Local Schools, Medical Professionals Taking Proactive Stance on Opioid CrisisOct 31, 2017 05:15PM ● By Shari Berg
In August, the Trump administration declared the opioid crisis a national emergency, citing the quadrupling of opioid-related deaths in the United States over the last 20 years as a reason for the move. The declaration, among other things, allows the federal government to prioritize funding to help combat the crisis.
The move was praised by those who have been in the trenches fighting the epidemic, including Dr. Neil Capretto, medical director at Gateway Rehabilitation Services.
“I’ve watched this evolve on a daily basis since it started 20 years ago,” said Dr. Capretto. “This is the worst addiction crisis that has ever hit our country and our society. It has hit western Pennsylvania even harder than many areas of the country. There are more people who are addicted to opioids, there are more people dying from them, and there are more families being devastated from them. It’s in every community. It doesn’t discriminate…it’s rich and poor, black and white.”
When Dr. Capretto first finished his residency in psychiatry in 1985, there were just 22 overdose deaths in Allegheny County. According to the Allegheny County Department of Health, in 2016 alone, 650 people died in from opioid overdoses.
Dr. Capretto called the opioid crisis a “perfect storm,” which started with the dramatic rise of prescription pain medications being more widely available and prescribed in the 1990s. “Physicians had good intentions, but they were misled by pharmaceutical companies about the potential for addiction,” he said. “Rates went up over 500 percent with the introduction of Oxycontin®. So much of this got into the wrong hands and we started seeing people coming in by the thousands, addicted.”
There is a lot of effort going into educating the medical profession about prescription opioids, including when they are necessary and how to evaluate patients to determine if they need them. Giving smaller dosages, and re-evaluating the patient to see if they need more later, rather than giving out 30-day supplies at once, are among the new guidelines. Pharmacy giant CVS recently announced plans to limit prescriptions for opioids to seven days at a time, which Dr. Capretto believes is a good idea.
“There is not one magic bullet solution to this whole epidemic, but this certainly will help,” he said.
There are a number of factors at play, including the fact that heroin is easier to obtain, cheaper than prescription opioids and purer than ever. The fact that it can be snorted and smoked, instead of just injected with a needle, also increases its popularity. “Someone may start with a $10-a-day habit, but quickly end up with a $140-a-day habit,” said Dr. Capretto.
The other danger with opioids is that anyone can become addicted. According to the Centers for Disease Control and Prevention, the risk of going from an initial prescription opioid user to becoming addicted can start early on. Using a prescription opioid for just one day raises the risk of addiction by 6 percent. While genetics can play a role in whether someone is more likely to become addicted, they are just one factor. “It’s tendency, not destiny,” said Dr. Capretto. “There are other factors that can affect whether a person becomes addicted, including trauma, PTSD and alcoholism.”
With the introduction of fentanyl and carfentanil now being mixed in with heroin–or sometimes totally substituting for it–overdoses are more common than ever before, even among experienced users. “It’s literally like Russian roulette,” said Dr. Capretto. “It’s why we’re seeing an increase in overdose deaths, particularly in experienced users. Some of them know how much heroin to use without crossing the line, but aren’t experienced enough with fentanyl and carfentanil, especially because they aren’t aware of how much is in there.”
Dr. Capretto said NARCAN should be on hand in every home where opioids are present, even for individuals with legitimate opioid prescriptions. Accidental overdoses can happen—by those for whom the drug is prescribed, or in children who may ingest the drug out of curiosity if they find it in their home or someone else’s.
“NARCAN is not a treatment for addiction. It reverses an overdose and saves a life,” said Dr. Capretto. “There has been a lot of talk about people with addictions not deserving NARCAN or denying it to them if they keep overdosing, but I do not support that measure.
“Zero percent of dead people recover,” he said. “As long as there’s life, there’s hope for recovery. For some people who are addicted, overdosing is the wake-up call they need to finally get help.”
Unfortunately, only 10 percent of people who are addicted seek help; sometimes the reason is because of the stigma attached to addiction. “I’ve never met someone who has said 'my goal in life was to end up addicted to heroin and to ruin my family’s life and mine,'” said Dr. Capretto, adding that in order to change the stigma, the community needs to get involved.
Some communities already are working toward greater awareness of the issue and pushing for both prevention and intervention.
A community roundtable has formed in Hampton Township, consisting of school officials, local and national law enforcement agencies, local clergy and local physicians from both UPMC and Allegheny Health Network. The roundtable held its first planning meeting on Oct. 5 with the focus on sharing resources and establishing a strategy to combat the opioid epidemic in the community and beyond.
“This is a true community issue, and we want to work together to combat it,” said Michael Loughead, Hampton Township School District superintendent. “It was wonderful to be able to share different ideas and resources. We don’t want to sweep this under the rug. We want to tackle it together.”
The Pine-Richland School District also is taking the initiative to spread awareness and provide resources to its community. The district has been working with a number of local and national organizations to share information related to the opioid and heroin epidemics.
In May, Pine-Richland held a community presentation about opioid use. The event included representatives from the FBI and DEA, who provided local and national trend data pertaining to the epidemic. The discussion was preceded by a production of Off Script by Saltworks Theatre Company–a powerful and thought-provoking portrayal of three high school students who share their stories of the consequences related to their addictions to prescription drugs. A shortened version of the program was presented to students in grades 9-12 the following week.
“Although these are difficult topics to discuss, we believe they are important for our community to understand,” said district spokeswoman Rachel Hathhorn. “The district is considering hosting another workshop for families in the future and is ensuring students receive health-related information through regular instruction.”
Light of Life Rescue Mission is also responding to the opioid crisis. Learn more about its new helpline to assist anyone in the throes of addiction, or actively searching for ways to help loved ones or friends. The LightLine number is 1-888-412-0036 and will be staffed M-F from 10 a.m.–8 p.m. To watch their new video, click here https://youtu.be/K_iXxIwKoxA.
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