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Rural opioid epidemic: Indiana overdoses have increased 22.5%

Every week in our country, the equivalent of two jumbo jets full of people die from a preventable opioid epidemic, and those deaths are often rising the fastest in farm country.
Every week in our country, the equivalent of two jumbo jets full of people die from a preventable opioid epidemic, and those deaths are often rising the fastest in farm country.

NOBLESVILLE, Ind. — The man picked up a hammer and then smashed it down on his hand. The woman unbuckled her seatbelt and then drove her car at full throttle into a dumpster.

They hurt themselves with the sole intent of acquiring prescription pain medications.

These true stories shared by Matt Niswander at the Young Farmers and Ag Professionals Conference in Noblesville depict just how devastating the opioid epidemic in rural America has become.

Niswander is a first-generation cattleman. He and his wife, Colbie, and their three children raise Black Angus cattle at Niswander Farms, a U.S. Department of Agriculture-certified direct-to-consumer beef cattle farm.

He previously worked in emergency medicine and now works full-time in his community as a family nurse practitioner, the owner of Niswander Family Medicine, a hometown, primary care family medical practice in Lawrenceburg, Tennessee.

The very first appointment on the first day he opened his clinic, the patient asked for narcotics, Niswander recalled.

“That was an instant wake-up call for me. I had to address that from a moral and ethical standpoint, but also from a business standpoint,” he said. “I didn’t do anything for him. He got mad. That’s typically how that works out.”

There is no difference between prescription opioids obtained legally from a doctor and heroin obtained illegally, Niswander said.

“Actually, heroin and opiate have the exact same reaction chemically in your body as each other,” he said. “You picture a heroin addict in your head and think of a drug addict on the street corner with a needle hanging out his arm. When you think of somebody addicted to pain pills, we don’t have that same image, for some reason. It is literally the same exact thing. It literally does the same thing to your body.”

A Country In Crisis

This is not just a “big-city” problem, Niswander stressed.

In fact, he said, more adults are dying from opioid overdoses in rural America, at a rate of 10.8 deaths per 100,000 people, greater than the national average of 10.6.

In 2018, 130 Americans died every day from an opioid overdose.

“If you loaded two jumbo jets full of people and crashed it into the ground every single week, that’s how many people die because of opioids every week in this country,” Niswander said.

“If two planes crashed out of the sky right now, what would the federal government do? They’d shut the airline business down. Everybody in the United States would be up in arms about it.

“It’s happening. It’s been happening, for decades. And nothing is being done, to that extent.”

Deaths caused by opioids now exceed deaths caused by diabetes and are getting closer to cancer and heart disease, Niswander said.

Specifically in Indiana, he said, opioid overdoses have increased 22.5%. For every 100,000 people, about 30 people have died — far greater than the national average of 19, he said.

Looking at how often opioids are being prescribed by physicians in Indiana, Niswander said there were a staggering 74.2 opioid prescriptions per 100 people — again far greater than the national average of 58.7. Only nine states prescribe opioids more than Indiana, he said.

How’d We Get Here?

In 1996, OxyContin was marketed as a “cure-all,” a non-addictive medication with an abuse-deterrent coating for first-line treatment of any kind of pain, not just severe pain from cancer or broken bones, Niswander said.

“They had this huge marketing push, all this research to back it up. Pharmaceutical companies back then could take doctors and nurse practitioners and nurses to the Bahamas, or to the Pacers game, or the Tennessee Titans game. You feel like you owe these people something. I had a friend, they took him duck hunting and gave him a shotgun,” he said.

“Then in the early 2000s — I don’t want to get conspiracy theory on you too much, but you’ll hear it in my voice maybe — the pain scale shows up as the sixth vital sign. So, a patient comes in the emergency room, we check their blood pressure, heart rate, oxygen, temperature, respirations. Now, we’ve got to add pain to that.

“Well, if you come in with high blood pressure, I’m going to see that. I’m obligated to treat your high blood pressure. If you come in with low oxygen or fast respirations, I’m obligated to treat that as a medical professional morally and ethically. You come in now with the pain scale, you’ve got a cough and you say, ‘I’m hurting like a 10.’ I’ve got to do something for that, right? Now, I’ve got this first-line treatment of OxyContin that’s supposed to be non-addictive anyway, so why not just give him this OxyContin?”

As patients became addicted, they quickly learned how to abuse the system, Niswander said.

“These people figured this game out really quick,” he said. “They come in, ‘Hey, I stubbed my toe. Boy, it’s like a 10.” Well, it ain’t broken. You know, it’s not even red. I don’t even see where you hit it. ‘It’s killing me. It’s killing me.’ So, we’ve got to do something about it. We fix people. Medical professionals fix people, and if there’s a resource to fix it, we give it to them.”

A lot of towns and small communities, where farmers get hurt, lack mental health resources, Niswander lamented.

“Let’s face it, farming is hard. Economically, financially, it’s tough,” he said. “You can get depressed. You can get anxious about it. And if somebody doesn’t have a good support system, or already has some mental health issues underlying, opioids give you that euphoric feeling. ‘I just lost $100,000, but I feel pretty good, though, let’s keep trucking. That cow just ran me over, but I feel pretty good.’ That’s really what they do.”

Niswander emphasized anyone can become addicted to opioids that are prescribed legally for a legitimate injury. It only takes three days to become addicted and for your body to crave the euphoria that opioids produce, he said.

What Do We Do Now?

If you suspect opioid abuse, try to have an honest conversation with that person, even though it can be uncomfortable, Niswander advised.

Do not get angry, or offended. Be calm and clear about what you ask and say, know when to stop the conversation and talk about it later and make sure the person knows you love them no matter what.

Niswander also recommended having Narcan medication on hand. Narcan, “the antagonist for opioids,” is the reversal medication for someone who has overdosed on opioids and is very easy to administer by nasal spray, he said.

In Indiana, it can be obtained for free by attending a one-hour training session at the county health department. Forty-nine Hoosier counties have already utilized the program, giving out 13,721 kits, Niswander said.

American Farm Bureau Federation and National Farmers Union joined forces to launch the “Farm Town Strong” campaign to raise awareness of the opioid crisis’ impact on farming communities.

A website — FarmTownStrong.org — provides easy access to information and resources that can help struggling farm families and rural communities.

Niswander also successfully lobbied for a resolution at the recent AFBF Convention to support a national prescription drug database, allowing physicians to track narcotic prescriptions, even across state lines, and combat drug misuse and unintentional overdose.

What Are Opioids?

Opioids is a term used for the entire family of opiate drugs, including natural, synthetic and semi-synthetic.

These drugs are chemically related and interact with opioid receptors on nerve cells in the body and brain, creating a feeling of euphoria.

Opioid drugs include:

• Buprenorphine

• Codeine

• Fentanyl

• Heroin

• Hydrocodone

• Hydromorphone

• Meperidine

• Methadone

• Morphine

• Oxycodone

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