Update on the Fight against the Opioid Epidemic during 2019

By Kirk Bradford | [email protected]

 Current national trends indicate that each year, more people die of overdoses—the majority of which involve opioid drugs—than died in the entirety of the Vietnam War, the Korean War or any armed conflict since the end of World War II. 

There have been many articles in the news of late regarding the opiate epidemic, for good reason. It is destroying communities, families and people’s lives. Riverton is an example of one city that has taken the numbers at face value and tried to provide tools to aid the fight. 

The City Journals noted that very few Utah cities have gone on the offense like Riverton Mayor Trent Staggs. We asked him why he decided to move ahead of many and start addressing the epidemic in Riverton.

 “I know individuals who have been affected by the opioid epidemic and have seen its devastating impacts in my own city,” he said. “As a mayor, I knew there had to be at least some small part I could play in being part of a solution and try to save lives. After having been introduced to a Utah-based firm that had a revolutionary solution to combat the epidemic, I conducted some of my own due diligence and found it to be a first-of-its-kind product that can destroy expired and unused medications on-site. Knowing that about 80% of addicts and those who die from overdose started using a legally prescribed drug (their own or from a family, friend or other household), we all must do something to limit the supply of drugs that are unused, expired or no longer need to be used as prescribed.”

But why haven’t other cities acted on all the statistics? 

 “I think most of it has to do with education,” he said. “Other city leaders may feel this is a county, state or national issue. However, there are now solutions like NarcX that are available to every city that are rather inexpensive, and having cities exert leadership on the issue can ultimately help save lives.”

When asked about plans for 2020, Staggs said,” We want to continue working with our communications team and other great community partners such as Intermountain Healthcare to raise awareness of the issue and let people know about solutions and actions they can take right now to be part of the solution. I see a more concerted use of the individualized bottles of NarcX that will destroy excess medications on-site in their own homes. In theory, if everyone was able to destroy these medications once no longer being used as prescribed by a physician at their own homes, there would be no need for community kiosks.”

The City Journals spent time speaking with Utah Support Advocates for Recovery Awareness, Medical detox facilities, leaders of multiple recovery groups and dozens of Utah residents recovering from addiction.

Collectively, they provided some understanding of this as a whole. The battles stemming from opiates extends back centuries, beginning 3,400 years ago in Mesopotamia. There is much documented history of the “Opium Wars” between Great Britain and China. China was trying to close its borders to opium being trafficked in, and Great Britain continued to find ways to smuggle it. China lost both of those wars. 

In 1803, German scientist Friedrich Sertürner isolated morphine from opium. Morphine was widely used in the Civil War, and there are estimates that nearly 400,000 soldiers became addicted. In its pure form, morphine is 10 times stronger than opium. According to the Annual Review, there were 0.72 per 1,000 people addicted to opiates in 1842. In 1890, it was 4.6 per 1,000. Compare that to the recent numbers in 2019 of six per 1,000. It begs the question, how did the opiate epidemic happen again?

Scientist began looking for a less addictive form of morphine due to the morphine addiction epidemic. In 1874, an English chemist refined a product from morphine they were excited about because it was intended to be much safer. It was called heroin. Bayer, known for its aspirin, accumulated much of its fortune selling heroin and in the 1890s even marketed it to help children with cough, colds and pain.

Due to these marketing campaigns, heroin addiction skyrocketed in 1900s. In the late 1960s, black tar heroin was being manufactured in Mexico and sent to the U.S. In 1971, President Richard Nixon coined the term “the war on drugs.” For roughly 40 years drugs such as heroin, cocaine and meth were the targeted threat. 

In 2001, the Healthcare Joint Commission rolled out its Pain Management Standards, which helped grow the idea of pain as a "fifth vital sign." It required healthcare providers to ask every patient about their pain, giving the perception at the time was that pain was undertreated.

The promotion and marketing of a new drug thought to be much safer due to its time released formula came about during that trend in using opioids in the treatment of pain called OxyContin. Purdue Pharmaceuticals pursued an “aggressive” campaign to promote the use of opioids in general and OxyContin in particular. In 2001, the company spent $200 million in an array of approaches to market and promote OxyContin.

Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona and California. More than 5,000 physicians, pharmacists and nurses attended these all-expenses-paid symposia, where they were recruited and trained for Purdue's national speaker bureau.

One of the now highly criticized parts Purdue's marketing plan was the use of sophisticated marketing data to influence physicians’ prescribing. According to NLMNIH, “They compiled prescriber profiles on individual physicians—detailing the prescribing patterns of physicians nationwide—in an effort to influence doctors’ prescribing habits. Through these profiles, a drug company can identify the highest and lowest prescribers of particular drugs in a single ZIP code, county, state or the entire country. One of the critical foundations of Purdue's marketing plan for OxyContin was to target the physicians who were the highest prescribers for opioids across the country.” Another large article could be written on it but just a few years later.

Fentanyl started being manufactured and shipped to the U.S. online. It is 50 to 100 times stronger than morphine and is one of the leading killers in the opiate epidemic. In November, a 29-year-old Utah man from Cottonwood heights named Aaron Shamo was convicted in a massive nationwide drug trafficking operation. Many are referring to him as the face of the opiate epidemic in the U.S. 

Shamo and associates in Utah were ordering fentanyl online that would be shipped here to Utah. They would press the fentanyl into pills with a purchased pill press machine and label and sell them all over the nation as different types of prescribed opiate pain pills. 

In speaking to a newly recovering opiate addict in South Jordan, he said just four weeks ago he ordered his last bag of Fentanyl online for $100 dollars. He said, “For $100 bucks and a cell phone to get on the dark web, it’s pretty easy. You get a crypto-currency account and login, and it’s just like shopping on Amazon Prime, minus the free two-day shipping.” He explained it was four or five days to get it or two days if you were willing to pay more for shipping. When asked if there were a lot of those sites, he said, “Not as many as before but probably still 400 or 500 where I went online.”

Laurie Callister spoke with the City Journals; she is a previous ambulance EMT and now registered nurse who works in labor and delivery at Mountain View hospital in Utah County. She has witnessed the opiate epidemic in the form of overdoses, death and delivering infants born into withdrawal symptoms that, “cause extreme pain and discomfort. t’s disheartening to hear their blood-curdling screams and be helpless. I don’t know what the answer is because on the one hand you are so angry, yet locking someone up doesn’t make them any less an addict; it just adds more issues to an already tough problem.”

She explained a trend of pregnant mothers having the highest risk of dying from an overdose if they had a history of addiction. The University of Utah Health program studied the patterns of women from 2005 to 2014 who had been recorded as deceased while either pregnant or within one year of giving birth. Drug-induced deaths were the leading cause of pregnancy-associated death for women in Utah, 77% from opioids.

In this year’s May issue of the journal “Obstetrics & Gynecology,” Dr. Marcela Smid, an assistant professor in U of U Health program and part of its study said, “80%of deaths were in their late postpartum period after mom has finished her last checkup with the obstetrician. We need to really look at fourth trimester (post delivery) care and how to enhance this care, especially women with substance use."

In separate article titled “Deadly Cocktail,” Smid details her experience treating addicted mothers. In one example, she treated a woman who had been in and out of prison and finally became stable taking the medication Suboxone. Methadone is being prescribed less and commonly being replaced with the pharmaceutical buprenorphine. It’s typically prescribed under the name Suboxone or Subutex. It’s a popular medication used to treat people with opioid use disorder.

While still another form of opiates, it contains another ingredient that blocks all other forms of opiates completely. When the woman became pregnant, many doctors recommended she ween off of it as quick as possible. As the doses lowered, the more she began craving heroin. Terrified, she reached out to Smid who said she pleaded with her, “Do not do anything; you are stable on the medication, and it’s the most important thing you can do for you and your child.”

Flash forward two years later, the woman reported that she is still on the same low dose of Suboxone. She has stayed clean and is a stay-at-home mother with her baby. While many providers and patients may view them as drugs they need to be weaned off, Smid disagrees. She believes the treatment helps to stabilize them and leads to the best outcome.

“Addiction has been constructed as a social problem,” Smid said. “Medicine is catching up that it’s truly a life-threatening, chronic medical condition.”

The City Journals sat down and spoke with a clinic that has made a huge impact from a small modern building located in South Jordan. White Tree clinic started in August of 2016 providing outpatient detox and long-term care for almost all types of addictions. It is unique because it is the first and only clinic licensed in the state of Utah to provide detoxification in an outpatient setting as well as being one of the few addictions clinics approved to accept Medicaid. 

The City Journals interviewed the three leading members of their staff. Owner and medical director Charles Canfield explained why the programs process is so successful. 

“It’s specifically designed to meet the needs of the mother, family man and working-class individual that doesn’t have any desire to go inpatient at a hospital,” he said. “Not everyone’s ready to put their life on hold to go check into a facility as they detox. An insurance company doesn’t want to pay $800 to $2,000 a day for detox and treatment either. So, it’s a win-win for both.”

When someone wants to do the program, he or she arrives for the initial setup. The patient must bring a sober companion, spouse, relative or close friend who will be accessible to the person detoxing 24/7 for roughly 30 to 45 days. The patient is trained and provided with take-home monitors for checking blood pressure, pulse rate and blood oxygen levels a few times each day to be recorded. After the first two-hour appointment for the next 30 to 45 days of detox, the patient is required to come once per day for about 20 minutes to meet with a caseworker, nurse and Canfield. Each day, the staff provides a drug screen and checks vitals and gives daily doses of buprenorphine. 

Each day, there are two groups coming in: the detox and long-term care. Throughout a two-hour period, more than a dozen people went from the waiting room to the drug testing bathroom, into a caseworker office, next to a nurse and then finishing by seeing the doctor. Once someone completes detox, he or she is seen once per week yet still sees the three different individuals and receives that much medication. After a month, the patient switches to biweekly care; after 90 days, the person comes in every third week, and after another 90 days, the patient comes in monthly. 

“It’s a gradual transition to get longer periods of medication and accountability,” Canfield said. “It also allows us to start addressing things like depression, bipolar disorder and other underlying mental issues that contributed to the problem. By treating those long term, the success rate gets better and better.” 

Traci Lujan, a nurse practitioner at white tree, compared quitting opiates and quitting smoking. Doctors everywhere were certain nicotine patches and gum would bring the death numbers down tremendously. These did a little but not even close to many professional estimates. 

“This speaks to the need for treatment,” Lujan said. “When you have the addictive ingredient nicotine available in the safe form of a patch or gum and smoking kills roughly 100 people per 100,000 where opioids kill 17.4 per 100,000 here in Utah, you would think it would be a given to quit.”

The assumption is that if the physical desire for nicotine is met, people would quit. They don’t, though, because the underlying causes of addiction go much deeper. Canfield’s son E.L. said, “Buprenorphine treatment it is similar in nature, which is why our recovery program involves a clinical team approach instead of a simple doctor visit. We are able to help someone with addressing the mental, physical and social issues that come with opiate dependence recovery in an ongoing capacity. We want to work with someone long term; in some cases even a year is much too short.” 

Canfield recommends around 18 to 24 months with at least over a year without any slip-ups. 

“Two years is a long enough period to get a solid baseline on how a patient deals with life stressors in recovery,” he said. “Similar to other diseases like cancer, the treatment is based on how severe the problem is. With opioid addiction, we detox and then over a few months, we take into consideration the underlying issues that were masking by the drug use to be able to make a recommendation. After a while together doing some fine tuning, individuals should leave us in a position to self-manage themselves for the rest of their life.”

Drugs known as opioid antagonists are another option for treatment. These drugs do not control withdrawals or cravings but instead block opioid receptors in the brain and stop the high users would normally experience. Naltrexone is a widely used opioid antagonist that can be given via injection every four weeks. 

Rob Hicks, a therapist and staff member said, “Medications play an important part in helping a person with opioid use disorder to stop using, but they shouldn’t be discontinued quickly. Instead, they should be viewed as a part of long-term treatment. Patients should realistically expect to remain taking some form of medication to aid with therapy for the first few years.”

The staff bantered with the analogy that if the brain is viewed as a cucumber and long-term drug use pickles it. Once it becomes a pickle, it doesn’t go back to being a cucumber for an unknown period of time. It’s the common reason they believe to need either mood stabilizers, antidepressants or other medications for long term stabilization and recovery. 

If you are struggling with opioids or know someone who is, White Tree encouraged a call for more information. It is located at 10437 South Jordan Gateway in South Jordan and can be reached by text message at 801-877-0705, by phone at 801-503-9211 or by email at [email protected]. 

If the loved one in your life plans to continue taking opioids, needs to continue taking them or is at a high risk of relapse, Naloxone is an antidote to an opioid overdose. Naloxone rescue kits contains everything that is needed to help reverse the effects of overdose. The Naloxone kits are widely available. You can get them for free at almost every single Salt Lake County library. You can also go to your medical provider to get a prescription almost all medical insurance covers.

USARA’s Evan Done said the opioid epidemic will continue evolving. 

“Those extra pills, if you aren’t using them, remove the temptation and destroy them properly by dropping them off at a drop-off location,” he said. You can also receive NarcX or Dispose Rx from the health department. Walgreens, CVS and Riverton City Hall have a medication disposal box with NarcX. 

The current trend seems to be prescriptions and then moving to heroin, and now at the end of 2019. More people are learning how to move on to concentrated fentanyl, with new FBI reports documenting the sale of the even more concentrated Carfentanil. Overdose deaths related to fentanyl increased by 54% in Utah between 2014 and 2018, according to the Utah Drug Monitoring Initiative. The lethal dose of fentanyl is small enough to fit in Abraham Lincoln’s ear on a penny and the lethal dose of Carfentanil is about the size of one of his teeth on a penny. 

If you aren’t sure about your prescriptions, speaking with your pharmacist will allow you to know if any of your medication contains opiates. Experts say to try and use non-narcotic pain relief medication for yourself and family whenever possible. Ask your doctor for other options may result in a little more short-term pain, but it may certainly avoid long-term life-changing requirements. 

One patient at White Tree Clinic said, “If I had known a 10-day supply of pain pills following the removal of my wisdom teeth would have resulted in everything I have been through, I would encourage any parent to allow their children to feel some pain. Going through a little pain isn’t going to kill you, but an addiction to those pills just might though.”