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Prakash Chandran (Host): The opioid epidemic in America has claimed hundreds of thousands of lives over the last two decades and chances are, you can think of someone you know that has been touched by this type of addiction. I’m Prakash Chandran and in this episode of Healthy Takeout, we’ll talk about how opioid use has become so pervasive and what we can do to help those who are struggling. Here with us to discuss is Meagan Gaine, who has a master’s in social work and is a licensed independent clinical social worker at Harrington Healthcare. Meagan, really a pleasure to have you here. so, I want to get right into it, and I’d love for you to explain first of all, what an opioid is and how they started being so widely abused.

Meagan Gaine, MSW, LICSW (Guest): Well an opioid is a – it’s a pain medication. It’s a pill or a medicine classified to treat pain which is – it’s been around for a really long time, but generally, it wasn’t a problem before the 1990s or so.

Host: And just to clarify a little bit, is an opioid like Tylenol or is it something that is more prescription given by a doctor?

Meagan: It’s only given by prescription. So, they’re much stronger than the pain medications you would find over-the-counter. So, opioids include, most people would know the opioids Percocet, codeine, and obviously the problem has become the street opiates which is heroine in general and now Fentanyl.

Host: Right, so I recognize a lot of those names. You mentioned that in the 1990s is when it really started becoming a problem and I know that most opioids besides the street ones come from a prescription by a doctor. So, I’m trying to get a sense of why it started becoming such a problem in the 90s.

Meagan: Well, in the 90s, that is when OxyContin came onto the scene. So, OxyContin was manufactured by Purdue Pharma in the early 1990s and at that time, my understanding is that there was a big kind of marketing push for the treatment of pain with opiates. Prior to that, doctors knowing how addictive they are, really didn’t prescribe that many opiates, only with severe pain. But in the 1990s, OxyContin came on the scene and there was a huge marketing kind of boom and doctors bought into it because of the amount of money they put into the marketing. So, the prescriptions increased dramatically in the early 1990s for opiates. So, that’s kind of why opiates have emerged.

Host: Yeah, it’s interesting what you say that and it’s eye-opening to see that the marketing not only works on us, but it works on the doctors and the type of medications that they prescribe their patients as well. So, when they noticed that it was becoming an issue and there was that dependency that was being fostered; at what point do you feel like they started noticing it and what did they start doing about it?

Meagan: Well, late 90s, early 2000s the government got involved. Because there was way too many prescriptions being doled out, pretty haphazardly. So, when the government got involved, there was a big kind of push back with the medical community to pull back on the prescribing practices and what happened then is that the doctors were required to pull back on the prescribing practices, but people where already addicted. So, when you are getting a prescribed medication that your body becomes physically addicted to and then that’s cut off; you have to find it elsewhere.

And that’s when people really turned to the illicit drugs, turning to the streets, turning to buy Percocet off the streets or buy OxyContin off the streets or buy ultimately a lot of people ended up buying heroine because to buy the pills off the streets is a much higher street value for those and heroine is much cheaper. So, it became a real, as we call it, an epidemic these days because the trend was to have to go to the street.

Host: Yeah, we always hear about the opioid crisis or the epidemic, but I think that you’ve broken it down well just to kind of explain how it happened, the government being involved and that people that have fostered this dependency they now have to turn to another source if they can’t get it from their doctors. So, I think one of the things that I am curious about is when is it valid? When is it valid to take an opioid and I think as a patient, you kind of always wonder like is my doctor prescribing me the right thing. Can you talk a little bit about those use-cases?

Meagan: Well, I mean that’s a better question for an MD or a medical prescriber. But pain is pain and there is a reason why opiates were manufactured in the first place and that was to treat intensive pain. Surgeries, chronic pain again, I don’t – I can’t really answer the question when it’s okay to prescribe but that’s at the doctor’s discretion. So, I’m always leery of people starting prescription opiates but, in some cases, and maybe even many cases, the only thing that’s going to take away some of that intensive pain is an opiate. I mean it works. That’s why it’s around. Right, it works for pain.

So, but the length of prescription has to be really monitored. So, you can’t have somebody on opiates. It only takes about two weeks to get addicted to an opiate. So, after two weeks, you really have to minimize the amount of opiates that you are prescribing, in my opinion. Just because people are – it’s an addictive product and you are going to get addicted, no matter what. So, and there’s ways to come off of those if you were on high doses to come off of it so that you don’t experience withdrawal symptoms but that’s really at a doctor’s discretion and with a doctor’s oversight.

Host: Yeah, that’s unbelievable that it takes only two weeks to get addicted to an opiate. So, and you mentioned there are ways to kind of wean yourself off. Is that called medication assisted treatment plan? What is that called when you start doing that?

Meagan: Well it’s just called a titration of medication. A medication assisted treatment plan what we call MAT in the world of substance abuse, is the medications that treat opioid addiction which is methadone, Suboxone, a newer product called Vivitrol, so if somebody is addicted to an opiate for an extensive amount of time or not even an extensive amount of time, we often consider prescribing one of those meds to be able to make that transition to abstinence, our goal is usually abstinence, easier. Because it’s not – it’s a very difficult process to come off of an opioid cold turkey. It’s almost impossible. I mean you get very, very sick. So, we use a lot of medication assisted treatments to be able to treat that transition.

Host: So, if I’m going in for something and my doctor wants to prescribe me an opioid, would you say that there is a case where there might be a less addictive alternative that you can recommend?

Meagan: Again, that’s a good question for a doctor. I think there’s probably often cases of less addictive medications, but the regulations are so strict these days that if the doctor decided that an opioid was appropriate for the treatment of a certain patient or their illness; they are only allowed to be given very short prescriptions at this point. It’s all regulated. I mean it’s all in a national database that any doctor can check so, if you go to a doctor and they don’t prescribe you what you want, and you go to another doctor; and they prescribe you what you want and then you go to another doctor let’s say, they can look it up to see if you’ve already been given a prescription for an opiate. But there’s other alternatives, again, I’m not going to go into naming what the alternatives are, but there are other alternatives to treat pain and there’s also many pain clinics now that will treat pain alternatively. So, with acupuncture or with chiropractic or with certain therapies. So, that’s becoming more popular as the epidemic is not going anywhere.

Host: Right Meagan. But I think what I’m hearing you say and this is good that there is now a really big lens on this issue and an effort to try to combat this, so if a doctor does prescribe you an opioid, there’s a very serious reason why they are doing so to really mitigate and manage your pain and I think the advice that I’m hearing from you is that if they do prescribe it to you, they are going to mention this as well but it’s important that you self-monitor the use because as you said, within just two weeks you can become addicted. So, I want to shift a little bit to friends and family members of someone that might be addicted. What might they do to help a person in this situation?

Meagan: Well, addiction is a really complicated disease. So, the best thing for a family member to do is to be supportive. What a family member should not do, that’s probably the better question, is what they shouldn’t do is push. So, if somebody is addicted, whether it’s because they got a prescription and they became addicted or because they used illicit drugs from the beginning; I can tell you based on my experience, there are three things that need to happen for a person to be able to submit to treatment and actually buy into recovery. And that is they have to be ready, they have to be willing and they have to have the resources available.

The most important thing – the most important piece of that, is that they are ready. So, if somebody is willing and wants to get sober or get clean but they aren’t ready; it’s going to go nowhere. So, if somebody – if a family member pushes somebody into treatment before they are ready; it’s neither here nor there. It’s likely not going to make any difference. Unless a switch flips during their treatment and they start kind of taking things in and learning. But until then, until somebody is ready; there’s not much you can do accept to provide as much support as possible. A lot of – sometimes that gets translated into enabling, so family members because they are – out of fear will protect somebody that’s using. I’ll use the example of heroine.

If somebody is using heroine as you know, the heroine – heroine that’s around these days is basically fentanyl so, it’s much more lethal than it used to be. So, if somebody is using heroine and they want to – a mother or father or sibling or a friend want to protect them, oftentimes they will house them, and they will provide money and everything just to kind of watch over them. But ultimately, that can be devastating because they are enabling the addiction.

On the flip side, if you push somebody into treatment and they are not ready, that can often result in kind of a rebellion and just saying okay I’m not doing any of this. I don’t want to listen to you, I don’t care, I’ve got to do this. And that’s really the addiction talking. It’s a brain disease. So, when the addiction kind of takes over and that person isn’t really ready or willing to take suggestions or maybe go into a treatment center; then it’s almost – and I hate to say this because it’s a – it’s kind of sad, but it’s almost pointless. It’s just a matter of kind of being there, watching them, protecting them as much as you can, supporting them and letting them come to a place on their own, where they are ready.

Host: But to be clear, I think in everything you said in terms of supporting them, that means emotional support, not giving them the resources so they can go out and get more, is that correct?

Meagan: Correct. Well you know a lot of times what families do is they abandon, because they are so scared and that oftentimes pushes somebody into addiction further. And as scary and as traumatic as it is to watch somebody you love be addicted; the worst thing you can do for them is say I can’t do this anymore, I’m walking away. You have to set boundaries, you have to set limits, you have to be firm in those. But to walk away and just turn your back is in my opinion, one of the worst things you can do for an addict.

Host: Well Meagan, I’m so glad you are educating us on this today. I actually have a friend and their family who is going through this and I know you see so many cases and it’s so much of what you said rings so true. I think, unfortunately you almost have to wait for them to hit rock bottom and to come to the realization themselves while giving them that loving and emotional support on the side just so they know that you are there for them.

Meagan: The real reality of addiction is not that addicts are bad people or people with addiction issues are bad people or they don’t have morals or values or anything like that. The reality is that it’s the exact opposite. They are usually hypersensitive, they usually take on other people’s issues, they are usually kind and with good morals and values that have an inability to really attach to meaningful things meaning, relationships or vocational or maybe they don’t have a spiritual connection or whatever and so, the way I think of addiction is that it’s really an attachment disorder. So, instead of attaching to something that the general population thinks is meaningful; they attach to a substance. And it deters them from attaching to anything that would be purposeful in their lives.

And the way people often gain long-term recovery is by learning how to develop meaningful attachments to things in their lives or things that they want in their lives and gain self-esteem and gain self-love to be able to not need – to kind of escape themselves which is really what every person with addiction issues MO is. It’s to escape themselves, to not kind of be, because they are not comfortable with that. So, that’s the tricky part about helping people get sober and helping people gain a life of recovery is it’s – I often liken it to a baby being born. When somebody gets sober after they’ve been using whatever it is for ten years, twelve years, even two years; they don’t have the skills to live. They don’t have the skills to live when they get sober so it’s teaching people how to be and how to be present and how to gain some self-love and how to function like “normal” people do. That’s all foreign to them.

Host: Well, I mean that is such important advice Meagan and I think just kind of the takeaway as we wrap up here is just to be as patient as possible, to be supportive and like you said to help them attach to something else, to provide them with something else whether that be love or just something detached from what they are used to in addiction to that opioid and I think the patience is one of the strongest things that I’m hearing there because I know how frustrating it can get for a friend or a family member watching a loved one go through this. So, thank you so much again and I really hope this information can help someone get the help that they need to overcome this addiction. So, everyone, for more information please visit www.harringtonhospital.org. Our guest today has been Meagan Gaine. This is Healthy Takeout from Harrington Healthcare. I’m Prakash Chandran. Thank you so much for listening.