The battle of addiction during the time of novel coronavirus

Mental anguish, idle hands may be recipe for relapse

Posted 4/19/20

Before the world was turned upside down, Arizona was, and still is, in the midst of a longterm fight against opioids --- highly addictive substances that have wrecked havoc on thousands of …

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The battle of addiction during the time of novel coronavirus

Mental anguish, idle hands may be recipe for relapse

Posted

Before the world was turned upside down, Arizona was, and still is, in the midst of a longterm fight against opioids --- highly addictive substances that have wrecked havoc on thousands of lives.

The Arizona Department of Health Services is amongst those taking charge to fight the drugs, while local law officials are seeing the rise of a synthetic type of drug --- which carries a high risk of death.

While much of the American population stays home to do their part in stopping the spread of COVID-19, addiction doesn’t falter in its constant appetite. However, through technology the fight against addiction can continue regardless of a person’s location or situation.

Scottsdale Police Department officials say there is no evidence to suggest overdoses or drug or alcohol use has increased during stay-at-home orders.

But, one addiction specialist says people going through recovery may find this time period more challenging.

From July 15, 2017 through April 9, there have been more than 5,000 suspected opioid deaths, and nearly 40,000 suspected opioid overdoses, numbers from Arizona Department of Health Services show.

Opioids can take the form of prescription drugs, or illegal substances such as heroin. Both types can be deadly.

In Arizona, more than two people die every day from opioid overdoses.

Due to an alarming increase in deaths attributed to opioids, Gov. Doug Ducey declared a state of emergency in June 2017 --- which kicked off the state’s fight against opioids.

Nearly a year after the state of emergency declaration, Gov. Ducey called for an end to the public health emergency, after the completion of emergency response deliverables and the implementation of the Opioid Action Plan and the Arizona Opioid Epidemic Act.

Drug Enforcement Administration Supervisory Special Agent Michael G. Brown says the opioid landscape is changing --- and fentanyl is the culprit of so many overdoses.

“Because of illicit fentanyl on the streets, this is why the rise of overdoses that so many communities have seen. So like Maricopa County, five years ago you might have had 600- to 700-opioid-related overdoses. Now we’re at 1,500-1,800 --- almost 2,000 --- because of the rise of illicit fentanyl,” Mr. Brown said.

“When you look at the opioid market nowadays, it’s heroin and fentanyl. There is not a lot of diverted pharmaceuticals.”

Illicit fentanyl made in a clandestine lab

Mr. Brown has been a DEA agent in Phoenix for about 15 years, and says he witnessed a changing opioid landscape during that time.

The early 2000s is when the pain medication, oxycontin, first hit the streets and 160 milligram pills were being produced --- which was basically heroin in a pill form.

“It was so strong,” Mr. Brown explained. “They had sales men, they would flood these specific areas. That's where you saw the rise of these pill mills. You saw the doctor shopping, doctors selling ‘scripts for cash.’ You would have a doctor set up shop, there would be lines of people outside the door, people from out of state would travel to these places, get these examines that really weren’t examines. They would get these prescriptions and then sell them on the streets.”

Mr. Brown says this system hit states like Ohio, Kentucky and Florida exceptionally hard.

After about 10 years of this happening, legislation and enforcement action took place to dry up the distribution of prescription drugs.

“So, if you look at the landscape now, you really don’t see as many of the diverted pharmaceuticals like we did going back 10, 15 years ago. Because doctors are keen of it, doctors don’t want to lose their licenses. There’s been a ton of prosecutions,” he said.

But now, in the past three to five years, Mr. Brown says, fentanyl has dramatically increased due to the price of methamphetamine.

About 10 years ago, the price of meth was $8,000 per pound --- the price now is about $1,000 per pound.

“Cartels down south are getting squeezed on their profit margins,” Mr. Brown said. “So being the savvy business people they are, they decided to make illicit fentanyl.”

Through clandestine labs in Mexico, illegal fentanyl is being made using a $2,000 precursor chemical from China called 4-ANPP.

“From one kilo they can make half a million of these fentanyl pills,” Mr. Brown said.

The fentanyl pills are being made to look like “M-30s” --- or oxycodone.

“These clandestine labs in Mexico, there’s no scientists there. It’s just a couple of guys they pay to run these labs. So when they make this fentanyl, there’s no quality control,” Mr. Brown. “When they make one batch --- they’re made to look like generic 30 milligram oxycodone pills. They’re sold on the streets here, they’re about $3 per pill. They contain nothing but fentanyl.”

Fentanyl is used in hospital, therapeutic settings as pain medication if someone breaks their leg, Mr. Brown said as an example. It typically is used in microdoses, and one person might get 25 or 50 micrograms.

“These illicit fentanyl pills that are sold on the streets can have as much as like 6,000 micrograms,” Mr. Brown said.

The local DEA agent warns that people who take these fentanyl pills, thinking they’re 30 milligram oxycodone pills, run into a lot of problems.

Drug addicts are smoking or snorting the pills, because you can control how much is ingested.

“That is the No. 1 question I get,” Mr. Brown said. “If the cartel is making this very strong, possibly deadly product, why would they? For them it’s a profit margin --- it’s just business.”

Mr. Brown said these pills are easy to smuggle across the Mexican border because they’re so small, people can walk across the country line with pills strapped to their leg. And, drug dogs typically do not hit on them because they’re odorless.

“Five years ago, DEA in Phoenix seized about 1,000 of these pills. Last year, we seized 2 million,” Mr. Brown said. “They are absolutely everywhere, and they are deadly.”

Mr. Brown said they see every demographic falling victim to fentanyl.

He spends a lot of time giving talks and creating public awareness so people understand that what they think might be one pain pill is actually something far more dangerous.

“To date, we’ve presented in front of about 20,000 kids --- we’re basically trying to hit the kids 9-12 grades to raise awareness of these deadly pills. And, obviously opioid addiction,” Mr. Brown said.

“Before they take anything, really, if it’s not from a trusted source --- like a Walgreens, a CVS, a doctor, your mom and dad --- just pause and think about what could be in there. Because the streets now are not like the streets five and 10 years ago, because of the rise of illicit fentanyl.”

The use of Narcan

Arizona isn’t the only location fighting the opioid epidemic. On April 1, U.S. Attorney Michael Baily announced that more than $163 million in Department of Justice grants is available to help communities address America’s addiction crisis.

“Our nation is facing the difficult challenge of curbing substance addiction, which threatens public safety and is among the Administration’s top domestic priorities,” said Katharine T. Sullivan, principal deputy assistant Attorney General for the Office of Justice Programs. “The Department of Justice is front and center in the fight to meet this challenge. OJP is making historic amounts of grant funding available to ensure that our communities have access to innovative and diverse solutions.”

AzDHS continues to track monthly indicators to measure its progress in addressing the opioid crisis. January 2020 numbers show:

  • 34.7% of individuals with suspected opioid overdoses in prior month received prescription opioids from 10 or more prescribers in the past year.
  • There were 259,070 opioid prescriptions dispensed last month in Arizona.
  • 48.3% of prescribers who prescribed opioids or benzodiazepines have “lookups” in the Controlled Substances Prescription Monitoring Program.

Between 2008-18, data shows prescription and synthetic opioid deaths outnumbered heroin deaths.

Opiate drugs include:

  • Fentanyl
  • Heroin
  • Morphine
  • Hydrocodone
  • Oxycodone

Non-opiate drugs include:

  • Benzodiazepine
  • Cocaine
  • Methamphetamine

If someone is having a drug overdose, a medication called Naloxone, or Narcan, can reverse opioid overdoses. The medication is an opioid antagonist --- meaning that it binds to opioid receptors and can reverse and block the effects of other opioids.

It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications.

Many law enforcement agencies and first responders now carry Narcan with them.

In addition, Dr. Cara Christ, director of the Arizona Department of Health Services, issued a standing order for Naloxone, authorizing any Arizona-licensed pharmacist to dispense Naloxone to any individual.

Data shows, from July 2017 to February 2020, 20,893 Naloxone doses were administered.

At a March public safety citizen forum, Paradise Valley Police Chief Peter Wingert said after Gov. Ducey declared the state of emergency on opioids, there was funding available for officers to carry Narcan in their cars.

“It’s a matter of having the training and having the Narcan available,” Mr. Wingert said. “Each officer is issued two doses of Narcan. I’ll be honest with you, we go to scenes where sometimes it takes four doses to wake them back up. So, yes, we carry it. I know Scottsdale carries it. I think most of the agencies in the Valley do carry it now.”

The Scottsdale Fire Department submits their report to the state of Arizona electronically, so there is not a report to provide on how many doses of Narcan have been administered, officials say.

A records request through the City of Scottsdale did provide data showing from Jan. 1, 2018 to Feb. 25, 2020, there have been 39 incidents involving the Scottsdale Police Department providing Narcan prior to the fire department and EMS arrival.

Mr. Wingert said there’s one Paradise Valley resident who’s life has been saved on two separate occasions using Narcan.

A buddy for sobriety

Licensed marriage and family therapist Paul Brethen says while people are confined to their homes during COVID-19, relapse can be more susceptible to some.

Mr. Brethen is the co-founder of SoberBuddy, a virtual drug and alcohol recovery coach. He started his career in substance recovery over 20 years ago.

During a time where anxiety levels are high, the chances of a trigger leading to relapse is much higher, Mr. Brethen explains.

The average relapse rate for substance use disorders is about 40-60 percent.

When asked if people are more susceptible to increased drug or alcohol use during this long stretch at home, away from friends and family, Mr. Brethen says there is some merit to that thought.

“Let me start from this premise --- there’s some research that came out this year, and they were looking at what emotional trigger --- the most potent trigger --- that people relapse over. It’s the sense of loss,” Mr. Brethen said.

“The loss of a loved one, loss of business, loss of a house or loss of your treatment support system. That in itself puts you at a high risk because you’re depending on the group or treatment or sponsor --- all of a sudden you have this disconnect.”

Mr. Brethen says in this time, people should reconnect. In addition to talking with loved ones, attending virtual 12-step meetings and social media, his company SoberBuddy offers a partner to traverse recovery with.

“This is critical --- there’s a lot of things you can do. We give suggestions. Such as how to plug into live meetings. There’s an app called In the Room that has like 100 live recovery meetings, you can use Zoom. If you’re with a group of people, create that and meet every day online,” he said. “There’s things to do to reconnect. And then dealing with stress, anxiety --- we just did [a challenge] the other day on suicide.”

SoberBuddy, which comes in the form of free emails or an app, gives users challenges every day --- something Mr. Brethen says is a little task with a large impact.

“It’s behavior, something that they do. It’s bite sized --- like schedule your day,” Mr. Brethen said. “From the time you get up in the morning, plan out what you’re going to do until the time you go to bed. When they’re idle, and have a lot of free time, then they are at-risk of fantasizing, dwelling on use, or call up a using friend.”

The drug and alcohol recovery support business has three tracks for people: alcohol, drugs and opioids.

“The thing about treatment, is you kind of have two camps --- drugs and alcohol, and then opioids,” he explained.

“They tend to separate, and right now a lot of our exposure is with the drug and alcohol, and less with the opioid population. Right now, the big concern with medication management is they can’t get to the clinic, like a methadone clinic, to get their dose.”

Drugs such as methadone, suboxone or buprenorphine can be used to curb withdrawal symptoms and cravings for people abusing opioids.

Mr. Brethen explains that regulations have been released, and those who qualify can have “take home doses” for up to a couple of weeks.

“There is some risk in that, in that they could overuse the medication,” Mr. Brethen said. “So they are trying to fill in the gap there --- someone who’s new on methadone, it’s not a good idea to give them that. That’s some of the problems, is getting doses and getting evaluated. So they’re now using more online interviews to try and expedite that.”

Methadone can be used for long-term maintenance therapy. It’s still a powerful opioid, but it can be reduced in a controlled manner that is less likely to produce intense withdrawal symptoms.

Mr. Brethen says these drug medications, although they’re not perfect and some can still be abused, they remove people from the chance of death.

“They don’t have withdrawal experiences, but they’re not getting high --- that helps them to live life normally, even though they’re having to go to the clinic to get their dose every day. Probably the biggest argument is it reduces death, and it gets them out of the illegal activity of trying to keep a habit going, sharing needles, and the spread of AIDS and hepatitis,” Mr. Brethen explained.

“Buprenorphine is really unique in that you take it, and it helps with withdrawals but it has a ceiling. So if you go out and use, it blocks the effects. They are like adjuncts to treatment. It’s really unique with the opioid population, and they’re tough to deal with because of the withdrawal phenomenon.”

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