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CLOSING RANGE DAVE SKINNER ECOLOGICAL AUTHENTICITY
GUEST COLUMN PATRICE A. HARRIS & N. CAMDEN KNEELAND
PUTTING A STOP TO
THE OPIOID ABUSE CRISIS
HE OPIOID EPIDEMIC CON- instructed, to safely store and dispose fronting the nation is leaving few of unused medication, and how to rec- areas untouched, including here ognize signs of a potential substance use
WANT A BREAK FROM MON- tana’s timber woes? OK!
In late July, the Ameri- can Association for the Advancement of Science (AAAS) published a signif- icant paper by a nine-person team on “Whole-genome species analysis” of wolf DNA. Big news? For some – really, really old news to others.
Turns out gray wolves are, yep, mostly wolves, nonetheless with about 8 per- cent coyote. But other “wolf-like canids” were, as the scientists put it, “gener- ated through admixture.” Red wolves, listed under the Endangered Species Act (ESA)? 80 percent coyote. Mexican wolves? 85.8 percent! In plain English, mutts!
Upon reading the news, I ashed back to a multi-year wolf/coyote hybridization experiment being conducted by L. David Mech, PhD, without question America’s top name in wolf science. I contacted Dr. Mech for an update. He replied: “The hybrids reproduced when 1 years old. I am currently writing this up for publication.”
Well, duh. It’s a pretty basic fact of biology that animals of the same species breed fertile o spring, while related spe- cies give sterile o spring. Rainbows and cutthroats? Fertile cutbows. Donkeys and horses? Sterile mules.
I then chased down my copy of the new genome paper. Amazingly, and to everyone’s credit, AAAS and the authors (led by Princeton evolutionary biolo- gist Bridgett M. vonHoldt), made the full 14-page paper in Science Advances freely available.
Dr. vonHoldt’s whole-genome team builds on a prior 2007 genetic analysis of o spring from the 1994 Yellowstone wolf reintroduction. Aside from the deep detail, the “vonHoldt 2007” team concluded successful re-introductions should have a large and diverse popula- tion of founders, and furthermore, “given the choice, wolves avoid breeding with close relatives.”
The “vonHoldt 2014” team sequenced 28 genomes from a “diversity of large canids” to get their over 5 million “SNP” data points, an epic feat.
Making matters more interesting is the emergence of two warring academic camps in wolf genetics. As Jens Hegg, PhD candidate at University of Idaho blogged, one faction is the “2-species” gang, believing “canids” (wolves and coyotes) came over the land-bridge from Eurasia several times during the Pleisto- cene (Ice Age).
The “3-species” gang believes a canid
species originated in North America, then land-bridged to Eurasia, evolved sig- ni cantly into wolves, then the evolved wolves land-bridged back to North Amer- ica. In the meantime, the canids that stayed turned into red wolves, Mexican wolves and coyotes, while almost too con- veniently remaining distinct from re-in- vading wolves – and, of course, “distinc- tion” is hugely critical for Endangered Species Act listings.
Trouble brewing? Yep. Hack- les up, I contacted another high-pro- le researcher, PhD biologist Rob Roy Ramey. Dr. Ramey is a scienti c here- tic, hounded in 2006 out of his position as curator of vertebrate zoology at the Denver Museum of Nature and Science because his genetic tests concluded in 2003 that the so-called Preble’s meadow jumping mouse (on Colorado’s booming Front Range) was improperly protected under the Endangered Species Act in 1998.
Well, other researchers found in 2013 the “Preble’s” mice were “part of a single lineage that is ecologically indistinct and extends to the far north” – as in Alaska, to New Mexico, and east to Georgia. This lineage of “meadow jumping mice” fur- thermore is ranked by the International Union for the Conservation of Nature as “least concern” – vindicating Ramey.
After a brief warm-up, Dr. Ramey pointed me at the “Conservation Impli- cations” section of vonHoldt 2014: Even though the researchers found “admix- ture” all across America, the kind that would render wolves/coyotes anything but endangered or threatened pure- breds, the authors declare “[t]he overly strict application of taxonomy to support endangered species status is antiquated,” a “Victorian typological concept.”
The vonHoldt team therefore sug- gested the ESA be “interpreted in a mod- ern evolutionary framework.” Policy could therefore “follow the ‘ecological authenticity’ concept, in which admixed individuals that have an ecological func- tion similar to that of the native endan- gered taxon [...] warrant protection [under the ESA].”
Ecological authenticity, explains Ramey, is “a really bizarre conclusion, counter to all logic,” but perfectly sensi- ble if researchers want to “protect their funding streams, prestige and power.” Bad? Yes, but worse, Dr. Ramey points out: “We have so many bona de, unique species, example elephants and rhinos, which truly deserve conservationists’ full attention and resources.”
in Montana where families know too well the tragic e ects of opioid addiction. Montana’s children have one of the nation’s highest rate of prescription drug misuse in the country; almost 10 percent of youth aged 12 to 17 have reported mis-
using prescription pain relievers. According to the Montana Depart- ment of Health and Human Services, from 2011 to 2013, prescription drug overdoses took the lives of more than
360 Montanans.
That is why the Montana Medical
Association (MMA) partnered with the state’s attorney general and colleagues in the insurance industry to create the Know Your Dose campaign to help edu- cate patients and physicians and other health professionals about ways to reverse this epidemic.
Big Sky Country is a great example of how states – with elected leaders col- laborating with those in the medical community – can develop real-world solutions. As physician leaders, we are unequivocal in saying that we must do what is necessary to reverse this epi- demic, and Know Your Dose provides practice- and policy-related solutions that will make a di erence.
And we are making a di erence.
Although the Montana Prescription Drug Registry could be improved, Mon- tana physicians made 42 percent more inquiries to it in 2015 compared to 2014, checking it nearly 160,000 times. The registry contains helpful information on whether a patient is receiving multi- ple prescriptions from multiple pharma- cies. We need it to more easily integrate into our practices and connect with our electronic health systems, but physi- cians are committed to using it as part of the clinical decision-making process.
Thanks to the MMA and its part- ners, Montana’s physicians can enroll at no cost for a pain management course designed to help medical professionals provide the best treatment for their patients, while preventing them from becoming addicted to opioids. We urge all Montana physicians who prescribe controlled substances to go to knowyo- urdosemt.org and take this course.
Other resources are available at the click of a mouse. The Know Your Dose campaign provides excellent educa- tional resources for patients, physicians and other health professionals, includ- ing resources on managing chronic pain.
Resolve Montana is an educational campaign developed by the state Attor- ney General’s O ce that illustrates why it is vital to use medications as
disorder. Importantly, it aims to reduce the stigma associated with having a substance use disorder by emphasizing the importance of treatment. If you or someone you know has a substance use disorder, talk to your physician today about getting help.
For our part, we understand the tre- mendous national interest in reducing the supply of opioids. We know pre- scribed medications wind up being used by someone other than the intended patient, as more than 70 percent of the individuals misusing opioids are get- ting opioids from other sources, includ- ing friends or family members. From 2013 to 2015, Montana’s physicians have decreased opioid prescriptions by 10.6 percent. Montanans have a proud his- tory of judicious use of resources and are taking that philosophy to how opi- oids are prescribed.
These steps will help reverse the course of the epidemic, but we also must put increased energy into two key places. We need to ensure that our patients with pain receive comprehen- sive – and compassionate – treatment. While the nation’s opioid supply will almost certainly continue to decrease, we need to ensure that we continue to work with our colleagues in the insur- ance industry to provide patients with a full range of evidence-based, non-opioid and non-pharmacologic treatments.
Similarly, patients with a substance use disorder need treatment just like for any other chronic, relapsing medical condition. We would never put treatment limits or prior authorization restric- tions on diabetes care or heart disease, so we need to ensure our patients with substance use disorders have access to a ordable, timely care that does not run out or is nancially beyond their reach.
Another key element to saving lives is for our state to enact laws that increase access to naloxone and provide strong Good Samaritan protections to those who help someone experiencing an overdose. Montana is one of only a few states without naloxone access provi- sions. These laws have helped save tens of thousands of Americans. It’s time for Montana to enact these laws.
Montana has made progress. The state has stepped up to lead a strong, dil- igent ght against opioid misuse, over- dose and death. We must continue the positive trends – and work even harder.
The American Medical Association is proud to support the work of the MMA and other leaders in this critical e ort. The lives of our patients depend on it.
Mike (Uncommon Ground) Jopek and Dave (Closing Range) Skinner often fall on opposite sides of the fence when it comes to political and outdoor issues. Their columns alternate each week in the Flathead Beacon.
Patrice A. Harris, M.D., M.A., is chair of the American Medical Association; N. Camden Kneeland, M.D., is a member of the Montana Medical Association Prescription Drug Abuse Reduction Committee.
AUGUST 24, 2016 // FLATHEADBEACON.COM
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