by Mark Schenker
It is only 9.4 miles from the cobblestoned streets of Chestnut Hill to the urban nightmare of Kensington and Allegheny, the local center of the opiate crisis. The images and stories of addiction on our streets are horrifying and tragic, and yet seem so far away from us. Unfortunately, addiction is a lot closer than Kensington.
The opiate crisis has grabbed the nation’s attention – justifiably so. In 2016 there were 64,000 drug-related deaths in the US, about 33,000 of them from opiates; more recent estimates put the 2017 death toll at 72,000. Pennsylvania alone saw a 37 percent rise in the rate of overdoses between 2015 and 2016. About 13 people die of an overdose in Pennsylvania daily, and, in 2017, there were more than 1,200 overdose deaths in Philadelphia, four times the murder rate.
Interestingly, a person who dies from opiates is likely to be a white (over 60 percent) male (nearly 60 percent). The modal age range is 4554. And in the last two years, at least 17 opiate deaths occurred among residents of Chestnut Hill or Mt. Airy. The opiate crisis may not be as far away as we think.
The current opiate crisis has multiple determinants. The pharmaceutical industry has been implicated, and in 2007 Purdue Pharma, the manufacturer of OxyContin, was fined $635 million for fraud, having marketed this medication as safe from addiction. Around the same time, the medical profession began stressing the importance of monitoring and treating pain in patients, and pain became the “fifth vital sign” of medical assessment.
The intersection of these two factors introduced many people to addictive opiate medications, creating dependency. For many, this eventually led to a switch to a cheaper substance: heroin. Other factors include the introduction of cheaper “black tar” heroin from Mexico, the more recent substitution of the highly potent synthetic opiate fentanyl for heroin, the reluctance of some insurance companies to provide more comprehensive, but costly, alternatives to the use of opiate medications, and a society which is increasingly alienated, with a search for the “quick fix.”
Several treatments are available for opiate dependence. The traditional approach has been abstinence-oriented, utilizing mutual support programs such as Narcotics Anonymous or, more recently, SMART Recovery. This has been tremendously effective for a huge number of addicted individuals and remains widely available.
The primary alternative has been what is known as “Medication Assisted Treatment” (MAT). The 1970’s saw the introduction of Methadone Maintenance, substituting methadone (a “weaker” opiate) for use of heroin or other “street” opiates. More recently a significant advance has been found in Buprenorphine (trade name Suboxone or Subutex) a medication, which satisfies the body’s craving for opiates and which wards off the pain of withdrawal.
One of the critiques of the use of Buprenorphine is that it does not address the underlying lifestyle and personality issues manifested by those with the disorder. Nevertheless, when used properly these have dramatically reduced opiate death rates.
Despite these appalling statistics and the human tragedy, we must be careful to put the impact of opiate addiction in perspective. The rate of cocaine addiction and deaths is on the rise, methamphetamine is having resurgence, and benzodiazepines such as Xanax are implicated in many of the deaths attributed to opiates (and vice versa).
Above all, deaths from alcohol and tobacco dwarf the number of deaths from all other drugs. In contrast to 33,000 annual opiate deaths, more than 88,000 die annually from alcohol-related causes. Alcohol is also implicated in a spectrum of social ills, including motor vehicle accidents, domestic abuse, and lost productivity. It would be an ironic secondary tragedy if our focus on the current opiate epidemic allowed us to turn a blind eye to the addictions which are much closer and more devastating than the opiate crisis. Again, addiction may be closer than we think.
The treatment of alcohol problems is complicated – not all drinking problems are due to “alcoholism.” A person with occasional bouts of excessive drinking does not require the same interventions as an end-stage alcoholic. There are now a range of available options, including moderation management, use of anti-craving medications, 12-Step programs, and addiction psychotherapy.
No one pathway works for all people, and it requires experience and sophistication to assess a person presenting with substance-related problems and to develop an effective recovery plan. Treatment options range from outpatient counseling or referral to AA, all the way through referral to residential treatment (e.g., “rehab”).
What may be the most important takeaway is the fact that recovery from both opiates and alcohol is possible, and in fact happens more often than most people realize. While opiate relapse rates are quite high without treatment, in general relapse rates are equivalent to other chronic diseases such as diabetes or asthma. The old saw that one must “hit bottom” in order to recover is now recognized as a myth – recovery is possible from any point, beginning with the realization that the use of alcohol or drugs has become problematic.
There are many warning signs of unmanageability – frequent conflict with friends and family; problems with work and productivity; spending too much money and time in the pursuit of using; craving or preoccupation with drinking or drug use, presence of withdrawal symptoms (e.g., having “the shakes” after a night of drinking), failed efforts to quit or cut down and continued use despite negative consequences.
Whether you have a problem yourself, or are dealing with a family member’s addiction, help is available, and sooner is better than later. Don’t let embarrassment or guilt deter you from taking care of yourself. You have a better life to live.
Mark Schenker, Ph.D. is a licensed psychologist in Chestnut Hill, with a practice focusing on addressing substance use disorders. His phone number is 215-264-5412.