233 is the number posted on the board in the group room of Rosary Hall’s inpatient detox unit. It’s the number of individuals in Cuyahoga County—as of today—who have died from a heroin or Fentanyl drug overdose.
It’s a crisis that led to a visit on July 12, 2016, from U.S. Surgeon General VADM Vivek H. Murthy, who came to Rosary Hall to speak to patients and providers and mobilize community partners. Today, the U.S. Surgeon General's office released a 400+ page report called, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs and Health."
How did we get to this point where people are dying daily? According to Dr. Ted Parran, addiction medicine specialist and associate medical director of Rosary Hall, the problem began when doctors and dentists starting prescribing prescription opiates—Percacet, Vicodin, Oxycotin, etc.—normally prescribed to treat end of life pain and acute pain for chronic pain.
“In people with addictive brain, opiates activate the pleasure centers through a process known as the dopamine surge,” Parran said. Lots of things cause a dopamine surge—being a parent, a warm sunny day, love of another… and opiates.
“Doctors have not been very good at figuring out who should never get within 100 yards of a prescription opiates—people with addictive brain,” he said. While many of the large pill mills that sprouted in Appalachia and Florida in the 1990s have been shut down by law enforcement, international forces really provide the supply today. “The resurgence of the Taliban in Afghanistan and an increase in supply of heroin from Mexico has led to record numbers of illicit opiate users.”
When prescriptions are hard to get or too expensive, people turn to heroin.
The scope of the heroin epidemic
Dr. Parran explains that drugs go through cycles of use. Following the Vietnam War, people were too afraid of heroin. But 25 years later, it has made a comeback. “Currently opiates are the epidemic, but the overall rate of usage is the same. It just pushed cocaine out of the way. In the background, the rate of alcoholism remains constant.”
Rosary Hall is the only hospital in Northeast Ohio that admits opiate addicts for detox. “People need a safe, clinically excellent place to chemically withdraw in a supportive environment,” he said. While in detox, Rosary Hall patients are integrated into the recovery program.
Being able to detox in a hospital setting is critical for opiate-dependent individuals. “When you’re drinking or drugging, you’re not worrying about your health,” said Parran. They often require lab studies, imaging, medical or surgical consults, physical or occupational therapy and psychiatric evaluations. “We have the ability to have those people seen and get treatment started while they are being detoxed,” he said.
Rosary Hall is rooted in the 12-step program of Alcoholics Anonymous that worked in 1935 and works today. With these new substances, there are medications that can serve as blockers to opiates and allow for individuals to maintain sobriety. However, Parran cautions that drugs such as Suboxone only work in conjunction with a bio, psycho, social, spiritual program.
“Once you’re through professional treatment, you need to maintain sobriety by having a sponsor and attending more than three AA meetings a week to stay sober.”
One of the Surgeon General’s biggest points is that we must treat addiction like the chronic disease that it is. “They will fail and lose hope, but that’s where we can help. The more often they try, the better the chance they will be successful in their sobriety. As clinicians, we must demonstrative unwavering positive regard for the person and optimism for recovery. We can separate the humanity of the soul from the behaviors of the disease,” he said.
Why are people dying?
The reason for the deaths is that those who use prescription opiates are using a fixed, known amount of the opiates. “When they buy heroin, they have no idea what the purity is and no idea what their tolerance is.”
Complicating the issue further are the illegal pharmaceutical labs that are making prescription-grade Fentanyl, which is 200 times stronger than heroin or morphine. “Even seasoned addicts are dying because they have no idea what the dose of heroin that is cut with Fentanyl is equal to,” said Parran.
So what happens to cause death and why doesn’t it happen to alcoholics or abusers of drugs like cocaine?
“There are a handful of fatal overdoses from alcohol,” explains Parran. “The difference between intoxicated level and fatal overdose of alcohol is very broad. With heroin and opiates, the difference between intoxicated and fatal is very narrow.”
Users are in search of the nod. A nod is a Level 1 coma. In a Level 2 coma, you are sound asleep. At Level 3 coma, you stop breathing. “The difference is a minor miscalculation and it hits when you are asleep,” he said.
Parran says the ways that epidemics are beat down is through broad and ongoing community awareness about the dangers, increased treatment capacity and aggressiveness of a well-rounded program, and reinforcing to people with addictive brain disease that if you have a problem with one substance, you will have a problem with all substances.
Learn more about addiction as a disease in our educational video, The Addicted Brain.