LSA junior Heather Martin was just 17 when her older sister Angie fatally overdosed in their family home, following a seven-year struggle with opiate addiction.
Martin said her sister, throughout her life, was always a bubbly, amiable person. As her addiction continued, though, instead of family remaining a priority as it always had been, getting her next bigger and better “high” took over, until one day — July 10, 2014 — they found a needle next to her unresponsive body.
“It was surreal for my parents in the way that all of this energy and time spent into her recovery was now gone; their daughter was gone,” Martin said. “It was definitely a shift coming back into reality, coming back from that world of heroin and opiates.”
Now, more than two years later, Martin still thinks about what life would be like had her sister not overdosed, noting the stigma that her family faced throughout her sister’s battle with addiction, which included numerous stints in rehab facilities, jail time and periods of drug testing.
“It was scary for me to try and come up with these lies to make us seem like we were a normal family that just couldn’t do certain things,” Martin said. “People caught on, but they didn’t really ask questions and that was probably one of the hardest parts… not knowing the line between wanting to talk about it but also knowing that if it’s talked about, people will look at you differently.”
Experiences like that of Martin’s family are growing in numbers both nationally and locally in Washtenaw County. In response, several initiatives within and surrounding Ann Arbor have been working to reduce opioid-related deaths and primarily raise awareness about what Martin calls a “silent opioid epidemic.”
Martin said she struggled entering her freshman year at the University of Michigan just two months after her sister’s death because she often faced the same common misconceptions about being family members of drug users do.
“I didn’t want to be that girl that was known in my town who, when you said your sister’s involved with drugs, you were automatically stigmatized of being bad and dangerous, and they couldn’t trust you,” Martin said. “Even though I had never touched a single drug in my entire life, it was still how I was perceived.”
Statistics from the Centers for Disease Control and Prevention show opioid overdoses have tripled nationwide since 2000. According to a January 2016 report, opioids — particularly prescription pain medication and heroin — are the main drugs associated with overdose deaths, a statistic that was made apparent in 2014, the year in which more people died from drug overdoses than any other year on record.
Statistics from Washtenaw County are just as severe as those nationwide. According to the Washtenaw County Public Health Opioid Report from June of this year, since October 2015 there have been about 20 Washtenaw County residents overdosing per month, and 25 percent of these residents do not survive.
Additionally, opioid and heroin overdose data show there have already been 33 opioid deaths in Washtenaw County so far this year, more than the total amount of overdose deaths in the county just three years ago.
Health effects
Opioids change both the physiological response and behavioral mindset of the user after prolonged periods of dependency on the drug, according to Marci Scalera, co-chair of the Washtenaw Health Initiative Opioid Project. She said users begin to need the drug just to feel “normal.”
Martin said her sister was active in a number of activities such as dance, student council, writing and sports until she first began experimenting with marijuana at about age 15.
Once Angie began using harder drugs, Martin watched her lose interest in academics, quit the dance team and drop her application for the high school student council — changes Martin said were indicative of a “slow but downhill” spiral away from her priorities and morals. Echoing Scalera’s sentiments, Martin said Angie began to prioritize chasing a high as her addiction continued.
“It manipulates people into being liars,” Martin said. “Wanting that drug was her main priority in life. Everyone else was doing life with drugs on the side, but she was doing drugs and life on the side.”
Research
Mark Ilgen, interim director of the UM Addiction Treatment Services and research investigator in the Department of Veterans Affairs, said his research aims to assess the success of treatment methods for his patients, use a combination of modification of methods to personalize treatment and interact with substance abusers at an earlier stage of their use.
Ilgen said the recent prescribing of opioid painkillers in medical settings is much of what increased the use and misuse of these medications. University researchers have supported this notion — last February, researchers found that giving patients smaller doses of prescription opioid painkillers for medical reasons may prevent overdoses.
“When you’re talking about opioid use disorders and prescription opioid misuse and now heroin dependence, you’re looking at confluence of a number of factors that all increase opioid use over the last 10 to 15 years or so,” Ilgen said. “Most people trace the current problems we’re having with opioids back to an increased emphasis in the early 2000s by different pain treatment advocates to more aggressively monitor pain and intervene to address pain.”
Another University study also found that adolescents who reported receiving a prescription from a doctor intended as a pain reliever are nearly 33 percent more likely to misuse these substances in the future in comparison to those who never received a prescribed opioid.
The CDC recently reported a similar trend — among new heroin users, about three out of four report abusing prescription opioids prior to using heroin — research that suggests alternatives to prescription pain relievers, such as physical therapy or less severe medications, may have more long-term benefits to a patient.
Working efforts
In 2014, Washtenaw County hit a peak of 65 deaths from opioid overdose, kick starting several local initiatives.
“The rate of escalation of addiction tends to be pretty rapid,” Ilgen said. “At least for the more easily abused medications, the time period between when someone starts using recreationally and then (later) one gets into trouble more along the lines of having an opioid use disorder, that pathway tends to be faster for opioids than you see for a lot of other drugs of abuse.”
Programs such as the WHI Opioid Project have acknowledged these growing numbers and Scalera said aim to encourage participation of medical practitioners, law enforcement, community leaders, treatment providers and recovering addicts in a number of multidisciplinary efforts, including addiction treatment, community education, diversion control and harm reduction in the fight against the opioid epidemic.
She said she believes the efforts of the Opioid Project have been fruitful, noting that in 2015, the number of opioid deaths in Washtenaw County decreased to 49. This decrease, she said, could be tied to the group’s efforts to introduce Naloxone — more commonly known as Narcan — into the UM Police Department over the summer.
Naloxone is a drug that counters the effects of an opioid overdose by preventing opioids from attaching to certain receptors in the brain, allowing an overdosing individual to breathe properly. Every police officer was trained to carry and administer Naloxone starting in June.
“We have to battle attitudes like, ‘Why would we want to save their life? They’re just going to go out and use again,’ ” Scalera said. “Which, in reality, is true to some extent. Many people who get to that point — they’re well in the throes of their dependency and addiction, and, yes, relapse is part of the process of recovery, but it’s not a reason to let somebody die, so we are always going to work towards saving somebody’s life.”
Martin recalled an instance when — after officers in her hometown began carrying this drug shortly after her sister’s overdose — her family was informed that three teenagers had been saved from the same fate as Angie. Her family had bittersweet thoughts about this news of increased efforts to reduce overdoses.
“My mom was so happy that these teens were saved, but why couldn’t that happen to my sister?” Martin said. “If this would have been talked about earlier, maybe they could have had these earlier and there would have been a better chance for my sister.”
Though she said she thinks supplying officers with this drug was necessary, Martin said it’s unfortunate these measures have to be taken, because in many instances individuals using harmful drugs do not realize the effect it has on those around them. She added addicts don’t realize they are making choices for more people than just themselves.
“It wasn’t our choice,” Martin said. “It wasn’t my choice to have my younger sister see her older sister lying in a casket.”
To fight against this, Scalera said much of her work — modeled after Project Lazarus, a nonprofit that aims to train and educate communities about drug overdoses — also extends outside of Washtenaw County, particularly in Livingston, Lenawee and Monroe counties, where overdoses are still occurring in these places due to how easy it is to access opioids, issues with proper disposal of the medications and a culture surrounding pharmaceuticals.
“We’ve got to change the American culture of taking a pill and you don’t feel anything,” Scalera said.
Alongside efforts of organizations like the WHI Opioid Project, the UM Health System’s Division of Pain Research hosts pain medication take-back days on campus, events where people can properly dispose of their medications.
The most recent event drew more than 100 people and collected 117 pounds of pills and more than 5,000 opioid medications, according to Chad Brummett, associate professor of anesthesiology and faculty lead of the Pain Medication Take-Back initiative.
“We’re overprescribing; a lot of it’s going unused and when it goes unused it’s subject to diversion and abuse,” Brummett said, adding that only about 28 percent of the opioids that are prescribed after common surgeries are used, while the remainder are left in medicine cabinets unattended.
Other organizations like the Red Barrel Program allow for similar safe disposal of opioids, along with all prescription medications throughout Washtenaw County and in surrounding areas. Brummett said all of these disposal initiatives contribute to reducing access and ease of abuse.
“Patients who use opioids chronically don’t bring back their opioids,” Brummett said. “What our problem is right now is that patients get them for surgery, they don’t use them, or dental extraction, they don’t use them, they get put in a medicine cabinet, they’re unattended, and … someone else gets to them.”
Moving forward
Martin and her family have also established an organization called Angel Wings for Angie in her sister’s honor. They hope their efforts will spread awareness of the epidemic and provide support for Endeavor House, a halfway house dedicated to recovery, and Families Against Narcotics, an educational program geared toward informing the greater community of the reality of opioid overdose.
What people don’t realize, Martin said, is that helping to reduce the stigma associated with addition can make a difference in helping those struggling with rehabilitation rather than turning to judgment and punitive measures.
“How can we expect these people (to recover) … if everyone just keeps looking at them and telling them that they’re not going to be anything, that that is all they’re going to be labeled with?” Martin said.
Update: On Monday, the Michigan Department of Health and Human Services also provided the Michigan Opioid Prescribing Engagement Network — run in part by Brummett — a five-year, $1.4 million per-year grant to launch an initiative to help medical practitioners care for their patients’ pain without predisposing them to potential misuse and abuse of opioids.
Brummett is one of the initiative’s leaders and will lead a team to analyze statewide prescription opioid prevalence in collaboration with results of the team’s take-back events.
The funding of this initiative, which is based in the University Medical School and Institute for Healthcare Policy and Innovation, is yet another example of the community-based efforts around Washtenaw County attempting to reduce the amount of opioids prescribed, reduce opioid dependency and ultimately, reduce opioid-related deaths. The new funding will lead collaborative efforts across medical professionals to aggregate data in hopes of informing the public, medical providers and policymakers about the epidemic, according to a University release.