About this story: Regular news reports have come out about a national opioid crisis, and this week President Donald J. Trump declared the crisis a national emergency. The Kansan wanted to know what is happening in Harvey County. Chad Frey sought out several local voices in the medical field and law enforcement to find out.
It's a chore he had done hundreds, if not thousands, of times — one he could do by rote. The routine after a roast dinner was to take the hot grease outside and pour it on the grass. But the last time he did it, it became a cry for help and a moment of realization.
He took the pan of hot liquid and poured it on his chest, inducing second degree burns on his chest and stomach. A lie to his wife about what happened, and a trip to the emergency room later, and he had what he wanted — a bottle full of opioid pain killers.
He realized his addiction, one that started innocently enough. His story is a true one, though his name never used, by his social worker. It is just one story of many told by Cody Beaton, a social worker at Prairie View in the mental health hospital's addiction unit.
“Right now, 60 percent of our treatment involves opioids,” Beaton said. “It used to be 60 percent for alcohol. There is something changing in our area.”
Often, Beaton said, the addiction begins innocently enough — like with the man in his story. A car accident, recovery and pain from bulging discs resulted in pain killer prescriptions. Unfortunately, those incidents also resulted in full blown addiction.
“It can be a football injury,” said Pam Kvas, director of emergency services at Newton Medical Center. “That is what has brought some of this to light, parents speaking up because their child had a surgery and ended up with an addiction. They start using their parents medication because they can't hold the dose and they want more, and more.”
According to drugabuse.com, opiates include numerous substances such as heroin, morphine, and thebaine, but they all have the same method of action. These highly addictive substances are called opiates because they are derived from chemicals found in the sap of the opium poppy.
On Thursday, President Donald J. Trump declared the opioid crisis as a national emergency.
Long-term effects from opioid use can include nausea and vomiting; abdominal distention and bloating; constipation; liver damage (especially prevalent in abuse of drugs that combine opiates with acetaminophen); brain damage due to hypoxia, resulting from respiratory depression; development of tolerance; and dependence.
An overdose can be deadly.
“We have seen several deaths here in Newton because of overdoses on the prescription meds, or heroin use,” said Eric Murphy, chief of police for Newton. “We responded to a hotel here in town, where the individual still had the needle in his arm when we got there.”
Opioid addiction in Harvey County is not the highest in the area, nor the state, but that is hardly a rallying cry.
“We can't say 'this is the midwest and this is a coastal problem.' It is here, and it is real,” Kvas said
While the Centers for Disease Control called opioid use “stable” for Harvey County during a five-year statistical period, usage of the drugs has increased.
“We have seen an increase,” Kvas said. “They are coming seeking a prescription for a product that they, or a family member, may be using or that they are going to sell for hard cash. Can we always tell that when they come to the ER with 'I fell off the front porch and I injured my shoulder and I need some (drugs)? No, we cant. They have a right to tell us that they have pain and to have that pain treated. That is how we got into this mess. We were taught that patients have a right to have their pain treated.”
According to drugabuse.gov, opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine and many others. These drugs are chemically related and interact with opioid receptors on nerve cells in the body and brain.
Recently the Centers for Disease Control released a county-by-county statistical analysis on opioid use, based on prescribed medications.
The CDC study counts how many opioid prescriptions are filled within a county and how concentrated those prescriptions are — to be clear, that is legal use of opioids. The CDC combines the two counts to describe how much opiate-based medicine is circulating in the county. It calls that number a “morphine milligram equivalent,” or MME, per person.
In 2015, the most recent year available, Harvey County scored a 694.8 MME per person, an increase over the previous number of 650 MME in 2010. That puts Harvey County 42nd in the state — in the top half of counties. However, six counties did not report opioid usage to the CDC.
Reno County is the hardest hit in the region, ranked 11th in the state by the CDC at 1185.7 MME, an increase from the 894 MME in 2010.
They are paced by Sedgwick County, at 903.9 MME and ranked 26th in the state. Butler County is not far behind at 894 MME and ranked 28th. McPherson County comes in at 868.3 MME and ranked 31st. Marion was the only county in the area to be in the bottom third of counties, at 87.2 MME and ranked 77th.
Looking at the region, Kvas said, is important when talking about what is happening in Harvey County — at what is being seen at Newton Medical Center specifically.
“Statistically, one of the things they may not be considering is we have a population that uses our ER That comes from Reno County because Hutch will no longer see them for their opioid prescription. They come from McPherson, they come from Butler County. They come from two or three different Wichita hospitals. They will come to us, seeking what they perceive to be a legal prescription.”
The illegal problem
There is, in addition to a problem with prescriptions, a problem with illegal use of opioids. That can be stolen or sold prescriptions, or the use of illicit drugs like heroin.
“We have seen a huge increase in illegal prescription medication use and sales,” Murphy said. “We actively work cases where individuals are selling prescriptions and quite often get reports of the theft of people's prescription medications. Sometimes those are legitimate, sometimes they are made up so they can get more medication.”
The department recently worked a case of an individual who was out of his medication within days because he was selling them.
And that is just the beginning.
“The street value of prescription medications is very high, and they will start turning towards illegal types of drugs like heroin d fentinol,” Murphy said.
According to investigator Jeff Van Horn with the Harvey County Sheriff's Department, undercover officers have been buying prescription opioids, and making arrests. They have been purchasing pills for between $6 and $10, depending on the dosage.
Beaton said the rate is about $1 per milligram.
“Once there is a crackdown on the pain medication, we will start seeing an increase in the illegal drugs — the heroins and things like that,” Murphy said. “We have seen an increase in heroin use in town.”
Those going to the Emergency Room looking for help with addictions have been telling doctors what they are using. Kvas said reports of heroin use has increased.
However, right now, prescription pills are available on the streets in Harvey County.
“There are lots of pills out there, for people who are looking for that” Van Horn said. “I made mention of that at one of the first (Drug Task Force) meetings that we had. … You need to be aware of where your medication is. If you have a grandson or granddaughter at your house, they do not need to be rummaging around in your medications.”
There are moves being made to begin dealing with the issue — in Kansas prescriptions are being tracked by a system called Ktrax. The federal government is looking at cracking down on “opioid related health care fraud.”
As those efforts begin, that may lead to even more problems for drug investigators for local law enforcement agencies.
“People can, and will, replace their prescription opioids with heroin,” said Sheriff Chad Gay. “It does not seem like we are seeing a lot of heroin around here, yet.”
The word “yet” is critical.
“If you don't have a problem with heroin in your community now, you will,” Van Horn said. “... The federal government is finally recognizing that this is an issue, and they will start cracking down on prescription medication which in turn means heroin use will skyrocket. If you can't get the pills, heroin will be available.”
The federal government has begun setting limits on prescriptions, and refill, in an effort to begin preventing pills from getting to the streets.
In Kansas, there is a system called K-TRACs. According to the Kansas Board of Pharmacy, the system requires pharmacies dispensing in, and into, the state of Kansas to report all schedule controlled substance prescriptions and drugs of concern.
That can be used to check a patient history. Kvas said that can lead to doctors not writing a new prescription.
“Providers can log on and see, for example, that John Smith has had 100 prescriptions this year,” Kvas said. “Typically our doctor will go back and (confront a patient). … Through K-TRACs there is accountability and we can see that things have been picked up under their name.”
The medical center has also made changes to how prescriptions are handled to try and make prescriptions more secure and unalterable. They, along with area pharmacies, found falsified prescriptions.
Beaton said education is important as well — namely because of how many of those ending up addicted started taking the drugs for valid reasons.
“When people are prescribed these things (they need to know) when things are not going how they should be, and how long they should be on them,” Beaton said. “They need to know about the problem. I have an information sheet I have worked up.”
That sheet contains statistics and how to reach out for help when a patient suspects an addiction.
Difficulty in treatment
Addiction to opioids is difficult to treat — with patients often relapsing and using the drugs again after treatment.
“People come to us looking for help,” Kvas said. “They tell the story that their life is falling apart. … I can tell you realistically they will be back. Almost always, a part of that story is that they have already been to six programs.”
One of the challenges, Beaton said, comes at the hands of insurance companies.
According to Beaton, often insurance companies do not approve payment for enough treatment and counseling to really deal with an opioid addiction.
“We do not get a lot of time (for treatment). The insurance climate is not really great when you consider opiates,” Beaton said. “Even though there is this epidemic, strictly opiate addictions do not get as much time as alcohol or (other drugs) because they do not have a life-threatening withdrawal. … We struggle to get a couple of weeks. You can get them feeling a little better and some coping skills, but you go right back into the environment with the stressors.”
It is returning back to that old life, in Beaton's mind too quickly, that makes treatment and care difficult and leads to relapse.
Murphy said a change of environment — changing a social circle and who a person associates with, is an important part of recovery.
“They may have a period of six months to a year that things are really great for them,” Kvas said. “But life falls apart again, and they don't have that crutch to rely on. This is a continual pattern that is familiar where they don't get out of that socioeconomic spot that is really tough on them.”
About this story
Regular news reports have come out about a national opioid crisis, and this week President Donald J. Trump declared the crisis a national emergency. The Kansan wanted to know what is happening in Harvey County. Chad Frey sought out several local voices in the medical field and law enforcement.
Why this is important
Overdosing on opioids can be deadly, and Newton Police have investigated deaths by opioids recently. In addition, the use of a prescription drug by someone it is not prescribed to is a crime, as is the sale of opioids. This national problem is growing in Newton.