Coping with a Crisis
As the opioid epidemic grows, local frontline experts are combating the problem
Our nation is facing a crisis of epidemic proportions. In the last two decades, the number of opioid-related overdoses has climbed at an alarming rate, turning a national issue into a public health emergency that impacts all races, genders and socioeconomic groups. According to statistics from the Centers for Disease Control and Prevention(CDC), drug overdose deaths involving opioids rose from 8,048 in 1999 to 47,600 in 2017. Among those overdose deaths in 2017, over 17,000 were the result of a prescription opioid overdose. The state of Michigan set a new record for overdose deaths that year with 1,941.
Even with the crisis deeply rooted in the Midwest region, it still comes to the surprise of many that opioid addiction can be found in their schools, workplaces or even their very own homes. The first wave of the epidemic occurred as a result of the increase in opioid medications to treat pain in the early 1990s.
For thousands of Americans, dependency on these addictive pain medications has led to an increase in heroin and synthetic opioid usage. Local experts working on all sides of the issue say that awareness, prevention and treatment are all key parts of the equation to help save lives.
“Of our time right now, it’s probably the leading health crisis,” said Adam Havey, executive vice president of business operations at Emergent BioSolutions. “I think we all have a responsibility to be behind and help solve (the problem).”
As the developer of the only anthrax vaccine approved by the Food and Drug Administration and Narcan, the brand name of the nasal spray used to deliver the opioid-overdose antidote naloxone, Emergent BioSolutions is no stranger to combating national health crises.
“I think we’ve come into this like we’ve come into many emergency situations in the past, like the anthrax situation back in the early 2000s: with an eye to our mission to protect and enhance lives,” Havey said. “We’ve tried to maintain that focus and make sure as many people as possible have access to Narcan, our nasal formulation of naloxone.”
A year ago, Emergent BioSolutions purchased Adapt Pharma, the company that invented and licensed Narcan nasal spray.
“The Narcan nasal spray and the formulation is the only FDA form of naloxone that is nasally administered,” Havey said. “That is ours and proprietary as an Emergent product.”
Havey said the company sees Narcan as a way to reverse the effects of an opioid overdose and a key medical countermeasure to help protect and save lives.
Emergent BioSolutions hopes to save lives by expanding access to Narcan, with a specific target on the population of Americans considered at risk of accidental overdose by the CDC.
“Of those 33 million Americans that are considered at-risk by the CDC guidelines of accidental overdose, about 21 million are receiving opioids prescribed by a doctor that meet those risk essentials,” Havey said.
Emergent BioSolutions works with all of the major retail centers — including CVS, Walgreens, and Walmart — to distribute Narcan through a standing order or on a prescription basis. In addition, the company is making Narcan available to community entities such as EMS, police and fire departments.
Havey said raising awareness of the company’s effective antidote in state and local communities is one of their key initiatives. Emergent BioSolutions has several programs aimed at schools, libraries and YMCAs designed to get naloxone out into the community. Havey said it is a common misconception that this is an inner-city problem, when in fact it is “an every community problem.”
Havey anticipates Narcan could be as readily available and administered as other similar emergency solutions, such as an EpiPen or automatic emergency defibrillator.
“The key part of this product and problem is you need Narcan nasal spray available at the scene,” he said. “Having it almost as a first-aid kit out there if it is needed is a key component of our mission.”
With 60% of overdoses occurring in front of a witness, friends and family around those who use opioids have the opportunity to intervene in an emergency.
“If a person was having an overdose event, and someone had naloxone and had been trained, that could save a life,” Havey said.
Having the community tuned in to the impacts of this epidemic is crucial, because the negative effects go well beyond addicts themselves. There are many costs associated with the crisis, including the burden on the health care and criminal justice systems.
“From a business perspective, one of the important components is the cost in the community,” Havey said. “Lost jobs, lost wages, lost efficiency, lost productivity-I think all of those costs factor into that.”
In addition to the tangible costs, Havey noted there’s an emotional cost: “We can’t as easily put a price tag on that, but that process is just as real as the hard costs of lost jobs and health care expenses.”
Larry Scott has served as the director of the Office of Recovery Oriented Systems of Care within the Michigan Department of Health and Human Services for two years and has over 30 years of experience in the field. His office provides state policy funding and oversight on substance abuse disorder prevention, treatment and recovery to regional entities that are responsible for providing those services to the community. He said one of the most common misconceptions is that people can be cured of addiction.
“People should understand that addiction is a chronic brain disease, which means that you are going to be in recovery for the rest of your life,” Scott said. “You’ll be in need of counseling and medication-assisted treatment.”
He said that while some might not believe in using medication to get off of a drug, it can be the best option to getting someone on the pathway to recovery.
“If their addiction goes untreated, it could have a devastating effect on their careers and maintaining their families,” Scott said. “Each person has their own needs for treatment and a recovery strategy.”
In addition to using resources to educate physicians and surgeons on proper prescribing, Scott also is involved with community coalitions to do opioid education and Narcan distribution campaigns. He said that this particular crisis is impacting all groups, races and genders, proving that opioid addiction does not discriminate.
Despite the devastating effects of the opioid epidemic, Scott noted that something good has come out of it: A number of community coalitions have sprung up across the state, consisting of family members who have dealt with the crisis.
“One positive out of this particular crisis is that we’ve had many family members that have become really strong advocates for treatment and prevention of opioid addiction and overdose deaths,” Scott said. “Through the grief process, through the education process, through the process of resiliency, they have actually become very effective advocates and tremendous peer support coaches.”
One of those coaches is Phil Pavona, founder and vice president of Families Against Narcotics in Ingham County. Pavona and his wife Pat lost their son, Eric, at age 25 to a heroin overdose in 2011. In the years after their son’s death, Pavona has been committed to helping families in similar situations by providing the type of support and resources that weren’t available when it happened to his family.
“When you have an addict in your home, once the disease of addiction hits, it’s terrible,” Pavona said. “These are good kids from good families, but they’re doing horrible things. They’ll say, ‘We never could imagine it could happen to us.’”
Many of the people Pavona works with were legitimately put on prescription medications before it got out of control. He said that people often delay seeking help because of the stigma attached to addiction, as well as the belief they can get through it alone.
“So often, they’ve had such success in their life that they have this misconception that they can get themselves clean,” he said. “I’ve never met a heroin addict who can do this on their own.”
Pavona said most of the families he works with involve young people in their mid- to late 20s or 30s – “You name a profession, I have one of their kids. Doctors, pastors, therapists, plumbers” – and come from suburban or rural backgrounds. Over 90% of the heroin addicts he works with began their addiction through prolonged prescription drug abuse, transitioning from expensive pills to what was cheaper and more readily available.
“When you have that in your own home, it’s so much chaos,” Pavona said. “There’s nothing worse. It’s the first thing you worry about when you wake up and when you go to bed.”
His son’s addiction took a financial and emotional toll, and the couple quickly realized the lack of resources available to families coping with addiction. Pavona founded the Ingham County chapter of Families Against Narcotics, providing local families like his with information and support.
The organization’s primary goals are raising awareness of the prescription opiate drug abuse epidemic, changing the face and stigma of addiction and having an impact on the community. The chapter was instrumental in making sure every police car within 25 miles of Ingham County is equipped with Narcan, something that wasn’t the case when Pavona’s son overdosed. Families Against Narcotics has peer recovery coaches in jails to help addicts who have been arrested. Through its Hope, Not Handcuffs program, nearly 2,800 people have been helped to get into treatment in the last two years.
“We’re helping the community access a whole bunch of things that were almost impossible to access before,” Pavona said.
It will take the awareness and support of everyone in our communities to address the opioid crisis head-on. Prevention, education, treatment, and life-saving Narcan are all key pieces to solving this complicated puzzle. By taking the first step of admitting our society has a problem, there can be hope for recovery.