Alternative options to the opioid epidemic in Rhode Island and America
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This the story of my brother Brandon, and countless other, who passed away due to opioid abuse. He passed away at 34 years old on March 24, 2017 due to an accidental fentanyl/opioid overdose. His story spans about a decade of drug abuse with at least half a dozen overdoses we know of. His story of addiction & death are eerily similar to so many other young people of his generation. Brandon was injured while building a shed with a family member. He was accidentally shot in the eye when a nail gun misfired. He was hospitalized & given narcotic pain medication for the severe pain he was in. He became addicted & his life was never the same again. He accidentally overdosed over the years with the frequency drastically increasing within the last year. He was revived by Naloxone or Narcan on many occasions except the last time when it was just too late. Sometimes he would be taken to the hospital by EMS only to return a few hours later as if nothing had happened. In most cases he was brought to Kent County Hospital by ambulance & once to RI Hospital where he stayed for a while after getting pneumonia due to the overdose. In November of 2016 he was hospitalized for many weeks due to a blood infection from shooting up.
There were many many times my mother & I spoke about having him committed. But this was never an option for us. I believe if it had been maybe we could have helped him & I am not alone. He was released from the hospital with NO plan of care, NO police intervention & NO consequences. He was turned away from Roger Williams detox just 3 weeks before he died & just one day after the previous overdose. There is a stigma associated with drug abuse and drug related deaths. Some people are uncomfortable admitting that someone died of a drug overdose or abused drugs. It makes people uncomfortable sometimes but I think its important that others know that these people that over dose, like my brother, were more than a drug addict or a secret to be hidden away. He was an amazing person not a stereotype but a person who lived and was loved. He loved others very much but unfortunately could not love himself. He was always there when someone needed him..Brandon was an amazing person with an infectious laugh & amazing sense of humour. He was much more than a stereotype. He was kind, caring, strong, loved his family & friends more than himself. He was my brother, a son, a father, a favorite Uncle & a best friend. He was loved for 34 years by so many & will not be forgotten. After his death we became involved with groups such as Grasp, a group for families of those who have died due to drug overdose. We also came to know the Banner of Love, a banner recently displayed proudly at the RI State house. The banner holds the pictures of dozens upon dozens of our youth lost to opioid related overdose. Meeting these grieving families one finds that the stories are similar and the endings are sadly all the same. But the individuals were all special, beautiful and gifted with plenty of life left to live. Some choose tough love and lost their children to the streets, others stuck it out only to find their child dead at home, still others won the battle seeing their children go off to rehab hopeful only to have their children found dead in a sober house loosing the war. These kids came from good homes, some attended private schools, they were talented and future oriented but most importantly they were all loved. They leave their families with their pain and suffering. Let's not watch idlely as another mother buries her child or another father weeps in the shadows. There are families suffering a loss too heartbreaking to even imagine.
Thirty-seven states allow some form of what’s known as involuntary commitment—forcing a loved one into rehab for a limited time period. In Massachusetts, parents can appear in court and ask a judge to commit an adult child to treatment, if there’s a “likelihood of serious harm,” according to state law. But in Rhode Island, involuntary commitment is only legal for alcoholism, not for substance abuse or for people suffering from other mental health conditions, it isn’t allowed for those battling substance abuse.
About eight thousand people were involuntarily committed in Massachusetts last year, sent to state rehab facilities or sometimes held in jail until a bed becomes available. Governor Charlie Baker introduced a bill to expand the practice so that families could request a 72-hour hold without first going to court, which could be helpful when an overdose happens overnight or on weekends. That bill is now making its way through the Massachusetts legislature. New Hampshire is also considering legislation that would make involuntary commitment legal in that state.
There have been many sceptics & many uneducated responses to these ideas. Some have stated that this was a CHOICE he made, thus his own fault. I agree to some points but I believe as do many people in mental health that after the first time these drugs are introduced into ones body they are never the same again. Once addicted it is no longer a choice. Some do not wish to be burdened with having to pay for involuntary committal or any rehabilitative services because they feel drug use is a choice. Yet they unknowingly are repeatedly "paying" for numerous hospital visits, ambulance rides and doses of Narcan. In 2014 alone 39% of patients admitted to Rhode Island Hospital emergency department for an accidental drug overdose were on Medicaid. If using the same rational; that it is a choice, we could also use the excuse and not treat some forms of lung cancer, Syphilis, Gonorrhea and even possibly Gout just to think of a few but concerns of money should not change our morals or intelligence. These are all stupid options. We should consider more funding for prevention, treatment and recovery. Medication like Vivitrol should be more affordable and available. We have to consider the idea that some help, whether its defied or not, is better than no help at all. If the abuser is constantly endangering their life and the lives of those around them, then involuntary treatment should be heavily considered. We need to help these people take back control of their lives and stop hurting themselves. This should also take effect when there are drug related arrests for personal use.
The American Medical Association declared alcoholism a disease in1956. Alcoholism is recognized as an addiction. The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterizes by altered brain structure and function.
According to DrugAbuse.gov, "addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her."...But addiction is characterizes by the inability to stop.
Addiction changes the brain, disrupting the normal hierarchy of needs and desires. In fact, the (DSM) Diagnostic and Statistical Manual of Mental Disorders, which is the definitive resource of diagnostic criteria for drug use disorders, distinguishing between two types: drug abuse and drug dependence.
That being said Drug addiction IS a disease.
According to Larissa Mooney, MD, director of the UCLA Addiction Medicine Clinic, “Individuals entering treatment should be presented with an informed discussion about treatment options that include effective, research-based interventions. In our current system, treatment recommendations vary widely and may come with bias; medication treatments are either not offered or may be presented as a less desirable option in the path to recovery. Treatment should be individualized, and if the same form of treatment has been repeated over and over with poor results (i.e. relapse), an alternative or more comprehensive approach should be suggested.”
When determining if a patient should be treated in physicians’ offices, intensive-outpatient, or residential setting, doctors should rely on American Society of Addiction Medicine (ASAM) guidelines, not guesses. The length of treatment must be determined by necessity, not insurance. If a patient relapses, is recalcitrant, or breaks rules, treatment should be reevaluated. They may need a higher level of care, but sick people should never be put out on the street. In addition, all practitioners must reject the archaic proscriptions against medication-assisted treatment; Rawson says that failing to prescribe addiction medications in the case of opioid addiction “should be considered malpractice.”
Programs must also address the fact that a majority of people with substance-use disorders have interrelated psychiatric illnesses. Patients should undergo clinical evaluation, which may include psychological testing. Those with dual diagnoses must be treated for their co-occurring disorders. Finally, initial treatments must be followed by aftercare that’s monitored by an addiction psychiatrist, psychologist, or physician. In short, the field must adopt gold-standard, research-based best practices.
People blame politicians, drug dealers, and pharmaceutical companies for the overdose crisis. However, that won’t help the millions of addicted Americans who need treatment now. Even the most devoted and skilled addiction professionals must acknowledge that they’re part of a broken system that’s killing people. No one can repair it but them.
The Rhode Island Strategic Plan On Addiction and Overdose from 2015 had many great ideas and plans of action but its long term goal was to "reduce opioid overdose deaths by one-third within three years". However according to th Rhode Island Department of Health accidental drug-related overdose remains steadily on the rise. They refer to drug overdose in Rhode Island as a public health CRISIS. Specifically stating that Fentanyl poses a great threat and exacerbates our overdose crisis. The number of overdose deaths related to Fentanyl has increased 15-fold since 2009. Nationally from 2002 to 2015 there was a 2.2-fold increase in the total number of drug overdose deaths. From 2002 to 2015 there was a 2.8-fold increase in the total number of opioid overdose deaths with a 6.2- fold increase in the total number heroin specific deaths.
Rhode Island is currently listed as #6 in the nation of states with the highest overdose deaths. In 2014 RI saw 23.4 overdose deaths per 100,000 people. The state also has a reported rate of illicit drug use of nearly 15% among those 12 years and older, the fourth highest in the nation. Up from 9.8 in 2004, a decade earlier, RI was then 22nd highest in the country for overdose deaths. The number of overdose deaths related to Fentanyl has increased 15-fold since 2009 and continues to be on the rise here.
Once labeled as a "inner city" problem statistically in RI the city with the highest overdose death rate is actually Warren a suburban town with a population of just over 10,600 people. In Rhode Island 72.9% of accidental drug-related overdose deaths are male and 27.1% are female. About 3 out of 4 people who die of an overdose are men. All age groups are affected, but most overdoses occur in adults in their 30's. In 2000, black Americans aged 45-64 had the highest death rate for drug poisoning involving heroin. Now, white people aged 18-44 have the highest rate. The heroin epidemic is hitting young adults more than any other age group. Drug use among Americans aged 18-25 increased 109 percent from 2002-2004 and 2011-2013. For Americans 26 and older, it increased 58 percent.
This is an epidemic that affects us all. It knows no race, religion, gender, social or economic factors. It does not differentiate between class or social groups. It is without prejudice, regardless of wealth, education or status. It knows no borders or boundaries. It is not a stereotype! It takes anyone unfortunate enough to get caught in its grasp. I wish there was more data available to show effects other states are having from using new strategies but this is all new.
The United States holds the THIRD highest over-dose and drug related death rate in the WORLD. The United States accounts for approximately one quarter of the estimated number of drug-related deaths worldwide. We have to continue the fight!
Lets stand together to help those who can not help themselves!
Join us in urging our RI State Senators, Sheldon Whitehouse (D) and Jack Reed (D), and Representatives, David Cicilline (D) and Jim Langevin (D), to introduce a bill in their respective house allowing involuntary committal and other possible life saving options to families and loved ones.
We don't want them to be a drop in the ocean but a flash of lightning in the sky. ~BM
References and Credits:
Rhode Island Department of Health
Rhode Island Strategic Plan on Addiction and Overdose (2015)
Rhode Island Governor's Overdose Prevention and Intervention Task Force
Katie Davis NBC 10
The Minteer Family
Build the Banner of Love
Centers for Disease Control and Prevention
National Institute on Drug Abuse
The American Medical Association
Diagnostic and Statistical Manual of Mental Disorders
American Society of Addiction Medicine
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