Overcoming opiates
Profiles
THE STORIES BEHIND THE EPIDEMIC. SEE MORE >
The Story
by: Francesca Collins
North Carolina is home to four of the top twenty-five worst cities for opioid addiction.
by: Jack Pasi & Tyler Patchen
Addiction can primarily start with pain; an injury, a sprain, a hit to the body, even a fall. It's what happens after that can define the rest of someone's life
by: Francesca Collins
Opiate addiction afflicts thousands of people every year. The consequences of such an addiction take a toll on not only one’s mind and body but those that surround the addict.
by: Francesca Collins
North Carolina is home to four of the top twenty-five worst cities for opioid addiction. Those cities are Wilmington, Hickory, Jacksonville, and Fayetteville. Since 2000, more than half a million people in the United States have died from opioid overdoses, according to the CDC.
The most common drugs involved in opioid overdoses are methadone, oxycodone, and hydrocodone. Opioids are highly addictive and carry many risk factors. These addictive properties make it likely that someone prescribed opiates will get addicted to them. The CDC reports that one in four patients receiving opioid therapy struggle with addiction.
The prevalence of opioid addiction is affecting entire communities. John Martin, a senior at Elon University who is from a mixed socio-economic area outside of Philadelphia, recounted that he has seen some photos where more people were dead from overdoses than alive. “Towns are literally falling apart,” he said.
Martin saw many opioid addictions that started from the use of stimulants. “If stimulants aren’t doing it for them anymore, then it’s the natural conclusion. You find opiates, you try opiates, and then your priorities change.”
Besides the physical damage, changing priorities is one of the biggest problems with opioid addiction. It can cause added stress, financial problems, and relationship issues. Martin said, “opiates are probably the only family of drugs that can overcome something like maternal instinct.”
Video Edited By Jackie Pascale
Opiates are widespread and relatively easy to find. Diego, a former opioid abuser, says “it’s really easy to and really tempting to and depending on where you live it’s not difficult to have access to [opiates].”
“If I walked out my front door right now, and I took a half hour lap around most of off-campus and came back; maybe even an hour lap," Martin begins, "I’d probably come back $300-400 poorer with frankly enough substances to incarcerate me for at least a couple lifetimes worth of sentencing….not that I would do that, I just could,” said Martin.
Beyond being easy to find on the streets, opiates are oftentimes over-prescribed by doctors. Diego says that it was much too easy to ask his doctor for refills as long as he waited a reasonable amount of time and described himself being in moderate pain.
Opioids provide addicts a tremendous feeling of pleasure. They activate the release of dopamine in the brain which then associates opioid use with pleasure. This association slowly leads people towards addiction and the cravings that go along with it. In addition, the active use of opioids creates brain abnormalities that are directly correlated with opioid dependence and addiction. These brain abnormalities thus lead the addict to try to obtain the substance regardless of what obstacles exist, according to NCBI. This is the cause for many addicts selling off personal belongings and stealing from others to fund their habits, according to Opiate.com.
“They’re all just people with circumstances that are uncomfortable," says Martin. "They would rather escape than face whatever it is that reality has set before them. And a lot of the times, they die in the process.”
Video Edited By Oly Zayac
HOW TO START AN ADDICTION, AND SUSTAIN IT, PROPERLY
by: Jack Pasi and Tyler Patchen
Addiction can primarily start with pain; an injury, a sprain, a hit to the body, even a fall. A doctor can prescribe painkillers, which are in most cases opiate based, to help a certain person relive and work through pain, and in many cases, the pain can be incredibly severe. The relief and the release that can come from prescription opiates is immediate and incredibly potent. However, in many cases, a person can receive more pills than they need to combat the pain in a medical sense.
In 2012, the National Institute on Drug Abuse estimated 2.1 million people in the United States suffer from substance abuse problems related to prescription opioid pain relievers and an estimated 467,000 addicted to heroin.
Overprescription has become a focus of this investigation. A Stanford study, published in the Journal of the American Medical Association, analyzed data for all Schedule II opioids in 2013 covering 381,575 prescribers and 56.5 million claims for prescriptions and the findings were astonishing.
They found that the top ten percent of opioid prescribers accounted for 57 percent of opioid prescriptions resembling the Medicare pattern for all drugs of the top 10 percent accounting for 63 percent of prescriptions. Most of these prescriptions come from family practitioners, internal medicine practitioners, nurse practitioners and physician assistants.
Dr. John Clapacs, a psychiatrist at Alamance Regional Psychiatric Associates, explains through his observations why doctors may be over-prescribing. He says it often starts gradually: once a patient finishes their first prescription, they feel the need to have more. Writing a second prescription isn’t necessarily an abnormal thing for pain relief.
“After a while it can become easy to continue prescribing with narcotics rather than working with somebody in trying to get off of it," says Clapacs. “At that point people usually tell you, if they don’t have their pain medicine they’re going to be miserable and they’ll really be in a lot of discomfort if they don’t have it.”
Clapacs stresses the importance of not leaving things open-ended in terms of how long a patient will use narcotic pain medicine or any kind of addictive or abusable medicine for that matter. Ideally, it’s good to be thinking about getting the patient off the medicine as soon as they start taking it and having that conversation with the patient.
​
Video Edited By Jackie Pascale
Diego [last name omitted] is an example of someone on the receiving end of over-prescribed prescribed pain medication. A little over two years ago he had four surgeries for his tailbone; after each surgery he was prescribed about sixty pills, claiming that the pain he felt throughout the recovery process likely did not justify these prescriptions. But soon, it became a norm to take the pills, since it was one of the few medications powerful enough to ease his anxiety.
​
“Despite me saying that I trusted him [his surgeon], it was way too easy to ask him for refills and describing me in moderate pain would get me a bottle I would overdose on multiple times over,” Diego said. “It did feel way too easy to get as much as I wanted as long as I waited a reasonable amount of time.”
He said he took the pills over the course of one year, estimating that he was prescribed around 400 five milligram Percocets.
Prescription opioids are a common physician response to patient pain, but once the pain fades and the injuries heal, Diego says instant pain alleviation remains an appealing thought.
“It’s really easy to and really tempting to and depending on where you live it’s not difficult to have access to them,” Diego said.
Even at a governmental level, there is an understanding that over prescribing and excess of opioid pills can lead to a dangerous path.
“What is so particularly pernicious about this is that they are in everyone’s medicine cabinet,” Attorney General Josh Stein said. The availability of these pills has lead to a massive epidemic in addictions to prescription opioids and stronger drugs.
There is a consensus that one of the root causes of opioid addiction in North Carolina is overprescribing. This action of overprescribing and over medicating has had a massive impact. The excess in prescribing has been a major catalyst in aggravating this crisis and leading to many young people to start an opiate addiction.
For those who aren’t able to get a prescription from a doctor; attaining opioids is easier now more than ever. Users now have resorted to buying illicit drugs anonymously via the darknet.
Rohan Potthoff, an Elon University student who is interested in technology and computers, is experienced in the deep web. The deep web is an encrypted web browser that enables users to act with more anonymity than on the surface web, where websites like Google and Facebook exist.
Video Edited By Oly Zayac
A more nefarious part of the deep web is known as the darknet, where it’s added sense of anonymity enables users to buy and sell illicit products online.
“The sheer anonymity makes it too hard for law enforcement to find you,” Potthoff said. “Law
enforcement is going after the suppliers, for the most part, not the end users.”
A survey of over 100,000 respondents say they buy their drugs online in a Global Drug Survey conducted in 2015.
Of the responses taken from the survey, users reported that the darknet was “cheaper, more reliable and safer than their alternative sources. Three-quarters of respondents reported being overcharged by their alternative source, compared with 38 percent reporting the same problem with the darknet.”
74 percent reported being sold a low quality product by their alternative source, while only 27 percent said they had the same problem on the darknet. Risk of threats and violence also was reportedly lower at seven percent saying they had experienced physical violence buying from their alternative source, when compared to one percent on the darknet. Eighteen percent reported receiving threats as a result of trying to buy drugs from their alternative source, compared with three percent using the darknet.
So, when it comes to illicit drug use, including opioids, buying online is becoming the method of choice.
THE AFTERMATH OF AN ADDICTION
by: Francesca Collins
Opiate addiction afflicts thousands of people every year. The consequences of such an addiction take a toll on not only one’s mind and body but those that surround the addict. Common side effects to addiction are abnormal vital signs, frequent blackouts, aggressiveness or irritability, and selfishness, according to Healthy Place for your Mental Health . Beyond just physical, psychological, and relationship damage, consequences to opiate addiction can include jail time, overdose, or possibly death.
Opiates are considered Schedule II substances. According to drug possession laws, in the state of North Carolina, possession of schedule II substances could result in one facing a Class I misdemeanor with six to twelve months in jail .
The attorney general of North Carolina, Josh Stein, introduced the Strengthen Opioid Misuse Prevention act of 2017, which is better known as the STOP act, to NC legislation. This act would enforce the use of a Controlled Substance Reporting System to regulate how much and how often a healthcare professional can prescribe Schedule II substances to a user. Further, the act allocates required funding to improve community-based treatment services. .
The attorney general said the act will “reduce the number of people who become addicted in the first place by controlling the amount of prescriptions” and that it will focus on treatment options.
Dr. John Clapacs, an on-call ER psychiatrist at Alamance Regional Psychiatric Associates, says that keeping track of where someone is receiving their prescriptions can be difficult. A possible solution and improvement Clapacs has seen over the last few years in NC has been a state-instituted tool. This tool is an online database. “[It] is available to physicians and other prescribers where every controlled substance prescription in the state that’s filled by a pharmacy in North Carolina,” said Clapacs. This system depends on each pharmacy entering this data, according to state regulations, pharmacies are supposed to report all data regarding prescriptions into the online database.
​
Video Edited By Oly Zayac
More people will die from an opioid overdose than a car accident this year, according to North Carolina’s attorney general. Opioid overdose is oftentimes irreversible. Naloxone is currently the only FDA approved medication that can reverse an opioid overdose. It was approved in November 2015. The National Institute on Drug Abuse reports that naloxone “binds to opioid receptors and can reverse and block the effects of other opioids.” Currently, Naloxone is only FDA approved in three forms: injectable, auto-injectable, and a prepackaged nasal spray. The auto-injectable and prepackaged nasal spray can easily be used with those without training. According to Dr. Clapacs, one can get insurance or medicaid to pay for the drug.
North Carolina police departments have initiated the fight against opioid addiction through some non-traditional programs. The Fayetteville Police Department has implemented the Law Enforcement Assistance Diversion, LEAD, program. The LEAD program allows for law enforcement to redirect low-level offenders involved in drug or sex work activity to community-based programs and services instead of jail and prosecution.
The Nashville Police Department has implemented a program similar to LEAD. Thomas Bashore, the chief of police in Nashville, NC, said that after looking at statistics to potentially implement the Angel program in October 2015, he discovered that EMS and police had used naloxone on opioid overdoses about 15 times per month. This shocking statistic led him and the police department to implement the HOPE initiative which was modeled after the Angel program. At that time, the Angel program was used in less than a hundred police departments across the nation. The HOPE initiative allows for addicts to turn themselves in and receive help without charges being pressed. This programs requires willing participants to turn themselves into the police department and to turn in all of their drug paraphernalia. After turning themselves in, their would be a 20-30 minute initial assessment that would be followed by the addict being checked into the ER. Once at the ER, individuals are assessed by a doctor, a behavioral specialist, and are then referred to a detox facility. On day three or four of an individual’s stay at a detox facility, Chief Bashore goes to the facility along with a transitional care social worker and a social worker in order to work out a post-rehab plan.
Video Edited By Jackie Pascale
Chief Bashore said, “It’s not uncommon for an individual who has substance abuses to return to use four or five times before they actually get to recovery and stay in recovery for a sustained amount of time .”
Beyond the HOPE initiative, the Nash County police departments have begun ‘attacking’ the supplier side. This involves a task force of ten different law enforcement agencies.
After an overdose, some addicts continue to use while others either voluntarily or involuntarily seek recovery options. Many attend Narcotics Anonymous meetings which aim to help addicts during recovery. NA encourages all addicts to come and get clean while having a community to support them.
Oftentimes, there is a stigma that goes along with being an addict and many are scared to reach out for help or attend a meeting lest they be seen a certain way. “If we’re going to preach to these stigmatized substance disorders, then we can’t be judgemental….it’s not fair to them because it is a brain disorder; it’s a disease; it’s not a moral failing or a choice for them on the most part,” said Chief Bashore.
In order to change the perception of recovering addicts, the attorney general and his office have started #opioidsurvivor. He said that usage of the hashtag will hopefully change the stigma and encourage people to talk about what they have experienced and are experiencing. “We want to remind people there is hope,” said Stein.