able to inspire those communities to actually move from the diseases of despair and desolation, to one where people are more optimistic about their community, their neighborhoods, their families?"
On the challenges posed by weaknesses in the health care system
"So here's an analogy: In this country if you get hit by a car, we're very good in helping you survive, getting you to the best trauma surgeons, the neurosurgeons and getting you that care. But if you have diabetes as a result or previously existing, we're not very good at managing that diabetes and preventing a stroke or a heart attack from happening long term. So I think we're going to be making progress in the ability to make gains in terms of overdose deaths and address some of the immediate aspects of this crisis. But when it comes to the long-term impact as how do we turn our communities into ones that are more integrated, that are looking at issues of workforce, education, air, water, food establishments, I think that’s gonna be a bigger task to happen, and that still needs to happen."
This segment aired on May 11, 2018.
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