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Heroin Fix Starts In Doc’s Office

by Melissa Bailey | Apr 18, 2014 12:59 pm

(10) Comments | Commenting has been closed | E-mail the Author

Posted to: Health, The Hill

Melissa Bailey Photo Targeting a heroin epidemic, a high-powered group assembled in New Haven sent a message to doctors: Stop helping patients get hooked on prescription drugs.

U.S. Sens. Dick Blumenthal and Chris Murphy convened the group Thursday morning at the Cornell Scott-Hill Health Center on Columbus Avenue to discuss a troubling rise in heroin addiction and deaths in Connecticut and beyond. The event brought together people recovering from addition, law enforcement officers, health care professionals, and Obama’s point-person on federal drug control policy.

Blumenthal opened the forum by outlining the scope of what he termed an “exploding epidemic” heroin problem in Connecticut: Heroin-related deaths have shot up from 174 in 2012 to 257 in 2013. Meanwhile, the use of heroin doubled nationally from 2007 to 2012. On average, heroin is killing one person per day in Connecticut, according to the senators.

Senator Murphy said in the vast majority of deaths by heroin overdose, the trouble began with the abuse of prescription drugs.

Office of National Drug Control Policy Acting Director Michael Botticelli (pictured) identified a top priority in fighting this epidemic: Educating doctors. Doctors are giving away opioid drugs like Oxycontin and Percocet too freely, Botticelli said.

Botticelli cited a personal example: He used to be addicted to drugs. He’s in long-term recovery, celebrating 24 years of sobriety. Botticelli said when he got dental surgery, he notified his dentist that he was in recovery. His dentist nonetheless offered him Percocet—a dangerous drug for someone recovering from addiction. Botticelli said the incident highlighted the need to better train health care professionals in how to treat patients who are addicted to, or recovering from addiction to, prescription drugs.

Patients are known to go “doctor shopping” for Percocet and Oxycontin, Botticelli noted. It’s too easy to fake symptoms and get a prescription you don’t need. That’s feeding the addiction problem, he said: 70 percent of prescription drug addicts get their drugs for free from family and friends.

Eric Burdett (pictured at the top of this story) testified to that statement. He said he started taking prescription drugs because a friend gave him a pill when he had a headache. That was the first step to years of prescription drug abuse.

“I knew for four to five years before I came clean that I needed help,” Burdett said. “I was just too ashamed to admit it. It had completely taken over my life and controlled me.” Burdett recounted going to desperate measures to find the drugs, including stealing his mother’s Vicodin tablets, then replacing them with aspirin that he had ground down and re-packaged.

He ended up going through inpatient detox at the South Central Rehabilitation Center on Cedar Street, which is run by Hill Health. He announced he has now been in recovery for 20 months.

For a new nurse practitioner or doctor, it can be hard to determine whether a patient really needs pain meds or is faking symptoms in order to feed an addiction, said Michael Taylor (pictured), CEO of Hill Health.

“New practitioners don’t always realize when they are enabling drug-seekers,” Taylor said.

Addiction drives people to deceit, acknowledged April Willis, who is also in recovery.

“We’re very sneaky. We’re very conniving. We’re very manipulative,” she said of people suffering from drug addiction.

“That’s like politicians,” quipped Blumenthal.

Doctors don’t get enough training to face the flood of requests from prescription drug-seekers, said William Sledge, medical director of the Yale-New Haven Psychiatric Hospital.

“In general, physicians haven’t been trained to say no,” he said.

Physicians’ behavior is a “major problem” contributing to prescription drug addiction, he said. Knowing how to tell when someone is addicted to prescription drugs—and how to help them—is difficult, Sledge said. In addition to well-meaning doctors getting taken advantage of, there a number of “bad actors” who knowingly overprescribe pain meds, he said.

“We need clear prosecutorial guidelines for inappropriate prescription of medication,” he said.

After people get hooked on prescription drugs, they often switch to heroin because it’s cheaper. Heroin is particularly cheap in New Haven and in Connecticut, Murphy said, because of the drug trafficking paths. Heroin often enters the country in New York from Colombia or Mexico and moves up the coast by way of Connecticut, he said. It starts in Stamford, New Haven and Bridgeport, “then moves up from there.”

For that reason, “the prices are cheapest in Connecticut,” Murphy said.

That drug-trafficking path also means that the drug is “in its purest form” in Connecticut, added Lt. Anthony Campbell (pictured), who just got promoted to the police chief’s chief of staff.

Because the heroin is so pure, it is “extremely dangerous” for New Haveners, Campbell said. The heroin epidemic is becoming “extremely frustrating” for New Haven police, he said. “More and more resources are going towards overdoses,” he said. When someone overdoses, the fire department takes care of their medical needs, and police also respond because there may be people with guns in the area, he said.

Campbell said police see that heroin addiction feeds many small-time crimes. He said New Haven police have been educating officers to try to steer addicts to treatment instead of arresting them.

“We know we cannot arrest our way out of it,” he said.

Botticelli offered one way to keep people from dying from heroin: A drug called naloxone. The drug is a powerful antidote to opioid overdose. If a person is overdosing on heroin, an injection of naloxone can save that person’s life.

Botticelli described a pilot program in which police in Massachusetts were equipped with naloxone so they can treat people on the spot. The program has averted over 100 overdoses, and has changed the relationships between citizens in police, he said: Often, police flash their lights and people don’t want them around. Now, he said, citizens are flashing their lights for police to come help them because they know the cops have naloxone.

Pat Rehmer, commissioner of the state Department of Mental Health and Addiction Services, said Connecticut has been enduring the heroin epidemic that has swept through Vermont and New Hampshire. The most troubling trend, she said, is that heroin users are getting “much, much younger.” People as young as middle school are using heroin, often in suburban towns, she said.

Rehmer last year pushed for a law that enables friends and family of opioid addicts to get a prescription for naloxone so they can save the addict’s life. Not many people are taking advantage of that law, she said. This legislative session, she is pushing for a law that would allow first responders—including cops, firefighters and EMTs—to carry naloxone on the job. She said given the recent heroin deaths and the scope of the epidemic, she expects the bill to pass without a problem.

Blumenthal and Murphy have also released a five-point plan to combat the state’s heroin problem: Click here to read it.

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posted by: DrJay on April 17, 2014  3:53pm

Excellent and important article.
Another problem is the erosion of the personal relationship with a physician. It is much easier to scam drugs when seeing a different provider each time,
And , as bad as the problem is in Connecticut, we are doing much better than many states. We have a controlled substance prescription database that identifies physicians and patients who are abusing the system, Many states have no real tracking at all.

posted by: cedarhillresident! on April 17, 2014  4:03pm

1412 state street!!!! State alot of activity…PD know all about it. Block watch told them about it (because of all the child sex offenders that live there) And the dealing of heroin.
they finally belived us when
http://www.nhregister.com/general-news/20131004/reported-new-haven-incident-probably-not-a-home-invasion-police-say

Alot more to that story than made the new because of who owns the house….who is still using.

posted by: Threefifths on April 17, 2014  4:10pm

Senator Murphy said in the vast majority of deaths by heroin overdose, the trouble began with the abuse of prescription drugs.

Not true.

American Troops Are Protecting Afghan Opium. U.S. Occupation Leads to All-Time High Heroin Production

http://www.eyeopening.info/2014/02/16/drug-war-american-troops-protecting-afghan-opium-u-s-occupation-leads-time-high-heroin-production/#.U1A0TYKNSTI

posted by: ilovetrucks on April 17, 2014  7:05pm

As an RN at one of the city’s major hospitals, I agree that many patients come in with an existing drug problem, however, many MDs in the hospital setting often give IV pain medication to patients who complain that their “pain is not being controlled” which is coincidentally one of the most common complaints that patients have when given a follow-up survey. Often, patients are released from the hospital without even having taken oral pain medications. Every day that I work, I deal with this issue. Not surprisingly, these are the patients that return day after day or week after week with the same complaints. Once again, they receive IV pain medications and the cycle continues. Many of the MDs who do this are the older, seasoned MDs.

posted by: sccampion on April 17, 2014  9:32pm

Many Thanks to Senators Blumenthal and Murphy for convening this panel on the heroin epidemic.
  As President of the CT Association of Addiction Specialists,CAAP, our workforce of 800 licensed addiction professionals have been fighting this growing epidemic in our State for far too many years.
  The struggle has grown fierce due to lack of access to substance abuse treatment due to shrinking federal and state dollars, HMO rationing of care, the stigma of addiction as a social malady and not the complex disease, which is terminal without proper treatment, and lastly, health care professionals,who, although very well-intentioned,lack the required fund of knowledge and skill-based ccmpetencies to effectively treat individuals with opioid addiction, who come to their medical services seeking help.
  In CT and other states, individuals with substance abuse disorders have to contend with the admission criteria of “failing at out-patient treatment to gain access to in-patient treatment. This stigmatization of the disease of addiction only intensifies the deep hopelessness and shame of the individual seeking help.
  The Association of Addiction Professionals is working to ensure that substance abusing individuals and their significant others receive best practice treatment in CT.
  Our Association has submitted a report calling for the licensed and credentialed addiction specialist to be key member of the State’s new health care delivery system, the primary care centered - Advanced Medical Home model. The Affordable Care Act calls for addiction specialists to be part of this team to assist MDs, APRNS, and behavioral health colleagues in offering specialized brief assessment, referral, and intervention to treat active addiction. 
  As credentialed specialists, licensed addiction professionals possess the skills, training, and non-judgemental approach necessary to successfully engage a substance user in treatment. Consumers deserve this standard of care.

posted by: wendy1 on April 18, 2014  10:17am

The flip side of this is that people who really need pain meds cant get them.

A lot of these so-called addicts would have become dependent on drugs or alcohol as a crutch anyway.

I think narcotics should be legal and accessible to all like in other countries.  Narcotics are not the reason our society is crumbling. The economy based on obtaining prohibited substances is to blame…that and the widening rich/poor gap and crooked pols.

posted by: connecticutcontrarian on April 18, 2014  12:28pm

Thank you Melissa Bailey for this brilliant article.  I’ve learned so much about the reasons heroin has taken hold of this state in such a potent way. I sincerely hope our elected officials will do more to educate the public. I do wonder how this epidemic is impacting young people. Do we have any data on heroin addiction and overdoses amongst young people in CT?

posted by: georgie on April 18, 2014  4:18pm

The drug-seeking addicts are already addicted and as ER medical providers, we may be fooled sometimes, but we usually can figure these people out by review of electronic medical records and the state prescribing database and refuse them narcotics. The problem patients are those who are not yet addicted, but are at risk, bc of multiple social problems and a medical condition that does not NEED narcotics, but the pt wants narcotics. One of the problems is that the providers’ jobs and salaries are in part dependent on patient satisfaction scores sent in surveys to DISCHARGED patients (Press Ganey). That means only patients sent home from the ER are even surveyed - those who have medical problems that require medical admission do not get these surveys. One of the main questions on the Press Ganey Survey is if the provider treated their pain adequately. All of the nurse practitioners, PA’s, and even doctors know that if they do not send these patients home with narcotics, they will get bad scores. 

So until providers’ jobs and salaries are no longer dependent on DISCHARGED patient satisfaction scores, do not expect much change.(I for one, would rather my job and salary depend on how well I care for patients coming in with strokes, heart attacks, pneumonia, appendicits, etc, who need high level ER care and then admission to the hospital.) Also, nurses have to continuously ask patients to rate their pain, and even have to tell the other providers when a patient rates their pain at more than a 6 out of 10. When pts are constantly asked to rate their pain on a number scale, this creates the expectation that we will be doing whatever it takes to get their pain to a very low number. OF course, many pts, even those sitting there laughing, texting and eating cheetos, rate their pain at a 10/10 every time and then get mad when no one gives them narcotics.

posted by: timshortty on April 18, 2014  4:29pm

Great article! Now that marijuana is legal, heroin will be easier and cheaper to access making the problem even worse.  It’s already happening big time in suburbia throughout the country.

posted by: Threefifths on April 20, 2014  11:49pm

James Brown-King Heroin

http://youtu.be/07SWjWaOxc4

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