The second plenary session of the 2016 Annual CFHA
Conference in Charlotte, NC was on Friday 14 October and included a panel of experts on
opioid dependence and treatment. The first speaker was Brooke who shared her
personal struggle with opioid dependence. Here is her story in her own words.
Brooke: "I first took opioids after gall bladder surgery. I
liked the way it made me feel. I felt like super girl. I could do anything.
Eventually though I started to spiral. I didn’t understand physical dependence
when I first started. Before I knew it though I was using just to feel normal.
Some people describe it like flu-like symptoms which makes me laugh because
it’s nothing like that. I was in and out of many, many rehabs. I had brief
moments of sobriety but it never stuck and I never got completely well. I heard
about methadone but I also heard about the stigma, how it was replacing one
drug for another. Even professionals along the way would say things like that.
I felt ashamed to go to a methadone clinic for a long time. Finally I decided I
had nothing to lose. There was a clinic one-hour away. I had immediate success.
I only failed one drug screen and haven’t failed one since then. After a year
of detoxing very slowly, I was diagnosed with post-acute withdrawal syndrome. I
was not right and needed a lot of help.
Fred Brason, President and CEO of Project Lazarus, then shared his
journey. He was hospice director and had no idea what was happening in the
community with drugs like opioids. "We had families from our clinic who were
using it, selling it, and sharing it. How did we get here?” he asked. He recounts
how the medical community had begun implementing asking all patients about
their pain level and then connecting patient satisfaction with pain outcomes.
He continues: "70% of diversion happens between friends and
family members. We realized we had to reach everybody in the community. Our
collaboration had to be person-focused.” They worked to educate prescribers in
outpatient and emergency settings. They started having success but realized
that it required a community-wide effort to solve this community-wide problem.
Don Teater, a physician with the Meridian Behavioral Health Services, then
described how he started treating opioid dependence. He believes that one of
the major problems in medicine is that we separate medical and mental health. He
recalls, "In 2004 I became certified to prescribe buprenorphine and it changed
my life to start helping people with opioid dependence.” His wife is a mental
health professional and worked alongside him to counsel the patients receiving
buprenorphine. He encourages all physicians to consider incorporating
medication-assisted treatment into their practice.
He says, "The number of opioid deaths is correlated to the
number of opioids we prescribe. Americans, constituting only 4.6% of the
world's population, have been consuming 80% of the global opioid supply.” He
points out that US physicians prescribe so many opioids today and yet pain
levels seem to be rising which suggests that medications may be leading to more
pain. The problem is that with the first dose, the human body decrease the
number of opioid receptors in response to the flood of medication in the system.
However, these opioid receptors help treat anxiety and depression which can
then lead to intense anxiety, depression, and even pain during the withdrawal
Donnie Varnell, Policing Coordinator, North Carolina Harm
Reduction Coalition, then stood up to talk about the law enforcement side of
the opioid epidemic. In a former life he jumped out of airplanes and
consequently dealt with a lot of pain and medication. "I’m very familiar with
opioids” Donnie says. He continues by saying law enforcement is trained very
well in many things but they are not trained in how to deal with substance
users. Incarceration does not work for these individuals. "In the past, we used
stigmatized language in their presence and so did family members. We were not
ready for when opioid epidemic hit our state. We did not know how to help.”
When Donnie took over the prescription drug abuse unit, he
knew that traditional methods would not work. So, first he started training
police officers in how to correctly investigate these cases and then how to
respectfully address people. He collaborated with Fred Brason at Project
Lazarus and Robert Childs at the North Carolina Harm Reduction Coalition. "Instead
of arresting people, we are trying to get them into the systems they need.” For
example, he says that police officers in Fayetteville, NC are implementing a
drug diversion program called LEAD which is a pre-booking program for substance
users. There are four other agencies in NC starting LEAD programs.
Robert Childs, Executive Director, North Carolina Harm
Reduction Coalition, the final speaker, made a strong case for making naloxone,
an opioid overdose reversal drug, available to as many people as possible. "We
can’t get rid of cars and highways to reduce traffic deaths, can we? No, that’s
ridiculous. Instead we make cars as safe as possible.” In the same way, he
argues, we can’t completely get rid of harmful drugs so we have to reduce their harm as much as possible. "We handed out 35,000
naloxone kits which lead to over 4,000 overdose reversals in North Carolina”. Naloxone
kits work, he argues. For clinicians who want to get involved, he recommends first
reducing stigma about opioid dependence treatment and prevention.