The Colorado Department of Human Services (CDHS) reports that there were 558 opioid overdose deaths in the state in 2017. According to information published by the Colorado Opioid Safety Collaborative, in 2015, one Coloradan died from an opioid overdose every 36 hours.
Opioid drugs include both prescription pain relievers like OxyContin (oxycodone) and the illicit drug heroin. Prescription opioid drugs are very effective at blocking pain, and in the past, they have been prescribed frequently without much oversight. Unfortunately, these drugs are highly addictive and can also be misused to create a mellow and desirable high. About 6 percent of Colorado residents report nonmedical use of an opioid drug during the past year. Government efforts to expand prevention efforts, raise awareness, control and oversee prescribing patterns, and increase access to treatment are making a difference in prescription drug diversion, abuse, and overdose rates.
As prescription opioids become more tightly controlled and less available, however, the illegal opiate heroin becomes more desirable. Heroin indicators are up across the state with increased availability and demand for the potent and highly dangerous drug on the rise.
Community-based organizations and governmental agencies in Colorado are working to address the opiate crisis by expanding treatment resources and targeting some of the areas that are the hardest hit, such as rural and underserved populations.
Resources for Managing Opioid Abuse and Addiction in Colorado
Opioid abuse in Colorado is addressed through prevention methods, awareness campaigns, and outreach programs, often funded through federal or state grants and hosted by community-based providers. Colorado is set to receive more than $30 in federal grant funds to address the opioid epidemic over the next two years, the Denver Channel reports.
Funds will go toward a number of programs and endeavors, including the Lift the Label program that has been rolled out at 10 Colorado hospitals. The program provides education on opioid prescriptions and attempts to reduce the number of these drugs that are prescribed.
Funds will also go to expanding access to medication-assisted treatment (MAT) services, especially in rural communities. Mobile health units will be disseminated to underserved communities to provide care and treatment for opioid abuse and addiction. Training on how to use naloxone, the opioid overdose reversal drug, as well as more access to the potentially lifesaving medication are also included in the grant funding.
There are many resources for opioid prevention, treatment, and recovery agencies and programs in Colorado.
- Colorado Crisis Services
- Colorado Department of Human Services (CDHS) Office of Behavioral Health (OBH)
- Colorado LADDERS (Office of Behavioral Health Licensing and Designation Database and Electronic Records System) referral resource
- Health First Colorado, Colorado's Medicaid Program
- Colorado Consortium for Prescription Drug Abuse Prevention
- Take Meds Back disposal options
- Colorado AmeriCorps Community Opioid Response Program (CORP)
- Tri-County Overdose Prevention Partnership serving Adams, Arapahoe, and Douglas counties
- Rise Above Colorado, promoting drug-free youth
- Speak Now Colorado, aiding conversations about drug use between kids and parents
- Colorado Narcotics Anonymous (NA)
- Coalition for Prevention, Addiction Education, and Recovery (CPAR)
- Managed service organizations by area and county served
The Opiate Overdose Epidemic in Colorado
There were more drug overdoses in 2017 than in any other year on record in Colorado, killing more people than car crashes, the Denver Post publishes. Nearly 1,000 Coloradans died from a drug overdose in 2017, over half of which involved an opioid drug.
Overdoses related to opioids reached an all-time high. While fatalities related to prescription opioid drugs had dropped for a few years with tighter controls on prescribing patterns, overdose death rates climbed again in 2017. Heroin overdose deaths also jumped in 2017 from 160 fatalities in 2015 to 213 deaths in 2017. Methamphetamine overdose deaths spiked in Colorado in 2017 as well.
The Denver metro area and El Paso County were some of the hardest hit regions reporting the highest rates of opioid overdose deaths. Rural communities are struggling with the opioid epidemic, as many of these areas do not have the infrastructure in place to offer education on these potentially dangerous drugs or to treat drug abuse and addiction. The Colorado Health Institute reports that frontier and rural counties in Colorado prescribe more opioids through Medicare than any other region, and that Colorado Medicare prescriptions for opioids are higher percentage-wise than average national rates. Opioid overdose death rates are highest in southern Colorado, the Colorado Health Institute publishes.
The Rise and Fall of Prescription Opioid Misuse
Prescription opioid drugs have traditionally been overprescribed and not well regulated. They were initially deemed safe medications that were heavily marketed to prescribers.
In fact, Colorado is at least the 28th state in the United States who has slapped Purdue Pharma, the makers of OxyContin (oxycodone), with a lawsuit regarding their alleged role in the opioid epidemic. Reps from Purdue Pharma have been accused of pushing prescribers to dispense more OxyContin to more patients, offering incentives and downplaying the potential addictive nature of the drug in its heyday in the early 2000s.
In 2012, at the height of the opioid prescription bubble in Colorado, there were enough opioid scripts for every resident of the state to receive a prescription; almost 4 million opioid scripts were written. Over 8 million tablets of OxyContin were dispensed in Colorado that year.
The Colorado Consortium publishes that in 2010 to 2011, Coloradans (aged 12 to 24) ranked second in the country for self-reported nonmedical use of opioid pain relievers. Around a quarter of Coloradans reported misuse of prescription painkillers in 2014, that is using these medications in a way other than directed by a doctor, and close to a third admitted to using pain medication that was not prescribed for them directly.
As a result of prescription opioid abuse, the jump in overdose deaths involving these drugs, and the rate of addiction to opioids in Colorado, lawmakers and government agencies have started to take notice. The Colorado Plan to Reduce Prescription Drug Abuse was introduced by Governor John Hickenlooper in 2013 to reduce the abuse of prescription opioid medications in Colorado.
A measure of reducing prescription opioid diversion and potential abuse is by going to the source of these medications, often the prescribers. Educating prescribers on the dangers of these medications and enabling them to understand and recognize potential misuse of these substances is beneficial. The Colorado Prescription Drug Monitoring Program (PDMP) aims to help prescribers and medical providers better track the dispensing of controlled substances to minimize diversion and abuse.
Colorado introduced a pilot program that issues "report cards" to prescribers to better track prescribing habits and ensure that opioids are not being overprescribed. It also places limits on how long these addictive substances can be prescribed, per the Denver Post. Other efforts to reduce prescription drug diversion, abuse, overdose, and addiction include:
- The Good Samaritan law. This law protects people who report an overdose from drug-related criminal charges in an effort to encourage swift medical treatment for opioid overdose.
- Increased access to naloxone. Naloxone is an opioid antagonist that can counteract and reverse an opioid overdose. Colorado law allows a standing order for naloxone that makes it more accessible and basically an over-the-counter medication that concerned citizens can pick up locally to combat overdose fatalities.
- Safe prescription medication disposal methods. Colorado has a state-funded program, the Colorado Household Medication Take-Back Program, that aims to set up at least one permanent medication drop-off location in each county in the state, providing a place to dispose of unwanted and unused controlled substances so they are not diverted and misused.
- Expanded treatment options, including medication-assisted treatment (MAT). Opioid addiction treatment services are being expanded through grants and state and federal funding to provide more than just detox services at emergency rooms when people suffer from an overdose. Emergency departments are regularly working with local community partners to offer MAT and other services beyond just detox.
A Spike in Heroin Indicators in Colorado in Recent Years
As prescription opioid abuse, addiction, and overdose rates have somewhat leveled off in Colorado in recent years — with all of the community and government efforts to more tightly control, regulate, and educate people on the hazards of these drugs and thus reduce their availability — heroin indicators have jumped. Heroin abuse often stems from prescription opioid misuse, as the National Institute on Drug Abuse (NIDA) publishes that someone who has previously abused a prescription painkiller is more than 19 times more likely to try heroin than someone who hasn't misused an opioid medication.
NIDA explains that around three-quarters of those entering a treatment program for heroin addiction, who began abusing heroin after the year 2000, first misused an opioid painkiller. As prescription opioids become harder to obtain, and a person is already struggling with addiction involving one of these drugs, people often turn to heroin, which is more accessible.
The Heroin Response Workgroup publishes the following trends involving a rise in heroin abuse in Colorado from 2011 to 2016:
- Heroin related overdose deaths have tripled, from 79 in 2011 to 228 in 2016.
- Rate of naloxone administered by EMS personnel increased 248 percent, from 997 times in 2011 to 3,465 times in 2016.
- Heroin-related arrests increased 152 percent, from 91 in 2011 to 229 in 2016.
- The incidence of HCV (hepatitis C virus) suspected to be related to injection drug use (IDU), which is commonly associated with heroin use, increased — from 366 cases in 2012 to 894 cases in 2016.
- Newborns born affected with NAS (neonatal abstinence syndrome) jumped 120 percent, from 132 in 2011 to 290 in 2016.
- Treatment admissions to state-licensed facilities for an opioid use disorder increased 189 percent, from 2,748 in 2011 to 7,949 treatment admissions in 2016.
- Calls involving heroin-related exposure jumped 70 percent, from 40 calls in 2011 to 68 calls in 2016.
In 2016, the majority of people entering a state-licensed treatment facility in Colorado for treatment of an opioid use disorder were white males between the ages of 18 and 42 who were unemployed and had never been married.
Heroin abuse impacts Coloradans across the entire state. Community-based and governmental agencies are working to prevent heroin abuse, increase treatment options, and expand recovery resources. One of the things being done is a harm-reduction approach that aims to provide a proposed "safe" space for people struggling with injection drug use to inject the drug. The pilot program proposed by the Denver City Council explains that the site would be staffed with trained professionals who have naloxone on hand as well as information and referrals for addiction treatment and services. This would be in addition to the Harm Reduction Access Center that provides a clean needle exchange location in Denver to reduce the spread of disease through the sharing of dirty needles.
Heroin continues to be an issue in Colorado. The goal is to manage addiction by providing treatment options and recovery support while expanding prevention and educational efforts.
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2017 Colorado Opioid Safety Pilot Results Report. The Colorado Opioid Safety Collaborative. Colorado Hospital Association.
The Opioid Epidemic: How We Got Here, How We Stop It. (July 2018). University of Colorado.
Colorado to Receive $30 Million Over Next 2 Years to Expand Opioid Treatment Programs. (September 2018). The Denver Channel.
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Lawsuit: Opioid Company Spread Pain Pills Around Colorado. (October 2018). The Denver Channel.
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Here's How Colorado is Combating the Prescription Opioid and Heroin Epidemic. (November 2017). Denver Post.
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Naloxone Standing Orders. (2018). Colorado Department of Public Health & Environment.
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Colorado Hospitals Get Grants to Treat Opioid Addiction in Emergency Rooms. (October 2018). 9News.
Prescription Opioid Use is a Risk Factor in Heroin Use. (January 2018). National Institute on Drug Abuse.
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Denver City Council Approves Possible Safe Injection Facility. (November 2018). Colorado Public Radio.