Veteran counselor addresses Opioid drug epidemic in Leadership Perspectives

People are dying all over the county from drug overdoses, and that includes communities right here in north Alabama.

The question is: "Just who gets addicted to the drugs, and why?"

Jessica Penot, a veteran licensed counselor who deals with drug issues nearly everyday joined us on set for Leadership Perspectives.

"That is a very difficult question because there's not a typical stereo typical addict. But there are two broad categories of them. The first category are people who have had chronic pain issues, or acute pain issues. So you get in a car accident, you're all messed up the doctors give you pain medicine legitimately 'cause you're in a lot of pain. But, after being on medication so long, you come out addicted. The doctor starts tapering you off and you find you can't live without it, and then you're going to the streets and you're going where you have to to maintain the medication that you no longer need. So, a lot of these people are normal people like you and I. And then there's chronic pain people who have issues like fibromyalgia, and they just can't cope with it. Again, they're normal people. They just don't know how to deal with the pain issues and they get hooked once they start on them. And the second broad category I see, a lot of our people with underlying mental health issues; some statistics show that upwards of 43% of Opioid addicts have serious depression. So they're people that really can't get off the Opioid speak until the mental health issue was treated as well."

Steve Johnson asked for more information: "Okay, is It does seem like we went from I guess just normal drugs to suddenly we have an Opioid crisis, and it seems like we've done it in just the last two or three years. Is it just that we started recognizing it in the last two or three years, or has it been going on longer than that ?"

"It's been going on forever," says Penot. "I worked at the methadone clinic for a long time, and you know that place is been open Huntsville Metro downtown has been open forever. And they had much larger numbers and they have now. I think the issue is is that we're cracking down now so you're seeing people pop up. So, there were doctors in the past that we really were not very well regulated; that were just handing out prescriptions left and right. And, these people just seemed like regular people who are getting meds from the doctor. But, when the state started cutting, cracking down on these doctors. Then these people started hitting the streets, and heroin started surging and the methadone clinic started seeing its numbers go up because they couldn't get it from the doctors. So it's changing forms essentially, but it's always been there"

"I know a couple of people that people I know personally who went from painkillers, I mean they had they had pain, and they got hooked that way," said Johnson. "But it's like, okay, if we know how this is happening, how can we not stop at least the people getting addicted because they use painkillers why can we not get control of that."

"I mean, chronic pain is a big issue," says Penot. "I mean, when you think about that, when you're in pain, you may very well cognitively be aware if you take this pill you can get addicted. But people tend to be blinded when they're in pain, and doctors are also blinded by pain. I mean, my husband works in the hospital, and he'll come home and he'll tell stories where, you know, you have patients that are just crying in pain, and you know if you give them too much pain medicine they might get addicted. But on the other hand. leaving them in that much pain seems cruel. So it's it's a hard balance."

"I get the feeling that we all know this is kind of out there, but the people who are addicted are keeping a secret as much as they can," suggests Steve. "Because I know a behavior changes happen. one person I know intimately, when he was hooked on painkillers, and ended up doing some other things to alleviate that they could hit the painkillers. It was obvious that something was wrong, and I now wonder, if it's obvious to me, it's obvious to other people. How can we lose control of this? I guess I'm I'm constantly amazed, and maybe we've never had control."

"I don't think we've ever had control," said Penot. "I think that it's just good at hiding itself. Especially since, for a long time, these people were getting it from doctors, you know. So it looked like they were taking legitimate medications, yeah, but it's always been there. (I) worked at the methadone clinic, guess it was I quit two years, three  years ago now, and that was before everybody was talking about the epidemic, which you could see it and those people then, and that was well before all of this."

Steve Johnson, "is there fault here? I mean, if doctors are prescribing too many pills or are or are handing them out in and numbers maybe that they shouldn't. Can we not stop this? I mean, is there somebody's fault; somebody to punish something that has to be changed to stop this? "

"I think we are working on that; I think the state has been," said Penot. "There was one doctor in particular who, when he was shut down, he was the largest opioid prescriber in the nation. And he was here local. People just drive by and get their scripts and he would give him whatever they wanted. I mean, it didn't matter how much it was. So I think the state is working to shut down doctors like that who are really out of control and contributing to the problem, so we're moving forward. I think the biggest problem now is treatment in Alabama. We've cut a lot of our mental health treatment and, since co-occurring mental health issues or one of the big underline issues for opiate abuse, that has contributed to the problem as well a lot of the people I see now who have opiate addictions. I can't treat the addiction until I treat the mental health issue. does that make sense?"

Penot says it's not just about getting off the drugs; it's also handling the problem that led to the addiction in the first place.

"If they come in with PTSD," says Penot, "they were abused their whole childhood, and then all of a sudden I'm trying to take them off whatever drug they've been using to self medicate, and arguably badly 'cause this is not really treating the issue, was just numbing. I have to help them deal with that underlying issue they've been running from their whole life. And, if you don't have access to that kind of mental health care, you're not going to be able to get off the drug. Does that make sense? And it's the same thing with chronic pain, you got to have some access to some sort of alternative treatment for pain. You can't expect people just to be able to come off Norco, or whatever it is they're taking, without some sort of alternative."

"Okay, so like like many things, this is way more complex than the than illegal drugs are coming in the U.S. and doctors are prescribing too many pills," says Steve. "And it's many things: it's people people in pain doctors who are prescribing too many pills access to drugs a mental health care, which is a recognized problem. I think you said that Alabama is the number one state for Opioid abuse in the country yes which is which is scary.... and also that 5% of the world's population is in America and we use 80% of the world's Opioids these are these are terrible numbers."

"And keep in mind though...you tend to think that everybody that's using Opioids as an addict. I think it's 3/4 of the opiates in the nation are consumed by 10% of the people using them. So there are a lot of people who are using painkillers in the right way, so just because someone's on painkillers, doesn't mean they're an addict if that makes sense."

"Okay, we first chatted on the phone you said there were a couple of misconceptions out there that you wanted to fix," said Steve. "Have you fixed them, or is there something you want to say about this whole problem that you would like for people to know?"

"Well," said Jessica, "I think the biggest thing is that it's not heroin addicts in the street in the gutter. These are regular people. A lot of the people I work with, at least, are construction workers, they're people that have to work long. They work their whole life, and then they get into a car accident; something goes wrong you know. They've been on IV morphine in the hospital and they can't stop taking it when I get out. It could be you or me, if something like that happened to us, because pain is horrible and most people don't know how to cope with it well."

Steve summed it up: "So what's the solution for all this?"

"I think one of the big issues we have is we need more treatment facilities and we need more treatment options," say Penot. "Right now, the first of all there's very few treatment options, especially if you're under or you don't have insurance. There's things like Bradford which is expensive and you have to have the right insurance to get in, and then there's some halfway houses, but all of these things tend to also follow a 30-day model which is also problematic. With opiate abuse, 25% of the people relapse within one day of exiting a 30-day program; 50% relapse within 30 days and 90% within 90 days. So the odds of those programs actually working are slim. We need programs that are longer than 30 days more IOP, which is intensive outpatient, where you can actually work and maintain a job. And that considers things like dual diagnosis, so it's not only treating your addiction, it's treating mental health issues. It's treating; it's allowing you to gain access to things for pain control and you know chiropractors thinks it'll help you with your chronic pain and medical issues as well. We need bigger options than just 30-day treatment programs that very few people can access."

"Now, you said that this this is been a problem for a while," prompted Steve. "Are we getting a handle on it at all; I mean, it is  getting plenty of national attention. Do you feel like there's a light at the end of the tunnel, or is it just 'okay everybody knows we have a problem but we got so many things to do to fix it they were just got to figure out what we're going to do?'"

"That's a hard question," said Penot. "I don't think we're getting, I mean, I think that we're doing well as far as cracking down on the doctors that have been over prescribing. I think the state has really, and the federal government has done a really good job and kind of weeding them out and letting them know that they can't do that anymore. I think we're falling down on treatment. There's not a lot of treatment options out there if you don't have insurance or you're not wealthy right now. You're number one treatment of options are like the methadone clinic or Suboxone which is similar to methadone. If you don't know what that is, that's essentially just substituting Peter for Paul. So it's a legal version of opiates that you can take regulated by a doctor and counseling staff. But a lot of people I work with on methadone say it's just as bad; it's just legal and better regulated so that's not the best answer out there. We need treatment options that allow people to get to the root of the problem or longer than 30 days allow them to work and that people can afford."