What Pains Me

Tuesday, January 3, 2017 - 8:20pm



Illustration by Claire Abdo

Months ago, when I was assigned a story on the opioid epidemic, I was confronted with an entirely foreign concept: I didn’t even know if opioids were injected or ingested. And this was an epidemic? I couldn’t begin to understand how overdose deaths could be happening in my community.

On November 23, I attended a community-wide event at St. Joseph Mercy Hospital in Ann Arbor that addressed the opioid epidemic and how to fight it, hosted by the Ypsilanti based addiction non-profit Dawn Farm.

From my aisle seat, I watched the auditorium fill with Ann Arbor and Ypsilanti residents, college students and a few families with younger kids. I watched intently, ready to scribble notes on trends in age groups, gender, appearance, or race. To my surprise, none of the categories followed a specific trend — there  were no similarities among the people I saw whatsoever.

I was struck. There were people from all walks of life who were dealing with an issue in my community I hardly knew existed.

What I found was that in 2014, within Washtenaw County alone, there were 65 reported opioid deaths according to the Washtenaw Health Initiative Opioid Project. Across the US, there are 78 deaths from opioid overdoses a day, putting the country at an all time high for opioid overdose deaths. This wasn’t another story which could be shoved aside for a later read, but something happening right now.

Opiates are a family of drugs for treating pain and affecting emotions. Common types include morphine, heroin, hydrocodone, and oxycodone, all of which are addictive. Opiates are commonly prescribed for suppressing pain after surgery, trauma, and various injuries.

At the event, I learned of the dramatic rise in opioid-related deaths in 2014, which spiked nationwide efforts to reduce this number, creating with initiatives such as the WHI Opioid Project and other public health models specific to overdose prevention and resuscitation after overdose. In some ways, it’s working. In 2015, there was a 25 percent decrease in opioid overdose deaths in Washtenaw County.

The numbers may have decreased, but forty-nine deaths is still an all too significant number.

The forum, and conversations I would later have with a number of its speakers, informed me of how Washtenaw County is currently responding to the problem. WHI’s new public health-based model has raised local awareness for a national crisis, sparking community action among the police force, healthcare administrators, and overdose subject bystanders, who often play a critical role as first responders, saving lives. Saving lives is the goal: since August of 2015, more than 96 Washtenaw County police officers have been trained in the administration of naloxone, an opioid overdose reversal drug. And there have also been community classes on naloxone use, and the medication can now be co-prescribed to family and friends who are concerned of loved ones overdosing, so 911 isn’t the only way to keep victims alive.

What was most surprising to me as a pre-health student was how little I knew about this prevalent problem, often rooted in the health industry, which was not only affecting the country as a whole but rampant in the community I lived in. Emotionally, the issue is comparably devastating to alcohol overdose or suicide. A death is a death. But I never encountered any information — no pamphlets, no emails — about the issue beforehand. For such a crisis, I was totally unprepared.

One of the speakers, Ashton Marr, is an Ann Arbor resident who has been in recovery for 12 years. When she was 19, she was prescribed Vicodin after an emergency appendectomy and from this introduction, her life began to spiral around opiates.

She sat in front of the auditorium with her purple Mohawk and matching color parka, among a panel of physicians, nurses, police officers, and other recoverers. When one of the audience members asked if the availability of an overdose counteractive drug would make opiate users likely to overdose just to be resuscitated, creating a false sense of security, Ashton shook her head. The row of silver hoops on her earlobes reflected against the spotlight, sending shards of light through the auditorium. When she spoke her voice was deep, but melodic.

“From my own experience in going through addiction, that thought never crossed my mind once and that certainly wasn’t the goal either. If naloxone knocks the opioids off of opioid receptors, then you eventually become dope-sick and that certainly wasn't the goal,” she said. Opioid and heroin withdrawal symptoms are often referred to as “dope sick,” which urges the abuser to continue drug administration to combat discomfort. The symptoms include depression, anxiety, intense cramping, bone and muscle pain, involuntary leg movements, cold flashes, among others. “I was trying to tread the line between life and death, I wouldn’t want naloxone administered.”

Since her introduction to opiates after surgery, Ashton said the intense craving for more frequent and larger doses, a bigger and better high, began to consume her. As she entered community college, she isolated herself from her family and friends, mostly living from her car, miserable and ashamed: “It was like it just took over my life and my mind, and I really was up and running with opioids. I truly believed I was the only heroin addict in Ann Arbor.”

The chase for the ultimate high, the brink between the conscious and unconscious seems to be a mutual driver for continued users, and often the direct reason for overdose. And more surprisingly, the other common intersection between users and overdose survivors is the beginning of their addictive trends. The majority of opioid addiction start from a sports injury or general surgery where opiates are prescribed to alleviate immediate pain. The patient never gets weaned off the medication properly, instead developing a dependence on pain suppressors.

Another speaker at the panel, Stephen Strobbe, is a practicing nurse and founder of the WHI Opioid Project. Throughout the talk, he suspected a fundamental issue in the prescription system to be a leading cause for excess prescription and eventual drug misuse. According to Strobbe, there are enough written opioid prescriptions for each adult in the United States to have a bottle for themselves. When I mentioned I was a pre-health student at the University during our phone interview the morning of the panel, Strobbe said he would stay after the event to answer all questions – going above and beyond from personal to research to data-based inquiries – to spread awareness on the opioid epidemic. During our conversation, he reaffirmed the absence of stereotypes in the epidemic. There is no “type” for opioid users who experience addiction and overdose, besides being prescribed a medication, failing to be weaned off and then suddenly being in the middle a downwards spiral, often with no knowledge of who to go to for help.

Marr raised similar concerns on the prescribing behavior of physicians. After the forum, we sat in two corner seats of the empty auditorium. Like Strobbe, she offered to give any information to increase the public knowledge on the epidemic and its severity. “I’ve heard time and time again that it’s easier to write the prescription, as opposed to getting into conflict with somebody or fighting about it,” she said. “But the fact of the matter is they have the hand in the individual’s death if they let the addiction spiral. Doctors are in a position where they need to do no harm and give care to people, so it’s important that they understand how to treat addiction, recovery-related resources, how to safely prescribe to people, and how to treat pain.”

The physician-patient relationship plays a vital role in continuation or discontinuation of medication following a painful event, and the doctor’s choices can be the rate-limiting step to the addiction narrative. A majority, if not all practicing physicians will at some point prescribe pain medications to their patients. One of the seeds to the epidemic could be immediately addressed in the hospital, but also the medical schools and undergraduate populations who will be the next prescribers within five to ten years. However, it may also be worth opening a discussion how much responsibility the doctor has over the patient. It cannot entirely be the doctor’s fault if the patient decides to misuse their prescribed dose, and the doctor cannot always neglect the patient of pain medication to alleviate their symptoms. These ethical questions do not have a simple answer to solve the problem.

So clearly I never pictured a reality where opioid addiction and overdose death was something real and proximal, something that could affect my relatives, family or friends.

Strobbe said another common intersection between users and overdose survivors is the beginning of their addiction. The majority of opioid addictions start from a sports injury or general surgery, when opiates are prescribed to alleviate immediate pain and the patient never gets weaned off the medication properly, instead developing a dependence on pain suppressors.

In light of all of this, I picture my best friend. I picture her brown ringlets of effortless curls falling down her shoulders and the black-rimmed glasses she wears that rest on her cheeks. The studious one of all of us, who has (maybe) gotten one B in college, organizes all of our volunteer events for the fraternity, and laughs five times more often than she frowns.

I never realized that she dealt with this crisis first hand. Again, an epidemic so widespread was lost to me.  

This makes me sift through my entire memory since the day I met her, the things we talked about, the secrets we shared. It never occurred to me that her own sister was a victim of this crisis. That she was a part of this silenced group, when she was so present in my life.

I told my best friend about this article, and I asked her about the issue at hand: the pain which leads people across the country, across the world, to opioid addiction.

“I’ve really never thought about it before. I guess it's different for everyone, like the origin of it,” she said. “But it's the twisting torment, that's builds up in your stomach and leaks into your heart and head and eyes until it's all you feel, see and think about. It lays dormant until you think it’s gone, or at least a little less, and then a tidal wave of emotions hit and it's like, you're there again, at the very first moment you felt it. It's always with you. I think we just learn how to control it, regardless of its love or loss or whatever else it stems from.”

You can’t tell me Tylenol will take that away.