Federal data recently published by the Washington Post shows that as the nation’s opioid epidemic spread, massive amounts of pain pills were pumped into Michigan every year — especially in the state’s rural northern counties most vulnerable to addiction.
Data from the federal Drug Enforcement Administration (DEA) shows that from 2006 to 2012, Ogemaw County in northern Michigan saw an influx of 125.7 pills per person, per year, the most in the state.
In neighboring Roscommon County, 73 pills per person per year were distributed. And nearby Clare and Iosco counties, each saw around 65 pills per person, per year, flooding into counties with populations smaller than many Oakland County suburbs.
According to recent state data, these counties have some of the highest unemployment rates in Michigan, just one of the negative indicators that’s been linked by researchers to increased opioid abuse and overdose.
And to Dr. Debra Pinals, the medical director for Behavioral Health and Forensic Programs with Michigan’s Department of Health and Human Services (MDHHS), the details of the flood of pain pills into those communities didn’t come necessarily as a surprise.
“Prescribing practices for many years were not as regulated as they currently are, and there were both problematic prescribers that LARA [Michigan’s Department of Licensing and Regulatory Affairs] has been trying to identify, as well as prescribers who were well-intentioned but perhaps not well-trained on dealing with pain, so their prescriptions became excessive,” Pinals said.
And Pinals noted that once those prescriptions turn into potentially deadly addictions, it’s frequently more difficult for those in rural areas to receive the appropriate care.
“Access to care providers in rural areas is always more difficult whenever we’re talking about these complex health issues … workforce development, expanding [the number of] people that are able to treat substance use disorders, and helping to train more individuals to prescribe medications that are used to help people with opioid use disorder are all certainly goals [of the state],” Pinals said.
A study published in May by University of Michigan researchers backs up Pinals’ assertion that “lack of access to substance use treatment is concentrated in Michigan’s northern and primarily rural jurisdictions,” and that “all but four of the 29 counties with no medication-based substance use treatment options are located in the Northern region of the state.”
Residents of rural Michigan are generally poorer, more likely to face unemployment, and more likely to face some chronic health conditions than their counterparts in the rest of the state — all risk factors associated with opioid addiction, according to the Mayo Clinic.
The Washington Post’s report followed a federal judge’s decision to unseal much of a federal database controlled by the Drug Enforcement Administration. That includes detailed data on the nation’s prescription system, including the specific manufacturers, distributors, and pharmacists who comprised the opioid supply chain during the period they examined.
For example, in Ogemaw County, the data reveals that its largest pharmacist and distributor was an Omnicare distribution center, a company now owned by CVS that specializes in supplying medication to long-term care and nursing homes.
Omnicare prescribed 7.7 million pills during the period in question, many of which could have been directed to facilities outside the county. (Omnicare did not immediately respond to a request for comment regarding where its customers were located.) But even removing those from the total entirely, a rough calculation shows that Ogemaw would have received more than 80 pills per person per year, still higher than any other county and well in line with its rural neighbors.
The consequences of opioid overprescription can be deadly. According to data compiled by the National Institute on Drug Abuse, even as overall prescriptions have declined, the rate at which Michigan residents have died from prescription opioid overdoses began a mostly uninterrupted climb during the time period measured by the Post. The last year measured, 2017, saw a slight decrease.
In recent years, Michigan’s regulatory agencies have taken steps not just to prevent opioid addiction and deaths, but to stem prescriptions and therefore the overall flow of pills into the state. U.S. Centers for Disease Control and Prevention (CDC) data shows that in the five years following the timespan measured by the Post, opioid prescriptions in Michigan declined by 25% overall.
A spokesperson for LARA credited the success of the Michigan Automated Prescription System (MAPS), a digital network created by the Legislature at the end of 2017 to track controlled substances and put significant guardrails around opioid prescription and use. In a recent press release, LARA claimed that almost 70,000 prescribers and pharmacists used the system in 2018, leading to a decrease in opioid prescriptions of 15%.
In an email, LARA’s Chief Deputy Director Kim Gaedeke said the organization “continues to partner with health care providers, other state departments, and communities as it relates to the use of MAPS and the administrative process as a way to encourage providers to take preventative measures before prescribing narcotics,” and said that “regardless of where the prescriber is located, a majority of licensed prescribers are registered and using MAPS.”
Gaedeke also said the agency plans on “continuing to build stronger analytics by adding other data, such as non-fatal overdoses or other data sets that will help with ongoing prevention efforts.”
Gov. Gretchen Whitmer has said the MAPS program has played a “critical role in … combating the opioid epidemic here in Michigan.” And LARA Director Orlene Hawks said in a statement that the recent data on declining prescriptions shows the state is “on the right track” in curbing opioid abuse and proliferation overall.
But the state still faces issues monitoring and providing care in rural areas that are the most vulnerable to those outcomes. According to the University of Michigan study from May, almost three-quarters of Michigan’s counties overall reported an unmet need for treatment programs, including majorities of “local government respondents” in many of the northern counties in question.
That study suggests what it calls a “hub and spoke” model for treating the addiction crisis that’s followed in the wake of the influx. Under such a model, regional hospitals would certify as substance abuse treatment centers, plugging into a network of resources beyond what’s now available to frequently limited rural health communities.
As part of a $5 million public-private grant announced in June, Whitmer announced that two Michigan hospitals will pilot new opioid projects — Beaumont Hospital in Royal Oak, one of the largest in the state, and Traverse City’s Munson Medical Center in northern Michigan.
“Opioid overdoses and deaths have hurt families all over Michigan,” Whitmer said in announcing the grant. “If we’re going to tackle the opioid crisis and get Michigan families on track to recovery, we need to build strong partnerships between state government, philanthropy and the medical community.”