The State of Health in New Mexico 2018
7. Substance Use
Substance Use Affects All New Mexicans
The Burden of Substance Use in New MexicoSubstance use is a major issue in New Mexico. According to the 2014-2015 National Survey on Drug Use and Health (NSDUH) conducted by the Substance Abuse and Mental Health Services Administration, the prevalence of past year alcohol use disorder among adults in New Mexico was 7.3%. The 2014-2015 NSDUH also estimates the number of past year heroin users among New Mexico adults to be 3,000. However, this number is underestimated, as there were 9,649 enrollees in the NMDOH Syringe Services Program in 2016, and of those 6,976 indicated heroin use. Additionally, using data from the New Mexico Board of Pharmacy Prescription Monitoring Program (April-June 2017) and the published research literature, the number of chronic prescription opioid users in New Mexico who may need treatment is estimated at 12,400 (22% of chronic prescription opioid patients).
The alcohol-related death rate was 66.0 deaths per 100,000 population, and the drug overdose death rate was 24.8 deaths per 100,000 population in 2016. This compares to national rates of 34.0 and 19.8, respectively. All the ten leading causes of death in New Mexico are, at least partially, caused by the abuse of alcohol, tobacco, or other drugs. The negative consequences of substance use in New Mexico are not limited to death, but also include domestic violence, crime, poverty, and unemployment, as well as chronic liver disease, motor vehicle crash and other injuries, mental illness, and a variety of other medical problems.
Alcohol-Related Deaths and HospitalizationsOver the past 30 years, New Mexico has consistently had among the highest alcohol-related death rates in the United States, and it has had the highest alcohol-related death rate since 1997. In 2010, the economic cost of excessive alcohol consumption in New Mexico was $2.2 billion ($2.77 per drink or an average of $1,084 per person). New Mexico's rate of death due to alcohol-related chronic disease is more than twice the national rate, while it's rate of alcohol-related injury death is 1.6 times the national rate (Figure 1). Alcohol-related chronic liver disease (AR-CLD) accounts for the most deaths due to alcohol-related chronic disease. Many drug overdose deaths are also alcohol-related. Indeed, from 2012-2016, among alcohol-related injury deaths in New Mexico, drug overdose was the leading cause.
Drug Overdose DeathNew Mexico had the 12th highest drug overdose death rate in the nation in 2016. The consequences of drug use continue to burden New Mexico communities. Unintentional drug overdoses account for almost 86% of drug overdose deaths. The most common drugs causing unintentional overdose death in 2012-2016 were prescription opioids (i.e., methadone, oxycodone, morphine; 49%), heroin (33%), benzodiazepines (25%), methamphetamine (21%), and cocaine (13%) (not mutually exclusive). In New Mexico and nationally, overdose death has become an issue of enormous concern as potent drugs are widely available (Figure 2).
Risk and Resiliency FactorsSome substance use behaviors are more prevalent among New Mexico youth compared to the rest of the nation, including marijuana, methamphetamine, and tobacco use. On the other hand, results of the New Mexico Youth Risk and Resiliency Survey (NM-YRRS) revealed that youth with high levels of certain resiliency factors were less likely than others to engage in such behaviors as binge drinking, drug use, and tobacco use. Resiliency factors include elements like having a caring parent at home, an encouraging environment at schools with clear rules on what to do and what not to do, involvement in sports, clubs, and group activities, social support, and clear plans for the future.
Health DisparitiesDeath rates from alcohol-related causes increase with age. However, one in six deaths among working age adults (20-64) in New Mexico is attributable to alcohol. Male alcohol-related death rates are substantially higher than female rates. American Indians have higher alcohol-related death rates than other race/ethnicities. Rio Arriba and McKinley counties have extremely high alcohol-related death rates, driven by high rates in the American Indian and Hispanic male populations, respectively. The counties with the most deaths in 2012-2016, were Bernalillo, McKinley, San Juan, Santa Fe, and Dona Ana. Alcohol-related chronic liver disease (AR-CLD) death rates are extremely high among American Indians, both male and female, and Hispanic males. The high rates among American Indians and Hispanic males between the ages of 35 and 64 years represent a tremendous burden in terms of years of potential life lost (YPLL). While Bernalillo County had the highest number of deaths due to AR-CLD (617 for the years 2012-2016), two counties that stand out for their very high rates were Rio Arriba and McKinley, which have rates that are more than five times the national rate. Males are more at risk for alcohol-related injury death than females, with American Indian males at particularly elevated risk. Disparities remain in alcohol-impaired motor vehicle traffic crash death rates, both male and female American Indians have elevated rates, especially among middle age males (age 25-64).
The highest drug overdose death rate was among Hispanic males, followed by White males. Rio Arriba County had the highest drug overdose death rate in the state (Figure 3). Bernalillo County continued to have the most deaths. Risky substance use behaviors such as binge drinking, heavy drinking, and current smoking are more prevalent among LGBT adults than straight adults in New Mexico (24% vs. 15%, 13% vs.6%, and 32% vs.20% respectively).
Assets and ResourcesNew Mexico Department of Health (NMDOH) has a team of substance use epidemiologists dedicated to tracking and responding to substance use issues. Funding through the CDC promotes use of evidence-based practices in preventing prescription drug overdose deaths, support of community health coalitions, evaluation of policies and programs, and partnership with health systems and law enforcement agencies to help prevent drug overdose deaths.
SAMHSA funding to the New Mexico Human Services Department has increased access to naloxone and medication-assisted treatment.
Through partnerships with professional licensing boards, pharmacies, community groups, academic institutions, health systems/hospitals, and a law enforcement training organization, NMDOH and NMHSD support a wide array of activities which address different aspects of drug overdose: reduce high-risk prescribing, improve emergency department reporting of drug overdoses and connections to treatment (including use of peer support workers), expand access to naloxone and medication-assisted treatment, prepare law enforcement and corrections officers to respond to overdoses, train pharmacists on naloxone billing requirements, and provide quarterly feedback reports to New Mexico clinicians who prescribe controlled substances.
Regional health promotion staff and community health councils focus on achieving equity in health, and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. Examples of their work include working with rural and tribal populations to address substance use in schools as well as community strengthening education and capacity, assisting partners to address substance use and its impact on quality of life, teaching youth about their rights to access care (behavioral, and reproductive) which holds promise as a strategy to develop preventive coping skills before substances are sought to escape the stress, trauma, or unhealthy relationships, and developing databases and maps exploring issues of substance use.
SummarySubstance use is a major public health issue in New Mexico. The major problems are excessive alcohol consumption resulting in the nation's highest alcohol-related death rate, and drug use resulting in the 12th highest overdose death rate nationally. The consequences of substance use constitute a huge burden on the state's economy as they are most prevalent among working age adults (20-64 years), disproportionately affecting men and the American Indian population. The New Mexico Department of Health's current efforts are focused on maximizing the use of the New Mexico Board of Pharmacy Prescription Monitoring Program, developing local responses to the prescription opioid and heroin epidemics, rigorously evaluating laws, policies, and regulations that have been recognized as "best practices" by both governmental and non-governmental public health authorities, and increasing the sharing of public health and public safety information with the goal of blocking access to diverted opioids and illicit drugs. Further strategies are being contemplated to address the substance use problem in New Mexico and limit its consequences.
Sources: NMDOH BVRHS, UNM GPS Program, CDC WONDER for U.S. data
Sources: NMDOH BVRHS, UNM GPS Program, CDC WONDER for U.S. data
Sources: NM HIDD, UNM GPS Program
What is Being Done?
- Enhancing the use of the New Mexico Board of Pharmacy Prescription Monitoring Program.
- Contracting multi-disciplinary work groups in high-burden communities to develop local responses to the drug overdose epidemic.
- Conducting rigorous evaluations of New Mexico laws, policies, and regulations that have been recognized as "best practices" by both governmental and non-governmental public health authorities.
- Increasing the sharing of public health and public safety information with the goal of blocking access to diverted opioids and illicit drugs.
- Increasing the use of medication assisted treatment
What Needs to be Done?
- Decrease alcohol outlet density in key areas.
- Increase alcohol screening and brief intervention in clinical settings.
- Increase the price of alcohol.
- Decrease alcohol sales hours.
- Encourage prescribers to adopt non-opioid based approaches to chronic pain management.
- Enhance the co-prescription, training, and dissemination of naloxone.