Opioid abuse grabs attention of S. Dak.

Jamie Hult, Staff writer
Studies show addiction to opioids often starts with a legitimate prescription. Jamie Hult/BV Journal

A prescription drug drop-off receptacle in the lobby of the Brandon Police Station is available for safe pill disposal.

Growing awareness of painkiller use, addiction builds at all levels

OxyContin, Percocet, Vicodin, Percodan, Tylox, Demerol – they’re all opioids, and they’re all commonly prescribed painkillers for conditions ranging from a toothache to bone cancer.
They’re also highly addictive. 
An increase in acceptance and use of prescription painkillers in recent years has led to a national epidemic. 
And while South Dakota doesn’t have the overdose rate that states like West Virginia and New Hampshire are seeing, opioid addiction remains a local problem. 
“It’s not even people dying. It’s people having their life ruined, or not being able to function,” said Tom Wullstein.
Before starting Brandon Pharmacy in 2010, Wullstein worked for larger-scale pharmacies in Sioux Falls.
Opioid addiction doesn’t look like the drug addiction most people picture in their heads, he said.  
“Do we have people in South Dakota dying with needles in their arms? No. The opioid epidemic is way beyond that. That’s just what people associate with it,” he said. “The actual epidemic is the over-prescribing of opioids, and that can manifest in several different problems.”
Opioids is a class of narcotics commonly prescribed to treat pain. Heroin is in that class, along with fentanyl, a synthetic opioid that is 80 to 100 times stronger than morphine, and more common pain-killers like oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone. 
“They’re all progressively stronger, chemically engineered to be super addictive,” Wullstein said. 
In 2017, 15 percent of adults in South Dakota had taken a prescription pain medication in the past 12 months, according to the South Dakota Department of Health.
Research has shown that addiction to painkillers often starts with a legitimate prescription. 
“Sometimes people do things because they’re so scared of the pain. So, they’ll go to different doctors and get it – not necessarily because they’re addicted; they’re just so scared of running out and having pain that they want to make sure they have enough,” Wullstein said. 
In 2009, Gregory Mayor Wade Juracek faced multiple felony charges for stealing painkillers from homes. 
Juracek, who suffered from colitis – an inflammation of the inner lining of the colon – later admitted an addiction to Vicodin.
The following year, he testified before the Senate Judiciary Committee in support of a new bill to create a prescription drug monitoring program (PDMP) in South Dakota. 
The program established a statewide database to which pharmacists submit information about each prescription for a controlled substance. 
It also essentially halted doctor and pharmacy shopping – the practice of a person visiting several doctors for the same pain and getting overlapping prescriptions at different pharmacies.
In 2017, former Governor Dennis Daugaard signed a bill into law which requires doctors to enter painkiller prescriptions into the statewide database within 24 hours.
At Lewis Drug in Brandon, the staff are trained to check the PDMP database to make sure unfamiliar customers don’t have a history of using multiple pharmacies or doctors, or overlapping therapy – for instance, if a person received a 30-day painkiller prescription filled 15 days ago.
“The hard thing for pharmacists is determining who’s legitimately using the medication and who’s maybe seeking it for other purposes,” said Anita Tigner, head pharmacist at Lewis in Brandon. “I never want to treat any patient as a seeker. My first thought is it’s legitimate, but we’ll do our due diligence to make sure that it is.”
That’s a responsibility some people forget, she added.
“I think sometimes people who legitimately need it almost are made to feel like a criminal, because we’re questioning, we’re asking,” Tigner said. “But as a pharmacist, it is our responsibility to make sure people are using prescriptions for legitimate medical purposes, and so the burden is not only on the physician, but also on the pharmacist.”
Even in a small community of 10,000, local pharmacists encounter customers who raise red flags.
“Sometimes you have to have unpleasant conversations with people about, ‘You are getting this filled too early,’ and they’re usually not too happy about that, but it usually straightens out,” Wullstein said. “I’ve had a couple of people that I’ve had to have a sit-down with and ask what I can do to help. Sometimes I have to say, ‘This needs to stop. I have to let the doctors know what’s happening, and you’re going to need to talk to them about your treatment hereon.’” 
Awareness from every angle
In the healthcare industry, awareness about opioid abuse is being perpetuated on every level, from the doctors handing out prescriptions to the pharmacists filling them and the insurance companies paying for them. 
“The big thing this year is insurance companies are putting some really strict prescriptions on what they’ll pay for,” Wullstein said. “We’ve seen several this year where they’re like, ‘We’re not going to pay for this.’ We’re getting the constant feedback that, ‘This person shouldn’t be taking it,’ and the doctors know they shouldn’t be taking it, and the pharmacists know they have to pay attention to it. So, it’s the awareness. Everybody from every angle is aware of it.”
That awareness has spread to communication between states, too. Forty-five states have joined a na-tional prescription drug database that allows states to share data. According to the National Associa-tion of Boards of Pharmacy, only California, Nebraska, Hawaii, Missouri and Washington haven’t signed on.
From a law enforcement standpoint, Brandon police see more meth- and marijuana-related cases than opioids, according to Chief Dave Kull. 
“We’ve had a very, very low incidence of it in Brandon itself, but we’re also cognizant of the fact that it could happen here. And it probably has, as far as illegally obtaining the stuff,” he said. “It no doubt has happened here in Brandon.”
Last spring, police and emergency medical professionals across the state participated in training on how to administer Narcan, a naloxone nasal spray that can reverse the effects of opioid overdose when administered in time.
Each Brandon police officer now carries the product, too. 
“It’s a good tool to have in the toolbox,” Kull said.
District 10 Rep. Doug Barthel agreed that while meth abuse is more rampant in South Dakota, the opioid crisis isn’t going away.
“It certainly is an issue,” he said. “It’s not something we’re going to legislate our way out of.” 
The solution, Barthel said, is a combination of education, enforcement and treatment. 
“Both meth and opioids are highly addictive,” he said. “You don’t just quit for a week. The effects take months and years to wear off.” 
Prescription drug awareness has spread to the school level, too. In December, Tigner went to Bran-don Elementary, Robert Bennis Elementary and Valley Springs Elementary to talk to students about pill safety.
“We hope to continue the program. I’d like to expand it to all grades,” she said.
Warning signs
In 2016, South Dakota had the fifth lowest rate of opioid overdose deaths in the nation – 5 per 100,00 people compared to the national rate of 13.3 deaths per 100,000 people, according to the Centers for Disease Control and Prevention. West Virginia led the nation, with 43 deaths per 100,000 people. 
“We don’t have people dying to nearly the percentage as the rest of the country, but that doesn’t mean we can be lax about it,” Wullstein said. “That just means, hey, we’re getting a warning before a lot of other places did, so let’s take what’s worked for other places and get it figured out.”
South Dakota took a proactive approach to tackling the opioid crisis in 2016 with a $215,000 federal grant to collect and analyze data about opioid misuse, abuse and overdose.
Secretary of Health Kim Malsam-Rysdon appointed a Prescription Opioid Abuse Advisory Commit-tee to review opioid use data for the state and develop strategies for preventing opioid misuse and abuse.
Reducing the health impact of substance abuse and mental health disorders is one objective of the Department of Health’s 2015-2020 strategic plan.
“South Dakota has some of the nation’s lowest rates of drug overdose deaths, but we can’t be com-placent and ignore what we’re seeing in the rest of the country,” Malsam-Rysdon said. “It’s important that we get a good handle on opioid use in our state and how to combat it now and not wait for the problem to grow.” 
Even sharing a prescribed painkiller is against the law, Kull pointed out. 
“If you take a hydrocodone that’s prescribed to you, it’s illegal. If someone gives you a bunch of hydrocodone and you overdose, they’re subject to prosecution, either at the state or the federal lev-el,” he said. 
If a person appears to be struggling with opioid addiction, red flags go up. 
As a pharmacist, the biggest red flag Wullstein sees is frequent requests for early refills. Most phar-macies don’t allow it. Hy-Vee, for instance, recently implemented a store policy of refusing to refill a prescription more than three days early. 
Brandon Pharmacy’s customer base is smaller, allowing staff to handle refills on a case-by-case basis. If a customer requests an early refill because he or she is going out of town, for instance, the staff typically fills it, noting that next month, the customer will need five fewer pills. 
While it doesn’t happen often, paying cash for a prescription is another red flag for pharmacists to look up someone in the prescription drug database, Wullstein said, especially if he’s never seen the person before and the prescription is for a controlled substance. 
In most cases, insurance companies deter people from trying to double up on pills. 
“As much as I hate insurance companies, that’s one thing they’re good for – monitoring,” he said.
The best thing people can do to combat the opioid epidemic, he said, is to make sure there aren’t any pain pills around the house from past medical procedures.  
Although South Dakota doesn’t have a pharmacy buy-back program for unused pills, most police stations have drop-off receptacles for unused prescriptions, including Brandon’s. 
“I try to tell everyone who’s getting a short-term paid med – when you’re done with these, if you have any left, get them out of your house where kids can’t get ahold of them,” Wullstein said. “If you have any extras – it’s not like, ‘Oh, if I have a toothache six months from now, I’ll have them.’ No. Get rid of them. Destroy them.” 
Prescription pills may be safely disposed of in the lobby of the Brandon Police Department at 304 Main Ave. Needles and over-the-counter medications aren’t accepted. 
For more information on opioid addiction, visit avoidopioidsd.com or call the South Dakota Opioid Resource Hotline at 1-800-920-4343.



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