Q/A
How one doctor is attacking Southern Colorado’s heroin problem from his SUV
Dr. Michael Nerenberg is taking on Pueblo’s heroin epidemic with few resources and just a couple of volunteers.
Dr. Michael Nerenberg thought he had seen it all during his more than 22 years as an emergency room doctor at Parkview Medical Center in Pueblo. The community activist, who retired in 2012, has made it his mission to combat the most destructive force he’s encountered in Pueblo to date: Black tar heroin.
On Tuesdays, Nerenberg volunteers at the Southern Colorado Health Network office in Pueblo, where he prescribes Vivitrol and Suboxone, medications that can help treat heroin addiction and dependence on other opiates.
Every Saturday afternoon, for a few hours, Nerenberg and a couple of his street-wise volunteers, operate a needle exchange service from the back of a white SUV in the parking lot of Bessemer Park in central Pueblo.
In an interview with PULP, the outspoken doctor talked candidly about the controversies surrounding heroin addiction and treatment, and how the disease of addiction has seized the local community in its destructive grip.
How did the needle exchange come about?
The last couple of years in the ER, we started seeing an increase in heroin overdoses. I hadn’t seen very many before, maybe half a dozen in the 22 years I worked there. It was around the time the State of Colorado started to crack down on prescription drugs.
All of a sudden, around 2010, heroin overdoses crop up.
After being appointed to the Pueblo County Board of Health, it was then that I noticed the second canary in the coal mine. That’s how I got into this. As a member of the Health Relations Commission, which is a quasi-government organization, I was asked to do a forum on mental health and decided to do it on drugs instead. I organized the first forum on heroin in town. There I met Lisa Raville who runs the biggest needle exchange in Denver. It took us about 10 -12 months from when we started to get accepted into the exchange program. We had to talk to law enforcement first. We got support from Mental Health America, the local community health center, city council and the county commission(ers). Everyone agreed that it was a good idea and that’s how the needle exchange started.
What is the purpose of the needle exchange program?
Access Point falls under the AIDS project. As part of our harm reduction activities, we do free testing for HIV and Hepatitis C testing, provide condoms and offer a syringe exchange service.
What do you think contributed most the heroin epidemic that started in 2010?
We had people come in 100 times per year — sick people don’t see their doctors that often. I don’t want to blame this person or that organization. Doctors were pushed. I blame the Drug Enforcement Agency, the state of Colorado and the feds. Patient satisfaction is one the big things they look at. That’s how they get paid.
What do your patients say about how the problem started?
I asked them what the problem was. When they cracked down on the pain med docs and took them out. What did they think was going to happen? The cartel knew about this — they pre-positioned themselves. With pills, you know how much is in it, it’s pharmaceutically clean and not mixed with anything. Big pharma does what big pharma does, they make money. This should not be a legal issue; it’s a health issue.
To me, the crucial first step in doing something about the drug problem is to legalize drugs. Legalize, regulate, control it that way, and use the money they are not spending trying to lock people up, for treatment that might actually work.
So then, how do you feel about the legalization of marijuana in Colorado?
I think marijuana is frankly a non-issue and has nothing to do with heroin. I’ve talked to two people about marijuana to heroin. One was a girl who got sent to prison for marijuana and found heroin there. The other was a high school kid who did marijuana in school, got sent to treatment, and found heroin there. (But) one of my Suboxone patients found out that marijuana stays in your system for 30 days and heroin will be out of your system for four days, so he switched.
I’ve never seen a heroin addict who started on marijuana.
How do patients end up coming to you for treatment?
I became a Suboxone provider. It alleviates the symptoms of withdrawal. I volunteer one day a week at the clinic. It’s not the ideal, but I’m about the only one in town that does this. Some are still referred; some are self-referred. There is not a typical case. We have people in the needle exchange program from every zip code in town. Out of 100, we started with, one stayed drug-free.
In your opinion, why do addiction treatments fail?
It’s too difficult to get into treatment. It should be as easy as showing up and asking for help and being accepted as opposed to the multiple steps and paperwork required to get in.
Drug addiction is a brain disease. Suboxone, like Vivitrol, is a time buyer. I have an 80-client waiting list, and I’m only allowed to take care of 30 patients at a time. I’m retired — I only volunteer one day a week. It took two months to get started because I didn’t have a counselor. I’m not an addiction counselor.
Is there a cure for heroin addiction?
Do you know what works? Heroin-assisted treatment. Have you ever seen a lazy addict? They spend their days trying to get money for heroin, hustling. They work all day long. They’re thinking “how am I not going to be sick today?”
There’s a stigma involved with addiction — misunderstanding — the notion that they’re weak and morally bereft. It’s not the drug. The drug makes you dependent. The definition of addiction is a compulsive behavior that you engage in despite the fact that it’s doing you harm.
Alcohol and tobacco are the biggest gateway substance to heroin. Marijuana might have been the first illegal drug they used, but it’s not the first drug they used.
It’s pills — that’s what they’re starting out on.
Do you have any figures for how the needle exchange program has grown?
We’ve doubled our intakes this year since last year. We started the last week of July 2014, and on the first day, we had one client. We had two clients our second day, maybe six or seven on the third and 20 by the fourth day. We average now about 100 a week. We’re open one day a week and then I do a walk-around Northern Avenue at Bessemer Park on Saturdays.
People ask me whether it’s because more people trust you or because there are more people using. That’s a question that no one has the answer to.
I talked to the chief of police, and he started ranting about marijuana. Marijuana is not the problem, heroin is. I have no position on marijuana in Pueblo.
How do you see the future of the addiction in Pueblo?
I think it’s a winnable battle if we start getting smart. If we keep doing what we’re doing, we’ll stay right where we are. They’re already building the next wave of heroin addicts. The newest thing is morphine.
How are you able to fund this operation?
Right now, all our funding comes from Southern Colorado Aids Project, with $20,000, a subsidiary of the Colorado HIV AIDS Project. Colorado sequestered funds for CHAP from the cigarette and tobacco settlement in the 90s. 15 to 20 percent of people with HIV in Colorado come from people who inject drugs.
The state sees needle exchanges as the entry point for when they want to seek treatment. Are they going to go the police who they’re hiding from, the doctors who were scared to help them in the first place or are they going to go to the people who have provided the outreach programs, who they trust?
We need to do more than we’ve been doing.
How can people help?
People need to understand that they should not base their opinions on simplistic solutions. Go to King Soopers and get Narcan and have it handy.
