Indiana may have itself to blame for being shorted millions to fight opioids, report says

Cortlynn Stark | IndyStar

Show Caption Hide Caption Opioid addiction's toll on Indiana Opioid addiction is a staggering problem in Indiana, affecting 1 in 20 Hoosiers or nearly 300,000 people. The IndyStar is partnering with the Richard M. Fairbanks Foundation on a yearlong reporting series to raise awareness of the opioid epidemic.

Based on the number of Hoosiers who have died from opioids, Indiana should receive more than twice as much in federal funds to fight the problem.

That is the main takeaway from a study released by the Richard M. Fairbanks Foundation that questions the fairness of how federal funds aimed at fighting the crisis are being distributed.

Specifically, the Fairbanks study, released in August, found that in 2017, when adjusted for under-counted deaths, Indiana accounted for 4% of opioid-involved overdose deaths in the nation. However, from 2017-18, the state received less than 2% of federal funding.

Claire Fiddian-Green, CEO and president of the non-profit Fairbanks foundation, is especially concerned that a funding gap could hamper the state's progress on the issue.

“We have seen a decline in opioid related overdose deaths in 2018 for the first time in nearly two decades,” Fiddian-Green said.“That’s due, in part, to federal funding the state has received. We want to continue with that progress."

What Indiana gets from the federal funding

In fiscal years 2017 and 2018, the federal government assigned $11 billion to combat the crisis, increasing access to medication-assisted treatment and naloxone, the overdose reversal drug, while educating medical providers. An additional $1.8 billion in funding from the U.S. Department of Health and Human Services was granted in September.

Indiana's share of those funds is roughly 2%.

State of Addiction: Confronting Indiana's opioid crisis

Fiddian-Green said the foundation saw a Bipartisan Policy Center report that examined how federal funding was dispersed across states, but didn't see how the funding was aligned to each state's need.

One common way to measure that, Fiddian-Green said, is by the number of opioid-related overdose deaths.

But that's not what HHS does.

A spokesperson for HHS said the agency uses several elements and "more nuanced data" than the overdose death rate. HHS also awards competitive grants to fund research and public health surveillance grants — the latter of which allows state and public health agencies to improve scrutiny of the crisis. The research funding goes to universities and researchers across the country, not based on the number of deaths in the state but on the researcher's ability.

If funding were based on deaths, the study showed that Indiana should be receiving between $157 million and $176 million more than it has received.

That estimate is based not only on reported opioid deaths, but also what the foundation determined was Indiana's disproportionate number of under-reported deaths. The foundation looked at two separate studies from researchers at the University of Virginia and the University of Pittsburgh that found the number of opioid-related overdose deaths are undercounted and varied by state.

Why death certificates are part of the problem

Under-reporting is especially severe in Indiana, researchers contend, because of how deaths are reported here on death certificates.

A study published in July 2018 found local jurisdictions might be significantly under-counting opioid-related overdose deaths. That study, previously reported on by IndyStar, recommended required toxicology testing and improved training for local coroners when it comes to death certificate reporting. The study recommended the additional training and testing to improve the accuracy.

On July 1, 2018, a new Indiana law requires all coroners in the state to use the same toxicology screenings to collect standardized information when controlled substances are suspected in fatal overdoses.

The issue isn't specific to Indiana. Other states, where the crisis has landed particularly hard such as Pennsylvania or Alabama, are similarly affected. One study published in June 2018 found that in five states — Alabama, Indiana, Louisiana, Mississippi and Pennsylvania — more than 35% of accidental overdose deaths were not specified.

The study classified an additional 70,000 deaths as potentially opioid-related overdose deaths.

The result is that the opioid crisis could be worse than it seems.

What under-counting means for Hoosiers

In Indiana, researchers found the number of opioid-related overdose deaths could be two times higher than reported. If so, Indiana could have had as many as 2,400 opioid-involved overdose deaths in 2017 — a total that would rank Indiana the ninth highest for opioid-related deaths, instead of the 15th.

Study: Opioid overdose deaths in Indianapolis are much higher than thought

“People suffering from opioid abuse disorder are worth the same across each state,” Fiddian-Green said. “We need to make sure that we have the best, most accurate data possible so we are making good decisions when allocating resources to address that crisis."

On Sept. 4, the U.S. Department of Health and Human Services announced the additional $1.8 billion in funding to combat the opioid epidemic.

"As future funding allocations are made, we would encourage using the most accurate data and align funding by the need," Fiddian-Green said.

More than 70,000 people died of drug overdoses across the U.S. in 2017. According to the Centers for Disease Control, 47,600 of those deaths involved opioids.

For every 100 Marion County residents in 2017, 65 had an opioid prescription, according to Gov. Eric Holcomb’s opioid epidemic Management Performance Hub. Other counties such as Starke, Vanderburgh or Floyd saw a prescription rate of more than 100.

That same year, Indiana doctors wrote 74.2 prescriptions for opioids for every 100 people. The average rate in the U.S. was 58.7. That said, Indiana’s rate has dropped significantly, from 107.1 opioid prescriptions in 2010.

How Indiana has made progress

Jim McClelland, Indiana executive director for Drug Prevention, Treatment and Enforcement, told IndyStar in a statement that Indiana is achieving better outcomes than many other states thanks to the funding the state has received.

McClelland uses five major strategies to do so: "reduce the incidence of substance use disorder, reduce additional harm that can result from substance abuse, improve treatment of those with SUD, develop and augment (McClelland's ability) to serve its stakeholders, and support and enhance substantial community-based collaborations aimed at prevention, treatment and recovery."

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While Fiddian-Green is concerned about appropriate funding here, Indiana is not the worst example, according to the report.

Ohio created the RecoveryOhio Advisory Council in January, with the task of recommending how to address mental health and substance abuse. The council's recommendations included establishing prevention coordination with state agencies across Ohio and creating a plan for safe, affordable housing.

Ohio, according to the Fairbanks report, is the most federally underfunded state without accounting for undercounting. When that factor is counted, Ohio is only topped by Pennsylvania. Ohio's 2017 drug overdose death rate was 46.3, compared to Indiana's 29.4,

Still, some progress is being made. Across the nation, according to the American Medical Association Opioid Task Force, opioid prescriptions have dropped by 33 percent between 2013 to 2018 — Indiana's prescriptions dropped by two more percentage points.

Indiana’s drug overdose deaths dropped by nearly 13% in 2018. That's a much more significant drop than the national average, which the CDC says was 5.4%.

“That’s encouraging,” McClelland said of the drop, “but there’s more work ahead as we continue to do all we can to attack the drug crisis and help more people achieve and maintain recovery.”

And there are still many more who need that help. The harsh reality — and consequences — of opioid use continues. So far in 2019, 191 people have died of opioid-related overdoses in Indiana.

Contact reporter Cortlynn Stark at cstark@gannett.com or 317-444-6311. You can follow her on Twitter @cortlynn_stark.