The opioid epidemic is in the news, part of our discussions with neighbors, friends and families, and affecting our kids. What can municipal leaders do about it?
Dr. Ruth Potee, a board-certified family physician and addiction medicine physician from Greenfield had a number of recommendations when she spoke at the Massachusetts Mayors’ Association meeting in Greenfield on Oct. 24.
As a practitioner who sees patients at the Franklin Recovery and Treatment Center as well as at the Franklin County House of Correction, Potee knows well what recovery looks like. To illustrate one aspect of the problem, she described the stark difference in care for a heart attack versus an overdose.
In one case, a middle-aged man who refuses to follow physician recommendations to quit smoking, eat better and exercise is rushed to the emergency room with heart attack symptoms and is immediately admitted for quadruple bypass surgery. This is followed by post-surgical treatment, drugs and rehabilitation, with total health care costs reaching around $250,000 – all without judgment from the medical community, even though the man’s condition was likely worsened by his lifestyle choices.
In another case, a 24-year-old woman who has been sober for nine months is found unresponsive in a bathroom. She is rushed to the emergency room, where she is stabilized and released with no follow-up treatment to help her regain and maintain sobriety. Her treating doctors also fail to congratulate the young woman on the hard work it took to remain sober for nine months.
Potee lamented the stigmatization of addiction and the lack of long-term support systems, and said it’s no wonder that the cycle of addiction repeats.
“The disparity in the care that we provide two human beings is appalling,” she concluded.
Opioids are a leading killer
Potee pointed out that the United States prescribes more opioids than any other country in the world, and opioid overdose is the leading cause of death among people under the age of 50. She admitted that she reads the obituaries daily, and when she sees that a young person has died, she knows it was most likely a drug overdose.
Potee said three factors predispose a person to addiction: genetics, early drug use while the brain is still developing, and trauma. We can’t change genetics, she said, but we can do more to address childhood trauma and to prevent kids from drinking or using drugs. She added that 40 percent of teens who begin drinking by age 15 become alcoholics.
Potee explained how opioids “hijack” the brain and how their use quickly leads to addiction. The drugs lower dopamine levels, driving users to increase their usage to feel better. An addict needs one-and-a-half to two years away from the substance to get better, she said, but “it only takes one thing to go wrong to have it all go down the drain.”
Potee described a range of actions and support services needed to prevent or treat addiction, including having a sense of purpose, mental health treatment, positive relationships with family and friends, stable and sober housing, medicine and physical movement.
In Greenfield, residents formed an Opioid Task Force to address some of these issues. One of many accomplishments was the opening of a 64-bed treatment center a mile from downtown. The task force also worked to increase public awareness about the problem and improve access to naloxone, the medication that reverses overdoses.
Potee made the following recommendations of what mayors can do to address the opioid problem:
• Provide more long-term, state-certified, sober housing to help with the transition from a treatment program to a new lifestyle.
• Increase prescriptions of methadone, which, studies show, is a very effective and inexpensive method for helping people get off opioids. Potee said it costs more when addicts relapse than it does to put them on methadone. She also recommended that methadone clinics be accessible, indoors and heated.
• Ensure that naloxone (Narcan) is available in every police and emergency responder vehicle.
• Increase the number of detoxification beds.
• Increase drug take-back programs.
• Offer needle exchange programs.
Potee concluded that progress on ending the untimely deaths of so many young people will be made when people stop viewing opioid addiction as a “crisis” and start viewing it as a public health issue that needs funding.