Monday, May 15, 2017
by Patty Johnson
BJC, WUSM | It’s an image that’s seared in the minds of those who’ve seen it — a young couple in the front seat of a car, on the brink of death from an opioid overdose, with a small child in the car’s back seat. The image offers a disturbing glimpse into the nation’s current opioid epidemic.
But the facts are equally grim. According to the U.S. Department of Health and Human Services, on an average day in the United States, more than 650,000 opioid prescriptions are dispensed, 3,900 individuals start taking prescription opioids for non-medical use, 580 people try heroin for the first time, and 78 people die from an opioid-related overdose.
Opioids are substances that work on the body’s nervous system or specific receptors in the brain to reduce the intensity of pain. Overdose deaths from such opioids, including prescription opioids such as oxycodone and hydrocodone, as well as heroin, have more than quadrupled since 1999, according to the Centers for Disease Control and Prevention.
Although the scope of the problem — and media coverage — both have exploded in recent years, the problem of drug addiction isn’t new, says Theodore Cicero, PhD, the John P. Feighner Professor of Psychiatry at Washington University School of Medicine and vice chairman for research in the WUSM department of psychiatry.
“Drug abuse has been a problem for years, but many people thought of it as an inner-city problem,” Dr. Cicero says. “That’s a myth. It’s in the suburbs and in the high schools and colleges. It’s a public health issue — and it’s not going away.”
Dr. Cicero will address the current opioid epidemic as the keynote speaker at a symposium from 7-9 a.m., June 9, in the lower-level auditorium at the BJC Learning Institute. The event, “Opioid Epidemic: A Community-Based Approach to Curtailing Supply and Demand,” will be hosted by the St. Louis Chapter of the National Association of Health Services Executives (NAHSE), a non-profit association of minority health care executives.
The June 9 symposium will also include a panel discussion with Daniel Isom, professor of policing and the community at the University of Missouri–St. Louis; Kendra Holmes, vice president and CEO of Affinia Healthcare; Cora Faith Walker, Missouri State Representative, District 74; Howard Weissman, executive director of the National Council on Alcoholism and Drug Dependence; and moderator Fred Rottnek, professor and director of community medicine at Saint Louis University School of Medicine.
How did we get here?
Dr. Cicero says the current crisis started 15-20 years ago with two primary occurrences. “The American Medical Association reported that pain was undertreated — that effective treatments weren’t being used because of an irrational fear of addiction,” Dr. Cicero says. “As a result, physicians began to prescribe pain medication abundantly, and some of those opioids ended up in the black market, on the streets.
“This led to a mushrooming of drug abuse among people who wouldn’t typically use opioids,” he says. “People were afraid of drugs like heroin, but they could take prescription opioids with confidence in the ingredients and the dose.”
The second occurrence, Dr. Cicero says, was the development of extended-release opioids. The extended-release oxycodone preparation, for example, contained pure oxycodone vs. previous formulations that had also included acetaminophen. “Addicts soon realized they could crush the pure oxycodone and inhale, or snort, it,” he says. “This created an even greater flood of opiates on the streets for people who use opioids for non-therapeutic purposes.”
Several years ago, however, the government required drug companies to develop an abuse-deterrent preparation that couldn’t be crushed easily and that would be difficult to inject. This diminished the supply of pure oxycodone on the streets and, in turn, increased the price of black-market prescription opioid tablets.
“What does a person do when suddenly cut off from opioids? In many cases, people turned to heroin,”
Dr. Cicero says. “Heroin is very cheap and very powerful, and the dealers are very clever. They moved in aggressively.
“People who had previously shunned heroin turned to it,” he says. “And, over the past few years, people have been switching from prescription drugs to heroin more and more.”
That’s an extremely dangerous trend, Dr. Cicero adds. “A lot of younger people began experimenting, and we’re seeing a lot of deaths,” he says.
Is there a solution?
Dr. Cicero says the solution is two-fold, starting with prevention/education. “Young people, especially, need to be informed,” he says. “A pattern develops from using tobacco and drinking. The younger someone is when they take their first drink or try drugs, the worse their prognosis for the future.”
Better treatment is the second part of the solution. “If people are using drugs, they usually have other problems, such as depression or anxiety,” Dr. Cicero says. “And the withdrawal and cravings can be overwhelming. We need more opiate treatment facilities, and we need to lose the stigma. Like all diseases, we need to treat the disease, not the behavior that led to the disease.
“We could save lives,” he adds. “It’s an immediate problem that needs to be dealt with. The whole population is being affected.”
In the meantime, he hopes the June 9 symposium will shine a light on these issues. “There needs to be recognition of the problem,” he says. “We should do everything we can to educate people.”
And, Dr. Cicero says, it’s important that the news media continue reporting on the problem to keep the issue in the spotlight — even if it’s starting to become “old news” and even if it’s disturbing at times.
The June 9 symposium is free and open to the public and is targeted to hospital and community leaders and those with an interest in the topic. Visit https://opioidepidemicdisparities.eventbrite.com to register or for more information.
More about NAHSE
Founded in 1968, the National Association of Health Services Executives (NAHSE) is a non-profit association of minority health care executives. By the close of 2016 the organization was represented by 29 chapters, 57 institutional members and 1,029 individual members nationally. The St. Louis Chapter of NAHSE has a two-pronged mission:
The re-establishment of the St. Louis Chapter in 2011 was spearheaded by professionals representing BJC HealthCare and Washington University School of Medicine. By the end of 2016, the local chapter had grown to 60 individual members and currently has 10 institutional members, including BJC, Barnes-Jewish Hospital, St. Louis Children’s Hospital, WUSM, Missouri Foundation for Health, Myrtle Hilliard Davis Comprehensive Health Center, St. Louis Regional Health Commission, St. Louis Integrated Health Network, Mercy and SSM Health. All St. Louis Chapter institutional members have a senior leader who sits on the chapter senior advisory council.
The St. Louis Chapter holds annual events that bring health care professionals of varying backgrounds, career levels and organizations together to network and discuss health issues that are unique to the region. “We strive to ensure that our programs and actions are aligned with our two-part mission of increasing diversity in health care administration and addressing health disparities in the St. Louis area,” says current chapter president Carmel Hannah, diversity and inclusion manager for the Barnes-Jewish Hospital Center for Diversity and Cultural Competence. “Our health care administration focus is key. We have to be inclusive in terms of race, experience and thought, because health care leaders should represent who they are serving.”
Some of the chapter’s more prominent annual events are its Health Disparities Symposium, Leadership Symposium, Administrative Fellowship Dinner and Networking socials. “We try to choose topics that everyone’s talking about, but that might need a new perspective,” says Hannah. “We can have an engaging discussion, ask the hard questions — and we hope that people have an open mind and leave with a different understanding of the topic as a whole.
“We also want to connect the conversations and help our audience members with questions such as, ‘How do we move forward?’ or ‘How can I help change this?’” she adds. “It’s important that individuals have a place to start and a way to take action.”
The upcoming Health Disparities Symposium on the opioid epidemic, for example, seeks to address these issues. “It’s time to have this discussion,” Hannah says. “It’s in the papers, it’s on the news. Individuals are taking it all in and wondering, ‘How does this affect me?’ We’re bringing in experts who are doing the work and doing it well.”
Hannah notes that every symposium has been free to attendees, thanks to the support of sponsors such as Washington University School of Medicine and the Missouri Foundation for Health. “We can’t do what we do without the support of our sponsors, our senior advisory council and our institutional members,” she says. “We want to limit barriers so everyone who wants to can attend. We can only do that with sponsors.”
In 2015, the St. Louis Chapter of NAHSE won the Building Block Chapter of the Year Award at the NAHSE National Convention, and to date in 2017, it’s the largest chapter in the nation. Hannah says the chapter has much to be proud of and is continually working to make connections among people.
“We want individuals to feel they have a place here,” she says. “For anyone trying to make a difference, it’s important to look at who’s around you. We surround ourselves with individuals who are just as passionate as we are. It’s a professional organization, but the work we do feels personal.”
To learn more, contact the NAHSE St. Louis Chapter, admin@nahseSTL.com or visit www.nahseSTL.com.
Patty Johnson, email@example.com
Tags : NAHSE
Number of views (1842)/Comments (5)
5/23/2017 5:56 PM
"Like all diseases, we need to treat the disease, not the behavior that led to the disease."
5/24/2017 9:20 AM
Thanks for your comment. If it's possible for you to make it to the symposium, Dr. Cicero will be talking about what he means by that, and he welcomes questions and discussion. The symposium is free.
5/26/2017 2:43 PM
With the problem being so bad why is there no FREE places for people to go to that want help. If you have no insurance your basically out of luck.
5/26/2017 10:10 PM
Do we need to RSVP anywhere?
5/30/2017 10:32 AM
Thanks for asking! To register for this free event, go to https://opioidepidemicdisparities.eventbrite.com