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The Journal Gazette

  • Crawford

Friday, August 03, 2018 1:00 am

Crisis proportions

Area awakens to need for opioid treatments

John Crawford

John Crawford is a Fort Wayne physician and an at-large City Council representative.

The opioid crisis is everyone's problem.

It drives up medical costs, increases crime and the cost of increased law enforcement, increases criminal justice costs, and the expense of caring for children of parents with substance use disorder. We are losing productive members of our society and workforce at the prime of their life. The majority of our Allen County drug fatalities were middle-aged, employed white males, according to data from the coroner's office.

The opioid crisis has continued to worsen nationally and locally. In 2016, the National Institutes for Health reported 42,249 fatal overdoses from opioids – more than 115 a day. That is more than the 41,070 breast cancer deaths per year. The crisis' national cost has been estimated at $504 billion, 3 percent of our gross domestic product.

The problem is also accelerating locally. We had 128 fatal drug poisonings in 2017, a 70 percent fatality increase between 2016 and 2017. The Fort Wayne Allen County Task Force for Opioid Strategic Planning led by The Lutheran Foundation, engaged a multidisciplinary team that has been working hard every day to make progress.

“Turning Hope Into Action: Evaluating the Opioid Crisis in Fort Wayne and Allen County,” as prepared for the task force and The Lutheran Foundation by the Purdue Fort Wayne Community Research Institute was released in May. An excellent review of all the background data and the efforts being made here can be accessed at www.pfw.edu/cri.

To make greater progress, we need to medicalize our approach and the way we regard this problem. There is a stigma about substance use disorder that we don't have about other diseases. We don't look down on someone who has diabetes or breast cancer. We rightfully regard these as diseases and approach them as public health problems.

We need to think of opioid use disorder the same way with no moral undertones to our thinking. Remember, there but for the grace of God go I. Somewhere around 8 percent to 12 percent of patients prescribed opioids for pain control will develop an opioid use disorder. Many times, drug problems arise in the setting of anxiety and depression. We need more early screening for these mental health diagnoses so we can prevent drug misuse or begin to treat it at earlier stages.

State-of-the-art approaches now include medication-assisted treatment. In some patients, this involves prescribing other drugs such as methadone to get the patient off of more dangerous drugs such as heroin. The goal is to gradually wean the patient off or at least substitute the less dangerous medications to reduce harm, crime and other problems. Medication-assisted treatment calms the brain, allowing the person to focus on treatment and recovery.

Yet the treatment also has a stigma associated with it. It is not simply substituting one drug for another. It is evidence-based treatment that can work for many patients – there is nothing morally wrong about it. It's like nicotine patches to help break tobacco addiction. The only difference being cigarettes are deadlier and nicotine is legal with no moral stigma. Medication assisted treatment availability needs to be increased here and used whenever appropriate.

Opioid use disorder is a public health problem, so our primary approach needs to be to increase availability of high-quality treatment and recovery programs here. The Bowen Center has recently expanded in Fort Wayne, and the hospitals – Parkview along with The Lutheran Foundation – have been ramping up their efforts.

Sometimes patients with substance use disorder want help but don't know where to turn. An excellent source is the website www.lookupindiana.org. In 2016, The Lutheran Foundation announced the launch of Look Up, a website-based initiative designed to provide mental and behavioral health and wellness resources, and reduce the stigma associated with these serious health issues. Visitors to the site can access 24/7 help at 800-284-8439.

Many employers now can't find workers for good jobs that are open now. Many prospective employees have a positive drug screen and are not hired. Some employers are now offering to hold a job for those failing the drug screen if they get into rehab. This is certainly to be praised since the prospect of a job and a path to a purposeful life is an extremely powerful motivator to someone who wants to stop using drugs.

Citizens can help by lobbying state legislators. Indiana is 49th out of 50 states in per capita funding for public health. We need to ask state legislators at next year's long session to increase state funding to fight this as well as other public health problems such as tobacco cessation and infant mortality.

The opioid crisis has worsened, and the wave has not crested. We need to have a comprehensive approach and use 21st century tools to combat it. A great deal of effort has been put in by the task force to build the medical infrastructure we need and to coordinate this with other disciplines.

We city leaders also must focus on this problem. We need to provide police the resources to stem the flow of illegal drugs and resultant crime. The city needs to be a leader in helping better plan how to combat this epidemic. We can convene meetings of all those disciplines involved to break down silos and focus on how best to coordinate our local resources.

We will need to all work together and collaborate in an effective manner to make more progress on this crisis.