Addiction Deja Vu
Too much of my work in healthcare, over the past six years since founding Oxeon Holdings, happens behind my desk, at a conference table, on a phone, video conference or airplane. It would be easy to lament that fact, but recently as the business has matured and my great colleagues have continued doing great work, I increasingly get to spend 1 on 1 time with the people who we are ultimately trying to make healthier. When this happens, it makes all the other times worthwhile and over the past two weeks, this has happened twice. What converged was a societally-frightening Déjà vu experience.
For those who don’t know me, I grew up in a small college town in New Hampshire. Hanover is home to Dartmouth College and as a result, the town sees many of the benefits of most small and rural college towns. When I grew up, I was surrounded by other kids of college professors, doctors at the medical center or people benefiting from the opportunities found in the economic boom of a small college town. Hanover is one of many Upper Valley communities that benefit from the presence of an institution like Dartmouth. However as you get further from the campus into towns like Lebanon, West Lebanon and others, the positive effects of the University start to lessen.
Lebanon, one of the bordering towns, was always more of a working-class community than idyllic Hanover. Hanover’s quaint Main Street, dorms and large lawns embodied the archetype of a quintessential New England college town. Lebanon’s did not. I recall preppy Hanover kids, largely influenced by the famous musical and movie that came out during my youth, referring to Lebanon kids as “Greasers”. They were always a tough sports rival for the preppy teams from Hanover; games of soccer and hockey were filled with yellow and red cards, the penalty boxes were always full. We looked forward to these battles all year and the bruises and bragging rights lasted almost until the next get-together. Deep down, while we referred to them as Greasers, we respected their grit and feared getting our asses kicked by them. It was that type of dynamic.
During this period, what I never saw nor heard about across the entire Upper Valley was a culture of hard drugs. But today, the region is ravaged with drug problems, particularly opioids including heroin, fentanyl and the full range of other prescription drugs. Lebanon worse than Hanover, but Hanover, with its affluence and education orientation, is not escaping the scourge. In quaint Hanover, there are hundreds of arrests and multiple deaths from opioids each year.
Last week, I had the opportunity to spend time at Groups, an opioid rehabilitation clinic outside of my childhood hometown. Steve Kraus and I spoke to Dr. Jeff DeFlavio, the founder and CEO of Groups and he was kind enough to facilitate a conversation for us with people recovering from opioid addiction. We are proud to release those conversations in an unedited A Healthy Dose podcast.
Today’s epidemic often starts with a doctor’s prescription and impacts many different ethnicities, genders, communities and socio-economic levels. During our conversation at Groups, we spoke to three people recovering from opioid addiction. All three were white. Two were women and all three were parents of young children. We heard stories of losing their kids to child protection services and showing up at custody hearings moments after overdosing on heroin. We heard about the struggles to get their kids back while battling the struggles of staying away from the reasons they lost their kids in the first place.
One woman’s addiction started with medicine prescribed after a C-Section. Another’s started after watching her brother and his girlfriend be murdered by their friend. Reduce. The. Pain. Physical Pain. Emotional Pain. All three had spouses and/or parents who were addicted. One was now a manager of a business, twice promoted since getting clean last year and helping his employer deal with the rash of other employee addictions.
Two out of three had sold drugs to fund their addictions. All three had progressed to multiple different drugs (crack, meth, heroin, cocaine and others.) All three had faced death themselves, through drug use or suicide. All three had saved their loved ones from death and watched as other loved ones suffered less fortunate fates. 50% of their “using friends” were dead or incarcerated. All three indicated that they could walk outside the Groups facility, in downtown Lebanon NH, and find opiates in less than 5 minutes.
Pain. It struck me that the world we live in today can be overwhelming painful. Jobs are very difficult to come by. Food is often not food, leading to explosions of obesity with the emotional and physical pain that comes with this condition. 24 hour news, available everywhere you look, perpetually reports on a divisive society; mistreatment of women, racism, gun violence, threats of war, political bullying just to name a few. Our education system is either not sufficient or is driving our youth to deep anxiety and depression from the stress. Our sports are too stressful, too painful or too political. And all the while, we have come to stare down at our phone. We escape by opening Facebook, Instagram or other social media outlets where people perpetually and almost exclusively post pictures of their happiest and prettiest moments, reminding us that we are either not there with them or that we are not living the same life. Pain. In today’s America, pain is pervasive and opioids offer an alternative escape, often endorsed by someone in a white coat.
I walked away from the conversation with Dan, Christy and Kailah deeply honored that they shared their stories with us. I found myself hopeful but nervous that they would stay clean of drugs; recidivism is sky high with opiates and the drugs run deep in their families and immediate communities. Driving down Interstate 91 that night, a drug superhighway through New England, journeying from my childhood home in the Upper Valley to my adult home in New York City, I couldn’t stop myself from mentally extrapolating the future societal impact of Dan, Christy and Kaylah’s health care challenges combined with the challenges passed on to their addicted and non-addicted children and their families as a result of the addictions. We spoke with three people, but how many others are there across the country? How many kids born addicted? How many opioid orphans? How many co-morbid conditions? How is our society going to provide healthcare to this “Opioid Generation” while trying to provide healthcare to every single other American?
Those thoughts that consumed me on the drive home came face to face with the future this past Tuesday in New York City. An odd form of Addiction Deja Vu, so to speak.
Two days ago, the Oxeon team here in New York City conducted part of our “Quarterly In-site” by cooking and serving an early Thanksgiving dinner at a Medicare/Medicaid driven Managed Care facility. VillageCare provides care and education to poly-chronic patients, all struggling with HIV/AIDS.
For reasons known to my family, I was assigned to the “serving” team versus the “cooking” team. While serving big plates of food, I had the opportunity to sit and talk to various VillageCare members and I spoke with two men, one 70 and the other 59, both long-term members of the program. One was African American and the other was Hispanic. Both had been long-term recovering drugs addicts; heroin, crack, cocaine and others. Both had relapsed multiple times. One had spent 27 years in jail and both had contracted HIV/AIDS from the lifestyles they had led earlier in life.
I thought back to a particular insight I’d gleaned in New Hampshire the week prior that today’s crisis is the second major opiate epidemic in the United States. The first received far less mindshare. This is because it was characterized as an “urban” problem which is code for; street heroin afflicting African American men living in the inner cities. By all accounts, it gained far less attention and focus than the current opioid crisis.
That said, the similarities in the stories of the two people I spoke with in New York struggling with HIV/AIDS but now past their drug addictions and those I spoke with in New Hampshire, still really struggling to stay sober, was staggering. The major differences were that the two New Yorkers were minorities, living in cities and now “senior citizens”, existing throughout their adult years fighting to stay off drugs and fighting the health conditions they contracted while on drugs. The three in New Hampshire were white, living in rural communities and facing 30 plus years of life as recovering addicts, the existence that the VillageCare members had been living in New York City. I realized that I left my childhood hometown 30 plus years ago and I found myself thinking across the depth and breadth of that time horizon; 365 days multiplied by 30 years. Where I emerged from that time scan was scary as I found myself confronting the reality for Dan, Christy and Kailah; a reality filled with medical illness, massive pharmaceutical product consumption, potential relapse, behavioral health issues and many other direct results from addiction.
That process has blown my mind as I have been trying to come to terms with the overall impact on our 21st century healthcare system from individuals and extended families recovering from opioid addictions and the myriad health issues that result from the addiction. This opioid crisis is affecting people living in rural communities where population densities make it hard to create businesses that have viable economic models to ensure their sustainability. It is affecting people who have employment situations that may not pay for the necessary care or where they cannot obtain the best possible care; Lebanon residents have access to Dartmouth Medical Center but what about those in other parts of New Hampshire, West Virginia, rural Kentucky and elsewhere. How do we build products and solutions to treat this “Opioid Generation”? How do we manage their various health conditions over the next 30 to many more years of needing care (the opioid babies will require help for far longer than their parents)? What models can scale into rural communities; doing well and doing good at the same time? How does technology enable this community care delivery? What are the range of physical and behavioral care implications that will result from this epidemic?
I don’t have answers to these questions yet, but I hope to help find them. The people that I interacted with are sick. They are not criminals. They are not “bad people”. They are sick. They suffer from a type of illness. It may be behavioral or mental in nature, but it is an illness. It has consumed their existence and translates to their physical health, the health of their kids, and the health of their extended families and communities. They deserve care for their illness like those with cardiovascular disease, Alzheimer’s, Asthma and other chronic conditions.
A major challenge facing us, merely 17 years into the 21st century, will be solving the onset of addiction in the first place, the prescriptions and drugs are still available and from accounts in recent New Yorker and Esquire articles, the source of these drugs is doing everything to continue to profit from addiction, domestically and internationally. However, stopping the unaddicted from becoming addicted is only a small part of our challenge. Avoiding addiction will pale in comparison to the challenge of caring for opioid addicts and their families trying to recover. This will likely consume a sizeable part of our healthcare system for the rest of the century.
Let’s hope that the Federal and State governments, our institutional healthcare companies (payers and providers), the entrepreneurs as well as the recovering addicts all dedicate themselves to rising to this challenge. I encourage you, the reader or the listener to our latest podcast episode, to think about how we will rise to this challenge.
I also encourage you, if you are reading this or listening to our podcast and find yourself struggling with opioid use, to please contact me and I will put you in touch with people who can help.
Trevor
(Special thanks to Michael Cullen for his late night editing and support in writing this piece)
