Floyd County Commissioners and representatives of local hospitals spent more time Monday talking about addressing the local opioid epidemic than suing the pharmaceutical companies.
"It's a multi-faceted problem," said Dr. Bob Williams, who headed the detoxification program at the now-closed Northwest Georgia Regional Hospital. "Identifying (abusers) is easy. What we're going to do about it is the question."
It's a relatively new phenomenon, mirroring a steep increase in the opioid prescribing rate since 2006. The national rate peaked in 2012, according to the Centers for Disease Control and Prevention, but in a quarter of U.S. counties there are still enough prescriptions for at least every person to have one.
The narcotic painkillers — such as OxyContin, Demerol, Percocet and Dilaudid — are highly addictive.
Dr. Ed McBride, chief medical officer for Harbin Clinic, said physicians are learning more about pain control each day. Pain is subjective and hard to quantify scientifically, he said, but there's a new focus on determining appropriate care.
"I think that level (of prescribing) was geared toward unreasonable expectations of no pain," he said. "But if you have surgery, an accident or an injury, pain is a natural reaction. The question should be how do we make it tolerable."
He and Dr. Julie Barnes, chief medical officer for Redmond Regional Medical Center, both said there are instances when pain pills are necessary. And Barnes voiced concern about an inappropriate push-back against them.
"We don't want to knock the legs out of these phamaceuticals so we don't have what we need for the people who need them," she said.
However, they both expressed support for new guidelines and rules, including limits on the number of pills prescribed in an emergency room visit. Checking the state prescription-drug monitoring database is another way to identify patients at risk of addiction or overdose.
McBride said they're also tuning in to other options, especially for long-term pain management.
"It's not always a pill for pain that solves the problem," he said. "It could be a combination of physical therapy or other modalities that work together."
He added that the medical community is just beginning to see how technology, such as the state database, can help rein in abuse.
'Part of the solution'
Tech help from the state is expected to be expanded in the coming years.
Sen. Chuck Hufstetler, R-Rome, introduced legislation last week that would require doctors to transmit opioid prescriptions electronically to pharmacies — eliminating paper prescriptions. Hufstetler said it's too late for a hearing on the bill this year, but he wanted to start a debate.
"There's a decent amount of opposition, especially as it relates to problems in rural communities," he said. "But I have some ideas on what we can do to fix that. I just wanted to put it out there now to start discussion off-session."
While the overall opioid prescribing rate in 2016 was 66.5 prescriptions per 100 people, some counties had rates that were seven times higher than that, according to the CDC.
Floyd County's rate was 153.3 per 100, while Chattooga's was 131.4 and Polk's was 166.8. Rome attorneys Andy Davis and Bob Finnell expect to file suit as early as this week on behalf on a number of local governments, including Rome and Floyd County.
It will join a multijurisdictional case in an Ohio federal court examining the liability manufacturers and distributors have for encouraging overprescription of the highly addictive painkillers.
Finnell said OxyContin manufacturer Purdue announced this month it would stop marketing the drug directly to physicians and cut its sales force in half.
"We think it's a big signal they're trying to send to the court that they want to be part of the solution," Finnell said.
Settlement money could be used to establish locally based initiatives to deal with the problems, he said.
Commissioner Wright Bagby Jr. said Rome and Floyd County spend close to $40 million a year on public safety and about 1,100 people are in the jail and prison on any given day. While it's not all drug-related, he said, much of it is.
Commissioner Allison Watters said there's also a connection with the homeless shelters, foster care and the closing of NWGRH.
"We can't wait for resolution of this complaint," she said.
The lawsuit is "the first step," Commission Chair Rhonda Wallace said, but the board also is planning to discuss community initiatives at its annual retreat next week.
"We'll certainly need your input along the way," she told the medical professionals at Monday's session.