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Addressing Crisis: Treating Opioid Addiction Like a Disease

Combatting America’s drug epidemic — which claimed over 65,000 lives last year, more than half from opioid abuse — will take a community effort and focus on prevention and treatment, said those on the local frontlines.

In wake of President Trump’s October declaration that the opioid crisis is a public health emergency, students, Clark County and Clark College officials say they are working to be part of the solution.

“Opioid overdose is completely preventable,” Clark County’s Public Health Director Dr. Alan Melnick said. One key approach, he said, is to start treating addiction like a real disease.

Melnick said that addiction isn’t treated like other chronic diseases, and that it’s important to treat the whole person, their physical and mental health along with the substance abuse problem.  He said access to appropriate medication-assisted treatment is vital.

“For most diseases if you get worse, you get more treatment,” Melnick said. “So, if your diabetes gets worse or your cancer gets worse people will want to treat you more. With something like substance use disorder, if you get sicker then you get thrown out of treatment or you get expelled from school.  We need to change our approach in terms of how we deal with it.”

Melnick provided data showing that 16 years ago Washington state had 270 opioid overdose deaths. By 2015, that number more than doubled to 623.  Last year in Clark County there were 55 overdose deaths, 40 of which were due to opioids according to preliminary data provided by the health department.

Over-the-counter opioids have been a growing problem since the ‘90s, when pharmaceutical prescriptions for pain management became more common.  The Centers for Disease Control reported a quarter of a billion prescriptions were written in 2013. One year later, the CDC estimated over 2 million Americans abused or depended on prescription opioids.

Dr. Marcia Roi, the department chair for Clark’s Addiction Counseling Education Department, a program which trains and certifies people as addiction counselors, has worked with students who transitioned from prescribed painkillers to illicit drugs.

“I have a number of students in this program who were in the trades and got hurt,” Roi said. “Roofers falling off of roofs, hairdressers with bad rotator cuffs, any number of injuries with people in the trades.They were prescribed OxyContin, they became addicted to it, and then it was cut off.”

Then, Roi said, they turn to heroin. She added that heroin is cheaper than OxyContin.

Clark’s Addiction Counseling Education Students club has Vancouver community partners that are at the front-lines of the crisis.  

ACES club president Norman Johnson said, “You have to work at a grassroots level. If you can get kids talking to each other, that works so much better than trying to talk to them all individually.” Anyone with an interest in addiction counseling can join the club.

“I wanted to do more to help people get out of their addiction than just be their sponsor,” Johnson, a recovering alcoholic, said. “I’ve seen people die as active alcoholics and addicts, it’s such a heartbreaking loss.”

Johnson volunteers once a week at the Clark County Public Health Needle Exchange, a one for one needle swap and disposal site that helps prevent the spread of communicable diseases like HIV and Hepatitis C.

Johnson has been certified through the exchange to administer Naloxone, an opioid overdose reversal antidote that has saved hundreds of lives in Clark County. He’s also trained over 40 people to administer the medication, and said certification follows 10 minutes of instruction.  

Kari Haeker, who oversees the exchange program, said “We are fortunate that, since April of 2014, we have been able to provide Naloxone and Naloxone training for anybody who wants it.  We also train police departments, first respondents, family members of anybody who uses drugs, friends or sometimes even just people from the community.”

Lt. Kathy McNicholas of the Vancouver Police Department said VPD has trained six officers to dispense naloxone and is looking into long-term training programs.

The Clark County Sheriff’s Department and Battle Ground Police Department have also trained and equipped their personnel with naloxone, public information officers said.

From April 2014 to April 2017 there were 6,212 doses of naloxone dispensed with training to community partners and 584 client-reported overdose reversals, although Haeker said not all reversals are reported back.

The Needle Exchange partners with Lifeline Connections, a substance abuse and mental health services provider, links a care navigator with the exchange to recruit opioid users into medication assisted therapy.Non-opioid users can be directed toward the detox or residential treatment programs Lifeline provides, according to Haeker.  

“You see some people there on the edge, bouncing off the walls and stuff. But a lot of people there are really looking for help, and looking to get out,” Johnson said.

The ACES club also supported the Oct. 28 Vancouver RX Take-Back, a DEA orchestrated and Prevent Coalition organized event. Held biannually in April and October, this year’s event saw an increase in the amount of pills collected and number of volunteers in Clark County.

In total, 3,549 pounds of pills were collected and 1,321 participants helped, Prevent Coalition Coordinator Kelley Groen said.

“The exposure is getting out there,” Groen said. “People would come up and say, ‘thank you so much for having these events.’”

Groen said that at the take-back, law enforcement personnel are required to accept the medications.

Lt. Kathy McNicholas of VPD said the take-back keep excess medications off the streets and out of the hands of people without a prescription. Medications can be disposed at Vancouver Police East and West precincts Monday through Friday year round.

These preventative and treatment resources in Clark County help address the crisis locally, but opioid deaths continue to rise every year.

The President’s Opioid and Drug Abuse Commission, created by executive order in March to advise the president on the crisis, submitted their recommendations on Nov. 1. The White House has not yet released their strategy for responding to the crisis.

The declaration and the commission recommendations call for a well-resourced campaign to treat this epidemic as a disease and provide comprehensive treatment.

The commission recommendations include calls for federal funding, tightened restrictions for prescribers and research on non-addictive painkillers. The report addresses the need for evidence based treatment of adverse childhood experiences, however, it wasn’t addressed further.

Treatment recommendations include increased access to medication-assisted treatment and a public campaign that does not ostracize those with dependency issues.

“It is time we all say what we know is true: Addiction is a disease,” Gov. Chris Christie, chairman of the Commission, said to the president in the report’s address. “However, we do not treat addiction in this country like we treat other diseases.”

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