Chief deputy: Treatment, not arrest, best prescription for addiction

By Kimball Perry The Columbus Dispatch Every day, Sgt. Shawn Pak saw the damage heroin and opioids cause in his job at the Franklin County jail. And the deputy with the county sheriff’s office believed addicts were responsible for their own misery. “It was kind of businesslike, kind of a detached view,” Pak said. Trending Articles That view changed, though, when the brother of Pak’s best friend became addicted to heroin, bringing to his family the pain and helplessness so many other families have suffered. Pak changed his attitude after “seeing the pain in my best friend’s eyes” when he told Pak about the horror addiction imposed on his family. The family’s matriarch, who is like a second mother to Pak, is now terrified by the telephone. “She told me, ‘Every time the phone rings, I’m expecting it be be the call that he’s dead,’” Pak said. The family was elated when that brother was taken off the streets. “He’s in jail,” Pak said. “They’re relieved. At least he’s alive.” Rick Minerd, the department’s chief deputy, wants more first responders to undergo Pak’s change in attitude if they want to save lives. Minerd, who has been a deputy for 26 years, used to believe addicts were too selfish to care about anyone else, so they deserved their woes. But he came to the same conclusion as Pak after taking part in a prostitution sting to arrest young women who sold their bodies to get money for drugs. After that sting, Minerd ultimately decided law enforcement officers should help addicts get treatment. “I used to think addicts came from bad families,” Minerd said. “The more I learned (about addiction), the more of an open mind I had.” Law enforcement officers are taking more drugs than ever off of the streets, but more people are dying. Last year, 353 people in Franklin County died from drug overdoses, a 10 percent increase over the 321 who died in 2015. As the heroin and opioid epidemic made a deadly sweep across Ohio, the 2015 statewide overdose deaths of 3,050 people rose in 2016 to 4,149 deaths, a 36 percent increase. Because the old attitudes haven’t worked, Minerd said, he is helping to change them. Law enforcement will better serve the community, he said, by better understanding addiction’s hold. “I think it’s one of the biggest gaps that’s here — a misunderstanding from cops and the community of what addiction is,” he said. “Some of those experiences open people’s eyes. I think for cops, you have to be slapped in the face.” More and more, health and addiction professionals note that addiction is an illness that can be treated with proper time, tools and techniques. None of those include dumping addicts in jails. That doesn’t mean no arrests. It means smarter arrests. “We have to educate cops on what addiction is, to allow cops to be traffic cops for addiction,” Minerd said. It also means addicts have to want to get clean, which might take several rounds of rehabilitation to stay clean. “It’s still a choice. You have to work extremely hard,” Minerd said. Last week, Franklin County’s Alcohol, Drug and Mental Health Board announced it will provide $1 million for a two-year program to provide rehabilitation, mental health and other services for overdose patients. That program stems from the county’s HOPE task force, or Heroin Overdose Prevention and Education. It is a collaboration of government agencies and social workers to crack down on drug dealers, including prosecuting those who provide drugs that result in overdose deaths, and to place those who overdose in treatment and educate them. “We are trailblazers in Ohio,” Minerd said of the HOPE model. Minerd wants the Ohio attorney general, whose office runs the Ohio Peace Officer Training Academy, to include training about addiction and rehabilitation. The Franklin County sheriff’s office already is providing more training for its deputies, including how to administer naloxone, the drug that can offset the effects of an opiate overdose. “It’s a mindset that we continue to turn around,” Minerd said. The design of the new jail that Franklin County plans to open in 2019 will reflect that change by adding more space to educate inmates about addiction. “It’s slowly changing,” Minerd said. “I do think it’s working.” kperry@dispatch.com @kimballperry

Science says: Medications prevent opioid addiction relapse

NATIONAL NEWS 11 of 50 prev next May 24, 2017 08:10 AM By CARLA K. JOHNSON AP Medical Writer CHICAGO (AP) - Remarks by a top U.S. health official have reignited a quarrel in the world of addiction and recovery: Does treating opioid addiction with medication save lives? Or does it trade one addiction for another? Health Secretary Tom Price's recent comments - one replying to a reporter's question, the other in a newspaper op-ed - waver between two strongly held views. Medication-assisted treatment, known as MAT, is backed by doctors. Yet it still has skeptics, especially among supporters of 12-step programs like Narcotics Anonymous, because it involves opioid-based medications. Price appeared to side with that camp when he said during a recent visit to Charleston, West Virginia: "If we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven't moved the dial much." But in an opinion piece published last week in the Charleston Gazette-Mail, he twice mentioned his agency's support for medication-assisted treatment. Here's a closer look. HOW MEDICATION CAN TREAT ADDICTION Because of how opioids act on the brain , people dependent on them get sick if they stop using. Withdrawal can feel like a bad flu with cramping, sweating, anxiety and sleeplessness. Cravings for the drug can be so intense that relapse is common. Medication-assisted treatment helps by moving a patient from powerful painkillers or an illicit opioid like heroin to a regular dose of a legal opioid-based medication such as buprenorphine or methadone. The ideal dose is big enough to fend off withdrawal, but too small to produce a euphoric high. Patients can drive, rebuild relationships and get back to work. "They're not walking around high" and it gives them the chance to practice new ways of coping with family and psychological issues, said Dr. Joseph Garbely of Pennsylvania-based Caron Treatment Centers. With counseling and education about addiction, patients can get back on track. They eventually can taper off medications, but some take them for years. WHAT RESEARCH SAYS Researchers studying these treatments use drug screening to see whether patients are staying off illegal drugs. If someone uses heroin while in treatment, it shows up in their urine. A 2014 review of 31 studies found methadone and buprenorphine keep people in treatment and off illicit drugs. The review by the Cochrane Collaboration, an international group of scientists that evaluates research, found each drug worked better than a dummy medication. A side benefit worth noting: Methadone also helps prevent the spread of HIV by reducing needle sharing, a different research review by Cochrane found. Methadone and buprenorphine can be abused and both can cause overdoses, particularly methadone. But researchers have found that methadone prevents more overdose deaths than it causes. For most patients, medication combined with counseling is superior to other strategies, according to the American Society of Addiction Medicine. OTHER OPTIONS "What's right for one person isn't necessarily right for another person," Price said during a May 9 visit to West Virginia. When asked whether he and his team leaned toward medication or faith-based approaches to opioid addiction, his reply lined up with those who favor abstinence. Abstinence-only philosophies "are not scientifically supported," according to the first surgeon general's report on addiction, published in November. Yet people who describe themselves as in recovery consistently say abstinence is important. All told, remission from opioid addiction can take years and multiple tries at treatment. "The public needs to know that there are proven, effective treatments for opioid addiction," former U.S. General Vivek Murthy told The Associated Press. Murthy was fired by the Trump administration after he refused to resign. Price also mentioned a non-opioid alternative - namely an injection of naltrexone called Vivitrol - as "exciting stuff." Vivitrol, a newer drug, can be used only with patients who have completely detoxed and has a limited track record compared to buprenorphine and methadone. Early studies have shown promise, but relapse is a danger after injections stop. Health and Human Services spokeswoman Alleigh Marre told AP that Price's comments don't signal a policy change. Price "has argued that we should be open and supportive to the broadest range of options, from medication-assisted treatments - including methadone, buprenorphine, or naltrexone - to faith-based recovery programs," Marre said. Not informing patients about the effectiveness of treating addiction with medication is like a doctor not telling a cancer patient about chemotherapy, said Dr. Mark Willenbring, a former director of treatment research at the National Institute for Alcohol Abuse and Alcoholism. "Scientifically, this is a settled matter."