By Nick Watson
The Times
GAINESVILLE, Ga. — In an effort to reduce the supply of opioids, the Drug Enforcement Administration and the Department of Justice proposed a quota reduction this month for U.S. manufacturing of certain drugs in 2019.
The proposal announced Aug. 16 would decrease “manufacturing quotas for the six most frequently misused opioids for 2019 by an average 10 percent as compared to the 2018 amount,” according to the DEA announcement.
“Once the aggregate quota is set, DEA allocates individual manufacturing and procurement quotas to those manufacturers that apply for them. DEA may revise a company’s quota at any time during the year if change is warranted due to increased or decreased sales or exports, new manufacturers entering the market, new product development or product recalls,” according to the DEA’s announcement.
The six opioids listed were oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine and fentanyl.
“We must continue to fight this epidemic on all fronts. The proposed decrease in opioid production is a step in the right direction to potentially save lives, while also minimizing the illegal distribution of these drugs within our community,” U.S. Attorney Byung J. “BJay” Pak in a news release.
Oxymorphone, which is commonly seen as the brand Opana, would reduce from 3,395,280 grams produced in 2018 to 2,880,000 grams next year under the proposal, which would be a 15 percent decrease.
The aggregate production of these six opioids dropped 35 percent between 2016 and 2017, resulting in roughly 105,000 kilograms fewer being manufactured.
The decrease between 2017 and 2018, however, was only 5 percent.
On Tuesday, Aug. 21, Georgia’s Statewide Opioid Strategic Plan Summit took place in Forsyth, where a draft of the statewide plan was released.
The work group recommendations were broken into six sections: prevention education; maternal substance use; data and surveillance; Prescription Drug Monitoring Program; treatment and recovery; and control and enforcement.
Deb Bailey, executive director of governmental affairs for Northeast Georgia Health System, was at the summit Tuesday with hundreds of other stakeholders.
“Now that (the Prescription Drug Monitoring Program) is a requirement, I think that it’s going to be an amazing tool for our physicians to start using for folks that are seeking drugs,” she said.
House Bill 249 during the 2017 Georgia legislative session made it law for prescribers to check the Prescription Drug Monitoring Program “before prescribing opiates or cocaine derivatives in Schedule II drugs or benzodiazepines,” according to the program’s website.
Prescribers were previously encouraged to do so, but it is now required as of July 1 of this year. Examples of benzodiazepines include Xanax and Valium.
The Centers for Disease Control and Prevention released a data series in July 2017 on the prescribing rates per 100 residents in counties across the country.
The CDC’s methodology took information from roughly 59,000 retail pharmacies, dividing the total number of opioid prescriptions dispensed in an area divided by the U.S. Census’ annual resident population data.
Prescriptions including “(buprenorphine), codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol and tramadol,” were identified, according to the CDC’s methodology.
According to the CDC’s data, there were 94.5 prescriptions per 100 people in Hall County in 2016. In neighboring Forsyth County, which has a similar population, the 2016 rate was 51.2 prescriptions per 100 people.
Bailey said those statistics may be skewed because Hall County serves as a hub for health care in the region.
Regarding the DEA’s manufacturing quota, Bailey pointed to Northeast Georgia Medical Center’s move in 2012 to cut back on prescriptions written.
The installation of the health system’s new electronic record system, Epic, this year has already shown Bailey and others that physicians are changing their practices.
“I think, first, there’s a recognition that we’re not writing as many. Historically ... physicians would write a prescription for 30 days, and that was because the industry had told us — and we had believed — that these drugs were not addictive,” she said.
As the medical community started understanding the addictive nature of these drugs, Bailey said they now scrutinize the amount prescribed and assessing alternative measures.
“Time and again, when we arrest these folks and we question them ... there’s a large number of them — I wouldn’t say all of them — do start off getting hooked on prescription drugs,” said Lt. Don Scalia of the Hall County Multi-Agency Narcotics Squad. “They get a prescription that they get hooked on, and then they enter that downward spiral and they end up on heroin and fentanyl.”
Scalia said he believes the plan for tackling the opioid problem will be multipronged, stopping those from becoming new addicts while providing the drug court treatment programs for existing addicts.
“I think they’re on the right track as far as reducing manufacturing. I think that’s going help,” he said. “I think that’s something that needs to have been done a long time ago. If you talk to most drug cops, they’ll tell you we could tell even as long as five, 10 years ago that there was going to be an issue just on the quantity that was being prescribed.”
In the enforcement section of the Georgia plan under the goal of reducing the supply on the street, one objective was to “review sentencing enhancements for the distribution of illicit and licit opioids.”
Law enforcement in North Georgia has already taken the step to accuse some suspects of felony murder in cases where the distribution of drugs led to an overdose. Those cases often involved fentanyl, a drug 100 times stronger than morphine.
Scalia said he agreed with the sentencing enhancements as a component, adding he felt the penalty should the match the danger it represents to the community.
The sources of fentanyl are few, but they come with deep pockets and are often located out of the country, Scalia said.
“I think you’re going to have to really get our country’s leaders on board to go after ... and get other countries’ leadership involved in reducing the supply of these other chemicals that are coming in such as fentanyl,” he said.