Recovery Town: Washington’s opioid epidemic
In a nationwide opioid epidemic, Washington County has gained recognition for a large amount of overdoses. But a robust recovery community is changing the image.
In August 2015, Washington County gained widespread attention when 25 people overdosed in two days.
Like the rest of the country, Washington continues to deal with the effects of the opioid epidemic – among them, an increasing need for foster care for the children of addicts, crime and death.
Washington’s recognition as a cradle of drug activity hasn’t been all negative, though.
“We have a very robust recovery community here. If you walk into any 12-step NA or AA program in Washington County, especially in the city here, you’re going to see 100 people all staying clean on a Tuesday night,” said Erich Curnow, director of clinical and case management services for Washington Drug & Alcohol Commission. “There are a lot of people here who are trying to stay clean and survive this issue.”
Dubbed “Recovery Town” by some, the county seat, the city of Washington, has a number of services for people trying to get clean. A quick drive from West Virginia and Ohio with access to two major highways, the county is also an ideal size.
“We might just be in the Goldilocks zone of the ability to help people because we’re not too big and we’re not too small,” said Curnow.
“We’re larger than Greene, but we’re not so big as Allegheny that we’re so full of bureaucracy,” added Cheryl Andrews, executive director of the commission. “There are relationships that are being able to be built.”
With District Attorney Gene Vittone, the commission formed the Washington County Opioid Overdose Coalition, composed of law enforcement, judges, commissioners and jail officials, to create initiatives toward lowering the death toll.
“All of those systems are flooded by this problem. They want a remedy as well … so, they’re willing, I think, to take that gamble and work with us in laying out different strategies,” said Andrews. “We’re very fortunate that we’ve been able to have those dialogues and those connections, because not every community is able to do that.”
Washington also seems to retain the people who come to recover in halfway and recovery houses.
“They start to get engaged, form relationships,” Andrews said. “They start working with people on our staff ... who help them navigate back into the community.”
“We might just be in the Goldilocks zone of the ability to help people because we’re not too big and we’re not too small.”- Erich Curnow
As the single county authority, the nonprofit commission provides intervention, prevention and treatment services to residents, contracting with treatment providers in the county for services from assessments to detox to halfway houses. The staff connects residents to treatment providers and assists with housing, employment and anything else they need to stay clean.
Last year, the commission began embedding staff in hospitals, schools, Children and Youth Services, the courts and jail in a proactive approach to outreach.
Experts believe only 10 percent of people with substance abuse disorders get the help they need.
“There’s no simple solution,” said Curnow. “Substance abuse disorders, depending on who you talk to, are hard to pin down, in terms of the type of malady. Some people say it’s a mental health issue. It’s definitely a behavioral issue. Some people even go so far as to say it’s a spiritual issue. It definitely has physical health components and physical health consequences, not the least of which is overdose death, which we are seeing in staggering amounts. Some projections are saying half a million people over the next 10 years. It’s a pretty dismal outlook right now.”
Opioids, including prescription pain relievers, heroin and Fentanyl, reduce feelings of pain and produce a sense of well-being. Overuse can cause respiratory depression, which can lead to death.
“(Opioids) don’t just take the pain away, they take everything away,” Curnow said. “Say you’ve got an injury, and you take a narcotic. The other thing that happens is that, now, the challenges of your job aren’t that big of a deal, your teenager, your spouse. ... It’s kind of like this Calgon effect. Like the old commercials. ‘Calgon, take me away.’”
The Centers for Disease Control point to the overprescription of opiates, starting in the 1990s, as a significant factor in the current epidemic.
Prior to then, narcotic were mostly prescribed to only patients with certain diagnoses, such as end-stage cancer. But with the unveiling of Oxycontin and the push for doctors to relieve patients of all of their pain, the number of opiate prescriptions started to rapidly increase.
In 2007, principles at Purdue Pharma, maker of the opiate Oxycontin, pleaded guilty to charges related to misbranding and paid $635 million to resolve a U.S. Justice Department probe. They also reached a $19.5 million settlement with 26 states, including Pennsylvania.
Purdue was accused of deceptive marketing practices in which doctors were told that patients taking Oxycontin would not become addicted. Those who appeared to be addicted, Purdue said, were “pseudoaddicted” and should be prescribed a higher dose of the medication.
“We can’t really pin this entirely on the medical community for overprescribing, although that definitely is part of the equation,” Curnow said. “The medical community was hoodwinked into believing (Oxycontin) wasn’t addictive, and they were handcuffed by some of the things they have to perform under, (like) managed care. What’s more cost-effective: 30 days worth of pills or 30 days of physical therapy, a massage therapist, acupuncture?”
When physicians cut back on opiate prescriptions, the price to buy the pills illegally skyrocketed and many abusers switched to the cheaper, and more potent, heroin.
“Ten years ago, if you look at the coroner’s report, initial waves of overdose deaths were pharmacological. Then you see people going from prescriptions to heroin,” said Curnow. “Now we’re seeing people who, I don’t even know that they know they’re making the transition. Fentanyl is sold and marketed as heroin most of the time.”
Through May 31 of this year in Washington County, there were 40 drug overdose deaths, 29 of which were Fentanyl-related, and eight of which were heroin-related, according to the Washington County coroner’s report. The information for Greene County was not released.
In 2016, there were 106 overdose deaths in Washington County and 19 in Greene County, a majority of which were opioid-related.
An older-than-average population may have contributed to the region’s spike in opioid addiction.
“We live in an area with a 7 percent higher median age than the rest of the country. We also lie in the rust belt. Most folks that age spent life doing physical, blue-collar jobs, which break down your body more. There was a higher need (for pain medication),” Curnow said.
Of the people served by the commission – 1,535 last year – 50 percent of them are what Curnow calls “traditional partiers,” and the other 50 percent are those who started with a prescription.
“Easily about half the people coming through our offices and programs are folks who really didn’t show much of a problem with substance abuse. Some may have drank socially or occasionally used marijuana. Then they get prescribed these powerful narcotic medications and it’s like a switch has been flipped,” said Curnow, snapping his fingers. “It’s kind of like a Dr. Jekyll and Mr. Hyde.”
People of any age and economic status become addicted, but there are risk factors, including genetics, family history of addiction and having another mental health disorder.
A user’s tolerance increases with ongoing use, so they have to take more to experience the euphoric feeling. When a frequent user stops, they become what is called “dope sick.”
“It’s kind of like the worst flu you’ve ever had multiplied by a factor of 10,” said Curnow. “Once addicted, you’re really just trying to avoid that.”
Withdrawal symptoms from detox – muscle cramps, fluctuating temperature, nausea, vomiting, diarrhea, dehydration, anxiety, rapid heart rate – last about three to five days.
“You can’t sleep. There’s literally no escape, no respite,” Curnow said. “It’s been described as this rangy energy, as if your bones could poke through your skin. It’s a hellish, hellish feeling. ... That’s the desperation that drives the behavior.”
After a person has stopped taking opioids, the risk of overdose increases because their tolerance is lowered. Taking the same amount they took before quitting could be lethal.
Most emergency medical services, police and fire departments in the county now carry Narcan, a drug that blocks the effects of opioids and reverses an overdose.
The commission’s goal is to take the overdose survivor from the hospital to a treatment facility.
But they can’t be forced and often refuse.
“They are immediately in withdrawal when hit with Narcan,” Curnow said. “EMS, police, emergency departments get frustrated. Family gets frustrated, we get frustrated. What we’ve done is, yes, we’ve saved their life, but we also put them in the state of existence that they most desperately seek to avoid. We’ve immediately made them a cornered animal. A certain amount of people refuse to get in the ambulance. If we get them to the hospital, they quickly realize they’re not given much in the way of comfort meds, so they seek to take that matter into their own hands and get rid of that hellish feeling.”
When a person does start the recovery process, commission staff determines what level of care they need and connects them with the right provider.
The commission contracts with about 60 inpatient residential facilities across the state, but a bed is not always available.
“Bed availability is the driver. It determines how fast we can get somebody into treatment,” Curnow said. “People have this idea, ‘When I’m ready, I’ll just go to rehab.’ It doesn’t work like that. Sometimes, the stars have to line up just right. Funding has to be in place, we have to have a bed available, have to have a driver in the area to take you.”
Once a person gets through inpatient, they typically go to a halfway or recovery house, then on to outpatient treatment and support groups.
In addition to a lack of beds, the length of inpatient treatment can be another impediment to recovery. Studies show that the length of stay is a predictor of successful outcomes, like longer periods of abstinence and lower rates of relapse. Experts believe 90 days of treatment should be the minimum.
“I’m a big fan of longer treatment stays. You get more programming, get more structure. If nothing else, you’re going to get more time away from the chemical,” said Curnow. “The research didn’t delineate residential versus outpatient. But, based on my experience ... if it were my family member, I would say you have to do a minimum of 90 days residential. I’m trying to give you the best chance of surviving and moving on. I would send everybody I know to 90 days.”
The standard is 14 to 28 days.
“Short-term rehab stays are really, for an opioid addict, like a triage. You’re not getting a lot done,” said Curnow. “We separate you from the chemical a little bit. We dust you off. We give you some information. We point you in the direction of ongoing help.”
Curnow equates a shorter length of stay to denying a person the minimum effective dose of treatment, giving a suboptimal dose, then scrutinizing them when they don’t respond.
Curnow said addicts are often stigmatized, especially by people who have not been affected by the epidemic.
“The unfortunate thing is, statistically speaking, as this thing progresses, more and more families are going to be impacted,” said Curnow. “As more and more people fall victim, more and more people are going to know a neighbor or cousin or niece or nephew ... or somebody in their immediate family. So everybody’s going to get an education who hasn’t gotten one if this thing continues at the pace that it’s on now.”
Curnow is intrigued by the comparison that the opioid epidemic is like the AIDS epidemic of the 1980s, in terms of stigma.
“If you recall the early days of that crisis, there was a lot of this type of talk. It’s volitional. ‘If you want to live this type of lifestyle, that’s what you get. You make your bed, you lie in it.’ The difference between people who suffered from AIDS and died from AIDS is they were much more vocal and much better to represent themselves. Our people are kind of voiceless because they are marginalized. They are relegated to, ‘Who’s going to believe a drug addict, anyway? What credibility does a drug addict have? What kind of credibility does a criminal drug addict have?’”
People have a right to have access to treatment, housing and employment, Curnow said.
“People standing in the way of that is really a civil rights issue,” he said. “What I encourage my staff to do is be the voice of those voiceless people who aren’t given any credibility because of the stigma that’s marginalized them.”
Curnow and Andrews said the opioid epidemic requires open minds and creative solutions. The county overdose coalition launched such an initiative this summer in the jail, where eligible inmates are given a drug that blocks opioid receptors in the brain for a month, helping prevent relapse. Five inmates have received the treatment, with 10 more to receive it before being released.
“We’ve come a long way in people being able to take another look at this and say, ‘OK, what we’re doing is not working.’ I think Washington County is on the path of moving in a very progressive direction,” Curnow said. “I think there’s a lot of great things here, but there’s always room for improvement.”
For recovery information, visit Washington Drug & Alcohol Commission at www.wdacinc.org or call 724-223-1181.