Fighting stigma

I’ve been wondering about the opioid epidemic for a while now. Who exactly are the players? What can be done? What can I do to help? When I found out about the STOP the Opioid Pandemic South Hills Symposium featuring Sally Wiggin of WTAE as emcee, I knew it was my chance to find out.

The September 19 symposium, at Christ United Methodist Church in Bethel Park, drew a large crowd that spilled onto the balcony. Panelists included Dr. Karen Hacker, MD, MPH; Soo C. Song, Acting United States Attorney, Western District of PA; Kelly Wesolosky, Community Outeach Specialist, FBI, Pittsburgh Division, and Director, The HOPE Initiative; Jane Binakonsky, JD; Kyle Harder, Gateway Rehab; and Ashley Potts, MSW and a former heroin addict. The panelists acknowledged the grimness of the opioid crisis but they also emphasized their genuine belief that it can and will be overcome.

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Much of the program contained information, including how illegal drugs are distributed. Do you still have the outdated notion that drugs are dealt on a dark street corner? Not so, says Ms. Song. Fentanyl, a powerful synthetic opioid, is easy to buy online and pay for with Bitcoin. The drugs are then shipped in from places such as China or Mexico. Thus, the problem must be attacked by law enforcement through the computer, which is obviously a challenge.

Ms. Song answered one of the questions I’ve had: Why would a drug trafficker substitute fentanyl for heroin? Looking at the text messages of traffickers sometimes proves that they knew a batch contained a deadly dose of fentanyl. And traffickers are being actively prosecuted in relation to those deaths. So, why take the risk? Ms. Song’s simple answer is: cash. Fentanyl may be easily produced by “throwing some chemicals together in a lab,” while heroin must be grown. Then, because fentanyl is much more potent than heroin, a kilo of fentanyl may be stretched into more kilos, increasing profits.

While law enforcement attempts to stop traffickers, Ms. Wesolosky’s HOPE program is working to prevent people from becoming users. HOPE, which stands for Heroin Outreach Prevention and Education, is a partnership between the FBI Pittsburgh Division and key community stakeholders. One of their educational projects is a high school public service announcement contest where students make videos raising awareness of the heroin epidemic.

Ms. Wesolosky, who speaks to the students, reported that “we take for granted what people know and don’t know.” She says that kids don’t realize how fast you can get addicted to opioids and how lethal they are. This is partly because drug education in schools is still more of an overview and not specific enough to inform on the opioid crisis. My biggest takeaway here was to talk to your kids. Yes, I know, I know, we’ve been hearing that for decades! But Ms. Wesolosky’s message was alarming and pointed to the need to get real in your conversations. In her experience, kids see naloxone, which reverses the symptoms of an overdose, as a “free pass” even though it sometimes takes more than one dose to revive a user. Research and talk to your kids based on hard data and statistics to prevent them from becoming part of those statistics.

Importantly, the discussion included how to manage pain with alternative methods. If your child gets a sports injury, think about other ways to make them comfortable. Ms. Binakonsky suggested the use of acupuncture and meditation. Ms. Wiggin shared a personal story of needing pain management after a car accident. Rather than accept the opioids offered for her pain, Ms. Wiggin chose to take Tylenol. While she admits she had pain, she was emphatic that we should accept some pain as a part of life. I also noted that she turned down the offered medication. We would do well to remember that our health care is up to us. Just because a doctor prescribes opioids doesn’t mean it’s the best choice for us or our families. We should feel free to decline.

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Although the panelists were all notably knowledgeable and passionate, the evening really belonged to Ms. Potts. She received a standing ovation for her story of addiction and recovery. Ms. Potts has a message for us: We need to reduce the stigma surrounding addiction. “We try to incorporate back into society, but society keeps saying you’re not good enough.” Despite being smart and driven, Ms. Potts experienced difficulty getting internships and renting an apartment due to two felony convictions on her record relating to her earlier use of heroin.

Ms. Potts’ story of addiction repeatedly reinforced the brain data presented by Ms. Binakonsky and Mr. Harder. While she was an addict, Ms. Potts told herself over and over that she wouldn’t use again. But, Ms. Potts lost the ability to have rational thought. Mr. Harder explained this problem in terms of dopamine, a neurotransmitter associated with feelings of pleasure. When you are using, “your body stops producing dopamine on its own to compensate for the large amounts released by opioid use,” Mr. Harder states. Therefore, formerly pleasurable activities feel less pleasurable. At the same time, as you use opioids, you build a tolerance so that you need more and more. “Addiction is about feeling less bad,” says Mr. Harder.

But people do recover, says Ms. Potts. Ms. Binakonsky, an expert in the science of addiction, referred to the concept of brain plasticity as a way to “learn new habits.” In turn, these habits can break the cycle of addiction, she says. One strong example cited by addicts is forming a spiritual connection, according to Ms. Wesolosky. She says spirituality is “undeniably part of the process.” So if you or someone you know is struggling, try to find a good house of worship or form a relationship with clergy. Also, be aware that relapse is not failure, according to Mr. Harder. Instead, it is also “part of the process.”

Dr. Hacker warned that the solution to the epidemic is “not a short term type of fix.” We we will be working on it for years to come, she says. In the meantime, let’s practice compassion and do our best to fight the stigma.

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