Opioid use among adolescents and young adults continue to rise. For police officers in middle schools and high schools, this is one more life-threatening crisis that must be managed. The good news is that there have been breakthroughs and innovations in addressing the problem. In this post, Bob Jones explores new treatments and possibly a bit of light at the end of the tunnel.
We are not getting better yet. The opioid epidemic continues to worsen. Overdoses and overdose deaths are increasing. Despite dire warnings and increased federal funding, the use of heroin and fentanyl is on the rise. Even teen deaths due to accidental overdose, which had decreased in previous years, are now increasing at an alarming rate. Not one of us wants this to happen. None of us want to see kids die.
“Transformative power is discovered in the dark – in questions and doubts, seldom in the answers.” ~ Richard Rohr
Nine-in-ten Americans who live in rural areas say drug addiction is either a major or minor problem in their community, as do 87% in urban and 86% in suburban areas, according to a Pew Research Center survey of 6,251 adults, conducted early in 2018. So what are we doing to throw ourselves into some solutions? Our darknesses, our questions, and our doubts are finally fueling a new path for prevention, harm reduction, treatment, and recovery. People are rising to address the challenges.
Communities That Care
Communities That Care (CTC) is a social development program with a strategy which helps communities to prevent substance use problems before they happen. This University of Washington project also addresses crime and violence issues. The result has been dramatic.
The National Institute on Drug Abuse (NIDA) reported that CTC-associated reductions in current substance use and delinquency, which had been observed when the children were in grades 8 and 10, were no longer evident in 12th grade. A benefit of CTC persisted, however: Although similar percentages of youths who had lived in CTC-using and comparison towns while in middle school reported that they had avoided those behaviors in 12th grade, higher percentages of those in CTC-using towns had done so in all previous grades as well.
The CTC social development strategy has five key components:
- Opportunities: Provide developmentally appropriate opportunities to young people, for active participation and meaningful interaction with prosocial others.
- Skills: Teach young people the skills they need to succeed
- Recognition: Provide consistent specific praise and recognition for effort, improvement, and achievement.
- Bonding: Acknowledge a young person’s effort and promote positive bonding — a sense of attachment, emotional connection and commitment to the people and groups who provide that recognition. Bonding can occur with a family member, teacher, coach, employer or neighbor.
- Clear Standards for Behavior: Through the process of bonding, young people become motivated to live according to the healthy standards of the person or group to whom they are bonded.
The CTC offers a series of web-based workshops for communities that are interested in really addressing the life and death problems facing kids today. The evidence-based system is being embraced by towns and organizations across the country. The series of materials include instructional videos, guides, and personalized support backed up by the latest research and strategies. All that is required is making contact with the organization to get started.
Harm Reduction Services
The term harm reduction at one time referred only to Medication Assisted Treatment (MAT) programs such as methadone clinics and physician-based DATA 2000 Suboxone practices. This nametag was based on a thinly veiled premise that medications prescribed in those programs allowed people to live more normal lives but that they were still under the influence of drugs (not authentic “recovery”). The Minnesota Model of total abstinence was the only truly recognized or accepted treatment model. There is a movement afoot to call MAT something else in order to remove the long-held bias and stigma associated with that name.
Harm Reduction Services now refers to a much broader effort of offering services to those who are not only seeking recovery but those who are still using. I recently interviewed Marc Burrows, a substance abuse disorder professional in the Upstate of South Carolina. He was candid in his assertion that everyone has to do a lot more to address the enormous problems facing us regarding overdose, overdose death, and addiction. His organization, Challenges INC is one innovative systemic program that does just that. And Marc knows what he is talking about. In addition to several years in the field, he struggled with childhood trauma that fueled his own addiction which began at age 12. By 17, Marc was using heroin. Now, with seven years of solid recovery under his belt, helping others is his passion.
During the regular work day, Marc is a counselor in a DATA 2000 practice and also works with a residential treatment facility. Off-the-clock he operates his own harm reduction service, most of which provide him little compensation. They are free to the consumer. He even travels to pre-arranged meeting places and helps people who are at high risk for overdose and health-related consequences of opioid abuse such as HIV. Other organizations around the country have stepped up to provide this emergency care as well. These are three of the critical services they offer;
- Fentanyl Test Strips – Fentanyl is 50 times stronger than heroin. Deaths specifically from synthetic opioids, including fentanyl, doubled from 2015 to 2016, Live Science reported in March 2018. There is increasing incidents of fentanyl in other drugs, such as heroin and cocaine. Most people who use drugs laced with fentanyl don’t realize that there is fentanyl in them. The State of California Department of Public Health began distributing fentanyl test strips at needle exchange centers over a year ago to allow users to test for the opioid in other illegal drugs. Fentanyl test strips have been increasing in popularity nationwide ever since. The strips cost only a dollar each and work by being dipped into a small mixture of water and the drug being tested. This bold step is saving lives.
- Clean Needles – The bottom line is undeniable. Clean needles save lives. The opioid crisis is so drastic that the government and medical communities are taking unprecedented steps to stem the tide of overdoses and deaths. Syringe access services are beginning to become more commonplace in many areas. Though the thought of giving heroin-dependent people the very means of injecting themselves may seem counterintuitive, the end result is that more users are introduced to non-threatening treatment professionals and fewer people die.
- NARCAN® (naloxone) – Naloxone is a nasal spray that reverses the effects of opioids in the case of an overdose. It is available in some states at pharmacies like Walgreens and CVS as a part of a “comprehensive national plan to combat drug abuse” and help the communities they serve. Naloxone is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications. Law enforcement is playing a big role in combating this crisis by allowing police officers to carry naloxone with them on the job in some areas. NARCAN® can not only save the lives of those who are overdosing but an officer’s life if they get accidentally contaminated according to David Battiste, who is in charge of the DEA’s Pittsburgh office.
There are several other things that Burrows and his Challenges INC provide including safe cookers for preparing the drugs, biohazard containers, cotton filters, and even condoms. He provides his clients with treatment resources and educational materials as well. Though some of his work is quasi-legal, Marc says that local government, police departments, first responders and recovery treatment providers support his efforts fully.
On A Better Path
While we are making some progress in facing the opioid epidemic, there is a long way to go. Programs like CTC and Harm Reduction are changing the ways we prevent, understand and deal with this crisis. Trauma Informed Care and ACEs are rooting out causal relationships with early childhood experiences and providing new kinds of compassionate care. The U.S. Department of Health and Human Services announced a 5 Point Strategy “to empower local communities on the frontlines.” This is their outline of action;
- Access: Better Prevention, Treatment, and Recovery Services
HHS issued over $800 million in grants in 2017 to support treatment, prevention, and recovery while making it easier for states to receive waivers to cover treatment through their Medicaid programs.
- Data: Better Data on the Epidemic
HHS is improving our understanding of the crisis by supporting more timely, specific public health data and reporting, including through accelerating CDC’s reporting of drug overdose data.
- Pain: Better Pain Management
HHS wants to ensure everything we do — payments, prescribing guidelines, and more — promotes healthy, evidence-based methods of pain management.
- Overdoses: Better Targeting of Overdose-Reversing Drugs
HHS works to better target the availability of lifesaving overdose-reversing drugs. The President’s 2019 Budget includes $74 million in new investments to support this goal.
- Research: Better Research on Pain and Addiction
HHS supports cutting-edge research on pain and addiction, including through a new NIH public-private partnership.
While the government is addressing the crisis from the top-down and seems to be responding pretty well, the best work and results will come from the grassroots. Innovative new approaches in prevention, treatment, and safety are emerging every day. Recovery doesn’t always occur around 12 Step tables in the basements of churches anymore (though their efficacy is unquestioned). Now it is happening on the very street corners where the problem exploded in the first place.
Robert Kenneth Jones has dedicated his life to making people whole again. His work in helping others overcome addiction and childhood abuse spans over four decades.