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Fighting Back the Tide: Connecticut Takes On the Opioid Epidemic

 

By Susannah Wood

The frightening rise in overdose deaths from opioids and rates of opioid addiction has been the subject of many news stories in the last few years. All of New England, including Connecticut, has been very hard hit. In 2015 there were about 700 deaths in the state due to accidental overdoses, and that figure is expected to be close to 900 by the end of this year, according to the Connecticut Department of Public Health. Closer to home, Litchfield County is now on a par with New Haven and New London Counties in deaths per 100,000. Overdoses are now the leading cause of accidental death in the state.

While those most likely to be using opioids for non-medical purposes are white males between the ages of 25 and 50, 16.3 percent of high-school students reported trying prescription opioids in order to get high and obtained them from friends or family. Also alarming is that 28.5 percent of students reported having been sold, given, or offered illegal drugs on school property.

What are opioids? The term describes an assortment of drugs that are either derived from the seeds of the opium poppy or synthetic chemical lookalikes. Prescription analgesics such as Demerol, Darvon, Percocet, Vicodin and Dilaudid are some of the common brand names. (The illegal opioid, heroin, has no medical applications in the U.S.) Since 2001, when doctors started focusing on pain as a vital sign, prescriptions for opioids have exploded. Aggressive marketing by pharmaceutical companies has also played a role. From 1997 to 2007, the flow of opioids through the prescription system increased more than sixfold. In the last few years, there has been a decline in opioid prescriptions nationally as doctors and patients have come to recognize the potential for addiction. Unfortunately, as these prescriptions have declined, heroin use has increased, in part because it is very cheap—between $5 and $12 for a typical purchase. Fentanyl, an opioid 50 to 100 times more powerful than morphine, is showing up more and more in overdose deaths, often because it was mixed with heroin. One of the great problems with opioids is that they change the chemistry of the brain, and, if taken long enough, can cause irreversible alterations, even when a person stops using them. It’s what makes getting free of them so difficult. Traditional 12-step abstinence-only programs have a woeful success rate of only 10 percent.

Why do people take opioids? Once reserved for post-operative pain, opioids have been used increasingly to treat chronic pain, even though research is weak on their effectiveness relative to other treatments—non-opioidal drugs, for instance, and non-pharmacological strategies such as physical and cognitive therapy. The Centers for Disease Control recommend trying a non-opioid treatment first and resorting to opioids only if this course does not bring relief. Non-medical users take opioids for the “high,” a feeling of euphoria, well-being, loss of anxiety—not surprising as the drugs light up the reward centers of the brain. It’s those receptors that our own naturally-occurring endorphins stimulate. Eventually, the user doesn’t feel “normal” when not on the drug and has to take more and more to get the same high.

As if prescription opioids weren’t enough of a problem, the dangers of addiction and overdose are complicated by widespread use of another class of drugs, the benzodiazepines, which include Valium, Xanax, Klonopin, and Ativan. These drugs are routinely prescribed to treat anxiety, panic disorder and depression. In 2015 about 550,000 prescriptions for Xanax were filled in Connecticut, often in conjunction with opioids. Because of the way these two classes of drugs interact, their combination can be deadly. Non-medical users often take Valium or Xanax along with an opioid to increase the high, particularly after they have built up a tolerance to the opioid. As both drugs are sedatives and suppress breathing, taking them together increases the likelihood of unconsciousness, coma and lack of oxygen to the brain. It’s expected that the state will see about 225 such accidental poisonings by the end of the year.

Our ambulance service has seen an uptick in overdose calls in the last few years, including a death in 2015. Most of the surrounding towns have seen similar increases. We don’t fully understand why residents of rural communities are more vulnerable to the opioid problem than urban dwellers. A peak in use among 40- to 50-year-olds may reflect more physical work over a lifetime, causing more chronic pain. Economic distress and unemployment may also play a role. One study from Columbia University suggests that a wide network of family ties in rural communities may actually contribute to the misuse of prescribed drugs, as many non-medical users obtain them from family members who may or may not be complicit.

What’s to be done? Locally and state-wide, doctors, treatment centers, communities and government officials have been stepping up efforts to combat the problem. Due to new regulations imposed this fall, the Norfolk Ambulance keeps 35 doses of Narcan on hand, and both EMT’s and EMR’s are trained to administer it. Narcan, also known as naloxone, is almost miraculous in its ability to bring someone out of an overdose, having a 91 percent success rate. (Unfortunately, this is an unfunded mandate.)

While in the past, emphasis has been on abstinence programs similar to AA, it is now widely accepted that medically assisted treatment has a far greater rate of success. Methadone has been part of treatment for heroin addiction for years, but bupenorphine (brand name Subutex) and bupenorphine plus naloxone (brand name Suboxone) have even better results and may be safer. In October, Governor Molloy adopted the recommendations of the Connecticut Opioid Response Initiative (CORE), a program established last summer to come up with strategies to put the brakes on the epidemic. Strategies targeting the next three years include training more health care providers to administer buprenorphine, increasing access to treatment, and better sharing of data to track both the problem and its treatment.

The Litchfield County Opioid Task Force has assembled an annotated list of treatment providers, sorted by location, population served and services available. See below for access to the most up-to-date list. The task force has also put in place a community case manager at Charlotte Hungerford Hospital, who meets with anyone admitted to the emergency room with an addiction problem and provides counseling and referrals to drug treatment programs. Research has found that getting someone into treatment immediately after an overdose is the most effective strategy for recovery.

One thing we can all do immediately is get rid of any opioid prescriptions languishing in our medicine cabinets. The Torrington Police Station and Troop B barracks in Canaan have a drug disposal boxes in their lobbies, open 24 hours a day, seven days a week. Any prescription opioids in use should be locked away.

 

Useful numbers and websites

 

Much of the information for this article is derived from a draft report written by Julie Scharnberg to be distributed early next year by the Northwest Connecticut Community Foundation, the Berkshire Taconic Community Foundation, the Foundation for Community Health and the McCall Center for Behavioral Health.

 

 

 

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