Originally published in the Manchester Journal on Feb. 2, 2018.
By Cherise Madigan
MANCHESTER — How can the Northshire community begin to combat the staggering opiate crisis that has swept our nation — and the overdose deaths that follow in its wake?
That was the question for a coalition of local organizations, whose inaugural event on Jan. 25 featured a screening of the documentary “The Opiate Effect” followed by a panel discussion. The event — organized by Fed Up Manchester, The Collaborative, United Counseling Service (UCS), GNAT-TV, and the Manchester Community Library — brought over one hundred community members to the library for the conversation.
Andrew McKeever, news director at GNAT-TV, led the panel discussion that followed the film, featuring Wendy Galbraith of Fed Up Manchester, Maryann Morris of the Collaborative, James Reilly of UCS, Beth Sausville of the Vermont Department of Children and Families, and Nissa Walke of Vermont Blueprint for Health.
“Every day in 2016, 175 Americans died from opiate related deaths,” McKeever explained. “That translates into 62,000 deaths per year. That’s more than the number of people who were killed during the 15 years of the Vietnam War. That’s more than died during the height of the HIV/AIDS epidemic in the 80’s and 90’s. More than died in the worst year of car accidents in the United States…This is a problem that is way past those levels.”
More than a number
Galbraith brought those staggering statistics to life in sharing the story of her son, who lost his battle with his addiction four months ago. His struggle led Galbraith to form the activist group “Fed Up Manchester,” comprised largely of local mothers dedicated to combating the disease of addiction.
“When I first learned that my son was using drugs I was terrified and paralyzed,” Galbraith began. “The stigma prevented me from reaching out for help. I figured I was super mom, and I was going to fix this.”
After what she describes as “eight months of disasters” Galbraith finally reached out for help, and quickly realized that she was not alone. Still, when her son came to her for help she found that there were few options for recovery in Vermont.
“We were lucky to get into a place that gave him two weeks — that was it,” she said. “It was barely enough to detox, and within a day after he left he relapsed.”
The situation continued to worsen, Galbraith said, until “it was such a mess that it was unbelievable.” Returning to his mother for help once again, Galbraith was dedicated to finding her son a long-term, residential rehabilitation facility. After four months in a new facility, with a job and apartment waiting, Galbraith’s son felt ready to resume his life.
“One night he says that he is fine, that everything’s great,” Galbraith said. “Twenty-four hours later I got the call that he had overdosed and died.”
An epidemic becomes a ‘tsunami’
Like Galbraiths son, many struggling with opiate addiction first develop a dependency following a prescription for painkillers. According to Reilly, a licensed alcohol and drug counselor, those prescriptions began to increase decades ago — with opioid prescriptions “nearly doubling” for adolescents and young adults between 1994 and 2007.
“This epidemic really started in the 90’s, and has turned into a tsunami at this point,” Reilly said. “The latest research that I’ve seen shows that fifteen percent of all people who have ever taken an opioid, any opioid, will develop a substance use disorder.”
“The drugs change the physiology of the brain, and it hijacks the brain so that they connect with pleasure in a different way,” Galbraith explained. “Pleasure to them is using the drug, and once they’re addicted that’s the norm. It’s when they don’t have the drug that they feel sick.”
While he expressed a hesitancy to “point fingers” at specific pharmaceutical companies or products, Reilly suggested that the marketing of painkillers like oxycontin and vicodin played a role in launching the current epidemic.
“We’ve come to believe, apparently, that if we have any kind of problem there should be a drug that will fix it,” Reilly said. “There are many ways to deal with the pains in life, and they do not include medicating them into oblivion with an effective pain reliever like an opioid.”
While there is a lack of federal restrictions on prescriptions, Registered Nurse Kelly Phillipe explained from the audience how the local Southwestern Vermont Medical Center has begun to address the issue.
“Opioids were being prescribed because pain became the sixth vital sign in the 90’s,” she said. “Our project looked at why providers were prescribing so many opioids, and when we peeled back the layers what we found was that they were doing what they were doing ‘just because.’ That had already been the practice and nobody questioned it.”
While SVMC has worked to charge their practices following that effort, Phillipe noted that there were no federal regulations in place forcing them to do so. Though other institutions are beginning to follow suit, she said, progress comes slowly.
In the meantime, the number of opiate addictions across the country continue to grow.
Treated as “second class citizens,” Reilly says, those struggling with addiction find many doors closed to them due to what is erroneously seen as a “moral failure.” Families are not only devastated by their loved ones disease, he says, but also the increasingly common thefts and burglaries necessary to support the habit.
Recently, a rising number of children have also begun to bear the epidemic’s burden.
“One of the devastating pieces of this epidemic is all of the very young children that are being brought into our foster care system,” Reilly said. “Not just that, but being parented by their grandparents, whoever can stand up, because our young people are in an epidemic.”
“In Bennington County in 2017, 62 percent of children the children who came into [foster] care were zero to five years old,” Sausville added. “Of that 62 percent, 50 percent were due to addiction.”
From the pharmacy to the streets
While panelists focused largely on the role of prescription opiates and tools for prevention and recovery, audience members urged a larger discussion on the illicit drug trade that has bloomed during the epidemic — even in Manchester.
“We’ve talked a lot about prescription drugs and the regulations around those, but let’s talk about heroin,” said Bennington County State’s Attorney Erica Marthage. “These people are dying from heroin overdoses, or heroin and fentanyl.”
“I’ve been involved in numerous controlled buys… [and] I have a lot of bonds with people who are suffering from heroin or opioid addiction,” explained Officer James Gulley, a member of the Vermont Drug Task Force working in Manchester. “A lot of my informants are resorting to black market suboxone… because they can’t get into your programs. We just did a large case where there were numerous bags of fentanyl… why are we not getting these people, members of our community, into your programs to get help?”
Despite a growing need, panelists explained that funding for recovery program needs to come from somewhere. As John Caceres of Bradford’s Valley Vista Medical Center explained from the audience, such programs are often dependent on insurance companies — which don’t always cover long-term recovery programs.
“We started out at one time being six months and maybe even longer, and we’re down to what is essentially a 28 day program,” he said. “We are a business, whether for-profit or non-profit it doesn’t matter, we still need to be funded to pay our employees.”
Often, a lack of resources for recovery combined with an increasing tolerance for the expensive drugs will lead many to seek our cheaper opiates like heroin, explained panelists. As an addict’s tolerance for the drug builds, however, some begin to seek out more dangerous products like fentanyl.
“What happens to people is that they develop and opioid use disorder and they start needing more and more, because its a physically addictive and tolerance forming drug,” Reilly explained. “People remember a few years back in Manchester when they found forty kilos of heroin in a van in front of a local establishment, and there have been huge busts ever since.”
“We’re seeing an increase of fentanyl being put into the heroin that’s on the market — a lot of the time the user isn’t aware that it’s there,” said audience member Stephanie Thompson of New England HIDTA. “In other instance I’ve heard anecdotally that people are aware that it’s there, that using fentanyl is cheaper, and that’s a situation where people realize that the risk of overdose is a lot higher. We’re still losing a lot of people as a result.”
A path forward
Though the emotion carried by the conversation was palpable, participating organizations also provided some insight on ways that the epidemic was being fought in both Bennington County and the state of Vermont. Walke explained a number of initiatives undertaken throughout the state, including the nationally recognized “hub and spoke” model for recovery. Morris, executive director of The Collaborative, also illustrated prevention efforts taken on by local organizations like her own.
“What’s the strongest in Bennington county is the partnerships,” Morris said. “There’s a clear and strong relationship with the medical community, there’s a clear and strong partnership with schools, and there’s a clear and strong relationship with law enforcement to work together towards increasing the health of our community and decreasing substance use.”
Working with the Bennington County Prescription Drug Task Force, collection boxes are now available at every law enforcement agency in Bennington County, she said. A permanent drop box has even been installed at SVMC.
Programs like “Parent Up” inform adults for those difficult discussions with their children regarding substance use, Morris said, and The Collaborative’s longstanding “Refuse to Use” program sponsors prevention education events outside of school.
In Bennington, law enforcement has begun to embrace “positive ticketing campaigns” to reward youth for positive behaviours like going to a movie rather than more destructive pursuits. In Manchester, a park ordinance banning the possession of any prescription drugs that are not your own sends a message that this community takes prevention seriously, she says.
Despite the number of prevention and education programs available, panelists argued, it is coordinated community efforts that have the most power to effect change.
“When I look at the film one of the things that was really reinforced for me was the substantial impact that opiates have had on our communities across the state of Vermont, and I think that impact is evidenced by how many people are in attendance here tonight,” Walke said. “The number of people in attendance tonight, however, gives me hope — because one of the aspects that we are well aware of is that strengthened, committed, and connected communities help to reduce the prevalence of substance use disorder.”
Reach Cherise Madigan at firstname.lastname@example.org, or by phone at 802-490-6471