Cris Alarcon, Publisher] A series on Opioid use in the U.S., how it happened, and what we are doing locally to respond. Including interviews with local health professionals, law enforcement, and recovered addicts.
‘Clear and Present Danger’
91 Americans die daily from opioid overdose.
The year of 2016 marked the first year in history that death related to opioid overdose has grown larger than deaths from car accidents, with more deaths from heroin alone than from homicides.
Generally, opioid addiction appears to be an American problem. Painkillers prescriptions in America grew from 76 million to over 200 million in the decade following 1991. Opiates are a class of strong painkillers such as Vicodin, Percocet, Fentanyl, OxyContin, Oxycodone, and includes Morphine and Heroin.
Although there was an increase in the use of painkillers, the amount of pain reported in the United States has not changed.
To remedy the rapid increase in the use of opioids, the U.S. government started cracking down doctors and pharmacists who were over-prescribing opioid painkillers. In 2014, the DEA reclassified some opioids as a more restrictive drug. A direct result of this is more stringent rules and regulations surrounding opioid prescriptions, requiring a written prescription from a medical professional for every refill.
In March of 2016, the Centers for Disease Control and Prevention released new guidelines for doctors prescribing opioids to limit the circumstances, quantity, and duration of any prescriptions they give to patients. Not only did this make it harder for someone using opioids for medical purposes to abuse them, by restricting the flow of opioid-based medications into our communities the result should be the decreased number of these pills that are available to sell on the streets.
However, as doctors tried to cut down painkiller abuse, some patients could not be prescribed opioids. An unintended consequence of the tightening of the prescription drug supply has led some users to turn to illegal heroin and other addictive drugs.
The “New” Who — Rural, White, Working
Gone are the days when heroin was an inner-city minority problem. Overdose and addiction victims in the U.S. are mostly the white and working class. As a percentage of the national population, people living in rural areas are the most affected by opioid epidemic.
A recent survey in Utah found out that nearly 80% of heroin users got into the habit following a prescription medication.
When Matt was little, (his mother) Kelly was a Head Start caseworker who patiently taught parents how to manage their autistic children. She loved hosting potlucks with friends and playing Barbie with Matt’s sister, Brianna. There was always music: Tchaikovsky when Kelly was at the piano, or Jimmy Buffett blasting through the speakers while she cooked. “Growing up, we were the house that everyone wanted to come to,” remembered Brianna, now 20. “I loved every minute of it.”
Then Kelly had neck surgery and got addicted to OxyContin. By 2015, she was spending her days napping, disappearing for hours at a time, or going to her neighbor’s house, where she would exchange cash for packets of heroin. She started yelling at the kids, letting the fridge go empty and the house lapse into a den of cigarette butts and dirty dishes. “It’s like her personality did a 180,” Brianna said. “I felt like I lost my mom to this pit that I couldn’t pull her out of.”… [JULIA LURIE]
A New Drug War
According to the DEA, “overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels.” For instance, in 2015, there were more than 50,000 deaths in America related to drug overdoses. About two-thirds (33,000) came from opioids. This is in comparison to 16,000 deaths in 2010 and 4,000 in 1999.
The main suppliers of heroin in the United States are Mexican transnational criminal organizations. The production of heroin in Mexico grew by over 600% in four years starting from 2009. In reference to the DEA, distributors and smugglers put the drug on the streets and have become very important to the Mexican cartels.
The director of Centers for the Diseased Control and Prevention, Thomas Frieden, stated that America is awash in opioids, and called for urgent intervention. It is expected that Donald Trump will set aside $500 million in 2017 to deal with opioid addiction. A commission to combat opioid addiction has already been established.
Funding the War on Opioids
It is easy to understand why, when Donald Trump promised on the campaign trail to “spend the money” to confront the opioid crisis and build a wall so drugs would stop flowing in, his message resounded. In 2016, Trump became the first presidential candidate since John F. Kennedy to visit Ashtabula County Ohio where the crisis is most intense. He promised to bring back jobs, to open the long-shuttered steel plants, to build the wall. Twelve days later, Ashtabula residents voted for a Republican president for the first time since Ronald Reagan in 1984.
But some now say that Trump’s plan to tackle the epidemic head-on may have nodded off. Trump’s 2018 budget proposes substantial cuts to the Administration for Children and Families, the Substance Abuse and Mental Health Services Administration, and the Temporary Assistance for Needy Families program.
Children of the Opioid Epidemic Are Flooding Foster Homes
A disturbing national trend has emerged: Largely because of the opioid epidemic, there were 30,000 more children in foster care in 2015 than there were in 2012.
The exponential growth in the number of people with addiction to painkillers and heroin, has produced a flood of stunned children who, having lost their parents to drug use or overdose, are now living with foster families or relatives. Often, the kids marvel at how quickly everything changed—how a loving mom could transform, as one teenager put it, into a “zombie.”
“I can’t remember the last time I removed a kid and it didn’t have to do with drugs”
About five years ago, CPS caseworker Mongenel noticed an uptick in the number of parents using heroin. “I used to get really pissed off at people—like how could you just let me take your kids and then go on a bender?” As she’s learned more about the parasitic way that opioids co-opt the brain, her attitude has softened. Unlike sex abuse or severe physical abuse cases, she said, there is no good guy or bad guy. “You keep thinking, ‘Without the drugs, what would they be like?’”
In Texas, Florida, Oregon, and elsewhere, kids have been forced to sleep in state buildings because there were no foster homes available.
Many in the Medical Profession now take this Position:
Let’s be clear: approximately 75 percent of heroin users started on the road to addiction with prescription drugs. Let’s change the conversation with patients from a footnote that prescription opioids can be dangerous if abused, to a frank discussion about how prescription opioids and heroin affect the brain and body in the same way.
Let’s tell patients and their family members that the majority of people who become addicted to prescription opioids were not engaged in drug-seeking behavior or recreational use, and were simply taking a medication to relieve pain as prescribed by their physician.
Let’s use opioids when they are the only option or for palliative or cancer care. Let’s be appropriately afraid of prescription opioids and treat them like the lethal drug they can be.
How these National Trends affects us here Locally
Statistically, our county should be highly impacted by opioid abuse. We are Rural with a predominantly White, Working-Class population. We have an older-than-average population and with many of the children in our schools being care taken by grandparents and foster parents…
Next in this series: Dr. John Bachman talks about the impact of opioid abuse on local health facilities and how they are responding.
[John Bachman, PhD received his doctoral degree from the University of California, San Francisco and has served as the the El Dorado County Mental Health Director before becoming behavioral health director at the El Dorado County Community Health Center, where he provides integrated behavioral healthcare services.]
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