Marshall details progress in opioid fight

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Alabama Attorney General Steve Marshall shared some encouraging news in the state’s effort to curb opioid deaths Thursday in the opening session of “The Journey Series,” a free virtual series on addiction and recovery.

Marshall, who co-chaired the Alabama Opioid Overdose and Addiction Council established by Gov. Kay Ivey in 2017, used the recommendations of the council’s formal report as the framework for his progress update. He pointed to efforts to modify opioid prescribing practices as one of the key areas of achievement since 2018.

Marshall and other council members heard numerous complaints from physicians about the state’s Prescription Drug Monitoring Program (PDMP), which doctors use to access a patient’s history of prescriptions and identify previous warning signs of addiction.

“Simply put, many doctors weren’t accessing this valuable information because it took too long and was not organized in a useful way,” Marshall said.

After the Alabama Legislature spent $2.3 million to upgrade the PDMP, nearly 23,000 healthcare professionals now have access to the PDMP, and the database received 4.5 million queries in 2019 – a 26 percent increase from 2018, according to Marshall.

In addition, the number of investigations initiated against physicians suspected of inappropriately prescribing controlled substances has increased by 300 percent.

Since 2014, the state’s number of total opioid prescriptions has decreased by 34 percent. However, Marshall noted that 2018 data shows that Alabama still has the highest prescribing rate in the nation – twice the national average – and Walker County has the highest rate in the state and four times the national average.

“While I look forward in seeing our continued progress reflected in the 2019 data, there is clearly more work to be done in this area,” he said.

Though he did not provide figures, Marshall said there is data to reflect a decrease of state opioid deaths in 2019. However, he also pointed out that national data suggests there has been an increase in drug-related overdose deaths during the 2020 pandemic compared to the same months in 2019.  

In Alabama, there has been an increase in emergency room visits for overdoses with the majority being opioid-related, Marshall said.

In the area of progress since the council’s report was issued in early 2018, fentanyl and carfentanil have been included in the state’s trafficking laws that previously only covered heroin, and more than 30,000 doses of the overdose reversal drug naloxone have been administered to non-EMS first responders.

“While the data is incomplete on how many lives have been saved, initial evidence suggests this effort is already making a difference throughout Alabama. Frankly, if just one life has been saved as a result of this particular effort, then I consider it a tremendous success,” Marshall said.

On another front, the state is in the process of finalizing a central database that will be open to designated agencies in charge of organizing a rapid response to areas of overdoses and other opioid-related events. An electronic dashboard that will help policymakers develop data-based strategies to emerging trends should be completed by the end of the year.

Legislation has also been passed to allow researchers to access prescribing data.

“While these two areas won’t make headlines and they’re surely not something we’ll talk about around the water cooler, having robust, accessible and cogent data is essential to our efforts to sustain the progress we have made thus far,” Marshall said.

Marshall also pointed to the success of the “Stop Judging, Start Healing” campaign launched by the Alabama Department of Public Health and Alabama Department of Mental Health in trying to eliminate the stigma around substance use disorder and mental illness.

“It remains too early to know what impact this public awareness campaign will have in what it’s produced, but here’s what I do know – it’s encouraged sometimes uncomfortable conversations to take place around dinner tables in ways they didn’t before,” he said.

Marshall opened his address from his office in Montgomery, with acknowledgment of the work being done specifically in Walker County.

“I am convinced that if we were having this conference again 10 years from now, our panels at that point would be focused on the significant progress that’s been made to address addiction in this community, of reduced overdose deaths and of restored individuals and families. We would be sharing a success story for other communities to know what can happen when people are mobilized across multiple disciplines and come together to deal with this issue,” Marshall said.

Marshall has experienced the opioid epidemic professionally and personally. For 16 years, he served as district attorney of Marshall County, an area nicknamed “meth mountain” until opioid deaths surpassed widespread methamphetamine use.

In 2018, Marshall’s wife Bridgette died by suicide following a battle with mental illness, chronic pain and opioid addiction.

Joining Marshall on the Zoom were the Rev. Paul Pradat of St. Thomas Episcopal Church in Huntsville, the Rev. Robin Hinkle of St. Mary’s Episcopal Church in Jasper and Rachel Puckett, behavioral health development manager for Capstone Rural Health Center and Walker County Health Action Partnership (HAP).

"The Journey Series" is based on "The Journey Day" offered in Jefferson County by the Recovery Ministries of the Episcopal Diocese of Alabama. The Recovery Ministries partnered with HAP to offer it in Walker County.

Originally planned as a one-day event, the virtual series was developed after the coronavirus pandemic made in-person gatherings unsafe. It will continue each Thursday through Oct. 8.

The next sessions, "Role of Health Professionals in Addiction and Treatment" and "How to Ask for Help and Start the Intervention Process," will be Thursday at 2:30 p.m. and 3:35 p.m. To register, visit www.walkerrecoverymap.org/journey-series.