Opioid prescriptions down in Hawaii

A state health official told legislators Thursday prescriptions written for opioid pain relievers in Hawaii have declined over the last four years.

Dr. Daniel Galanis, an epidemiologist for the Department of Health, said the average number of prescriptions written for opioid painkillers monthly decreased from roughly 69,000 in 2015 to 54,500 in 2018. That revelation was made at an joint informational briefing of the Senate Committee on Commerce, Consumer Protection and Health and the House Health Committee at the state capitol in Honolulu.

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“We’ve seen a 21 percent decrease in the number of opioid prescriptions in the state over this four-year period. And you can see it’s probably going to keep going down over time,” Galanis said, pointing to a projected slide with a graph mapping the decrease.

Galanis credited the decline in opioid prescriptions, in part, to the Hawaii Prescription Drug Monitoring Program, or PMP, a database administered jointly by the Health and Public Safety departments which can be accessed by physicians, pharmacists and other health care providers. He said the database has drastically reduced patients obtaining narcotic prescriptions from multiple sources, a practice known as “doctor shopping.”

“Without the use of PMP, if someone’s seeing multiple providers, a physician might not know that they’re getting substance X over here and substance Y over there,” Galanis said. “There’s certainly room to improve going forward, but these are certainly trends in the right direction.”

Opioid abuse and fatalities have been a growing concern nationally. State Sen. Rosalyn Baker, a Maui Democrat and Commerce, Consumer Protection and Health chairwoman, began the hearing by pointing out that nationally there were “47,600 fatal opioid-related overdoses in 2017,” accounting for “67.8 percent of all the drug overdose-related deaths.”

Baker also noted that while opioids are a concern in Hawaii, their abuse and related fatalities haven’t reached epidemic proportions here, citing statewide statistics between August 2017 and August 2018.

“We had 59 opioid-related fatal overdoses,” Baker said. “We had 384 nonfatal opioid-related overdoses. We had 180 opioid-related calls to the Hawaii Poison Hotline. We had 503 people admitted to treatment programs, and we had 1,332 patients that (Emergency Medical Services) responded to and treated with naloxone. So, I think the state of Hawaii can pat itself on the back for making naloxone available to our first responders — police, fire and EMS — as well as to families of folks who may have prescriptions to opioids.”

Naloxone is an injected medication designed to rapidly reverse opioid overdoses.

Alleged over-prescription of opioid painkillers came to the forefront on the Big Island in October after Drug Enforcement Administration agents raided the office of Hilo physician Dr. Ernest Bade.

Bade and four employees — Yvonne Caitano, Sheena Strong, Marie Benevides and Theresa Saltus — are scheduled for trial on June 12 in U.S. District Court in Honolulu on conspiracy to distribute and dispense controlled substances.

Bade is accused of prescribing unusually large quantities of Schedule II controlled substances, including opioids such as hydrocodone, oxycodone, fentanyl and morphine.

According to the complaint, Bade also prescribed opioid painkillers and benzodiazepines, which are anti-anxiety medications such as Valium and Xanax, to the same patients.

A 2017 study published in the Journal of Addiction Medicine found that more than 30 percent of opioid-related deaths also involved benzodiazepines.

Bade’s employees are accused of flying from Hilo to Maui to pick up large quantities of narcotics after Hilo pharmacies stopped filling Bade’s prescriptions.

The DOH stopped tracking drug fatalities by county in 2017, but between 2012 and 2016, there were 298 opioid-related deaths statewide and 774 overall drug-related deaths.

By county, Honolulu had the largest number of opioid-related deaths during that period, with 203, and drug-related deaths, with 544. Maui had 50 opioid-related fatalities, and 105 drug-related deaths. Hawaii County tallied 38 opioid-related deaths and 94 drug-related deaths. Kauai had only 7 opioid-related fatalities and 31 drug-related deaths.

Galanis acknowledged the small number of drug-related deaths on Kauai skewed statewide statistics downward, but told the Tribune-Herald in an email, “Rates for Hawaii County residents (by population) were not significantly different for rates for residents of Honolulu or Maui counties, for poisonings from all drugs or those that involved opioids.”

Galanis told the lawmakers health officials “want to see … an impact on deleterious prescribing habits.”

“The (Centers for Disease Control) has outlined these to avoid prescriptions with more than 90 MME, morphine milligram equivalents,” he said. “… And over the last five quarters that we have data from the PMP, that’s steadily decreasing in the state. And they also want to avoid prescribing for both opioids and benzodiazepines, which can lead to overdoses. … That’s a little less consistent, but you can see that over the last four quarters, that’s also been going down.

“In general, when we look at fatalities, we’re on the good side compared to the other states. We, unlike the rest of the country as a whole, have sort of a level trend or no trend when it comes to opioid … fatal overdoses, and so far, knock on wood, we have not seen the huge jump due to fentanyl and some of the other synthetics.

“We don’t really have a good explanation so far why Hawaii’s different, but it’s certainly something to be conscious of.”

At this point, there are no drug-related bills for the current legislative session, and state Health Director Dr. Bruce Anderson told legislators his department received a two-year, $8 million federal grant to address drug issues and policies.

“We’re trying to use this as an opportunity to deal not only with the opioid problems but other substance abuse issues,” Anderson said. “… We do have a lot of other substance abuse issues, and this is an opportunity for us to do a lot of outreach and education as it relates to all of those issues.

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“We’re working with the federal government to make sure we can use those funds for that purpose, but so far, we’ve been successful.”

Email John Burnett at jburnett@hawaiitribune-herald.com.

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