By Anthony Mendicino
Unprecedented numbers of drug overdoses have not only grabbed the attention of local officials, but now even Senators and the President are joining the fight – especially in Washington County, one of the hardest hit counties in the country.
The numbers are staggering. According to the Washington County Coroner’s office, there were 13 overdoses in January and February of this year alone. Last year, the Coroner’s office reported 73 drug overdoses, 38 of which were directly related to heroin or another form of opiates. Heroin alone caused 13 deaths in 2015, while alcohol and cocaine only caused two each.
Over the past six months, politicians, law enforcement and rehabilitation specialists have come through the county lamenting the problem. While other insidious drugs like methamphetamine and crack cocaine still exist in the area, heroin has taken over the market. The highly addictive drug has been found in increasingly large numbers throughout not only the county, but the country.
The rush to find a way to curb the epidemic has placed an added focus on available rehabilitation – or the lack thereof – and the roll it plays in perpetuating the scourge.
The problem starts with addiction, then potentially spirals into death, destroying families and countless relationships along the way.
“Any drug drastically impacts the physiology of the brain. You’re infusing it into the brain, so the brain just adjusts to the chemical you’re telling it to adjust to,” said Dr. Rueben Brock, a nationally certified counselor that has been working in the social services since 1998.
How It Starts
As the overdose epidemic continues into this year, it has forced both medical professionals and rehabilitation specialists to rethink how they deal with addiction.
“The substance becomes the way that they deal with pain,” Dr. Brock said. “Once you’ve learned that as a coping skill, it is difficult to unlearn.”
Opiates attach themselves to opioid receptors in the brain and then mimic natural brain opioids, like endorphins and endomorphins, which regulate pain throughout the body.
Opiates are derived from the opium poppy plant, commonly found in Afghanistan. In fact, it is estimated that Afghanistan produces about 90% of the world’s opium plants.
Those plants can then be synthesized down to pill forms like Oxycontin, Vicodin and Percocet.
“The opioid epidemic started years ago when the pharmaceutical company that was marketing Oxycontin marketed it to physicians,” said Holly Martin, Chief Operating Officer of Greenbriar Treatment Center located in Washington County.
“For them it was a very successful marketing effort to family physicians, saying this isn’t as addictive as the Vicodin and the Percocet for the pain, and as family physicians, you aren’t doing enough for the patients.”
At about the same time, the VA system adopted the concept that “pain is the fifth vital sign.” Essentially meaning that when someone goes to the doctor, on top of checking your blood pressure, pulse and your temperature, doctors would also ask about a patient’s pain.
“My dad was in the hospital just a few months ago and I had to walk in through the emergency room to see him and right there is this big flashing billboard thing and it’s like, ‘How did we manage your pain? Let us know,” Martin said.
‘How did we manage your pain’ became a frequently asked question on patient satisfaction surveys.
Martin says that the hospital’s insistence on managing pain can lead directly to abuse, especially with the rise of “pill factories,” places where unethical doctors freely write prescriptions to addicts. Once the addicts run out of pills, they graduate to heroin, a cheaper, more readily available drug on the streets. The addictive quality of heroin has also dramatically increased in recent years.
“We really have to look at the prescribers, that’s huge, these physicians cannot be prescribing pain medicine like this,” Martin said.
“A little bit of pain is okay. Being pain free is not realistic.”
According to Martin, limiting the amount of pain medication that doctors are prescribing is stepping in the right direction, but more needs to be done.
“We also have to look at other alternatives to managing pain rather than doing that (prescribing opioids) first, that’s huge, and having the database, which they are working on.”
The database Martin is referring to is the ABC-MAP Prescription Drug Monitoring Program. The program is a combination of efforts from the Pennsylvania Medical Society (PAMED), Pennsylvania Department of Health (DOH) and other outside stakeholders. The program is aimed at stopping ‘doctor shopping’.
“It is so easy for patients to go from one doctor to the next to get scripts for opioid pain medication,” Martin said.
Trying to Get Treatment
Over-prescribing is not an issue unique to Washington County, but the country as a whole. What makes the county the number one locale for overdoses in the nation is a much more complicated answer.
“Number one, it’s right on the interstate, it’s so easy access to route(s) 79 and 70,” Martin said. “The people who are dealing the drugs and that are bringing them in, they have such quick access to get in and out.”
Martin also points to athletic injuries, especially for young people, as a common path towards addiction.
“There are so many kids that are active and have been for a very long time, well a lot of kids get injuries and they get pain medication, so then as they get older it just continues.”
“I don’t believe it is what people believe it is,” said Dr. Brock. “People go to Washington County because there is a strong recovery community there.”
According to Dr. Brock, this creates a concentration of patients, and when those patients cannot get access to the care they need because of insurance or other obstacles, their body tells them to go back to the drug. This need for the drug, and the fact that it is so readily available in the area couple together creating a concentration of overdoses.
Whatever the answer may be for addicts, access to much needed treatment can introduce another hurdle to recovery.
“If you’re working full-time, you have a great job, then you have this great commercial insurance, right? You’re going to get less treatment, depending on the insurance you have, than someone who has no insurance whatsoever,” Martin said.
According to Martin, managed care at insurance companies is hit or miss. Some patients will think they have proper insurance but the insurance companies can still deny them treatment they need.
“We might get somebody and say, well they’re shooting 20 bags of heroin a day, they overdosed at the hospital last night, they had to revive them, they’ve been using like this for a year, they can’t hold a job, they can’t do anything,” Martin said.
“And they’ll (insurance companies) say, ‘Well they haven’t filled an outpatient so,’ and they’ll deny the patient’s admission.”
According to Martin, this issue with insurance coverage happens somewhat frequently.
Martin added that some insurance companies will only give a patient two or three days of treatment. At Greenbriar, the recommended number of days in treatment to kick an opioid habit is roughly 30.
Martin noted that while insurance companies may say they cover, say seven days of detox and 30 days of treatment, they won’t tell you that they manage that. Meaning that even though someone may think they are covered, the insurance company has the ultimate say over how much treatment will be paid for.
“The patient will get here, we’ll call their insurance and give them vitals. We’ll say they’re sick, their blood pressure is elevated or whatever, and the insurance company will say that they’ll only give them one day,” Martin said.
“That is a huge problem.”
The Role of the Government
On top of insurance issues, the ever-present “War on Drugs” also weighs on patients looking for help.
“We treat addiction like a crime, it’s not even close,” Dr. Brock said.
“It is a disease like any other. We should completely remove the criminal aspect of this stuff.”
The DEA and U.S. Attorney David Hickton have taken a slightly different approach to combating the epidemic.
Southwestern PA region 13 Fusion Center, set up at the end of last year, has become an important resource for law enforcement.
Fusion centers began after 9/11 as a response to domestic terrorism. The centers accumulate, organize and distribute information among law enforcement agencies.
Pittsburgh’s fusion center has increasingly focused on consolidating information on heroin use in the region. The information is aimed at giving law enforcement a quicker response to overdoses and other drug related activity.
Another measure, this time a collaboration with The University of Pittsburgh’s Program Evaluation and Research Unit, established OverdoseFreePA. The website – www.overdosefreepa.pitt.edu – notes that the goal of the project is “to increase community awareness and knowledge of overdose and overdose prevention strategies as well as to support initiatives aimed at decreasing drug overdoses and deaths within the participating counties.”
At the same time, some prosecutors have also begun charging drug dealers when their clients die from their drugs.
Hickton noted earlier this year that law enforcement would give dealers “no quarter” in prosecutions where heroin is involved. He also added that he has directed the FBI and DEA to double down on investigations of drug trafficking.
Both Attorney Hickton and Senator Bob Casey have condemned the epidemic, even prompting Casey to call it a problem “straight from hell.”
But the bottom line, according to both Dr. Brock and Martin, is that there needs to be a multi-platform program to attack the epidemic and its root causes. Meaning, as Dr. Brock said, removing the criminal aspect of the drugs and treating it as a disease.
“You wouldn’t put a diabetic in jail for eating sugar would you?” Dr. Brock said. “That is what we are doing to addicts.”
Also, making sure that addicts can get the help they need regarding insurance companies.
“The longer term programs that are necessary for opioid addicts aren’t covered by insurance,” Martin said. “They’re handcuffing the patients because they can’t get treatment.”
“If we’re going to lock people up for taking drugs, we should be locking them up in treatment centers,” Dr. Brock said.
Anthony Mendicino graduated Point Park University with a Journalism degree in Spring 2016. He has accepted an internship with the Pittsburgh Post-Gazette after graduation.