Quarter of Michigan counties see rise in opioids

Karen Bouffard
The Detroit News

Opioid prescriptions increased in 21 of 81 Michigan counties in a five-year period, with the most pills doled out in rural parts of the state, according to a recent federal study.

More opioids were dispensed in Roscommon County than anywhere in Michigan — enough for 443 five-milligram hydrocodone pills (a commonly prescribed opioid) for every man, woman and child in the county, placing it among the top 1 percent of counties nationwide for most opioids prescribed.

Nationwide, the number of prescriptions for oxycodone, hydrocodone, morphine and other opioids decreased each year from 2010 to 2015 — but the amount prescribed in 2015 remained three times higher than in 1999, according to a report released last week by the federal Centers for Disease Control and Prevention that provided a county-by-county breakdown of the problem.

The overprescription of opioids is considered to be a major driver of the overdose epidemic that resulted in 52,404 drug-related deaths nationally in 2015; 33,091, or 63 percent, involved an opioid. Experts say patients can become addicted, even under a doctor’s supervision. And because of the abundance of the pills, the medications are being acquired by others — often friends and relatives — who can become addicted. When those opioids are no longer available, those persons can turn to heroin.

Michigan’s drug-related death rate has more than quadrupled during that period — to 20.36 per 100,000 residents in 2015 from 4.65 per 100,000 residents in 1999. Statewide, 1,980 people died of overdoses in 2015, up from 460 in 1999.

The new CDC report found that only a third of the Michigan counties surveyed experienced declines in prescription opioids, compared with half of counties across the country. The amounts were reported in morphine milligram equivalents, a standard measure used to equate different kinds of opioids so that their potency can be compared.

The highest numbers of opioid prescriptions per person were found in Roscommon, Iosco and Cheboygan counties, all located in the northeast corner of lower northern Michigan. Alpena, Aranac, Gladwin, Manistee, Clare, Kalkaska and Grand Traverse were among rural areas with copious amounts of opioids prescribed.

“This has been an issue (in rural Michigan) for quite some time,” said Dr. Jennifer Morse, medical director for three health departments that cover 19 rural Michigan counties, the Central Michigan District Health Department, District Health Department No. 10 and the Mid-Michigan District Health Department.

In Roscommon, 2,215 MMEs of opioids were prescribed per person in 2015, a 13 percent increase over 2010. Roscommon placed 25th in the nation for most opioid prescriptions filled among 2,734 counties surveyed.

Iosco had an 11 percent increase with 1,975 MMEs of opioids per person prescribed in 2015, enough for 395 five-milligram doses of hydrocodone for every resident. In Cheboygan, 1,883 MMEs of opioids per person were prescribed, the equivalent of 377 five-milligram hydrocodone pills per person.

Morse said the lack of jobs, poverty and a shortage of mental health care providers contribute to overuse of opioids in rural Michigan.

“Trying to get people help with mental health or substance issues is difficult,” Morse said. “Opioids have a big numbing effect, people don’t feel high, they really feel quite numb. So for some people who have depression or abuse (issues) it really is a self-therapy choice.

“Unfortunately, in areas where they don’t have many other treatment options people have found that this is something that works better than maybe alcohol or other drug choices.”

The study included 81 of Michigan’s 83 counties; Lake and Keweenaw counties were excluded because of insufficient data, according to the CDC. Data was provided by Quintiles IMS, a North Carolina-based health services technology and data-mining company.

In Metro Detroit, the amount of opioids prescribed per person remained stable in Wayne, Oakland and Macomb counties. Macomb tops the local area, with 1,027 MMEs per person prescribed in 2015 — the equivalent of 205 five-milligram hydrocodone pills for every resident.

Macomb was among 30 Michigan counties that ranked in the top 25 percent nationally for the amount of opioids prescribed.

The amounts of opioids prescribed in Oakland and Wayne counties in 2015 were relatively unchanged at 805 and 801 MMEs per person respectively. That’s the equivalent of about 160 five-milligram pills for each resident in those counties.

“I’m glad we’re stabilized, but we have some educating to do,” said Bill Ridella, director and health officer with the Macomb County Health Department. “It may mean talking to hospitals and medical societies on better ways to manage pain and safer prescriptions so people aren’t getting addicted.”

Dr. Deborah Dowell, a senior medical adviser with the CDC and co-author of the study, noted that opioid prescriptions either remained about the same or increased in more than two-thirds of Michigan counties, and said that’s not good enough to curb the rising death toll.

“In general, from 2010 to 2015 the amount of opioids prescribed in Michighan (was) stable...so it’s not getting worse but its not getting better,” Dowell said.

“We know from other research that most people who are starting to use heroin (or) other illegal opioids start with prescription opioids and become addicted,” Dowell added. “We need to improve prescribing practices so people don’t become addicted in the first place.”


Opioid prescriptions

Here are the Michigan counties that tallied the most opioid prescriptions, measured in morphine milligram equivalents, in 2015 compared with 2010:

COUNTY 2015 2010

ROSCOMMON 2215.4 / 1960.4

IOSCO 1975.5 / 1782.6

CHEBOYGAN 1883.0 / 1622.1

WEXFORD 1857.7 / 2037.2

OGEMAW 1846.7 / 1681.7

LUCE 1841.2 / 1969.0

OTSEGO 1768.3 / 2238.2

KALKASKA 1754.7 / 2057.4

GRAND TRAVERSE 1591.0 / 2006.3

CLARE 1561.1 / 1897.5

OSCODA 1557.0 / 1377.9

EMMET 1483.8 / 1861.1

MANISTEE 1391.4 / 1376.1

MUSKEGON 1351.8 / 1687.8

Source: Centers for Disease Control and Prevention

Note: Lake and Keweenaw counties were excluded from this study because of insufficient data.

A closer look at opioids

The problem

■Enough opioids were prescribed in 2015 to medicate every American around-the-clock for three weeks

■Even at low doses, taking opioids for more than three months increases the risk of addiction by 15 times

■A dose of 50 MME per day (the equivalent of 10 five-milligram hydrocodone pills) doubles the risk of death by overdose, compared to 20 MME or less per day

The solution

■Use opioids only when benefits outweigh the risks

■Replace opioids with alternatives like acetaminophen, ibuprofen and naproxen, physical therapy and exercise, and cognitive or behavioral therapy

■When necessary, use prescriptions only while pain is acute; three days or less is often enough

■Use the lowest possible dose of immediate-release opioids when starting; reassess benefits and risks when considering an increase

Source: Centers for Disease Control and Prevention