EP13: Facing the Opioid Crisis

NASW Social Work Talks Podcast

Aliah Wright:
From the National Association of Social Workers, I'm Aliah Wright, and this is Social Work Talks. Thank you so much for joining us for this episode, which focuses on the opioid epidemic that's gripping the nation, and how some social workers are dealing with this issue. The opioid epidemic is devastating communities nationwide. According to the Centers for Disease Control and Prevention, more than 40% of all US opioid overdose deaths in 2016 involved a prescription opioid, at least two thirds of which were tied to opioids like painkillers, heroin, and fentanyl. Today, we're chatting with David Stoeker, founder and director of the nonprofit Better Life in Recovery, a Missouri-based organization that helps those who struggle with substance use and mental health issues. David is also a counselor for the Green County, Missouri treatment courts through Preferred Family Healthcare. We became aware of David, a licensed clinical social worker, when he was awarded the Consumer Peer Family Leadership Award by SAMHSA during The Voice Awards held in Los Angeles in August. David, welcome to Social Work Talks and thank you so much for joining us.

David Stoecker:
It's good to be here.

Aliah Wright:
Can you tell us a little bit about yourself and Better Life in Recovery and your work there?

David Stoecker:
I'm a person in longterm recovery. For me that means I haven't used alcohol or other drugs since January 31st of 2009. I always say because of that, I get to do a lot of positive things in my community today. Better Life in Recovery came out of my sobriety. I got sober and I started looking around the community and I saw that there wasn't a whole lot of fun pro-social things for sober people and their families to do. So I created Better Life in Recovery, started that in 2012. We did one event the first year, we did three events the second year and then in 2014, Phillip Seymour Hoffman died in February. I remember reading through comments that people had left on the article in the local paper and on some of the local news stations. A couple of them that stood out to me were, who cares? Just another dead junkie and, we should get this stuff away for free so they can eliminate themselves from the gene pool. That was when I decided, maybe we needed to start doing some positive things in our community to being a little more visible and vocal. So the first year we did a couple disability events, like Recovery Day at Hammond Spiel, which is our AA, St Louis Cargill affiliate where we did a parade of people in recovery and their families. One of our members threw out the first pitch, we also did a 5K, 10K recovery run with a family fund barbecue after and we did a big river cleanup. In 2015, we filed for our 501(c)(3). In 2016, we opened up the Springfield Recovery Community Center along with two other nonprofits. Last year, we did over 100 events in groups. We picked up three and a half tons of trash at the Missouri River ways with our stream team and I think we painted 11 elementary school playgrounds, just people in recovery and their families giving back to make their community better.

Aliah Wright:
David, what would you say is a major cause of the ongoing epidemic?

David Stoecker:
We're not really in the midst of an opioid epidemic, it's more a pandemic, where we have increases in opioid overdose deaths, but we're also seeing increases in methamphetamine, benzodiazepine, cocaine, alcohol still kills more people than all of our other illicit drugs combined. Then we have poverty, abject poverty and racism, hate, anger, all those different things going on and it's almost created a perfect storm. You tend to see a lot of depression and anxiety whenever you see a huge disproportion between the richest in a community and the poorest in a community. And as we start to see that socioeconomic, the rich pull more and more away from the middle class and the poor, I think we're going to continue to see this get worse, not better.

Aliah Wright:
David, there are a lot of social workers out there who are trying to figure out how to help people dealing with this in their communities, in addition to best practices, what are some resources, some successful strategies and interventions that you've seen that social workers could use out in the field?

David Stoecker:
In Missouri, I'm proud that we've started a medication first model through what's called the STR, the State Targeted Response to the opioid crisis grant. Basically, what it allows is for somebody to go looking for treatments, and even though we might not be able to get them in treatment immediately, we can get them medication like Buprenorphine, which a lot of people know by the name suboxone or subutex. We can get them on that medication same day, which eliminates a couple things. It eliminates their cravings, it stops them from going into detox and it stops them from injecting, and it also stops them from having to go seek illicit substances. Now they have a medication that they can start taking under the guise of a doctor until we can actually get them a place in treatment.

Aliah Wright:
Now, with 175 Americans dying daily, and experts predicting that a million people will die from an overdose by 2020, what are the solutions to the opiate crisis?

David Stoecker:
Well, I think harm reduction is something that a lot of people miss, and I feel that it comes right out of some of our core values with empathy, unconditional positive regard, and I will throw compassion in there, but it's basically meeting people where they're at, somebody doesn't have to be sober to have worth. I think people inherently have worth, because they're sentient beings. We need to be reaching out to people who are still actively using, and, worst case scenario, sometimes maybe we support that and we just help them learn how to use in safer ways. Like syringe access and things like that, where we look at somebody who's not ready to quit now, but maybe if we can get them some resources that will help them stay healthy, then we can get them to a place where we can actually help them. We started prescription drug monitoring programs around the country. I know Missouri has been infamous, where I live, because we were the last state not to have one. It was a really good tool for prevention and early intervention, but it was really harmful to people that were chronic longterm users, because basically what we did was go into pharmacies and doctors and make it so that people couldn't falsify scripts or go to more than one pharmacy and get their prescriptions, so what happens is now we have somebody who's become physically dependent on opioids. If you don't know what dependence is like, I always say combine the worst you've ever felt with the flu, with the worst cramps you've ever had in your life, and then add an inability to hold down anything. I mean, not Sprite, not crackers, anything for 10 to 14 days. That's what going through a withdrawal is like for somebody. Most people can't make it through a withdrawal. What happens, now I can no longer get my medication, I turn to street drugs, because A, it's going to be cheaper, and B, it's going to make the withdrawal stop. If I'm going to a pharmacy and I'm getting say, morphine or dilaudid or Oxycontin, I know exactly what is in that. If I'm going out and buying heroin, I have absolutely no idea what's in heroin. It could be 30% pure heroin. It could be 80% pure heroin or it could be heroin cut with something like fentanyl, Carfentanil, Acetol, fentanyl, something that can be up to 100 times stronger than heroin. A lot of people start off using, like I said, because it serves a purpose. With me, I'd gone through years of childhood physical abuse. I went through sexual abuse, and when I first used, the summer before seventh grade, it numbed me and helped me escape and not think about all that abuse. It served that purpose for years and then years later, when negative consequences started happening, I was dependent on it. I think that's what happens with a lot of people. A lot of people it serves the purpose, whether it's an amplification to allow them to have more fun or it allows them to escape, say depression, anxiety, trauma, things like that. They do it and it serves that purpose and they fly along under the radar with no problems. Then they reach a point where they begin to have problems, whether it's legal or there's family issues and they say, "Hey, you know what? This isn't working for me anymore." They try to stop and when they stop, that's when withdrawal sets in, because now their body has become physically dependent on it and that continues that use from there. There's a difference between addicted and dependent and I think that's where we really need to define those clearly. I read articles say about babies born addicted. A baby can't be born addicted. A baby can be born dependent on a substance, but when we look at addiction, we look at that continued use despite negative consequences. There's a lot of people that are dependent on their medication. I don't think there's an issue with being dependent on your medication. I know a guy that's been prescribed methadone for 10 years, that's a firefighter in Kansas City. I know school teachers that are prescribed suboxone, that have been some prescribed suboxone for years that are going in and teaching our kids. It's no different than any other medication. Imagine I have high cholesterol and my doctor prescribed me medication for my high cholesterol and then once my numbers got where he wanted them, he didn't say, "Okay, time for you to stop taking your medication," he said, "You know what, your medications doing what we needed to do, it's working. Let's continue where we're at." I think, if we're going to look at addiction as a disease, which the American Medical Association said that back in, I think, 1956? It's been recognized as a disease, then we need to treat it like a disease, which means some people may get on medication for a while and then end up getting off that medication later, some people may be on medication for the rest of their lives.

Aliah Wright:
Can you talk about the ripple effects of drug addiction?

David Stoecker:
There's a guy, his name's [Donca Hojas] and he uses an analogy that I really like. He says that, imagine that you have a sick tree living in an unhealthy forest, and you uproot that sick tree and you put it in a nursery in nutrient dense soil and you give it the water that it needs and you give it adequate sunlight, and as soon as it starts to turn green, you take it and you replant it right back in the same corrupted soil, in that unhealthy forest that it originally came out of. He said, nobody would do that because we know that the trees are going to get sick again. Yet, we do that with people coming out of treatment, jails and prisons every single day. Recovery supports work to make our communities healthier. That's what we need to do, is focus on making our communities healthier. Otherwise, we're going to continue to have a revolving door where people come out of treatment and they move right back in next to the dealer and they don't have positive, pro-social activities to engage in. They can't find positive people to hang out with. People that don't use to hangout with or sober things to do, and they end up going right back down that road that they originally came out of and were trying to escape.

Aliah Wright:
Do you think getting tough on crime by threatening to sentence drug dealers to death is a real solution?

David Stoecker:
The war on drugs is a failed war. It is a fiasco. If it would have worked, we wouldn't have the problems that we have right now. As far as death penalties for drug dealers, I mean, a lot of times we're not even catching the people that we need to catch when we have these zero tolerance laws. Basically, three quarters of the time what we're catching is somebody who is dependent, who has an active substance use disorder, who is going to get drugs for their friend that also has an active substance use disorder. They're not doing it to make a bunch of money. They're doing it to supply their own habit, to get them what they're dependent on so that they won't go into withdrawals. And those are the people that we're catching. We're catching these low-level people with substance use disorders instead of these kingpins that we actually need to catch. I mean, that's part of the problem. The people that should be getting in trouble or the people that should be getting caught, aren't the people that need to be. It's the people that are living in poverty, that don't have the money to pay for their attorneys. Those are the people that are getting caught and getting sentenced to life sentences and now they're looking at death sentences for people who have a disease. I started off personally an abstinence-only person, so, I don't know. I think it was about the 30th, 35th funeral that I went to of somebody that I knew who died from an overdose. I realized that maybe abstinence doesn't work the way that we think it should. I also realized that my pathway to recovery isn't the only pathway out there, so why not support people when they're actively using? If you look at Switzerland, where they've started, they used to call them safe injection facilities, and now we're talking about comprehensive user-engagement sites, where we actually have staff so that if somebody overdoses, we have somebody right there that can revive them. Getting Narcan into the hands of lay people and getting them trained. But there's so many different things that we can do and I think they almost all revolve around harm reduction. Treating people with compassion, love and respect, even though they're using and trying to help them live a self-directed life and make improvements where they can for now, because it's my experience that dead people never find recovery. We've got to help people stay alive and healthy long enough to walk down that road. If that's the road they choose to go down eventually.

Aliah Wright:
What would better access to addiction treatment look like?

David Stoecker:
People in longterm recovery, recovery community centers, syringe-access sites, get them plugged into that so that they can talk to people who have been where they've been to maybe impact them where they're at and help them continue to live a healthy life.

Aliah Wright:
Lawmakers have agreed to allocate funds for this problem, and while experts and advocates welcome the extra funds, they say it falls short of the tens of billions that are likely needed to fully confront the epidemic. What do you think?

David Stoecker:
Yeah, I do. Especially when it comes to the money that's getting thrown around right now. I think when a lot of people hear $3.3 billion, I mean, when I hear $1 billion, I think it should echo, it's so big. Like 1 billion, billion, billion dollars, dollars, dollars. But honestly, if you look at $3.3 billion a year, and you look at the estimate that there's 22.5 million people with an active substance use disorder, that's about $150 for each of those people every year. I mean, it's literally a drop in the bucket. As long as we continue to throw what's really a pittance at this problem, we're probably going to continue to have it. As long as we look a treating a disease punitively, we're probably going to continue to have issues. I mean, we really need to look at this problem through a different lens. I think that harm reduction lens is probably one of the best things we can do. If you look at a lot of the European countries that have tried that approach, they've seen huge decreases in overdose deaths. Last year we lost what, 72,000 people? We lose more people every year to overdose and deaths than we did in the entire 20 years of the Vietnam conflict. It's mind boggling how many people we lose. 198 people a day is what we lost last year.

Aliah Wright:
David, I want to thank you so much for taking the time to talk to us.

David Stoecker:
Absolutely. Thank you for the time. I would leave with just a couple words. Harm reduction and recovery support. I mean, we really need to look at both of those. I don't think either of them get the attention that they deserve when it comes to being an effective tool of addressing the opioid epidemic. In fact, the huge pandemic that our country's in currently.

Aliah Wright:
Thank you again, David. Unfortunately, the issue of opioid addiction isn't going away. We invite you to join our virtual forum called The Opioid Crisis, No Community Is Immune, on November 14th and 15th, 2018. That's the week before thanksgiving. The forum will address the opioid crisis from a social work perspective and will feature plenaries and breakout sessions and offer CE credits. It will be live streamed, so you'll be able to participate from your office or a mobile device. So mark your calendars and check NASW social channels for details.

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