Homer’s ongoing struggle with opioid addiction continued last Wednesday with a community presentation and conversation at Homer High School, “Responding to Opioid Addiction in Our Community.” Moderated by Pastor Lisa Talbott of Homer United Methodist Church, the discussion included talks by a recovering addict and the parents of a recovering addict.
Sponsored by MAPP, or Mobilizing for Planning and Partnership, of the Southern Kenai Peninsula, Talbott noted that MAPP looks at community health in terms of social, physical, financial and spiritual health.
“It is going to take all those dimensions of wellness to address the opioid epidemic,” she said. “We are not talking about an issue. We are talking about people, people we know and love.”
The term “opioid” has been used to refer both to opiates, drugs like heroin and opium made from the poppy flower, and opioids, synthetic pain relieving drugs like hydrocodone (Vicodin) and oxycodone (OxyContin). Both classes of drugs interact with opioid pain receptors in the human brain.
When used cautiously and not overprescribed, opioids can relieve pain from surgery or injury. Opioids can change the wiring of the brain in some people.
About 5 percent of people have underlying brain chemistry that makes them susceptible to addiction, said Dr. Sarah Spencer, who spoke last week on the science of addiction.
Once that happens, “It’s completely out of their control at that point,” she said. “It’s changed their brain. It’s a problem they’re going to have the rest of their lives.”
Dr. Spencer showed a chart that illustrated the rise of opioid deaths and treatment correlated with the increase of sales of prescription opioids. The lines rose together.
“It’s pretty obvious what the underlying cause here is. Prescription opioids were the underling cause that triggered this,” she said.
According to an April 2016 Epidemiology Report by the Alaska Division of Public Health, “Update on Drug Overdose Deaths,” in 2016 the statewide opioid overdose death rate was the highest since 2009, and represents a fourfold increase since 2005. In 2016, Alaska had 65 deaths from opioid pain relievers, 81 from illicit drugs and 49 from heroin. Total overdose deaths from all drugs was 128, or 17.1 per 100,000. The overdose death rate was the highest for people ages 25-34 (30.3 per 100,000). By region, the Gulf Coast, including the Kenai Peninsula, had the highest rate, 23.7 per 100,000 compared to Anchorage and the Matanuska-Susitna area, 18.7. Overdose death rates were similar for Alaska Natives and non-Natives, 16.6 and 16.1 per 100,000. The problem has hit every village and city in the state, from Ketchikan to Utqiagvik.
According to DHSS, from 2015-16, the Kenai Peninsula had 26 deaths from opiods and 31 from all drug overdoses. That compares to 12 deaths from opioids in 2010-11 and 15 for all drug overdoses. The mortality rate for opioids jumped from 11.9 per 100,000 in 2010-11 to 22.4 in 2015-16. Those figures do not separate out deaths by city.
Dr. Spencer specializes in addiction treatment and advocates medication-assisted treatment, where prescription medicine is used to help people detox from opioid and reduce cravings. She compared addiction to a chronic disease like diabetes or asthma. When prescribing insulin for diabetes, you don’t give it for six months and expect a patient to be cured.
“We know it’s a lifelong disease,” she said. “We can think about addiction in the same way.”
A drug like buprenorphine is a partial agonist, that is, it partially blocks the opioid receptors in the brain. A patient won’t feel high if they have a tolerance to opioids. They feel normal, Dr. Spencer said.
“That’s just a good feeling, to feel like a normal human being,” she said.
Medicine alone won’t cure addiction, though. It takes time for the brain to recover, and the longer a person stays in treatment, the better the outcome. It also takes time for people with addiction to rebuild their lives. Often someone entering treatment has hit rock bottom and has lost homes, friends and family. They have to make new friends who don’t use drugs.
Annie and Rob Wiard spoke of working with their daughter Megan, now 28, to get her clean after using drugs for 10 years. Megan urged them to tell their story after she began to speak about her recovery.
Actually, the Wiards said their revelation came when they realized that Megan had to do the work — that for her to get sober she had to make the choice to do so.
Annie Wiard compared it to seeing your daughter swept downstream in a raging current. You want to throw her a life ring. You want to push a boat out to her — a yacht.
“I’m running down the river bank saying, ‘Megan, come over here,’ and she’s ‘Nope, not gonna,’” she said. “Everything I did was preventing her from getting her own treatment, her own accountability going forward.”
The Wiards held an intervention with their daughter. They cut off all contact and said she couldn’t call them except to talk about how to get sober.
“Letting Megan go was the hardest thing I’ve ever done,” Annie Wiard said. “When we truly let her go to do that, Megan got sober.”
“I am an addict,” another person in recovery said in telling her story. Jody, who did not give her last name, told a story similar to Megan Wiard’s. Jody used meth, heroin, opioids, “anything to just get by.” She wound up in jail, and that led to her recovery. A court order said she could have no cell phones and had to get periodic urine tests.
“I needed accountability,” Jody said.
She went to church and Narcotics Anonymous, “anything I can get my hands on to build me up,” Jody said.
The Wiards said one thing they didn’t quit doing was keep loving their daughter.
“It took me a long while to realize that my mother’s love was not going to save her,” Annie Wiard said. “Only Megan’s love was going to save herself.”
That kind of support also helped her recover, Jody said.
“I’m just thankful I was loved until I could love myself,” she said.
The state’s response to the opioid epidemic intensified in February when Gov. Bill Walker declared opioid addiction an epidemic. Walker did that for one practical reason: so Dr. Jay Butler, Chief Medical Officer and director of the Division of Public Health, would have the authority to issue statewide medical orders in response to the epidemic, said Andy Jones, deputy incident commander for the state’s opioid response team with DHSS.
One result of the disaster declaration has been distribution of 5,000 Narcan kits in three months. Narcan can be sprayed up the nose of someone overdosing on opioid.
“It gives them that second chance. It brings them back to life,” Jones said.
Narcan kits packed in crayon boxes — an innovation Jones thought up to make the kits less innocuous — have been distributed at clinics run by Dr. Spencer, including clinics at the Harbormaster’s Office to reach out to fishermen. Narcan comes in a nasal inhaler like that used for some asthma drugs.
According to DHSS, of patients who had Narcan injections and went to Kenai Peninsula hospital emergency rooms for overdoses in the years 2010-2012 and 2015, less than 9 percent of them died. The percent of patients who received Narcan injections in emergency rooms has increased from 2010-2015 as has the number of patients who died.
Though the Wiards and Jody spoke of some successes, the road to recovery can be long and torturous, with lots of dead ends and backtracking. Stephanie Stillwell, a public health nurse in Homer, handed out a flier showing the steps: addiction, withdrawal management, intake assessment, residential treatment and sober living, outpatient treatment, and ongoing recovery services.
“I thought it would be simple,” she said. “There are a lot of barriers … Sometimes people walk the path over and over.”
One problem: the lower Kenai Peninsula lacks some of those services, like residential treatment and sober living homes. The area also doesn’t have enough people to support methadone treatment clinics, Dr. Spencer said.
There also can be an overlap between addiction and homelessness. People suffering addiction lose their jobs, their homes and apartments, and might have alienated families who could give them housing.
“You have no one left to take care of you and you can’t take care of yourself,” Dr. Spencer said.
Jones said addiction also can lead to homelessness in family members like adult children who don’t use drugs.
Homer has one outreach clinic that helps people find treatment — ironically, by giving them safe needles. The Exchange meets 5-7 p.m. every other Tuesday at the South Peninsula Hospital Annex on Pioneer Avenue.
A $10,000 grant received in February from the Alaska Mental Health Trust Program will keep the program going another two years. Drug users can exchange dirty needles for cleaner needle kits, and also get hepatitis C and HIV testing. They also can get Narcan kits.
“When they go, it’s a safe place,” Dr. Spencer said. “It’s a place they can talk about ‘what if I wanted to detox.’ They know they can ask the questions. It reduces risk taking behavior and increases access to treatment.”