During a Nevada “Opioid Response Summit,” health professionals warned of the coming third wave of the opioid crisis while reviewing tactics the state has deployed to respond to the epidemic.
The Nevada Department of Health and Human Service’ two-day event, which started Wednesday, gathered healthcare providers, law enforcement and nonprofit professionals to learn about the ongoing efforts to reduce the number of unnecessary prescription drugs, the state’s lawsuit against pharmaceutical companies, useful tools to track opioid use and overdoses, and increased educational and prevention programs.
While experts noted strides the state has made to combat the epidemic, Stephanie Woodard with the Division of Public and Behavioral Health said it is “an evolving crisis.”
As seen nationally, the first waves of the opioid epidemic have included overprescribing and the overabundance of prescription drugs on the streets, which lead into the next wave of heroine and other intravenous drugs being used as cheaper alternatives to pills.
“The third and more important work that needs to be done is to address the third wave, which is fentanyl, synthetic and counterfeit drugs and the combination we’re beginning to see,” Woodard said. “It’s not a matter of if. It’s a matter of when we will see fentanyl and similar drugs hit our communities.”
Keith Carter, Nevada High Intensity Drug Trafficking Area director, said law enforcement agencies in Nevada are starting to see more products mixed with or laced with fentanyl. He referenced multiple cases of black market marijuana being laced with fentanyl.
Gov. Steve Sisolak, who spoke Wednesday, said Nevada is “moving the dial on opioid addiction” and the summit will highlight “the progress that has been made so far and the work we’re planning to move forward.”
Efforts to curtail Nevada’s opioid crisis date back to 2014, which Woodard said helped the state begin to develop best practices. The first opioid summit, which was in 2016, “created a roadmap for Nevada” that has resulted in better practices and legislation.
Strategies, she said, have included mandatory prescriber education, improving data collection between health agencies and law enforcement, looking at access at opioid treatment clinics and increasing access to overdose reducing drugs, such as naloxone.
In the last year, there was an uptick in the number of law enforcement agencies and people who are prescribed opioids — those at greater risk of overdose — carrying naloxone. “We had 56 law enforcement agencies across the state that were supplied with just under 3,000 units of naloxone,” she added.
Assembly Bill 474, a 2017 bill that aided in reducing the number of prescription drugs being prescribed, was also influenced by the work being done.
While it reduced the number of prescription pills on the streets, Yenh Long with the Nevada State Board of Pharmacy said the law also created a lot of confusion about the parameters around prescribing.
Some health care providers, Woodard added, became worried so stopped prescribing opioids even in appropriate circumstances.
Assembly Bill 239, speakers noted, was passed this session to help to clarify some of the language and concerns. Woodard said the move will help “swing the pendulum back to the center.”
Attorney General Aaron Ford, the keynote speaker on the first day, also touched on efforts to hold manufacturing companies accountable. “Manufactures designed and implemented a deceptive marketing strategy to create a series of misconceptions in the medical community that reversed the long understanding of the risk of opioids,” he said. “My office filed an expanded complaint to bring justice to multiple co-conspirators responsible for the opioid crisis.”
Ford’s previous law firm, Eglet Prince, represents the state in the suit.
Holding manufacturers accountable is just one part of dealing with the opioid epidemic, which Ford said should be a multi-pronged approach.
Another aspect, he added, is addressing how the criminal justice system deals with drug use. He said the justice system focuses on retribution and deterring criminal behavior rather than rehabilitation and restoration. Despite substance abuse being seen as an illness by many professionals, harsher laws mean they are getting locked up.
“We can’t incarcerate everything based on drug addiction,” Ford said.
While Ford said that drug courts and other drug programs have noted benefits, they cost money and not all lawmakers want to allocate additional funds for those programs.
“People don’t want to pay for it,” he said. “Snoop Dogg has a saying. ‘Everybody got their cup, but they ain’t chipped in.”