Opioids abuse: Tackling an unprejudiced and unprecedented crisis13 min read

Jenny Snarski
Catholic Herald Staff

Fewer than 100 Wisconsin residents died from taking prescription opioids, benzodiazepines, heroin and cocaine in the year 2000. By 2016, the number had spiked to 1,352 deaths, 42 percent of them due to prescription opioid use.

The substance abuse epidemic – in particular the opioid crisis – was addressed by two regional conferences during the month of October.

On Oct. 11, the Community Bioethics Committee of Price County hosted a seminar on the ethical and professional boundaries associated with the opioid crisis at Northcentral Technical College in Phillips. On Oct. 31, the Wisconsin Department of Health Services offered the third in a series of three faith-based summits as part of the Governor’s Task Force on Opioid Addictions at Red Cedar Church in Rice Lake.

Even acknowledging that much of the opioids crisis starts out as unintentional abuse, each conference highlighted the far-reaching causes and consequences, leaving virtually no sector of the population untouched regardless of age, gender, race, education or economic level. Both conferences discussed the problem from multiple angles within treatment and prevention efforts.

While both events were attended by various medical personnel social workers and behavioral health professionals, the Phillips conference focused more on treatment-related aspects, whereas the Rice Lake event brought together service providers associated with nonprofits and faith-based organizations. Both advocated for collaboration across multiple sectors of the community as the most effective course of action.

“Opioids do not have a prejudiced impact in our communities,” said Tracy Johnson, president of TTJ Group, LLC, who led the Faith-Based Summit with thre e other professional presenters. TTJ Group promotes public health by community collaboration creating and providing innovative and culturally appropriate nationwide services.

They had been invited by Paul Krupski, director of opioid initiatives for Wisconsin’s Department of Health Services, and organizer of the summits. Three sites were chosen – Milwaukee, Green Bay and Rice Lake – with approximately 70, 80 and 50 participants, respectively.

Considering the opioid epidemic a public health crisis, and seeing faith-based groups as an untapped resource, Gov. Scott Walker signed an executive order for initiatives to help them play a larger role in attacking the crisis statewide.

Effective prevention and collaboration

Albert Gay, a Gary, Indiana, youth pastor with nonprofit experience, affirmed that faith-based organizations have been positioning themselves for decades to take part in this current crisis. “What happens in the faith world is dynamic and has the ability to change lives,” he said, adding, “Sometimes what is not said is just as influential as what is said.”

Examples were given of FBOs as historically influential leaders in raising awareness of and reversing societal ills: slavery, human trafficking, homelessness, poverty, crime and violence, alcoholism and drug addictions, among other human inequalities and injustices.

Another summit presenter, Carl Alves of Massachusetts, shared how difficulty and tragedy can be the impetus for people and organizations to come together and work for change. FBOs were recognized as adept at seeing that behaviors, not people, were problematic. They are influential in people’s lives both inwardly and outwardly, and often bring together people with a passion for serving the underserved.

One summit participant was Aaron Hendricks, business manager for St. Joseph Catholic School and parish in Rice Lake. After small group discussion, Hendricks shared the need to make better connections between potential needs of their people and available community resources. He said he was unaware of people seeking out the church or school as a referral source.

“If they are faced with a (drug-related) crisis, they aren’t coming to us … families and parents should be comfortable and trusting – if we’re doing our job building relationships, they’ll come to us in these needs.

“You never know which kids are going to become susceptible or vulnerable to something like an addiction. It’s a further call for us to be our brother’s keeper and form a support network around each kid, so that when they do enter a crisis in their life, we’re the first place they turn,” he concluded.

Prevention and its most effective elements formed the bulk of information and ideas discussed at the Rice Lake summit. Johnson defined prevention as “a planned sequence of activities that is effective through the practice and application of evidence-based prevention principles, policies, practices, strategies and programs.”

He said prevention decreases risk factors and enhances protective factors. It acts directly, with at-risk populations, and indirectly, focusing on the population at large.

Americans as “a seatbelt people” was given as an effective example of the indirect approach. With data-driven decision making (number of automobile accident injuries and deaths) and outcome-based prevention (regulation of seatbelts as safety measure and standardization of their use in the automobile industry), population-level change has been achieved.

“Prevention works!” he said and offered the parallel example of measures to curb smoking and secondhand smoke inhalation.

“With God on our side, everything is possible,” he added.

Affirming good prevention has to be multi-pronged, Johnson and his co-presenters walked attendees through the “Strategic Prevention Framework” in use by the Substance Abuse and Mental Health Services Administration.

Data assessment was the topic addressed by Los Angeles native Raylette Pickett. Pickett currently resides in Dallas and, in addition to being co-owner of TTJ Group, is the co-founder of SheRay’s & Associates, which offers specialized trainings, organization development and technical assistance for community response programs.

Pickett presented graphic data from the Wisconsin Department of Health Services.

A general look at drug-related deaths between the years 2000 and 2016 shows that the combined number of deaths from cocaine, heroin, benzodiazepines and prescription opioids spike upwards both in the years 2007 and 2015. With fewer than 100 deaths in 2000, by 2016 that total number was 1,352; 568 deaths – 42 percent – were prescription opioid related.

Looking solely at opioid-related deaths during the same period, more were caused by prescription opioids than heroin. All the data shows a sharp uptick around the year 2015. (It was noted that the 2017 numbers were available but the presenter did not have them incorporated into the presentation).

Barron County stats

Pickett asked Sarah Turner, prevention specialist with the Barron County Community Coalition, to share more local data. She added that trends are similar for methamphetamine use and confirmed that Barron County numbers are reflective of the Northwest Wisconsin region. Attendees gasped hearing that the number of meth-related out-of-home placements rose from 10 children in 2014 to 142 in 2017.

Turner said there has been a similar trend in the actual termination of parental rights. Another number that shocked attendees was the youth use rate – 2 percent regionally, whereas the statewide rate is .3 percent.

“Let the data marinate,” Pickett said. “Let the data marinate,” she repeated slowly a second and third time. Turning to the participants as a focus group, she asked, “What does drug use look like in your community?”

Answers given included marijuana and meth use, doubled rates of Hepatitis C in under-40-year-olds and increased requests for mental health services. Lack of transportation was mentioned as prohibitive for access to treatment in rural areas.

Alcohol use and abuse was brought up as an “elephant in the room” topic, “taboo to tackle” in the region and local culture. Various participants agreed on alcohol being a gateway to more serious substance abuse, but that its cultural acceptance adds to challenge of addressing the roots of the current opioid epidemic.

“We have some work to do in the state of Wisconsin,” Pickett concluded and segued into the vital role accurate assessment plays. “Problems can be solved only when they’re understood.” Qualitative and quantitative data help identify existing resources and gaps which lays the groundwork for effective planning.

When FBOs join forces for prevention, transformative power is the result. Johnson defined this as a coalition – a term with a military background – “a formal arrangement for collaboration between groups or sector of a community, in which each group retains its identity but all agree to work together toward a common goal of building a safe, healthy and drug-free community.”

Johnson said, “Collaboration not clobberation, not turf protection.” He advocated the coming together of individual groups who, while maintaining their individual identities, can effectively join forces in the face of a universal threat, such as opioids, affecting them all.

The information offered was recapped encouraging participants to leave with more than ideas; to leave with actions, focused on a common goal, without getting discouraged if it takes multiple attempts to get it right.

Ethical considerations for treatment

The Phillips conference focused on treatment more than prevention.

Sheila Weix, director of Substance Abuse Services for Family Health Center of Marshfield, presented on the neurobiology of opioid use disorder.
Building on the complicated narrative given to physicians and patients of “amazing pain treatment drugs” and “the complicated twisting of money, marketing and medicine” they have led to, doctor of bioethics Leslie Schmidt gave an engaging presentation.

With case story examples of her husband and young adult son, Schmidt spoke to the tensions between a misunderstanding of pain management as pain elimination, and lack of consideration of the consequences of prescribing opioids haphazardly without proper follow-up.

Schmidt’s declared goal was not to give attendees ready made answers to questions surrounding disparity of care, rather to prepare them for courageous self-reflection and candid conversations with colleagues within their own treatment sector and adjacent partnering service providers.
“All of these people who are dealing with this substance use issue are persons – how are we responding to them?” she asked. Parallels were drawn between the use of defibrillators, widely available in case of emergency, and that of the controversy surrounding the use of Narcan, which can block the effects of an opioid overdose, for first responders and law enforcement.

One participant shared that her co-worker’s mantra is “I choose to believe that they wouldn’t be in this situation if they were given a choice.” Trauma-informed care was brought up as a good starting point to see the person seeking care not merely as an addict, but a whole person.
In order to act this out, Schmidt spoke to three guiding principles: human dignity, balance and respect for autonomy.

“Our contemporary understanding, our societal understanding of human dignity, is that human dignity is a math problem. You do this, and you have human dignity … You are a productive member of society, and you have human dignity.

“What I would encourage or at least challenge us to think about is how that math problem is grounded in judgment and bias. If we look at all persons, all persons,” she emphasized, “all persons as having inherent dignity, worth and value – would that impact the way that we respond and approach (each of) them?”

Case studies were discussed as starting points to identify tension between human and treatment values and help participants see the various perspectives at play.

One such perspective – that of the legal and professional boundaries providers need to adhere to – was the theme of Anne Ruff’s final talk at the community bioethics conference. Ruff is an attorney with Ascension Health Indiana. She advises on aspects of health care law as related to clinical services and patient care issues.

The medical field’s regulatory landscape, Ruff said, has the goal of garnering prescriber accountability. However, she acknowledged that what the law is and what it should be aren’t often agreed upon by those dealing with the various persons and entities driving and affected by the opioid crisis.
“I think very often that people who write rules need conversation with those who use them,” she said.

Ruff applauded and encouraged community-based solutions for their creativity and collaboration. She confirmed that the current crises “cannot only be healthcare providers’ concern.”

Speaking from experience, she said providers cannot practice medicine to avoid litigation. “Always practice good medicine and do reasonable documentation… Medicine practiced honoring patients cannot be defensive medicine.”

Ruff recognized the prevalence of patients threatening lawsuits to coerce their providers. Her answer was to repeat that “good medicine and reasonable documentation” will stand up against patients trying to manipulate the system.

She echoed Schmidt’s call for treatment based on the dignity of the person. Given that the epidemic’s effects cross over beyond medical consequences, Ruff encouraged treatment plans that equally reach beyond medicine. At the same time, she raised concerns that this type of continuum of care was not incentivized by the business side of medicine and role that insurance providers play in the cost-vs.-benefit equation.
“Community driven programs are working,” Ruff confirmed. “This cannot only be healthcare’s problem.”

The Phillips conference, though it took place a few weeks prior to the Governor’s Task Force summit, was the fruit of the type of community collaboration held up as exemplary at the Rice Lake seminar.

Chris Hurtubise, associate director of the diocesan Office of Catholic Formation, drew a connection with the current opioid crisis and the Church’s timeless mission. Attending the faith-based summit, he was surprised to learn “just the incredible strain on families” associated with persons struggling with opioid abuse, especially its effect on children.

Leaving the conference with information and motivation, Hurtubise said, “We need to redouble our efforts to preach and teach to Gospel of Christ and rededicate our own lives to being transformed by His grace and mercy. The risk factors boil down to gateway drugs like alcohol and marijuana combined with hopelessness, alienation and despair. Christ – active in His Body the Church – is the antidote. Christ transforming our hearts and lives first and then working through us in the community.”

As a former addictions counselor, now working with Catholic Charities of La Crosse in Eau Claire, Julienne Linberg’s experience and employment brought together the objectives of both the Phillips and Rice Lake seminars.

In her current role working mostly with the homeless, Linberg shared that 80 percent have addiction or mental health issues. “Most are in the system due to some traumatic or life-changing event that they never recovered from,” she said.

“I’m put there to love these people. And maybe I can’t fix their problems, but they feel safe, they feel welcome and they know somebody is listening and somebody cares,” Linberg added.

During a moment for group sharing, she addressed the participants at the faith-based summit. She said her goal was to “see the face of Christ in them and for them to see Christ’s light in me.” She was able to add how often people come back to share the ways they have grown or are working towards a better life.

Linberg spoke clearly of the need to “meet them where they’re at – help them see they were created for a purpose. It’s our responsibility to help them become who Christ wants them to be.”