Searching for the Light in the Midst of the Opioid Crisis
May 6, 2018
Northeast Ohio: one of the regions in the U.S. most hard hit by the opioid epidemic. I spent last week in Ashtabula County and Cleveland to look beyond the statistics of the opioid epidemic and to listen and learn from the people and communities that are affected.
I was on a Leaders’ Quest with a group of bioscience executives who recognize that the pharmaceutical industry bears significant responsibility for the opioid crisis and must step up to help create solutions to address it. Exactly what this will look like is still unknown, but this group of people came first and foremost to listen to those willing to share their stories.
A week since returning from the Quest, my mind is still full of these stories; stories of individuals and families, of devastation and loss, of hope and renewal. I am noticing how the act of telling these stories helps me to make sense of the experience and find hope in the midst of a dark and harrowing moment in time in this country. Here are some of the people I met last week.
Let me start by telling you about Jamie, a paramedic, whose sister Betheny was murdered in a drug-related double homicide seven years ago. I could describe to you the sound of her mother’s piercing, heart-wrenching wail, when Jamie went to break the news to her that Betheny was dead. I could tell you about the young man who shot Betheny and her boyfriend. He was afraid because he owed Betheny’s boyfriend money for drugs and couldn’t repay his debt. In that place of darkness and desperation, he committed a senseless murder of two people who had been his childhood friends.
We read in the media almost daily that drug overdose is the leading cause of death for Americans under the age of 50. Around 65% of overdose deaths involve an opioid such as oxycodone, hydrocodone, fentanyl, heroin. Of those who began abusing opioids in the 2000's, about 75% reported that their first opioid was a prescription drug. When the supply of meds (or money) runs out, they turn to heroin which is less expensive. Today even more powerful substances are easily accessible such as fentanyl and even carfentanyl, which are synthetic opiates and often, and unbeknownst to the user, mixed in with other drugs such as marijuana and cocaine. They are so potent that even the tiniest amount can be fatal.
Dan is a first responder, often the first on the scene of an overdose call. He is disappointed and angry on the numerous occasions when he arrives at a person’s home in the aftermath of an overdose to be told by a family member that everything is fine and that he is not needed after all. He knows it’s not the truth, but he understands that people feel shame and don’t want him to see the disarray and hopelessness and self-destruction in their home, so they push him away. They may have been able to revive their family member this time without the help of emergency services, but Dan knows that this will not be the last call from this home, and that he might even be called back an hour later to the same home, the same person, the same family, the same story. Because this happens over and over and over again. What keeps him going when he feels compassion fatigue? It’s the voice of his boss Vince at the Northwest Ambulance District, who reminds him every day that this person is someone’s mother or father, brother or sister, son or daughter, and if they can be kept alive, they have a chance of getting well again.
I learned about drug court, an innovative approach to holding people with addictions accountable for their crimes, offering alternatives to incarceration or lighter sentences for people who agree to complete a drug rehab program. Stephanie coordinates the drug court in Ashtabula and she explains that the program seeks to treat rather than punish. It includes mental health services, drug treatment programs, random drug tests and appearing before the judge at regular intervals. I met Josh who had a drug charge and was admitted to drug court. He did everything to comply with the terms and requirements of the program over a period of 18 months so that he could graduate and get back to his life. And the whole time he was in the program, he knew that as soon as he was done, he would go and get high again. And he did. So he ended up back in the court system for another round. For other people, the program can be a wake-up call, the right thing at the right time, but there is no way of knowing when it will work and for whom.
I remember the words of Cleveland drug court’s Judge Matia, who said that people suffering from addiction can be masters of manipulation. They quickly figure out exactly what they need to say and do in order to comply with the program and satisfy the requirements of their probation. And the Judge has to be able to discern the truth of each person’s situation and whether they truly are motivated to remain sober and stay on a path of recovery.
I met a young woman called Amanda who was convicted of aggravated robbery seven years ago after she attempted to break in to a pharmacy to secure a supply of opiates. She will be released from prison next week and placed in transitional housing for a few months before she can return home. She is excited to see her son, who is now eleven years old. Amanda is the chef of a culinary program called Chopping for Change and leads a team of people who help prepare 2,000 meals a day for local homeless shelters. This is a photo of her culinary graduation. She is pictured with Bryan Mauk, VP of Workforce Development from the Lutheran Metropolitan Ministry, which sponsors Chopping for Change. While serving her sentence she has been able to leave the prison during the day to work in community with others and learn skills that will empower her to create a better future for herself and her child after she has served time. I remember how my heart ached when I saw that on her name tag was the word “INMATE” written in large capital letters.
James is a young man who has spent the last 4 months in jail, and it’s not his first time. He is tired of this way of life, cycling in and out of prison for drug-related offenses. He wants a different life. During these past months while incarcerated he has connected with an organization called Towards Employment which helps people with barriers to employment find and develop a career. Towards Employment provides vital services that the prison system doesn’t; services which provide hope and vision for a different kind of life beyond addiction and incarceration. Today is James’ first day out of jail. I find myself wondering how he is getting on.
I had lunch with Nate, a restaurant owner, who relates the stories of workers in his establishment. Many of them have past addiction problems or criminal convictions, are in recovery and constantly battle the urge to use chemicals for their dependencies. He has learned how to identify when someone may be falling back into use and is clear with them that they will lose their job if this happens. In Nate’s words, “One of our core values being compassion, when we know someone has a past history of addiction, we keep the door open with them, and inform them that being transparent will get them a leave of absence with a secure position to return to after treatment. Violating that trust will not. It appears to work.” Nate offers compassion, hope and a helping hand towards recovery.
I learned how hard it is to break the cycle of addiction. Between 10 and 30% of people in rehab programs are successful in remaining sober six months after the program ends. I learned that Medicaid only covers 30 days of rehab, which is nowhere near enough - so of course the relapse rate is high. There aren’t enough facilities with detox beds. Outpatient programs are oversubscribed and often turn people away if they don't have a felony. And the jails are full to overflowing. Even if you have private medical insurance for rehab, you will still have to pay hundreds of dollars a day out of pocket for the treatment, and who can afford that?
This is JP. JP is County Commissioner and a lifelong resident of Ashtabula County, Ohio, a man deeply connected to his community. He runs a funeral home that has been in his family for five generations and knows only too well the stories of those whose lives have been lost to addiction. Just yesterday he shared with me that one of the young men we met last week has taken his life. This young man was in an outpatient treatment program for his addiction. Just last week he was looking forward to returning to his family and career. A few days later, he is dead. It can be a harrowing, dark and lonely path to recovery and for some the journey ends abruptly and violently.
This haunting, powerful week has helped me to understand the opioid crisis as intricate web of challenges. The pharmaceutical industry has engaged in unethical marketing practices around opioid pain medications which they claimed to be non-addictive. Their behavior has played a significant part in the increase in opioid use disorder in this country. Addiction is first and foremost a mental health (rather than a criminal) issue. We are sadly lacking in resources to support the increasing number of people with addictions. Incarceration may stop people from using while they are locked up, but it rarely lasts once the person returns to their previous situation. There are not enough treatment facilities and many people are turned away even when they are ready to commit to a program. Others who complete programs are unsuccessful in staying sober especially when they go back to their familiar social environment after treatment, and so the cycle begins again.
To find the light in the darkness required me to listen to some very painful stories from these and many more people in NE Ohio who generously shared their time with us. It is their courage, resilience and humanity in the face of such personal challenge that give me hope. I think of the young man who committed suicide this week, who taught me that there is just a very fine line between life and death. I think of Jamie, who stands on stage together with the mother of the man who killed her sister, talking to high school students about making good choices. I think of James who had the courage to be honest with himself about his addiction and, with his readiness and commitment to change his life, is now re-entering society. I think of Amanda and how she too is about to embark upon the journey of navigating the world as a returning citizen and learning how to parent the child she has been separated from for seven years. I also think of our Quest participants who have returned home as touched and motivated as I am to continue to listen, learn and move into action as they seek to ensure that people suffering from pain or addiction have access to treatment and support when they need it and without stigma.