The new face of opioid addiction
by Laura Stone | July 27, 2018 8:21 am
Brad Gerfin, the director McLeod Health Clarendon Emergency Medical Services and Cypress Transport, spoke about the rising opioid epidemic at the Rotary Club meeting last week. Gerfin serves on several paramedic advisory boards, has presented at conferences across Tennessee and is currently pursuing a bachelor’s degree in emergency medical service management from Columbia Southern University.
Gerfin’s experience in emergency medical services has exposed him to the rising opioid crisis as well as to the changing face of what the typical addict looks like.
“The difference we’re seeing is it’s got a new look for my folks that are on the front lines,” said Gerfin. “When you say drug addict, you get a mental picture in your mind, and I can tell you, that’s not what it looks like now. It’s not the junkie hanging out in the back alley sharing needles. Those are not the drug addicts we’re looking at today. With opioids, there are no boundaries whatsoever. There are no gender, race or socioeconomic boundaries. This is hitting people of all walks of life.”
With opioids such as Fentanyl, Oxycontin, Oxycodone, Hydrocodone and Codeine easily available with a doctor’s prescription, the number of addicted patients rises with each passing year. Gerfin refers to the new type of addicts as innocent addicts.
“These are people who had a back or knee injury and went to the doctor and got medications for pain. Over time, the addiction becomes stronger and stronger,” said Gerfin.
Gerfin shared anecdotal information regarding speakers he had heard and situations he had dealt with in Tennessee.
“At a recent conference, a successful businessman spoke about his experience. He had a wisdom tooth pulled and was prescribed Percocet. That was fine. Several years later, he had a back injury and received more pain medications. Over time, he ended up with four different doctors prescribing and was using four different pharmacies to fill the prescriptions. He lost his successful military career, lost his family and was buying heroine from a street dealer.”
Gerfin cautions that this has no age boundaries either, and they are as likely to see it in the elderly as in younger people. He makes sure his responders do not have blinders on with only the stereotypical picture of what an addict looks like, because overdoses happen even in the nicest parts of town.
“There’s nothing sinister or terrible about it, but it can happen. It can be anybody,” said Gerfin.
Gerfin discussed a successful emergency room nurse he once knew. She had a severe jaw problem, and the doctor told her she needed surgery. He prescribed opioids for the pain. She finally was able to see a surgeon, who agreed she needed surgery. However, he was leaving for vacation, and her surgery was scheduled for some time after he returned. The surgeon wrote her another prescription.
By the time her surgery date arrived, she was addicted. Eventually she voluntarily surrendered her RN license, stating, “I have not stolen drugs from the hospital yet, but I know I’m going to.”
“The addiction is that powerful,” said Gerfin.
In the U.S., 116 people died from an opioid overdose each day in 2017. This was a 30% increase from 2016. Online medical sources predict the opioid crisis will get worse before it gets better, and opioids could kill between 500,000 and 650,000 people in the next ten years. This does not include other drug overdoses.
According to Gerfin, 21-29% of people who get a prescript from doc for opioids will misuse them. They’ll take more than they should or they’ll doctor shop and get multiple prescriptions. In order to combat this, the U.S. is creating national registries to track opioid prescriptions.
Opioid addiction is not a new problem. The first known opioid addictions on record were Civil War soldiers given morphine to curb pain. They returned from the front lines addicted. However, it wasn’t a national epidemic.
Purdue Pharmaceuticals ran an ad in 1998, provided to over 15,000 doctors, which showcased seven patients who were helped with Oxycontin, a drug Purdue manufactured. The ad, titled “I got my life back,” had each patient briefly tell his or her story. Purdue insisted the drug wasn’t addictive and would curb pain better than other medications available.
Around this same time, doctors began being assessed by surveys, and one survey question concerned how well the doctor had helped manage the patient’s pain. Doctors were under the gun to produce results or risk being given bad reviews.
Years later, information came out that Purdue did know of the addictive dangers of Oxycontin. In 2007, Purdue and three executives pled guilty to giving misleading information about the drugs and paid $634.5 Million in damages. The company continued to sell the drugs at higher and higher volumes, however.
In late 2017 and early 2018, states began banding together to sue the pharmaceutical giant again. Twenty-three states and Puerto Rico had joined in the suit by May, with 718 combined lawsuits in Ohio alone. In June, Massachusetts joined the fray, adding a defendant.
The Sackler family founded Purdue Pharmaceuticals, profiting over $13 Billion since the drug’s release. Massachusetts has sued them, stating they should also be held responsible and pay reparations. The case is still ongoing.
Gerfin insists that opioids, when used properly and for the brief duration prescribed, pose no threat. The threat comes when a patient misuses the drug, which can lead to an addiction.
“I can assure you, when you go around our beautiful town, and you’re out and about in Walmart, you will pass someone that’s under the influence of opioids. You can’t tell,” said Gerfin. He states that’s the difficulty for EMS and first responders as well. It’s simply not easy to tell.
A patient, who legitimately received a prescription for a real need uses the drugs properly until one day they need a little more. They take an extra pill, and it helps. Soon it’s a few extra pills.
“That’s the cycle. You get on medications. You begin to abuse the medications. You look for more medications. The doctors realize you have a problem and begin to treat you and take those medications away. That’s when you’re going to turn to street drugs to fill that void. You want to feel that way again. Your body wants to feel that way. It’s not a conscious thing,” said Gerfin.
He asserts that opioid addicts are not bad people. A powerful brain chemistry shift has taken place. He states it’s more difficult to discover this type of addiction, as people won’t talk about it or be honest about it.
Gerfin discussed a case where he went to a call for a non-responsive man. By the time they arrived, the man was no longer breathing. They immediately bagged him, forcing oxygen into his lungs. Before intubating him, they chose to administer Narcan, a drug designed to fight an opioid overdose.
The patient rapidly became alert and communicative. He immediately stated he would not go to the hospital and denied taking any sort of drugs. Though Gerfin told him he had been moments from complete death and needed medical care, the man still refused. Had he gone to the hospital, the doctors would have performed a drug test and would have found opioids. The man would likely have lost his job.
“He was willing to risk his life to hide it,” said Gerfin.
Gerfin cautioned the dangers of depending on Narcan as a magic fix-all drug. Narcan was designed to block opioid receptors in the brain and is absorbed through the nasal and airway passages. While Narcan will have a rapid effect on an opioid overdose, it will have no effect of any kind on a patient who has not taken opioids.
Gerfin likened it to a child safety cap inserted into a plug, blocking the opioid from having an effect. However, the opioids are still present in the blood stream. When the Narcan wears off, which happens far more quickly than the opioids, the patient will be right back where he or she was prior to administration of the Narcan if no medical help is given.
Narcan can also cause immediate detox symptoms, including violence. Many reports have come in regarding EMS crews nationwide being physically assaulted after administering Narcan.
In Manning, first responders and police all carry Narcan. However, they have been trained and educated and are prepared to handle what may come.
“They’re going to save lives with it,” said Gerfin. “They understand when they administer it what might happen.”
To combat recurrence of opioid overdoses, the Clarendon County EMS program is partnering with the state in a program called COPE. They will participate through the Clarendon County Paramedic Program, although the funding for the COPE visits will come through the state rather than the Duke Endowment for the Paramedic Program.
Through the COPE program, when a patient is brought to the hospital with an overdose situation, the paramedics will follow up with four weekly home visits. This allows paramedics to do pill counts and assess the stressors in the home environment which may contribute to misuse of the drugs.
“We’re going to begin a program to see what we can do to help them out so this doesn’t recur. We can get them the help they need,” said Gerfin.
However, he also states any individual can help. The first step would be to properly dispose of any extra medications not taken from a prescription.
“A lot of us don’t like taking medications. We take just what we need, and the rest sits in our medicine cabinet,” said Gerfin, who insisted leaving those untaken medications available opens the door for another person to abuse the drugs.
The Clarendon County Sheriff’s Department has a drug disposal unit. Residents are encouraged to stop by with unused portions of prescription medications and dispose of them in the large box provided in the lobby.
Gerfin also encourages residents to be aware of those around us. If we see drastic prolonged changes in behavior including excessive sleep, behavior or personality changes, lack of motivation and increased absence from work, discuss it with a professional.
“No one is immune to the possibility of addiction. If you know anyone you suspect is [addicted], get them help immediately,” said Gerfin. “The quicker you can get them help, the better success you’ll have getting them through the addiction and out the other side.”
The crisis is present in Clarendon County. According to Gerfin, 38 doses of Narcan were administered in 2017. In the first half of 2018, 25 doses have already been administered, showing the rise here at home.
“The main people I see in drug court are middle-aged, middle-class white women,” said Amy Land, Third Circuit Drug Court Judge. “They look just like me. It’s a very, very scary addiction.”
She stated many of the overdoses she has heard about are during the process of kicking the habit. When breaking a habit, be it nail-biting or eating too much candy, a person will have relapses. Land insisted it is the same with a drug habit. However, with opioids, once a patient is off of the drug for a while, sensitivity lowers. If the person takes the high dose used previously, the body can no longer tolerate that dose and overdoses happen.
“A lot of recovery is accountability,” said Land. “This year in drug court, there were close to 20 graduates, so there are success stories. We just need to remember what the dangers are.”
With the changing face of addiction and the possibility open to any person from any walk of life, both Gerfin and Land encouraged watchfulness not only for others but for ourselves. They also stressed the need for addicts to receive professional help, as it’s not a habit most people can kick on their own.
“It’s not a character flaw to be addicted,” said Gerfin. “It just means you need help.”