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Virginia’s Epidemic Next Door

Caitlin Barbieri | April 17, 2018

Topics: drugs, opioid addiction, opioid epidemic, opioids, prescription opioids, Virginia drug addiction, Virginia drug overdose

A routine day for paramedics in Richmond finds them at a hotel where a young woman is overdosing on heroin. She’ll live because of the 911 call her 4-year-old son placed, but the future for this woman and her son is still hazy. This is the sixth time she’s overdosed — her son has seen it enough times to know how to respond — and it will most likely happen again.

Alex Brooks, a trauma technician at MCV and paramedic at Chippenham Hospital, shared this story with us as we investigated the opioid epidemic in the River City. He said this story was a common one, estimating that four to five overdoses occur every day in Richmond. With the introduction of fentanyl and ever-stronger heroin, this epidemic becomes harder and harder to control.

Originally printed in RVA #32 Spring 2018, you can check out the issue HERE or pick it up around Richmond now. 

“This summer was pretty rough,” Brooks said. “I recall one particular evening we had seven [overdoses] at one hospital.”

People who suffer from addiction have a complex disease that compels sufferers to seek and use a particular substance. This disease, now called Substance Use Disorder by the American Psychiatric Association, changes the mood, personality, and actions of those struggling with it. On top of the physical and mental challenges individuals face during recovery, there are also social challenges that make long-term recovery very difficult.

A survey conducted by the Johns Hopkins Bloomberg School of Public Health showed that the general public does not believe treatment options for drug addicts are effective, and are opposed to government spending on treatment facilities. Their research also showed that people are averse to working with sufferers in a job space, and most would not welcome a family member’s marriage to someone with the disorder.

In an interview with Johns Hopkins University’s The Hub, lead researcher Colleen L Barry told reporters, “While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition.”

Alumni of The Healing Place and work program graduates

However, despite conventional wisdom, there is hope for people who suffer from this disorder — even the mother in that hotel room. We were unable to find out where she is now, but interviews with other locals suffering from the disorder give a partial picture. The people we spoke to hoped that sharing their story could help others by removing some of the stigmas they’ve faced.

“I used to hate to see the sun come up,” said William, who seeks to rejoin society following years of substance use. “I didn’t want to get up and go outside in the freezing cold to stand out there and wait for somebody to get beat, or somebody to score so I can get some. But I couldn’t help myself.”

William (who wished to be identified only by his first name) grew up in Richmond and struggled with heroin for 10 years. He has been in recovery at the Healing Place, a local treatment center for people struggling with substance use disorder, for two years; currently, he’s working on rebuilding the life heroin took from him.

“In step one they talk about powerlessness. I was powerless over the drug,” William said. “Every part of my life, heroin was in it. If I woke up, I needed it; if I went to sleep, I needed it; if I took a shower, I needed it; if I ate, I needed it. If I looked at you, I needed it.”

The disorder does not discriminate across race, gender, or economic lines. Although the face of addiction in mainstream culture is predominantly male and black, men and women from all races and walks of life have suffered from the same dependence.

Marie Pruitt, who is now in recovery, is a former college student from an upper-middle-class background. She talked about how heroin supplanted school and the future she originally saw ahead of her.

“Junior year, I gave up. I felt like school was irrelevant,” she said. “I was just going to go to NOVA [Community College] because there was really no point in me leaving the area because I don’t know people who will sell me drugs outside of the area.”

At first glance, Pruitt and William are polar opposites, but substance use disorder has erased many of the gaps between them. While William is an African American man from poverty, Pruitt is a young white woman from an upper-middle-class household in Fairfax, Virginia, born with every resource to succeed.

Opioid use statewide

However, at the age of 20, Pruitt has been through inpatient rehab five times. She began experimenting with drugs in middle school, and by the time she was 18, Pruitt had tried almost every drug imaginable, and developed a dependence on heroin.

“I felt like [I had lost control] before I even got to heroin. I felt like that with oxies,” said Pruitt. “I had too much money and access, and things were getting really awful.”

No one plans on getting addicted to substances, but their availability both behind the counter and on the street makes it easy for individuals to slip into dependency. Both Pruitt and William were introduced to opiates by people they trusted. A trusted adult in Pruitt’s life would trade prescription opioids to her in exchange for marijuana. Later, Pruitt began buying opioids outright. It was a short step to buying heroin.

“I think the main reason why there is such a big heroin problem now is because of over-prescribing meds,” Pruitt said. With opioids being prescribed so frequently, they become easily accessible for a wide range of people. “They’re available, and you don’t realize they’re that bad. You don’t think it’s bad because it’s in a [prescription] pill bottle.”

Before William could get heroin himself, his uncle would share his heroin with him. In the environment where he grew up, these substances seemed like an inescapable part of life.

“I grew up on misinformation,” William said. “I thought the only way I was going to get out the ghetto or get a pair of Jordans was I had to sell drugs; only way I thought I was gonna get a nice car was I had to sell drugs.”

That misinformation is not isolated to the Richmond community. A study from Harvard’s Equality of Opportunity Project showed that the American Dream of upward income mobility is dissolving. Only 50 percent of children born in 1985 were expected to earn more than their parents did, down from 90 percent of children born in 1940. For people like William, who are born into poverty, that means they are likely to stay in poverty throughout adulthood. In areas of poverty and high unemployment, the people with the most money tend to be drug dealers, who in turn become idolized for their apparent success.

But once William’s uncle introduced him to heroin, the desire to better his socioeconomic status dissolved into a desire to get more heroin. “I’d seen these people living in abandoned houses, and I had a house to go home to and a car, but I’d rather be with them than go home,” William said.

Pruitt’s addiction caused her to value the substance over her own life. “I definitely thought I was gonna die, but I just felt like, whatever.”

Pruitt’s story of upper-class suburban addiction might seem like an outlier in comparison to the stories told in dramas like The Wire, but it’s a fast-growing trend. A research study in JAMA Psychiatry found that there has been an increase in heroin abuse throughout the country — especially in white suburban areas.

Bus and walking routes at The Healing Place

Mike St. Germain, a middle-class family man from the Atlanta suburbs, struggled to help his daughter Tori as she struggled with substance use disorder during her high school years. Her grades started to drop, her mood became more volatile, and the little girl that once happily roamed their house was erased by substances. Like William and Pruitt, Tori’s addiction affected everyone in her life.

“The addiction takes everything around it and sinks these little hooks into it, and just pulls it all the way towards itself,” Mike St. Germain said.

Once a person becomes dependent, life revolves around two things: the substance, and the money to afford it. Another man at the Healing Place, Sean, said, “We live to use and use to live — it’s a vicious cycle.” Family, friends, work, and the future suddenly lose their significance, and the top priority becomes the substance. “Our stories may vary, but the disease of addiction does not discriminate,” he said.

Pruitt felt isolated from everyone she cared about. At her lowest point, many of her friends wouldn’t even speak to her, and she had nowhere to stay. St. Germain’s daughter’s addiction got so bad she gave up her child. “She was in such a bad place she actually signed guardianship over to me and my wife,” St. Germain said.

Nearly a year went by before Tori returned to see her baby girl. Today her daughter is five years old and has a two-year-old sister. Both girls live with their grandparents; just when St. Germain and his wife were expecting to retire, they found themselves becoming parents again.

“I have a lot of conflicting emotions about it because I love my grandkids, I do,” St. Germain said. “But I don’t want to be a parent again.”

Tori is currently in recovery and living with her parents. St. Germain and his wife have done everything they can to help her, and are hopeful that Tori will continue to improve her life. That hope is a common theme for the people who suffer, the people who love them, and the people who work with them in recovery.

“That’s the secret sauce of what works about collegiate recovery, is that you infuse hope,” said Thomas Bannard, Program Coordinator of VCU’s Rams in Recovery. “You give this long-term treatment approach, which is especially necessary with opioids, but is true of all drugs.”

While centers like Rams in Recovery and the Healing Place share a focus on creating a community to serve and support people in recovery, they approach the issue with different models and foundations. Rams in Recovery is a VCU-based support group for students struggling with substance use, while the Healing Place is a recovery treatment center created by CARITAS, a relief organization with an abstinence-based peer-to-peer recovery program. Both centers strive to create an environment of hope for people in recovery, and give them a place to go as they cope with the physical, mental, and social aspects of that process.

“People that have substance use disorders have a marginalized, stigmatized health condition,” Bannard said. “That makes it really challenging to seek help.”

Stories from Healing Place residents in recovery demonstrated the sheer strength it took for these men to get where they are. Arnold, a resident who only used his first name, said, “I had enough. Enough killing myself, enough going in and out of jails. I decided I had to do something different, make a change. My kids were getting older, and I wanted to be there for them — and definitely be there for my grandkids.”

Recovery is a trying experience, requiring hope and support from a community that cares. “You don’t just get recovered. There is nobody who has been an addict, and is recovered, and everything is fine,” Pruitt said. “I know people that are 50 years old and have been clean for 10 years. [They] tell me they still think about it every day.”

Recovery isn’t impossible, but it’s frequently punctuated by relapse. According to the National Institute on Drug Abuse, 40 to 60 percent of those with the disorder experience a relapse. However, what is important is an individual’s ability stay committed through those relapses.

“Relapse is a part of recovery,” said Albert. “What’s important is that when we fall we get back up and keep trying.”

Despite significant relapse rates, all of the individuals we spoke with are succeeding in recovery. Pruitt is currently attending VCU and is working towards a degree that she once thought she wouldn’t live to see. Tori and her children are currently living with St. Germain and his wife, as Tori attempts to rebuild her life. And after two years at the Healing Place, William believes he is finally ready to leave.

“Bad days don’t exist no more,” William said. “I wake up every day and find something to be grateful for — the smallest things. Because I don’t have to wake up and roll over to no dope.”

Photos By: Branden Wilson

The Rise of an Epidemic: Opioids, Their Impact on Virginians, and Efforts to Combat the Growing Crisis

Nidhi Sharma | November 28, 2017

Topics: and hydro/oxymorphone, codeine, drug abuse, Drug addiction, fentanyl, hydrocodone, irginia Department of Health, opiates, opioid, opioid addiction in Virginia, opioid crisis, overdose, oxycodone, pain killers, Percocet, prescription opioids, University of Richmond, Virginia Center for Addiction Medicine

Kim grew up on the west end of Richmond, a young girl with big blue eyes living in the nice part of town — bad things didn’t happen to girls like her, not in the suburbs.

By 14, though, she had started experimenting with weed and alcohol. As a freshman at Hermitage High School, Kim moved onto bigger and better drugs. Forget her school colors of red and blue, she’d found white — in prescription opiate pills and powdery bleached cocaine.

At 19, her mother dropped her off at a twelve-step program in Richmond. She walked in the front door and straight out the back.

Kim started shooting up heroin. Her biological mother had died of a heroin overdose weeks before Kim was born, but those things didn’t seem to matter at the time. Kim was addicted. There was no choice but to leave her family, leave her life behind. Until July 8, 2010.

Kim was living in a recovery home with 13 other women, sandwiched between one addict reading from the bible and another woman blasting Eminem. It was then that she decided she’d finally had enough.

So she got help, and she got out. Today, she works at the Virginia Center for Addiction Medicine (VCAM). Unfortunately,  not everyone’s as lucky as Kim, though. Only two weeks ago, President Trump declared the opioid crisis plaguing the nation a public health emergency, and the number of opioid overdoses has only increased since then.

“Every three weeks, 3,000 people die from this opioid epidemic,” said Chantal Thompson, a representative of VCAM. “There’s a 9/11 that happens every three weeks. Think about that. Every three weeks, the same number of people who died on September 11, 2001, die in the US because of an opioid overdose.”

And yet, doctors regularly prescribe opioids for pain relief. According to the Virginia Department of Health, 1,268 people in Virginia died in 2016 from overdosing on opioids. 465 of those deaths were caused by prescription opioids.

With statistics like these, it’s  important to know the science behind the drugs. Moreover, it is especially important to question why doctors are prescribing opioids so willingly in the first place, knowing the associate risks. 

“The number, the recklessness, with which doctors have started prescribing opiates began in the late 1990s,” said James Thompson, the CEO of VCAM. “Traditionally, doctors were careful not to overprescribe opioids because of the risk of addiction.”

A movement generated by concern for those suffering from chronic pain, Thompson said, changed the way doctors prescribed opioids for good. “People were living longer and surviving diseases, but then going on to live lives of chronic pain,” he said. “So doctors began routinely prescribing opioids for pain.”

Drug deaths in Virginia
Infogram

According to Thompson, doctors were also encouraged by pharmaceutical companies like Purdue that released self-funded studies in the 1990s, suggesting that the risk for opiate addiction was not high, not for patients that were truly in chronic pain.

Opioids, the drugs in question, are all derived from the natural opium poppy. The old standby derivative is morphine, and morphine has been modified to make products such as codeine and heroin. Then there are the synthetic opiates that are similar to morphine molecules, like oxycodone, hydrocodone, and hydro/oxymorphone.

“What happens is that opioids, after they are administered inside your body, they bind to something called a receptor, which are proteins usually found on the membrane of a cell,” said Shannon Jones, a biology professor at the University of Richmond. “They are able to recognize different substances and activate specific pathways that create a response in the body by activating specific genes.”

In the case of opioids, after binding to the receptor called GPCR, the opioids recruit a protein within the pathway called a G-protein. These G-proteins can affect either an activating or an inhibitory pathway.

Adrenaline, for one, binds to GPCR receptor proteins and recruits the G-protein that ultimately activates a fight or flight response within the body. Opioids also bind to the GPCR receptor, but they recruit a structurally different G-protein that ultimately inhibits pain receptors, enabling the body to feel little to no pain.

That’s why prescription opioids became so popular with both doctors and patients during the opiate movement — they block out our biological capacity to feel pain at all. Sore limbs, old wounds, nagging toothaches; it all just fades away.

Thompson, as a young doctor in the early 2000s, experienced this shift firsthand. “When I was in medical school, we were kind of taught that if we were underprescribing opiates, we were undertreating pain and that we were basically guilty of malpractice.” He went on to say, “In the past, some opiates were prescribed only for brief periods of time after injury or surgery. It was rare to have someone prescribed opiates for a long period of time. By 2001, it became okay to give someone who had something as common as say, arthritis or fibromyalgia, a prescription for lifelong opiate use.”

All this may seem like a gift for patients with arthritis, migraines, and other diseases that cause chronic pain. Underneath the pretty wrapping paper, however, is something far more sinister.

“There are three types of opioid receptors in our bodies,” said Jones. “Two of those receptors lead to pain relief. One of the receptors overstimulates a pathway that can cause respiratory depression — it slows down your breathing.” 

And that’s where, Jones said, the danger of overdosing lies. “You’ve slowed down your breathing so much that you could die,” she said.

So opioids have become the quintessential example of a double-edged sword. No pain, no hurt, but an extra pill or two slipped unthinkingly into the back of your throat could leave you breathless.

Despite this, hospitals and medical practices in the 1990s continued and still continue to prescribe opioids daily, all across the US. Why? Because along with moral motivations to eradicate pain, doctors also had a monetary incentive to keep prescribing opiates.

“This movement began to grow at around the same time hospitals and medical practices began using the internet to get feedback,” said Thompson. “There were people who would give bad reviews to doctors who weren’t joining in on the prescribing frenzy.” 

Thus, doctors had a strong incentive to prescribe painkillers. According to Thompson, getting good reviews meant getting making more money. Reimbursements were connected to customer satisfaction and pain relief was linked to customer satisfaction, so there was a huge draw to prescribe opioids.

This paradox is explored famously by Sam Quinones in his book, Dreamland: The True Tale of America’s Opiate Epidemic.

In his book, he describes this situation, “Our desire as American health consumers to have an easy solution to a complicated problem has played a role in the opioid crisis,” he said.“Sometimes pain is only fixable if you, as a patient, do a lot of the work yourself but we as a country, culturally, have not made those choices.” 

It is Quinones’ opinion that doctors have come to rely on prescription drugs because of the relative ease of prescribing a pill as opposed to suggesting that the patient work out, eat better, sleep better, drink more water.

Undeniably, the saturation of opiate prescriptions in American society is alarming enough when all you are considering is the threat of overdose — but there are still more layers. Opioid addiction, which has devastated the lives of so many, is another risk that looms ominously over our heads.

In November 2016, Governor Terry McAuliffe released a statement declaring the opioid crisis a public health emergency. According to the press release, in the first half of 2016, the total number of fatal drug overdoses in Virginia increased 35 percent from 2015, and fatal drug overdoses became the number one cause of unnatural death in the state.

One of the most popular opioids, Percocet, is a combination of oxycodone and acetaminophen. In 2015, more than 4 million Americans reported abuse of oxycodone-containing pain relievers like Percocet.

Musicians across the US have been waxing poetic about the inconceivable high these drugs give you for years, but what does that high really entail, and why is it so addictive?

“Biochemically speaking, synthetic opioids mimic natural opiates your body produces, like endorphins,” said Jones. “These opioids bind to the reward pathways in your brain that bring about that feeling of euphoria commonly associated with these drugs.” 

According to Jones, opioids have the highest rate of addiction out of any drug group in existence.

When you take an opiate, your body is flooded with the drug, and your cells try to cope with the onslaught– they pull their receptors away from the surface so that the opiates can’t bind and create their effect, a dangerous mix of euphoria and breathlessness.

Jones explained this further, “Drug users will take more and more drugs, trying to achieve the high they had the first time they took an opiate.” He also explained how taking opioids is about diminishing returns, once your body’s cells have adapted and become desensitized to the drug, “still, people keep trying and trying anyways, constantly chasing a high they’ll never feel again.”

It’s the reason drug cartels buy heroin from processors that make it out of morphine and mix it with powerful synthetics like fentanyl. Because, in Thompson’s experience,  it makes for an attractive product — and addicts with hollow eyes and bruised veins will come from all over, will search for the powerful high born from a mixed, street-made drug that has caused many an overdose.

It’s also the reason that Thompson will have weekends in Virginia when he ends up with a bunch of overdoses caused by the same product, sold by the same person, to people just trying to get their fix.

“Your brain informs you of your decisions constantly, whether you’re conscious of it or not, and it is a powerful learner,” he said. “Using opiates over and over changes the impulses and drives you have. It can make it so that your desires, wishes, goals, they all revolve around the drug. Even if you can’t admit that to yourself.”

Still, Thompson has made it clear that the solution to this nationwide opioid crisis does not lie in banning the drug. For him, education, not restriction, is the solution.

“About half of the patients I see started out being prescribed opiates for a medical issue, and quickly became addicted from their first exposure,” he went on to say. “That doesn’t mean doctors should never prescribe opiates — it just means we should help people to better understand the risks of addiction and that doctors should be more mindful of what may happen if they prescribe opioids.”

In October, US Senator Tim Kaine introduced a bill that would invest $45 billion into prevention, detection, surveillance, and treatment of opioids. Should the bill pass, it would also include nearly $5 billion for substance abuse programs in individual states from 2018 through 2027.

Over the last few years, focus on policies concerning the opioid crisis has expanded exponentially, both nationwide and in Virginia specifically. In an exclusive interview with RVA Mag, Attorney General Mark Herring discussed his efforts over the years to curb the epidemic, and provide the public understanding of opioid addiction that Thompson advocates.

Attorney General Mark Herring. Photo by Landon Shroder

“I have known from the very beginning that this is not a problem we are going to solve with arrests,” Herring told Landon Shroder, RVA Mag’s editorial director, in the interview. “Many of our drug policies of the past have not worked well and we need to take a fresh look at [the issue]. Drugs are not going after one particular demographic. It isn’t an urban, suburban, or rural problem. It’s happening everywhere.”

And according to Herring, Virginia is trying its best to solve the problem everywhere — it is part of a 41-state investigation into pharmaceutical manufacturers, to see if they are engaging in any unlawful practices regarding their marketing and distribution.

“These drugs are incredibly powerful, and devastating the lives of so many families,” Herring said. “The opioid crisis is a national tragedy and a problem that is decades in the making — and it has its roots in the medicine cabinet much more than it does in the streets.”


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