[EDITOR’S NOTE: This is part of an ongoing series on the impact of heroin and opioid use on Stokes County. Please see future editions of The Stokes News for more coverage of this issue]
As Stokes County, North Carolina and the nation deal with a growing heroin epidemic officials with CenterPoint Human Services say help is available for those dealing with addiction.
“It is a growing national problem,” said CenterPoint Chief Clinical Officer/Medical Director Dr. Chad Stephens. “Some counties have been hit so hard by this that they actually have task forces to deal with it”
He said CenterPoint provides a variety of services to help addicts and emergency responders who are dealing with the issue on the front lines.
“We are supporting education efforts and awareness that these are not benign drugs,” he said. “We are also trying to provide support for rescue and law enforcement agencies with Naloxone.
“On the treatment side we have various programs out there that we want to make people aware of,” he continued. “We have a methadone maintenance program which is very helpful for folks who are chronically addicted. In order to get into these programs they have to meet the federal guidelines which means they have to be in active addiction for at least a year.”
He said another alternative to help deal with addiction is a drug called naltrexone.
“It actually blocks the opioid receptors in the brain,” said Stephens. “So if you are taking that drug and slip up and take something else it is not going to affect your brain. If someone is really committed and is willing to say they will take naltrexone and either have somebody watch them take it every day or get a shot every month then that is very effective. It helps the brain stay totally narcotic free and helps the brain heal over time.”
Stephens said there are also programs for people who have been addicted for a shorter time period.
“We have inpatient detoxification if you really need it,” he said, ” but for most detoxification you don’t have to go to the hospital. There is a three day detox program and the we have a 14 day residential program to get people stabilized. Then there is a substance abuse outpatient program where people go every day for four hours of programming and that is very good as you are transitioning into treatment. There is another substance abuse intensive outpatient program which is just a couple of hours of programming a day. There are also substance abuse support groups like Daymark in King and support groups like Narcotics Anonymous.”
Provide support when an addict asks for it
Stephens said anyone seeking help can call the CenterPoint hotline at 1-888-581-9988 24 hours a day and get treatment within 48 hours.
“We consider it to be an urgent problem,” he said. “The idea is that people have windows of being willing to enter therapy, so when you are emotionally and mentally ready to talk to someone we want to get you help as quickly as possible.”
“When they say they want help, do everything you can to move heaven and earth to get them help immediately,” agreed CenterPoint Utilization Review Specialist Sandra Jones. “You have to move quickly because the addition takes over and they change their mind.”
Stephens said once a call for help is placed the staff at CenterPoint will work to determine what form of treatment is needed.
“We try to figure out what their motivation is,” he said. “We engage them with where they are at in the addiction process and find out what they want to do for themselves and then tell them the things we can offer them. We have to look at issues like their recovery environment and how that will impact their ability to engage in treatment services.”
How opioids impact the brain
Whether it is prescribed pain medication or illegal heroin, Stephens said all opioids have a dramatic impact on the brain.
“The brain system finds narcotics very rewarding,” he said. “Not only do they reduce pain but they produce a sense of euphoria that is very addictive. That comes from elevated levels of dopamine in the brain and unfortunately over time the brain adapts to the narcotic that you are using.”
He said the brain will actually start to produce less dopamine as users continue to take opioids.
“You get less euphoria and less pain reduction, so to feel good again you have to take more,” he explained. “You get in an escalating cycle where the brain adapts and you need more of the drug. The problem is that if you stop taking it, the brain has adapted and with the drug gone you are now not only not feeling good, but you are actually worse because the brain does not know where the normal level of dopamine is anymore.
“You go into negative territory with the dopamine which makes you feel horrible, so to even get back up to normal you have to use more of the drug than you originally started with,” said Stephens. “You cannot function with or without it. With it you are intoxicated, or doing illegal things to obtain it, or you are using it in ways that are harmful to you and your family. But without it your brain does not know where normal is. It is a vicious cycle. It is a trap.”
Recovery is possible
Stephens said that as vicious as opioid addition is, many people manage to recover and live meaningful lives.
“It is a very long process,” he said. “The brain does not recover quickly. It is lifelong project but lots of people recover and do great. It is a very treatable and manageable illness.
“The brain has been altered by the drug, but they can re-adapt and get pretty close to back to normal if they take their time with it,” he added.
He said methadone treatment can take years, allowing the patients to slowly wean themselves off of the addiction, and noted that treatment comes with its own hazards.
“When people are off of the drugs for a while their tolerance goes down,” he said, noting that if an addict in recovery relapses, they may unintentionally cause an overdose. “A lot of deaths are from folks who have a history of abuse but have been off it for a while and something triggers them to use again. They try to use at the same level they used to use it and now it is an overdose because the brain is not used to that level.”
Families need to be supportive, aware
Stephens said there are several signs family members should watch out for if they suspect someone is using opioids.
“They need to watch to see if a person seems sedated or out of it, if they have slurred speech, or are less active,” he said. “If they are dealing with withdrawal they may have sweats, or be experiencing pain and cramps or an upset stomach. You can also look for aberrant behaviors. Are they not showing up at work, has their wake-sleep cycle changed, is their mood more irritable? Do they seem super happy at times and then seem distressed and wanting leave?”
Stephens said dealing with addiction in a family member is a difficult balancing act.
“Obviously you need to not engage in any behavior that supports the addiction like giving them cash or helping them to use the drug,” he said. “But on the other hand, you need to set strict expectations for them that they cannot have drugs in the home and tell them they are welcome there when they are drug free. You need to be supportive but set limits.”
Opioid epidemic is a societal problem
While law enforcement and first responders are fighting the opioid epidemic on the front lines, Stephens said solving the problem will involve a broader approach.
“We have to make treatment much more available and also work to decriminalize folks when they do say they need help,” he said. “Right now in many communities if you are found with drug paraphernalia you can be charged.”
He said some communities, like Nash County, are working to make getting treatment less frightening for addicts.
“In Nash County you can go into the police department and say here are my drugs, I want to get off of them and you will not be charged with a crime,” said Stephens. “They will dispose of the drugs in a safe manner and help you get into a treatment program. We need to decriminalize all of this because nobody wants to get help because they are afraid they will be put into jail.
“We have to look at this as a brain disease and realize these drugs are very tempting,” he added. “You don’t get dependent on it after just one exposure, but after one exposure you may say ‘that was really nice’ and then try it again the next week. Pretty soon you are trying it every day and then you need it just to function. It is a very slippery slope.”
Nicholas Elmes may be reached at 336-591-8191 or on Twitter @NicholasElmes.