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2016 Conference: Second Plenary Session

Posted By Matthew P. Martin, Monday, October 17, 2016



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 process.


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.

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