It’s in the headlines: A state health crisis. A national health crisis the White House recently said cost half a trillion dollars in 2015. It confounds communities. It’s a disease that leads to crimes: of opportunity, of hope, and of despair. It’s a disease that captures those in high places and low.
It’s a subject that cries out for the humanities. As we’ve seen so often, the humanities are what help us understand and make relevant the impact of current events on human lives. Understanding can help us heal.
Too often, the discussion of the opioid crisis is expressed in terms of statistics. Like how drug-related deaths have doubled in Wisconsin and as of October last year, 277 people died of overdose in Milwaukee County alone. This doesn’t count the number caught in time with Narcan, used to stop the effects of an overdose. In 2014, the Department of Health Services reported an average of 66 administrations of Naloxone per 100,000 population in the state.
People become numbers. They become dollar signs. We lose sight of understanding this crisis as a human crisis.
In September, the WHC joined Madison’s The Capital Times to host a facilitated discussion during the paper’s inaugural two-day Idea Fest. The discussion followed a panel that included Rep. John Nygren R-Marinette, and Sen. Janet Bewley D-Mason, Wisconsin Voices for Recovery Director Caroline Miller and Rise Together Project Manager Nadine Machkovech, who talked about what Wisconsin’s road to recovery from the opioid crisis might be. We wanted to give participants an opportunity to share their own stories and maybe learn something from each other.
We didn’t know what to expect.
There were tears. There was anger. There were many ideas, and gallows humor. People engaged in exercises of hope in the face of devastating heartbreak in their families, among their friends or in their professional work. Some had insights about how a loved one became addicted. Others offered recommendations for making approaches to prevention and recovery more effective.
This was something new for WHC
Staff underwent facilitation training and studied details of the opioid crisis. We still weren’t really prepared for the moment when the numbers became humans. We all have our examples: a loved one, a neighbor, a particularly tragic case. But each story is individual. The stories have an impact – hearing them, sharing them, becoming invested in them – as strangers share with strangers some of the most life altering and gut-wrenching moments they may ever have faced. This problem is everyone’s problem and for many, the need to learn more, to share stories, to do something was palpable.
The humanities help us see that their stories are also our stories.
That opioid addiction is a problem in America, and that governments have struggled to find solutions for it, isn’t new. In 2006, National Institutes for Health researchers reported to Congress increased abuse of prescription drugs like OxyContin by children, as scientists sounded an alarm at the rapid increase in prescriptions of hydrocodone and oxycodone.
People have also been pointing fingers for years. In the 2006 testimony, scientists blamed a confluence of factors including increasing prescription rates, greater drug availability, aggressive pharmaceutical marketing and the easy access to illegal internet pharmacies. For example, a Pulitzer award winning report from Eric Eyre of the Charleston (West Virginia) Gazette Mail noted that drug companies distributed more than 9 million hydrocodone pills to one pharmacy in a town of 400 people. More than 750 million pills flooded the state in 6 years, enough for 433 pills for every single person in the state.
Some have argued, including people at our facilitated discussion, that the only reason we are talking about opioid addiction today is because it’s no longer solely an inner city crime in marginalized neighborhoods, but one that strains under-funded rural communities that are predominantly white, and that snares the children of the wealthy and well-positioned as often as it guts poor families.
Rep. Nygren understands this issue all too well, with his family’s personal tragedy making headlines as his daughter battles addiction and faces charges for alleged involvement in a fatal overdose. He argued that looking backward to blame just deflects from the important recognition, now, that something must be done. He’s posed more than 20 measures in the state Legislature to target the problem.
Yet nothing has done the job. And after 40 years of PSAs, new calls for education campaigns can feel frustrating.
While the ultimate cost may be in deaths, needle sharing has increased disease transmission dramatically, according to state data. Then there are the societal costs in hospitalization and treatment, lost jobs, and criminal records that prevent recovering addicts from obtaining jobs or housing.
And families torn apart.
We didn’t want our discussion about this important social issue in Wisconsin to simply end when our discussion ended. And neither did many of the participants. With Nygren and Bewley in the audience, participants wanted to be sure the lawmakers heard them. Some wanted more newspaper reporting to uncover the issues. Many wanted to continue the conversations, which were as diverse as the people who populated each table.
Below is a synthesis of the discussions. A full set of notes and participant comments were shared with all the participants who provided us contact information, including the legislators, and The Capital Times.
Note takers had different approaches to reporting the conversations. There were three guiding questions: what brought people to the discussion, reactions to the panel, and what can communities do to address the issue of opioids. Please note: assertions and opinions expressed are those of the individuals; WHC did not fact check any claims.
ASSESSMENT and TREATMENT
- A serious lack of data exists on outcomes of treatment and legal hurtles to following patients and tracking recovery.
- Silos of professional services are not working together and when coaches/peers are in the mix they can be sending conflicting messages.
- Consider a team approach. The ACT model used in mental health for approaching a patient’s entire life needs to be applied to addiction.
- Voices of families who have lost children and have insights into their addictions are being ignored by agencies and the Governor’s task force. This is data that could be useful for understanding the problem.
- The whole person must be treated (e.g. housing, mental health, physical health, sense of wellbeing (spirituality/community)) and communication with family members critical to the individual’s recovery, such as children in protective services.
- Peer/community support is necessary to recovery.
- People need to be met where they are, not forced to travel for services. Community based programs can be a central hub and reach people more effectively and create high engagement for education. There are access issues for transportation and getting off work, even in urban areas.
- Need a “No Wrong Door” policy for treatment so that people can go to the county they are in for treatment.
- Priority shouldn’t be on the least expensive approach, it should be on the most effective.
- If treatment doesn’t address the problems that led to the addiction (e.g. poverty, mental health), there’s a risk of relapse.
- Concerns about cost of health care to individuals, including those on minimum wage or who lack local treatment opportunities.
- Support for engineering solutions such as apps to help addicts with recovery and systems engineering to help connect various programs.
PREVENTION and EDUCATION
- There are many factors, but advertising of drugs and overprescribing are contributors.
- Pharmaceutical industry should be asked to counter the advertising to explain how addictive many of these substances are.
- There needs to be community education to erase stigma. Need education in schools, not only in the evening, for prevention. Need education for how to appropriately respond to an addict.
- Need to engage addicts in education: how they got into it, experiences with treatment –this information needs to be shared.
- Can’t keep ignoring alcohol as part of the addiction issue. Cultural acceptance of inebriation or “a pill for everything” as gateways?
- Why isn’t the medical and mental health community a part of these discussions?
- Costs associated with participating in this kind of discussion leads to missing perspectives.
- There need to be more public discussions; it shouldn’t be a matter of privilege (cost to attend).
- Need an in-depth series of news stories on the issue covering the cost of the epidemic (to communities), prevention, and treatment
- Pharmaceutical companies need to take responsibility and be held accountable. Concern about lobbying preventing appropriate oversight.
- Concerns about drug testing: job screening, Medicaid screening for drugs; Disagreements over drug testing range from no testing should be allowed (can’t get a job adds to the problem) to only for jobs with a risk of harm to others (e.g. driving under the influence).
- Concerns about prison as a disincentive/control. Concerns about for-profit prisons that are getting kickbacks for incarceration like doctors getting kickbacks for prescriptions; stigma of incarceration adds to addiction stigma. Are inmates receiving appropriate treatment?
- Alternative pain killers? There are people with chronic pain. Alternatives that are less addictive should be promoted E.g. medical marijuana, less addictive (more expensive) painkillers.