Painful reality: The opioid crisis in Kansas

Published: Nov. 17, 2016 at 5:49 PM CST
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We are a nation that likes to feel good and, over past two decades especially, we've learned there's no need to live in pain - better, stronger drugs can help.

"For a long time, the policy was, no matter what, give people what they need," said Dr. Eric Voth, chief of pain and addiction medicine at Topeka's Stormont-Vail Health. "I think we all in the medical world are sensitized to trying to treat pain and trying to get ahead of pain and keep people pain free."

Trouble is, now, we're hooked. And it's had deadly consequences.

"The reality is narcotics are dangerous. You take too many and you can easily overdose," Dr. Voth said.

By the numbers

In Kansas, drug poisoning deaths increased 121.6 percent since 2000, according to the Kansas Dept. of Health and Environment's latest vital statistics report. Health officials attribute the increase largely to the increased use of opioid medications, which are drugs like Oxycontin, Percocet and Vicodin.

In 2015, KDHE figures show more people died from poisoning than motor vehicle wrecks or firearms (379 poisoning deaths, 376 motor vehicle wreck deaths, 330 firearms deaths). The figures include deaths from suicide and homicide. In young people specificically, the Trust for America's Health notes the Kansas overdose rate for people ages 12 to 25 quadrupled from 1999 to 2013. Only Wyoming saw a bigger jump. However, their study does note Kansas still has the 14th lowest overall rate of youth overdose.

Nationwide in 2014, the Centers for Disease Control reports the U.S. saw more than 270,000 deaths involving prescription opioid medications or heroin - that's one death every 20 minutes.

"The big trick here that's different is that a lot of the drugs they abuse are legal and you can get them through legal channels - and it doesn't take a lot of manipulation to get them," Dr. Voth said.

Keeping track

The health care community has launched a whole-scale treatment plan to sew up the loopholes that can lead to the somewhat easy access.

The K-TRACS system is one tool. It stands for the Kansas Tracking and Reporting of Controlled Substances Program. K-TRACS is a database, administered through the Kansas Board of Pharmacy, which captures information on all prescriptions for controlled substances written and filled by participating doctors and pharmacists.

"It's just a tool to give them additional information about prescriptions that have been filled by patients that might have drug-seeking behavior, shopping behavior, and so that you can always check in on a patient before you write a prescription or fill a prescription," said Alexandra Blasi, the board's executive secretary.

K-TRACS program manager Reyne Kenton said prescribers and dispensers must register to participate in the system. The information they find can offer clues to a potential problem. For example, if they see a 30-year supply of medication lasting only a few days, or if two prescriptions for the same drug show up on the same day.

"That is a good indication that you may have a shopper," Kenton said.

The system is set up to issue an alert if a patient has used five doctors and five pharmacists within 90 days. Between July and September of 2016, K-TRACS alerted on 221 patients potentially shopping doctors for prescription drugs. While there may be a legitimate reason for the use, Kenton says it gives doctors a shot at intervening.

"I think it's a way doctors and pharmacists can help patients who do have issues," Kenton said.

System shortcomings

But K-TRACS is not perfect. Blasi estimates the system averages more than 16,000 inquiries a day, as it shares information with 25 states. One it doesn't? Missouri, which is currently the only state in the nation without a state-wide prescription drug monitoring program. Kenton said doctors and pharmacists on the Missouri side of the border may register to participate in K-TRACS, which may close the gap somewhat. Also, Missouri has launched prescription drug monitoring programs on a county-by-county basis, but Kenton said that process can be slow going.

In addition, K-TRACS can't always account for a patient using a false name or birth date, and not all states update information on the same schedule. Oklahoma is the only state which provides data in real-time; Kansas provides information within 24 hours; for some states, it can take a week or more.

One more big drawback is that, while Topeka's Stormont and St. Francis are among systems encouraging its providers to use it - and a White House strategy to combat the opioid epidemic recommends use of these programs - so far, only seven states mandate it. A report from the nonprofit group Shatterproof found that, in Kentucky, deaths linked to prescription opioids fell 25 percent after the state began requiring prescription drug monitoring program log-ins and implemented other control measures in 2012.

Blasi says K-TRACS has more than 10,000 registered uses. She says that accounts for about 40 percent of the state's pharmacies and 50 percent of the state's prescribers. She says the board works continuously to get out the word so people know the system is available.

"Obviously, in the health care setting, time is of the essence and when you're sitting with a patient and insurance dictates you can only be there so long, you can only provide so much time to that patient - sometimes that's limiting, and so taking the time to go into an additional system, log in and return information - even though it may only take a few minutes - we're trying to make that process a little bit easier," Blasi said.

To that end, Via Christi received a federal grant for a pilot project to integrate K-TRACS into its computer systems. Communication Director Roz Hutchinson said the effort includes its facilities in Manhattan and Wamego.

Still, K-TRACS' more immediate concern is surviving, much less mandating. Blasi says the program's total budget this year is around $500,000, including the $215,000 which supports the basic software and staffing to merely administer the program. (Kenton is its only dedicated staff member - she says other Board of Pharmacy staffers pitch in to assist if she needs help.) Blasi says the money comes from grants and surplus Board of Pharmacy fee funds. That means, beyond June 30th, no funding source is assured.

Beyond tracking

Health care systems are taking other steps as well. In May, the CDC issued its first guidelines for prescribing opioids. In keeping with those, at Stormont, Dr. Voth says patients who receive a narcotics prescription will sign an agreement that outlines risks and refill policies. In fact, the Stormont emergency room will only issue narcotics for acute injuries. Patients with chronic pain must see a primary care physician.

Plus, don't expect a powerful narcotic to be your first option.

"If you just had surgery, maybe you might get a week's worth of some narcotic," he said. "In most primary care offices, if you go in and say, 'Oh, my knee hurts' or something, you probably won't get a narcotic."

Topeka's St. Francis Health has enacted similar policies and procedures, including utilizing pain management agreements and limiting access to narcotics through the ER.

"The emergency department is not a safe location for the management of chronic pain, because extended narcotics need to be managed by a PCP or pain management specialist with a pain management agreement," said Dr. Randy McAllister, medical director of the St. Francis emergency department.

Law enforcement, too, is part of the equation. Dr. Voth says he's seen agencies stepping up awareness of their drug takeback days, so extra meds aren't sitting in cupboards, waiting to get into the wrong hands. He also suggests families lock up their medications. Reports show people who abuse prescription medications most commonly are given them by a family member or friend, or steal medications prescribed to someone else.

On the supply side, the Drug Enforcement Administration announced it will cut production of nearly every Schedule II opioid medication by at least 25 percent in 2017.

The Heroin Connection

Another reason the prescription drug epidemic is so concerning is because it's often a pathway to abuse of heroin, a synthetic, highly-addictive opiod.

The U.S. Attorney's Office estimates nearly 80 percent of new heroin users started by abusing prescription opioids. They turn to heroin because it can be more accessible and less costly once their sources for prescription drugs run dry.

While Kansas isn't seeing the huge heroin problem other parts of the country are, it is showing up. The Kansas Bureau of Investigation says, nationally, imports of heroin have increased sevenfold since 2008. In Kansas, the KBI saw a 36 percent increase in heroin in 2015 and is on track for an 87 percent increase for 2016.

KBI Communications director Melissa Underwood said heroin is considered the largest opioid concern for the state, but they're also wary of other synthetics. One called U-47700, considered eight times more powerful than morphine, is suspected in deaths in at least four counties this year. Underwood could not provide further details because the cases remain under investigation, but she said the KBI and Board of Pharmacy will lobby state lawmakers this year to add them to the state's list of scheduled drugs. The federal government recently approved emergency scheduling for the substances.


No matter the approach, Dr. Voth says people must be educated on the dangers.

"Prevention's really got to take place," he said. "Everybody needs to pay attention to this."

U.S. Attorney for Kansas Tom Beall agrees. He issued a statement in September calling opiods and heroin a national epidemic.

"The opioid crisis is fundamentally a public health problem," Beall said. "We all need to work together, including law enforcement, public health officials and medical professionals, youth leaders, parents, faith-based organizations, social service providers and educational institutions."