Hair stylist Ashley Smith spends most of her day chatting with her clients, but their conversations are far different than the usual hair dryer gossip.
Most of the chatter at So Vain Salon in Huntsville is about the challenges of caring for a family member who is recovering from addiction.
Smith’s son Christian has struggled with addiction for 11 years but is now in recovery. She has endured the pain of seeing her son overdose multiple times and has checked him into a rehab clinic more than once.
“But, you know, there has not been one person in my chair who hasn’t known someone who’s struggled with opioid addiction. Not one,” said Smith, who is part of Not One More Alabama, which works to support those battling opioid addiction and their families.
Smith, of Huntsville, hopes her salon chats will encourage more people to learn about opioid addiction — a crisis that’s killing more Americans per year than car accidents and HIV. About 100 Americans die from opioid overdoses daily, a rate that has more than quadrupled since 1999, according to the Centers for Disease Control and Prevention.
While the challenges of the opioid epidemic are evident, pinning down a solution for these challenges is difficult. Alabama lawmakers agree open conversation and education about opioids and the dangers they pose is the fastest way to effect change.
Members of the Alabama Opioid Overdose and Addiction Council say a multi-faceted approach — with an emphasis on education — is needed.
According to a 2017 CDC report, Alabama has had the highest rates of opioids prescribed per capita for the past five years. State government understands it has a role in the epidemic, but legislators said they won’t be quick to propose restrictive legislation.
“We can talk, issue policies and write editorials, but it’s going to have to come from people in our communities understanding the scope of this,” said acting Alabama State Health Officer Scott Harris. “No matter where we go, it’s amazing the amount of people who don’t know about the problem or don’t think about the problem.”
Harris explained most of the areas hardest hit by the opioid epidemic have a large population of people with low educational achievement.
“When you look at the demographics of opioid addiction throughout America, you see a lot of small towns and rural areas,” he said. “You do have these pockets of urban areas in the Northeast, but it tends to be associated with rural areas and people with a much lower education. Ultimately, that’s our demographic.”
Opioid drugs include narcotic painkillers such as morphine and OxyContin and illegal street drugs, such as heroin. Most prescription opioids are obtained legally from a doctor, then abused by the patient or illegally resold to other users.
Sen. Tim Melson, R-Florence, a physician, said educating the community and re-educating doctors on the risks of opioids will cause more immediate relief than any legislation could.
“There’s other issues we need to be concerned about besides the government making rules and requirements, because rules and requirements will be broken,” Melson said. “We obviously have a big problem, but I don’t see any law — either strengthening or lessening them — will make a major contribution.”
In February, the New Jersey Legislature passed the nation’s strictest opioid reform law, The Associated Press reported. The legislation limits opioid prescriptions to a five-day supply.
CVS Pharmacy announced a similar rule Sept. 22 that will limit opioid prescriptions to a seven-day supply for new patients nationwide beginning in February 2018.
Harris expressed support for CVS’ decision at a town hall meeting at the University of North Alabama on Sept. 27, but also acknowledged the challenges associated with limiting prescriptions.
“The challenge is protecting the rights of the patients that need them and keeping others from abusing them,” he said, noting cancer patients and those with chronic painful conditions should be exempt from these restrictions.
Most of the drugs being abused are legally acquired through prescriptions, which brings the challenge of identifying individuals who manipulate doctors and of doctors writing the prescriptions despite a lack of medical necessity.
Patty Sysktus, president and co-founder of Not One More Alabama, praised New Jersey’s legislation and said she hopes to see similar actions taken in Alabama.
Alabama Attorney General Steve Marshall said there is no legislation to limit opioid prescriptions in the works yet. The opioid task force isn’t in a position to start drafting legislation, he said.
The Alabama Opioid Overdose and Addiction Council will present its recommendations on handling the epidemic by the end of the year. Then, discussions about legislation will be free game, Marshall said.
Addiction Specialist Steven Hefter said most opioid abusers could be stopped in their tracks if more doctors were required to check the Prescription Drug Monitoring Program (PDMP), which displays all the medicines prescribed to the patient.
Every state except Missouri has a working PDMP, but information isn’t shared freely across state lines, nor is the PDMP updated in real time, Marshall said.
For example, Alabama shares PDMP data with Florida, but Florida does not reciprocate, he said. Creating open communication across state lines about prescribing information also could reduce the rate of people who cross state lines to get more opioids, he said.
U.S. Attorney General Jeff Sessions identified north Alabama as an area most deeply affected by the opioid epidemic when he dispatched 12 special prosecutors to high-impact cities in August.
The city of Birmingham filed a public nuisance complaint against opioid distributors in August, federal records show. The complaint claims the companies sold the drugs to doctors without properly educating them on the dangers of the drugs.
The complaint asks for drug companies to pay a share of the cost the city has incurred to deal with the repercussions of the opioid epidemic.
Other cities and state have filed similar lawsuits against Perdue Pharma for their marketing of OxyContin, a long-acting opioid painkiller. The plaintiffs argue Perdue presented inaccurate information about the addiction risk that accompanied using OxyContin.
No north Alabama cities or counties have filed lawsuits against opioid makers or distributors, Decatur attorney Greg Reeves said, noting that similar lawsuits helped get the U.S. Surgeon General’s warning on tobacco products.
“A lawsuit isn’t always the way to go with this, but it does help get things changed,” Reeves said. “However, they certainly help get things done.”