During the ongoing opioid crisis, it could be said that North Dakota was less impacted by the huge national rise in deaths from drug overdoses when compared to many, many other states. If you take a look at the very latest data, available via the National Vital Statistics System (NVSS), you will find that North Dakota saw only a 6.9% increase in this type of mortality during the 12-month period up to August 2020.
However, any increase in mortality during a national epidemic is always a bad, yet clear sign that the current policy direction is not working effectively.
That said, compare North Dakota’s figure of 6.9%, estimated by the “Provisional Drug Overdose Death Counts” project overseen by the Centers of Disease Control & Prevention (CDC), to the likes of Louisiana, which saw an alarming 12-month increase of 53.1%, or in Arizona, which, again alarmingly, saw a 35.9% rise.
Louisiana’s mortality is over 7 times worse than that seen by the “Peace Garden State.” Certainly, the state government and private health agencies in North Dakota can collectively breathe a monumental sigh of relief. At least for the moment, anyway.
However you view these kinds of statistics, one aspect you can’t deny is that, like everywhere else in the U.S., the number of fatal drug overdoses is still relentlessly rising, driven by opioids like heroin and prescription painkillers, and, now, particularly by the synthetic opioid fentanyl.
For example, in Bismarck County, ND, experienced law enforcement official, Deputy Chief Randy Ziegler, recently commented, “Been doing this, law enforcement, for 28 years. I’ve never seen anything like what we’re seeing now. They’ve introduced these fentanyl pills, which back in the day you’d never seen on the street. The street names are 30s or blues. People think they’re getting oxys, but they’re actually getting pills that are laced with fentanyl, or they’re straight fentanyl.”
The U.S. opioid crisis, to be clear, is no better now than when the epidemic was first officially declared, and any short to mid-term outlook is, realistically, looking bleaker and bleaker, with many more premature deaths still to come. To put it bluntly, in many regions of the nation, it is demonstrating the potential to spiral out of control.
North Dakota’s Opioid Crisis: Status Update
Even though the actual number of additional deaths through drug overdoses was comparatively minor when compared to other, more badly affected states, for North Dakota, 2020’s mortality toll is truly shocking, especially in their more populous cities, such as Minot, Bismarck, the state’s capital, and their largest city, Fargo.
This dramatic upturn in fatal drug overdoses has shocked many, including Minot Police Chief John Klug, whose city saw a 600% increase. Chief Klug stated, “This is a new trend. We went from 3 overdose deaths in 2019 to 18 in 2020, and before that, we didn’t have any.”
In the capital city of Bismarck, opioid-related overdoses went from 36 in 2019 to 102 in 2020, with actual fatalities rising from 4 to 10. In Mandan, overdoses jumped from 15 to 27; Mandan Police Lt. Patrick Haug commented, “We’ve already had several this year, it doesn’t seem to be slowing.” And back in Police Chief Klug’s Minot further reported that suspected fentanyl overdose calls went from 28 to 84.
Limited Capacity for Increasing Volume of Opioid-Addicted Patients
North Dakota has only 3 opioid treatment centers in the entire state. Yes, just 3. One of these is the Heartview Foundation in Bismarck. Their Chief Operating Officer Jessica Brewster had this to say, “We oftentimes are operating on waitlists, because people are calling in for services, and we have more people calling in than we have the capacity to serve. We absolutely do have people that are driving to us from Beulah, Hazen, [and] Dickinson. ”
Heartview, a nonprofit treatment center, has expanded its telehealth services significantly during the coronavirus pandemic, but COO Brewster is still not convinced of their effect, “They’re better than nothing.”
Out of North Dakota’s cities and into the rural countryside, drug and alcohol addiction, overdoses, and use are regularly observed by the “Strengthening the Heartland” project, a collaboration between North Dakota and South Dakota state universities to address the clear shortages in drug-related health services in rural areas.
Meagan Scott, co-leader of the project, stated, “One of the big things is that 90% of the counties have a mental health care shortage, so getting this knowledge and [these] resources out to the counties was this project. In small communities, there’s also a stigma. You don’t always want to admit that you might need help, so that’s also a problem too, that everybody might find out about it.”
Fentanyl: The Deadly Denominator
All of those in North Dakota who need to address these recent challenges, such as state governors, city Mayors, Chief Klug, Jessica Brewster, and others, do agree on one primary cause: the influx into the state of the man-made opioid, fentanyl.
Despite recent high-profile drug seizures in North Dakota, including one notable illicit drug operation that began in Detroit, Michigan, Chief Klug is realistic, “It’s very hard to get any sentence that holds somebody responsible for the death [from overdose], because, in a typical case, you have to prove intent. Well, my intent was to deliver, not to kill you.”
All first responders in North Dakota carry NARCAN® nasal spray, the naloxone opioid overdose reversal medication, while on-duty. However, there is a clear downside to the life-saving medication, as Mandan Police Lt. Haug readily explained, “Narcan is probably kind of one of those wonder drugs, but it also has a backside to it, because yes, it’s helping us prevent death in these heroin and fentanyl overdoses. But it’s also giving these people [the understanding that if I do overdose, there’s Narcan. It can save me.”
Like the rest of the U.S., there is no imminent end in sight to the current trend of fatal drug overdoses being seen in cities like Fargo and Bismarck.
Purdue Pharma’s OxyContin & Counterfeit Oxycodone: “M30”
The U.S. opioid crisis first came to prominence in mainstream media back in 2015, when life expectancy in the nation actually fell – a situation not seen since 1918, following the combination of “Spanish Flu,” also known as the 1918 Influenza Pandemic, and World War One.
Only this time, it wasn’t the combination of a global pandemic and global warfare – it was caused by prescription medications, approved, legal drugs given to people by their very own family doctors.
So exactly how did approved medication, provided by a person that people trust, create a national epidemic, and be the root cause of hundreds of thousands of premature U.S. deaths?
The answer lies in the confluence of a number of unique factors, and some of these, it has since been shown, were clearly criminal. In other words, the opioid epidemic should never, ever have been allowed to happen in a consistently progressive nation like the U.S.
An attempt by family physicians to improve their patients’ pain management, aggressive and fraudulent marketing by pharmaceutical manufacturers, such as Purdue Pharma, the makers of possibly the most addictive opioid medication, OxyContin, and the U.S. healthcare system, where doctors in private practice are financially rewarded for expanding their patient volume, among other factors, all combined to create the crisis.
The right legal and medical framework existed, too, with U.S. states passing pain treatment legislation, removing any threat of prosecution for physicians who treated pain with controlled substances. However, it wasn’t until the mid-1990s when “Big Pharma” began manufacturing new opioid-based medications that the real damage was done; among these new products, an innocuous-looking, slow-release oxycodone pain pill, branded as OxyContin by its makers, Purdue Pharma.
Purdue and other pharmaceutical companies were aggressive in their marketing tactics, and consistently made criminally fraudulent claims about their products – the clearest being that these new opioid medications were hardly addictive at all.
The rest, as they say, is history. A bad history, sadly, but history nonetheless.
Purdue Pharma: Too little, Too Late from the “OxyContin Sales Team”
Purdue Pharma, or, more accurately the owners, the Sackler family, the proud creators of the lucrative OxyContin pain pill (and, some say, the true creators of the current U.S. opioid epidemic) are now trying to sell us something else – their long-awaited “settlement” proposal.
The main points of the proposal include:
- $10bn in compensation, enabling Purdue Pharma to emerge from bankruptcy, and be transformed into a company funneling all profits into the fight against the opioid crisis
- More than $4bn would come from members of the Sackler family, the pharmaceutical company owners, and
- The plan would settle more than 2,900 lawsuits from state and local governments, Native American tribes, hospitals, and other entities
Most of those to benefit from the plan are onboard. However, 23 state attorneys general, and the District of Columbia, has issued a response stating the offer “falls short of the accountability that families and survivors deserve.” They are demanding more money from the Sackler family, and for Purdue Pharma’s future to be one where it does not “excessively entangle it with states.”
Interestingly (and very quietly), in a separate federal deal, the Sackler family agreed to pay $225m to the federal government, as long as they did not have to admit any wrongdoing.
OxyContin: The “Most Addicting” Opioid Prescription Medication
There is something unique about oxycodone, the primary ingredient of OxyContin. Relative to other opioids, its arrival into the brain is exceptionally quick. One long-held axiom of addiction research is this: the quicker (or more dynamic) the user experiences a pleasure, the more addictive the drug is to the user.
Additionally, early continued use of powerful opioids will quickly “train the brain” into a process of withdrawal avoidance, thus creating a neurological need for a constant supply.
“We find the risk of addiction [to oxycodone] greater than that attributed to morphine… We do not recommend the use of oxycodone continued past the initial phases of treatment for pain.” – John Bonica, MD, esteemed U.S. anesthesiologist, known as the “Founding Father of Pain Medicine” speaking back in 1976.
Furthermore, the Substance Abuse & Mental Health Services Administration (SAMHSA) runs a surveillance project known as the DAWN (Drug Abuse Warning System). Data derived from DAWN has consistently shown that oxycodone is associated with more ER visits than any other individual drug – a clear sign that OxyContin should be labeled “the most addicting prescription opioid.”
Counterfeit Oxycodone: “M30” – The Little Blue Pill
If there is one single substance that is driving this national increase in fatal drug overdoses, it’s fentanyl, an exceptionally powerful synthetic opioid, now being added to virtually every illicit drug it is possible to buy on the backstreets of the U.S.
Furthermore, fentanyl is the prime ingredient in the relatively recent illicit drug “M30,” which, it could be said, is specifically driving North Dakota’s increase in drug overdose mortality.
And guess what?
Its unique selling point is a simple one: it’s counterfeit oxycodone, the Mexican drug cartel’s (among others) updated version of OxyContin. Let’s face it – they were given a masterclass in marketing by one particular pharmaceutical company, so they simply copied their tactics.
However, with the additional use of fentanyl, it’s got a bit more of a “kick” than the original, to say the least.
A harmless-looking, little blue pill, sold as replacement oxycodone tablets, like the original 30mg OxyContin prolonged-release medication, these illicit drugs are also sometimes known as “Oxy,” “OxyCotton” and “Hillbilly heroin.” The tablets currently affecting North Dakota, and other states, too, are usually stamped with an “M” and “30” for identification purposes – hence, M30, as in 30mg.
Speak to any North Dakota physician, ER doctor, or member of law enforcement about M30s, they will all quickly tell you the exact same thing: “Keep away! Those pills will kill you!”
The Mexican drug cartels have been attempting to flood the illicit drug marketplace with M30s. In fact, seizures of the drug by relevant law enforcement authorities, like state police and the Drug Enforcement Agency (DEA), have increased notably in the last few years, too.
However, they readily admit it’s nowhere close to preventing the huge amount of trafficking of these M30 tablets into the state of North Dakota.
North Dakota’s Overdose Prevention and Immunity Law
One last point. Fortunately, like many other states, North Dakota has the much-needed legislation to ensure those suffering an opioid drug overdose can receive help from those around them. The Law states: “An individual is immune from criminal prosecution if in good faith that individual seeks medical assistance for another individual in need of emergency medical assistance due to a drug overdose.”
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