The impact of the opioid crisis in Hawaii is very different from the mainland, but no less compelling and concerning. Similar to the mainland, overdose deaths now rank higher than traffic fatalities in the state of Hawaii.
However, the situation in Hawaii diverges from the mainland in several key ways that illustrate the opportunity to proactively respond. For example, age-adjusted rates of drug- and opioid-related fatal poisonings are generally lower for Hawaii residents compared to the U.S. as a whole. Hawaii had the 43rd highest rate (or 8th lowest) rate of either type of mortality among the 50 states over the 2012-2015 period.
The impact of the opioid crisis in Hawaii is very different from the mainland, but no less compelling and concerning. Similar to the mainland, overdose deaths now rank higher than traffic fatalities in Hawaii. More importantly, mortality rates in Hawaii have been relatively stable after reaching a peak around 2010, while increasing trends persist for the U.S.
However, Hawaii often experiences a delayed impact in relationship to national trends in substance use. It would be a mistake to assume the difference in trend patterns between Hawaii and the contiguous U.S. means that there is no need to be vigilant.
Hawaii has one of the lowest age-adjusted rates of drug overdose deaths involving opioids. In 2017, there were 53 drug overdose deaths involving opioids—a rate of 3.4 deaths per 100,000 persons.
There has been no overall change in the number of overdose deaths involving prescription opioids in the last decade, with 40 deaths reported in 2017. Ten deaths involving heroin were reported in 2017 and like those involving prescription opioids, no significant change has been seen since data collection began in 2013. Even less data is available on deaths involving synthetic opioids other than methadone (mainly Fentanyl) with no reported deaths submitted in 2017.
Males comprised nearly two-thirds (63%) of the victims, and had slightly higher mortality rates at every age group. A sampling of autopsy records from a single year (2016) in Honolulu County provides a wealth of information when examined for primary and underlying causes of death related to opioids.
The data provides an unsettling snapshot into the etiology of opioid related fatal overdose deaths in Hawaii. Two-thirds (66%, or 37) of the 56 overdose victims reviewed were positive for opioid pain relievers (OPR) other than morphine, codeine, and methadone.
The most common OPR were Oxycodone (17 victims), Oxymorphone (9), Fentanyl, and Hydrocodone and methadone (8 each). Twenty-one percent (12) of the victims were positive for heroin, including 4 who were also positive for OPR.
Heroin users were significantly younger (38 years on average, vs.49 years) than the other decedents. Nine victims (16%) were positive for methadone, including 4 who were also positive for OPR.
Thirty-eight percent (14 victims) of the 37 victims who were positive for OPR were also positive for benzodiazepines. Nearly one-half (6) of those 14 victims were known to have their own prescription for benzodiazepines.
In 2017, Hawaii providers wrote 37.0 opioid prescriptions for every 100 persons, compared to the average U.S. rate of 58.7 prescriptions. This was among the lowest rates in the United States that year (per the CDC). This was also the lowest rate in the state since data became available in 2006.
The age-adjusted rate of overdose deaths involving opioid prescriptions has also followed a decreasing trend from a peak of 4.8 deaths per 100,000 deaths in 2007 to 2.5 deaths per 100,000 persons in 2017.
NAS or neonatal opioid withdrawal syndrome (NOWS) may occur when a pregnant woman uses drugs such as opioids during pregnancy. A recent national study revealed a fivefold increase in the incidence of NAS/NOWS between 2004 and 2014, from 1.5 cases per 1,000 hospital births to 8.0 cases per 1,000 hospital births.
This is the equivalent of one baby born with symptoms of NAS/NOWS every 15 minutes in the United States. During the same period, hospital costs for NAS/NOWS births increased from $91 million to $563 million, after adjusting for inflation.
Recent rates of NAS/NOWS in Hawaii are not available. The most recent findings were reported for 2013 when the rate was 0.7 per 1,000 hospital births (per the CDC).
In 2016, 9 percent (3,480) of the 39,589 new diagnoses of HIV in the United States were attributed to opioid and prescription opioid abuse. Among males, 6.3 percent (2,530) of new cases were transmitted via opioid abuse or male-to-male contact and opioid abuse. Among females, 2.3 percent (950) were transmitted via opioid abuse (per the CDC).
Of the new HIV cases in 2016, 82 occurred in Hawaii. Among males, 13.7 percent of new HIV cases were attributed to opioid abuse or male-to-male contact and opioid abuse. Among females, 22.2 percent of new HIV cases were attributed to opioid abuse.
In 2015, an estimated 2,788 persons were living with a diagnosed HIV infection in Hawaii—a rate of 233 cases per 100,000 persons. Of those, 13.0 percent of male cases were attributed to opioid abuse or male-to-male contact and opioid abuse. Among females, 25.1 percent were living with HIV attributed to opioid and prescription opioid abuse.
In Hawaii, there are an estimated 6,800 persons living with Hepatitis C (2013-2016 annual average), a rate of 610 cases per 100,000 persons. A good number of these cases were attributable to opioid and prescription opioid abuse.
Fortunately, Hawaii has multiple drug and substance abuse rehabs in place. There are many types of treatment centers such as long term addiction treatment facilities, short term drug abuse treatment, outpatient detoxification programs, outpatient substance abuse treatment services, inpatient drug abuse treatment and others.
There is a vast range of drug and alcohol rehab facilities available. They include individual psychotherapy, dialectical behavior therapy, couple/family therapy, trauma therapy, trauma-related counseling, cognitive/behavior therapy and others, to name a few. If you need rehab in Hawaii, place a call to any of the available rehab centers.
If you are addicted to alcohol or drugs, it is imperative that you look for professional help as soon as you possibly can. However, you might not know where to start or the options that are open to you. Similarly, you may have little to no idea about the differences between the different treatment facilities and the programs they have in store for their patients.
Do you need help finding the right drug or alcohol rehab facility in your area?
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