In the throes of addiction: part three

Editor's Note: This is the third in a three-part series about Ohio's heroin crisis. A symptom of a larger disease, opioid abuse and pharmaceutical abuse have ravaged the Midwest — and people are finally waking up to it. The path out of addiction twists and turns, and it is littered with obstacles. The National Institute on Drug Abuse puts the relapse rate for drug addiction at 40 to 60 percent. Although recent endeavors such as the Comprehensive Addiction and Recovery Act aim to equip law enforcement and health providers with more tools to fight addiction, there’s much more work to be done.Dr. Teller of Kettering Medical Center noted that harsher guidelines for who can prescribe opioids and what they can be prescribed for may help. Teller spoke about the report card project, something he is working on in hopes of lessening the rampant rates of prescription.“We can enact a system that puts doctors on a bell curve based on how much they prescribe. We keep track of the patients that doctor sees in a month, and of how many of them received an OAARS (Ohio Automated Rx Reporting System) reportable drug,” Teller said. “If you overprescribe, we can detect that, talk to them and work backwards from there.” The idea of greater control over the outgoing flow of prescriptions in hospitals is certainly enticing. The Ohio Automated Rx Reporting System is an existing tool that monitors prescription drug dispensing to detect possible abuse. Teller believes an expansion of the system tied into the report card project would be a welcome step in detecting and putting a clamp on abuse and malpractice.Project DAWN, an overdose education program aimed at spreading awareness and training regarding the opioid epidemic, has dedicated serious resources toward the proliferation of naloxone. Sometimes called Narcan, naloxone is administered to victims of a suspected opioid overdose to reverse its effects. The use of naloxone has had significant results. Given that 64.6 percent of surveyed drug users reported having seen an overdose in person, efforts such as its proliferation may help combat lethal overdoses.As a community based program, Project DAWN highlights how local efforts to stem the opioid epidemic may be the most effective. Rather than focusing on overarching policy so broad it’s blind to the needs of local communities, Dr. John Gay, executive director of Health Recovery Services, indicated that future health care initiatives would be better suited focusing their efforts on local programs. Athens County, for instance, received only $2,390 in funds for naloxone, according to the Ohio Department of Mental Health and Addiction Services, with many others receiving even less. Engaging victims on a personal level and offering support for those most vulnerable, such as the children of addicts, is another means of ending addiction’s grip on communities. Ohio Attorney General Mike DeWine recently announced the creation of a program aimed at assisting these children throughout 14 of Ohio’s worst hit counties. Dr. Teller repeatedly intoned that a more compassionate, human-focused treatment plan incorporating such ideas as this has a greater chance of success than merely throwing more money at the problem. History seems to back such an approach; the National Institute on Drug Abuse found that opioid-addicted prisoners who began methadone treatment and drug counselling fared better and had a lower relapse rate once released from prison than those who hadn’t. Establishing treatment on demand for victims of drug abuse, too, is an option — though Teller noted that such a thing demands a fundamental change in how the public views health care in the U.S. “People will ask, ‘What’s my responsibility for another’s addiction?’ What’s the social commitment here?” Teller said. Those advocating for a tough-on-crime approach note that harsher penalties for selling and trafficking such drugs as heroin and it’s more potent relative fentanyl could deter sales. Such proposals have been met with mixed feedback, particularly due to the racial inequality that often stems from such approaches.  Integrating local law enforcement forces with statewide initiatives, too, could aid authorities in tracking and combatting the epidemic. Ultimately, Teller believes the solution to this epidemic lies not in the halls of hospitals nor Congress, but in the American living room. Our agents of socialization — those people and institutions which teach us early in life how to behave — must be recruited and weaponized against addiction. “We need to bring community leaders together. Let’s bring in the clergy and ask ‘What are you doing for your congregation?’” Teller said. “Let’s engage employers. Let’s expand education for parents. To what extent are we energizing family to help patients?” Both Teller and Gay insisted that a community-based approach that focuses on the foundations of this problem — on preventing addiction altogether, rather than treating it — is desperately needed. If families can be engaged in their homes, congregations in their churches and employees in their workplaces, Ohio may yet see the day when it gets clean.