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The opioid epidemic BY BRENT MCCRAW, M.ED. DIRECTOR, CENTRA ADDICTION & RECOVERY SERVICES
A community takes action
JULY 2016
The opioid
epidemic BY BRENT MCCRAW, M.ED. DIRECTOR, CENTRA ADDICTION & RECOVERY SERVICES
D
eaths from opioid overdoses are skyrocketing across America. An estimated 44 Americans die every day from prescription opioid and heroin overdoses, and at least two of them occur in Virginia. The Centers for Disease Control and Prevention (CDC) has labeled prescription drug abuse an “epidemic� in America with prescription opioid
overdoses more than quadrupling since 2000. CDC researchers estimate that 28,647 drug overdose deaths in 2014 in the United States involved some type of opioid, including heroin. Non-fatal opioid overdoses that require medical care in a hospital or emergency department are even more prevalent, with the number of such events increasing by a factor of six in the past 15 years, according to the CDC.
Central and Southside Virginia are no exception to these state and nationwide trends.
Virginia has not escaped the opioid crisis. In 2014, the Virginia Department of Health reports 733 Virginians lost their lives to opiate overdoses — a 38 percent increase in fatalities since 2012. And in 2014, for the first time, prescription opioid and heroin overdoses killed more Virginians than automobile accidents. According to Virginia Commonwealth University School of Medicine, prescription opiate deaths are concentrated in Southside, the Shenandoah Valley, Southwest Virginia, Hampton Roads, Metro Richmond and Northern Virginia. Deaths from heroin overdoses are highest in the Shenandoah Valley, Hampton Roads, Metro Richmond and Northern Virginia. An estimated 30 to 40 percent of Americans are reported to suffer from acute or chronic pain. A decade ago, the healthcare industry made a major effort to better manage chronic pain’s disabling effects, causing opioid analgesics, including oxycodone and hydrocodone, to become the most commonly prescribed class of medications in the United States. The CDC reports that in 2012 alone, 259 million prescriptions were written for opioids—more than enough to give every American adult his own bottle of pills.
A crisis arises from pain
This greater availability of prescription opioids has been a contributing factor to today’s opioid epidemic. These pain relievers present an intrinsic abuse and addiction liability because they are similar to, and act on the same brain systems affected by, heroin and morphine. Well-intentioned treatment for pain has triggered addiction in people who may have been genetically disposed to dependency. With prescription opioids flooding the marketplace, many are diverted to family or friends who are often unaware of the dangers of nonmedical use. In addition, opioids are often stolen from medicine cabinets and sold on the street. A second contributing factor to today’s opioid/heroin epidemic is the reintroduction of heroin in a different form – that which can be smoked or snorted. Two or three decades ago, heroin use was solely by intravenous injection. The known risk of serious, longterm viral infections such as HIV, Hepatitis C, and Hepatitis B, as well as bacterial infections of the skin, bloodstream and heart, kept many people away. The easier administration of heroin has changed all that, with its use more than doubling among young adults, ages 18-25, in the past decade. continued on next page
75%
of heroin addicts used prescription opioids before turning to heroin New York Times, 10/31/15
A certain percentage of heroin abusers began with a legitimate prescription for painkillers, became addicted, but were no longer able to get opioids because their health was better or they were abusing their prescriptions. They had to find another source for their addiction, and that source was heroin. At least half of the patients who are in treatment for heroin addiction at Centra’s Addiction & Recovery Services began with opioids prescribed for pain from sports injuries, car accidents, surgery or other legitimate medical reasons.
Overdose deaths Although the 4.5 million Americans who admit to nonmedical use of prescription pain medications and the 289,000 who admit to heroin use do not compare to the 61.6 million Americans who are binge or heavy drinkers, the alarming number of opioid overdose deaths has brought the opioid crisis to the national forefront.
to opioid use after a period of abstinence. Opioid users who do not realize they have lost their tolerance may use the same amount as they did before a recovery period, overdose and die. The risk of dying from a heroin overdose has increased further by contamination with other drugs such as fentanyl, a potent prescription opioid by itself. From 2001 to 2014, there was a six-fold increase in the total number of overdose deaths from heroin, reports the National Institute on Drug Abuse. continued on next page
Fifty-eight percent of all overdose deaths were from opioid or heroin in 2014, with prescription pain medications representing 37 percent and heroin overdoses, 19 percent. Why are people dying? Opioids, when used repeatedly over time, induce tolerance – a physiological change thatrequires a higher dose of the same substance to achieve the same effect. With opioid dependency, the tolerance reverses very rapidly, which contributes to a greater risk of an overdose death during a relapse
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Prevention and treatment Physicians across the country are working to manage patients’ pain with alternatives to oxycodone and hydrocodone. Many emergency departments have a policy limiting access to prescription opioids. Patients in treatment centers like Pathways are being warned of the serious risk of overdose death if they relapse after treatment. And hospitals, such as Centra Virginia Baptist Hospital, are stabilizing and minimizing the withdrawal effects of opioid dependent pregnant mothers and their newborns. Centra’s Women & Children’s Services developed a
Public health initiatives have been launched throughout Virginia and across the nation to educate, prevent and treat opioid addiction and curb the mounting number of overdose deaths.
coalition to address the increasing trend of pregnant women who are dependent on opioids and placing their newborns at risk for withdrawal. With the growing body of research supporting medication assisted treatment, Pathways and other treatment centers also have better ways to manage withdrawal and cravings from opioid dependence. Examples of medication assisted treatment include suboxone, naltrexone and methodone (only in licensed opioid treatment programs). Methodone assisted treatment always includes counseling and support. Friends and family members of opiate and heroin abusers also are being educated about the life-saving drug naloxone, which reverses the effects of opioid overdoses. The nonaddictive medication is administered through nasal spray or auto-injector. Naloxone is becoming more readily available and can be purchased without a prescription in pharmacies such as CVS. Communities across the country can have an impact on this epidemic by raising awareness, reducing the stigma associated with addiction, educating young people about the risks associated with opioid and heroin abuse, and changing prescribing patterns to reduce the availability of pharmaceutical opioids.
A community takes action “Heroin: the hardest hit” More than 300 healthcare workers, treatment providers, educators, law enforcement officers, individuals in recovery, family members and concerned citizens crowded into the First Colony Conference Center at Centra Lynchburg General Hospital in May to watch the documentary and hear the personal stories of two people in recovery and a courageous mom who lost her son to an overdose. Screening events have been held in
more than a dozen locations across the Commonwealth since the film premiered last year in Richmond. According to the Attorney General’s Office, the Lynchburg event drew the largest audience to date. The 40 minute film, which can be seen at www.HardestHitVA.com, has been viewed more than 60,000 times online. After the screening, Attorney General Mark Herring outlined his five-point plan to combat heroin and prescription opiate abuse. A key point in the plan is to develop and implement partnerships to find creative solutions
to the growing problem. Other parts of the plan include educating the public, developing legislative solutions, ensuring accountability for professionals who make prescriptions illegally available, and emphasizing prevention by addressing the issue with young people so they will not use in the first place. Herring became a champion in the fight against heroin and opiate addiction after learning of the growing public health and safety issue from the commonwealth attorneys across Virginia. The film is an example of the preventative and educational measures Herring is taking to make all Virginians more aware of the growing crisis involving heroin and prescription drugs. “I am impressed with the initiative that is coming from law enforcement,” said Brent McCraw, director of Centra Addiction & Recovery Services. “Attorney General Herring said he realized early on that we will not arrest ourselves out of this problem. He recognizes the importance of increased awareness, prevention and treatment.”
“Our objective from this event is to create a community coalition to address this epidemic,” McCraw said. “It is not enough to just watch the film. We need to take action.”
Community coalition formed As a result of the screening event with Attorney General Herring, a local coalition is now in its formative stages to take further steps to address the heroin/opioid crisis in Central Virginia. People who have lost loved ones to overdose, individuals in recovery and family members of those struggling with addiction have joined with representatives of nonprofit organizations to pursue ways in which they can fight heroin and opioid drug abuse in Central Virginia. Three dozen people attended the first meeting in June, including representatives from Centra, the UP Foundation, Horizon Behavioral Health, The Healing Place, a mutual self-help group and the YWCA of Central Virginia. “We broke into small groups to discuss the needs around heroin and opioid abuse and some of the actions that we could take,” said Brent McCraw, director of Centra Addiction & Recovery Services. “Addiction is
not going away. It’s been here forever, but we can make a difference. The groups discussed educating the community, preventing heroin/opioid abuse, reducing the stigma associated with addiction, access to treatment, changing prescribing patterns, reducing the availability of drugs and training in the use of nasal Naloxone (a drug to counteract opiate overdoses).
“There are a lot of things we can do to make an impact on this epidemic,” McCraw said. The group’s initial steps include forming an advisory committee to determine the coalition’s purpose, structure and achievable goals.
“Our first objective is to make this coalition as broad as possible,” said McCraw, encouraging anyone with an interest in battling the epidemic to join the group.
For more information, call Christy Meeks at 434.200.4455 or email christy. meeks@ centrahealth.
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MENTALHEALTH
MATTERS
JULY 2016 | VOL. 30 ISSUE 3
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