The Opioid Issue: Part 1

Part One: Dangerous Prescriptions

The opioid crisis seems to hit everyone, everywhere, regardless of socioeconomic class, geography, age, profession, or religious affiliation. Overdosing on drugs, especially opiates and heroin, is now the most common cause of death for Americans under fifty years of age. I spent forty years embroiled in active addiction. It started innocently with a case of beer, but quickly led to marijuana, cocaine, and inhalants. The longer I struggled, the more hopeless I became. Friends stopped calling me or inviting me to parties. Family felt they could no longer trust me given the hundreds of broken promises and countless runs on their medicine cabinets for opiates. Although I was able to stop drinking and taking street drugs in 2008, I battled with benzodiazepines (Xanax, Ativan) and oxycodone for another eight years. I am blessed presently with nearly two years without taking narcotics.

Opiates in Pill Bottles

This epidemic has reached every corner of the United States. This is the first in a series of blog posts regarding opiate addiction in America. This series will address dangers of opiate prescriptions, collateral damage, impact on the nation’s foster care system, homelessness and addiction, troubling developments in drug rehabilitation, addiction and crime, and a Christian response to the crisis.

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Current medical opinion indicates the reason the U.S. is experiencing a disastrous epidemic of opioid abuse can be summed up in two words: pain avoidance. In the 1990s there was a proliferation of health care professionals trying to address the symptom [of pain] and not so much the underlying causes of the pain a person has. In 2015, opioid-related deaths stole the lives of over 33,000 Americans. To put this number into perspective, this outnumbers fatal car crashes and gun deaths during the same year. According to the federal government, in 2016 the nation mourned close to 64,000 deaths from drug overdoses. Two-thirds of those involved the misuse of opioids. Karl Benzio, M.D., a Christian psychiatrist and member of Focus on the Family’s Physicians Resource Council (PRC), fears the toll could reach 80,000 deaths in 2018.

We wouldn’t be here if opioids weren’t so effective. Americans want something for their pain—regardless of whether that pain is physical, mental, or emotional. We live in a psychologically compromised society that is impatient and entitled, whose citizens feel there should be no pain in life. Accordingly, greater demands have been made on providers to eliminate all pain with medication. The problem is—and I know this all too well firsthand—once a patient gets a taste of the relief, some develop a dependence that leads them down a dark path. Ironically, that path leads only to deeper struggles. For some, the exit will only come in the form of fatal overdoses as opioids shut down the body’s ability to breath.

It is time we start helping patients deal with life’s pain and its root causes head-on, rather than masking it through medication.

How it All Began

Chronic Pain The Silent Condition

The current crisis can be traced back nearly forty years. Medical researcher Hershel Jick and graduate student Jane Porter of Boston University Medical Center analyzed data from patients who had been hospitalized there. Close to 12,000 had received at least one dose of a narcotic pain medication during their stay. Of those, Jick and Porter’s analysis found only four had developed a well-documented addiction. Jick sent the findings to the New England Journal of Medicine, who published his analysis as a letter to the editor in 1980. “Despite widespread use of narcotics [sic] drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction,” Jick wrote. Unfortunately, this quote was given far more merit than it deserved. Moreover, the conclusion had not been subjected to peer review.

In 1990, Scientific American called the Jick/Porter research “an extensive study.” About a decade later, Time proclaimed it “a landmark study.” Most significantly, Purdue Pharmaceuticals, maker of the popular narcotic OxyContin, began a promotion asserting less than one percent of patients treated with their time-released opiate medication OxyContin would become addicted. In the 1990s, pain was correlated with a greater probability of a patient having ongoing health issues. So the medical community elevated it to the position of the fifth vital sign along with heart rate, blood pressure, body temperature, and respiratory rate. The medical community, thinking that reducing pain would help long-term patient satisfaction, health and outcomes, started to prescribe more pain meds.

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The ’90s also saw the development of stronger and more effective opioid painkillers. As the decade drew to a close, the opioid epidemic was ignited. It took some time for most of the country to realize the metaphorical fuse had been lit, but the numbers back up this concern. According to the U.S. Department of Health and Human Services (HHS), between 2000 and 2017 opioid prescriptions increased 400 percent. Between 2000 and 2010, misuse involving noncompliance with prescription instructions or using medications prescribed for another person doubled. Now, the results are playing out in heartbreaking fashion nationwide, which are impossible to ignore. Overdose deaths—116 per day, according to federal statistics—are shaking Americans of all incomes, ages, and ethnicity. From the rural back roads of Appalachia (Kentucky, West Virginia) to the urban sprawl of New York and Los Angeles, the epidemic is cutting a path that threatens to leave no family unscathed.

The Blame Game

It’s become quite popular (if not convenient) to lay the blame for the epidemic squarely at the feet of the big pharmaceutical companies. For example, according to an article in the Los Angeles Times in May of this year, more than 350 cities, counties, and states had filed lawsuits against makers and distributors of opioid painkillers. The LA civil action accuses drugmakers and distributors of deceptive marketing aimed at boosting sales, claiming the companies borrowed from the “tobacco industry playbook.” One of the companies most frequently put under scrutiny has been Purdue Pharma, maker of OxyContin.

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In May The New York Times called Purdue “the company that planted the seeds of the opioid epidemic through its aggressive marketing of OxyContin.” The Times article uncovered a disturbing report on OxyContin compiled by the U.S. Department of Justice, which found that Purdue Pharma knew about and concealed significant incidents of abuse of OxyContin in the first years after the drug hit the market in 1996. The article further noted that Purdue Pharma admitted in open court in 2007 that it misrepresented the data regarding OxyContin’s potential for abuse.

Overdose Deaths Not Just Related to Opiate Prescriptions

Government reports have recently stated that today’s increase of fatal opioid-related overdoses is being driven by abuse of heroin and illicit fentanyl. A study prepared by the National Institute on Drug Abuse last September found that overdose deaths from heroin and other drugs laced with fentanyl increased 600 percent between 2002 and 2015. Street dealers have increasingly been cutting their drugs with fentanyl—a particularly dangerous and relatively inexpensive substance 50 to 100 times more powerful than morphine—to boost their profit margins. In most cases, the users don’t even realize they’re buying fentanyl-laced products.

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It is important to note that although many people believe Big Pharma is complicit in fueling the epidemic and should shoulder the loin’s share of the blame, Dr. Benzio sees it differently. “Pharmaceutical companies only make the meds,” Benzio says. “Only about 6 to 8 percent of people who take an opioid will misuse or overuse it in a destructive way. It is the doctors who over-prescribe and a society that is looking for a quick fix and can’t tolerate any discomfort [that’s to blame].”

The Road Ahead

The opiate epidemic may have grown somewhat quietly, but the nation’s attention is riveted to it now and policymakers aren’t sitting still. In 2016, Massachusetts became the first state to limit the duration for painkiller prescriptions at seven days. Since then, more than two dozen other states have also established limits. In my home state of Pennsylvania, Governor Tom Wolf initiated a statewide prescription drug monitoring system to help prevent prescription drug abuse. Of concern is the practice of “doctor shopping,” which involves a patient visiting multiple doctors and emergency departments in search of opioids. Unfortunately, this is something I did quite often while in active addiction. This practice often necessitates filling prescriptions at multiple pharmacies. The governor’s new policy includes the monitoring program, a standing order for naloxone (Narcan, used to reverse the effects of an opiate overdose), a patient non-opioid directive (which allows patients to opt out of opioid pain medicine in advance) a “warm hand-off” where ER attending physicians and other providers can set up a face-to-face introduction between a patient and a substance abuse specialist, and revised prescribing guidelines relative to opiates.

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At the federal level, President Donald Trump declared the opioid crisis a public health emergency in 2017, and formed a commission to fight it. Meanwhile, HHS now has a multi-pronged strategy to get the crisis under control, including getting better data through research and improving prevention, treatment, pain management, and recovery services. The federal crackdown is estimated to cost $13 billion to $18 billion over the next two years. Dr. Benzio believes this is “a good start,” but said providers must resist the urge to automatically jump to the quick fix of narcotics for those in pain. “There are many ways to combat pain through physical therapy and fitness, relaxation, better sleep and nutrition,” says Benzio. It seems likely that we will not get a significant handle on opioid abuse until the core issues that lead people to the drugs are addressed.

The Christian Perspective

W. David Hager, M.D., a member of the PRC, notes three principle root issues in addiction: rejection, abandonment and abuse. Hager has been a facilitator for the Christian program Celebrate Recovery. He said, “Unless we enable [people] to identify their root issue and deal with it first, the rates of relapse are high. When they are able to deal with their root issues by offering forgiveness, making amends, and seeking a personal relationship with Jesus Christ, we find that large numbers are able to enter and maintain sobriety.” That is why the Church has the unique ability to make a difference in combating the opioid crisis.

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“We have to convince faith-based communities to get their hands dirty, to get involved and realize that this is an issue,” Benzio says. He suggests inviting laypeople to develop a working knowledge of dopamine, the brain chemical that provides the pleasure-inducing sensation many who use drugs are seeking. “There is only one [higher] power that can sever synapses in the brain that have been stimulated by a substance to achieve [a certain] dopamine level,” he adds, “and that’s the power of the Holy Spirit.”

Exactly how Christians appropriate the Spirit’s power to take on the opioid crisis will vary from case to case. The point, Benzio and Hager say, is that this needs to become a top-of-mind concern for the Church. But are North American churches up to the mission of addressing opioid use among their members? Pastors are in a unique position to proclaim and demonstrate the Gospel to individuals struggling with addiction. Many are too ashamed to confess an addiction to pain medication. As the opioid crisis deepens, so must the response of the local church. If the Christian church has anything to offer those hurting from drug addiction, it is hope and community. I was only able to break the bondage of addiction over my life through the Power in the Name of Jesus.

Power in the Name of Jesus

Programs such as Narcotics Anonymous and Celebrate Recovery have been extremely effective in changing lives, but it’s not always enough. Addressing the root of addiction is one of the most effective long-term solutions, which for Christians is about the heart. The church must be willing and capable of seeing those struggling with addiction as not merely a program of the church’s community outreach; these individuals are children of a God who loves them no matter their current condition. I believe America’s recovery can find its roots in the local church.

What does love look like? It has the hands to help others. It has the feet to hasten to the poor and needy. It has eyes to see misery and want. It has the ears to hear the sighs and sorrows of men. That’s what love looks like. -St. Augustine

 

 

High-Achieving and Religious Students At-Risk Youth For Substance Abuse?

New research shows high-achieving kids are more likely to drink and use drugs during their teen years and develop addictions by adulthood.

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DO YOU ASSUME THAT since your kid gets good grades and goes to a good school that they’re not drinking or doing drugs? Think again. That’s the takeaway from two new studies suggesting that academically gifted youths are more likely to abuse substances, both as teens and adults. One surveyed 6,000 London students over nine years. Those with the highest test scores at age 11 were more likely to drink alcohol and smoke marijuana in adolescence – and were twice as likely to do so “persistently by age 20.”

Notably, a study taken by Arizona State University (ASU) study found that high school students who were more afraid their parents would punish them were less likely to drink or get high as adults. One professor, Luthar, said her guidance for parents is to start the conversation in middle school, and not to downplay the seriousness of underage or or excessive drinking. She says, “Tell them it only takes one arrest, and all the things they are working for so hard can be derailed.”

BETWEEN 23% AND 40% OF HIGH-ACHIEVING UPPER MIDDLE-CLASS BOYS ARE DIAGNOSED WITH DRUG OR ALCOHOL DEPENDENCE BY AGE 26 ACCORDING TO A STUDY OF NEW ENGLAND HIGH SCHOOL STUDENTS.

The ASU study followed 330 high-achieving high school students from suburban New England schools. It found that their frequency of drunkenness and use of marijuana, stimulants, cocaine, and other drugs was substantially higher than the norm for their peers. By age 26, they were two to three times more likely to have been diagnosed with an addiction.

“The assumption has always been that if there is a group of kids that are at greatest risk of addiction, it is those living in poverty. Our data shows there is another group at great risk here,” says Suniya Luthar, lead author and ASU psychology professor. Luthar suspects pressure to excel at AP courses and extracurricular activities and get into a good college may drive some to self-medicate. While not all students in her study came from wealthy families, the schools were in affluent neighborhoods where access to disposable income makes it easier to purchase fade IDs, alcohol, and drugs.

Parents with high cognitive ability and socioeconomic status also tend to drink more themselves, thereby modeling a relaxed disposition regarding alcohol consumption as a means of reward or a way to unwind after a hard day. Some of these parents take a laissez-faire attitude when they catch their high-achiever child drinking alcohol. Luthar says, “People assume, ‘How bad can it be? She’s still on the honor roll.'”

We all have a basic need to receive positive regard from the important people in our lives (primarily our parents). Those who receive unconditional positive regard early in life are likely to develop unconditional self-regard. That is, they come to recognize their worth as a person, even while concluding that they are not perfect. Such people are in a great position to actualize their positive potential. Unfortunately, some children repeatedly are made to feel that they are not worthy of positive regard. As a result, they acquire conditions of worth; standards that tell them they are lovable and acceptable only when they conform to certain guidelines. Next comes acquiring a distorted view of themselves and their experiences.

Consider the song “Perfect” by Alanis Morissett:

Sometimes is never quite enough;
If you’re flawless, then you’ll win my love.
Don’t forget to win first place,
Don’t forget to keep that smile on your face.

Be a good boy,
Try a little harder,
You’ve got to measure up,
Make me prouder.

How long before you screw it up?
How many times do I have to tell you to hurry up?
With everything I do for you
The least you can do is keep quiet.

Be a good girl,
You’ve gotta try a little harder;
That simply wasn’t good enough
To make us proud.

I’ll live through you,
I’ll make you what I never was;
If you’re the best, then maybe so am I;
Compared to him compared to her,
I’m doing this for your own damn good,
You’ll make up for what I blew;
What’s the problem, why are you crying?

Be a good boy,
Push a little farther now,
That wasn’t fast enough
To make us happy;
We’ll love you just the way you are
If you’re perfect.

23% OF FULL-TIME COLLEGE STUDENTS ABUSE OR ARE DEPENDENT ON DRUGS AND ALCOHOL – THAT’S TWO AND A HALF TIMES THE NATIONAL AVERAGE.

Daily marijuana use is at its highest level among young adults of college age since the early 1980s, with 4.9% of college students reporting daily use, and 12.8% of non-college peers admitting to smoking pot every day. What’s wrong with a little pot smoking? you might ask. There has been a major movement toward legalization of medical marijuana, as well as recreational marijuana, giving the impression that opponents of marijuana are guilty of much ado about nothing. According to a September 2017 study, however, new research suggests that marijuana users may be more likely than non-users to misuse prescription opioids and develop prescription opioid use disorder. The study was conducted by the National Institute on Drug Abuse, part of the National Institutes of Health, in conjunction with Columbia University.

Heavy alcohol use appears to be higher in college students than in non-college peers. Binge drinking (consuming five or more drinks in a row) is practiced by 32.4% of all college students, compared to 28.7 % among those in the same peer group who are not enrolled in college. 40.8% of college students report frequent intoxication (having been drunk) According to Nowinski (1990), a certain degree of rebelliousness develops in the adolescent. This seems to be linked to tension that exists between teens and authority, and reflects the underlying dynamic of individuation. This basic developmental process is the pathway that leads from childhood to adolescence. If it is successful, individuation ends in identity and autonomy. One key dynamic in individuation is the development of willpower. It is important to note that willpower without the ability to plan and delay gratification – this is what the Bible calls temperance or self-control – is dangerous; both are necessary, and teens who develop willpower without self-control are apt to be reckless and to get into trouble. This is especially true of substance abuse.

CONCLUDING REMARKS

Substance abuse has fast become America’s number one health problem. Of primary concern is the opiate epidemic, including misuse and abuse of opioid painkillers, especially OxyContin and Fentanyl, and heroin. The substance abuse problem touches the life of every American child, family, congregation, community, and school, and is no respecter of socioeconomic status or culture. Interestingly, however, the opiate epidemic seems to be primarily hitting the category of white low and middle class males between the ages of 18 and 49. Geographic evaluation of the trend shows an initial explosion from within the Appalachian region. This seems to be due to the prevalence of occupations requiring hard labor, with frequent work-related injuries, and eventual economic collapse secondary to joblessness.

Given the tremendous negative impact of substance abuse, researchers, policy makers and practitioners look to identify factors that protect people from initiating the use of drugs, and help people who have become addicted to recover. A growing body of research suggests that religion is an important protective factor against substance use, and that religion may help people who are trying to recover from substance abuse by helping them find meaning, direction and purpose in life. Given the likely impact clergy can have on their congregation, they should pursue continuing education about the causes, consequences, risks and protective factors for substance abuse. Additionally, clergy and faith-based leaders should take a public stand against the use of drugs that is consistent with their personal and denominational beliefs and values.
I believe clergy and church leaders should identify and use congregation members with training, expertise, and experience in the area of addiction (e.g., social workers, addictions counselors, doctors, nurses, and people in recovery) to educate the congregation and create programs and ministries that address the problem. This is especially important for churches who also operate or are affiliated with a Christian-based school. It is advisable for churches to make space available for prevention activities, as well as for people affected by substance abuse (such as Celebrate Recovery).

 

REFERENCES

Community Commons. (October 27, 2016). “Mapping the Opioid Epidemic in the U.S.” [Web blog article.] Retrieved from: https://www.communitycommons.org/2016/10/mapping-the-opioid-epidemic-in-the-us/

Marshall, L. (October 2017). “Smart, Privileged, and At-Risk.” WebMD. 55.

NIH. (September 26, 2017). “Marijuana Use is Associated With an Increased Risk of Prescription Opioid Misuse and Use Disorders.” National Institute on Drug Abuse. Retrieved from: https://www.drugabuse.gov/news-events/news-releases/2017/09/marijuana-use-associated-increased-risk-prescription-opioid-misuse-use-disorders

Nowinski, J. (1990). Substance Abuse in Adolescents & Young Adults: A Guide to Treatment. New York, NY: W.W. Norton & Co.