Opioids–What to Do?

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Tim Dove, Rachel Goss, and Rani Gutting on the panel at the Community Opioid Crisis Forum at Washington College on 25 January 2018 from 1:00-4:00 pm.

A panel discussion Thursday, Jan. 25 at Washington College’s Hynson Lounge brought together some of the key players in the effort to combat the opioid crisis.

Organized by WCTR radio, the panel included Tim Dove, the Local Addictions Authority for Kent County Behavioral Health, Peer Recovery Specialists Rachel Goss and Rani Gutting, Jen Moore of the Local Management Board, Chestertown Mayor Chris Cerino, Police Chief Adrian Baker, and Ginger Gregg of the Kent County Office of Emergency Services. Leslie Sea, general manager of WCTR was the moderator.

Sea opened proceedings by introducing Chrissy Chisholm, executive director of Foundations of Recovery and a recovering addict. Chisholm told how she had become an addict in her early teens on Long Island, ending up in treatment for the first time at age 15. “I had no intention of staying sober,” she said, recounting how she was jailed, expelled from school, and kept relapsing despite all efforts. At age 23, she was still living in her parents’ basement, trying to get through college. She was “barely functioning,” she said. One night, driving in pouring rain to try to get drugs, she ran off the road and crashed. She woke up in the wreck, with airbags deployed, going through DTs. The police put her in the hospital, charged with driving under the influence.  This was the turning point for Chrissy.

Chrissy Chisholm, founder and executive director of Foundations of Recovery and a recovering addict

Finally, Chisholm said, she turned her life over to God and began getting better. She stayed away from her old friends and stayed sober. Moving to Kent County, she began to put her life back together and decided to do what she could to help others do the same. Realizing that recovery is a lifelong process, she opened Foundations of Recovery and Mission House – so others in recovery can support and encourage each other. “I’m tired of watching people die,” she said; “I want to be part of the solution.”

Sea said the opioid crisis has two prongs, street drugs like heroin and prescription pain-killers. She called attention to the sign near the corner of Washington Avenue and Morgnec Road listing the number of overdoses and deaths; “We want it always to be at zero,” she said. She then turned the microphone over to Dove.

Dove said the word that resonated in describing the opioid crisis is “insidious,” especially in terms of its effect on families. “You can’t erase the trauma” of overdoses or multiple trips to the emergency room. He cited the Maryland overdose statistics for 2016, the last year for which there are complete records for the state; 2089 overdose deaths were recorded, he said. That’s the equivalent of all the passengers and crew of five Boeing 747 airliners dying in crashes in one year – and that story would dominate headlines if it occurred in the state. But it is swept under the carpet because of the stigma of overdoses, he said. “We need to work to create sympathy” for the victims of the opioid epidemic – to treat it as a public health issue.

Heroin has been a problem for decades, but it was “a dirty word until it hit the middle class,” often as a result of built-up tolerance to prescription painkillers. When prescriptions for the legal painkillers run out, or the cost gets out of reach, many patients begin to turn to street drugs like heroin to manage the pain. Some of them have a genetic susceptibility to becoming addicts, he said. And that’s when they find themselves dealing with the risk of overdoses. The big killer, he said, is fentanyl, which drug cartels intentionally add to heroin to increase its potency – but which is 100 times more potent than morphine. Carfentanil, another opioid, is10,000 times more potent than morphine.  So it does not take much to overdose.  The amount that would normally just get you high now will kill you.

Tim Dove, Local Addictions Authority for Kent County Behavioral Health 

Dove told about the benefits of Narcan, an easily administered nasal spray that can reverse the effects of overdoses. It’s like a miracle, everyone agreed–almost instantly restoring the person to sobriety.  Those who were unconscious, barely breathing, are suddenly conscious and breathing normally again.

Narcan works on all the opioids, including fentanyl. However, if fentanyl has been used, the recovery may last only a minute or two before the person relapses.  In these cases, Dove said, several doses of Narcan may be necessary, sometimes as many as four or five doses of Narcan.  This is one of the reasons why everyone should call 911 right away when trying to help a comatose person who has overdosed. If the first dose is not sufficient, emergency personnel should already be on the way and they will have more Narcan and other first aid equipment and treatments that may be needed.

Narcan is being distributed to local law enforcement and emergency response personnel and has already saved many overdose victims locally. Dove said anyone wanting training in how to use Narcan can contact him at the Whitsitt Center. It is now available at many local pharmacies.

Recovery is an attainable goal, he said, with a number of treatment facilities in the local area. Many people in respected roles and occupations are in recovery, he said.  All someone needs to do is ask for help. If they’re in the emergency room, they’ll be referred to the Whitsitt Center. He noted the availability of Vivitrol, an opioid antagonist drug that works for a month at a time, attaching to the opioid receptors in the body and preventing the person from getting high; at the end of the month, the patient needs to get another shot. This allows the patient to work on the psychological aspects of recovery. It is being used in the Kent County Detention Center and is available from three private treatment centers in the county.

Chief Adrian Baker of the Chestertown police and Ginger Gregg, emergency planner for Kent County

Ginger Gregg said that 911 teams responding to overdoses first administer Narcan, then deliver the patient to the emergency room, and then, if the patient is willing, take them to Whitsitt Center. But the patient must be willing to go to the hospital, she said. The paramedics will provide information about recovery, but they cannot take the patient in for treatment against their will.

Trish McGee, speaking from the audience, asked how accurate the numbers reported on the sign at the Morgnec Road intersection are. She said the community needs accurate numbers to respond effectively to the crisis. “Getting real numbers is part of removing the stigma,” she said

Dove said it’s difficult to get accurate numbers because different agencies are responding to overdoses. He said the number of patients transported to the hospital is the statistic he places most weight on. But the hospital doesn’t test for which substance is responsible for an overdose, so it’s not always clear whether a patient has been using heroin, fentanyl, or something else. Also, if a local person experiences an overdose somewhere out of the jurisdiction, that isn’t reported.

Gutting said Narcan is saving lives; many of the overdoses would result in deaths without it, she said. She said there were six overdoses the previous week, and she suspected all were caused by fentanyl.

Chief Baker said his department had looked into liability issues before issuing Narcan to officers. Once he was satisfied there would be no problem, he had his officers trained — it took about half an hour. “They were saving lives within a week,” he said.

Mayor Cerino said prescription opioids are a key ingredient of the epidemic. He said he was given an opioid after knee surgery and knows the relief it provided. He said he understands how legal drugs can lead to addiction. As mayor, he said, he is concerned about how addiction leads to crime sprees as addicts need to finance their habits. A few individuals can have a big effect in a small town like Chestertown, he said.

Baker said Chestertown’s reputation as a safe place ironically makes crime easier because people are negligent about locking doors or taking other safety measures. He said a spree of burglaries and break-ins last year was the result of a small number of addicts trying to find cash or things they could sell to get drugs.

Jen Moore of the Local Management Board

Jen Moore said that most clients in recovery programs have been in active addiction for 20 years, while a normal course of treatment lasts only 28 days. Some of those arrested for narcotics-related crimes “relapse before they even get out of jail,” she said. There’s a better chance if they go through long-term treatment. “they need two or three years of recovery programs and treatment to have a chance to get out of it. We need to close the gap between jail and the treatment center,” she said.

Dove said the different local agencies are meeting monthly on the first Wednesday of the month to deal with the epidemic. The meeting, which is open to all, is at the Kent County Commissioners hearing room at 400 High St., at 7:30 a.m.

Rachel Goss noted that there is a focus on reducing the stigma of addiction and offering support.  “We need to talk about it, get the message out to teachers and coaches” and other role models to stop it before it starts. “I met a lot of great people in recovery,” she said.

Moore said it’s far too easy for young people to get drugs. “Doctors will automatically prescribe if you tell them the right symptoms,” she said. “A lot of kids have figured it out before ninth grade.”  They know exactly what “symptoms” to tell the doctor in order to get the drug they want.  And then they tell other kids what to say in order for them to get drugs, too.

Goss said young people are exposed to drugs before they’ve developed coping skills to deal with the problems they face. She said she started using drugs and alcohol when she was 12. “The scare stories didn’t work, I tried it and it felt good, so I kept it up.”

Cerino agreed that it’s far too easy to obtain drugs. “You can order them on a cell phone.” He said it should be more difficult, at least requiring the buyer to talk to somebody.

Dr. Ben Kohl of Eastern Shore Psychological Services said from the audience that the availability of Vivitrol allows recovery on an outpatient basis. The good news is that insurance programs usually cover the drug, allowing patients to do rehab with less chance of relapses. “The whole community needs to support recovery,” he said. Jobs and housing need to be available for those in recovery. “We understand the brain a lot better, and how addiction and recovery work,” he said. “We need to emphasize the disease model” and remove the stigma from recovery, he said.

Maryland’s Good Samaritan law protects those helping an overdose victim or calling to report an overdose.

An audience member asked whether the recovery programs emphasize the spiritual dimensions of the process.

Dove said most rehab programs are built around the Alcoholics Anonymous 12-step model, which is spiritually based. “There are many ways to find a spiritual path to recovery. There’s no wrong way — just get there,” he said.

Goss said that many churches support those in recovery.  The various recovery programs and personnel also refer users and their families to resources in churches and many spiritually-inspired or based programs.  “We know what’s out there and we offer it,” Goss said.

Gregg said Gov. Larry Hogan’s declaration that an opioid crisis existed in the state “opened up resources.” She said it “let us treat not just addicts but their families.” She gave as an example the van the county has acquired.  The van contains a mockup of a young person’s bedroom showing places an addict could hide drugs and other clues a parent could use to start a conversation about drug use. The van will be on exhibit at numerous community events in 2018.  Only those over 18 are allowed in, so it doesn’t give ideas to teens. She said anyone interested in having the trailer come to an event should call the sheriff’s office.

Moore said several projects are in progress to help raise public awareness of the crisis. Among them, she mentioned a state website,  BeforeItsTooLateMD.org, with resources for patients, families, medical professionals, and others. There is also a 24-hour crisis hotline, 1-800-422-0009, that anyone can call anonymously for help for themselves or another.

Leslie Sea and Brian Moore, owners and operators of WCTR radio in Chestertown, organized the Opioid Crisis Forum

Maryland’s Good Samaritan law protects those helping an overdose victim or calling 911 about an overdose.

Drug Education Kit at the opioid forum had a display of drugs and various drug paraphernalia.

 

 

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