The United States is being crippled by a growing—yes, growing—opioid crisis. There was a staggering 21 percent surge in drug overdoses in 2016, the last time the Centers for Disease Control and Prevention released official figures on record, with 64,070 deaths attributed to drug overdoses in the U.S. Of those, 75 percent were from opioids. Whether legally prescribed for pain, bought on the street as heroin or increasingly, shipped from China as synthetic Fentanyl, opioids are seemingly America’s drug of choice.
Illegal drug use comes and goes in waves—marijuana starting in the ’60s, LSD in the ’70s, cocaine in the ’80s and methamphetamine in the ’90s. Opioids have been the newest staple of this still-young millennium. Yet statewide, opioid addiction seems to be experiencing a decline.
“We have been proud to see the CDC report in March that Oregon saw the steepest decline in prescription opioid-related deaths between 2015 and 2016,” says Saerom Williams from the Oregon Health Authority, the go-to expert in Oregon’s handling of the crisis. “We experienced a decline of 17 percent. This is when many states are still experiencing increases,” she says. The state where deaths have been highest: West Virginia, followed by Ohio, New Hampshire, Pennsylvania and Kentucky, according to the CDC. “No area of the United States is exempt from this epidemic,” wrote CDC Principal Deputy Director Anne Schuchat in a March 2018 report.
Statistically, those most commonly overdosing are males between the ages of 25 and 44, according to a 2016 CDC report analyzing data from 31 states, including Oregon. Troubling was that the overdose rate from synthetic opioids more than doubled, likely driven by cheap and easy access to Fentanyl from China. Opioid prescription-related deaths increased by 10.6 percent while heroin-related overdoses increased by 19.5 percent.
Williams boasts of the various strategies Oregon is employing. “The Oregon Health Authority has been leading the state Opioid Initiative for several years now,” she says, “focusing our work on four major strategies: better and safer pain management, improving addiction treatment and naloxone access, reducing the number of pills in circulation through prescribing guidelines and other supports for prescribers, and real-time data (where possible) to track our progress and challenges.”
“And then eventually my idea of fun became one not of training and being on the trails but one of chasing cocaine dealers around town at 2 am, trying to get high. I let everything go. And so, I ran away from Bend.” —Spencer Nuwell
Local stats
Dr. Kimberly Swanson, behavioral health director at Mosaic Medical in Bend and chair of the Pain Standards Task Force, seems to agree that doctors are getting the message. “There has been a 59 percent decrease in opioid prescribing,” says Swanson, who says the reduction was quantified from Deschutes County statistics from early 2014 to late 2017.
Swanson says the reduction can be partially accredited to the Oregon Health Policy and Research’s Health Evidence Review Commission Low Back Pain Guidelines, released in 2016, giving doctors advice on how to manage pain without opiates. According to the CDC, an estimated 100 million Americans live with chronic pain. Since the 1990s, go-to treatments have included opiate drugs such as oxycodone, oxycontin or hydrocodone.
Between 1999 to 2014, the rate of opiate prescribing quadrupled. The CDC estimates that one out of five patients with “non-cancer pain or pain-related diagnoses are prescribed opioids,” with the biggest reasons for prescribing being pain management (49 percent), surgery (37 percent) and physical rehabilitation (36 percent). Though, primary care providers are attributed to prescribing more than half of opioids.
Research into alternatives in managing chronic pain have been slow going, mostly because scientists still don’t know the complete science behind chronic pain. The common theory is that the body has multiple pathways to the brain regarding pain receptors, which in turn, means multiple pathways addressed by painkillers, according to research conducted by the American Public Health Association. So, if researchers don’t know which neural pathway is causing pain in each person, they turn to the one-stop numbing solution: opiates.
When faced with treating short term pain, doctors are now trying to employ alternative strategies so that opioids are not the first go-to method. Alternative therapies such as physical therapy, talk therapy, acupuncture, massage, yoga and chiropractic care have increased.
Data in Deschutes County corroborates these stats. Swanson from Mosaic Medical states, “By Q4 of 2017 there has been a 64 percent increase in requests for all of these services combined.”
Insurance is still hesitant to pay, however. Swanson notes, “Medicare does not cover many alternative pain management services,” and adds, “Central Oregon does not have a comprehensive, multidisciplinary pain treatment center.” She also notes that those who live in rural areas in Crook and Jefferson counties need to travel long distances to Deschutes County to access alternative pain management services. A round trip can span hours, a few times a week. No wonder prescribing a painkiller seems like the path of least resistance.
But still, Swanson does acknowledge the aid being given to the region and says, “access to medication-assisted therapy, the gold standard treatment for opioid use disorder, has increased.” She also says, “health systems in Central Oregon are adopting several treatment strategies such as group visits and adding movement classes in primary care.”
District Attorney John Hummel, who last year began his pilot program, “Goldilocks,” aimed at giving treatment rather than incarcerating those found with “user quantities” of felony-type hard drugs, says 92 people have entered the “Clean Slate” part of his program and that two are being prosecuted in the “Deter” part of the program. He’s unsure if he’ll continue the project until he gets better stats—probably in the fall of this year.
Meanwhile, Deschutes County law enforcement officers now carry the opioid overdose-reversing drug agent, Naloxone. According to Swanson, it reversed 17 overdoses in 2017.
Apart from statewide decline, Williams from OHA says the state-funded Oregon Recovery Treatment Center, which has locations throughout central and rural Oregon, including Bend, was granted $1.28 million this year to expand opioid treatment and service capacities. They recently opened a clinic in Springfield and plan to open a Pendleton location later in the year. That center has been plagued by what Williams says are “workforce challenges…. common in rural areas.” Overall there will be 11 centers dedicated to opioid related disorders in Oregon by 2019.
And just how many folks are taking advantage of that Bend clinic? Since May 2017, 202 patients have walked through the doors for opioid specific treatments. Where they are now though, is harder to quantify.
Personalizing addiction
“I reached a boiling point. I was working 80-hour work weeks peddling real estate in Bend,” says Spencer Newell, a Bend-based ultramarathoner now turned triathlete, who knows the trials and tribulations of addiction. He wrote the book, “Appetite for Addiction,” released this year.
“I was blind drunk when I walked through those doors. My fiancee had just accused me of cheating on her. I got home, took my phone out, threw it against the wall, grabbed a bottle of Percocet (an opioid pain reliever) and sat there screaming and crying, ready to end my life.” Newell says if his friend hadn’t been home that day, he wouldn’t be here now. “Brian threw me in the car, I was a complete wreck and brought me to the ER of St. Charles. I got checked into Sage View [Psychiatric Center] for the next week.” This was Newell’s first stint at Sage View. There would be another visit a year later.
“There was just this buildup of internal pain that I haven’t acknowledged for all those years and finally it accumulated to a boiling point. I couldn’t take it anymore.” Newell says his troubles began, like most addicts, in childhood. “I went to a ski school growing up, surrounded by wealthy kids. I was an introvert surrounded by kids I couldn’t connect with, so I used alcohol to become this gregarious, confident character.”
Alcohol turned to Adderall, which turned to cocaine, which turned to opiates. It was a vicious cycle.
“I’m a speed guy. But it quickly turned into anything that would keep me going through my depression.” Newell learned he could visit oral surgeons, schedule wisdom teeth removal surgeries solely to get prescribed opiates before the surgery. “I never had them removed,” he laughs, “I found out how to play the system instead.”
Once in Sage View, “It was like living in a cell,” he recalls of the tiny rooms with whitewashed brick walls and plastic sheets. “My cell phone was taken, I had no access to the outside world for a week.”
His ego protested. “I looked around the room and there was 12 of us in there and I was definitely the most functional. I thought, ‘what the hell am I doing in here among these crazies?’
“There were people that were huge cutters, schizophrenics, those on suicide watch 24-7 a day, bipolar… One woman even accused me of raping her. I found out she had accused pretty much everyone of doing that. So I thought I was pretty normal.”
Two days later, experiencing heavy withdrawal, Newell realized he was at his first rock bottom. He would drive himself, hammered, a year later, back to Sage View, because he wasn’t ready to utilize the tools the psychiatrists and therapists had given him for his depression. After the second stint he was sober for six months, then drunk for another three. It would take more than three rock-bottom moments to get him sober. A three-day blackout bender nearly seven years later, in which he locked himself in his Corvallis apartment, would be the final catalyst for sobriety.
“I originally moved to Bend for the aura and the mystique of it all,” Newell says, “For it being an absolute playground. And then eventually my idea of fun became one not of training and being on the trails but one of chasing cocaine dealers around town at 2 am, trying to get high. I let everything go. And so, I ran away from Bend.”
Getting Sober
Now more than four years sober, Newell’s counseling others on how to deal with addiction. “I once loved getting hammered by myself. And if I get lazy, if I let my guard down, I can be right back where I started,” he says. “Every day I choose to be sober.”
Newell lost everything in the global financial crisis of 2008. He’s scheduled to be featured this week in NPR’s Marketplace’s “Divided Decade” series and is completing his first half-Ironman later this year. He says exercise has been a key component in his recovery.
“Getting sober is not a linear process. It’s not an A to B thing.” Newell says he knows of addicts who celebrate being sober for a year with a drink. He laughs, “It’s not a finish line goal. A lot of people get caught up in it but you’re never finished with sobriety or your addiction. When an addict is unchecked, that’s when things go haywire.”
This article appears in Jul 18-25, 2018.
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Don’t forget the Transitions Program at Mosaic Medical, treating opioid use disorders including medication assisted treatment.
One of the things that jumps out at me is that no real distinction is made between the illegal use to get high of drugs like heroin and morphine, versus the person in acute or chronic pain.
The opiate problem is not going to be solved unless those two issues are dealt with separately.
Oregon surrendered to drugs in 1973 when I was a child. This isn’t the first time that Oregon’s had an opiate-based epidemic that I’ve seen. Nor will it be the last.
One thing apparent back then and now is that it’s extremely rare for a person to get addicted to painkillers if they are using them for pain. Some try to lump in chronic pain as addiction, but that’s not very honest to do so.
I’ve known a considerable number of people over the years who got addicted to heroin and other street drugs used to get high. In every instance, they got high at a party and got addicted.
It may sound strange, but I’ve noticed over the years that when a person is using a painkiller for pain, they normally don’t get addicted and it normally doesn’t change their personality or morals.
By contrast, in every case where I’ve known or known of a person using drugs to get high, there is a marked personality change that I call a moral slide where the person’s morality goes. First they start lying, then stealing, then lose all other morals as time goes on. The family and friends lament the change. They can’t trust the drug abuser.
What is weird is that this moral slide is independent of a drug’s pharmacology, as one saw the same effects from euphoriants, stimulants, depressants, and so on.
One can argue why this is, but anyone who has dealt with drug abusers knows that happens. Something about the motive for the drug use is of primary importance.
An example is the pornography field. Having known six women prior to their going into the porn “industry”, the change in personality by drugs made it possible for them to do so, the morals of their life having been eclipsed by the desire to party, do drugs, fornicate, and they eventually decided to make their chosen lifestyle pay for itself. But without the drugs I doubt any of them would have done so.
Thank you so much for the article “The War Wages On” about the scope of the opioid crisis across the nation and here in Central Oregon. What I most appreciated was the portrait of a person who in many ways could be the poster child for the values of this region: an ultra-runner/real estate agent what could be more Bend than that?
It is time to end the hyperbolic stigmatization of addicts and alcoholics as slovenly ne’er-do-wells and start waking up to the fact that we are your neighbors, your daughters, even your grandparents. The more the media portrays those struggling with addiction in a polarized manner, the more shame is entrenched, and the less likely addicts are to seek help. Just because half the town downs a growler every night but manages to get up for work the next day, doesn’t mean that we are not all somewhere on the spectrum for addictive and destructive behaviors.
I recently returned from inpatient rehab (round two after two years sober and a protracted nosedive with booze after Christmas), where I experienced firsthand the use of Medication-Assisted Treatment (MAT) in the form of Suboxone for the majority of clients recovering from opioid addiction. Suboxone (brand name for Buprenorphine) is a partial opioid agonist, meaning it fills the same receptors and activates them to a moderate degree, which reduces cravings and prevents overdose, or even euphoria, if opioids are reintroduced. At first I was skeptical and prejudiced. I snidely remarked “it’s just trading one drug for another,” a feeling that I discovered is widely shared by both the recovery and medical communities.
And then I did some research.
Those on Suboxone or Methadone are 50% more likely to stay in treatment and stay sober, and studies in Europe have shown MAT is actually more effective than group/talk therapy in a cohort of patients who were given one or the other. Yet only a small percentage of treatment programs in the US offer MAT. Instead the majority (85% or more) of rehabs adhere to the abstinence-only philosophy promulgated by 12-Step programs. The most devastating aspect of this hard line approach is that many of those who become abstinent in rehab overdose as soon as they start using heroin again because their bodies no longer have tolerance, and multiple studies have shown that over 90% of opioid addicts (not on MAT) will relapse within weeks of treatment. Opioids are not alcohol, and to treat it the same is not only doing a grave disservice to the victims of this epidemic, it’s literally killing people.
So, where can you get Suboxone in Central Oregon? Pretty much nowhere. My rehab was unable to set up continued care with Suboxone for a fellow patient returning to this region, and an internet search brought up only three prescribing doctors in Bend, some of whom might only use it for pain, or likely require time-consuming outpatient treatment to “qualify” for help.
Obtaining a license to do so requires a mere eight hours of training. Doctors, where are you? I thought you were in the business of saving lives.
What’s holding you back? Is it because addicts are a bunch of lying thieves? Don’t worry, here in Bend we’re ultra-running real estate agents.
(For references concerning the facts above, please see Adam Bisaga’s (MD) book titled “Overcoming Opioid Addiction.”)