Over the past fifteen months or so, most of us have been consumed with news about the Covid-19 pandemic. Over 20 thousand Michiganders have died from the disease. Many more have had their livelihoods upended by Covid and its related shutdowns.
But there is another disease that has been mostly absent from headlines across Michigan. Another disease which did not go away during the pandemic. Indeed, it became resurgent as we were all dealing with the stress of Covid-19. That disease is the disease of addiction and specifically opioid addiction.
How serious is the problem in Michigan? The Michigan Department of Health and Human Services (MDHHS) last week announced a new opioid resources dashboard. According to MDHHS, 2,417 Michiganders died due to overdose during the first 11 months of 2020. This compares to 2,354 overdose deaths in 2019 and 2,599 overdose deaths in our state in 2018.
In addition, the dashboard breaks down the overdose deaths by county and by race, gender, or age. In Berrien County, Hispanics have the highest rate of overdose with 58 deaths per 100,000 population, followed by Blacks, whites, and Native Americans. The overdose death rate for males is double the death rate for females.
Decades ago, I worked as a Senior Internal Auditor at the headquarters of one of the largest pharmacy chains in the country. Opioids are a controlled substance and the prescription of these is highly monitored. In the first quarter of 2021, 73 million opioid units were prescribed in Michigan. The population of Michigan is about 10 million. In Berrien County, 847,509 units of opioids were disbursed in the first quarter of 2021. The population of Berrien County is about 154,000.
The dashboard displays by county the quantity of opioid units disbursed or prescribed per 100,000 population. The six counties with the highest rate of prescribed opioid usage are Oscoda, Alcona, Iosco, Roscommon, Arenac, and Manistee. In southwest Michigan Van Buren County has the highest rate of opioid prescriptions with 11,460 units per 100,000 residents. Berrien County has a prescription rate of 6,623 units per 100,000 residents. Cass County’s rate of 4,480 units per 100,000 residents is lower still with only three other counties having lower prescription of opioids. However, the data does not include distributions of opioids that originated in Indiana or other states, which may affect the recorded rates for border counties.
According to Professor Marcia Ory of Texas A&M University, “Daily (legal) opioid use in the U.S. is the highest in the world, with an estimated one daily dose prescribed for every 20 people. That rate is 50 percent higher than in Germany and 40 times higher than in Japan,” according to the Professor in a 2018 article. Professor Ory is a chair of the Texas A&M Opioid Task Force and a Vice President of the University. The Professor further states “…until the past few years, there were few U.S. regulations for the medical prescription of opioids. With the goal of eliminating pain, physicians generously prescribed opioids after most surgical procedures or for routine patient complaints of pain…Conversely, in Europe, opioids are dispensed by specialists and more tightly regulated, including restrictions on advertisements. It’s less common to dispense opioids for non-cancer related pain such as chronic back or musculoskeletal pain.”
One reason that Americans over use opioids in comparison with other countries may be explained in the profits of pharmaceutical companies. Johnson & Johnson has been in the news the past year for its coronavirus vaccine. The best of science, these vaccines are miracles of modern science and life savers. But there is also a dark side to companies like J&J. That dark side is their manufacture, promotion, and distribution of opioids.
Last week, the New York Attorney General announced a settlement with J&J for their involvement in the opioid crisis. J&J will pay the state of New York $230 million to settle claims because according to the AP “the pharmaceutical giant helped fuel the opioid crisis.” The BBC indicates this is part of a $5 billion settlement nation wide that J&J has agreed to pay out over the next decade. In a February New York Times report, management consulting company McKinsey has agreed to pay $600 million for its role in providing sales advise to Purdue Pharma, the manufacturer of Oxycontin, an opioid.
Are these just the tip of the opioid abuse iceberg? Attorney General Nessel, our politicians, and medical researchers and professionals ought to be asking serious questions. Should all of us ask: are we putting the profits of pharmaceutical and medical companies over the health and well-being of Michiganders?
The MDHHS dashboard can be found at:
https://www.michigan.gov/opioids/0,9238,7-377-94655---,00.html
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