When an epidemic is causing illness and deaths as the heroin and opioid crisis has done in New England and elsewhere in the nation, someone has to step forward to fight back against its growth.
And that was why U.S. Attorney Peter Neronha, District of Rhode Island, held one of four planned town meetings on the opioid crisis this week to help highlight National Heroin and Opiate Awareness Week.
Neronha brought together a panel of experts in the treatment of heroin and opiate addiction as well as federal, state and local officials doing their part to curb its impacts on the region’s young people, their families, and many others.
The goal of the awareness week was advanced by the federal government and President Barack Obama as a response to the continuing problem of opioid-related deaths and addiction, and Neronha said he hoped everyone involved in the sessions in Rhode Island would spread the word that there is help and treatment available to combat the epidemic.
At the same time, he commended those in law enforcement for doing their part to stop the distribution and abuse of the drugs and the firefighters and first responders who are now trained and equipped to save a growing number of people from overdose deaths.
“There have been 160 Opiate Awareness Week events held by U.S. Attorneys across the country and we are doing four here,” Neronha said of the national response to the problem.
“It is incredibly necessary because this is such a dangerous thing for young people,” Neronha said.
During his presentation to the crowd of about 60 people in Harris Hall – many of them from care programs, law enforcement, school representatives, and substance abuse prevention organizations – Neronha said the response undertaken by the Department of Justice contains three components.
“One is enforcement but equally important are prevention and treatment, and that is what I want to focus on tonight,” he said.
“There are so many people in law enforcement, federal, state and local, that are working really hard to interrupt the supply of heroin and fentanyl into Rhode Island and across the country and I can tell you that the DEA and the State Police and local police departments like this one in Woonsocket are seizing large supplies of those substances all the time,” he said. “And yet that is not enough for us to solve this problem because the supply is seemingly inexhaustible so again our focus tonight and this week is on prevention and treatment,” the U.S. Attorney said.
Neronha offered the gathering a sampling of numbers from the crisis in Rhode Island that he described as “truly staggering and they are truly startling.”
In 2015, he said, there were 258 overdose deaths in R.I. from prescription pills, illicit drugs, or a combination of the two. “That is a 50 percent increase since 2011. And equally telling is the fact that in 2014, emergency medical services administered Narcan over 1,500 times,” he said.
The treatments with Narcan, or Naloxone, a drug that stops the effects of a heroin or opioid overdose and can restore an unconscious person’s breathing immediately, show that there were another 1,500 instances where “someone was potentially at risk of death and were brought back by the use of Narcan,” Neronha said. “And that is a number that is steadily increasing. So to get a sense of the problem we can't just look at the deaths, which are bad enough. They are bad enough, but when we realize how many times Narcan is being administered, people who are at risk for death, we start to get a sense of how deadly this problem really is,” he said.
“Also of concern to all of us is the fact that the use of fentanyl, or the involvement in fentanyl in these deaths is on the rise,” Neronha said. “In 2015, fentanyl was involved in 50 percent of the overdose deaths,” he said while offering another Rhode Island statistic from the crisis.
The added danger from fentanyl use is that most users, Neronha offered, “are not trying to get it and don't know when they are getting it. And when they get it, it is incredibly deadly,” he said.
Neronha said he had just heard from Col. Stephen Lynch, Burrillville’s chief of police, about a case that community where emergency responders administered about ten doses of Narcan to get a person back and fentanyl was suspected to be involved because of the concentrated strength of the synthetic narcotic.
Burrillville Police took on the task of training in the use of Narcan after the community experienced six overdose deaths during a period of six weeks, according to Lynch, and the department’s has since been successful in saving more than eight to nine people from similar deaths, according to Lynch.
Some Progress Made
“In this overall, and some might say gloomy environment, I do want to mention that, due to the work of many, many people, and none of them being me, Rhode Island is clearly making progress,” Neronha said. “As I speak to my colleagues around the country, Rhode Island was at the forefront of trying to address this threat. And that is due to a lot of really, really good people. Many of them are people who have been doing this work for a long time, he said while commending the Woonsocket Prevention Coalition’s Lisa Carcifero and the other substance abuse prevention officials present for the work they have been doing across the state.
He also praised Gov. Gina Raimondo for the work she has done in Rhode Island putting together a task force on intervention and prevention involving a variety of people in public health and also working with the General Assembly to change laws related to the monitoring of prescriptions for controlled medications such as prescription opiate pain medications.
“And if I don't mention anything else I would encourage all of you if you haven't done it yet to go to preventoverdoseri.org. I spent a lot of time in that website and there is a lot of information there,” he said of the state’s substance abuse prevention website.
The Prescription Monitoring Program (PMP) legislation supported by Raimondo and approved by the General Assembly, is helping prescribers of such medications to know “what the people they are treating are doing,” he said.
“So if you have a patient, and my wife is an internist, and she wants to know where that person is getting opioids – if they are getting them from her, that they are only getting them from her and to make sure that they are not getting them from another source. It is a way to check that,” he said.
It had not been mandatory for prescribers to register and use the PMP until the past session, and the state legislation also cleaned up the process for the monitoring system to be accessed by doctor offices – another accomplishment of the governor and the General Assembly, he said.
“Today registering for the PMP is mandatory, so now prescribers have to sign up for it, but they also have to use it,” he said.
Prior to passage of the legislation in 2014, Rhode Island physicians wrote 33,000-plus Schedule II prescriptions, but ran PMP reports just 26 percent of the time, Neronha said. “That's just not enough. It not enough when you are issuing that many prescriptions to check it just 26 percent of the time. So like I said, thanks to the leadership of Gov. Raimondo and the Prevention and Intervention Task Force, we have members of that here today, and the General Assembly, Rhode Island is now one of 21 states that requires prescribers to check the PMP prior to prescribing an opioid,” he said while describing the change as “a huge step forward.”
Rhode Island is now just one of 21 states using such a system of checks, and Neronha said Rhode Island is also one of six states, “thanks again to the efforts of our elected officials,” requiring prescribers to check the PMP every 90 days after prescribing an opioid.
Only five other states require any type of follow-up checks at all, whether at 180 days or annually, he said.
Rhode Island is also one of only 11 states that now set dosage limits on the prescribing of opioids as another step forward to reducing abuse, according to the U.S. Attorney.
“Now that alone, those steps alone are not the answer but that is progress and it is why I say that Rhode Island is on the leading edge of making some really significant efforts that may impact this problem,” he said.
Mayor Lisa Baldelli-Hunt told the gathering that she felt Woonsocket was fortunate to be hosting one of the U.S. Attorney’s forums on opioid crisis, and noted it was in keeping the goals of National Heroin and Opiate Addiction Week.
“Our aim is to reinforce the national and regional approach to stem the opioid and heroin epidemic by illustrating a message of prevention and awareness, enforcement and treatment,” Baldelli-Hunt said.
“I would like to recognize efforts of several organizations and individuals who are here tonight as part of this collaboration and who brought this event together,” she said.
Baldelli-Hunt noted the role of President Obama and Attorney General Loretta Lynch in Washington in designating the crisis awareness week and also the support of U.S. Attorney Neronha and Gov. Raimondo, “who came out with a strong overdose prevention and intervention action plan this year,” she said.
She also praised the work of Carcifero, the Woonsocket Prevention Coalition, and the similar groups around the state for their work on the crisis.
“It was 30 years ago this year that former Mayor Charles Baldelli (the mayor’s uncle) had the good sense and foresight to form a task force in the community to address the harmful effects of addiction and drug abuse in Woonsocket,” she said. “Today that taskforce, which is known as the Woonsocket Prevention Coalition, and their efforts, is as needed now as much as they were 30 years ago. The Woonsocket Prevention Coalition has spearheaded efforts to educate youth, provide resources for those affected by addiction and to spread a positive message in our community,” she said.
“They meet monthly right here in historic Harris Hall and they are always interested in folks getting involved,” the mayor said.
The organization has recently worked to regionalize the Blackstone Valley Prevention Coalition and capitalize on large scale collaboration “to better effect communities, to leverage resources and to streamline their efforts,” Baldelli-Hunt said.
The mayor also commended the Woonsocket Police Department and the public safety personnel who “are on the front line every day doing what they can to save lives, enforce the law and the forge relationships with the community.”
She noted the Woonsocket Police Department was one of the first in the state to implement a prescription drug disposal box at the station that helps prevent drugs from being abused or entering the community.
“I hope everyone here tonight will become empowered by the information and the experiences that you will gather and create,” she said.
So Many Susceptible
The session continued with the showing of a short film, “Chasing the Dragon, the Life of an Opiate Addict,” that was created by the FBI and DEA to show the tragedies behind opiate abuse.
FBI Director James Comey offered an introduction to the film as it was played, and explained the opioid crisis can affect any community in America.
“You will see that those whose lives are taken over by drug addiction are often kids from stable homes and strong families. Good people, who had great childhoods, who were given everything they wanted and had everything going for them. But they took one wrong turn and they were hooked; once you are hooked it is so very hard to get off these drugs and the spiral down is so predictable,” Comey said.
The stories told included one of a woman who became addicted to Oxycontin after giving birth to her daughter at the age of 22 and continues to struggle with the aftermath of drug use to this day.
Another mom told of her daughter’s struggles with opiates and how she even agreed to send her to jail in an attempt to get her off drugs.
Things looked better when her daughter was released, at least for a few days, but then she went out and came back with something she took up to her room with her, the parent related.
When her daughter didn’t come down to dinner with everyone else, the mom went upstairs to get her. “I knocked and knocked and when I opened that door, my little girl is on the floor dead,” the mother said. “I was in my kitchen cooking dinner and that happened 17 steps up and I had no idea that was going to happen,” she said in the film.
Other users described how they overdosed as the last step in their long addictions and were brought back with extreme measures through the use of cardiac defibrillators and resuscitation.
During the panel discussion, Dr. Stuart Gitlow, a psychiatrist, voiced a concern about impact of over prescription of opioid painkillers for conditions that do not truly require them or the excessive amount of such pills included in a single prescriptions. “There are many ways to treat pain but one of them is not opiates,” Gitlow said.
As a result of the availability of such drugs, Gitlow said 10 to 15 percent of Americans have some exposure to opioids. Among that group are people who could have addiction predisposition and doctors need to be asking the right questions of their patients before writing prescriptions to properly screen them. The quantities prescribed are also a problem when providers issue a prescription for 30 days of a medication when only two days might be appropriate for a procedure such as a tooth extraction, he suggested.
The participants from the treatment and counseling agencies related the details of their work with young people and their concerns over the increases in the problem that have been seen more recently. Sally McAuley of the Community Care Alliance told of the programs for medicine assisted treatment such as methadone available from her organization and others in the state.
She also commended those who seek to address their problem. “It is never a weak person that wants to seek help,” she said.
Woonsocket Police Chief Thomas Oates said that his officers are also seeing an increase of fentanyl in the city as part of their interdiction efforts. “It is an extreme concern because now we are seeing it sold purely as fentanyl,” the chief said of the powerful and overdose causing opiate.
Follow Joseph B. Nadeau on Twitter @JNad75