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The fight against the national opioid crisis is a matter of life and death for Jim Wolfe.
This 60-year-old township man lost his job as a welder. His wife, aged 30, sent her to the door and an overdose in June almost cost her life.
"I had a good life, but opiates snuck in and attacked me, and I guess I chose to do nothing about it," Wolfe said. "I became everything I despised."
His long-standing addiction to addiction began with alcohol consumption at age 18 and methamphetamine at age 28. He became healthy and spent a sober decade before a knee surgery triggered a downward spiral from Percocet to heroin and crystal meth.
"I did not think I had a problem with the pills until I got addicted, and it was a battle," Wolfe said. "Opioid withdrawal, it's nil, it's painful, you're sick, you have diarrhea, it's miserable, it's one of those things that you would rather use rather than be sick. "
Wolfe's death took him to hospital for a week, followed by a stay in an inpatient treatment facility at Dodge City and his outpatient services at CKF Addiction Treatment. Cleaned up for six months, Wolfe receives treatment, including counseling and treatment by Suboxone, from a grant through the Drug and Addiction Services Administration's administration. Department of Health and Social Services.
Today, Wolfe is engaged, has a relationship with his two adult daughters and four grandchildren and helps others get treatment at CKF Addiction Treatment.
"I do not even think about opiates, I have more pain than before," he said.
Public health emergency
More than 1,500 Kansans have died from an opioid or heroin overdose since 2012, according to the Governor's Task Force on Substance Use Disorders, which published a report in September. Drug poisoning killed more than 300 Kansans in 2016 alone, and prescription drugs were involved in 80% of drug poisonings from 2012 to 2016. Nationally, overdoses involved in opioids killed 42,249 people in 2016, according to the Kansas Drug Prescription and Opioid Usage and Overdose Strategic Plan released in July.
According to Greg Lakin, Chief Medical Officer of the Kansas Department of Health and Environment and Chair of the Task Force on Substance Use Disorders, several factors have contributed to the rise of opioids, starting with the elimination of pain. The medical community has also been led to believe that opioids are not addictive by pharmaceutical companies that market these drugs aggressively, he said.
In 2016, the CDC issued guidelines on the prescription of opioids for the treatment of chronic pain aimed at reducing the risk of opioid use disorder. In 2017, the Trump administration declared a nationwide public health emergency regarding the opioid crisis.
While Kansas has not yet realized the scale of the problems faced by other states, "we've always been hit hard, it's a real crisis," Lakin said.
As for the people involved, "This is not who you think of," Lakin said, pointing out that many people who are fighting opioids are middle-aged professionals.
"Often, they are very good people, but they have to steal, they have to rob, they have to take money from their mother's bag, they have to do things that they would not have done. never do, "he said.
While attention is focused on prescription drugs, many overdoses can be attributed to illegal drugs, such as heroin containing fentanyl that comes from China, Lakin said.
The opioid crisis has evolved into three waves, said Karan Braman, senior vice president of the Kansas Hospital Association and a member of the task force. The first wave, which began in the 1990s, was that of prescription opioids, driven by OxyContin's Oyster Market, she said. This was followed by a wave of heroin overdoses after Mexican drug cartels targeted areas where OxyContin was mistreated. The third wave is fentanyl addiction.
"I think everything we do for opioids – because that's where attention and money are concentrated – will certainly help treat other substances as well," said Lakin.
Looking for solutions
The state received about $ 30 million in federal grants, which supported prevention, awareness, education and treatment for the opioid crisis. But funding, which comes "a little at random," has been a source of frustration for treatment providers, Lakin said.
The Governor's Task Force made 34 recommendations in five areas: service provider education, prevention, treatment and recovery, law enforcement, and neonatal abstinence syndrome. Recommendations include the creation of permanent funding sources for various programs, awareness and use of the government's drug monitoring program, expansion of medication-badisted treatment, and promotion of the use of naloxone, antidote to overdose.
Lakin has signed an order allowing anyone in the state to enter a pharmacy and obtain naloxone. It is now working to increase awareness of the life-saving drug marketed as Narcan, with the hope of putting it in the hands of more police officers and police officers. emergency medical services, as well as friends and family members of potentially-at-risk individuals. overdose.
"It's just a safe way to save lives," he said, pointing out that the nasal spray was harmless if it was administered unnecessarily.
"Many patients who became aware of their addiction realized that they were about to die … realized that it was time to seek treatment," Lakin said.
Local efforts
Efforts to address the opioid crisis at the local level have included efforts to reduce opioid doses and prescriptions, use alternatives to manage pain, and badess patients' ability to function rather than d? use a traditional pain scale.
"Every community is different and the solutions that work the best are local solutions," said Braman, of the Kansas Hospital Association.
Labette Health in Parsons is a leader in the fight against the opioid crisis. He drew national attention to his efforts to improve patient safety and participated in national presentations to share successful experiences with other hospitals.
In 2014, the organization is committed to reducing drug-related adverse events, with the goal of reducing by 40% the number of naloxone administrations by patients receiving opioids at the time of treatment. Hospital by September 2016, said Teresa DeMeritt, Director, Quality.
The organization has adopted a multimodal approach involving perioperative, pharmaceutical, orthopedic and front-line staff. Among the measures adopted include the gradual administration of lower doses of opioids and the use of alternatives to opioids, such as regional blocks, acetaminophen IV and gabapentin .
Labette Health has exceeded its target, reducing naloxone administration by 73.2%, opioid administration by 44% and increasing its 90th percentile pain treatment scores, DeMeritt said. .
"Overall, we have not made any significant changes to the system," she said. "We made small incremental changes that had a significant impact, it was critical to be transparent with our data and share it to educate and engage our team."
Prescription monitoring
One of the most effective tools of the state to fight the opioid crisis is the K-TRACS prescription drug monitoring system. Established in 2010, K-TRACS alerts prescribers and pharmacists when patients reach the threshold required to obtain at least five controlled substance prescriptions from prescribers and visit at least five pharmacies to complete them within 90 days.
Lori Haskett, Deputy Director of the Kansas Board of Pharmacy, reported that one of these patients had received 15 controlled substance prescriptions from 14 different prescribers, which had been administered in 15 different pharmacies in Kansas, and that improvements to K-TRACS thanks to a grant had helped. significantly reduce this suspicious behavior of the patient.
According to the Kansas Board of Pharmacy, the number of patients with screening thresholds increased from a record 300 in September 2013 to 118 in December 2013.
The Kansas Board of Pharmacy and KDHE are collaborating on an initiative funded by a CDC grant to integrate K-TRACS with the electronic medical records of health care providers. The integration saves an average of four minutes per patient because providers do not have to connect to separate systems. Thirty hospitals and 127 pharmacies are integrated.
Eric Voth, vice president of primary care at Stormont Vail Health, said the fight against the opioid crisis requires a balance between conflicting demands. On the one hand, there are those who have a legitimate need for opioids. But the consequences can be serious when the drugs are misused.
Stormont Vail is participating in a national research project with the Centers for Disease Control and Prevention to study the effects of using electronic medical records to track opioid prescriptions.
The organization has integrated K-TRACS into its electronic medical record, thus allowing healthcare providers to easily access a patient's prescribing history. Stormont Vail also selects patients with detailed questions, administers screening tests and obtains informed consent agreements before prescribing opioids.
"You can not just restrain opiates," said Voth, "but in the same vein, there seems to be a clear trend toward addiction, it's really not wise to add opiates on it ".
The problem is much more complex than careless doctors prescribe too much opioids, Voth said, warning against excessive reactions that could harm doctors or lead to changes that could somehow harm providers.
"There are some vendors that are less active than others, no doubt, and there has been a lot of marketing, of course, but I've always felt that the vendors I was working with were very cautious and trying to do what is best for patients, "he said.
Treatment
The opioid crisis requires a holistic approach that takes into account the policies, funding, education, social factors and traumatic experiences of childhood, in three main stages: decreasing supply Opioids, decreased demand, and lifesaving, said Gianfranco Pezzino, head of strategy team at the Kansas Health Institute.
"There is no doubt at this stage that it is a brain disease and that it should be treated as such. This is not the result of bad personal choices, "he said.
Braman, of the Kansas Hospital Association, emphasized the need to increase access to addiction treatment services.
"Addiction is an illness, it's not a moral failure," she said.
Based in Salina, CKF Addiction Treatment treats approximately 2,000 Kansans a year at its outpatient treatment centers in Salina, McPherson, Abilene and Junction City, and is considering an additional 5,500 as part of a screening program at Stormont Vail regional hospitals and Salina. Treatment includes doctor's appointments, counseling and medications, and the CDC grant covers the full cost of eligible Kansans on low income. Lindsey Ray and Shilo Redger are two of those Kansans receiving CKF addiction treatment.
Ray had been opioid-addicted for about 10 years and became hooked after treatment for chronic back pain. A long-time dependent, initiated to cocaine by her father at the age of 14, Ray had been trying to stop using drugs multiple times when she had asked for it. help after the birth of his fourth child in 2013.
"After she was born, I realized that I did not want to live like that anymore," said the 33-year-old Stockton. "I did not know that there was a way out, I did not think I would ever get better."
She said that she had been using drugs throughout her pregnancy and was lucky that her baby was not being weaned.
"It's not something I'm proud of, but it's part of my story," she said.
In October 2014, she began taking Suboxone, which combines an opioid and an opioid blocker. She said that she was recovering well until her relapse after missing an appointment and stopped taking the medication. She is recovering and has been taking Suboxone for about a year.
"For me, it's a miracle drug, it has allowed me to lead a normal life, to be a good mother to my children and to be a good wife," he said. Ray, whose children are now 17, 15, 9 and 4 years old.
Drug-badisted treatment is controversial, critics claiming that it amounts to replacing one drug with another. Ray said that two of his siblings, who also fought addiction, were skeptical. Since she saw her sober, they started treatment, she said.
Shane Hudson, CEO of CKF Addiction Treatment, said that if Suboxone patients were physically dependent on the drug, it allowed them to overcome the chaos and negative effects of addiction and find balance and stability in their lives.
"I do not use it to smash me," Ray said. "I want to feel normal, and people do not understand it.I had already so damaged my brain because I was an opiate."
Opioid addiction has also gone through Shilo Redger's family, including his grandparents, parents, aunt and uncles. The 29-year-old Plains woman recounted that she had begun to fight opioid addiction among her teenage girls after surgery and whether or not she was receiving treatment. She also battled methamphetamine addiction.
Redger said her traumatic experiences contributed to addiction and that she had her share of problems, including a series of health problems, the sudden death of her fiancé of carbon monoxide poisoning and the loss and the recovery of custody of his two sons aged 10 and 7 years.
She has little confidence in doctors, who she says "distributed (opioids) like sweets". Redger believes that Suboxone saved her life, but she added that she hoped to end up taking her meds.
"I do not like the fact that I still feed this monster of pharmaceutical companies," Redger said. "It's ridiculous, they have their hands in the pockets of every American in this country."
She points to two needs that she sees as disadvantages of dependency and keys to recovery: a spiritual connection with God or a higher power, and close social bonds, especially with the family.
"Nobody wants to talk about addiction, everyone has it, but nobody wants to talk about it, nobody wants to take care of it," Redger said. "Almost all families I know have been affected by these drugs one way or another."
Jonna Lorenz is an independent writer. She can be contacted at [email protected].
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