260 in Morehead hear speakers on opioid recovery and solutions to the epidemic: rebuilding communities and long-term treatment

By Melissa Patrick
Kentucky Health News

Treating opioid-use disorder as a chronic disease, finding local solutions and restoring communities were the overarching themes of an event in Morehead Sept. 5 for health professionals: “Recovery and Solutions: The Next Chapter in Northeast Kentucky’s Opioid Epidemic.”

Alex Elswick

About 260 people heard keynote speaker Sam Quinones, author of Dreamland: The True Tale of America’s Opiate Epidemic, say that he started out to write a book about drug trafficking and marketing, but soon realized it was a “much bigger story” and that “at the root of the problem” was the destruction of American communities.

Quinones’ book is named for a now-closed community swimming pool that was once the social epicenter of Portsmouth, Ohio. A town ravaged by the epidemic, it is across the Ohio River from South Shore, Ky.

He told the crowd, “Heroin is a final expression of values that we have fostered for 35 years in this country. A final expression for our fetish for the private at the expense of the public, for isolation at the expense of community It is a final ‘stuff’ for a culture that is convinced that consumption, that buying stuff, is the path to happiness. Heroin is the final expression of that idea.”

Added to this “scourge of isolation,” Quinones said the opioid epidemic flourished as Americans became a people who wanted easy answers to complex problems and took on unrealistic expectations of how much pain they should tolerate, both physically and emotionally. And, he added, we became “ferocious” in our efforts to keep our kids from feeling any pain.

“It’s all connected,” he said, adding later, “Why do we wonder that heroin is everywhere? It seems to me that our search for painlessness, convenience and comfort above all other things is a lot about what led us to it.”

Quinones said the epidemic requires not one solution, but a “symphonic” approach that will come from communities working together toward this common goal.

“Isolation is heroin’s natural habitat,” he said. “I believe more strongly than ever before that the antidote to heroin is not naloxone, it is community. . . . There is no silver bullet, it is only through collaboration that innovation comes.”

Asked after his talk if he thought marijuana should be legalized, he said yes, but said we should proceed “slowly, humbly and cautiously,” and that it should also be regulated for potency. He added that we also need to learn from the heroin epidemic: “A supply of high potency drugs matters.”

Alex Elswick and his mother Shelley Elswick, the co-founders of Voices of Hope Lexington, told their stories of addiction and recovery from a family perspective and an individual one. Voices of Hope is a nonprofit that offers recovery support to people with substance-use disorders.

Shelley Elswick simply asked for compassion: “I’m asking for compassion for families when we don’t know what’s happening in the beginning, when we’re looking for solutions once we know we have a problem and at the end when we get our loved ones into recovery and we don’t know what to do.”

Alex Elswick, a doctoral student in the Department of Family Sciences at the University of Kentucky, told the story of his heroin addiction, which started with prescription oxycodone, and his rocky path to long-term recovery. He stressed that finding a solution to the opioid epidemic must include treating addiction like a “chronic disease.”

“Because the inevitable result of mismatching a chronic disease with acute treatment is a huge gap in management,” he said. “And it is in that gap that people relapse. And unfortunately in the context of an opioid epidemic, it is in that gap that people we care about lose their lives.”

He added later, “I think as soon as we begin to fill gaps in treatment, to create a continuum of care that helps people get to that critical five year mark where the risk of relapse drops below 15 percent, that’s when we’ll see some changes.”

Dr. Michelle Lofwall

Dr. Michelle Lofwall, a UK psychiatry professor and part of the College of Medicine Center on Drug and Alcohol Research, talked about the hope that comes with treatment and recovery, and the need for more of it.

“We see people getting better that have been so, so ill and have suffered so much and that very clearly turn their lives back around and give back to their communities,” she said. “It is an illness and it is treatable.”

Lofwall also emphasized that people with opioid-use disorders need ongoing care.

“We really need treatment to be more continuous because it is frequently chronic, and the drug supply, the way it is right now is that one single lapse can be deadly . . . It’s important that we stop just doing these acute episodes of treatment,” she said.

She noted that only a small percentage of people with opioid-use disorder are getting treatment, with only 20 percent getting specialty addiction treatment and among those, only 37 percent receiving medications approved by the Food and Drug Administration. In addition, she said opioid-related inpatient hospital stays are increasing, up 64 percent nationally between 2005 and 2014, often for conditions like heart-valve replacements, which can cost “hundreds of thousands of dollars.”

“How senseless is it if we are not treating the underlying disorder — opiate-use disorder — especially when we have really effective, evidence based medications,” she said. “And we need to couple them with counseling and all the other important wrap around services. That is not rocket science.”

Lofwall said we need to make drug screening, treatment, naloxone and syringe exchanges more accessible; improve treatment retention; train a larger work force to treat opioid use disorders; and better link recovery services and treatment.

The event was sponsored by the Northeast Kentucky Area Health Education Center.