Opioid pain killers were sold to doctors as little raindrops of happiness that would end a patient’s agony without being addictive.
In reality, addiction to opium-based prescription drugs triggered what Dr. Greg Colbath, an orthopedic surgeon at Spartanburg Regional Medical Center, calls “the largest manmade scourge we’ve ever unleashed.”
The “we” in that statement refers to society as much as to doctors. Because doctors opted to prescribe copious amounts of pills over having long and involved conversations about what to expect from surgeries, Colbath says, patients went home with dozens more painkillers than they needed. Because patients didn’t question the doctors, they just took the pills (and, just as problematically, didn't). And because pharma sales reps and drug companies so slickly pitched what opioids could do for patients in pain, everyone went along for the ride – for about 20 years.
In the last decade, doctors have watched patients return to emergency rooms desperate for more pills. Families have disintegrated and buried sons and daughters and parents who’d become terminally addicted to narcotics. Cheap heroin flooded the streets when doctors slowed their opioid prescriptions – black tar heroin brought the same respite at a fraction of the price. And tens of thousands of Americans per year started dying from opioid-related overdoses.
In the past three years, the effort to end the kind of societal trauma opioids have wrought has started making some headway. Purdue Pharma, maker of OxyContin, recently pled guilty to illegally marketing opioids and agreed to an $8.3 billion settlement. The billionaire family that owns Purdue, the Sacklers, will pay $225 million. Doctors are writing fewer opioid prescriptions, and the pills that are dispensed are more carefully monitored.
What’s more, the conversation about what patients can do with unused pills is becoming more commonplace. Products like Deterra bags – plastic pouches containing a carbon mixture that renders drugs inert enough to throw away in the trash – are getting into more hands, at the front end of medical procedures and in addiction treatment centers.
But cleaning up the estimated billions of opioid pills left untaken, in medicine cabinets and on nightstands, is a tall task.
How We Got Here
“Ninety-nine percent of surgery patients get opioid prescriptions,” Colbath says.
That can be mean back surgery (which, for what it’s worth, Colbath has had on himself) or, says Ashli Watts, an addiction counselor and president of Rock Hill-based substance abuse education and advocacy group All On Board, oral surgery.
“A lot of youth tell us that their first experience with a prescription, like codeine or a painkiller was through getting their wisdom teeth out,” Watts says.
The problem for both Watts and Colbath is not that painkillers exist – they agree they have their place and purpose. The problem is that for years doctors wrote gigantic prescriptions for opioid pills – dozens of pills per patient.
And while plenty of patients became addicted to their own prescriptions, the larger problem lay in the fact that people might get 60 pills at once, but take only a few. A 2018 report in the Journal of the American Medical Association estimated that 92 percent of patients prescribed opioids didn’t take all of their pills. A Connecticut-based substance abuse nonprofit called Shatterproof subsequently calculated the number of untaken opioid pills in the United States to be 3.3 billion.
Products like Deterra bags – plastic pouches containing a carbon mixture that renders drugs inert enough to throw away in the trash – are getting into more hands, at the front end of medical procedures and in addiction treatment centers.
“And what do people do [with unused pills]?” Colbath asks. “They’re not going to throw them away.”
Instead, people hold onto unused pills, feeling they might need them again some day – “the rainy day fund,” as Colbath calls it.
And over the course of 15 or 20 years, pills no one was watching over sat in easy-to-grab locations. Someone’s grandma had a surgery and didn’t take most of her pills? Easy pickin’s for a grandson with a substance abuse problem.
“We want parents and family members to be more aware of the fact that about 50 percent of youth that misuse a substance, or take a prescription that wasn’t prescribed for them, report that they got it from home or a family friend,” Watts says.
And have you ever heard of pharm parties?
“[Teens] are basically taking all these pills and putting them in a bowl and that’s their common source party,” Colbath says. Like a punch bowl, only spiked with who-knows-what.
How are kids getting these pills?
“For a lot of teenagers, this is easier for them to come by than alcohol or tobacco,” he says. “They have opportunities where they have access to either their parents’ medications or their grandparents’ medications, or maybe they’re babysitting for somebody. Those are some easy targets.”
It’s not all about sneaky or unsupervised kids, of course. Adults find pills lying around their parents’ houses too – and around other people’s homes.
Teens are putting random pills and in a bowl like punch at a party. It's called a 'pharm party' and it's easier to have than a party featuring alcohol.
“I’ve talked to a lot of the real estate agents here in town,” Colbath says. “If they’re going to have a client who’s going to have an open house, they recommend that they go through and clear out their medicine cabinets, because people will pose as interested buyers just for the sole purpose of being able to come through someone’s house and scoop up some pain meds.”
And Colbath warns about holiday parties. Even if you’re having a socially distanced one this year, he says, clean out your medicine cabinets first. Guests looking to use your bathroom might be scouting for pills – and that includes guests you trust, whom you think would never have a problem with opioids.
Cleaning Up the Problem
Colbath and Watts, who do not know each other, are at the fore of efforts to help rid the Upstate of those tempting, often forgotten-about pills. Both have worked with grants to get hold of Deterra bags and hand them out with a healthy dosage of education.
Colbath received $20,000 through the Spartanburg Regional Foundation for his work. That work is not just about handing out a bag to dump old, unused drugs into, it’s about making sure his patients know why it’s important to use those bags.
But it’s also about reeducating his colleagues and, to a degree, himself. Three-and-a-half years ago, Colbath says, he started noticing some alarming trends: how many people were coming into emergency rooms because of some type of opiate; the amount of pills patients had been given; the number of young names in the obituaries that were epitaphs of overdose.
Doctors, he says, “were duped” by the slick marketing that opioids were non-addictive miracles, and subsequently failed to do their due diligence. Doctors often gave out lots of pills in lieu of having discussions about pain management “because it was easier.”
When he sounded the alarm, Colbath says he was met by resounding indifference from his colleagues. They told him they were aware that patients were getting swamped with opioid pills, but that “it was no big deal.”
Colbath disagreed. He didn’t see why so many people coming to see him still needed to be taking opioids after long periods of time. Moreover, patients coming into his office already taking them were making his job much tougher.
“If somebody is already on opioid medications prior to surgery,” he says, “it makes it that much harder to control their pain and wean them off those medications afterwards.”
Colbath say the doling out of painkillers in lieu of real, front-end conversations about pain management post-surgery is a disservice to patients. He does not prescribe many opioids; rather, he talks to patients to help them understand what to expect in recovery and recommends Tylenol and ice as the primary pain dampeners, along with an understanding that the pain will pass.
What he found by relying less on pain meds and more on pain management plans was that “a lot of [patients] were having better outcomes and faster recovery,” he says. "For me, that was even more proof that we were doing the right thing.”
He’s been speaking in front of colleagues – who are paying a lot closer attention now, he says – for the past few years on how to get back to having real conversations with patients.
And, of course, he talks to patients about what to do with those pills that they end up not taking. He hands out Deterra bags, making sure that people know how to use them and when.
Watts is working with a State Opioid Response grant through Keystone Substance Abuse Services of York County that helps All On Board hand out the bags and information packets with resources. The grant bought $11,541 worth of Deterra bags (which can cost about twice as much, but were bought in bulk) that All On Board has given, often by the hundreds, to police, emergency response, and social services and medical organizations throughout York County.
The agency has about 70 partnerships in the county, Watts says. She’s hoping to get that number past 100 soon. Two entities she is looking forward to connecting with in 2021 are senior living facilities and dentists. She says her efforts to get into nursing home centers and senior facilities got interrupted by the coronavirus pandemic. But she’s waiting eagerly for society to open back up so she can talk to them.
Watts encourages anyone who wants Deterra bags, or anyone who needs help with a substance abuse issue, to call All On Board at 803-324-4118, or visit allonboard.org.
Quick Stats About South Carolina
The state Department of Alcohol and Other Drug Abuse Services (DAODAS) keeps track of the opioid epidemic in South Carolina. According to DAODAS, in 2018 there were:
- 1,131 overdose deaths (up from 1,103 in 2017)
- 923 deaths involving prescription drugs (up from 863 in 2017)
- 876 opioid-related deaths (up from 816 in 2017)
- 537 deaths involving fentanyl (up from 460 in 2017)
- 725 opioid prescriptions dispensed per 1,000 residents (down from 771 in 2017)
- 9,713 patients with an opioid use disorder (up from 8,578 in 2017)