Why West Virginia's Heroin Overdose Rate Doubled After It Mandated Doctors Use the State Drug-Monitoring Database

Could the program have driven some West Virginians to use heroin?
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Used drug paraphernalia in Huntington, West Virginia.

Used drug paraphernalia in Huntington, West Virginia.

Statewide prescription drug monitoring databases are a popular fix for America's opioid epidemic. Forty-nine states have so-called prescription drug monitoring programs, and 36 states have laws requiring doctors to check them. But some new research adds an important caveat about how well prescription drug monitoring programs work. After West Virginia required doctors to use its database, overdoses from heroin among 18- to 34-year-olds actually went up, more than doubling in just three years.

"It really underscores the need for a multi-faceted, comprehensive solution for this," says Sara Warfield, a graduate student in epidemiology at West Virginia University, who led the new research. In other words, prescription drug monitoring alone can't tackle opioid overdoses.

In fact, among those who study opioid addiction, there's a hypothesis suggesting that policies that restrict people's ability to get prescription painkillers—like prescription drug monitoring programs—can lead to more problems with heroin, if they're not accompanied by policies that help people overcome addictions. The evidence for this idea comes from studies like these, which examined what happened after Purdue Pharma, the maker of OxyContin, reformulated the pill to make it more difficult to crush and inject. Some former OxyContin abusers switched to injecting heroin, which is chemically similar to OxyContin, providing a similar high and preventing withdrawal. Another way to think about this idea is that, to solve a drug problem, you can't only dry up the drug supply. You also have to reduce drug demand.

Warfield's data isn't detailed enough to show whether West Virginia's prescription drug monitoring program law caused the spike in heroin overdoses. It's possible that young West Virginians began using heroin more around that time, by coincidence. It's also possible the West Virginia heroin supply—also by coincidence—became more dangerous around that time, which happened elsewhere in the United States. Caused or not, the data shows an important shift in the problem of opioid overdoses, which have hit West Virginia particularly hard. "It's extremely difficult to say anything with causality, but our findings did show that the current opioid overdoses are really being driven by heroin and not by prescription opioids," Warfield says.

Warfield's data comes from a network of dozens of West Virginia University-affiliated hospitals and outpatient centers that share data with each other. Warfield and her colleagues looked for how often these facilities admitted adults for prescription painkiller and heroin overdoses every year between 2008 and 2015. In 2012, the year West Virginia mandated doctors consult its prescription drug monitoring database, heroin overdoses among young adults began spiking significantly. Warfield and her team presented their findings last week at the annual meeting of the American Public Health Association.

Asked what she thinks her state needs for those who overdose on heroin, Warfield answers, "Syringe services programs, naloxone, treatment." She's referring to programs that distribute clean needles to injection-drug users; a medicine that reverses opioid overdoses; and addiction treatment. The state amped up efforts to provide all three recently, Warfield notes, including launching a 1-800 number that West Virginians can call to get connected to mental-health care, including, but not limited to, addiction treatment. How well do they work? Warfield doesn't know yet. These programs really only picked up in 2015, she says, so she'll have to analyze the data again in the future.

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