The Opioid Crisis: A Moral Failing of the System, Not Users

Updated: Dec 9, 2020

Image courtesy of Rehab Center Parus

ALBANY, N.Y. — The road to opioid recovery is littered with myths, misconceptions, stigmas and service shortfalls, according to local social-justice advocates.

“We’re entirely geared toward treating substance abuse as a moral failure,” said Keith Brown, Director of Health and Harm Reduction for Katal, the Center for Health, Equity and Justice. “We try to arrest the problem.”

Luke Grandis, the statewide organizer of Vocal-NY, agreed.

“I think a huge part of this is putting it on personal failures rather than systematic failures,” he said.

Worse yet, care providers skip over critical aid — like equipping opioid users and their loved ones with harm-reduction measures that so they can survive and recover, Brown and Grandis said. These measures include clean needles and Naloxone — commonly known as Narcan — the drug first responders and medical personnel use to reverse overdoses.

“People need to be alive in order to recover,” Brown said.

There were 55 opioid-related deaths in Albany County in 2018 – 15 more than in 2017, according to county officials.

But societal attitudes — including the language we use to discuss drug abuse — are the larger problems that undermine solutions, they both emphasized. The opioid problem isn’t a crisis involving individual opioid users, it’s a public-health issue, Grandis emphasized.

Reforming the terminology will change perceptions, put the myths and misconceptions to rest and pave the way to treating the opioid crisis as a public health issue, according to Brown. It may also lead to reforms that will address the underlying causes of substance abuse — on the individual-user level and in the nation as a whole.

“It’s why we’re not dealing with the overdose crisis and opioid use as a public health issue,” he explained.

Harm Reduction: Surviving to Recover

The myths and misconceptions about opioids range from the types of opioids that are being abused to the nature of opioid abuse itself, according to Grandis. The synthetic opioid fentanyl, for example, has a reputation that precedes it — so much so that it interferes with intervention, he said.

“Recent tests show that 86 percent of the heroin supply tests positive for fentanyl,” he said.

Heroin overdoses take effect long after the user has administered the drug, Grandis said. This makes it more likely that the user will collapse in public, where others will see and intervene, he explained.

But fentanyl overdoses occur quickly, directly after the user has taken the drug — in whatever private space the user has chosen, he said. This makes the chance of life-saving intervention less likely, he said.

“Now more people are dropping dead with a needle in their arm,” Grandis said.

But the idea that that any fentanyl exposure is dangerous is a myth, he said. Nonetheless, that myth has created another obstacle.

“It makes people afraid to help someone who’s unresponsive,” he explained. “They’re afraid to touch fentanyl.”

But even those in a position to help, like an opioid user’s loved ones, might not be equipped to do it, Grandis said. That’s because treatment centers and emergency rooms rarely provide them Naloxone — commonly known as Narcan — the drug first responders and medical personnel use to reverse overdoses, he said.

In addition, clean needles could prevent opioid users getting diseases like AIDS, blood poisoning and hepatitis, Grandis said. But Catholic Charities is the only local organization that distributes clean needles, he added.

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) oversees almost all state treatment centers, Grandis explained. However, they need to implement greater harm-reduction oversight, and perhaps provide more funding for it, he added.

Overdose-prevention sites (OPS), also known as supervised-consumption services (SCS), could go even further to save lives, Brown said. The Drug Policy Alliance (DPA) describes these centers as “legally sanctioned facilities that allow people to consume pre-obtained drugs under the supervision of trained staff,” that are “designed to reduce the health and public order issues often associated with public drug consumption.”

“Facility staff members do not directly assist in consumption or handle any drugs brought in by clients, but are present to provide sterile injection supplies, answer questions on safe injection practices, administer first aid if needed, and monitor for overdose,” the DPA website said. “SCS staff also offer general medical advice and referrals to drug treatment, medical treatment, and other social support programs."

There are over 100 of these centers operating in Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain and Switzerland, according to the DPA website — but there are none in the United States.

While there are plans and proposals for overdose-prevention sites in several American cities, federal prosecutors are suing Safehouse, a non-profit group, to prevent them from founding an OPS in Philadelphia. Prosecutors cited the so-called “crack house law,” which makes it a felony to open, lease, rent, use, or maintain a property to make, distribute or use controlled substances.

Though New York City has a plan to allow the establishment of four overdose-prevention sites, New York Governor Andrew Cuomo’s administration has yet to approve it. Attempting to spur the administration to approve the plan, about 200 drug-safety advocates marched in front of Cuomo’s Manhattan office building on Aug. 28, and police arrested 13 activists who blocked the entrance.

“We don’t have (overdose-prevention sites) here, but we’re fighting for them,” Brown said.

Until then, opioid users and their families should be proactive, Grandis and Brown explained, by getting overdose prevention training and safe drug supplies like clean needles, water and fetenayl test strips.

“Focus on health and safety first,” Brown said.

Service Shortfalls

Though admitting to a substance abuse problem may be the user’s first step to recovery, being admitted into treatment or recovery is another matter entirely. Treatment centers check a narrow list of withdrawal symptoms before admitting opioid users, according to Grandis.

“But not everyone goes through withdrawal the same way,” Grandis said. “If you’re not sick enough, you’re not getting a bed, and you’re not getting treatment.”

Conifer Park is one of the only places that checks twice for symptoms, allowing an opioid user a second chance for admission and treatment, he said. Admission at other places may also hinge on the personality of individual care providers, he added.

“Sometimes there’s more compassion shown by some nurses,” he said.

Yet some treatment-center “regulars” — opioid users who are also abusing services — have learned how to present withdrawal symptoms and get admitted, he said. One user deliberately drank to create the appearance of upload withdrawal, he recalled.

Other treatment centers have space constraints, he said. St. Peter’s Hospital, for example, only has 18 beds and offers a rapid detox program, Grandis explained.

“But people don’t get the solid four days (of detox) that they need,” he said. “Even if you do get the 72 hours detox time, you need to know how to self-advocate to transition smoothly to become an outpatient.”

Moreover, Albany County lacks the appropriate treatment centers that can best help opioid users — clinics that can dispense methadone and buprenorphine, Brown said.

“They work incredibly well,” Brown said of the medications, which are prescribed to reduce opioid withdrawal symptoms. “The fact that you can’t get them at local care providers is an incredible failure by our systems. Methadone saved tons of lives back in the 70s.”

But Albany County only has two methadone clinics, and they’re both located in the city of Albany, Brown said. This is another added hardship for opioid users who live outside Albany and lack reliable transportation, he explained.

“People are being shipped into Albany to get methadone,” he said. “They should be getting care where their social support is — where they live.”

Societal Failures

Then there are the barriers that society at large creates. Substance abuse has been stigmatized as a problem involving an individual’s moral and physical constitution, Grandis explained.

Some people shame users in medically-aided recovery, which involves prescribed medications, as “not really being sober,” and “not really being in recovery,” he said — even though the medications are not the same as opiates of abuse.

“People believe they should demand abstinence of themselves, instead of using a medicine that works well for them,” he said. Denied of this recovery tool, users fall off the wagon and their self-esteem – already low – drops even lower, he added.

Moreover, “tough love” doesn’t work, Brown said.

“I’ve worked with parents who said ‘tough love killed my kid,’” he recalled. They would give anything to spend five minutes with their kids again. The person has to be shown love, care, dignity and respect.”

Grandis and Brown stressed that psychological and socio-economic factors lead to opioid and substance abuse.

“Drug use is usually a symptom of something else,” Grandis said. Users may have an undiagnosed mental illness, or they might be using drugs to numb themselves to problems and trauma in their lives, he explained.

“Find a specialist to help you deal with that trauma,” Brown said. “If there’s a gateway, it’s trauma.”

But the overarching gateway is socio-economic decline, according to Brown.

“Any place where industry bottomed out is going to have higher drug fatalities, drug arrests and overdose deaths,” he said. “Overdoses are the symptom, not the disease.”

Denied jobs and opportunities, people despair and turn to drugs for relief, Brown said.

“Substances help out with that a lot,” he said. “People can feel numb for a time. We have a perfect storm right now, in this society, for this crisis.”

The use and possession of drugs should be decriminalized, according to Brown, and money being spent on drug enforcement should be spent on health, housing, employment and education.

“You can’t treat any health issue as a crime,” Brown said.

The Way Ahead

Nonetheless, the resources are out there and waiting to help, Grandis said.

If possible, people should use Conifer Park, he said. In addition to allowing users to stay longer, Conifer Park offers natural surroundings, a pool and compassion, he explained.

“There are parts of it that are more humane,” he said.

People should be selective when choosing a support organization, Grandis said. There aren’t many support organizations outside of Narcotics Anonymous and Alcoholics Anonymous, he added.

“If those aren’t a good fit for you, it can be very difficult to find a supportive community,” Grandis said.

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