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No magic pill

November 24, 2017
In The News

When Dan McMahon fractured his leg over the Fourth of July, he refused to take prescription drugs for the pain.

McMahon dislikes pain as much as anyone else, but he has a somewhat unique perspective.

“Pain is good,” he said. “It lets us know we’re not supposed to do something.”

What McMahon shouldn’t be doing is taking prescription painkillers. He took some when he was a teenager, and was introduced to years of torturous opioid addiction as a result.

Had he accepted an offer of Percocet in July, he said, it would have destroyed him.

U.S. Rep. Suzanne Bonamici, the Democrat representing Yamhill County, along with the rest of Oregon’s 1st Congressional District, said she hears Dan’s sort of story all too frequently. She has been going around the district holding roundtable discussions with addiction specialists, law enforcement officers and physicians, as well as recovering addicts.

More than 20 percent of opioid addicts received their first prescription for painkillers as teenagers, typically for sports injuries or after extraction of wisdom teeth, Bonamici said at a roundtable held Tuesday at McMinnville Civic Hall.

“It’s important to hear the human stories behind this,” she said. “I’m a mom, and these stories break my heart.”

Christopher Wright shared his story of cancer surgery as a teen in 2005 and emerging addicted to oxycodone.

When he could no longer access prescription drugs, he turned to shooting up heroin. “The opioid crisis, it’s real,” he said.

The reality of the crisis is one thing Democrats and Republicans can agree on these days in Congress, Bonamici said.

“Not everything is a partisan issue,” she said. “Something like addressing opioid addiction is very bipartisan.”

Still, Republicans and Democrats on Capitol Hill have very different ideas on how to approach the problem.

President Donald Trump frequently addresses the opioid crisis, but he has not recommended any money to fund the fight. Instead, he talks in general terms about “really tough, really big, really great advertising,” designed to persuade Americans not to take using opioids in the first place.

Bonamici hears the echoes of First Lady Nancy Reagan’s “Just Say No” anti-drug campaign of the 1980s. And she doesn’t think that tactic will work.

People already know opioids are addictive and lead to negative consequences, she said.

Addiction can’t be treated with advertising slogans, she said. “We need evidence-based education.”

While insisting the issue was nonpartisan, Bonamici also took swipes at Republican efforts to repeal the Affordable Care Act, passed in 2010 under the Obama administration.

Coverage will be taken away from people when they need it to battle their addictions, she said. “This will be exacerbating this crisis at a time when we should be expanding coverage not taking it away,” she said.

Wright receives medical care through the Yamhill Community Care Organization, an alliance of area health-care providers that serves Oregon Health Plan members in Yamhill County and parts of Clackamas, Washington, Polk, Marion and Tillamook counties.

It costs $1,500 per month. “If I didn’t have YCCO, there’s no way I could afford it,” he said.

Some people can’t afford it. A friend of his without insurance overdosed on opioids this last week and almost died, he said.

Chris Cardinal, a certified recovery mentor at the McMinnville nonprofit Provoking Hope, said many people aren’t so lucky. “I’m sick and tired of attending funerals for people I care about,” he said.

There are a few points of light in the darkness, said Silas Halloran-Steiner, the director of Yamhill County Health and Human Services. There has been a heartening community-wide response to the opioid addiction, from hospitals and social agencies offering recovery mentors to physicians voluntarily limiting opioid prescriptions.

First responders in McMinnville are also allowed to administer Narcan, a medication used to block the effects of opioids, especially in overdose situations.

Local physicians once prescribed up to 120 morphine-equivalent doses for chronic pain unrelated to cancer, said Dr. William Koenig, a physician with the community care organization. Under guidelines adopted by the coordinated care organization, physicians try to keep those dosages below 90.

Dr. Karen Gunson, Oregon’s medical examiner, said the Oregon Medical Board send physicians a letter if one of their patients dies from an opioid overdose.

When the Affordable Care Act went into full effect in 2014, Halloran-Steiner said the number of people insured by the Yamhill Coordinated Care Organization jumped from 17,000 to 25,000. It also experienced a 37 percent increase in outpatient treatment services for people struggling with addiction, he said.

This week’s roundtable further illustrated “the power of the community in solving these problems, especially individuals stepping forward to do peer support,” Halloran-Steiner said. “There’s a tremendous power in that.”

At the same time, he found the discussion sobering.

“I was also struck by the danger of what we’re facing and the potential things like heroin laced with Fentanyl to really wreak havoc in our community,” he said. “There continues to be a need for targeted care.”

People must regard opioid addiction as an affliction that can strike anyone, Halloran-Steiner said, not as a personal weakness. “It is really something that cuts across the fabric of our community,” he said.

Bonamici said there are several aspects of the opioid crisis people often overlook.

One is leftover drugs. Drugs left in medicine cabinets can also lead to addiction, even with people who never received the initial prescription.

Koenig said young people sometimes hold “fish bowl parties” where they take drugs from a medicine cabinet and put them in a big bowl. Then they swallow them by the handful to see what effect they have.

“It’s the Russian Roulette of medicine,” Koenig said.

Yamhill County offers five sites where people can safely dispose of leftover drugs, one immediately outside the county courthouse. Bonamici said that program should be expanded.

Immigrants tend to avoid law enforcement, she said, so might not be comfortable disposing of leftover drugs in such close proximity to the sheriff’s office. Perhaps more local pharmacies could offer disposal sites, she said.

Capt. Chris Ray, who heads the sheriff’s office drug team, said he is well aware of the danger posed by leftover drugs. Nonetheless, he said. he felt a bit hypocritical when he went through his own medicine cabinet at home and found Percocet and oxycodone leftovers.

“That’s the problem,” he said. “They stay there until someone finds them.”

Bonamici said people need to be warned about the danger of buying drugs online. But McMahon said such warnings don’t always work.

“Addicts are going to say, ‘I have a 50/50 chance of this working. I’m going to take it,’” he said.

Yamhill County Commissioner Stan Primozich said opioid addiction is a problem that defies easy solutions, which he learned after his own daughter spent 18 years as an addict and more than a year behind bars, he said.

She is doing well now, and is serving as an addiction counselor in an effort to help others, he said. But he said, “There is no magic bullet.”

The best thing members of Congress can do is come up with a pilot project addressing addiction that can be implemented on the local level, Primozich said. Local communities need to take the lead, he said.

“Everyone in this room is entirely committed to Yamhill County,” he said “If you give us a few bucks, we can get it down a heck of a lot sooner.”

Wright said one of the most effective ways for addicts to combat addiction is to avoid other drug users. Going to Methadone clinics to get chemical treatments can sometimes keep people in the company of other addicts, he said.

After overdosing four times and racking up six felony convictions, Wright said he finally made a decision to turn his life around.

“When you’re homeless, an addict, and you don’t have food, your life can’t get much worse,” he said. “I know if I can control this addiction, I know I can help the world rather than destroy it.”