IU Health Simon Cancer Center

Tobacco, Opioids Killed More Than 14,000 Hoosiers Last Year

We are IU Health

November 06, 2018

IU Health is on the front lines in the fight against addiction.

A pair of reports released last week by the Richard M. Fairbanks Foundation paint a dismal picture of the opioid and tobacco epidemics that are killing Hoosiers, but IU Health Simon Cancer Center employees who are on the front lines of treatment are not surprised.

Tobacco and opioids claimed 14,200 Hoosier lives in 2017 and cost the state $12.6 billion annually in healthcare costs, lost productivity and other economic damages, according to the reports.

There were 1,700 deaths linked to drug overdoses last year, a 75 percent increase since 2011, the report said. The vast majority were attributed to opioid misuse. Despite that sobering statistic, tobacco claims seven times as many lives each year. Smoking and second-hand smoke cause a combined 12,500 Hoosier deaths annually.

When Debi Hudson reviewed the reports, she said, “I wanted to stand up and cheer.” Not because it was good news, but because she’s on a mission to reduce tobacco-related deaths. Tobacco doesn’t get the attention that many other addictions do, said Hudson, director of the IU Simon Cancer Center Tobacco Treatment Program, “even though more people are dying from tobacco every day and every year.”

Hudson, a tobacco treatment specialist for 21 years, said during that time, Indiana has always been in the top 10 for “highest adult smoking prevalence.”

The two addiction crises are the root causes of Indiana’s poor health outcomes and burdensome healthcare costs, said Claire Fiddian-Green, president and CEO of the Fairbanks Foundation. “All Hoosiers must realize the urgency and work together to address them.”

While there has been a steep decline since 2011 in the number of fatal overdoses that involve prescription opioids, Indiana has seen a rapid rise in the synthetic narcotic fentanyl. The presence of fentanyl in Marion County overdoses increased from 6 percent in 2013 to 46 percent in 2017.

Linda Bond, lead therapist in IU Health’s Chemical Dependency Program, said the OD numbers listed in the report actually seem low to her. “Everybody who comes in here pretty much knows someone who OD’d.”

The intensive outpatient program housed at IU Health Methodist Hospital is five hours a day, five days a week for four to six weeks. Within that window are activities including group counseling, art therapy, yoga, physical therapy and meditation. Currently, 22 are enrolled in the program. A similar program is offered in the evenings.

About half of the participants are being treated for alcohol abuse, the remainder for methamphetamine and opioid addictions, she said. But it’s not like a lot of drug treatment programs.

“We’re not a pill mill,” Bond said. “We don’t give out Suboxone or methadone,” two medications often used to treat pain and addiction.

The program uses opiate blockers such as Vivitrol and naltrexone to reduce the craving for drugs and alcohol. It has a 79 percent completion rate, Bond said, though overall success rates are difficult to measure.

“Intense work gets done in a very caring, comfortable environment,” she said.

Andrew Gaddie is a peer recovery coach in the same program. Since January, he has been on the front lines in the addiction fight, meeting people in the emergency department at Methodist when they have overdosed and presenting them with treatment options.

Gaddie knows what they’re going through. For 20 years, he battled addictions to alcohol, cocaine and heroin. He’s been clean for 12 years, though he admits to still being a smoker. “That’s one of my vices I have not been able to put down and it’s probably the most deadly one.”

As a recovering drug addict, though, he delivers a dose of reality to the patients he sees in the ED.

“We have found that peer recovery coaches can reach the addict better than a doctor or nurse or technician because we’re people with lived and learned experiences. We’ve been in their shoes.”

But not everyone is receptive. Some are hostile when he tries to talk to them, Gaddie said. He has been there when people have been saved with Narcan, which helps reverse an opioid overdose. “I’ve heard people say, ‘Why’d you bring me back?’ A lot of people just want to go back out and use. They’re not looking at the fact that they have another chance to live life.”

Gaddie knows what it’s like to get another chance at life. He might be on his ninth life already – having survived multiple heart attacks, a gunshot wound to the head and other health crises. Now if he could just kick the cigarette habit.

Like drugs, tobacco has a devastating effect on Hoosier health, the Fairbanks study said. More than one in five Hoosiers smoke, a decline from 25.6 percent in 2011, yet Indiana consistently places among the 10 states with the highest smoking rates nationwide.

IU Health has been at the forefront in treating tobacco-related lung disease and cancers, said Dr. Khalil Diab, IU Health pulmonologist. A large number of patients with smoking-related diseases, including COPD, asthma and lung cancer, are treated at IU Health facilities across the state, he said.

Research by pulmonologists and lung cancer specialists at the IU School of Medicine aims to understand the mechanisms of DNA damage and repair in cancer cells. “We have multiple clinical trials with cutting-edge therapies for lung cancer patients in Indiana,” he said.

A lung cancer screening program also has been developed to improve the survival rate of Hoosiers who are current or former smokers, said Dr. DuyKhanh P. Ceppa, associate professor of thoracic surgery for the IU School of Medicine. In addition, a multi-disciplinary tobacco treatment program funded by a two-year grant from the National Cancer Institute, launched Nov. 1 at the Simon Cancer Center; the goal is to eventually expand it to include all IU Health hospitals.

Still, Ceppa said, “The data are very clear that more strict smoking laws have a direct effect on decreased lung cancer rates in our states.”

The key is prevention and early diagnosis, Diab agreed. “And state laws are urgently needed to address that.”

Tobacco use is the leading preventable cause of premature death and disease in the United States, causing more deaths annually than alcohol, HIV, car accidents, illegal drugs and firearm-related incidents combined, according to the Tobacco Prevention and Cessation Commission.

Each year, 3,700 children under 18 become new daily smokers, the Fairbanks study cited. Nearly 14 percent of women in Indiana smoke while pregnant, ranking the state 11th worst in the U.S.

Action steps suggested by the Fairbanks study include: increasing the cigarette tax by $2 and the legal smoking age to 21; expanding access to medication-assisted treatment; increasing syringe exchange programs and safe disposal sites for opioids; and boosting prevention programs in schools.

-- By Associate Senior Journalist Maureen Gilmer

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