That was the sentiment expressed Monday night by Kentucky Gov. Matt Bevin, who gave the opening keynote here at the National Prescription Drug Abuse and Heroin Summit, probably the largest annual conference focused specifically on the nation’s opioid crisis. More than 33,000 individuals died from opioid overdoses in 2015, the year in which the most recent data is available from the Centers for Disease Control and Prevention. That number represents a high-water mark for such deaths, and a 15 percent uptick from the previous year’s death toll.

Bevin’s state of Kentucky — and the Appalachian region — has been ravaged by drug abuse and death in recent years. The commonwealth ranked third on the list of states with the highest rate of overdose deaths, behind West Virginia and New Hampshire, with 29.9 fatalities per 100,000 residents. Kentucky saw a 21 percent increase in opioid overdose deaths, year over year, according to the CDC.

“Where is the outrage? Where are the headlines?” Bevin asked the more than 2,000 attendees at the conference, which organizers said is a record number in its sixth year. “We all know about it. We wouldn’t be here if we didn’t. People are working on it, true enough. But how badly do you individually want to see this scourge removed from the landscape of America, and what are you willing to do above and beyond anything that you have even previously thought about doing to make sure that we succeed? Because I’ll tell you, failure is not an option.”

Bevin, and fellow speaker U.S. Rep. Harold “Hal” Rogers (R-Ky.), said they are encouraged by the swelling attendance at the summit, and a seemingly increasing wiliness from all stakeholders in this fight to try to reverse these trends. This is an immensely complicated problem, and it’s clear that it won’t be doctors, hospitals, politicians or law enforcement alone that’ll solve it. The Kentucky governor offered those in attendance — representing 48 different states, plus D.C., along with three other countries (Australia, Canada and China) — six ideas that the Bluegrass State is trying in order to end the epidemic:

  1. Three Day Supply: The governor just last week signed into law a new measure that limits some opioid painkiller prescriptions to just a three-day supply, rather than the weeks of pills patients sometimes come home with. Bevin pointed to past studies, showing that 86 percent of users who inject opiods used prescription pills non-medically prior to developing their heroin addiction. “This isn’t to prevent people from getting what they need. It’s to apply a modicum of common sense and a bit of a constraint at the front end of addiction,” he said.  
  2. Nationwide Data Sharing: Kentucky makes use of what’s called a prescription drug monitoring program to track individuals’ opioid use, along with who is prescribing and dispensing those drugs. The Kentucky All Schedule Prescription Electronic Reporting System, or KASPER as it’s called, allows the state to see if a doc’s habits aren’t up to evidence-based guidelines, or if patients are shopping from doctor to doctor for more pills. But it doesn’t follow them if they got the pills out of state. Why not have a nationwide system to track such activity across state lines? “What if you had one robust system that allowed information to be put in that every single state could modify at their own end, but they would talk to one another? That information would be in there? Is this rocket science? The technology exists. Why would we not use federal dollars to create a program that we all could use modules of?”
  3. Scrap Pain as the Fifth Vital Sign: Health care needs to stop striving to remove every last drop of pain from its patients, Bevin said. “Everybody’s a 10. They’re all a 10. Frankly, it’s good sometimes to feel some pain because you know whether or not your body is reacting to whatever else is being done. This idea that we need to remove any and all pain from everything in America is a problem.” He quoted a stat that 85 percent of all opioids prescribed in the world go to the U.S., and in Kentucky alone last year, there were 350 million doses of opioid painkillers administered. That’s enough to give 79 pills to every man, woman and child in Kentucky. “Are we in that much pain?”
  4. Neonatal Abstinence Syndrome: As we’ve explored previously in H&HN, neonatal abstinence syndrome — when a baby in the womb becomes dependent on the opioids his or her mother is taking — is a massive problem in Kentucky and the rest of the U.S. One estimate pegged the total cost to care for such babies in the U.S. in 2012 at $1.5 billion, with 80 percent of that tally paid for by Medicaid. But one Kentucky program has shown success in curbing those costs by proactively reaching out to mothers and educating them about this issue. Bevin says the program has been able to reduce the average days spent in the costly neonatal intensive care unit from 30 down to five.
  5. More Treatment Beds: Kentucky and the nation fall far short of the number of beds needed to treat those addicted to opioids. As research from the Pew Charitable Trusts points out, there is an obscure Medicaid rule that prohibits using federal dollars for addiction treatment facilities with more than 16 beds. However, according to the research, the feds have granted waivers to four states and several others, including Kentucky, are seeking the same. Why not do away with this “arcane law,” Bevin asked. “Why does it exist? Why do we limit to 16 beds by federal law the ability for people to deal with what so many thousands have come here to figure out how to deal with?”
  6. Naloxone Over the Counter: As I mentioned previously, thousands are dying every month from opioid overdoses in the U.S. One drug, called naloxone, can prevent those overdoses, and yet, it can be hard to obtain. Why not make this life-saver available over the counter, with some careful thought put into the how, where and what? “We know how affective it can be when applied properly in the right instances. Why is that still a legend drug? Why is it not available over the counter?”

“Kentucky is leading on this front because someone needs to and I’ll tell you this, America needs ideas,” Bevin said, closing out his remarks. Some of these we pioneered and some we didn’t. Let’s steal ideas from one another. Go home and ask yourself: What are you willing to do differently? How badly do you want to fix this problem? And do you want to do it badly enough to work yourself right out of the need to attend this conference or even have the job you’re in?”