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health, loss of family or loved ones and quite often loss of life mark the trail of devastation from opioid addiction.
The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
Evanston is not immune from what has been labeled the “opioid epidemic.” Local resources are going toward finding ways to prevent, manage and heal residents dealing with side effects of pain management.
There is no question that this is a nationwide crisis, said Evanston resident and physician Keith Sarpolis last March, months before Chicago Tribune reporter John Keilman wrote on Aug. 21 that deaths in Illinois rose by 10% over a 12-month period. He said the information comes from the Centers for Disease Control and Prevention and “mirrors a nationwide jump that reflects the ever-greater toll of the opioid crisis.” That same week the New York Times in a story said 72,000 Americans were killed last year in the opioid epidemic. By contrast, said Dr. Sarpolis, “At its peak, the HIV/AIDS crisis topped out at 18,000 deaths per year.”
Quantifying the exact extent of the problem locally is “a challenge,” said Maureen McDonnell, MPH, Executive Director of PEER Services, 906 Davis St. PEER Services provides substance abuse prevention and treatment services to the residents of Evanston, Northfield, New Trier, Maine and Niles Townships, and the north side of Chicago. Its mission is “to prevent and treat the problems that substance abuse causes individuals, families and our communities.”
Ms. McDonnell said, “There is definitely an increase in the city and suburbs. I’ve seen nothing to think rates of overdose deaths have done anything but continue to increase. There is a steady number coming here for treatment.”
The epidemiology report “Increase in overdose deaths involving opioids – Chicago, 2015-2016; October 2017” (available at cookcountypublichealth.org), says opioid-related overdose deaths in suburban Cook County increased from 221 in 2015 to 340 in 2016. Broken down by specific drug, the heroin-involved overdose deaths increased from 152 to 206 and fentanyl-involved deaths increased from 32 to 140 in that same time period. The number of overdose deaths involving opioid pain relievers jumped by more than 25% from 2015 to 2016 – from 45 to 65.
“Although Evanston has not seen the high number of opioid overdoses experienced by some other communities, emergency responders have indicated that overdoses in Evanston continue to grow on a yearly basis,” said Erin Fisher, a Public Health Educator with the City of Evanston Health Department. “Currently, naxolone is deployed by Evanston Fire Department Paramedics about 84 times a year on average,” she told the RoundTable.
Students at Evanston Township High School seem to be using opioids at about the same rate as their peers across the state. Ms. Fisher pointed to the 2016 Illinois Youth Survey which showed 6% of ETHS students said they used a prescription drug that was not prescribed to them in the past 30 days, in line with the state of Illinois rate of 6%; 11% of ETHS students used a prescription drug that was not prescribed to them in the past year, higher than the state of Illinois of 9.44%; 3% of ETHS students used a prescription painkiller (e.g. Oxycontin, Vicodin, Lortab, etc.) to get high in the past year, slightly lower than the state of Illinois (4%); 8% of ETHS students used other prescription drugs (e.g. Ritalin, Adderall, Xanax, etc.) to get high in the past year, higher than the 6% state of Illinois rate.
“Heroin use has been reported by less than 1% of our student population and there has been no reported surge of opiate use,” said Andrea Bercos, a Social Worker in ETHS’s Student Assistant Program. Using the school’s September 30, 2017 enrollment number of 3,567, that’s about 35 students.
“The substance use patterns of ETHS students mirror what is being observed in surrounding communities. It is our practice to consistently monitor the substance use trends of ETHS students, the larger North Shore Community and the state of Illinois and then adjust our messaging and programming to reflect the identified needs.”
The ETHS Student Assistance Program “provides a comprehensive framework for the delivery of prevention, intervention and support strategies and programs.” Students are referred to the Program Social Worker from a disciplinary or non-disciplinary referral. Interventions range from educational groups to referring students to inpatient treatment.
Addiction is a disease, said Dr. Sarpolis. “It’s a disease involving dopamine receptors,” he said. The D-2 receptors, located mid-brain, are stimulated by pleasure – including the pleasures offered by opioids. “The brain gets stimulated by drugs – up to four or five times level of what occurs naturally. When the dopamine level is lowered, the brain tries to get it back,” he said. The craving for more is a physical reaction, not a moral choice.
The Addicted: Dr. Sarpolis said in his practice at the Gateway Foundation on the west side of Chicago he has seen that opioid addiction “is largely a disease of young adults. We see patients of all ages, but the numbers tend to start to rise in the late teens and peak in the 20s. They tend to decline as one goes out each decade. People addicted to pills at older ages will be less likely to go on to heroin.”
Ms. McDonnell said the age range of clients seeking treatment at PEER Services for addiction is “broad – late teens into the 70s.” Older people, she said, “are often more willing to seek treatment. They are ‘sick and tired of being sick and tired.’”
Research shows that approximately 80% of current heroin users first misused opioid painkillers before switching to heroin, Ms. Fisher said. For many, that first taste of opioids came from prescription drugs – in their own medicine cabinets or those of a friend or relative. According to the Centers for Disease Control, “Prescription opioids continue to contribute to the opioid overdose epidemic in the United States. More than 40% of all U.S. opioid overdose deaths in 2016 involved a prescription opioid, with 46 people dying every day from overdoses involving prescription opioids.” The most common drugs involved in these deaths included methadone, oxycodone (such as OxyContin) and hydrocodone (such as Vicodin) – the latter two often prescribed by doctors for chronic pain.
Asked whether PEER’s clients tell how they became addicted – whether through prescribed painkillers of their own, painkillers poached from the family or straight heroin, Ms. McDonnell replied, “All of the above. … It’s a confluence of a long-standing epidemic and more access. Prescription patterns leave people dependent. Some go to heroin because it’s cheaper on the black market than pain pills.”
As with many diseases, family history, environmental factors, social and economic factors and genetic disposition play a part in whether someone taking a prescription opioid will become addicted. But for those with a disposition to the disease, addiction can slip in quickly.
“As long as the body is burning the drug to deal with pain, there is not a problem. The problem begins with tolerance over time,” said Ms. McDonnell.
The Families: Helping a loved one with addiction is in itself a battle. PEER provides counseling for families. “They often struggle with loving the person and struggling with their behavior. They want to help but when they try it makes it worse,” said Ms. McDonnell. Working with families is “like in the airplane, put your mask on first then figure out how to help the person.”
The ETHS Student Assistant Program works with families as well. “We believe that education and accurate information are the best tools to empower not only students to make healthy decisions for themselves regarding substance use but to also inform the adults in their lives about how they can best support our students and be aware of potential signs and symptoms, referral sources etc.,” said Ms. Bercos. “This has been accomplished through a parent and guardian night, training for athletic coaches/ activity sponsors and updated information for staff through lunch and learns and larger group meetings.”
Not all addicts overdose, and not all overdoses are by addicts. The age of overdosing, though, is getting lower. Children as young as a year have found and ingested prescription opioids, according to some reports.
According to the Substance Abuse and Mental Health Services Administration, “Survivors of opioid overdose have experienced a life-changing and traumatic event. They have had to deal with the emotional consequences of overdosing, which can involve embarrassment, guilt, anger, and gratitude, all accompanied by the discomfort of opioid withdrawal. Most need the support of family and friends to take the next steps toward recovery.
“While many factors can contribute to opioid overdose, it is almost always an accident. Moreover, the underlying problem that led to opioid use—most often pain or substance use disorder—still exists and continues to require attention.”
“There is a huge opportunity to improve the safety of our own families,” Ms. McDonnell. She suggested families have as little medication as needed in the house and get rid of the rest when done. “Patients can negotiate with the doctor to not have more pills than needed. They should keep the medication locked away and destroy remaining pills when the pain is gone.”
Those wishing to safely dispose of unused and expired prescription medications, including controlled-substances, may use the drop box in the front lobby of the Evanston Police Department, 1454 Elmwood Ave. This is part of the national drug take back program. The service is free and anonymous, but it does not accept liquids or needles or sharps, only pills or patches. Used sharps may be dropped off around the corner at Fire Department headquarters, 909 Lake St.
In 2017, the City formed the Opioid Response Group to address the impact of the opioid epidemic in Evanston. The group, composed of representatives from various City departments, the Evanston Public Library and local community organizations, is discussing tactics to help save lives and reduce the impact of the epidemic locally, including education, prevention, collaboration with community providers, data collection, diversion from prosecution and the deployment of naloxone by Evanston Fire paramedics.
PEER has received a grant from Evanston Community Foundation to conduct more outreach as well. PEER is developing a plan to deal with community safety and health.
“There are about 100 people who die each day nationwide but more than that survive and need to find that next right step,” said Ms. McDonnell. “We want people to get help.”