 Smacked by the Storm Event Banner We recently attended an informative event at Adelphi University that offered a lot of important information on prevention, treatment and recovery from the personal and public health crisis that is opioid addiction. It was based on Jeffrey Reynolds' TEDx talk "Smacked by the Storm" , which discussed the opioid epidemic and how we can achieve the care and skills needed to navigate through this crisis.
The TEDx talk is down to earth, evidence based, and forward looking. We’ve seen it at least three times and will watch it again. The speakers on the various panels were passionate and knowledgeable. Dr. Reynolds, himself, emceed the event. “I wish things were better now than when we did that talk,” reflected Jeff. “In some ways, unfortunately, things are worse.” Jeff talked about the rise of Fentanyl, which makes Heroin look tame. On the brighter side, he pointed to the value that Long Island’s first Recovery Center has brought, in term of access to treatment and follow up care. He also expressed gratitude for the numbers who are taking this situation seriously, crafting meaningful efforts and establishing diverse partnerships, including the one with Adelphi. Dr. Reynolds then warmly introduced Nassau County District Attorney Madeline Singas, who has made dealing with the drug epidemic central to her administration. Keynote Speaker Madeline Singas, Nassau County District Attorney Ms. Singas emphasized that Nassau County, and the Nation as a whole, is in the middle of a drug crisis of unprecedented magnitude. While we cannot arrest ourselves out of this problem, strong enforcement to crack down on dealers and distributors is critically important. She is proud that forfeited funds from these arrests have been directed to mapping out comprehensive solutions, including education and getting people into treatment. Singas reflected on her earlier experiences during the crack epidemic, the junkies she had met then, and how the population affected by drugs like heroin is no longer simply that fringe. The opioid epidemic knows no class, culture, race, gender, age or zip code. Opioid overdose is now the leading cause of death for individuals under 50 years of age, taking more lives than car accidents and guns combined. She further reported that life insurance policies have now lowered life expectancies due to the opioid epidemic, essentially nullifying the impacts of advances in medicine and understanding of healthy lifestyles. In Nassau County in 2010, 82 people died of an overdose. In 2016, that number more than doubled, to 195. Last year, 348 people were taken to the Emergency Room for overdose. 3000 were admitted into treatment programs. “This crisis affects EVERYONE,” emphasized Singas, “Our Emergency Service Providers are CONSUMED with responses to these types of calls. All police and emergency service providers have Narcan. Some are administering it to the same people two, three, four times per month.” She noted that Fentanyl is 50 times more potent than heroin. It’s also cheaper, with 2-3mg (enough to cover Lincoln’s head on a penny), being fatal. People touch it and overdose. It gets laced in marijuana and cocaine. In 2012, three people fatally overdosed on Fentanyl. In 2016, 39 died. The opioid epidemic is at the crossroads of public safety and public health. She said, “It is nonsense to arrest addicts. It makes every kind of sense to arrest drug dealers and to take down criminal enterprises.” Not only does arresting addicts fail to solve the problem, it exacerbates it. Singas spoke passionately about the need to overcome the stigma of addiction and ideas about moral failings, and to recognize that addiction is a disease and that these drugs physically change brains. Especially in young people. She discussed work with doctors and how that culture has changed due to overprescribing/overfilling laws. In recent years, prescriptions for the top three killer drugs has dropped more than 6%. She is now pushing for other laws. For example, although heroin is much more potent than cocaine per gram, the drugs are treated the same. This allows people to effectively be carrying more heroin and yet receive a lesser sentence. A major focus for Singas is stopping traffic at its source. She noted that most of these drugs come from China, Mexico, and out of state. Taking down entire enterprises is resource intensive, but is far more effective than arresting individual, highly replaceable small-scale dealers, “We HAVE to go to the top and make it very uncomfortable to do business.” She reported that in April the 110 Crew was apprehended, constituting one of the largest take-downs in Long Island history. In May, over a million dollars’ worth of heroin and cocaine was taken off the street. Last week they caught 17 individuals who were smuggling drugs from Arizona to JFK Airport, using Nassau County as a hub from which to move drugs north to places like Syracuse and south to Maryland. Speaking about related forfeitures, Singas proudly reported that they had directed $650M of seized funds to the Maryhaven Center of Hope – New Hope treatment center Unfortunately, New Hope cannot treat adolescents, so they have issued a request for proposals to help establish crisis intervention facilities for addicted Nassau County adolescents. Singas spoke about the Nassau County Heroin Prevention Task Force, which monthly convenes diverse stakeholders including individuals in recovery, parents, teachers, treatment professionals, law enforcement, community members, and others. She also talked about going to schools and working with them to bring families to hear from police officers, as well as offering nurses and others training by drug recognition experts so that they can better identify and solve problems while they are small. She encourages parents to put drug avoidance on the same or higher level than other things they tend to emphasize. Yes, the college they apply to, the score on the SAT, the sports team they choose to play on is important. Still, what happens Friday night can have much bigger impact on a kid’s future. One way arresting does help solve the problem, noted Singas, is through diversion programs. Individuals do get forced into treatment through plea deals. Often, people do well with these programs. Still, while this can help and while cracking down on dealers is paramount, Singas emphasized strongly that the message to families and afflicted individuals has to be clear: “We’re here to help.” Keynote Speaker: Linda Ventura, Thomas’ Hope Foundation Emphasizing the importance of mothers in making things happen, Dr. Reynolds recalled a meeting with a legislator who wasn’t entirely focused on the subject at hand: Improving access to treatment for opioid addiction. A major issue is that many insurance companies want people to “fail out” of outpatient treatment before they will cover more intensive services. Jeff remembered how an attendee finally got the official’s attention. She took a Tupperware container out of her purse and put it on the table. “Meet Thomas,” she said. “They told him to fail out of outpatient services first. Can you help him now?” Since losing her son to addiction in 2012, Linda Ventura has become the founder of Thomas’ Hope Foundation. According to their website, they are “dedicated to promoting drug addiction awareness, prevention, and achieving victory for those individuals seeking sobriety through education, advocacy, research and treatment. Ms. Ventura shared the story of her son, a gifted athlete and excellent student whose difficulty in dealing with multiple crises in his life spiraled out of control once he tried drugs. She shared a little bit about the impact of his disease and death on their family, as well as her personal mission to prevent as many people as possible from joining this “club” of grief. Her bottom line: EVERYONE needs to be engaged in prevention and treatment EVERYONE needs to be given skills and support, starting at age 5, if not sooner! This is about addiction. This is about so much more than addiction. This is about learning to survive and thrive in the modern world. We need to work together. PREVENTION PANEL Jamie Bogenshutz, LCSW, R, CASAC, BCETS, Executive Director, YES Community Counseling Center Ms. Bogenshutz explained that prevention takes on many faces. She doesn’t believe it starts at 5 years old. Rather, she finds it essential that we start in infancy, letting babies know that they are loved. Unconditionally. Love and emotional support, she explained, is a key protective factor. Yes, there are many risk factors including genetics, our environment and social relationships. All of these are lessened when we instill in kids effective decision making and coping strategies. Why do people take drugs? Because they take away pain. Many addicts are responding to physical and/or emotional pain. Unfortunately that benefit is sharply limited and long term consequences are devastating. We need to develop and to teach other more effective coping strategies. She emphasized: REACH OUT AND HELP. We need to talk about addiction because:
Judi Vining, Executive Director, LONG BEACH AWARE Ms. Vining emphasized that prevention is a community affair. We need to be mindful of the messages we send, to acknowledge that addiction is a disease, and to understand that prevention is a science. There is evidence-based curriculum that has been shown to work. Unfortunately, out of the 3-4 million people in the US between the ages of 5 and 20, only 30,000 are exposed to it. We can do better. She expressed frustration with parents who express relief that their children are “only” involved in marijuana and alcohol. The statistics, she noted, indicate that a person who drinks regularly (i.e. 2x per month) at 15 years of age is 40% more likely to have problems with substance abuse later on. Furthermore, studies also show that the single most reason that kids abstain from drugs and alcohol is that they don’t want to disappoint their parents. Parents may not believe this, but they should know it. So, she advised, take the medicines out of the bathroom cabinet. Mark the liquor bottles. Above all, let them KNOW you are watching. Lisa Ganz, LCSW, CASAS, Clinical Director, LI Council on Alcohol and Drug Dependence Ms. Ganz reported that LICADD works in one way or another with over 90 schools across Long Island. She agreed with others that shuffling 500 kids into a yearly assembly doesn’t qualify as prevention. Prevention, she emphasized, is about learning to navigate our world today. It’s about navigating the conflicting and often damaging messages of culture and media. It’s about overcoming the drive for instant gratification, to consistently overschedule, and to neglect self-care. It’s about learning how to deal with the news – our kids are highly educated, with extraordinary access to so much information that they don’t know what to do with! How do we learn to enjoy life, to learn that it’s okay to enjoy life, without needing an escape? These kids grow up on social media, which tends to be a shallow, scripted and judgmental forum for relationship building. How do they learn to deal and to communicate, in real time, in a world where everyone seems expected to perform? How do we teach kids to build deep, supportive relationships? To identify, process and discuss difficult feelings? To make good decisions under pressure? To take breaks in order to mentally and physically recharge? Academics are important. This may be even more so. We need to teach teachers (and parents and others) how to teach kids about how to deal with life on a daily basis; how to cope in a terrifying world and to realize that it’s not so bad if we can learn to take care of ourselves and those around us. This is not a one-shot deal, she emphasized, “It’s like lipstick or deodorant -- You have to keep applying.” TREATMENT PANEL Moderator: Jeffrey Reynolds, Ph.D., CEAP, SAP, President and CEO of Family and Children’s Association (FCA); Anthony Rizzuto, Families in Support of Treatment (FIST); Claudia Ragni, CASAC, Director and Owner, Kenneth Peters Center for Recovery; Audrey Freshman, Ph.D., LCSW, CASAC, Director of Continuing Education & Professional Development, and Postgraduate Certificate in Programs in Addiction, Adelphi University A primary message from panelists was that the starting point in treatment is not necessarily the individual; that effective recovery occurs in systems of family and people who care about people. If someone calls concerned about someone, we should start by working with them. Often, families are mandated to participate in treatment. This is especially the case when dealing with individuals under 26 years of age who remain dependent on their parents. Additionally, drug addiction cannot be treated in isolation. Other mental health issues need to be treated in conjunction, and complete medical evaluations should be conducted. Environmental factors must be considered. Patients must be committed to a long term endeavor, as with any chronic illness. A major challenge is that overcoming addiction often requires more intensive treatment than insurance companies will pay for or that people can afford. It was felt strongly that medicine can be an appropriate intervention. Do we sometimes replace one addiction for another, such as with Methodone? Yes….still, if it succeeds at significantly increasing quality of life, it should not be dismissed. Other drugs, such as Suboxone, can be poorly prescribed, but if administered properly to the appropriate patient, it can make a difference. Vivitrol, an opioid antagonist that basically makes it impossible to get “high” is another tool. Patients and families should research the quality of services they are receiving. Unfortunately, there are predatory, for-profit entities who are more interested in exploiting this crisis for monetary gain than they are committed to providing quality service. Treatment is both an art and a science. Choose your service provider carefully and make sure they are using evidence-based treatment methodologies. Additionally, it was expressed that practitioners should be aware of their own limitations as professionals, and know when to recommend other help. Panelists discussed the need for broader definitions of recovery, which may involve a long term process, ups and downs, and possibly long-term medication. Yes, relapse is common, but not all relapse is the same between or even within individuals. Further, abstinence does not necessarily mean recovery. With adolescents, we must be mindful that we are dealing with brains that are still developing, and whose development may be impacted by the substance abuse. Yes, there can be substandard care. Still, the bigger problem is insufficient funding that yields insufficient treatment. Particularly given the individualized nature of these cases, panelists felt that qualified professionals should determine courses of treatment, not insurance companies. If you had $10m to spend…what would you do? Audrey Freshman suggested a major campaign to shift the definition of when these problems start, recognizing that trauma can be transmitted across generations and that at ages 0-5 we can start to identify risk factors. She also noted that need for controlled environments doesn’t end in high school. She would invest in sober colleges and other safe, secure environments for individuals in recovery. Claudia Ragni echoed the desire to invest in sober high schools and colleges, as well as in more entities like “New Hope” where people can access care. She would love to see a LICADD in every community offering accessible prevention, treatment and recovery services. Anthony Rizzuto agreed that money should be split across prevention, treatment and recovery. He would love to see Urgent Care centers designed for addicts that are easy to enter, with trained doctors and nurses on hand who can get people into treatment without delay. RECOVERY PANEL Robert Evans, Recovery Coach, Beneath the Surface Life Coaching, Inc. explained that he’s an adult child of abuse who has experienced treatment since he was 13. He message was that, especially when one’s family is struggling, it is hard to acquire the necessary skills to maintain recovery without a lot of time. He felt strongly that he needed to be closely monitored in order to get healthy enough to be able to begin to take charge of his own life. Krystal Stoddard, Peer Advocate, THRIVE reported to applause that she has been clean since 2014. She emphasized that, when a person comes out of treatment, the fog is just beginning to lift, and that people need access to continual care, be that a 12-step program or something else. Richard Buckman, LCSW, CASAC, CEAP, SAP, CETII, CARC, Founding Member, LI Recovery Association agreed that skills require development. Further, he noted that folks need to be able to recover in their own communities and that building recovery-ready communities is important. He emphasized that help should be available no matter what stage people are at, mentally, be they thinking about whether they have a problem, are contemplating how to get help, or are ready to receive it. Further referring back to treatment, he noted medication can be very helpful, but people who are on it often then find that they can’t get housing. He wished that legislators had had greater foresight, reflecting that an unintended consequence of legislation making it harder to get pharmaceuticals was that it spurred the heroin epidemic as those addicted sought anything they could find and afford to ease their pain. He noted that, since 2012, prescriptions have gone down incrementally each year. At the same time, overdoses are up. Dealers seem to be learning that killing their clientele isn’t good for business, but that’s certainly not enough. A final issue was broadening our ideas of what life in recovery means. 12-step programs can be highly effective. Still, while 23 million people live in recovery, only 3 million participate in programs like Narcotics Anonymous. We have to look at what’s working for those other 20 million and see how we can tailor those findings to diverse individuals. Robert Evans spoke about the prevention program his organization is pitching to schools. It involves 22 encounters per year, almost like a weekly class, and offers a diversity of elements that can help foster an environment conducive to sobriety. Krystal Stoddard spoke about the THRIVE recovery community and outreach center, different pathways to recovery, and how effective support involves the mind, body and spirit. She emphasized the power of peers helping peers, and how meeting others who have overcome these challenges offers hope. What would you do with limitless funds? The recovery panelists shared desire for many of the items on the treatment panel’s wish list, agreeing that prevention, treatment and recovery each need substantial investment. Specific desires included sober schools and colleges, urgent care facilities designed to help addicts, and more recovery centers that are accessible even if one doesn’t have a driver’s license. Access to adequate care without the challenge of insurance companies was also mentioned. Wouldn’t it be nice if money wasn’t an issue? One thing added was housing for folks in recovery, especially for young people on medication who can’t get housing due to that stigma. Richard Buckman referred to an out-of-state pilot program that involves a full-recovery community, including a factory where people work. He noted that there are many things we can model; that other states do better than NY, especially with the reentry from prison population. If 80% of folks in prison have a substance abuse issue, we should think about what that means and how we can improve outcomes for the individual, their family and society as a whole. CLOSING – ACTION ITEMS Dr. Reynolds implored attendees to do what they can to take responsibility. “Look in your own home. Look at your own life.” If you are a parent, show up at School Board Meeting and ask: “What exactly are we doing about this issue? Are our responses Evidence-Based?” If a candidate for office comes to your door, advise them that we are facing a singular issue that is affecting our public health, our public safety and our economy. What are we doing about it? Jeff noted that New York State seems to have finally awakened to this crisis and is now firing on all cylinders. Still, we can do more. On the Federal side, we are taking serious blows. All of these budget cuts make a huge impact. Although some will tell you that there are new initiatives, even the Recovery Act is only 70% funded. Cutting health care benefits, especially kids’ access to medical care and food stamps is a huge mistake. Changing the Affordable Care Act for the worse is a huge mistake. Together, these cuts compound and will have a serious impact. Still, he noted, in politics “There are no permanent friends. No permanent enemies.” Talk to your representatives. Help them see the light. The bottom line, he explained, is that people need people. While systemic initiatives are important, nothing compares to taking individual initiative to help people we love. If you know someone you’re worried about, look them in the eyes and say, “I care and I’m concerned” The first five times you do it, they’ll tell you you’re full of it. Then they’ll probably get mad Keep going. Trust your gut. It helps.
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