Barriers, bridges to recovery subject of opioid forum

by Kate Shunney

Four speakers led attendees through the tangle of issues related to the local opioid crisis during a public forum last Saturday, June 15 at Berkeley Springs High School.

Fewer than three dozen community members attended the session, which was sponsored by the Berkeley-Morgan County Board of Health and multiple community groups.

Facilitator Jennifer Schetrompf said the current way of trying to reach people with substance use disorder was like standing on the ground trying to help someone on a carousel that’s rotating.

“What we’re missing is there’s nobody on the carousel with them,” she said.

Jan Augusta Nieves, RN, has worked with the Berkeley Medical Center’s substance abuse program. Nieves said 20 million Americans have substance abuse disorder, but just one in 10 have access to addiction treatment when they seek it out.

Barriers to treatment can be insurance-related, lack of treatment providers and stigma.

“We want people to get help, but not next door,” said Nieves.

Nieves said how we talk about substance use and those who are addicted to drugs has a big effect on our level of compassion or desire to help them.

Nieves advocates for medically-assisted treatment for the disorder, which means a person takes some form of medication, like Suboxone, while getting counseling and treatment for their opioid addiction.

Substance abuse disorder is a brain disease, with clear medical evidence to support that way of looking at drug addiction, said Nieves.

“It becomes a disease hen the brain changes,” she said.

Nieves and Dr. Brandt Williamson of Berkeley Medical Center described how opioid use floods the brain with dopamine in unnatural amounts.

Dopamine makes us feel good, and after using opiates for a prolonged period, the brain stops making its own natural supply of the chemical.

When a person stops taking the opioids, the body releases stress hormones that cause shaking, sickness and distress.

Medications like methadone and Suboxone fill the brain’s dopamine “receptor sites,” Nieves said, so cravings for the opioid don’t happen.

Dr. Williamson acknowledged that many are uncomfortable with the idea of treating opiate addiction with a different opiate, such as helping a person addicted to heroin with methadone.

Both said the medication-assisted treatment in the Martinsburg area helps drug users move toward recovery from their disorder.

“I believe we’ll get rid of the opioid epidemic in its current form. We need to tailor interventions to medically assisted treatment while addressing why people are using in the first place,” said Nieves.

Dr. Williamson has led a program to connect emergency room patients to recovery services through Berkeley Medical Center in Martinsburg.

He said his interest grew out of major overdose deaths in 2016.

“We were seeing two to three overdose deaths per day,” said Williamson.

“We touch these people more than everybody. Why shouldn’t we be the ones to connect them with care?” he said.

Williamson said ER staff now have access to recovery coaches and behavioral health workers when a patient comes in with a substance use disorder crisis.

Doctors can manage acute opiate withdrawal with medication, then “bridge” that patient to longer-term recovery services.

Williamson said medications help “so the patient gets the monkey off their back so they can have a meaningful discussion with a recovery coach.”

According to Williamson, medications used during addiction treatment don’t have the euphoric effects of opioids and avoid the withdrawal sickness. That can give people a chance to get into recovery programs.

He said there is a perception that methadone or suboxone are replacement drugs for those who used to be addicted to heroin or pain pills.

“Nobody would say you’re addicted to the medication to treat diabetes. You’re dependent on it – yes – but you’re not addicted to it,” said Williamson.

Williamson said physicians have to take training to prescribe medications for substance abuse disorder, and then can connect patients to recovery options, even if there’s a waiting period to get a bed in a treatment facility.

“That’s a huge gap we just bridged,” he said.

There was substantial interest at the forum for establishing that kind of program at War Memorial Hospital.

Health nurse director Angela Gray and researcher Andrea Wright talked about harm reduction programs that can assist drug users in avoiding disease until they are in recovery.

Gray said programs in Berkeley County now serve up to 60 people per week. Those harm reduction programs will begin in Morgan County this summer.

Programs include needle exchanges, free and sterile injection supplies, free health screenings for diseases like Hepatitis and HIV and access to recovery coaches.

Gray said West Virginia is in the midst of a Hepatitis A outbreak that has reached over 2,000 cases statewide. A wave of new HIV cases is being tracked in the Huntington area now.

Those diseases are spread through bodily fluids and often spread through IV drug use populations when needles and injection supplies are shared. Harm reduction programs can interrupt the spread of those diseases into the wider community.

Gray emphasized there is 20 years of evidence that the programs work to stop disease spread and connect users to recovery options. They also save public dollars that would be spent treating disease outbreaks among all community members.

“We allowed this to happen. Now we have to fix it,” said Gray.