MSU Extension | Montana State University

Prescription Opioid Use and Misuse in Montana

Did you know that 52% of rural Montanans over the age of 45 know someone who has misused prescription opioids to the extent that it affected their life? To help decrease the rate at which the prescription opioid crisis is affecting Montanans, learn about the facts, signs of misuse and overdose, and some ways to protect yourself, family and friends.

Last Updated: 12/19
by Michelle Grocke, PhD, Assistant Professor, MSU Extension Specialist; Barb Allen, MS, Program Director, MSU Extension; Wendy Stevens, Program Manager, MSU Extension; Kristen Vardanega, Intern, MSU Extension; Alison Brennan, PhD, Assistant Professor, MSU Extension Specialist; Kim Paul, PhD, Tribal Liaison, MSU Extension

What is an Opioid?

An opioid is a medication (typically, a pill or patch) prescribed for pain relief. Because opioids are used for pain relief, people sometimes call them “painkillers.” Opioids are often prescribed after surgery or injury. In recent years, they have been prescribed for longer-lasting chronic pain, despite risks and a lack of evidence supporting this practice. It is common to see the terms “opioids” or “opiates.” Opiates are derived naturally from the flowering opium poppy plant. Opioids (which include opiates) refer to any substance (synthetic or non-synthetic) that binds to the opioid receptors in the brain. Examples of prescription opioids include:

Natural opioids: Pain medications like Morphine and Codeine
Semi-synthetic opioids: Pain medications like Oxycodone, Hydrocodone, Hydromorphone, and Oxymorphone
Synthetic opioids: Fentanyl, Tramadol, Methadone (an opioid used to treat pain, but it can also be provided through opioid treatment programs to treat opioid use disorder)

Opioid Use and Misuse

Proper opioid use is defined as taking prescription opioids in the amount and for the duration specified by a medical professional. Opioids are prescribed based on a complex assessment of patient height and weight, medical condition, and individual tolerance.

Opioid misuse occurs when opioids are taken in a manner or dose other than prescribed. Misuse can include taking too much medicine, taking someone else’s medicine (even for a legitimate medical complaint)¹, taking it in a different way than you are supposed to, or taking the medicine to feel euphoria (i.e. to get high). Opioid misuse affects people of all ages, genders, ethnicities and income levels.

¹ Taking someone else’s prescription medications is not only a form of misuse, it is illegal.

Addiction is, “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.” American Society of Addiction Medicine, 2019

Did You Know?

For every 100 Montanans, there are 83 opioid prescriptions filled annually in the state.

In a recent MSU Extension survey, it was found that among rural Montana residents over 45 years of age, 65% felt that opioid misuse is a problem in their community.

In Montana, more than 700 people have died from opioid overdoses since the year 2000.

In Montana, the third leading cause of accidental death is poisoning.

According to a recent MSU Extension survey, 29% of rural Montanans keep their unused prescription opioids for one year or longer.

Opioid Misuse Resources

Call 211, Montana’s 24-hour helpline, health and human services information and referral. Visit www.montana211.org for more information.

Call 1-800-273-8255 (TALK), Montana’s Suicide Prevention Lifeline

Text HOME to 741741 from anywhere in the U.S. to talk with a trained Crisis Counselor.

Prescription opioid misuse treatment facilities exist throughout Montana. For more information on the nearest facility, or where to drop off unused prescription opioids, please visit: http://health.msuextension.org/opioid_misuse.html

When in doubt, refer to a local health- care provider or local mental health professional.

Medical professionals in Montana know more about accurately prescribing opioid medications and managing pain than at the beginning of this epidemic. Treatment standards now suggest [or include] consultation with experts to help patients manage complex health issues.

Signs of Opioid Misuse

If you notice someone exhibiting any of the following behaviors, it could be a sign they are misusing prescription opioids, and that they could use further resources (see back page of this guide for more information):

Regularly taking an opioid in a way not intended by the doctor who prescribed it, including taking more than the prescribed dose or taking the drug for the way it makes the person feel
Taking opioids “just in case,” even when not in pain
Experiencing changes in sleep patterns
Borrowing medication from other people or “losing” medications so that more prescriptions must be written
Seeking the same prescription from multiple doctors, in order to have a “backup” supply
Making poor decisions, which includes putting themselves and others in danger

Other side effects that may be a sign of opioid misuse include: dry mouth, drowsiness, nausea, constipation, abdominal cramping, depressed respiration, skin rashes, weight gain, menstrual problems, depression, headaches, bad dreams, loss of libido, sexual dysfunction, and mood swings.

Anyone who takes prescription opioids can potentially become addicted to them thereby developing opioid use disorder (OUD)². In general, the longer you take a prescription opioid, the risk of becoming addicted increases. Taking too many prescription opioids can also lead to an overdose, which is often fatal.

² The National Institute on Drug Abuse uses these terms interchangeably.

Signs of an Opioid Overdose

If someone is experiencing any one of the following signs of an overdose, call 911 immediately:

The person’s face is extremely pale and/or feels clammy
Their body goes limp
Their fingernails or lips have a purple or blue color
They start vomiting or making gurgling noises
They cannot be awakened or are unable to speak
Their breathing or heartbeat slows or stops

It is also important to note that taking benzodiazepines (central nervous system depressants such as anxiety-relieving medicines, seizure medications, and sleep aids) and/or alcohol alongside opioids greatly increases the risk for overdose and death.

Prevention Efforts: We Are All In This Together

How do we prevent future prescription opioid misuse cases from happening? At an individual level, safely using, storing, and disposing of prescription opioids greatly reduces the risk of misuse or potential overdose.

Safe Use:

Like any medication, take opioids only as prescribed, never take more than instructed, and never take somebody else’s medicine. Never give or sell medication to someone else. Combining prescription opioids with alcohol or other drugs greatly increases the risk for death. Taking opioids for something other than pain such as anxiety, sleep, or to feel euphoria can create a harmful dependence or risk of OUD.

Safe Storage:

When not stored properly, opioids can fall into the wrong hands, leading to unintentional poisoning. Hide and lock away opioids where family, friends, or guests cannot find them. It is advised to keep medications in their original packaging, so it is clear who the medications are for and how they are to be used.

Safe Disposal:

As soon as you no longer need medication, dispose of it right away. Do not keep opioids “just in case.” The best place for unused medications is in a prescription drug drop-box. To find a nearby drop-box in Montana, visit https://dphhs.mt.gov/amdd/substanceabuse/dropboxlocations.

Photo of a Deterra drug deactivation pouch.

A Deterra drug deactivation pouch. PHOTO COURTESY OF DETERRA

If no drop-box is available, medicines can be mixed with an undesirable substance such as coffee grounds or kitty litter in a sealed plastic bag and disposed of in household trash.

Also available are single-use drug deactivation pouches, which contain a substance that when combined with prescription opioids neutralizes the medication, rendering it safe to dispose of in household trash. Contact your local Extension office for more information about Deterra disposal bags.

Why Can’t I Just Flush My Medications?

Flushing opioids is only recommended when no other disposal options are available. Some medications, like fentanyl patches, may be especially harmful with just one dose if they are consumed by someone other than the intended recipient. Remember that the type of plumbing (i.e. septic systems) plays a role in flushability of medicines. Check the FDA flush list to see if a medication can be flushed: https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-flush-potentially-dangerous-medicine#FlushList.

What Can You Do Now?

Reducing the impact of the opioid epidemic in your community starts with knowledge and education. You have already taken an important step by reading this guide. Read more about the facts, risks, and signs of prescription opioid misuse, ask questions at your next doctor’s appointment, and advocate for safe use for yourself, family members, and people in your community. Keep prevention in mind. Safely store medications, go through old medications, and participate in drug-disposal efforts.

Useful Prescription Opioid Terms

Chronic pain: Ongoing pain that usually lasts longer than six months.
Dependence: Occurs when the body adapts to the presence of a drug, causing withdrawal symptoms when drug use in reduced or discontinued.
Doctor shopping: The illegal practice of visiting multiple physicians to procure multiple prescriptions.
Prescription drug drop-box: A box, often found at pharmacies and law enforcement offices, that allows for safe, anonymous disposal of prescription drugs.
Drug deactivation pouches: Single-use pouches that contain a substance that neutralizes medication, rendering it safe to dispose of in household trash.
Opioid misuse: Taking prescription opioids in a manner or dose other than prescribed, which includes: taking too much medicine, taking someone else’s medicine (even for a legitimate medical complaint), taking it in a different way than you are supposed to, or taking the medicine to feel euphoria (i.e. to get high)
Overdose: An excessive and dangerous dose of a drug that can result in severe injury or death.
Prescription drug registry: Databases that aim to protect patients by determining if other controlled substance prescriptions have been filled and can identify drug- seeking individuals who may need help with addiction.
Prescription opioids: A class of drug prescribed by doctors that bind to receptors in the brain and relieve pain. Common types include natural opioids like morphine and codeine, semi-synthetic opioids such as oxycodone (OxyContin) and hydrocodone (Vicodin), and synthetic opioids like fentanyl and methadone.
Proper opioid use: Taking prescription opioids in the amount and for the duration specified by a medical professional.
Public health emergency: In the case of the opioid epidemic, this is a distinction made by the Department of Health and Human Services that defines an event as an urgent need for health services to respond to an event or outbreak.

References

Centers for Disease Control and Prevention. (2018). Opioid Drugs. Retrieved from https://www.cdc.gov/drugoverdose/opioids/index.html

Grocke, M., Allen, B., Stevens, W., Vardanega, K., Bailey, S. (2019). Current perceptions, behaviors & prevention strategies of prescription opioid misuse: a Montana statewide summary report.

Montana State University Extension. (2018). Opioid Use/ Misuse in Older Adults: Fact Sheet.

Montana Department of Public Health and Human Services. (2010). Montana Injury Prevention Burden Report. Retrieved from: https://dphhs.mt.gov/Portals/85/publichealth/documents/EMSTS/prevention/BurdenOfinjuryReport2010.pdf.

U.S. Department of Health and Human Services. (2019). What is the U.S. Opioid Epidemic? Retrieved from https:// www.hhs.gov/opioids/about

World Health Organization. (2018). Information sheet on opioid overdose. Retrieved from https://www.who.int/substance_abuse/information-sheet/en/s://www.who.int/substance_abuse/information-sheet/en/

Acknowledgements

We would like to thank the following individuals for reviewing an earlier draft of this guide:

Dr. Ed Dunbar, Montana State University
Joclynn Ware, Montana Department of Public Health and Human Services
Lorelyn Mayr, Montana State University Extension