The ER department fighting the US opioid crisis

By Thomas Urbain
AFP

Opioid abuse has turned into a public health crisis in America, blamed for the deaths of tens of thousands of people. But one hospital is determined to reverse the epidemic.

Since January, St Joseph’s Regional Medical Center, which boasts the largest emergency room in New Jersey, has stopped prescribing opioid painkillers in all but essential cases, slashing overall use by more than 40 percent.

While these powerful drugs are an “excellent” medication for terminal cancer patients or those with a broken leg, for the vast majority there are far safer courses of treatment, says emergency medicine chief Mark Rosenberg.

“In our first 60 days, we were absolutely shocked,” Rosenberg told AFP. “We had 300 patients. And out of those 75 percent of them did not need opioids.”

“It’s just a remarkable change of our prescribing habits and our management of patients’ acute pain,” he added.

In 2014, 14,000 people died from an opioid overdose in the United States, according to the Centers for Disease Control and Prevention (CDC). Since 1999, these powerful painkillers have caused 165,000 deaths.

The problem dates back to the 1990s but critics accuse President Barack Obama of being slow to respond to the scale of the epidemic, comparing his delayed reaction to Ronald Reagan’s sluggish response to the HIV/AIDS crisis.

Back in the mid-1990s, drug companies, professionals and authorities promoted opiates as a compassionate medicine that would end pain and minimized concerns that they were addictive.

“It led to the epidemic that we’re dealing with today,” says Andrew Kolodny, chief medical officer at Phoenix House Foundation, which treats addiction, and executive director of Physicians for Responsible Opioid Prescribing.

Clean for three months, former heroin addict Erik Jacobsen, 24, is determined to turn his life around after getting hooked on the class A narcotic.

– Endless cycle –

It all began when he popped a quarter of one of his grandfather’s painkillers in order to impress a girl he fancied.

“She was using it,” he told AFP at Odyssey House, a treatment center in New York’s East Village. “That’s why I got into it.”

He never tried to get them legally from a doctor. He didn’t have to, they were so easy to buy on the street in Gordon Heights, a hamlet an hour’s drive from celebrity summer resort the Hamptons on Long Island.

“There were so many kids that would get 200 pills a month and they’d sell it. And then they’d still owe their dealers because they were using more than they were selling. It would just be an endless cycle.”

That was until local authorities realized there was a problem, doctors clamped down on prescriptions and the police got involved.

“There was one night I couldn’t find any pills. So I tried heroin. And from there, I never went back,” he said.

He knew three people who died of an overdose, including a close friend.

“I just kind of accepted the possibility that one day I might die,” he said. “It’s horrible… It’s just crazy what it does to your body,” he said.

– White problem –

He got help when he was arrested and hauled before a judge, who ordered him to enter a treatment program or go to jail.

He likes Odyssey House and their approach but he is full of regret.

“I lost everything,” he said. He and his fiancee broke up because of his drug use and three of his best friends still refuse to talk to him.

“I want my life back,” he said.

He believes America’s opiate addiction is getting worse and wants to do more to help others before it’s too late.

“It’s scary,” he said. “The people that were young in my town at least, they didn’t realize what they were getting into,” he said. “You don’t really comprehend how intense it is when you try this thing.”

Experts say the opioid epidemic is a white problem. While heroin use is on the decline in inner city New York, painkillers are most abused in suburbs and rural areas — generally wealthier, whiter areas.

Rosenberg says St Joseph’s one-year fellowship, offered since January to New Jersey professionals, teaches safe alternatives, how to support patients to best manage pain and explain to them the dangers of opioids.

Next January, the program will expand to doctors, nurses and educators from across the United States and around the world, with enquiries already in from Britain, Canada, Scandinavia and Turkey.

“If you can sleep, if you can walk, then pain is not going to be your enemy. That’s what our goal is, to make you functional in pain, not to eliminate it completely,” said Rosenberg. “We need to do something.”

Preventing heroin overdoses

New York State Attorney General Eric Schneiderman is spearheading an effort to equip more law enforcement officers with the heroin antidote Narcan. It takes just three minutes to revive a person overdosing on heroin or prescription pain medication by pushing the drug out of their system.

Mary Callahan, senior manager, director of Odyssey House Outpatient Services, was featured in a News 12 segment about the initiative. “By doing this, they’re saving an immeasurable amount of people from overdose,” she said.

Monitoring the Future survey shows rates stable or down for most drugs

Rates of drug use among teenagers have decreased for most drugs, the 2012 Monitoring the Future* (MTF) survey found. The survey also revealed an alarming decline in the perceived risks of substance abuse, which can lead to future increases in use.
Despite some increases in drug use over the past several years, rates of drug use among young people today are far lower than they were in the late 1970s. This year’s MTF survey also shows several declines between 2011 and 2012, and rates for some of these drugs in some grades are at their lowest levels since the 1990s.
Aggressive prevention efforts and effective treatment programs have been essential in the reduction of drug use among youth but this weakening of attitudes demonstrates the continued need for education, prevention and guidance toward effective treatment. Adult influencers, such as parents, doctors and coaches, and institutions such as treatment programs and schools, have a critical role to play in helping young people understand the dangers of drug use and encouraging them to make healthy decisions.
* The Monitoring the Future (MTF) study is an annual survey of 8th, 10th, and 12th graders in the United States. The study is funded by the National Institute on Drug Abuse with a grant to the University of Michigan’s Institute for Social Research. Visit the MTF website to see the full survey result or download a fact sheet from the Office of National Drug Control Policy here(pdf).

Treating newborns dependent on painkillers

At the Odyssey House Family Centers of Excellence, we treat a range of women with substance use disorders, including those who are pregnant, have recently given birth, or are taking care of young children. In his letter in today’s New York Times, Dr. Peter Provet, President of Odyssey House, comments on a recent front page article that highlights the lack of educational and treatment resources for young women who become pregnant while addicted to prescription opiates.



To the Editor:

It is troubling to read how little progress has been made in understanding the impact in utero exposure to addictive drugs can have on babies born to pregnant substance abusers. In the 1990s concern was expressed over a potential lost generation of “crack babies.” Treatment organizations responded as best they could with programs for women and children that provided links to medical and child development services and with programs that tackle the mother’s poverty, poor education and lack of job skills.

But despite data supporting increased financing of prevention services and treatment programs that target pregnant substance abusers, limited resources and stigma discourage women from seeking treatment for fear of having the baby removed from their care.

Renewed effort must be made to reach drug-troubled women before they get pregnant, and in the event they are expecting a child, community clinics and hospitals need to be educated about addiction treatment and where to refer both mother and baby for long-term care.

PETER PROVET
President, Odyssey House
New York, April 11, 2011

Click here to read the original article, “Newly Born, and Withdrawing from Painkillers” (April 9, 2011), on The New York Times website.

Lock Your Meds campaign comes to Odyssey House

Melanie R., a young woman in treatment at the Odyssey House Lafayette Avenue Teen Girls Program, was interviewed last night about prescription drug abuse by Dr. Jay Adlersberg, WABC-7’s health and medical reporter. Melanie spoke about how easy it is for teenagers to get prescription drugs, showing how important it is for adults to lock up their medications.
The segment highlighted the Lock Your Meds campaign and the rising rate of prescription drug abuse among teenagers. Lock Your Meds is a national multi-media campaign designed to make adults aware that they are the “unwitting suppliers” of prescription medications being used in unintended ways, especially by young people. The campaign is produced by National Family Partnership.

Teens attend town hall meeting on prescription drug abuse

Last week, 30 Odyssey House clients from the Teen Leadership Center attended a town hall meeting in Albany to discuss prescription drug abuse. It was a great learning experience – the teens learned how to identify prescription drug abuse and how to find and access prevention and treatment services. There were approximately 400 attendees, including treatment professionals, state agency representatives, law enforcement officials and community members. The panel discussion was lead by Jeff VanVonderen, an interventionist on A&E’s Intervention; Billy Fusco, executive director of Dynamic Youth Community; District Attorney David Soares; and Brooke Schewe, Statewide System of Care Director for Families Together.

According to the panel, prescription drug abuse is a growing problem in New York State – surveys have found that 18% of high school seniors in NY abuse prescription drugs, compared to 13% nationwide. The Drug Abuse Warning Network, which tracks drug-related emergency room visits, reports that prescription drugs account for more ER visits than marijuana and heroin combined. The drugs most commonly abused by teens are OxyContin, Vicodin, Xanax and Adderall.

Sponsored by Time Warner Cable, A&E and the Alcoholism & Substance Abuse Providers of New York State, the town hall included a screening of an episode of Intervention. The meeting was filmed and will be aired on Time Warner’s Local On Demand stations throughout New York sometime in June. We’ll post more information as we get it. For photos from the event, visit the OASAS page on Facebook.