The Missouri Department of Health and Senior Services (DHSS) recently completed nine regional opioid summits as part of a statewide initiative to raise awareness of opioid addiction, discuss best interventions available and to spur local leaders to champion the cause.
“As we’ve been in each region throughout the state, listening to people’s concerns, we have been incredibly moved by people’s willingness to share their experiences and by those who want to help,” stated DHSS Director Dr. Randall Williams. Speakers at the summits included men and women who are recovering from opioid addiction.
The regional opioid summit kick-off was held in July in Springfield, followed by Cape Girardeau in September; Joplin and Poplar Bluff in October; and Kirksville, Kansas City, St. Joseph and Columbia in November.
The final summit took place December 5 in St. Louis, before an overflow audience in the Eric P. Newman Center at Washington University School of Medicine, hosted by the St. Louis Department of Health. Attendees included representatives from health safety net providers, community leaders and elected representatives. Sponsors included the St. Louis Regional Health Commission, Washington University School of Medicine, SLUCare Physician Group, SSM Health St. Mary’s Hospital, NCADA, Missouri Department of Mental Health, the state Office of Minority Health, Missouri Opioid State Targeted Response project, St. Louis County Public Health and the City of St. Louis.
The St. Louis metropolitan area and counties to the south and west are hotspots for opioid-related deaths. The city reports the number of opiate overdose deaths in the City of St. Louis has been trending upwards for the past 10 years with a six-fold increase during that time period. In 2016, there were 273 drug overdose deaths involving opiates in the city compared to 131 in 2015.
DHSS data shared at the St. Louis summit indicates the City of St. Louis has the highest rate of death due to opioid overdoses compared to all Missouri counties. St. Louis County ranked ninthhighest. The data is from 2012-2016. Another sobering statistic: In Missouri, 22,753 total years of potential life was lost in 2015 from opioid overdose deaths.
The use of Narcan to rescue persons who have overdosed on opioids was discussed, along with the science behind medication used for opioid use disorder. Medications to treat opioid addiction include naltrexone (the long-acting version is Vivitrol), methadone, and buprenorpine (which comes in a single product, Subutex, and a combination product, Suboxone).
“We featured work of Missouri’s State-Targeted Opioid Response – which is a medication-first model,” said Dr. Fred Rottnek, professor and director of Community Medicine at Saint Louis University School of Medicine. “In other words, in Missouri, we are working to decrease barriers and delays for people who need access to medications for treatment for addictions.”
Rottneck moderated a panel of three speakers who are in opioid addiction recovery. The panelists spoke about their history and what started their addiction, and whether and how medications helped their recovery.
Archie Tyson, a 64-year-old who described himself as a child of the 1960s, said his life was set up for him to use heroin.
“Where I come from, for blocks, I don’t think there were three fathers or father figures where I lived, so my heroes, the people I got information from, were the older guys – the drug dealers, the car thieves, the burglars – the hustlers, we called them,” Tyson said.
“I didn’t know any better. I wanted to be ‘down,” I wanted to be like them, I wanted to be ‘in.’ And they told me the only way to be all the way ‘in’ was to be ‘hip,’ and to be ‘hip’ by snorting dope, or heroin.”
He said using it led to dealing it – at only 14 or 15 years old, running errands for older dealers – then prison, then back on the streets and back to the same behaviors.
A probation officer, and his counselor at the Center for Life Solutions, had faith in him that he had a lot more to offer society. That was in 2006.
“By then, I had been in three different treatment programs – three different treatment facilities,” Tyson said. They got him into a methadone treatment program the next day.
“I came down, got examined, ‘dosed’ that day. I haven’t used since,” he said. “God is good. And methadone is too, in my case.”
Tyson said he wanted to quit for decades, but addiction is fierce and controlling.
“Addiction is slavery. Seriously – slavery,” he said. “I’ve known good men and women to prostitute themselves just for a hit – police, lawyers, good people. Slavery.”
Now, his battle is to get off of methadone. He is in a program called West End. Tyson said he understands that he can’t just quit on his own and that his addiction is an illness, just like cancer is an illness.
“Right now, I am on a voluntary detox, and until I think I can make it without it, I will continue to use methadone on whatever dose I’m on right now,” Tyson said. “But ya’ll pray for me, because one day, I’m going to make it off this thang. And life will be good”
Addicted to the pain pills
Jeanine Young drank alcohol and smoked marijuana during her teen years, but abstained from those behaviors during her marriage and as she raised her children. Her issues with opioid abuse began later in life following some medical issues in 2008, when she was prescribed increasingly stronger pain pills over a 10-month period.
“My surgeon called me into the office and stated that he thought I could be addicted to the pain pills, because as soon as I would run out of my prescription I would become physically sick,” she said.
Young – a white woman who said she comes from a middle-class background – said she didn’t know anything about opiates or withdrawal symptoms, which were similar to the symptoms she had been experiencing before the surgery. When her surgeon refused to prescribed any more pain pills, Young said she went back to her primary doctor and started the cycle all over again. She said it was about six months before her primary doctor caught on that she was addicted.
“I did what all addicts do after he stopped prescribing me, I started doctor-shopping and then, hospital-hopping,” Young said. “I would just make my rounds to the ER – get a 30-day prescription – then I’d hit another ER, get another 30-day prescription.”
In 2010, Young said she befriended a group of people who were using heroin. Her prescriptions had run out, and one member of that group told her she could snort, instead of inject, heroin.
“Once I found out that I could snort it – I was okay with that,” she said.
For two years heroin ran her life—and ran through her good paying job, retirement money, mutual funds and whatever else she had available.
“It’s a lot of work being an addict,” Young said. “You have to be creative, and it’s a lot more stressful than getting up and going to work every day.”
Then in 2011, she was in an accident that broke her neck and caused a head injury.
“For me, it was a great reason to never run out of pills because now I have a great excuse on deck – I can still use my heroin, I am getting other medications,” Young said. “From 2011 until I went into treatment, in December 2012, I continued to use.”
After getting caught in criminal activities to feed her addiction, Young said her attorney suggested treatment. She eventually sought recovery.
“Education is vital, because I am getting rid of the stigma and stereotype with the medically assisted treatment that we need right now in our society,” Young said.
The next steps beyond the state Opioid Summits should include promoting overdose education, Narcan rescue and addressing ongoing stigma around opioid addiction, Rottnek said. Additionally, he said decreasing institutional and policy barriers and increasing pipeline training of health professionals with the tools to treat opioid use disorder would increase access and capacity for care.
“There is low-hanging fruit than can be addressed in Jeff City, Rottnek said. “Add physician assistants to the list of Department of Mental Health providers, lift the five-day rule for nurse practitioners and physician assistants to prescribe buprenorphine, open prescribing of these medications to clinical pharmacists (PharmD’s) who work collaboratively with physicians, and simplify training rules.”
Find out more about Missouri State-Targeted Opioid Response at https://missouriopioidstr.org.
