Local pharmacist details history of opioid epidemic

Editor’s Note: This article has been updated to correct the type of drug that librium is, which is a benzodiazepine.

To some, the opioid epidemic gripping the state of Alaska and the nation at large might seem to have appeared almost overnight. Those in the health care industry know that in reality, it’s a problem that was percolating for several decades.

Stephen Mueller, a pharmacist at Ulmer’s Drug and Hardware, was at SVT Health and Wellness for the most recent Thriving Thursday to set the record straight. He took the handful of attendees through the history of Big Pharma and its role in the opioid crisis, as well as the prescribing practices of doctors that contributed to the issue.

Of Alaska’s 128 drug related deaths in 2016, 78 percent of those involved a type of opioid, according to a 2017 State of Alaska Epidemiology bulletin. In 2015, Alaska’s opioid overdose death rate, at 11 deaths per 100,000 people, was higher than the national rate — 10.4 per 100,000.

Mueller described the rise of medical advertising and marketing directly to consumers — as opposed to the traditional route of drug sales reps to doctors to patients — as a major contributor to increasingly higher numbers of people getting addicted to their pain medications.

And it goes back farther than that. Originally, the United States was wary of opioids, Mueller said. The only one in common use for a long time was morphine, and it had the connotation of being a drug for the terminally ill and in pain.

An early benzodiazepine called librium, made by Hoffmann-La Roche Inc., was found to be a muscle relaxer and have a hypnotic affect to help people sleep. This drug was tweaked to eventually become valium, and the successful marketing of valium as something that would relieve “psychic tension” translated into doctors prescribing it for more and more people.

Psychic tension, as it turned out, was a term coined not by actual doctors, Mueller said, but by the man in charge of marketing the drug.

“They were giving it to everybody,” Mueller said. ” … Valium almost became a right.”

The rise of prescriptions like benzodiazepines and opioids and the means to market them directly to consumers gave way to over generous prescribing practices, Mueller said in his presentation, as well as prescribing doses that were much too high.

In 2007, Purdue Pharma pleaded guilty to charges that executives misled doctors, regulators and patients about the risk of becoming addicted to opioid painkillers. In essence, doctors overprescribed opioids for a long time because they were being misled about how dangerous it was, Mueller said.

Mueller pointed to surgeons in the Homer area who use responsible prescribing practices and a focus on nonopioid treatments for pain as an example of how the tide is turning. The Southern Kenai Peninsula also has Dr. Sarah Spencer who, in addition to being a family practitioner in Ninilchik, works in addiction medicine.

Still, there’s a long way to go. Opioids are still one of the most often prescribed medicines in most drug stores, Mueller said.

Homer residents will have another chance to discuss the ongoing opioid epidemic during an upcoming meeting, “Your Voice, Your Community: What is Homer Doing about Heroin?” hosted by the Mobilizing for Action through Planning and Partnerships (MAPP). The meeting will be held from noon to 5 p.m. Wednesday, March 7 at Land’s End Resort.

Reach Megan Pacer at mpacer@homernews.com.