Guest Commentary

In the opioid crisis, Kansas must remain vigilant

The opioid epidemic is considered the deadliest drug crisis in American history. Prescription and illicit opioids are driving the U.S. drug overdose epidemic — accounting for more than two-thirds of the drug poisoning deaths nationwide in 2017. While Kansas has not, as of yet, faced the tremendous impact that many states have encountered, opioid abuse is a public health concern that we must be pro-active and vigilant in addressing.

So, how did the opioid epidemic begin? Several factors and influences led to the current crisis, and it is often described as having three distinct but interconnected phases. Phase 1 involved a significant increase in opioid prescribing, which was associated with increased prevalence of opioid use disorder (OUD) which then led to increased opioid-involved morbidity and mortality.

OUD involving prescription opioids is also associated with transitioning to heroin use. When opioid medications are no longer available from a health care provider or pharmacy, a patient with OUD may seek opioids from other prescribers and pharmacies or purchase them illegally. Prescription opioids can be expensive to purchase illegally, and confronted with this high cost, an individual may switch to using heroin, as it is much more potent and significantly cheaper than prescription opioids. Increased heroin use and poisonings are driven by the pharmacological similarity of heroin to prescription opioids, coupled with its decreased price, increased purity and widespread availability. This transition is Phase 2 of the opioid crisis.

The switch from using prescription opioids to heroin and other illicit substances is a dangerous one. Heroin is manufactured illicitly, and is often combined with unknown adulterants, including fentanyl. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine, and 30 to 50 times more potent than heroin. Due to its potency, fentanyl overdoses have a fast onset, and are more difficult to reverse. According to the Drug Enforcement Administration, drug distributors are increasingly integrating fentanyl and its analogs into the heroin supply. Fentanyl has been involved in most opioid overdose deaths in recent years. Whether used as a standalone drug or combined with others, synthetic opioids, mainly illicit fentanyl, are essentially driving the rapid increase in opioid-overdose deaths across the nation and are considered Phase 3 of the opioid epidemic.

The opioid epidemic is often described as an abuse crisis, but we should be framing this as an “epidemic of addiction.” Addiction, or more appropriately termed, Substance Use Disorder, is a disease of the brain in which an individual continues using substances despite negative or harmful consequences. The disorder effects the structures of the brain that control motivation, self-regulation, stress response, impulse control, memory and logic.

While Kansas remains below the national average for fatal opioid overdoses, we must remain vigilant. As Kansas’ secretary of health and the state health officer of Kansas, I am pleased at the proactive work being done in Kansas, but our work is far from finished. I am committed to continuing to work collaboratively and raise awareness of this important issue impacting the health of Kansans.

Dr. Lee Norman is secretary of the Kansas Department of Health and Environment and the Kansas State Health Officer