A neighborhood problem

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In 2012 Sandra Coletta, then CEO and president of Kent Hospital, looked at hospital records and was alarmed to discover the number of deaths resulting from overdoses of prescription drugs. On examination the overdoses, whether resulting in death or not, cut across age and socioeconomic groups. This did not fit the “druggie out of a job, down on his luck without friends or purpose to life” stereotype often applied to overdose victims.

Coletta rallied the Kent medical team, community and state leaders and first responders to shine a spotlight on the problem and heighten awareness.

Fast-forward to last Friday and the National Governors Association meeting in Providence, where governors came face-to-face with the same issue. Only now, in place of a few statistics gathered by a community hospital, was a state-by-state picture of a national epidemic that is killing more Americans than die annually in automobile accidents and by gunfire every year – combined at an estimated 60,000 deaths in 2016. That is more deaths in a single year than all the American soldiers killed during the Vietnam War.

During Friday’s panel discussion, governors talked about programs and measures they have taken to address this epidemic, from imposing strict controls on the prescription and tracking of opioids commonly prescribed to help patients cope with pain, to the use of “coaches” to help people break addiction, to the creation of task forces drawing together professionals from the medical, law enforcement and treatment communities.

While Gov. Gina Raimondo reported some success with a 25 percent reduction in opioid prescriptions, she said 1,200 Rhode Islanders have died from overdoses in the last five years.

“This issue is like no other we’re dealing with. It requires an unprecedented level of collaboration,” she said. She went on to say that no one is taking ownership of the problem, “which means it’s our problem to solve.”

North Carolina Governor Roy Cooper, likewise, called for a comprehensive effort based on reliable data. He spoke about the alarming appearance of heroin laced with fentanyl, adding, “We cannot arrest our way out of this problem.” The appearance of flakka, a drug described as 10,000 times more potent than morphine, was also mentioned during the discussion.

Massachusetts Governor Charlie Baker said the crisis has developed over 15 years of bad behavior and will require continued vigilance to remedy. How might that happen?

Dr. Michael McGinnis of the National Academies of Medicine offered key messages for clinicians, including the prioritization of non-opioid strategies for chronic pain management and following five basic axioms for responsible opioid prescriptions.

Treatment was identified as critical to addressing the problem. But for people to seek treatment they must acknowledge that they need help. In addition, they need the support of the community to get it.

Gov. Baker related how neighbors will rally to help the mother next door who has breast cancer, bringing over casseroles to help the family yet, when a neighbor has a drug addiction, he or she will seek help from out of town in fear that their personal situation will be exposed.

The starting place, as Coletta did five years ago, is to recognize and define the problem. But this is not simply for the medical or the law enforcement community to do, but for all of us. Drug addiction is not an illness limited to urban cities. It’s hitting our neighborhoods and people of all ages.

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JustBeWell

In response please allow me to point out that the Oxford Dictionary defines epidemic as:

"a sudden outbreak of infectious disease that spreads rapidly through the population".

There is no “opiate epidemic.” Opiates are NOT AN INFECTION. There was an AIDS epidemic, there was an Ebola epidemic, and there was a SARS epidemic. But there’s no opiate epidemic; rather what we do have is crime, also defined by Oxford as: "an action or omission which constitutes an offense and is punishable by law." Therein lies a big difference; opiate users are breaking the law, consuming illegally obtained drugs, and that's the difference between a crime and an epidemic.

If stupidity was a medical disease, then we would have an epidemic.

And despite Ms. Coletta's well intended remarks and admirable approach, every one of those 60,000 U.S. deaths in 2016 from opiate over-dose were criminals. Drug addiction is not a crime which society can prevent; only the addicts themselves can stop this crime. Society has enough other medical problems to treat; as Kent CEO and hospital president, Ms. Coletta must know addicts should not be treated as a medical problem, with medical resources.

It's a crime, and should be treated with judicial and law enforcement resources.

Monday, July 24
HealthMatters

In response to the comment from "JustBeWell"--unfortunately this issue is much more complex than it seems on the surface. We have drugs on the street that are so potent that even law enforcement officers and dogs are inadvertently overdosing simply by searching homes where these substances reside. If there was an easy solution, we would have already solved the problem. Let's stop pointing fingers and all commit to helping our communities. You can learn more facts on this from Friday's Wall Street Journal: https://www.wsj.com/articles/an-american-scourge-fentanyl-is-now-stinging-law-enforcement-1501234203.

President Barak Obama put it best when he said, "For too long we've viewed drug addiction through the lens of criminal justice. The most important thing to do is reduce demand. And the only way to do that is to provide treatment--to see it as a public health problem and not a criminal problem."

Monday, July 31