Regional Experts Address Opioid Crisis, Addiction, & Public Policy In New Month-Long Series

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The opioid epidemic has become a crisis not only impacting the country, but close to home as well with 1,268 people overdosing in Virginia, and nearly 500 of those deaths caused by prescription opioids.

While there have been state-wide efforts to curb the problem, addictions and fatal overdoses remain on the rise, up 35 percent in 2016 from the previous year. The Ache of Addiction Lenten Series aims to address the current state of the opioid crisis battling the nation, how it came to be, solutions, and treatment in a nine-session series, which kicked off Wednesday.

Addiction series graphic

Last November, Virginia Health Commissioner Marissa Levine announced a public health emergency. This was partly in response to the REVIVE RVA regional opioid summit held last October to identify the road to recovery.

“2016 was a record-breaking year, unfortunately, in terms of the number of deaths and also the significant increase of people in the ER with overdoses,” said Levine.

Levine also placed a standing order on naloxone in 2017, allowing public statewide access to the opioid antidote at nearly any pharmacy or local health department. “We were at the point that on any given day, three people {were} dying from drug overdoses in Virginia and dozens of people every day showing up in emergency departments statewide with drug overdoses,” Levine said. “That was about a 40 percent increase from the year before, and almost a 75 percent increase (in terms of deaths) compared to five years earlier.”

The talk series will examine this relation from public understanding of addiction as well as any hope of ending the most devastating drug crisis in American history.

Dr. Danielle Dick, a professor of Psychology and Human & Molecular Genetics at VCU will discuss what causes addiction. “Historically there is a lot of strong feelings about what causes addiction, whether it’s a moral deficit, a choice, especially in recent news with the opioid crisis,” Dick said.

Aside from the stigma of lacking morality, addiction is well known in the scientific community to be a genetic predisposition, yet this fact falls short with the public.

Dick stressed the gravity of environmental factors. “Genetic predispositions affect one’s likelihood to develop problems and essentially is a part of the story; we’re not all equally at risk, so how you think about environments can impact who’s going to develop problems or not.”

And this understanding was well received by other officials. “All of us, we’ve looked at it like this illegal choice that we make. And because you’re committing a crime, you’re less of a person,” Levine said.  “According to an article released last year by the CDC, it only takes 3-5 days of taking a prescribed opiate to become addicted, and the longer after that- the higher the probability.”

Fellow speaker, Dr. Mishka Terplan will go over the history of the opioid crisis, as well as the impact upon Virginia. “I am going to highlight the tension between the awareness that addiction is a chronic disease and a public health- and the reality that every 25 seconds someone is arrested for a drug crime in the US,” Terplan said.

The stark rise in opiate usage in the US began with prescribed morphine pills in the 50s and 60s, only to be further complicated with the beginning of the Vietnam War in 1955 setting a precedent of misled conflicts, left many to navigate foreign land and a lampless sea of illicit drugs, forsaken in their search for solace.

The continued War on Drugs through present day saw itself repetitively revitalized through times of internalized conflict, causing American society to further splinter upon grounds of moral ideology and misinformation.

Fast forward several years after the ‘opioid-phobia’ of the early 80s with the advertising of Oxycontin; a seemingly benign prescription opioid produced by Purdue Pharma, with a famously speculative ad marketing campaign housed around biased journals and proficient lobbyism to back.

For many with chronic pain, this was the elixir they had hoped for. Intractable pain regulations began sprouting across numerous states, doctors were not only given the green light for prescribing, it became their unspoken duty; though the true nature of these drugs was gravely misunderstood.

“As physicians, we really thought, based on the information that was provided and some of the early science, that some of these medications were benign and worked really well for pain, and the truth is, as we’ve gotten better evidence- they’re not benign, but addictive,” Levine said. The harm resulted was much worse than the benefit.”

While advertising for drug promotion flourished, the mid-80s through the 90s, in contrast, was littered with inept anti-drug advertising that pushed youth into a generation of amoral culture.

Many individuals in need of pain management became addicted, castigating a wide margin of society into the shadows of amoral deviancy, people overnight labeled criminals. Pharmaceutical companies like Valeant and Turing functioned practically as model hedge funds, price gouging their products, targeting insurance companies, and inducing a medical fallout that still leaves many in need of medication under the gun, despite congressional ‘intervention’.

This wildfire of excessive lobbyism from pharmaceutical giants are what Mike Zohab, upcoming speaker, and retired Richmond police captain, said was to blame.

“Lobbying is legal bribery,” he said.

After 29 years of service to Richmond, Zohab continues his efforts to provide treatment options for those addicted to opiates, extending an olive branch to those he was once ordered to incarcerate. His talk- highlights the role of law enforcement in this effort. “Ideally, the role of law enforcement is to get people that need help to where they can receive help,” he said.

In 2016, Zohab started Virginia Recovery Foundation, a grassroots campaign turned a non-profit treatment group with a 40 percent placement rate. Their tactic- operating along the “overdose” grapevine. “We go to hospitals and talk with people about seeking treatment, ask if they have a stable home, food to eat. It’s all word of mouth; their response narrows down what’s available for them.”

But it can be complicated work. “Just because someone overdoses, doesn’t mean they’re ready for help,” he said. “Eventually, some hospitals stopped letting us come in, only offering out our information upon discharge. Which is crucial, because when an individual is asking for help, they can leave that point really quickly in the hour it takes to be discharged. And instead of going to treatment, they’re going to score another hit.”

According to a cost-analysis conducted by Zohab, mass incarceration is not a solution but a barrier: “When a cop arrests you and processes you through court, it’s about $9,000 dollars. All you’ve done is convicted the individual of a felony and done nothing to heal their medical issues. Wouldn’t it have made sense to put them through some mandated treatment, it costs a fraction of the price? Once you incarcerate them, the government is responsible for all their medical issues, and that adds up quick.”

“Jails are not hospitals, and that’s where we have a huge failure in the American system. We are incarcerating people who need psychological and substance abuse treatment.”

In Richmond, rates of opioid usage have skyrocketed since 2013, reaching an estimated 1,458 by the end of 2017. According to a quarterly report published by the Virginia Department of Health and Office of the Chief Medical Examiner, fatal drug overdose has been the leading method of unnatural death in Virginia since 2013 and the leading method of accidental death since 2014.

Yet prescription drugs are no longer rising. Prescription pills are mandated much more effectively, yet overdoses continue to rise. This change of tide marked a shift in 2016 especially; the addiction machine setting its sights on another market- fentanyl-laced heroin.

“This is a time where heroin started showing up at increasing rates since we were so focused on working to decrease the number of prescription opioids that were available to people. As we did that, the marketers, the economic engine of the addiction world took and introduced cheap heroin,” Levine said.

As a way to increase profits on heroin, much of the heroin smuggled into the state is laced with fentanyl, making it far more potent yet undetectable to an untrained eye. Originally approved by the FDA for usage in 1959 under the pretense for anesthesia and severe pain, the drug fentanyl stayed relatively under the radar, having a brief spike in the early 90s until beginning its rise in 2013.

“Drug use in this country is cyclular, we have the pain pills then we go up to stimulants, cocaine has tripled in the past 18 months, heroin is still on the rise, I mean these guys are in the business of making money,” Zohab said. “Truth be known, there’s no magic solution here or we wouldn’t be talking.”

And according to Terplan, addiction treatment is quite the lucrative route in the eyes of policy reform. “Addiction can be treated, successfully. In fact, outcomes from addiction treatment are similar between hypertension, asthma, and diabetes. However, most individuals with addiction do not receive any treatment, only 11 percent of Americans with addiction receive treatment,” Terplan said.

Terplan also spoke of recent policy reform in the state. “Last year the passage and implementation of ARTS was huge as it greatly expanded available treatment in the state,” she said. The state offers naloxone and overdose training for free with REVIVE! Training. Along with basic response training, REVIVE! provides a basic understanding of opioids, how overdoses happen, and risk factors involved. Other programs include those operated by VCU, like Rams for Recovery- a collegiate recovery program offering a haven for many students who succumb to the pressures around them. According to Tom Bannard, Program Coordinator for the group and upcoming speaker, this is a program essential to every college campus. “College campuses are recovery hostile environments,” he said. “It ultimately results in individuals being blamed for when they struggle because you’re asking broken people to navigate a broken system.”

Bannard also pointed to several alternatives to consider, including safe injection facilities, while remaining unphased in his description of the war on drugs: “It would be really {hard} to convince me that war on drugs was not a complete failure. It’s totally uncompassionate, it’s ineffective, it’s destroying people’s lives.”

Ashley Morgan, an adolescent psychologist, and upcoming conference speaker will discuss the opioid crisis’ impact on Richmond from a family perspective- and the effect on teenagers.  “It’s become a family problem. “We’re not giving them a forum to have open conversation. To say don’t do it- They’re already doing it. ”

According to Morgan, we also need to take into account the credibility of both our physicians and health professionals. “When you go into med school, you may take a class or two, but once you go into your specialty, they’re not adequately trained on the pharmacology; unless they’re involved in the research.”

Despite signs of growth, Virginia is still relatively low in resources allocated for treatment, a problem Morgan further eludes upon. “There are very few effective treatment programs here in Richmond, I do believe the community at large is looking to make improvements, but the funds backed by our government are just not there,” she said.

What she offers instead, an alternative to expand coverage across the state. “If we put the money into adequate rehabilitation services that operated on sliding scale fees, where the low-income individuals could qualify for state insurance, and the lower middle class- with little to no help on coverage- could get help,” Morgan said. No area of our society is inclusively bad, simply flawed. Every facet increasingly diverse, but so is the culture that defines us. As Morgan perfectly summarized: “We have to have read deal conversations about prescription painkillers and their impact.”

Whether directly or indirectly it affects us all, the first step in change is understanding the societal impact of addiction. Amidst a national crisis, Virginia looks to embark on change; through education.

The next talk in the series will be Terplan’s Do Less Harm: Public vs Punitive Health Feb. 28 at 7 pm at St. James Episcopal Church. 

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