The Opioid Epidemic: A Local Perspective
By Guest Blogger and Brien Center Medical Director Jennifer Michaels, MD
Last month I listened as a new patient recounted his descent into heroin addiction. I was struck by the realization that this young man, clean-cut and barely in his twenties, looked as though his biggest life battle should have been on the soccer field, not in his childhood bedroom being resuscitated by EMTs. He told me that this brush with death convinced him he needed help. His relationship with opioids began in high school when he and his friends began mixing opioid pills to their weekend party cocktail of alcohol and marijuana. Weekend use progressed to daily use, until the expense of pills ($30/pill) made cheap heroin ($7/bag) a necessary next step.
His calamitous story reminded me of how our county’s and country’s opioid epidemic has evolved over the past two decades. When I moved to the pastoral Berkshires in 1995 to join the medical staff of the Brien Center and Berkshire Medical Center, I imagined I would have little need for the skills I cultivated during my psychiatry addiction fellowship. I was spectacularly wrong. Two years later a 23-year-old woman urgently sought treatment for opioid pill addiction. Her physician had been prescribing her opioid pills for migraines for the past seven years. While the pills alleviated her pain temporarily, during the ensuing years her need for pills escalated, and ultimately, she resorted to forging prescriptions. She proved to be the tip of the iceberg. Community providers, in line with national trends, had been prescribing copious amounts of opioid pills in response a variety of national pressures. Purdue Pharma had aggressively and effectively convinced providers that their blockbuster drug OxyContin was safe and minimally addictive to those suffering from pain. Pain became the fifth vital sign, and doctors who did not entirely alleviate pain were at risk for complaints and sanctions. Finally, overstretched providers appreciated the time-saving of prescribing opioids. While it can take 20 minutes or more to effectively assess pain, it takes a minute or two to write a prescription for OxyContin. As a result, in 2005, Berkshire providers prescribed more than 14 million opioid pills (National Pharmaceutical Annual Database), enough for every man woman and child in our community to receive 105 pills that year. Opioid overdose deaths quadrupled in Berkshire County between 2000 and 2005, consistent with national trends. Our community watched as an unprecedented number of our citizens struggled with opioid addiction. By the early 2000s a growing procession of opioid-addicted Berkshirites began appearing in local emergency rooms and clinics.
The Berkshire County medical community responded rapidly in a variety of ways. The Brien Center opened one of the state’s first OBOT (Office-Based Opioid Treatment) programs, offering comprehensive evidence-based treatment for opioid addiction. Berkshire Medical Center formed the Berkshire Community Pain Management Initiative. This program educates providers and residents about the risks of opioids and encourages safe, integrative pain management alternatives. Last year Berkshire Medical Center established a 28-day rehabilitation program, strikingly effective at fortifying early recovery. The Brien Center is poised to open a 17-bed women’s recovery home this fall. Local pharmacies have made Narcan available without a doctor’s prescription. Pittsfield and North Adams have approved local syringe access programs. Local community coalitions have galvanized to advocate for lifesaving and cost-effective treatment. Consequently, for the first time since this epidemic emerged, the rate of overdose deaths in Berkshire County did not increase significantly last year.
This accumulation of Berkshire County efforts has facilitated my patient’s early recovery. He is now 26 days sober. He, like our community, is on a path of recovery. But there are no shortcuts, and the journey will be arduous and humbling.
Jennifer Michaels, MD, is the medical director of the Brien Center, Berkshire County’s largest community mental health provider. She is dual-board certified in Addiction and General Psychiatry.