A 2017 survey by National Farmers Union and the American Farm Bureau revealed that as many as 74% of farmers nationwide have been directly impacted by the opioid crisis.
It usually starts with pain associated with an injury. Just ask Dr. Tina Chesek of the University of Nebraska at Kearney, who experienced firsthand the numbing effects of opioids. She shared her story during the Nebraska AgraAbility Conference in Lincoln earlier this year. Chesek is an associate professor in the Department of Counseling and School Psychology.
w“The first day back to work in 2000 from my maternity leave I was hit by a pickup running a stop sign. The driver was intoxicated and the whole community knew he had an alcohol problem.”
Ironically, she notes that he saved her life even though he caused the accident.
The accident left her with a crushed wrist and she was sent home from the hospital with two prescriptions, one for Darvocet and another for Percocet, with instructions to take two pills every four hours.
“A lot of our opioid stories start like this,” she said.
Making a long story short, she noted that the opioids disrupted her life for weeks before she was finally able to work herself free from their hold. If she, as a professional, could become swept into the opioid web, how easily could others?
“In the 1960s, 80% of opioid abusers got hooked on heroin,” she noted. “In the 2000s 75% of opioid abusers started with prescription opioids.”
Today an estimated 2.1 million people suffer from substance abuse disorders related to opioid pain relievers, and the number of unintentional opioid overdose deaths has quadrupled since 1999.
Chesek pointed to the book, “Dream Land – The True Tale of America’s Opiate Epidemic,” by Sam Quinones. In it Quinones outlines the history of the opioid epidemic.
“The big changes came in 1996 when Purdue Pharma developed OxyContin and doctors were urged to treat pain as a vital sign,” said Chesek.
At about the same time in Portsmouth, Ohio, Dr. David Procter was prescribing opioids with regularity, and from his practice the phrase, “pill mill,” was coined. Through his practice “an army” of new addicts was created that still grips the region of southern Ohio and northeastern Kentucky.
Meanwhile, in Xalisco, Mayarit, Mexico, the Xalisco Boys heroin cells began operating. They brought black tar heroin to the U.S. and set up shop where pill mills were located.
Chesek noted withdrawal from opioid use is uncomfortable, much like the flu, once the brain is trained. She noted there was a cell in Omaha and law enforcement is finding more and more, as individuals attempt to withdraw from opioids.
“Lots of money will be rolling into states as they deal with this,” said Chesek. “Sixteen states and counting have sued Purdue Pharma, and now they have been granted a patent for opioid-addiction treatment via a patch.”
Americans consume more opioids than in any other country, she said, noting they estimates 50,000 doses per one million people. Canada is the next closest with 30,000 doses per million people.
“In one family discount pharmacy in West Virginia they filled 16 million doses of oxycodone and hydrocodone for town of 1,700,” said Chesek. “The new crime is breaking into small-town pharmacies because there isn’t a lot of security. Pharmacists are kind of a target right now and medical facilities of any kind are increasingly at risk.”
Among the opioid prescription medications commonly found in home medicine cabinets are variations of oxycodone such as OxyContin, Percocet and Percodan. Hydrocodone drugs include Vicodin, Lortab, Lorcet, MS Contin. The list continues with oxymorphone, hydromorphone, propoxyphene, morphine, codeine and fentanyl.
Bringing it back to the country, Chesek cited a survey that showed three of four farmers say it’s easy to obtain opioids without a prescription compared to 46% of urbanites. A Massachusetts study found that opioid-related deaths in farming, fishing and forestry was five times higher than among other workers.
There is a narrow window between using an opioid to ease pain following an accident or surgical procedure before becoming addicted.
“The risk of continued opioid use increases at four to five days,” Chesek said. “That’s when using the medication in a helpful way and your risk of becoming addicted spikes. At one year you become caught in a loop that just doesn’t end.”
It keeps getting scarier, said Chesek: “National overdose deaths are spiking. The rates of drug overdoses in rural areas are surpassing rates in urban areas according to 2017 statistics from the Center for Disease Control. Fentanyl can be ordered from China with no questions asked and it is coming in the mail. Heroin, fentanyl and carphenanil (which is an elephant tranquilizer) are all readily available with minimal search effort.”
The dangers of opioid misuse are all too real, as Chesek noted the number of overdose deaths in Nebraska for the 12-month period from March 2017 to 2018 was up 48%.
With permission she shared the nightmares two Nebraska families endured following the loss of loved ones to opioid overdoses.
“In rural communities we don’t talk about mental health and drug issues,” Chesek said. “The family of Andrew Oswald III wrote a heartfelt, no-holds-barred obituary that outlined how opioids contributed to his death.”
Ruth Ehrke of Minden left two small boys. She overdosed on heroin and had an altercation that resulted in her death.
“I tell my students it starts with a choice, but soon our choice is taken away from us,” Chesek said.
The cycle of addiction basically hijacks the brain, noted Chesek. It starts with dopamine dump that excites the brain. Shopping, gambling and binge intoxication are just some of the results of an opioid high, she said. This is focused in areas the basal ganglia in the brain.
What follows is a crash or negative affect withdrawal.
“Coupled with anxiety we need something to make us feel good, and this is found in the extended amygdala,” she said.
This leads to the preoccupation or anticipation stage, which is found in the brain’s prefrontal cortex. This portion of the brain acts as the general, exercising executive function, Chesek said.
“People caught in this cycle are fighting their own brain. In the addiction cycle it is like people are always hungry,” she said.
The journey back isn’t easy, noted the speaker. Opioid use disorders treatment uses a combination of medication assisted treatment (MAT) and therapy. Some of the drugs used in MAT include methadone, buprenorphine, Naltrexone and Suboxone.
Options for psychosocial or behavioral treatment include outpatient or residential treatment. Family therapy and group counseling are also important as patients seek a new normal. Some benefit from 12-step facilitated therapy, others from cognitive behavioral therapy, contingency management or psychoeducation.
There are a number of intervention and treatment efforts underway to combat the dramatic rise in opioid misuse, noted Chesek. There are “take back” days, where local pharmacies or organizations collect unused opioids. There are also social campaigns and psychosocial education opportunities.
Prescription drug monitoring programs are also helping to tighten up the prescription rate. Above all, Chesek advises: “Educate yourself and when possible lock it up.”
While treatment options exist the biggest challenge is finding it locally. In rural areas it’s typical that only one in three people can get treatment for substance abuse.
“That’s what we’re looking at when dealing with substance abuse disorders,” Chesek said. “There are all types of programs for diabetics and those with heart disease. No other disease would be this ignored.”