By: Marcus J. Hopkins, Blogger
National Public Radio (NPR) has begun a new series, Embedded, wherein reporter Kelly McEvers embeds herself within various communities to find out the deeper story. In her most recent segment, The House, she embeds herself in Austin, Indiana, ones of the towns at the center of the 2015 Scott County HIV and HCV outbreak.
In this story, McEvers goes into a house and interviews a number of Injection Drug Users (IDUs), all of whom are addicted to Opana (Endo Pharmaceuicals), a relatively new prescription opioid drugs that is stronger than OxyContin (Purdue Pharmaceuticals). Opana was designed to be a time-released drug, but users quickly discovered that it could be abused by crushing the pills and snorting them, for faster, more immediately powerful effects. In 2012, Endo reformulated the drug to make it much harder to break up, but, as with all addicted people, they will find a way around that roadblock: they learned how to cook the drug down into liquid form for injection purposes.
With state and Federal governments cracking down on the distribution of prescription opioids, addicts begin to turn to street sources – drug dealers whose sources or products may or may not be good quality. At essentially $140/pill on the street, many addicts struggle to find the money to pay for their addiction. When McEvers asked why Jeff, her first interview, didn’t just turn to heroin, because it was cheaper and easier to find, Jeff informed her that Opana is simply stronger; better; cleaner.
What McEvers discovers is that, regardless of the “abuse-deterrent” label Opana carries, it’s relatively easy to abuse. In the process of her interviews, McEvers discovers just how easy the process is, as her subject, Joy – a former nurse – demonstrates for her how to use (read: abuse) Opana. Joy says that, though she started taking the pills by mouth, in February of this year, she began injecting the drugs. As a former nurse, she doesn’t share needles, but that she carries such abject shame as a result of her drug use, it makes her want to cry.
This is one of the most difficult aspects of addiction, for many IDUs – the shame that comes along with knowing you’re risking your health and safety. Joy, specifically, expresses hope that she can escape her addiction; she’s made an appointment with a doctor who can prescribe Suboxone (Invidior, Inc.) on an outpatient basis. Suboxone is a combination of buprenorpine and naloxone, and is classified as a partial opioid and can be used to treat addiction.
Another subject, Devon, admits to sharing needles to inject Opana, as well as admitting that he did not begin using the drug legally, but because people around him were using it. When asked about the recent HIV epidemic, he says that nobody knew that there was HIV in the area. McEvers interjects that, after the AIDS epidemic of the 1980s, everyone just sort of “knew” not to share needles; Devon disagrees. He tells her that clean needles were hard to come by; that drug dealers offered clean needles, but few people wanted to pony up the extra cash for clean needles.
These admissions represent a stark reality – that, despite nearly forty years of HIV being in the news, people living in rural and suburban communities seem to labor under the belief that the problem exists in their area. Both Devon and his girlfriend, Samantha, have tested HIV-Positive, and are either too ambivalent about or too preoccupied with their addictions to seek treatment.
What’s interesting, to me, about these situations is that McEvers, when meeting the town’s lone full-time practitioner, is told that once IDUs begin using Opana (or any other injectable opioid drug), their brain chemistry changes. Once they’ve used Opana, they become dependent upon it from a biological standpoint, and asking of addicts, “Why haven’t/don’t/can’t you just quit,” is an unfair request. Expecting someone to quit opioid drugs on their own, without medicated assistance, is a monumental, timely, and potentially devastating process. Withdrawal from Opana, other prescription opioids, and heroin is truly an awful, gut wrenching process, and without that medicated assistance, both relapse and failure to successfully complete a recovery scenario become exponentially more likely.
It is this key component that is currently absent from many states’ approaches to drug addiction. Though it may be difficult to operate from a position of empathy and understanding of addiction, simply expecting IDUs and other addicts to “recover” without wraparound support services has created a culture in which it’s simply easier to give up on recovery and learn to do without certain comforts in order to maintain one’s high. In my own experience with methamphetamine, I once spent over a month in the middle of the summer in Atlanta without electricity or hot water, because it was easier that way to afford both rent and meth.
As with Joy, I felt a great sense of shame over my actions, knowing that, with having HIV, smoking meth could potentially kill me in a variety of ways, not the least of which being the compromising of my immune system. Because accelerants were.to seek treatmebtvalent or too preoccupied with their addicitionsdealers offered clean neddles drugs of choice, I never personally found the idea of opioids being “for me;” as such, I cannot even begin to imagine the grip those drugs have on their users. I can, however, use my own experiences to temper my reactions and efforts when working with prescription opioid and heroin addicts; I come to the table with a level of understand that legislators do not (or do not openly) share, though they are the ones responsible for crafting and codifying programs and legislative efforts designed to take on drug addiction.
This is why programs and services that focus on patient input – saying what actually works, for them, on the ground – rather than simple edicts handed down from inexperienced government officials with little or no first-hand knowledge of addition, are so vitally important. While there are lights at the ends of certain states’ drug addiction tunnels, we still have a long way to go with incorporating the patient voice into legislative action, and hopefully, we’ll soon be able to sport multiple programs that are proven effective, because they litstened to patients.
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.