Wednesday, January 4, 2017 / The Statement
4B
Wednesday, January 4, 201 / The Statement
5B

The personal
and painful
of the opioid
epidemic

M

onths ago, when I was assigned
a story on the opioid epidemic,
I was confronted with an

entirely foreign concept: I didn’t even know
if opioids were injected or ingested. And
this was an epidemic? I couldn’t begin to
understand how overdose deaths could be
happening in my community.

On
November
23,
I
attended
a

community-wide event at St. Joseph Mercy
Hospital in Ann Arbor that addressed the
opioid epidemic and how to fight it, hosted
by the Ypsilanti based addiction non-profit
Dawn Farm.

From my aisle seat, I watched the

auditorium fill with Ann Arbor and
Ypsilanti residents, college students and a
few families with younger kids. I watched
intently, ready to scribble notes on trends
in age groups, gender, appearance, or race.
To my surprise, none of the categories
followed a specific trend — there were
no similarities among the people I saw
whatsoever.

I was struck. There were people from all

walks of life who were dealing with an issue
in my community I hardly knew existed.

What I found was that in 2014, within

Washtenaw County alone, there were
65 reported opioid deaths according to
the Washtenaw Health Initiative Opioid
Project. Across the US, there are 78 deaths
from opioid overdoses a day, putting the
country at an all time high for opioid
overdose deaths. This wasn’t another story
which could be shoved aside for a later read,
but something happening right now.

Opiates are a family of drugs for treating

pain and affecting emotions. Common types
include morphine, heroin, hydrocodone,
and oxycodone, all of which are addictive.
Opiates are commonly prescribed for
suppressing pain after surgery, trauma, and
various injuries.

At the event, I learned of the dramatic

rise in opioid-related deaths in 2014, which
spiked nationwide efforts to reduce this
number, creating with initiatives such as the
WHI Opioid Project and other public health
models specific to overdose prevention
and resuscitation after overdose. In some
ways, it’s working. In 2015, there was a 25
percent decrease in opioid overdose deaths
in Washtenaw County.

The
numbers
may
have
decreased,

but forty-nine deaths is still an all too
significant number.

The forum, and conversations I would

later have with a number of its speakers,
informed me of how Washtenaw County
is currently responding to the problem.
WHI’s new public health-based model
has raised local awareness for a national
crisis, sparking community action among
the police force, healthcare administrators,
and overdose subject bystanders, who often
play a critical role as first responders,
saving lives. Saving lives is the goal: since
August of 2015, more than 96 Washtenaw
County police officers have been trained
in the administration of naloxone, an
opioid overdose reversal drug. And there

have also been community classes on
naloxone use, and the medication can now
be co-prescribed to family and friends who
are concerned of loved ones overdosing, so
911 isn’t the only way to keep victims alive.

What was most surprising to me as

a pre-health student was how little I
knew about this prevalent problem, often
rooted in the health industry, which was
not only affecting the country as a whole
but rampant in the community I lived
in. Emotionally, the issue is comparably
devastating to alcohol overdose or suicide.
A death is a death. But I never encountered
any information — no pamphlets, no emails
— about the issue beforehand. For such a
crisis, I was totally unprepared.

One of the speakers, Ashton Marr, is

an Ann Arbor resident who has been in
recovery for 12 years. When she was 19, she
was prescribed Vicodin after an emergency
appendectomy and from this introduction,
her life began to spiral around opiates.

She sat in front of the auditorium with

her purple Mohawk and matching color
parka, among a panel of physicians, nurses,
police officers, and other recoverers. When
one of the audience members asked if the
availability of an overdose counteractive
drug would make opiate users likely to
overdose just to be resuscitated, creating
a false sense of security, Ashton shook
her head. The row of silver hoops on her
earlobes reflected against the spotlight,
sending shards of light through the
auditorium. When she spoke her voice was
deep, but melodic.

“From my own experience in going

through addiction, that thought never
crossed my mind once and that certainly
wasn’t the goal either. If naloxone knocks
the opioids off of opioid receptors, then
you eventually become dope-sick and that
certainly wasn’t the goal,” she said. Opioid
and heroin withdrawal symptoms are often
referred to as “dope sick,” which urges the
abuser to continue drug administration to
combat discomfort. The symptoms include
depression, anxiety, intense cramping,
bone and muscle pain, involuntary leg
movements, cold flashes, among others.
“I was trying to tread the line between
life and death, I wouldn’t want naloxone
administered.”

Since her introduction to opiates after

surgery, Ashton said the intense craving
for more frequent and larger doses, a bigger
and better high, began to consume her. As
she entered community college, she isolated
herself from her family and friends, mostly
living from her car, miserable and ashamed:
“It was like it just took over my life and
my mind, and I really was up and running
with opioids. I truly believed I was the only
heroin addict in Ann Arbor.”

The chase for the ultimate high, the brink

between the conscious and unconscious
seems to be a mutual driver for continued
users, and often the direct reason for
overdose. And more surprisingly, the
other common intersection between users
and overdose survivors is the beginning

of their addictive trends. The majority of
opioid addiction start from a sports injury
or general surgery where opiates are
prescribed to alleviate immediate pain.
The patient never gets weaned off the
medication properly, instead developing a
dependence on pain suppressors.

Another speaker at the panel, Stephen

Strobbe, is a practicing nurse and founder
of the WHI Opioid Project. Throughout
the talk, he suspected a fundamental issue
in the prescription system to be a leading
cause for excess prescription and eventual
drug misuse. According to Strobbe, there
are enough written opioid prescriptions
for each adult in the United States to have
a bottle for themselves. When I mentioned
I was a pre-health student at the University
during our phone interview the morning
of the panel, Strobbe said he would stay
after the event to answer all questions –
going above and beyond from personal
to research to data-based inquiries – to
spread awareness on the opioid epidemic.
During our conversation, he reaffirmed
the absence of stereotypes in the epidemic.
There is no “type” for opioid users who
experience addiction and overdose, besides
being prescribed a medication, failing to be
weaned off and then suddenly being in the
middle a downwards spiral, often with no
knowledge of who to go to for help.

Marr raised similar concerns on the

prescribing behavior of physicians. After
the forum, we sat in two corner seats of
the empty auditorium. Like Strobbe, she
offered to give any information to increase
the public knowledge on the epidemic and
its severity. “I’ve heard time and time again
that it’s easier to write the prescription,
as opposed to getting into conflict with
somebody or fighting about it,” she said.
“But the fact of the matter is they have
the hand in the individual’s death if they
let the addiction spiral. Doctors are in a
position where they need to do no harm and
give care to people, so it’s important that
they understand how to treat addiction,
recovery-related resources, how to safely
prescribe to people, and how to treat pain.”

The physician-patient relationship plays a

vital role in continuation or discontinuation
of medication following a painful event, and
the doctor’s choices can be the rate-limiting
step to the addiction narrative. A majority,
if not all, practicing physicians will at some
point prescribe pain medications to their
patients. One of the seeds to the epidemic
could be immediately addressed in the
hospital, but also the medical schools and
undergraduate populations who will be the
next prescribers within five to ten years.
However, it may also be worth opening a
discussion how much responsibility the
doctor has over the patient. It cannot
entirely be the doctor’s fault if the patient
decides to misuse their prescribed dose,
and the doctor cannot always neglect the
patient of pain medication to alleviate their
symptoms. These ethical questions do not
have a simple answer to solve the problem.

So clearly I never pictured a reality where

opioid addiction and overdose death was
something real and proximal, something
that could affect my relatives, family or
friends.

A
majority,
if
not
all
practicing

physicians will at some point prescribe pain
medications to their patients. One of the
roots of the epidemic could be immediately
addressed in the hospital, certainly, but
also in the medical schools and even
undergraduate programs, whose students
will be the next prescribers within five to
ten years. But it may also be worth opening
a discussion of how much responsibility
the doctor has over the patient. It cannot
entirely be the doctor’s fault if the patient
decides to misuse their prescribed dose,
and the doctor cannot always refuse the
patient pain medication to alleviate their
symptoms — in many cases it is necessary.
These ethical questions do not have a
simple solutions.

Strobbe
said
another
common

intersection between users and overdose
survivors is the beginning of their addiction.
The majority of opioid addictions start
from a sports injury or general surgery,
when opiates are prescribed to alleviate
immediate pain and the patient never
gets weaned off the medication properly,
instead developing a dependence on pain
suppressors.

In light of all of this, I picture my best

friend. I picture her brown ringlets of
effortless curls falling down her shoulders
and the black-rimmed glasses she wears
that rest on her cheeks. The studious one
of all of us, who has (maybe) gotten one B
in college, organizes all of our volunteer
events for the fraternity, and laughs five
times more often than she frowns.

I never realized that she dealt with this

crisis first hand. Again, an epidemic so
widespread was lost to me.

This makes me sift through my entire

memory since the day I met her, the things
we talked about, the secrets we shared. It
never occurred to me that her own sister
was a victim of this crisis. That she was a
part of this silenced group, when she was so
present in my life.

I told my best friend about this article,

and I asked her about the issue at hand: the
pain which leads people across the country,
across the world, to opioid addiction.

“I’ve really never thought about it before.

I guess it’s different for everyone, like the
origin of it,” she said. “But it’s the twisting
torment, that’s builds up in your stomach
and leaks into your heart and head and eyes
until it’s all you feel, see and think about.
It lays dormant until you think it’s gone, or
at least a little less, and then a tidal wave
of emotions hit and it’s like, you’re there
again, at the very first moment you felt it.
It’s always with you. I think we just learn
how to control it, regardless of its love or
loss or whatever else it stems from.”

You can’t tell me Tylenol will take that

away.

What
Pains
Me:

b yYo s h i k o I w a i

D e p u t y M a g a z i n e E d i t o r