International Overdose
Awareness Day was last month. I’ve wanted to write about the opioid
crisis, especially since our new governor has made it a priority,
but have very little awareness of the subject except for what I read
in the newspapers. I know I’ve used some opiates after surgery, at
least I assume that’s what made my recoveries from lower back
surgery, a hysterectomy, lung surgery and a head injury pain-free.
Grateful, I recovered from the surgery, stopped taking pain meds,
have no connections with addiction so little awareness of what
causes the problem.
So I decided to wait until
my son, a licensed drug and alcohol counselor (age 51), came from
Northern Nevada to visit and then interview him.
Barbara: What is
the difference between my experience and whatever makes some people
opioid addicts?
| |
 |
| |
Barbara's
son Lance |
Lance: Well, I work
with teenagers and adults who struggle with addiction to all kinds
of substances, but lately opioid dependence has increased
tremendously. Many of the clients I work with start out by abusing
opiate pain pills such as Vicodin, OxyContin or Percocet. Many
patients also get hooked on pain pills because of surgery or some
other kind of medical issue. So I suspect many of them were not made
aware of the addictive nature of these drugs or were just looking
for a quick high without thinking of the consequences.
In my view, many of these
drugs have been overprescribed, creating an avenue toward serious
addiction. Recently many states have cracked down on overprescribing
by doctors, tightening up the supply and increasing the price on the
street. In Nevada, one OxyContin pill can sell for as much as $80.
The problem with these
drugs is that they build tolerance, so patients who continue to take
them will have to increase the amount they use to avoid withdrawal
symptoms. These are so painful that addicts are desperate to avoid
them, so they switch to heroin, which is cheaper and more readily
available than illicit prescription drugs. They can get a balloon of
heroin (about the size of a pill) for about $10, but again,
tolerance increases quickly, so that an addict may develop a habit
costing $100 a day or more. Heroin addicts often start out smoking
or snorting the drug, but may switch to IV use simply because it is
more economical.
The drug cartels have
increased the flow of highly processed heroin to the U.S. to meet
the new demand. They have become more sophisticated in transporting
the drug throughout the U.S. and marketing it to users, even
offering free samples to get buyers hooked.
Barbara: What is
Nevada doing that may be helpful as the country tries to deal with
the problem?
Lance: First of
all, access to prescription medications must continue to be
tightened up except for patients who really need it, hopefully for
the short term. In Nevada, a new law requires doctors to utilize a
database to make sure that patients aren’t getting multiple
prescriptions from different doctors.
Nevada doctors are also
required by this law to undergo
training in the dangers of prescription drug abuse. More people
have died in recent years from opioid overdose than from car
accidents. A public health approach is needed to educate doctors so
that they in turn can educate their patients and offer other
alternatives, such as physical therapy or lifestyle based
interventions (diet, exercise, meditation, yoga, etc.), whenever
possible. Lastly, the law allows first responders to use Narcan, a
drug that reverses overdose.
Many of my clients are
referred by the courts, and are compelled to enter therapy in order
to avoid incarceration. Drug court programs balance accountability,
including random chemical testing, with mandated treatment
participation. Treatment may include medical referral for
medications to help clients to abstain from drugs or alcohol. This
“carrot-and-stick” approach provides motivational enhancement to
help clients get sober.
But treatment programs
often are expensive and/or have long delays to access treatment. In
my view, we need to invest in building accessible treatment programs
close to where people live, to help them to get clean early and
avoid the legal system entirely. We need to double down on education
and intervention in the schools, to prevent or address substance use
before it becomes chronic.
Barbara: A law has
been proposed in Massachusetts to test students in the schools. Does
Nevada do this?
Lance: No, this is
generally considered a violation of privacy when it is applied to
all students, who must attend school but may not choose to
participate. However, young people who are suspended for having
drugs in school can reduce that suspension by agreeing to undergo
assessment and counseling/education. Students involved in voluntary
school activities are also tested randomly and for cause.
Barbara: What can
parents do to help their children avoid becoming addicted to drugs?
I know (now) that you did your share of experimenting growing up
here in Marblehead in the ‘70s and ‘80s; I can tell you that I
didn’t really notice anything but the drinking, which was familiar
to me as a problem during my generation’s youth.
Lance: You were
firm about the drinking, wouldn’t sign for me to get my driver’s
license; I eventually outgrew that phase. I had you convinced that
the pot plants on my windowsill were herbs for cooking, that the red
eyes were caused by allergies. Parents should keep their
prescription drugs locked away.
There was an excellent
program in the Marblehead schools called Beyond Boundaries, part of
Project
Adventure, which is still based in Beverly. This got me addicted
to the great outdoors, to rock climbing, then working in similar
programs with teenagers out West, which led to my being a juvenile
probation officer and now, into my present career of drug and
alcohol counseling.
This kind of program is
called strength-based intervention, and is the best way to lure kids
away from drugs and into a productive, happy lifetime.
Nevada also has
alternative education programs, but instead of calling them, say,
“recovery high school,” we call our similar program “ASPIRE:
All Students Pursuing Integrity, Responsibility and Education.”
Barbara: I’m
feeling much more aware, and I hope readers can see why I am proud
of my son.
Barbara Anderson of
Marblehead is a weekly columnist for the Salem News and
Eagle-Tribune Publishing Company.
