Where in Utah have opioid overdose rates been highest? In Carbon and Emery counties, where treatment services are scarcer.

(Toby Talbot | AP file photo) This Feb. 19, 2013, file photo shows OxyContin pills arranged for a photo at a pharmacy, in Montpelier, Vt. Five state attorneys general announced lawsuits May 16, 2019, seeking to hold the drug industry responsible for an opioid addiction crisis that has become the biggest cause of accidental deaths across the country and in many states. The new filings bring to 45 the states that have now taken legal action in recent years against Purdue Pharma, the maker of OxyContin.

Between 2014 and 2016, the state’s opioid crisis hit hardest in two rural counties — Carbon and Emery, where adults died of drug overdoses at nearly three times the statewide rate.

The vast majority of the fatalities were from prescription drugs. And adults from ages 45 and 54 were the most at risk, a state opioid fatality review committee has found.

It was the worst of the overdose “hot spots" identified by the committee, which determined that the opioid problem was also particularly acute in downtown Ogden and the Glendale and Rose Park neighborhoods of Salt Lake City.

But the review committee, which released its first findings Wednesday, didn’t want to settle for viewing the opioid problem as a set of data points; they also sought to understand the epidemic by examining overdose deaths one at a time.

“I think a lot of times, especially with data ... people become numbers, and this way, this person is definitely not a number. This person had a family,” said Meghan Balough, an epidemiology manager for the Utah Department of Health.

By studying 58 opioid deaths that happened in 2017, the fatality review group noticed that treatment resources for addiction are scarcer in rural areas. That there seem to be links between domestic violence and opioid abuse. And that uncertainty about the state’s Good Samaritan law — which is supposed to protect people from drug charges if they summon first responders for an overdose — is giving people pause about calling 911.

(Christopher Cherrington | The Salt Lake Tribune)

“It goes far beyond just the numbers. It’s a deep dive into these different systems to figure out how we as a state can work together to improve our response to the opioid problem as it exists in different communities,” said Joey Thurgood, opioid fatality review coordinator with the health department.

The fatality review committee formed in January 2018 with participation from the Utah Office of the Medical Examiner, Utah Department of Corrections, Utah Attorney General’s Office, Utah Department of Commerce, Utah Department of Human Services, University of Utah Medical Center and Utah Poison Control Center.

Balough said the group tried to develop a timeline of each fatality and understand what led up to the overdose. They examined toxicology reports, looked at what types of pills were near the person at the scene and figured out if the person had participated in drug court or been incarcerated.

For its first year of work, the group focused on three topics: geographic areas with the highest overdose rates, dangerous drug combinations and risks associated with a recent release from an institution.

The review committee found that gabapentin, an anticonvulsant that is sometimes prescribed for chronic pain, was mixed with a prescription opioid in 42 overdose deaths in 2015 and 35 in 2016.

“It appears there has been an increase of prescribing gabapentin in inpatient and outpatient settings to provide a safer opioid alternative, however when gabapentin is co-prescribed with an opioid it increases the risk of fatality,” the review committee’s report stated.

The fatality review committee also noticed that individuals recently released from jails or medical and mental health facilities might be at higher risk of overdosing because they’ve been off opioids for a while and their body’s tolerance for the drugs has decreased.

The committee’s three reports concluded with a series of action items for physicians, policymakers and public safety officials.

Some of the recommendations are:

  • State lawmakers should pass legislation requiring doctors to review the controlled substance database to check for drug-seeking behaviors before prescribing opioids;

  • Officials should increase the number of physicians, especially in rural areas, who are qualified to dispense methadone and other medications that help wean people from opioid dependency;

  • Law enforcement and at-risk communities should receive more education about the state’s Good Samaritan laws and overdose reporting requirements;

  • Physicians should distribute naloxone, the overdose-reversal drug, when patients are discharged after being treated for an opioid overdose;

  • Physicians should co-prescribe naloxone with every opioid prescription;

  • Health care providers should be educated on the risks of mixing gabapentin and opioids;

  • Seek funding for critical substance abuse and mental health interventions and treatments, especially in rural local health and mental health authority districts.

The review committee will continue its meetings to study the opioid problem in Utah and will focus next on studying addiction among veterans, Balough said.

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