Drug Policy Panel

Substaince Addiction in the Bluegrass
Policy and ideas of how to minimize the impact

On Friday, December 8, 2017 a drug policy panel convened to discuss ideas on how to address the regional opioid epidemic and possibly identify strategies to help minimize the impact. There were 77 individuals who attended from many organizations and government agencies around the Bluegrass Region. The panel included seven (7) speakers in the morning followed by lunch and then a strategic discussion and open forum used to identify the main issues and create several strategies of how to address the issues.

In order to gain some understanding of the scope of the Opioid epidemic there are a few statistics that should be shared. First, the opioid epidemic has arisen from abuse of prescription drugs and painkillers, such as morphine, methadone, buprenorphine, hydrocodone, oxycodone, (some brand names include Vicodin, Percodan, Tylox, Demerol, Palladone, Percocet, and Oxycontin). Patients become addicted to these substances, which leads to prescription forgery, black-market pill sales, and a shift to the cheaper opioid – Heroin.

Second, drug overdose deaths in the US has increased dramatically (quadrupled) since 1999. Of all drug over-dose deaths, six (6) out of every ten (10) are caused by opioids. In 2015 alone there were 20,101 overdose deaths related to prescription pain relievers, and another 12,990 overdose deaths from heroin1. Overdose deaths in Kentucky during the same time frame exceeded 1,400 people. This is startling as it means that fully seven-percent (7%) of all overdose deaths that occurred in the U.S. happened in Kentucky.

 

First Panel

The first panel was made up of three (3) individuals from different sectors of the workforce who are specifically dealing with the drug epidemic, including Dr. Ryan Stanton, M.D., Kathy Miles from the NCC Boyle County Agency for Substance Abuse (ASAP), and Amy Baker, program coordinator for Substance Abuse and Violence.  Each panel participant spoke about their experience dealing with addicts, the specifics of which shall be discussed below.

Dr. Ryan Stanton, MD

Dr. Stanton played a video where he narrates a compilation of statistics and proposed solutions of how to recover those who are addicted. He made many good points within the video starting with a discussion of addiction in general. He states that addiction means that you no longer have the ability to decide to avoid the substance, that your brain in essence tells your body that you need that substance to survive, like the body needs food, or water, or oxygen. He gave an example of mice who were given opioids and in the tests, these addicted mice would forego food and water and instead press the button for the drug and would eventual starve to death. We, humans, are similar. The opioids act on the reward center of the brain – the natural dopamine. The opioids rewire the brain and has more effect on young children and teenagers than adults.

After this above discussion, he then went on to show evidence that the current epidemic was brought on by several studies in the 1980’s that basically stated that there was a low risk of addiction from opioids. The studies were then used as a way of monitoring pain and overall pain management. Opioids however, have reset our pain thresholds.

It is interesting to note that the United States consumes more than 90% of all manufactured opioids (99% of Hydrocodne). When opioids are used our pain thresholds are changed and shift our overall ability to sense pain. For instance, the more you take the more you need to dull the pain. When you stop taking the opioids you become more sensitive to the pain you had before and are less able to deal with that pain.

Oxycontin, another opioid was developed in 1996 and was marketed as addiction free. The 1980 study mentioned above was used to show the low risk. As such, when it was released its use exploded. This included 32,000 coupons for free prescriptions, over 20,000 education programs, and over 50% of the prescriptions were being written by the primary care physicians with no training in pain management. Profit went from $45 million to $3.1 billion – one of the most profitable drugs in the US.

Enter heroin, the stronger and cheaper alternative to the opioids that the addicted individuals were getting in the pain clinics. Dealers then took heroin to middle America.

Now, the primary fight against the addiction is Narcan or Naloxine which act as goal keepers for the body by blocking or inhibiting the opioids from binding in the brain. They, however, have low endurance and only last about 45 minutes.

To combat this heroin dealers are adding additional drugs such as fentanyl. One of the areas hardest hit is the Appalachian region.

It is clear that there is a major problem. There needs to be an intervention to get these people into recovery programs. Without recovery, these individuals will either change the substance they are taking to increase the effect or they will die.

Kathy Miles
Ms. Miles joined the panel as the local ASAP coordinator and shared some “take-aways” from her work in Boyle County. Her background has included 40 years of work as a clinician and a program director with substance abuse and mental health patients. She said that Lexington and Scott County came down and warned them that heroin was in their community. Heroin babies were being born in their local hospitals as proof. In order to be successful to fight this is to make sure the community knows you are in this fight for the long haul and that education is very important. We cannot just represent the facts but to present stories – humanize the situation.

In spite of expanded Medicaid and other insurance options there is not enough money for treatment coverage. Her organization has helped raise money for treatment and travel to the treatment centers as there are zero facilities in Boyle County.

It is important to build upon the resources each community has, including the faith based community. Include the local government and request to receive regular reports from the organizations that are working in this area. Address the needs of the local jail – should it be expanded, or should other programs be created in the jail itself, i.e. volunteer intensive outpatient programs.

Statistics show that even if these people go through the programs in the jail and then, when they are released, if they don’t have a job lined up, many will repeat offend and end up back in jail.

Creation of prevention materials and school programs is important and should include education of other drugs and alcohol, not just opioids.

Inevitably HOPE is important and the success stories should be shared to help instill this hope in addicts that there can be a future.

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