- Associated Press - Friday, July 17, 2015

SPRINGFIELD, Mo. (AP) - As heroin use jumps in Springfield and throughout Missouri, the Show Me State stands alone in not having a prescription drug monitoring program - a key to curbing the drug’s proliferation, according to federal experts.

Nationally, heroin use has been on the rise. It has become more prevalent among women and the middle class, and many of its users came to the narcotic after having first become addicted to prescription drugs, according to a recent report from the Centers for Disease Control and Prevention, the Springfield News-Leader (http://sgfnow.co/1MooE3O ) reported.

The drug has made inroads in Springfield, too, said police Lt. Shawn Williams.

“It’s widespread. It’s from teenagers to middle-aged adults, and from every socioeconomic background.”

Heroin’s rise in Springfield can be seen in the amounts police have confiscated in recent years. Four years ago, Springfield police seized 13 grams of heroin. The next year the figure almost doubled to 22 grams. In 2013, it more than doubled again, shooting up to 52 grams. Last year, the department took possession of more than three times that amount - 180 grams.

The trend seems likely to continue. In the first six months of this year the department has already seized 288 grams, Williams said.

Heroin overdoses are also up, said Tom Van De Berg, chief investigator for the Greene County Medical Examiner’s Office.

“In the first 10 years I worked here there was one heroin overdose,” Van De Berg said. “In the past few months it’s been weekly. There is a lot of it out there.”

Looking statewide, Missouri also appears to have seen an increase in heroin use.

The Missouri State Highway Patrol seized 501 grams of heroin last year, said spokesman Sgt. Shawn Griggs. That figure was down 170 grams compared to 2013, but more than four times what the department confiscated in 2012 - 104 grams, according to Griggs.

Unlike heroin, prescription drug abuse has haunted communities like Springfield for years. The prescription drugs most commonly abused are opioid painkillers, which produce a similar effect to heroin, and that’s why there is such a strong connection between the two, said Griggs.

“Many people that we interview didn’t wake up and decide to do heroin, but they started out with prescription drugs,” he said.

About 75 percent of new heroin users first became hooked on prescription opiates, a class of morphine-like drugs that includes OxyContin and Vicodin, before turning to heroin, the CDC found.

Williams said prescription drug addicts are turning to heroin because it’s relatively inexpensive.

“It’s gotten to the point where they can buy heroin cheaper than prescription drugs on the street,” he said.

In order to feed their prescription drug addictions, some people go “doctor shopping.” In this scheme, people seek prescriptions from multiple doctors in order to feed their drug habit or to sell prescription drugs illegally.

“There’s a lot of doctor shopping that occurs,” said Jim Anderson, CoxHealth vice president of marketing and public affairs.

Forty-nine states have prescription drug monitoring programs that allow, or in some cases require, pharmacists to consult a database to make sure clients are not buying extra drugs. Missouri is the lone exception.

Making monitoring programs stronger is key to curbing heroin use because prescription drug abuse is “the strongest risk factor for heroin addiction,” according to the CDC report.

Legislation that would have created a monitoring program in Missouri has been stymied in recent years by filibustering senators.

“It has always been a challenge in the Missouri state Senate,” Anderson said, adding CoxHealth supports a drug monitoring program.

Sen. Rob Schaaf, R-St. Joseph, a family doctor, is one of the monitoring program’s stiffest critics.

In previous years, Schaaf has filibustered bills aiming to create a monitoring program, arguing the creation of a database would violate Missourians’ privacy rights. He has said the threat of hacking makes the idea of a prescription drug database especially troublesome.

But this year, Schaaf didn’t filibuster.

“I agreed to sit down after they agreed to my concessions,” Schaaf said, noting he was able to tack on an amendment to the bill that addressed some of his privacy concerns. Even with his amendment, however, Schaaf said he still opposed the bill.

Some Republican lawmakers from the Ozarks agree with Schaaf.

“Even though it has been passed in every other state, it has not stopped the problem,” said Eric Burlison, R-Springfield.

Rep. Sonya Anderson, R-Springfield, said she too opposes the creation of a monitoring program because of privacy concerns.

But other Springfield Republicans, including Rep. Lincoln Hough and Rep. Kevin Austin, said they support a monitoring program.

“I think it’s a good idea,” Hough said, adding that a database would hopefully help identify addicts so they could get treatment.

By the time the legislation made its way through the Senate this year, several privacy protections had been added to it. Among them were that the database must be encrypted and prescription information could only be kept in the database for 180 days. The bill would also have required the legislature to reconsider the program in 2020.

“We probably have the most secure, the most effective PDMP (prescription drug monitoring program) in the U.S.,” the bill’s sponsor, Sen. David Sater, R-Cassville, a pharmacist, told the Associated Press in April.

Calls for comment made to Sater were not returned.

The bill passed the Senate on a 24-10 vote. Meanwhile, a similar bill passed the House. But by session’s end, neither piece of legislation made it through the other chamber.

The story behind why Sater’s bill failed depends on whom you ask.

Anderson, the lobbyist for CoxHealth, said the bill had enough momentum to make it to the governor’s desk, but it was left by the wayside when the statehouse more or less shut down during the end of the session.

The session ground to a halt early this year mostly because of a controversy created when former House Speaker John Diehl was caught sending flirtatious texts to a 19-year-old intern. A Senate filibuster over controversial right-to-work legislation also helped stymie progress.

“It would have passed, I’m convinced. And the governor would have signed it” had it not been for the controversies, Anderson said.

Schaaf and Burlison said they heard the bill had begun to lose steam before the end-of-session commotion.

“I was told it was snagging up over there (in the House) even before the right-to-work stuff,” Schaaf said.

Anderson said he is optimistic a similar bill could pass next year.

“I am hopeful we can get it done this (coming) year,” he said, but with it being an election year, he added, “You never know.”

Sen. Ed Emery, R-Lamer, who like Schaaf has been a strong opponent of a monitoring program, said there is a good chance he would try to filibuster the bill if it is brought back next year, even with the privacy protections that were added.

Last year, there were 79 fatal drug overdoses in Greene County, according to medical examiner’s office records. That is up from 60 overdoses in 2013, and 63 in 2012.

Prescription drugs remained the county’s No. 1 cause of lethal overdoses, killing 49 people last year. Illegal drugs - the office doesn’t specify which type - killed 15 people. A combination of prescription and illegal drugs led to seven fatal overdoses.

Nationwide, between the early 2000’s and 2013, the number of people using heroin rose 150 percent, according to the CDC report. There were an estimated 517,000 people who used heroin or were dependent on it in 2013, the report said.

As use has grown nationally so have overdose rates. In 2013, more than 8,200 people died from opiate overdoses, almost four times as many as in 2000, the report said.

Heroin is sometimes more deadly today because dealers are cutting it with fentanyl, an opiate stronger than heroin used to treat intense pain.

Van De Berg said to date he has only seen one overdose where the victim had heroin laced with fentanyl. In other cases, people had overdosed on heroin and also had separately been using fentanyl patches.

But while heroin users are showing up in the morgue, not many have yet come to treatment programs, said Willie Carter, a drug counselor at Recovery Outreach Services in Springfield.

Carter said he knows the drug is out in the community, but he said many of its users in Springfield appear not to have hit rock bottom yet, and therefore aren’t seeking treatment.

Most of the heroin coming into Springfield is being transported in from Mexico, coming from the country’s drug cartels, by way of St. Louis and Chicago, said Williams, the police lieutenant.

In parts of Indiana, spikes in heroin use have led to an outbreak in new HIV cases because the users were sharing needles. Fortunately, that has not happened, at least not yet, in the Ozarks, said Bob Holtkamp, outreach and prevention director for Aids Project of the Ozarks.

Holtkamp did say his organization, which offers free HIV testing, has seen high rates of hepatitis C, which can also be spread by intravenous drug use. Is that trend related to heroin use? Holtkamp said he is not sure.

___

Information from: Springfield News-Leader, http://www.news-leader.com

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