State jumping into opioid investigation

Sept. 20--It would seem that Kansas' legal war on opioids is beginning, at least with Attorney General Derek Schmidt.

This week, he issued a letter in which he took on insurance companies, and a day later announced Kansas is part of multi-state investigations of companies that manufacture and distribute prescription opioid drugs.

Schmidt said his office is one of 41 state attorneys general participating in the joint investigations.

Nationwide, the Centers for Disease Control and Prevention estimates opioid overdoses kill 91 Americans every day. According to the Kansas Department of Health and Environment, pharmaceutical opioids are a leading cause of drug poisoning deaths in Kansas. The CDC says the number of opioid prescriptions has quadrupled since 1999, despite Americans reporting a steady amount of pain.

And in Newton, law enforcement has investigated deaths as the result of opioid use.

"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, during an August interview with The Kansan. "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. 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.

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.

"The overall public health harm caused by prescription opioid misuse requires far more than a law enforcement response," Schmidt said. "But enforcement is an important component, and we are focused on doing our part."

This week, the investigating offices escalated the investigations by subpoenaing or otherwise demanding information and documents from both manufacturers and distributors of prescription opioid drugs. The first of the investigations began last year.

It is unusual, Schmidt said, for the Kansas Attorney General's office to publically announce an investigation.

"Because of the unique and multi-faceted nature of prescription opioid misuse, the heightened public scrutiny and policy discussions surrounding it, the decisions by several other state attorneys general to discuss publicly their separate individual enforcement actions, the decision by our multi-state working group to publicly confirm our investigation, and the reality that public awareness of this problem is an important component in addressing it, I have concluded it is in the public interest to confirm that Kansas has been and remains part of this broad-based, bipartisan, coordinated investigation," Schmidt said.

Schmidt said he would not discuss the specific companies that are targets of the multi-state investigations at this time nor would he characterize the status of the investigation or what they have found to date.

In a related action, Schmidt announced this week he is among the leaders of a bipartisan group of 37 attorneys general who are asking insurance companies to alter their payment practices to reduce the incentive for doctors to prescribe opioids for pain relief.

"Insurance companies can play an important role in reducing opioid prescriptions and making it easier for patients to access other forms of pain management treatment," the AG's letter said. "All else being equal, providers will often favor those treatment options that are most likely to be compensated, either by the government, an insurance provider, or a patient paying out-of-pocket."

Previous efforts

For eight years, Kansas law enforcement has participated twice yearly in the Prescription Drug Take-Back initiative, which encourages people to clean out medicine cabinets and bring unwanted or unneeded prescriptions, including opioids, to drop-off sites for safe destruction. To date, that program alone has collected and safely destroyed nearly 59 tons of excess medications in Kansas, and some law enforcement agencies and pharmacies have begun offering secure drop-off sites year around.

Schmidt also said that Kansas last year filed suit against the manufacturer of the drug Suboxone, which is used to counteract the effects of opioid overdoses. In that lawsuit, which is ongoing in the U.S. District Court for the Eastern District of Pennsylvania, Kansas and the other plaintiffs allege that the defendants took anticompetitive action to keep generic competitors off the market.

About opioids

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.

The addictive substances are called opiates because they are derived from chemicals found in the sap of the opium poppy.

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.

In August, President Donald J. Trump declared the opioid crisis a national emergency.

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