Opioid epidemic in the spotlight at AFN
The opioid epidemic is ravaging the state. Last year alone, it claimed the lives of 96 residents who overdosed on the drugs. There's no part of the state it hasn't touched, including the North Slope and Northwest Arctic.
"When we use the term 'epidemic,' it generally is for something that has increased, and when we look at deaths due to opioid overdose, it's now fourfold higher than what it was 20 years ago," said Alaska's Chief Medical Officer Dr. Jay Butler.
This public health crisis, its origins and ideas for moving forward from it were the subject of a panel discussion at the recent Alaska Federation of Natives Convention in Anchorage.
"When I think about how this has changed over the past 20 years, I think about what my daughter said to me. She said when she was a teenager growing up in Anchorage, she'd never even heard of the concept of sticking yourself with a needle to administer drugs until she was basically graduating from high school. But, her six-year-old son, my grandson, already can name somebody who has died of a heroin overdose," said Butler, who was one of the panelists. "I think that shows how prevalent this problem has become."
Butler explained the origins of the epidemic to the convention audience, saying he's seen it change and evolve over time.
"The first wave of this tsunami came in after a shift occurred that we didn't even feel because it was so far out in the ocean, and that was when, in medicine, we began to change how we managed pain and how we prescribed opioid painkillers," said Butler. "And when you look at this fourfold rise in overdose deaths, it was accompanied by a fourfold rise in the prescribing."
Fueled, in some cases, by effective marketing and lobbying by pharmaceutical companies, doctors began prescribing more opioid painkillers. More pills went into communities, legally.
"This began to create a vicious cycle," he said.
This shift wasn't even grounded in science, Butler explained, saying there was no comparable drop in pain to the rise in pills.
"We know that about 80 percent of people who use heroin nowadays started their opioid use with prescription painkillers," he said. "That's the opposite of what it was some 40 years ago."
The second wave of the epidemic came around 2010, he said, when there was a large influx of heroin into the United States.
Then, fentanyl hit the market in the third wave. It's extremely potent and has been on the rise in Alaska as a cause of overdose.
"The good news is we are starting to see some declines in the numbers of deaths due to prescription opioids. The number of heroin deaths this year is actually down a little bit now. But, we're seeing about three times as many fentanyl deaths," he explained, "So overall, the total number hasn't really changed."
So, what needs to change? He said, in his view, the response to the epidemic needs to be "multi-tiered," "multi-sectoral" and "multi-molecular" to be effective.
That means it has to address many levels of need from rehab facilities to needle exchange programs to long-term support systems. It also has to incorporate a wide variety of people and organizations — those "sectors" he referenced — including tribal health entities, families, the state and other medical professionals. Finally, it has to be prepared to address the wide variety of opioids out there and look at how they intersect with other substances like alcohol.
Harm and risk reduction is part of that equation, said panelist Lakota Holman, of the Alaska Native Tribal Health Consortium.
"It's a bridge between early prevention and treatment. It's a way to keep people who are active users [and] people who are possibly addicted safer and healthier," she explained. "It's an opportunity to work with people who are using injection drugs to reduce their risk of HIV, contracting other blood borne infections, Hepatitis C, other bacterial infections — so, keeping people healthier while they're actively using."
Dr. Sarah Spencer, who has worked for the last several years on the Kenai Peninsula as an opioid specialist, said she's seen a few types of programs and treatments work during her time there.
"One way to think about harm reduction is not just to reduce harm to the individual, but to reduce harm to society as a whole," Spencer said.
She gave the example of a needle exchange program, which provides people who are addicted to injectable drugs access to clean needles.
"If you provide someone who is using IV drugs with everything they need to have sterile injections for an entire year, the cost is about $500. The chance that person, in their first year of drug use, is going to contract Hepatitis C is about 50 percent. To treat that one case of Hepatitis C costs $100,000," she said. "So, it's hugely cost-saving to society for us to invest that money that we use for our medical care in harm reduction."
During her time working in Homer, which had a syringe exchange program, she said she saw about five people who met health care providers through the program and went on to seek additional help.
"So, it's a great door in for people to access treatment," she said.
Finally, the panel came to the idea of a peer recovery support system. This is roughly like the model for the commonly-known Alcoholics Anonymous or Narcotics Anonymous programs where people who have gone through similar struggles help one another on the journey to sobriety.
"In the interest of breaking stigma, I am a person in long-term recovery. I've been in recovery from drugs and alcohol for 28 years. I am also a successful re-entrant. I spent some time in prison, like a lot of us, and I've made it through homelessness," said panelist Rebecca Ling, director of recovery services for Cook Inlet Tribal Council.
She explained that peer recovery support is not about telling people what to do, but helping them as they do what they need themselves.
"A peer specialist is modeling behaviors that we want another individual to mimic: stay sober, have housing," she said. "There's also some family members of substance abuse individuals that can provide support in a navigational role."
While each of the panelists addressed the issue from a different standpoint, they came together in agreement that a multi-faceted approach is what is needed to legitimately address Alaska's opioid crisis.
"We can't arrest our way out. We can't treat our way out. We can't educate our way out," said Butler. The only way out, he said, is working together.