MIAMI COUNTY — As several countries outpace the United States in such areas as education and health care, and continue to gain economic ground on our nation, America consistently outranks the rest of the world in one area: the use of highly addictive opioids.
When the words “opioids” and “addiction” are bandied about, most people’s minds conjure images of emaciated, hollow-eyed users of illegal “street” drugs, barely alive but somehow surviving to chase their next high, to pursue their next fix, which they will obtain by any means necessary. For many, “addict” and “drug abuser” are viewed as synonymous with “loser” and “lowlife.”
But the truth of the matter is that many drug addicts and abusers look like your friendly neighbor, a beloved relative, your coworker, the honor student who works part-time at your favorite coffee house. Like you and me.
In a 2016 report for CNBC, award-winning journalist Dina Gusovksy found that the U.S. makes up 5 percent of the world’s population and consumes approximately 80 percent of the world’s prescription opioid drugs.
As such, these users’ drugs of choice aren’t obtained via furtive transactions in sketchy neighborhoods, and their dealers aren’t menacing thugs working on the wrong side of the law. Quite to the contrary, they are authorized to use powerful — but legal — narcotics, prescribed in the antiseptic confines of a hospital or doctor’s office by a reputable professional, often to take the edge off post-surgery pain.
“Seventy-five to 80 percent of the stories I’ve heard started with painkillers prescribed after surgery, from wisdom teeth to sports injuries,” said Stacy Litz, a state-certified peer support specialist and patient advocate for Lighthouse Project in Dayton.
In addition to helping those who are struggling to overcome drug dependency, Litz herself is a recovering addict.
“My addiction started off with the legal substances — opioids — when I found out I was pregnant with my third child. In my second trimester, I was having extreme pain in my arm, neck and shoulders. I had two daughters, and it was nothing I’d experienced before,” she said. “It turned out I had a herniated disc.”
After delivering her son, Litz had the disc removed and was given a prescription for painkillers.
“That led me into full-blown active addiction. I started out with Oxycodone and graduated to 80 milligrams of Oxycontin. With each visit, I increased in either milligrams or quantity of pills,” she said. “I would go from doctor to doctor.”
Eventually, Litz found a way to make money off the drugs she accumulated. “In my addictive thought process, I believed I was helping people by selling them my prescription medication,” she said.
The immediate payoff was more cash in her pocket, but ultimately, she would pay a higher price: a conviction for drug trafficking in 2003.
“I did almost five years. I was incarcerated at the Ohio Reformatory for Women (in Marysville), then transferred to the Dayton Correctional Institution. During my time of incarceration, I got into Tapestry with Candace Paulucci,” Litz said, referring to the director of Therapeutic Community Development and Advocacy at the Columbus-based treatment program.
“The 15-month program helped me to learn whole new way of life, that I mattered — that’s what I teach my clients every day, they are a life worth saving,” she said.
Through cognitive behavioral therapy, Litz committed herself to getting — and staying — clean, and is now coming up on 10 years sober.
“At the time they’re using, addicts don’t think about the things they’re doing or have done. They just want to numb the pain, make it go away. Knowing there’s someone in their corner saying, ‘You matter’ helps them to get through that hurdle and that’s when they can find recovery.
“The work that I do today — I have worked with courts and corrections, sober living houses, detox centers … they’re stepping stones. I want to help others to live without drugs, to rediscover themselves and show them that we can be the person we always dreamed of being.”
The war wages on
As a recovering addict, Litz hasn’t lost sight of what the struggle was like for her as she helps others who are facing that same battle.
“It takes you over. You become completely consumed. When I think of addiction, it’s like going to war. You never come back the same; some don’t come back at all,” she said.
The ones who “don’t come back” include users who succumb to overdoses, along with users who move on to other, even more dangerous substances that are illegal but lower in price.
“I’ve heard so many stories about people who came to the point that they couldn’t get the pills anymore, so they went to harder drugs,” Litz lamented.
“I would say prescription opioid abuse starts out for most with drugs like Percocet, Vicodin; they start on the low doses, then they want more. A lot of my clients graduated to heroin, crack, molly. Some were stealing from their grandparents and even taking their dogs to the vet just so they could get pain pills.”
Moving on to other drugs is not an uncommon occurrence, according to the Centers for Disease Control and Prevention, which found that because of its cheaper price, heroin has become the drug of choice for many who are addicted to opioid pain relievers. Approximately three out of four new heroin users misused prescription opioids prior to using heroin, a CDC report states.
Also according to the CDC:
• Prescription opioid drugs contribute to 40 percent of all U.S. opioid overdose deaths.
• Prescription opioid overdose rates are highest among people ages 25 to 54 years.
• Men are more likely to die from prescription opioid overdose, but the gap between men and women is closing.
• Unintentional overdose deaths involving opioid pain relievers have more than quadrupled since 1999, and have outnumbered deaths involving heroin and cocaine since 2002.
Other pathways to pain relief
Litz is a proponent of non-addictive alternatives to pain management like, for instance, Exparel, a non-opioid pain reliever that works in the body directly at the surgery site, unlike opioids, which affect the whole body. Exparel contains a specially formulated local anesthetic that is designed to release into the body over a long period of time for lasting relief. Because Exparel works over time, the patient may need fewer doses of other medications, including opioids.
“It’s been FDA-approved and it’s been proven to work,” Litz said. “Yes, there’s a price difference, opiates are cheaper. But in the long run, it’s not cheaper for those who have to go into treatment, for people who’ve been burglarized or have to pay for a funeral.
“I’ve met too may people who had to lay their children to rest and too many children who had to lay their parents to rest.”
Kathryn Eten, a program administrator at Good Samaritan Hospital’s Orthopedic Center of Excellence in Cincinnati, is another advocate of non-opiate pain management.
“Traditionally, pain management has always been opioids, and the more pain, the more opioids and stronger opioids from pills to intravenous morphine. We have to develop new pathways, with multimodal pain management,” Eten said. ”My job is working with the surgeon to continually look for ways we can provide pain management without using opioids.
“Opioids should not be first thing given to patients. There should be a whole menu.”
Eten listed numerous alternatives for pain relief including cold therapy, injecting medication into specific body parts, ambulation, holistic medication and healing touch, and music therapy.
“There are multiple ways to deal with pain so that there’s less reliance on opioids,” she said. “Messages go to the brain in different ways. The more you scramble those methods, the difference in the way your brain receives the message.”
The uphill battle for non-opioids
As Litz stated, non-opioid alternatives tend to be on the pricier side, which Eten agreed can make it difficult not only to convince patients to use them, but, “We’re constantly having to justify to the hospital system why we want to use a non-opioid medication,” Eten said.
“Opioids have been on market so long that they’re very inexpensive, whereas things like Celebrex (a non-steroidal anti-inflammatory) other medications cost a lot of money,” she continued. “If the patient can’t afford the prescription and they have a large co-pay, they might choose not to use the non-opioid prescription.”
As an example, Eten recalled a patient who’d had a joint replacement and was given two prescription for non-opioid medications — each costing $200 to $300, a far cry from the less-than-$10 co-pay of some opioids. “He filled half the prescription for the non-opioid and used his wife’s opioids for back-up,” Eten said.
“Even if we lay out a plan to avoid opioids, the patient may alter or maneuver the plan based on the regulations and cost.”
Taking up the fight
Many health care professionals are now calling for legislation that will help offer non-addictive alternatives and educate both doctors and patients about these options.
“The patient is a consumer, so they can shop around for a doctor, they can shop around for a hospital and there’s more of a push for value for the patient,” Eten said, adding that when armed with the information, patients “can now ask if (doctors) can provide multimodal pain management.”
Litz has taken her story to Capitol Hill, where she shared her experiences with a room full of congressional staff members. “I feel like this was the rewards of what I was able to accomplish by being incarcerated,” she said. “I could get bitter or I could get better.”
In addition to telling her story, Litz spoke with lawmakers to bring awareness to the need to make changes so that doctors are required to inform and educate patients about non-opiate alternatives.
“One match can cause a fire,” she said. “I’m hoping this will light the pathway.”