How the War on Drugs Has Changed Tunes

The Ann Arbor District Library had a Bright Nights Community Forum talk on Tuesday, 11/15/16, entitled: An Opioid Crisis in Washtenaw County: What Can We Do? by Stephen Strobbe, PhD, RN, NP, PMHCNS-BC, CARN-AP, FIAAN at the University of Michigan Department of Psychiatry. He also served as the moderator for the panel discussion that included members of the community:

Back in the 1960s, the US began the "War on Drugs." This served to criminalize drug addiction and increased the number of incarcerated Americans which disproportionately affected African Americans and Latinos/Hispanic. Some are still incarcerated from the 1980s. During this epidemic, the drug of choice that led to alarming rates of incarceration was crack cocaine.

Addiction has continued to ravage communities. Today's drug or substance of choice is opioids and they often come directly from one’s primary care physician.

Substance Abuse and Mental Health Services Administration (SAMHSA) has provided multiple definitions for substance use disorder. According to Wikipedia, opioids are substances that act on opioid receptors to produce morphine-like effects. Opioids are most often used medically to relieve pain.

From 1999 to 2014 the number of opioid related deaths has quadrupled to a staggering 165,000. These are people. Who have died. From opioids.

The number of deaths caused by opioid overdoses was approximately 48,000 in 2015 at a rate of approximately 129/day or 5/hour, and that figure has doubled over the last year. This number exceeds that of deaths caused by motor vehicle fatalities. During the 90-minute talk on Tuesday, about 10 people died due to this national issue. Because of how widely prescribed these pain medications are to patients, for example in 2012 alone there were 259 million prescriptions for opioid pain medications, presently there is enough prescription pain medications for every adult in the United States to have their own bottle of pills!

The 19th United States Surgeon General, Vivek Murthy, MD, MBA, wrote a letter to other physicians: "I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. It is important to recognize that we arrived at this place on a path paved with good intentions. The results have been devastating." The letter in its entirety can be found on turnthetiderx.org, and Murthy told physicians he understood their desire to keep patients out of pain. In March 2016, the Centers for Disease Control (CDC) came out with a report that has provided a more well laid plan for prescribing opioid medications which has changed a lot of provider practice.

Initially, as Murthy suggests, providers prescribed medications suggested by pharmaceutical companies for pain relief. Years ago, these companies lied and said that these medications were not addictive. We have since learned differently, which can be explained through this balanced and interesting perspective on the opioid epidemic from John Oliver (warning: explicit language). See the potency of opioids below and how these numbers have an impact on the ones who use and may end up becoming addicted to these medications. Carfentanil was made to take down large animals such as elephants; thus it's sad that it is available, albeit illegally, for human use.

Opioid potency:

  • Carfentanil: 10,000x

  • Fentanyl: 100x

  • Heroin: 2x

  • Morphine: 1x

Many providers will use a tool called a morphine calculator which is helpful in developing a treatment plan for patients.

Washtenaw County uses the Project Lazarus Model:

This holistic model looks at the entirety of this epidemic and even delves into non-opioid pain relief and alternative therapies like yoga, physical therapy and mindfulness. For its own part, Washtenaw County has trained over 400 community providers to use naloxone including the University of Michigan Police Department, University of Michigan Security, Ann Arbor Police Department and Washtenaw County Sheriff's Office.  Naloxone, whose brand name Narcan among others, is a medication used to block the effects of opioids, especially in overdose. Fifty lives have been saved in Washtenaw County as a result of implementing this plan to use naloxone. Funding for this particular medication as treatment for substance use disorder is provided through a Block Grant and the Affordable Care Act.

When a member of the emergency medical services (EMS) or police comes on scene of an overdose, they have the training to administer naloxone and the knowledge to contact outreach workers, members of the recovery community who help the sufferer start the journey to recovery. They will transport the overdose victim to the hospital and give him or her the option to go to treatment or rehab at places like Dawn Farm or Home of New Vision. Today, deputies work proactively to help people addicted to drugs, unlike in the past.

Aaron Doyle, one of the panel participants, was one of the 50 people saved in Washtenaw County. He needed two naloxone doses. While in the hospital, his lab results showed fentanyl and cocaine in his system. As was previously stated, fentanyl is 100 times stronger than morphine. He thought he had just used heroin intravenously. He is currently in recovery utilizing the SMART Recovery system, which has worked for him for the last year.

To answer some questions about naloxone: It is not possible to overdose or get addicted to the medication. If too much of the medicine is administered, a common side effect can be GI upset (nausea, vomiting and diarrhea).

Now that the understanding about opioid addiction is that it is a disease which often includes, but is not limited to the the following symptoms: strong desire for opioids, inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, withdrawal symptoms with discontinued use, we are in a unique position to help sufferers of this disease as we were not able to decades ago with the crack cocaine epidemic. Opioid abusers can become empowered in ways that they could not or would not previously and that can lead us to hope, a feeling of expectation and desire for a certain thing - recovery - to happen.

Washtenaw County has been more successful than other communities in their recognition and admission that opioid addiction is a disease. It is clear that their desire to provide sufferers with compassion, short-term treatment via naloxone to possibly reverse opioid overdose and long-term recovery treatment and support is the foundation from which providers, first responders and rehabilitation facilities operate. This is imperative and encouraging because as one wise panel member interjected poignantly, “People cannot recover if they’re dead.”

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How to get involved:

  • Washtenaw Recovery Advocacy Project (WRAP) and any of the number of activities and/or advocacy work they do.

  • Reading recommendation: Dream Land by Sam Quinones about the opioid epidemic in Mexico

  • Reading recommendation: Huffington Post blog post by Greg Williams, filmmaker and recovery advocate.

Resources:

 

 

 

Questions to continue the conversation:

  • How can I help a loved one who is struggling with opioid addiction or alcoholism?

  • Are there resources for me as one who has a family member or friend who is struggling with opioid addiction or alcoholism?

  • What can I do to help with the disease of alcoholism and/or addiction?

ArticlesChidimma Ozorwar on drugsComment