Everyone Was Looking For Answers

My wife and I went to a town hall meeting in Carroll County, Maryland, yesterday. The meeting was about the opiate drug abuse epidemic and what different agencies and people were doing about it. The keynote speaker was an agent with the Drug Enforcement Agency (DEA). He gave the usual statistics on number of deaths and overdoses, and what his agency has been doing to counter them. He also talked about how most of the heroin being used in Virginia, Maryland, Pennsylvania and West Virginia flows from Baltimore on what is called “the heroin highway.” (Of course, he clarified that heroin and other opiates are being illegally imported from Mexico.) We then got to hear from people in the community who run different intervention programs. Included in those presentations was one by the local hospital. It went “dilaudid-free” this year, and they’ve seen the number of “seekers” go down along with an increased positive response about pain control from other patients. In essence, not everyone needs dilaudid — a powerful opiate-based analgesic — for things like sprained ankles or strained backs.

People from the local and state health departments also spoke about their agencies’ efforts to curb the epidemic. Locally, they’re raising awareness about the link between abusing prescription painkillers and getting hooked on heroin. They’re also using recovering addicts to talk to peers about prevention. And, of course, they’re distributing Narcan to friends and family of people abusing opiates and heroin in order to prevent deaths from overdoses. Statewide, new rules are coming online to keep track of what opiates and how many are being prescribed. In that vein, a lot of finger-pointing was done at dentists who give prescriptions for 30 days of OxyContin for tooth extractions or installation of braces. A lot of the attendees — many of them parents whose children were prescribed these opioids for “simple” procedures — said that it seemed to them that prescribers (e.g. dentists) didn’t want to deal with a complaint about pain, so they just prescribe the strongest thing in their arsenal.

Most painful of all were the stories of parents whose children died recently from heroin overdose. One parent, a pharmacist, talked about a “pill mill” not far from our location. He wanted something done about that because his child started off addicted to OxyContin. Another parent said that she still has some heroin from her child at the home, and she wanted the local sheriff to take it and analyze it to see if they could trace it back to the source. (Something that is very difficult, if not impossible, to do.) Other parents gave similar stories of otherwise “normal” children who fell into opioid drug abuse and then moved onto heroin, which is easier to acquire and quite cheap.

I say that these stories were painful not only because of the loss of life, the loss of their children. It was painful because it was obvious that they wanted answers, they wanted someone to pay the price for their loss. But there was no one to blame, at least not in the room. For the parents who wanted the drugs analyzed in order to maybe find a dealer, it’s probably not going to happen. And, even if they do track down the dealer, the chance of the dealer being charged with their son’s death are low. And I can see how that must be incredibly frustrating. Someone, somewhere, made the conscious decision to manufacture and sell poison to their kids. Someone profited from their deaths. Even if the chances of people “in the game” are likely that they’ll get killed or seriously hurt for being in it, someone is getting away with hurting those who overdose and/or die.

However, the answers to the epidemic are almost as varied as the drugs that are being used. You can seal up the border to keep heroin from coming in through Mexico, but you’ll have it come in from Asia via Canada. Or you’ll have designer opiates (like all the Fentanyl variants) being made here in the US. And, of course, you’ll have prescription opiates being handed out like candy by people who don’t want to hear your whining about your broken leg. Or could severely restrict prescriptions, piss-off the pharmaceutical industry, and have people move to heroin as they can’t get their pills. Then you could do both, but the underlying social and mental health issues that drive people to addictions are not addressed and they go to other dangerous/illicit drugs (or some licit ones like alcohol and marihuana in several states).

In a perfect world, you would dismantle drug cartels by taking away the demand for drugs. You’d take away the demand by solving social problems that lead people to want to escape their situations by abusing heroin and other drugs. You’d also have mental health readily available to help people who have something happen in their life that leads them to want to escape. Or, if they’re there already, you’d have recovery services ready to help. You’d also have clean needles to prevent infections and people from dying, or Narcan in every public place (like Automated Electronic Defibrilators are now) and in the hands of every addict and their immediate circles in order to keep them alive.

Of course, there are other things that work which I might be forgetting.

While some at the meeting were being optimistic that maybe the epidemic was subsiding, I’m not as optimistic. Looking at the trends, this thing is happening in waves. As Baltimore and other major cities get “dangerous” during the summer, people turn to other drugs to fill their needs. Then they go back to buying heroin once things calm down in the cooler/colder months. Heroin overdoses seem to wax and wean like that, just like almost everything else in epidemiology. I certainly hope that it is calming down. I hope that more parents aren’t looking for more answers. But I don’t know… I just don’t know.

I'm a doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen

3 thoughts on “Everyone Was Looking For Answers

  1. A funny thing happened to me last Monday. Doctor prescribed hydrocodone, replacing the no longer effective tramadol.
    The change came after I caught my wife, preventing a fall after her gallbladder and umbilical hernia repair (the hernia was secondary to a failure of her c-section scar), resulting in rather severe back pain, back spasms and more dire, spasms in both calves that had me honestly wondering if my feet were going to twist off.
    Once the immediate trauma has healed, we’ll have to see if L4-L5 finally has failed. It’s been bulging for 30 odd years and I’ve long had sciatica.
    Annoyingly, doctor also prescribed tizanidine, a “muscle relaxer”, which really doesn’t relax muscles, it’s simply a CNS depressant. I rarely take that one, as the spasms are relieved by the hydrocodone, which is a CNS depressant in its own right.
    I’m not exactly the happiest camper on the block, as I’m really not all that fond of narcotics anyway, but when they’re necessary, they’re necessary.
    My wife has been taken off of her hydrocodone with APAP, as she now has bilary cirrhosis and further insult to the liver isn’t exactly a good idea. She’s now on oxycodone without any NSAID. She complained of breakthrough pain, I suggested ibuprofen, which is synergistic with the oxycodone, to excellent effect.
    She has her neurosurgeon appointment on 31 August, for every cervical disc and her L5-S1, which is badly pressing upon the cauda equina. She has bladder control problems, so the pressure is quite great.
    I’m still taken aback by her cervical spine, as the MRI imagery was one where I was looking to find even one disc not impinging upon the spinal cord!

    What really stinks on my end is, even 10 mg of hydrocodone isn’t relieving my shoulder pain and doctor still has yet to refer me out to an orthopedist or sports medicine specialist for the separation.
    Still, I’m better off than my wife, who became hypertensive from her pain, but returned to normal pulse and blood pressure when her pain was treated.
    I’m still scratching my head over her mild LVH, confirmed as such by atrial flutter, as any hypertensive episodes weren’t long in duration.
    What a pair of train wrecks! Oh well, at least my title as being the eldest male from my father’s side of the family to not be diabetic. It’s all body mass related there. As long as I keep the tonnage under control, I should be fine in that respect.

    Oh, a bit of medical trivia. In the UK, heroin is used in hospital for post-operative pain. In the US, it’s considered an uncontrollable drug, with no valid medical usage.
    The UK treats substance abuse as a disease to be treated, the US as a moral failure on the part of the addict.
    For some odd reason, the former method is effective in treating addicts, while the latter approach is fraught with failed opportunities.

    Oh, for the record, I am indeed addicted to one drug – caffeine. Withdrawl symptoms from that include PVC’s that toy about with v-tach. I’ve cut back on my caffeine consumption for that very reason.

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    • See, there are people who really need these things. But a young kid having otherwise simple teeth extractions or braces? Come on!
      And I hear you about the caffeine. I’m a horrible, horrible person if I don’t have it, and an intolerable goof if I do.

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      • Heh, I was rather pissed off that doctor had to prescribe such a strong drug. It meant, I was farked up badly, as he understands my wishes.
        As for braces, well, I’ve a complicated dental condition. Bad reflux and tooth/gun bed erosion that’s actually resulted in otherwise healthy teeth breaking off at the gumline.
        Kids don’t have that kind of a problem, as such a thing takes many, many years of the problem creating such a condition. It’s beyond their current lifetimes.
        Still, I’ve had a ham fisted dentist (literally, in terms of size of his hands) work on my mouth, leaving me with aches that lasted for days. Others would likely experience greater pain. I have a rather high pain threshold. I can see how a dentist would want to avoid whining.
        That said, the number of patients thus overtreated isn’t actually all that high, despite what some over represent. By an order of magnitude at a minimum.
        Meanwhile, physicians are infamous for overprescribing narcotics. They’re also infamous for failing to police their own ranks, despite being trusted to do so. Hence, antivax physicians and pill mill physicians. Honestly, I’m wondering if we could adapt RICO statutes to address both groups.
        For, if they can’t police their own, we have to address it via legislation.

        As for caffeine, well, I awakened late last night and had to toss my clothing into the air, then jump into it and drive to work. Amazingly, the brazen act of bravado worked out – I arrived at work both clothed and alive. To find one passphrase had aged to expiration.
        Five minutes proved that reasoning what new passphrase would be accepted by the system proved utterly refractory and I was replacing a man who covered a coworker’s shift and was up for 18 hours already, so I sidelined it until I could actually think and figure out how to look up the rules for it.
        Around 8:00 AM Eastern, I was ready to log off, alas, that very same coworker was tardy. I investigated the parameters for the passphrase and used it, resulting in the loss of connection for a dozen and spare change tools, but eagerly awaiting his arrival.
        I ended up logging into everything again, as I awakened an hour tardy.
        But, having my caffeine in my system allowed me to figure out the rules and change the passphrase (it actually also requires a token’s numbers with it, making it an official pain in the ass) and full access finally was attained.
        As I couldn’t create a daily report, due to a lack of access to specific network resources, his tardiness was utilized to generate said report, place our shift log into place, as mine was offline to our primary share and catch up with a few other odds and ends that were unavailable previously, due to the expired passphrase.
        I couldn’t figure out a lick of that when I reported to work, in caffeine withdrawl.
        I’ll be cutting back a bit more, as I really loathe being that incompetent!

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