Overdose deaths in Michigan: What is causing them and what is being done about it.
Article by: Chief Executive Officer – Patrick McGinn – MS, MA, LLP, CAADC, CCS-M
I woke up this morning, turned on the news and discovered that yet again another person has been taken due to an overdose. I can only assume that this is an opiate type overdose, as that seems to be happening more and more each day. This past week alone there has been four overdose deaths that I am aware of in Northern Michigan alone. This is very alarming and leaves me with the question of what is next?
Last week a past resident of Harbor Hall made a post on our alumni Facebook page. The post was very inspirational and uplifting. This person stated that he was utilizing all of the tools, was going to meetings and had made excellent connections in the recovery community. Two days later he was found passed out in the bathroom of his place of employment. Narcan was administered but he was not revived. He was pronounced dead shortly afterward.
As I was writing my comments about the recent overdoses, I received a letter from a mother of a past Harbor Hall resident. In this letter she stated that her son had gained so much and understood what he needed to do to maintain a sober/clean life. When he left Harbor Hall he was happy, confident and strong. He had made tremendous growth. When he returned home he did not continue to actively work on his recovery. In January he overdosed and passed away. This mother stated that she has now lost two loved ones to the addiction and her daughter is in recovery today. I can only imagine the pain that this family is suffering as the result of addiction.
A Deadly Drug
I need to say something about the drug fentanyl as I believe that the recent deaths are related to it. According to the DEA Resource Guide on Drugs of Abuse (2017 ed). Fentanyl is a potent synthetic opioid drug that is approximately 100 times more potent than morphine and 50 times more potent than heroin. This drug has been around since about 1959. Over the past several years there has been a reemergence of trafficking, distribution and abuse of illicitly produced fentanyl. This has been associated with the dramatic increase of over dose fatalities. Fentanyl can be injected, snorted, smoked, taken orally, put on blotter paper. Illicitly produced fentanyl is sold alone or in combination with other substances like heroin, methamphetamine or cocaine and has also been identified in counterfeit pills, mimicking pharmaceutical drugs such as oxycodone. Overdose may result in stupor, changes in pupillary size, cold and clammy skin, cyanosis, coma, and respiratory failure leading to death. The presence of triad of symptoms such as coma, pinpoint pupils, and respiratory depression are strongly suggestive of opioid poisoning.
The disease of addiction is cunning, baffling and powerful. I have been in the addictions field for over 30 years now and I struggle to understand what the key is to a successful recovery. There are a wide variety of solutions. Some say that the 12 step program is the way, others may say it is church and others suggest that cognitive solutions are best. In his book “Slaying the Dragon” (2014), William White describes five models of treatment:
- The medical model that emphasizes genetics and neurobiological roots to addiction.
- Psychiatric model which views addictive behavior as self-medication of emotional distress or psychiatric illness.
- Psychological model viewing substance-related problems as consequences of maladaptive learning.
- Sociocultural model viewing substance related problems as consequences of a dysfunctional family, or peer socialization.
- Spiritual model that views these problems as the result of failed searching for meaning and purpose in one’s life.
I believe, as William White, that they are all true to one extent or another. Treatment interventions need to be designed to address all aspects of self.
Treatment Success is Different for Every Individual
At Harbor Hall we use our PIES model: Physical, Intellectual, Emotional, and Spiritual. However, when it comes to treatment, we could have the best approach in the world but the individual still needs to make a heart-felt, personal decision to do something different. Without that personal decision there is no amount of knowledge that will keep a person sober. Also with the decision is commitment, “are you willing to do what ever it takes to remain clean and sober?” This is an internal process, there is new learning involved but the process cannot be taught forced by external entities.
Recovery is Like Learning to Ride a Bike… Backwards
The video below is The Backwards Brain Bicycle. It is about 7 minutes long and it is worth watching. In recovery treatment, we ask the individual to change every aspect of themselves and to remain that way – essentially re-wiring their brains so that new, pathways are created that support healthy habits. This video demonstrates how longs it takes for an adult to learn something new, and how easy it is to relapse.
In recovery, we say practice, practice, practice and you will get it. Then one day something clicks in the individuals brain and we begin to see a change from the old behaviors to new. When an individual stops, or is inconsistent in his or her recovery process, the return to old behavior or old learning happens very fast. As in the video, what took eight months to unlearn how to ride a normal bicycle (learning a new habit), took less than an hour to revert to riding the bike the “normal” way (old habits). This scenario rings true about addiction treatment and an individuals ability to change through a process called neuroplasticity. I touched on this a little in a blog post about stigma.
So what does this have to do with keeping people from dying? Quite a bit actually but this is a very complicated problem.
It’s about Saving Lives
I would be remiss if I did not say something about Naloxone or NARCAN. Naloxone is a prescription medicine that is used to reverse an opioid overdose and can be administered by injection or nasal spray. https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio
Naloxone is safe and effective and has been used by medical professionals for decades. Opioids can slow or stop a person’s breathing and Naloxone helps the person wake up and continue breathing. Naloxone is a tool that can save lives. Pharmacist are being asked to educate people on how to administer and there is an effort to make NARCAN available without a prescription. (Photo: http://upnorthlive.com/news/local/ludington-man-saved-by-overdose-reversal-drug)
Michigan’s Good Samaritan Law
This relatively new, perhaps little known law states that during a drug overdose, a quick response can save a life. However, people illegally using drugs sometimes fail to seek medical attention during an overdose for fear of alerting the police to their illegal drug use. In order to prioritize saving lives, Michigan passed a Good Samaritan law in 2016. Michigan’s Good Samaritan law prevents drug possession charges being filed against those that seek medical assistance for an overdose in certain circumstances. This law makes saving lives the priority during a drug overdose, not criminal prosecutions of illegal drug users.
I implore all of us to be vigilant. This problem effects all of us. Some more directly than others but it certainly impacts our community as a whole. I do not want to see any more people dying. I believe that the solutions needs to involve all of us.
Butler Center for Research Articles
Below are two excellent fact sheets to understand some of the research and trends in this ongoing opioid crisis.
Prescription Rates of Opioid Analgesics in Medical Treatment Settings