CREATING A SOFT PLACE TO LAND: SUPPORTING FAMILIES OF THE

OPIOID EPIDEMIC

Stefanie Anne Oka

Professional Artist/Owner

Paintings by Stefanie

Mindi Spencer

Associate Professor

University of South Carolina

• Current state of the opioid epidemic

• Connecting opioid addiction to Adverse Childhood Experiences (ACEs)

• Addiction as a family disease

• Trauma-informed approaches to prevent and treat opioid addiction

PRESENTATION OBJECTIVES

USING THE PAPER AT YOUR TABLES....

• Think about the times in your life when you felt truly ALIVE

• For 30 seconds, write down words (one per sheet) that remind you of that feeling – people, adjectives, places, etc.

• Fold or roll each sheet of paper and place it inside the bottle at your table

NOW IMAGINE THAT ALL OF THE THINGS THAT YOU ASSOCIATE WITH FEELING ALIVE ARE SUDDENLY TAKEN AWAY….

• What would such a loss feel like?

• What would you do to get that feeling back?

• Would you risk something?

• Give something up?

• Do something that would likely cause you harm?

• Harm someone else?

THE CURRENT STATE OF THE OPIOID EPIDEMIC

DRUG CLASS ORIGIN DRUG NAME

Natural

opiates

Alkaloids in the

opium poppy plant

• Morphine

• Codeine

• Thebaine

Semi-synthetic opioids Created from natural

opiates

• Hydrocodone

• Hydromorphone

• Oxycodone

• Oxymorphone

• Diacetylmorphine

(Heroin)

Fully synthetic opioids Chemically made

• Fentanyl

• Methadone

• Tramadol

• Meperidine

OPIOIDS 101

• 1990s – Pain became widely-recognized in the medical field as the “5th vital sign“ (Foreman, 2014)

• 1996 – Perdue Pharma launches its marketing campaign for OxyContin (Van Zee, 2009)

ADDICTION BY PRESCRIPTION

THE RISE OF THE “PILL MILL”

• Where did the epidemic begin?

• When did policymakers start paying attention?

From left, Howard R. Udell, the top lawyer for Purdue Pharma;

Dr. Paul D. Goldenheim, the company’s former medical

director; and Michael Friedman, Purdue’s president.

Photographs by Don Petersen for The New York Times

• Purdue Pharma agreed to pay $600 million in 2007 to resolve civil and criminal charges of “misbranding”

STRATEGIC TARGETING OF DISTRESSED COMMUNITIES

THE U.S. EPIDEMIC (IN 2015)

• An estimated 2 million people have a substance use disorder related to prescription opioid pain relievers (CBHSQ, 2016)

• Of those patients who are prescribed opioids for chronic pain…

• 21 - 29% misuse them (Vowles et al., 2015)

• 8 - 12% develop an opioid use disorder (Cicero et al., 2014)

• Transition to heroin due to low cost and availability (NIH, 2016)

• An estimated 591,000 suffered from a heroin use disorder (CBHSQ, 2016)

• Approximately 4-6% who misuse prescription opioids transition to heroin (Cicero et al., 2014; Muhuri et al., 2013)

• About 80% of people who use heroin first misused prescription opioids (Muhuri et al., 2013)

THE U.S. EPIDEMIC (IN 2015)

OVERDOSE DEATHS INVOLVING OPIOIDS IN THE U.S. (2000-2015)

More than 33,000 Americans died as a result of an

opioid overdose in 2015 (Rudd et al., 2016)

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

Total Female Male

Source: National Center for Health Statistics, CDC Wonder

OVERDOSE DEATHS INVOLVING OPIOIDS IN THE U.S. (2000-2015)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000 Total Female Male

OVERDOSE DEATHS INVOLVING HEROIN IN THE U.S. (2000-2015)

Source: National Center for Health Statistics, CDC Wonder

HOT OFF THE PRESS!

Available at: https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html

ONE JOURNEY OF ADDICTION

LIFESPAN IMPACT OF ADVERSE CHILDHOOD EXPERIENCES (ACEs)

Mechanisms by which ACEs influence health and well-being

• Individuals reporting 5+ ACEs are…. • 3x more likely to misuse Rx pain medication

• 5x more likely to engage in injection drug use (Quinn et al., 2016)

• 80% of patients seeking treatment for opioid addiction have experienced at least one ACE (Sansone et al., 2009)

• Individuals with ACEs are more likely to report chronic pain and take Rx pain medication (Davis et al., 2005)

ADDICTION, OR “RITUALIZED COMPULSIVE COMFORT-SEEKING”?

Image Credit: New Life House (2017). Available at: https://newlifehouse.com/

NEONATAL ABSTINENCE SYNDROME

• Overall incidence has increased almost 300% during 1999–2013 (Ko et al., 2016)

• 1.5 6.0 cases per 1,000 hospital births

• In WV, 33.4 per 1,000 births

NAS incidence rates for 25 states, 2012–2013

ACE

ACE

ACE

ACE

ACE

ACE

ACE

ACE

ACE

• Direst exposure to opioids (Allen et al., 2017)

• Declines for all age groups < 20 between 2000 – 2015

• 6/10 exposures were children under age 5

CHILDREN AND ADOLESCENTS

• Addiction chaos in the child’s social and physical environment

ONE CHILD’S PERSPECTIVE

KINSHIP AND FOSTER CARE (GENERATIONS UNITED, 2017)

• 2.6 million children are

being raised by kin

• 30% (127,819) of children in foster care are being raised by kin

• For every 1 child in foster care with kin, 20 are being raised by kin outside of the system

• Numbers are increasing

THE TIES THAT BIND

TRAUMA-INFORMED APPROACHES TO PREVENTION

AND TREATMENT

USING RESEARCH ON ACES (CAMPAIGN FOR TRAUMA-INFORMED POLICY AND

PRACTICE, 2017)

1. Create “programs to prevent exposure to trauma (primary prevention) and to promote resilience in groups put at risk by exposure to adversity (secondary prevention).”

2. “Use trauma-informed treatment approaches to help existing addicts recover and return to productive lives.”

SUPPORTING CHILDREN AND FAMILIES: EDUCATION

• Collect and use data on ACEs to select and implement prevention programs and drive local decision-making (SAMHSA, 2017)

• Educate the public about addiction to decrease stigma about the disease

• e.g., medication-assisted treatment (MAT)

• Consider the family unit instead of the addicted individual as the “unit of service” (White & Daley, 2016)

SUPPORTING CHILDREN AND FAMILIES: PROGRAMS

• In 2016, the National Institute of Drug Abuse published a guide that includes several trauma-informed, evidence-based programs

• Based on the 7 Principles of Substance Abuse Prevention

• Available (free) online

SUPPORTING CHILDREN AND FAMILIES: POLICY

• Consider harm-reduction public health strategies to “keep addicts healthy” (e.g., needle exchange, MAT, life-saving emergency Narcan)

• Elevate and promote trauma-informed, evidence-based prevention and treatment for the entire family

• Decriminalize addiction

• Support and empower kinship caregivers in the foster system

“WE MUST RISK DELIGHT”