Authorities know the opiate crisis has come to Wyoming.
They’ve seen it in the uptick in criminal cases for heroin and pill thefts. Pharmacists report more prescriptions being filled for painkillers.
Nationally, the crisis has left a trail of bodies that rivals the death toll of the AIDS crisis at its peak. In 2015, opioids such as OxyContin and Vicodin were involved in about 33,100 overdose deaths across the country — quadruple the number in 1999, according to the Centers for Disease Control and Prevention.
But its exact toll here is hard to gauge.
Officials say the difficulty starts on the local level, with county coroners and health care providers, and is further obfuscated by a patchwork of incomplete indicators, such as ambulance rides, police calls and the number of people seeking help for drug abuse.
All of those markers have holes. The ambulance rides don’t account for overdose victims riding in police cars or personal vehicles. Not everyone seeks help for substance abuse. Police may not be able to differentiate a heroin overdose and an OxyContin death, or an accident versus a suicide.
Kim Deti, the spokeswoman for the Wyoming Department of Health, said her agency relies on information from coroners and health care providers in the state’s 23 counties. But that information is reported differently across the state, which results in inconsistent data. Put simply, there is no complete count of opiate-related overdose deaths in Wyoming.
The numbers that do exist are improving as awareness of the national drug epidemic increases, she said, but the existing reporting system still creates difficulties for tracking exact death rates.
Because of the incomplete numbers, the department has trouble breaking down its overdose data into anything more specific. Overdoses are generally lumped together, a death caused by methamphetamine indistinguishable from one caused by oxycodone. Opioids are a class of drug that includes heroin as well as substances commonly used to medically treat pain, like morphine.
For instance, in 2015, Wyoming had 95 overdose deaths. How many of those were caused by prescription drugs, Deti and other health department officials said, is difficult to determine.
“Sometimes (coroners and health care providers) know more than other times, that’s true,” Deti said. “Sometimes it’s hard to determine. But they provide the best information they can. There’s not always full toxicology, or (people) can have more than one cause of death.”
However, the state does possess some data. Between 2005 and 2014, prescription drugs were a contributing factor in 400 deaths, according to a department of health chart. The Rx Abuse Stakeholders group, a collection of law enforcement officials, health care providers and other community members dedicated to fighting prescription drug abuse, says that prescription drugs contributed to a combined 96 deaths in 2014 and 2015.
Those numbers come from the health department, but Mariah Storey, a statistician for the agency, said officials cautioned against the release of that data because it may be incomplete and out of context; she said coroners have improved at reporting prescription overdoses, which may create the impression that they’re going up.
“We have no way of knowing” the exact numbers and exact severity, Deti said.
The stakes are high. The Rx Abuse Stakeholders group says that Wyoming has the 15th highest overdose death rate in the country. It’s 11th in rates for people who are 12 to 25. Lewis attributed the rise partially to Wyoming’s “I-25 and I-80 corridor, which is a major pathway.”
Kevin Bohnenblust, the executive director for the Wyoming Board of Medicine and a member of the Rx Abuse Stakeholders group, said it’s “pretty well agreed that we could have better numbers.”
“There are a lot of well-meaning coroners in communities who maybe don’t have the expertise to make determinations,” he said.
Part of the problem in tracking fatal opioid overdoses in Wyoming is that each county coroner fills out death certificates differently.
In Wyoming, county coroners are elected officials. State law doesn’t require coroners to be doctors or nurses, though all coroners undergo specialty training.
Paul Zamora, Carbon County coroner and president of the state coroners association, said that each of the 23 coroners list causes of death differently. While some might list the specific drug suspected in the death, others won’t.
“It’s like trying to herd cats,” he said. “I think herding cats would be easier than herding 23 county coroners.”
But he said he and other coroners have been working to standardize how deaths are recorded. In the past eight months, coroners have been asked to specify what kind of drug is suspected in an overdose death.
Guy Beaudoin, the deputy state registrar, said that emphasis on giving the exact drug helps give clear data. If the coroner were to put “multi-drug toxicity” — indicating that multiple, undisclosed drugs were involved in the overdose — the data is given the ambiguous classification of “unspecific drugs.” But the number of deaths that fall into that category has been dropping as coroners become more detailed in their reporting.
“The coroners are very proactive in trying to clarify some of these and unspecific events,” he said
Zamora said he has also been working to create a statewide database that would track all deaths and would standardize how coroners enter information. However, he doubts there will be funding for that program in the near future.
Natrona County Coroner Connie Jacobson echoed Zamora’s diagnosis of the problem: Everybody fills out the paperwork differently. She said that death certificates are made of two parts: The first is the cause of death, and the second is a list of contributing factors.
Jacobson said that she generally lists any drug suspected in a death in the second part of the certificate. Other coroners, however, don’t list the drugs as thoroughly, or they don’t list them at all, she said.
Aimee Lewis, the chairwoman for the Rx Abuse Stakeholders group, said the reporting system recently still had an option to check Quaaludes as a cause of death. The drug was a sedative popular in the 1970s, but it was banned in the U.S. decades ago.
“Getting general detail is difficult, and getting more detail on what we’re facing and what we’re overdosing on is difficult,” Lewis said.
National epidemic hits home
Perfect data or not, she said, there’s no question that prescription drug use “is an issue” in Wyoming. Pharmacists and physicians say the number of opiate prescriptions being distributed is going up. Law enforcement officials say they’ve seen a rise in the number of people abusing and dealing prescription and illicit opioids.
“I think it would be a more clear picture if we had better data,” Lewis said. “But would we be doing anything different? No. We’re doing a full-court press already.”
Natrona County District Attorney Mike Blonigen said his office has seen an uptick in cases involving heroin and prescription pills that are used illegally. But he said there’s a lack of reliable data about overdoses, both fatal and non-fatal.
“We don’t have numbers — we don’t know what our problem looks like,” he said. “We just have people’s anecdotes.”
Unlike many other drugs that are brought into the state, many of the illegal prescription pain pills in Wyoming are bought at local pharmacies and then sold in the area, Blonigen said. In a few recent cases, people working as caretakers for the elderly have been charged with stealing the older person’s painkillers for their own use or sale.
“Nobody’s cooking this in Mexico and bringing it across the border — it’s in every kitchen cabinet,” he said.
The larger problem, Blonigen said, is that it’s common for people who abuse prescription painkillers to transition to heroin because it’s cheaper. Wyoming also has relatively high levels of all types of substance abuse, and those who have or had addictions are also more likely to abuse opioids.
He said that part of the problem with prescription painkillers is that people assume they’re safe because they’re prescribed through a doctor and can be legally obtained. In the past few years, Blonigen said he noticed local medical practitioners working to better educate patients about the risks of painkillers and the proper ways to use them.
Recent changes, including the creation of the prescription monitoring program and prescription drop-off boxes, have helped mitigate the spread of opioids, Blonigen said. But the state needs to be ready to better fund substance abuse treatment, drug courts and testing, he said.
“You can’t just wish this away,” he said.