#NPFopioids Day 1

I woke up earlier this morning than I have ever in my adult life: 4:30 a.m. My fiancé and I left just after 5 a.m. for the Yeager Airport in Charleston, WV. I was very nervous — I’ve only been on one other flight before. The flights from Charleston to Atlanta, then Atlanta to Baltimore were smooth sailing though! I got checked into my hotel and was amazed by the beautiful Baltimore view from my 11th floor room.

We kicked off Day One by meeting the other NPF fellows and program directors. Some of the other journalists shared some incredibly compelling stories of how opioid addiction has affected their communities and even their families. One fellow referenced a doctor in his town who faces criminal charges for overprescribing, which sounded remarkably similar to Dr. Michael Kostenko with Coal Country Clinic in Daniels, WV. He said some patients accuse the doctor of running a pill mill, while others praise the doctor’s curative practices.

“Addiction is a disease” is the overarching theme so far from the speakers. I learned so much from our first speaker, Dr. Leana Wen, Health Commissioner for the City of Baltimore @DrLeanaWen. She described a three-step process in which the city is fighting addiction and overdose deaths.

  • No. 1 — By providing every Baltimore resident with a prescription for Naloxone, a drug used to prevent narcotic overdose death. Wen said with more overdose deaths than homicides, the city had to act. Although there was some pushback from legislators who feared providing the prescription would cause more people to become addicted, the legislation was passed and Wen issued a blanket prescription for the city in October. She compares having Naloxone to treat an overdose to having an EpiPen to treat an allergic reaction — It’s literally a lifesaver.
  • No. 2 — By giving addicts the treatment they need, through medicine (such as Suboxone), counseling and wraparound services (such as food and housing). Dr. Wen agreed this step is a long term process, but the city is making progress through a 24–7 hotline for addicts, partnerships with police and prosecutors, as well as state funding for a Stabilization Center specifically for overdoses. She said the city also hopes to create more in-patient treatment centers.
  • No. 3—By educating city residents, patients and doctors. First, Dr. Wen said the city launched an educational campaign, dontdie.org, which provides information on how to get certified to administer Naloxone. (See handouts below). She also discussed a re-education of doctors on the amount of pills to prescribe. She agreed opioids can be beneficial to treat pain if taken appropriately, but she said when she was in medical school, appropriate pill counts wasn’t something she was taught. In the past, patients have also given doctor reviews based on their pain management (i.e. If the patient was in no pain, the doctor would receive positive feedback), which Dr. Wen said led to overprescribing in some instances.
Dr. Wen, right, asked two National Press Foundation fellows to help her demonstrate how to administer Naloxone, either intranasally or intramuscularly. Intranasally, the prescription is administered just like someone would use Flonase or nasal spray. The intramuscular method was also simple — the device actually comes with a pre-recorded message with instructions on how to remove the film and where and how long to apply it.
These handouts are part of the city’s education campaign to help prevent overdose deaths.

Our last speaker for the day, Dr. Stuart Gitlow, Executive Director at the Annenburg Physician Training Program in Addictive Disease at the Frank Foundation, discussed the psychological factors behind addiction.

“We don’t know what the disease looks like at onset,” Dr. Gitlow said, describing how drugs modify the brain. He, too, said addiction is a disease, but he went in-depth about the genetic predispositions some people have, and how childhood experiences can play a part in how we deal with addiction later on in life.

Some people simply find the world uncomfortable to begin with, he said. Those people take stimulators to feel how others normally feel. “There’s something wrong in the first place.”

He said there are options for treatment, including 12-step programs such as AA, dealing with the discomfort of having no medications through drugs like Suboxone, and a societal shift (i.e. How society now views smoking as “politically incorrect”).

Most people respond poorly to opioids, Dr. Gitlow said. Most do not like the fuzzy feeling they get from the drugs. But he estimated around 10 percent of people who try opioids describe the drug as “the best feeling they’ve ever had.”

To share a personal experience, I broke both of my ankles — one in 2012, the other just a year and a few months later. I was prescribed Vicodin and Percocet before and after my surgeries. I was in a lot of pain and I took the medications for about two weeks the first time (largely because my surgery was delayed a week so the swelling could go down), and about a week the second time. I was thankful for the pain relief, but I felt I was given entirely too many pills, 60 for each script, and a refill. I could have easily become one of the statistics, because I’m one of those people who felt, “This is the best feeling I’ve ever had.” I broke my ankles playing roller derby, but when I took one of those pills, my mind was completely at ease. I thought I’ll be back on the track in no time, no problem. It was the most peaceful feeling for about 30 minutes, until I drifted off to sleep, pain free.

I hope this overview was helpful. I’m already learning so much. I can’t wait to hear what our speakers have to say tomorrow. Please send me questions, comments, etc. via Twitter @WendyHoldren or via email wholdren@register-herald.com. See you tomorrow!