Opioids, Addiction and the Lehigh Valley

The opioids epidemic has hit home in the Lehigh Valley, and medical professionals, therapists, county agencies, police departments, and residents are all dealing with it.

“I have witnessed a large increase in the volume of patients arriving at Lehigh Valley Health Network or being transferred to LVHN secondary to opioid overdoses,” explained Robert Cannon, DO, an Emergency Medicine Physician and also a Medical Toxicologist. “There’s definitely been a steady increase over the past few years.”

According to Dr. Cannon, there are genetic factors that influence the way an individual’s brain responds when exposed to opioids that may increase risk of addition. “Genetic factors likely account for 35-40 percent of an individual’s likelihood of developing opioid addiction. Physical dependence can start as early as several days after the initiation of an opioid pain reliever,” said Dr. Cannon.

“The prescribing of opioids has skyrocketed since the mid-1990s creating an epidemic of prescription drug use,” said Paige Roth, Addiction Recovery Liaison at LVHN. “As the number of prescriptions rose, so did the number of deaths from opioid overdoses, and they continue to rise every year. The United States makes up little more than 4 percent of the world’s population, but we consume over 80 percent of the world’s opioid supply.”

Overdose and Naloxone

For addicts suffering an overdose, the drug Naloxone has been saving lives across the country, and more recently here in the Lehigh Valley thanks to a 2014 change to Pennsylvania laws on who can administer the drug. Also known by its brand name Narcan, Naloxone is available in injection and nasal spray forms, and reverses the effects of heroin or prescription opioids such as morphine and oxycodone.

The Dorothy Rider Pool Health Care Trust provided some of the first support in the Commonwealth for the acquisition and distribution of Naloxone in 2014. LVHN received a grant from the The Pool Trust to make Naloxone kits available to first responders to save the lives of drug overdose victims. LVHN’s George E. Moerkirk Emergency Medicine Institute trained local police, EMTs, and paramedics on how to recognize symptoms of a drug overdose and how to administer the drug Naloxone. Additional resources were used to purchase Naloxone kits for first responders to keep on hand in their emergency vehicles. Each kit contains two pre-filled syringes, two atomizers for nasal administration, sterile gloves and a booklet on the use of the drug.

“Given the increase in overdoes rates, there has been a concerted effort at both the state and local levels to place Naloxone in the hands of police, emergency responders, and schools, and we are seeing these groups use it frequently to save the lives of opioid overdoes patients. It is an important part of a public health harm reduction strategy,” said Dr. Cannon.

Treating addiction

“Many people go to inpatient treatment centers for anywhere from a few days to a standard 28 treatment cycle, depending on insurance and Medicaid policies,” said Roth. “Medicated assisted treatment is becoming more widely used as research confirms the efficacy of the drugs used, including methadone, buprenorphine and naltrexone.”

But relapse is always a concern with any type of addiction. “It’s not uncommon for me to see patients who have had four or more attempts at rehab. Studies have shown that the longer people with substance use disorders are able to remain in treatment, the better their chance of recovery,” said Roth.

“Addiction is a chronic brain disease and needs to be managed life-long like other chronic diseases with a multidisciplinary approach including medications, counseling, and social support,” said Dr. Cannon.

Addressing the opioid crisis locally

Changing the way opioids are prescribed by physicians is an important component to reducing usage and thereby abuse. “Physicians can follow the principles of opioid stewardship by opting for non-opioid thereby whenever possible,” explained Dr. Cannon. “Many cases of acute and chronic pain can be successfully managed without opioids by utilizing non-opioid medications, physical therapy, cognitive behavioral therapy, and other modalities.”

“LVHN and other local hospitals are actively developing educational programs and protocols for their staff and the public. Most local healthcare networks have or are reviewing their processes and procedures to set up a protocol for prescribing opioids and alternatives in treating pain,” according to David Zimmerman, Director of Marketing Research for the Lehigh Valley Health Network Department of Community Health.

Changes within the criminal justice system have also taken place locally. Through collaboration between the Lehigh County District Attorney’s Office, Adult Probation, Pretrial Services, Lehigh County Jail and Lehigh County Community Corrections Center, over 1,000 individuals are identified and referred for treatment annually.

“In 2016, 168 individuals in Lehigh County jail were identified as meeting the criteria for inpatient treatment through an early release diversionary program, and 164 of them successfully completed the clinically identified treatment,” said J. Layne Turner, Administrator of the Lehigh County Department of Drug and Alcohol. “This 97 percent success rate illustrates that accountability and treatment is possible.”

Local law enforcement is also making changes since many individuals will seek out police for help, or are identified by officers as those who are abusing substances.

“The Allentown Police Department piloted an Outreach Program in October 2016 that places a substance abuse professional in the community seven days a week to work with our officers and link individuals in need to services,” said Turner. “Since its inception last year, more than 1,400 individuals have had contact with the Outreach team. This service will soon be expanded to support the Whitehall and Bethlehem Police Departments.”

“In January 2017, the Lehigh County Department of Drug and Alcohol created the Hospital Opioid Support Team, a 16 hour-per-day, 7-days-per-week program that works collaboratively with our six hospitals and primary care practices to provide warm-handoff support for overdose survivors and those who are presenting with substance abuse disorders,” said Turner. “In total, the Department has set aside $1.5 million for prevention education and intervention services to residents of Lehigh County. These programs span from youth to seniors, and are open and available to all in the community.”

Ending stigma through education

However the stigma of being an addict, or being the relative of one, weighs on many people and often keeps them from getting the help they need to treat the disease.

“Today there are 23.5 million Americans living in long-term recovery. People can and do recover every day,” said Roth. “But unfortunately fear of stigma and shame keep most people quiet about their recovery.”

“Community members should learn about opioid use and its characteristics since significant stigma still exists,” said Zimmerman. “Addiction is a chronic condition that is either symptomatic (active) or in remission (sober). Learning how to recognize these states and learning what actions to take and how to assist the addict best would be helpful for everyone to know.”

“A change in perspective in seeing addiction as a treatable condition is important too,” continued Zimmerman. “Too often addicts are unable to take control of their lies. This can cause isolation and prolong the opportunity for intervention and treatment.”

“In Lehigh County, one person dies of a drug-related overdose every 1.5 – 2 days. Sooner or later, this epidemic will directly impact all of us,” said Turner. “Our communities should be aware of the local impact and the role we can all take in addressing this disease.”

Learn more about opioids and local resources for assistance on the LVHN web site here:

https://www.lvhn.org/for_health_professionals/progress_notes/features/managing_opioids

 

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