Long wait lists for treatment. Insurance coverage requirements that can prevent an addict from getting help. A persistent negative stigma about addiction.
These are some of the myriad complaints aired during three community forums last week hosted by Your Voice Ohio, a collaborative of more than 30 media organizations working to identify solutions to a drug epidemic that kills thousands every year. Two more forums are scheduled for this week.
“Something’s wrong at every step of the process,” Kristi Lobaugh of St. Clair Twp. in Butler County said at a session Monday night in the Middletown downtown library. Lobaugh said her entire family has suffered because her brother’s opioid addiction.
“When you have a person that wants to get help, it’s really not as affordable and accessible as some of these agencies would have you believe,” Lobaugh said.
The aim of the sessions is not to attach blame, but to give people a chance to have their voices heard by the media and other key members of the public and private sectors.
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What has emerged so far is this: people are fed up — with overdoses and deaths, with official lip service and inaction, and with the persistent negativity surrounding opioid addiction.
Each session covered a broad range of topics, but a few key themes emerged:
- A stigma persists across communities about mental health and addiction. This leads those in crisis to isolate themselves and self-medicate, participants said. It is both a contributing factor to the crisis itself, and the reason many families dealing with addiction still feel like they are going it alone. Participants said they’d like to see more public awareness campaigns to lessen that stigma and more community conversations so addicts and families feel supported. From the media, they’d like to see more stories of hope and success.
- There is an overwhelming sense of chaos from the public on what is being done, even though hundreds of government agencies, non-profits and businesses across southwest Ohio are working to attack the opioid crisis and doing so collaboratively in many cases. People seeking help for themselves or a loved one still feel like they don’t know where to start. One suggestion during the forums: A more streamlined system for intake and referrals to get people connected with the proper treatment quicker. Someone else suggested a one-stop shop for the region. Several counties maintain comprehensive resource guides on their websites (see box), but participants say people don’t always know where to look.
- Different communities have differing resources. Middletown, for example, doesn’t have a residential addiction treatment facility. Those in rural Preble County have even fewer options. There are long wait times in some jurisdictions to get into rehab programs, and many complain the programs are too short for meaningful recovery — sometimes only a few weeks. Participants requested a better system for connecting the right resources with the people who need them, and several said quality ongoing services beyond detox are needed. One idea that seemed to resonate: Divert money used for incarcerating people found guilty of drug possession and use it to provide better treatment options.
- The enemy is us. From advertising drugs on TV to glorifying drug use in entertainment, we’ve become a nation of pill-poppers. There is a perception that a pill can fix all. Several big-picture suggestions were floated: get rid of drug advertisements on television, have doctors move more toward a holistic medicine approach, adopt a school curriculum that doesn’t just teach drug abstinence, but emphasizes healthy choices, decision-making, coping skills and how to get help for mental health issues or trauma.
The most agreed upon statement at the end of each session was that the conversation needs to continue.
“We need more of these,” said Jewell DeFrates, a coordinator with the Salvation Army’s Safehouse at Damon Park in Middletown. “I think definitely forums like this promote awareness and hopefully decrease stigma.”
‘It’s not that easy’
The stigma can be a barrier to employment, too, said Lobaugh, even when drug users are getting treatment.
When a person in recovery is taking suboxone, methadone or other medication as part of their treatment, she said, it will result in a positive drug screen for opioids. They are getting help, but could get drug-tested out of a job.
“But why is that drug any different than an anti-depressant or bi-polar medicine or anti-anxiety, because at the same time it’s all mental illness,” Lobaugh argued.
Although Ohio’s opioid epidemic has touched virtually every corner of the state, there is still a perception that it’s a choice, or a bad decision or “not my problem,” several participants said.
“That was me before my son died,” one woman in Middletown said.
Added Lobaugh: “There are some people that think, ‘just stop.’ And it’s not that easy.”
Keeping people alive
Not all treatment tries to cure people; in some cases, participants pointed out, you have to focus your efforts on keeping people alive.
Practices like making overdose-reversing naloxone widely available and hosting needle exchanges are considered harm reduction.
The goal, one participant said, is to “keep people alive until they can get cured.” Many expressed frustration with public attitudes that addicts with multiple overdoses should be left to die.
“There are people coming out of these treatment centers that are dead within hours of leaving,” said Paula Detrick of Troy. “It’s a whole new ballgame whenever we’re dealing with fentanyl and carfentanil.”
Fentanyl is many times stronger than heroin and carfentanil — often described as an elephant tranquilizer — is many times more potent than fentanyl. Many at the forums described the impact these powerful opioids are having on their families.
Detrick’s son is in an ongoing battle with addiction and is currently incarcerated. Harm reduction solutions, such as safe injection sites and free test strips to detect if a drug is laced with fentanyl, could have avoided her son’s two overdoses, she said.
Safe injection sites are designated places where addicts can go to get clean needles, and use drugs they know to be safe from fentanyl or other additives. Facilities of this type in other countries typically provide treatment referrals, counseling and access to medical staff on site.
San Francisco and Philadelphia officials recently OK’d the creation of safe injection sites in those cities, which would be among the first such sites in the United States.
Local officials are not considering safe injection sites right now, but are looking at the possibility of offering free testing strips at existing needle exchange locations, said Dan Suffoletto, public information supervisor for Public Health Dayton and Montgomery County.
‘There’s a down side’
One piece missing from most of the conversations, despite being the biggest push by lawmakers, was the flurry of lawsuits against drug companies. Several people mentioned drug companies as part of the cause of the current crisis and want to see them held accountable, but there wasn’t any consensus about whether lawsuits will have an impact on local communities.
Montgomery County is the latest government entity to enter the legal fray against drug makers, announcing on Tuesday that it has hired a national law firm with success in past drug company lawsuits to take legal action against “individuals and entities related to the marketing, prescribing, distribution or sale of opioids.”
Medical professionals in attendance at Tuesday’s forum in Cincinnati’s Madisonville neighborhood said the responsibility for overprescribing opioids falls more broadly on the entire health care system.
Part of the problem began with the push in the medical community to treat pain as the “fifth vital sign,” several professionals said. Doctors and hospitals were judged based on satisfaction scores that incentivized getting rid of people’s pain in order to secure full reimbursements.
That opened the door for the pharmaceutical companies to push their products, said Dr. Craig Cleveland, an internal medicine doctor who is now the program physician at Sunrise Treatment Center in Cincinnati.
“Then the docs, just like everyone else, they found that there was a way to make money, by being pain docs and pushing these medicines more than they should,” he said. “But on the other side, there’s the patients who — whether it’s bipolar or depression, anxiety — got a benefit from the drugs and actively went out seeking them.”
Opioids, Cleveland said, “solve so many problems — it’s kind of a universal drug” when used properly. But, he added, “there’s a down side.”
Doctors need to change the way they treat underlying issues like mental health and pain, but legislating restrictions on prescribing opioids is not necessarily the right answer, Cleveland said, and could negatively impact those with real pain management needs.
“The top down mandates are coming from people who don’t really realize what’s important,” he said. “They’re not talking to the people who are in the trenches treating patients.”
Need help now?
Participants at the local forums expressed frustration in finding information on treatment options. Although there is not one site with all local resources listed, several health agencies have created comprehensive pages and hotline numbers for those in crisis or concerned family or friends to utilize.
Montgomery County: Comprehensive list of resources at mcadamhs.org.
Crisis hotline: 937-224-4646 or text “4hope” to 741741.