Opioids in Alabama...The 50 Year Long War on Drugs That We Can't Seem to Win
There are many social issues out there that we can discuss, but none are more reaching and impactful than the current opioid addiction/"crisis" that is continuing to proliferate despite our best efforts to curtail it, and it is devastating to the quality of life for such a large segment of our population that almost all of us are affected by it in some way.
Our response over the years have been a combination of law enforcement, incarceration, and substance abuse treatment, through both counseling and clinical medical treatment, but there seems to be no "one size fits all" formula for recovery, and we are simply losing this battle under current protocols.
As I continue to seek position as your District 4 Representative, I felt it beneficial to develop a round table discussion on the issue, from varying perspectives within the community to "compare notes" and lend toward an integrated, coordinated approach to our response within the various disciplines of the district.
On Thursday, April 12, our first meeting was held. It was attended by Scott Anderson, Morgan Co. District Attorney, Ron Puckett, Hartselle Chief of Police, Michael Johnson, Dispatch, Morgan Co. Sheriff's Office, Julie Clausen, Morgan Co. Republican Executive Committee Secretary and State party member, Bill Lawrence, also on both State and Co. Executive Committees, Dr. Greg Cheatham, and hosted by me.
Dr. Cheatham gave a well structured discourse on the medical process of opioid addiction, the social origins of how we as a society created this monster, current treatment ideology, and the social environments and process issues that are limiting successful treatment rates.
Scott Anderson gave a synopsis of how the DA's office handles arrests, convictions, and how the Morgan Co. Drug Court system operates.
Ron Puckett gave his perspective as a local Law Enforcement Chief on the transition toward heroin in our community, and increases in overdoses and deaths related to its usage, as well as the emergence of Fentanyl, an incredibly powerful synthetic opiod that is hitting the streets, affecting potency of heroin, and potentially lacing marijuana and other non-opioids to alter their effects, often without the knowledge of the consumer.
The rest of us listened, and asked questions. Here is what we took from this meeting:
- We Created This Problem
America is by far the largest per capita consumer of opioids. This began to escalate in the 90s with runaway prescription rates for newly developed oxycontin and a push by the manufacturer to present the drug as "safe when taken as prescribed", coupled by a new government push to consider pain management integral to proper medical treatment. Usage rates exploded, as did addiction rates.
- The Rise of Heroin
As we entered the current decade, efforts to prevent abuse with new formulations that made prescription opioids harder to abuse, coupled with legislation in Alabama in 2012 to monitor and limit pharmaceutical dispensation rates were relatively effective, drove availability down, and street price up, and many abusers moved to heroin as a cheaper, more readily available and effective drug to provide their fix.
Available in a variety of forms, and varying in potency, Fentanyl is both a wonder drug, and a potential killer. It is a synthetic opioid developed over 50 years ago, and can be up to 10,000 times more potent than pure heroin. In the hands of nefarious illicit drug dealers, it is becoming commonplace to lace street drugs, including marijuana, with varying degrees of fentanyl to create increased pleasure and dependency in unsuspecting users, but the results can be deadly.
- Modern Treatment Protocols
Advances in the understanding of the mechanism in which opiods attach to pain receptors has led to some effective treatment protocols, including methadone, and now the new "wonder drug" Suboxone, a highly effective low level opioid that attaches to pain receptors, prevents, and even reverses the effects of much stronger opioids like heroin. However, the success of these clinical methods depends heavily on the will of the patient, the social environment of the patient, and the ability to fund treatment.
The "will of the addict" is critical. Many addicts are high functioning, and would rather stay addicted than go through the treatment process. In some cases, addicts need to remain addicts to genuinely treat a pain condition, in others, partial success can be obtained by moving a heroin addict to a Metadone or Suboxone for extended duration, ideally, the addict will seek clinical treatment that will lead to complete departure from all opioid consumption. Some choose not to seek treatment due to either a social stigma or lack of insurance coverage. Of those who seriously seek to get off of heroin, Suboxone has a very high success rate.
Environment is a major factor as well. Treatment will be ineffective when a patient cannot distance himself from the source. Often, a recovering addict will return to a home environment with access to opioids, and will immediately succumb to the temptation.
Often, opioid addiction can lead to criminal behavior, and an addict will find himself in jail. This can be an effective tool toward realizing the need for treatment, but proper assessment of the mental state of the user can be challenging for law enforcement, and well intentioned drug courts can be compromised by deceptive posturing designed to facilitate release without any true intent or desire to seek effective treatment. Jail personnel, prosecutors, and judges find it challenging to properly determine what treatment methods are truly appropriate, and invariably, end up bogging down the court docket with repeat abusers trying to use drug court to simply get back on the street. Psychological assessment is difficult and expensive to provide, and with mental health already heavily compromised in Alabama, simply recognizing that opioid addiction has a mental health component does not mean that it is properly addressed.
Drug Courts are ideologically empathetic toward addiction, but delayed dockets, abuses by inmates who don't really want to be treated, and costs can limit their utilization.
- Education and Deterrence
Prevention is fundamental. We have created this monster through bad governance, bad marketing, and bad parenting. When our children grow up thinking the normal thing to do when you hurt is to get a pill from grandma...and grandma complies, she is not only a drug dealer, she is proliferating the mentality that leads to addiction.
Better patient understanding of the potential for addiction can mitigate abuses.
Continued evolution of risk management within the medical community in pain management, and a more cautionary approach to treatment can mitigate abuses.
Certainly, the best way to treat addiction is to prevent it.
- Where do we go from here?
We have a twofold problem. We have addicts who need to be helped, and we need to help keep everyone else from becoming addicts.
On the former, more comprehensive assessment of patients by doctors, and inmates by law enforcement, as to the state of mind and will of the patient to seek and comply with medically supervised treatment can improve overall success rates considerably. As with any social ill, this may require additional legislative action, professional education, improved symbiosis between the treatment providers, law enforcement, and the courts, and funding.
On the latter, parental discipline in how we educate youth on the hazards of opioids, the social stigma of opioid abusers, and the desire of society to assist those suffering addiction are key. Limiting prescription exposure by enforcing or enhancing the 2012 legislation, and promoting a mentality whereby recovered addicts are not ostracized, but will willfully tell their stories to those who need to hear it, in our schools, churches, and social clubs should also be encouraged.
This "crisis" is not something any of us should dismiss. We all have a part to play in addressing the ills of our society, and this problem will not go away until we all work together to achieve that goal.