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home : opinion : e-opinion March 23, 2019

1/27/2019 6:01:00 AM
Opioid Epidemic: A Mental Health Problem
From 1999 to 2017, more than 700,000 people have died from a drug overdose.Around 68% of the more than70,200 drug overdose deaths in2017 involved an opioid.In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999.On average, 130 Americans die every day from an opioid overdose.
From 1999 to 2017, more than 700,000 people have died from a drug overdose.

Around 68% of the more than
70,200 drug overdose deaths in
2017 involved an opioid.

In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999.

On average, 130 Americans die every day from an opioid overdose.

Wayne Howard
Staff Writer

I have no medical training.  I'm not a doctor or nurse, nor a paramedic, nor a law enforcement officer.  I did work for over twenty years in a drug store and as a certified pharmacy technician helped on occasion to fill prescriptions for pain meds including opioids.  

I am a reporter, and as such, I am prone to question things.  I have followed the developing opioid crisis for many years, and I have come to a conclusion that to me makes sense: the Opioid Epidemic is a mental health problem.

I believe that almost everyone knows that opioid addiction is a major issue in our area.  In 2016,  Castlight Health reported that the Hickory area ranked #5 in the US in opioid abuse.  In 2017, Gastonia City Councilman Robert Kellogg organized an Opioid Roundtable at which NC Attorney General Josh Stein was joined by the chiefs of police of the Gaston County and Gastonia police departments, health officials including those from public health and CaroMont Regional Medical Center, numerous church and other civic leaders in talking about the growing problem.  In May of last year, Lincoln County Commissioners joined in a lawsuit against opioid manufacturers.

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According to the NC Department of Justice, “every day, four North Carolinians die from a medication or drug overdose. Since 1999 the number of drug poisoning deaths in North Carolina has increased by 440%."

According to the Centers for Disease Control, in Lincoln County there were 115 opioid prescriptions per 100 residents in 2016.  

The NC Dept. of Health & Human Services says that in 2015, Lincoln County had prescriptions that allotted 88.4 opioid pills per resident; Catawba County had 94.8; Gaston County had 93.9.

Prescriptions for opioids per resident (2015) were 1.252 in Lincoln, 1.255 in Catawba, 1.292 in Gaston, and 1.322 in Cleveland.

President Trump proclaimed that the opioid problem is now a national emergency.  The President also claimed that the opioid crisis “is a worldwide problem.” It isn't. Throughout Europe and other parts of the world where opioids are readily available, people are not dying at comparable rates to those in the US.  This is largely because addiction is treated there not as a crime but as a public health problem.   

At that Gaston County Opioid Roundtable both Chief Robert Helton and Gaston County Chief Joseph Ramey agreed, "we can't arrest our way out of this problem."

CBS News has been running a series of stories about the Sacklers, the wealthy family who are being sued by the state of Massachusetts along with Purdue Pharma, the company that produced oxycontin, one of the most potent and problematical prescription opioids.  

There have been numerous reports about doctors and some drug stores who have overprescribed or legally distributed copious amounts of prescription opioids.

North Carolina, as well as some other states, has passed legislation over the last two years, to try to curtail the over-prescribing of opioids; but this reporter wonders (along with many others) if that's really addressing the 'illness' or just treating the symptoms--and if some of what's been done might actually not be a good idea.  I fear that limiting prescribing opioids for chronic pain runs a risk of harming patients with severe chronic pain without doing much to stop addiction.

In recent years, the opioid fentanyl, which produces a heroinlike high but is considerably more potent, has added to the problem.  Some opioid addicts turn to heroin because it's often easier to get and costs them much less than legal opioids.  Heroin is sometimes adulterated with fentanyl, which can be fatal for unsuspecting heroin users who think they're using heroin alone.

In several European countries, free anonymous drug-purity testing services are offered. If a sample contains adulterants, users are informed. Law-enforcement should do similar testing whenever they confiscate street drugs, and then notify the community whenever potentially dangerous adulterants are found. 

In Germany, Switzerland, the Netherlands, and Denmark, opioid treatment sometimes includes daily doses of heroin, given to addicts to keep them from buying street drugs, along with treatment for medical and psychiatric issues. Some of these addicts hold jobs, pay taxes and live productive lives.

I was especially impressed with information provided at Friday's meeting related to smoking cessation classes being offered by Atrium Healthcare in association with Lincoln County EMS.  That program, scheduled to begin in February, is one of two avenues for quitting smoking that were mentioned at the meeting.  

Barbara Hallisey with Partners Behavioral Health Management told the group that close to 90% of those in treatment for Opioid Use Disorder report smoking. This is many times higher than the general population (< 20%).

"There is now convincing evidence that successfully quitting smoking improves long-term recovery rates for other substances," she said.

"The Gaston-Lincoln Medication Assisted Recovery Services (MARS) Project funded through a federal SAMHSA grant (September 2018 through September 2021) will be addressing tobacco use and promoting smoking cessation through counseling and other supports. Tobacco and nicotine use disorders will be addressed and treated by MARS (Medically Assisted Recovery Services) programs under this grant as an additional activity designed to promote improved health and recovery outcomes, as there is strong evidence of a high correlation between improved rates of recovery for individuals who successfully quit smoking. Nicotine is recognized as a primary gateway drug that perpetuates activation of addictive neural pathways."

While quitting smoking may help some addicts or help deter others from becoming addicts to opioids as well as tobacco, I am still convinced that the underlying problem with opioid addiction (perhaps with most addictions) is a mental health issue.

One of the reasons we have had limited success in dealing with the Opioid Epidemic is that far too many of those who aren't addicted don't recognize addiction as a health problem--but as one of character.  There is an abundant tendency to blame addicts for having made bad choices and a tendency also to believe that they can reverse their addiction by repenting for their failures not to resist temptations.  Unfortunately, this attitude is most prevalent in the religious community--to whom, were it not so, addicts could turn for help through a perplexing problem

As for addressing the problem, it may be most helpful to begin by trying to understand how and why it developed.  

Not everyone who takes prescribed opioids temporarily for pain becomes addicted.  You may have seen one of those billboards that compares giving pain medication to children to giving them heroin. It was a few years ago, but a National Survey on Drug Use and Health said that most opioid misuse started with people using medication that wasn’t prescribed for them. One 2015 review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.

Two-thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes.  At least half of people with opioid addictions also have a mental illness or personality disorder.

For addicts, many of whom are still fully functioning members of society--holding jobs, raising a family, going to church--the stigma of addiction and the attitude of 'you did it to yourself' is made even more difficult because of the similar (perhaps worse) stigma associated with admitting to a mental problem.

Recently, the availability of the drug naloxone has become widespread among medical first responders and law enforcement.  It has helped to save lives; but when people overdose on opioids and are revived,  the experience is far from pleasant. Naloxone (also known asNarcan), the antidote that reverses the deadly effects of the drugs instantly ends any lingering opioid high, replacing it with the fear, anxiety and nausea of withdrawal. While in this distressed state, it’s nearly impossible not to realize the closeness of death and the damage addiction can do.

That makes it an ideal time to offer treatment, especially since without it, many will overdose again. The hours or days people are hospitalized after overdose are perhaps the best opportunity to start people on maintenance medication. Such treatment not only relieves withdrawal but also cuts the overdose mortality rate by 50% or more. Maintenance is the indefinite, possibly lifelong, use of opioid drugs like methadone, buprenorphine (Suboxone), etc.  No other treatment--including inpatient rehab and 12-step programs--has been found to have its life-saving impact.

Instead of treating overdoses and addiction as health problems, we have far too often 'treated' them as criminal problems.  Some who overdose are arrested for drug possession or on prior drug-related warrants when law enforcement accompanies the ambulance that responds. From the hospital, they’re sometimes taken to jail, where withdrawal may be left untreated, sometimes with deadly consequences.

We also need to educate the courts on handling drug problems differently.  Simply referring those who are convicted of offenses to rehab programs isn't working.  They sometimes don't go--and the real problem that precipitated their crime is often never addressed.

I am hopeful that the efforts of the Substance Use Coalition will bear fruit--that we will have a positive impact on reversing the opioid problem and perhaps also the methamphetamine problem that is equally present in our area.  

We (and the community) must do more than just talk about it.  If we don't (pardon my language here), we'll just be farting in the wind.

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You may have noticed an editorial difference between the Lincoln Herald and area newspapers.  Rather than share opinions published by other newspapers across the state or around the country, we are never shy about expressing our opinions.  We also welcome the opinions of our readers from our service area (Lincoln, Catawba, Gaston and Cleveland counties) and gladly publish letters to the editor and guest columns on current issues.  We consider it an important part of providing the best local coverage to our readers.

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Reader Comments

Posted: Friday, February 22, 2019
Article comment by: Mark Beam

Wow Wayne that was a great article that was spot on.

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