creating a soft place to land: supporting families of the opioid epidemic
TRANSCRIPT
CREATING A SOFT PLACE TO LAND: SUPPORTING FAMILIES OF THE
OPIOID EPIDEMIC
Stefanie Anne Oka
Professional Artist/Owner
Paintings by Stefanie
Mindi Spencer
Associate Professor
University of South Carolina
• Current state of the opioid epidemic
• Connecting opioid addiction to Adverse Childhood Experiences (ACEs)
• Addiction as a family disease
• Trauma-informed approaches to prevent and treat opioid addiction
PRESENTATION OBJECTIVES
USING THE PAPER AT YOUR TABLES....
• Think about the times in your life when you felt truly ALIVE
• For 30 seconds, write down words (one per sheet) that remind you of that feeling – people, adjectives, places, etc.
• Fold or roll each sheet of paper and place it inside the bottle at your table
NOW IMAGINE THAT ALL OF THE THINGS THAT YOU ASSOCIATE WITH FEELING ALIVE ARE SUDDENLY TAKEN AWAY….
• What would such a loss feel like?
• What would you do to get that feeling back?
• Would you risk something?
• Give something up?
• Do something that would likely cause you harm?
• Harm someone else?
DRUG CLASS ORIGIN DRUG NAME
Natural
opiates
Alkaloids in the
opium poppy plant
• Morphine
• Codeine
• Thebaine
Semi-synthetic opioids Created from natural
opiates
• Hydrocodone
• Hydromorphone
• Oxycodone
• Oxymorphone
• Diacetylmorphine
(Heroin)
Fully synthetic opioids Chemically made
• Fentanyl
• Methadone
• Tramadol
• Meperidine
OPIOIDS 101
• 1990s – Pain became widely-recognized in the medical field as the “5th vital sign“ (Foreman, 2014)
• 1996 – Perdue Pharma launches its marketing campaign for OxyContin (Van Zee, 2009)
ADDICTION BY PRESCRIPTION
• Where did the epidemic begin?
• When did policymakers start paying attention?
From left, Howard R. Udell, the top lawyer for Purdue Pharma;
Dr. Paul D. Goldenheim, the company’s former medical
director; and Michael Friedman, Purdue’s president.
Photographs by Don Petersen for The New York Times
• Purdue Pharma agreed to pay $600 million in 2007 to resolve civil and criminal charges of “misbranding”
STRATEGIC TARGETING OF DISTRESSED COMMUNITIES
THE U.S. EPIDEMIC (IN 2015)
• An estimated 2 million people have a substance use disorder related to prescription opioid pain relievers (CBHSQ, 2016)
• Of those patients who are prescribed opioids for chronic pain…
• 21 - 29% misuse them (Vowles et al., 2015)
• 8 - 12% develop an opioid use disorder (Cicero et al., 2014)
• Transition to heroin due to low cost and availability (NIH, 2016)
• An estimated 591,000 suffered from a heroin use disorder (CBHSQ, 2016)
• Approximately 4-6% who misuse prescription opioids transition to heroin (Cicero et al., 2014; Muhuri et al., 2013)
• About 80% of people who use heroin first misused prescription opioids (Muhuri et al., 2013)
THE U.S. EPIDEMIC (IN 2015)
OVERDOSE DEATHS INVOLVING OPIOIDS IN THE U.S. (2000-2015)
More than 33,000 Americans died as a result of an
opioid overdose in 2015 (Rudd et al., 2016)
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Total Female Male
Source: National Center for Health Statistics, CDC Wonder
OVERDOSE DEATHS INVOLVING OPIOIDS IN THE U.S. (2000-2015)
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000 Total Female Male
OVERDOSE DEATHS INVOLVING HEROIN IN THE U.S. (2000-2015)
Source: National Center for Health Statistics, CDC Wonder
HOT OFF THE PRESS!
Available at: https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html
LIFESPAN IMPACT OF ADVERSE CHILDHOOD EXPERIENCES (ACEs)
Mechanisms by which ACEs influence health and well-being
• Individuals reporting 5+ ACEs are…. • 3x more likely to misuse Rx pain medication
• 5x more likely to engage in injection drug use (Quinn et al., 2016)
• 80% of patients seeking treatment for opioid addiction have experienced at least one ACE (Sansone et al., 2009)
• Individuals with ACEs are more likely to report chronic pain and take Rx pain medication (Davis et al., 2005)
ADDICTION, OR “RITUALIZED COMPULSIVE COMFORT-SEEKING”?
NEONATAL ABSTINENCE SYNDROME
• Overall incidence has increased almost 300% during 1999–2013 (Ko et al., 2016)
• 1.5 6.0 cases per 1,000 hospital births
• In WV, 33.4 per 1,000 births
NAS incidence rates for 25 states, 2012–2013
ACE
ACE
ACE
ACE
ACE
ACE
ACE
ACE
ACE
• Direst exposure to opioids (Allen et al., 2017)
• Declines for all age groups < 20 between 2000 – 2015
• 6/10 exposures were children under age 5
CHILDREN AND ADOLESCENTS
• Addiction chaos in the child’s social and physical environment
KINSHIP AND FOSTER CARE (GENERATIONS UNITED, 2017)
• 2.6 million children are
being raised by kin
• 30% (127,819) of children in foster care are being raised by kin
• For every 1 child in foster care with kin, 20 are being raised by kin outside of the system
• Numbers are increasing
USING RESEARCH ON ACES (CAMPAIGN FOR TRAUMA-INFORMED POLICY AND
PRACTICE, 2017)
1. Create “programs to prevent exposure to trauma (primary prevention) and to promote resilience in groups put at risk by exposure to adversity (secondary prevention).”
2. “Use trauma-informed treatment approaches to help existing addicts recover and return to productive lives.”
SUPPORTING CHILDREN AND FAMILIES: EDUCATION
• Collect and use data on ACEs to select and implement prevention programs and drive local decision-making (SAMHSA, 2017)
• Educate the public about addiction to decrease stigma about the disease
• e.g., medication-assisted treatment (MAT)
• Consider the family unit instead of the addicted individual as the “unit of service” (White & Daley, 2016)
SUPPORTING CHILDREN AND FAMILIES: PROGRAMS
• In 2016, the National Institute of Drug Abuse published a guide that includes several trauma-informed, evidence-based programs
• Based on the 7 Principles of Substance Abuse Prevention
• Available (free) online
SUPPORTING CHILDREN AND FAMILIES: POLICY
• Consider harm-reduction public health strategies to “keep addicts healthy” (e.g., needle exchange, MAT, life-saving emergency Narcan)
• Elevate and promote trauma-informed, evidence-based prevention and treatment for the entire family
• Decriminalize addiction
• Support and empower kinship caregivers in the foster system