A Call for Action. The Opioid Crisis in Camden County

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What If someone told you that 3000 people in your state would be dead at the end of the year? What if someone told you that the same thing killing these 3000 people only killed 2 people in 2010? What if someone told you that no one is immune from this, that it attacks all walks of life What would you think was killing these 3000 people? No, not a terrorist attack, or a flu epidemic. It wasn’t a mass shooting or a natural disaster or casualty of war. No, it wasn’t any of these, it is opioid overdoses. 3000 people died in New Jersey in 2018 of opioid overdose. 3000 people, that were mothers, fathers, brothers, sisters, teachers, doctors, lawyers, blue collar, white collar, rich, poor, male, female, old, and young lost their lives in 2018 from an epidemic that could have been prevented. If Camden County doesn’t act now the number of deaths will rise, communities will wither, and society will pay the toll. Look at the community now compared to 10 years ago. Fire departments have been transformed into mobile emergency rooms. Police now carry drugs that block the brain’s opioid receptors. High schools have started to stock up on naloxone, with principals getting trained to administer the emergency drug. Residents of Camden County and New Jersey in its entirety must act. You must demand, that state and County officials propose new legislation and provide funding to educate physicians & the public, create effective treatment options, and end the stigma of drug addiction, in order to stop the rise in opiate related deaths in Camden County, New Jersey because even though national death tolls have fallen, opiate overdoses in New Jersey have increased by 24% with Camden County ranking 2nd for the most opiate deaths in the state.

“Education is key.” We have all heard this saying one time or another, and as cliché as it sounds, it is the truth for many things, because in order to understand, you must first learn. Education is important because it helps us develop a unique perspective of looking at life. Educating physicians and the public is key to ending the opioid epidemic. State and county officials should propose legislation requiring all physicians to educate patients on the effects of opioid use, abuse, and overdose. According to a recent report from, Medical Group Management Association, open patient-provider communication is essential for providers trying to combat the opioid epidemic (2018). The use of educational techniques to ensure patients are using their opioid correctly, can self-identify the warning signs of addiction, and dispose of opioid prescriptions correctly when they are no longer in use, is essential for combating this epidemic. A 2018 article published in the Journal of the American College of Surgeons found that patient education about opioid disposal increased the number of patients correctly disposing of opioids by 22 percent (Journal of the American College of Surgeons, 2018). All medical schools should require addiction training in order to graduate. They should also enhance curriculum by adding more material and competencies related to addiction, and the shift from prescription opioids to heroin and fentanyl, as well as how to treat such addictions in order to prevent future overdoses (Ratycz, Papadimos, & Vanderbilt, 2018). State and county officials must provide funding to train current physicians in addiction. Physicians and future physicians’ education are critical to ending the opioid epidemic. Unfortunately, most physicians feel ill-equipped to effectively identify, assess, and treat opioid and heroin addiction in their patients. Proper training and implementing best practices can better serve the community by having physicians on the front line of this battle combating this epidemic. Federally funded Substance Abuse and Mental Health Services Administration offers continuing medical education courses available at no charge (SAMHSA, 2018). According to MGMA president and CEO Halee Fischer-Wright, MD, “By arming practice leaders and healthcare providers with this information, we’re hopeful that they can be even more effective in fighting this epidemic at one of the most critical junctures: the point of care (Heath, 2018)

Physician continued education and curriculum for medical students is crucial but will be inefficient without educating the public as well. The public needs to be educated on the basic realities of addiction and why this epidemic needs our attention. Public awareness campaigns need to be implemented to target different groups in Camden County, NJ such as, the elderly on safe storage and disposal of opioid medicating, parents on the signs of addiction and how to get help, and teens on dealing with a parent addicted, or self-addiction, and overcoming the stigma. The state should implement curriculum in high school to bring awareness and knowledge on opioid addiction. Residents of Camden County must spread awareness and begin the hard conversation that no one wants to talk about, because if not the next talk may be at a funeral of a loved one that loss their battle to addiction.

There are evidence-based treatments that can save lives, but has been underused because of the stigma, and limited access associated with, Medication assisted treatment and Naloxone. Medication assisted treatment also referred to as MAT, is the use of medications with counselling and behavioural therapies to treat substance use disorders and prevent opioid overdose (2018). According to The Substance Abuse and Mental Health Services Administration, MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals. MAT provides a more comprehensive, individually tailored program of medication and behavioural therapy (Substance Abuse and Mental Health Services Administration, 2018). Medicated assisted treatment has been effective in improving patient survival and treatment retention, decreasing illicit opiate use and other criminal activity among addicts, increasing ability to gain and maintain jobs (SAMHSA, 2018). methadone and Buprenorphine were each found to be more effective in reducing illicit opioid use than no medication in randomize clinical trials. Methadone and Buprenorphine are used in medication assisted treatment and has shown evidence to reduced risk of overdose death. Unfortunately, even with all the evidence, Medication Assisted Treatments are underused. Many patients that use medication to treat addiction are often not accepted by communities, physicians, most sober homes, or 12 step programs like Narcotics Anonymous because of the stigma. The biggest misconceptions range from trading one drug for another to MAT not being as effective as abstinence treatment, but MAT is a proven evidence based opioid treatment, that is the gold standard of care for OUD. American Academy of Addiction Psychiatry, American Medical Association, The National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, National Institute on Alcohol Abuse and Alcoholism, Centers for Disease Control and Prevention emphasize MAT as first line treatment. MAT bridges the biological and behavioral components of addiction. Research indicates that a combination of medication and behavioral therapies can successfully treat addiction and help sustain recovery (National Council for Behavioral Health, 2018). The limited access is another barrier because, simply put, it’s easier for doctors to prescribe opiates than it is to prescribe medications to treat addiction. In order to received methadone treatment, the clinic must be authorized to dispense it, and requires patients to come daily to receive a dose under direct observation. Buprenorphine can be dispensed from a doctor’s office only after the physician completes eight hours of training and applies for a special waiver. State and county officials should present a plan to implement a team of medical professionals and peers in recovery to intervene with patients admitted for opioid use disorder. Doctors at Oregon Health & Science University in Portland recently implemented a similar program and the results were promising. 80 percent of patients were open to working with a team. Of those, 60 percent started on addiction medications in the hospital (Oregon Health & Science University, 2018). The university also found that it changed the views of health professionals and they told researchers that they now see addiction as a chronic disease with treatments available. the use of methadone or buprenorphine for treating opioid use disorders early this year, they concluded the medications reduced the risk of death by two-thirds, according to British researchers who studied the treatment.

Naloxone. a medication called an “opioid antagonist” used to counter the effects of opioid overdose, for example morphine and heroin overdose, is another treatment that stirs up a bit of controversy with the public. The Public sees it as a safety net for addicts to get high, but the Surgeon General and many health agencies advocate for the broad distribution of the live saving drug, Naloxone. Research shows increasing the availability and targeted distribution of naloxone is a critical tool to reduce opioid-related overdose deaths. When combined with the availability of effective treatment, Naloxone could be a leading force in ending the opioid epidemic.

The biggest hurdle we face in ending he opioid epidemic is stigma that surrounds addiction and treatments for addiction. If we continue to shame induvial and limit resources this stigma will impede progress in reducing the toll of overdose. Stigma involves processes of labelling, stereotyping, social rejection, exclusion, and extrusion as well as the internalization of community attitudes in the form of shame by the person/family being discredited (White, 2018). The biggest stigma attached to addiction is that addiction is choice, not a disease, but Addiction is a chronic disease that can be successfully managed for life. In order to change this stigma, put a face on addiction and recovery through public service campaigns, use real stories throughout our community, and show the public that addicts can and do recover. The Betty Ford Institute recommends “de-stigmatizing the language associated with alcohol and drug addiction, and the portrayal of drug addiction in news and entertainment media (Betty Ford Institution, 2018). Changing the language, can go a long way in changing the perspectives of addiction, and reducing the number of deaths in Camden County.

Since the beginning of 2019, 18 people have died in Camden County from this epidemic. 18 lives taken. 18 families destroyed. 18 times we could have prevented this from happening. Finding our way of this won’t be easy, especially in a time when the nation is so split and trying to muster up national willpower is difficult. Camden County residents must find the will to beat the deadliest epidemic to ever hit the community. The opioid epidemic must be seen as a public health crisis and not a moral failure. There are tools that need to be implemented, medication assisted treatments and wide spread use of Narcan. There are conversations that are being whispered about that need to be screamed out on the top of every roof top. The tide is changing, Camden County will you be swept away, or will you jump the tide and take back the community you love? There is no time but now. You must say, “Not one more preventable death to this crisis, is acceptable! Camden County will not be just a statistic of the most deaths in this state! Camden County will be the leader in condemning and combatting this disease!

References

Heath, S. (2018, August 02). Patient-Provider Communication, Education Key for Opioid Prescribing. Retrieved from https://patientengagementhit.com/news/patient-provider-communication-education-key-for-opioid-prescribing

Journal of the American College of Surgeons. (2018). Guideline for Discharge Opioid Prescriptions after … Retrieved from https://www.journalacs.org/article/S1072-7515(17)32055-0/fulltext

Medical Group Management Association. (2018). Six Principles for Opioid Prescribing. Retrieved from http://miramedajuba.com/blog/2018/07/26/six-principles-opioid-prescribing-mgma-report/

National Council for Behavioral Health, 2018National Council for Behavioral Health. (2018). National Council for Behavioral Health – Opioids. Retrieved from https://www.thenationalcouncil.org/

NJBM. (n.d.). Combatting the Opioid Crisis. Retrieved from https://njbmagazine.com/monthly-articles/combatting-the-opioid-crisis/

New Jersey Reentry Corporation. (2018, October 01). NJRC New Jersey Opioid Addiction Report: A Modern Plague. Retrieved from http://njreentry.org/reportpressrelease/

Oregon Health & Science University. (2018). OHSU Home. Retrieved from https://www.ohsu.edu/xd/

Ratycz, M. C., Papadimos, T. J., & Vanderbilt, A. A. (2018). Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula. Medical education online, 23(1), 1466574.

SAMHSA. (n.d.). Opioid Overdose Prevention Toolkit. Retrieved from https://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA18-4742

Walsh, L. (2015, June 15). Medication and Counseling Treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment

White, W. (2009). Long-term strategies to reduce the stigma attached to addiction, treatment, and recovery within the City of Philadelphia. Retrieved from http://ww.williamwhitepapers.com/pr/2009Stigma&methadone.pdf