Clarence Fanto | Combating stigma essential to tackling opioid epidemic

LENOX — Opioid addiction, until recently stigmatized just as cancer, AIDS and mental illness once were, is coming out of the shadows in our area, thanks in part to the efforts of the recently organized Central County Opioid/Heroin Work Group.

During a presentation this past week at Trinity Episcopal Church, Gina Armstrong, Pittsfield's director of public health, emphasized the lives saved by first responders administering the overdose-reversal drug naloxone, better known as Narcan, to opioid abusers.

Attending were two police chiefs — Jeffrey Roosa of Lee and Stephen O'Brien of Lenox — along with ambulance service staffers, other first responders, medical professionals and health service workers.

There were 20 unintentional, opioid-related overdose deaths last year countywide, a reduction from 32 in 2015, according to state statistics.

A state Department of Public Health report released last month showed that opioids were the confirmed cause of 1,465 deaths across Massachusetts and suspected in 514 additional deaths. Opioids killed or were suspected of killing five times more people than died in car crashes.

Berkshire County has one of the state's higher death rates, exceeded only by Cape Cod, Martha's Vineyard, and three counties in northeast and southeast Massachusetts — Essex, Plymouth and Bristol.

"These numbers make it really clear that administering naloxone is critical, now more than ever," Armstrong said.

Naloxone blocks opioid drugs from interacting with the brain's receptors, counteracting the drugs' most severe effects — slow respiration, coma and death during an overdose. The drug almost instantly pulls an overdose victim back to sobriety and has only minor side effects for opioid users.

A spike in the use of fentanyl, a powerful, illegal, especially dangerous and fast-acting synthetic opioid pain medication, contributes to the surge of overdoses in recent years, as Jennifer Kimball, senior public health planner for Berkshire Regional Planning Commission, pointed out.

Fentanyl, which can be 50 to 100 times more powerful than heroin, is often mixed with heroin or sold as an alternative.

Kimball, also the coordinator of the Berkshire Opioid Abuse Prevention Collaborative, stressed the importance of carrying Narcan by first responders as well as family members and friends of users, as well as pharmacies offering no-cost access to it.

"There was such a stigma around cancer and AIDS," said the Rev. Michael Tuck of Trinity Episcopal, organizer of prayer vigils for drug abusers and the professionals seeking to help them. "And now, the next one is addiction and mental illness, the intersection of those pieces. I believe faith communities play an important role in helping to change the landscape and the language."

Among the first responders carrying Narcan are Egremont, Great Barrington, North Adams and Williamstown police, the Lee and Lenox Ambulance Services, and the fire departments of Egremont, Great Barrington, New Marlborough, North Adams and Pittsfield.

The antidote is also available through Tapestry Health Centers in Pittsfield and North Adams, and at CVS pharmacies.

According to information relayed by Pittsfield Fire Chief Robert Czerwinski, his department responded to 30 overdose incidents in the city from November through March, saving 28 lives through the use of Narcan.

In North Adams, within the first 24 hours after the police and fire departments started carrying the antidote, there were nine overdoses, said Amalio "AJ" Jusino, assistant chief and operations manager of North Adams Ambulance. However, with Narcan more readily available, there have been no opioid-related fatalities in the city over the past several months, he noted.

"It's doing its job, it's there to eliminate fatalities," Jusino said. He pointed out that law enforcement and first responders now have the right to transport overdose victims to a medical facility for intervention and monitoring, a change from previous state regulations enabling users to refuse treatment.

Jusino also said that in the past, victims of severe overdoses were stigmatized with the assumption that they were attempting suicide. Now, it's understood that the vast majority of cases are accidental.

North Adams Ambulance created a form authorizing the disclosure of protected health information so the Brien Center in Pittsfield and other organizations can follow up with accidental overdose victims.

As Jusino explained, it's a great opportunity to encourage people to seek medical treatment for their addiction — "to keep them in the system and keep somebody in contact with them on their road to recovery."

"Narcan isn't a recovery tool; it's a life-saving tool that gives you another opportunity to potentially find that path that works for you," he said, "because the same path doesn't work for everybody. Find the path that works for you, get back on that road to recovery, take those steps for change."

Unfortunately, according to a report by Truven Health Analytics, the price of naloxone has spiked sharply in recent years — an injectable version of the drug has gone from 92 cents a dose to more than $15 a dose over the last decade. An auto-injector version is up to more than $2,000 a dose.

The discussion last Wednesday was very helpful — kudos to the Central Berkshire Group for organizing the monthly series.

While I still hear people say that drug abusers choose their lifestyle, there's a growing consensus that addiction is a treatable illness, only if drug users make the choice to get help and stay with the program.

The root causes of the drug scourge remains an open question. A recent study from the journal JAMA Psychiatry found the sharpest increase in heroin use and addiction among young white men with lower education and income levels, even as the mortality rates among middle-aged white women has been rising for the past decade.

According to the Drug Enforcement Administration, "the world is filled with addicts who got a legitimate prescription for an opioid and then became dependent on that and continued long after their recovery. Pill addiction is extremely expensive, so they move to heroin because it's cheaper and easier to get.''

The national death toll from opioids exceeded 33,000 a year in 2015. Last week, President Trump signed an executive order creating a commission led by N.J. Gov. Chris Christie to ``combat and treat the scourge of drug abuse, addiction and the opioid crisis."

Trump's proposed budget even proposes an additional $500 million for the Department of Health and Human Services to "expand opioid misuse prevention efforts and to increase access to treatment and recovery services."

While those are welcome initiatives, the depths of despair and desperation that drive too many Americans to potentially lethal opioid abuse must be understood if we are to treat effectively the causes as well as the effects of this insidious epidemic tearing at the fabric of our society.

Reach correspondent Clarence Fanto at The opinions expressed by columnists do not necessarily reflect the views of The Berkshire Eagle.


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