NASW Social Work Talks - EP13: Facing the Opioid Crisis

Episode Date: September 18, 2018

Opioid addiction has become a public health crisis in the United States. Our guest, David Stoecker, LCSW, is founder and director of Better Life in Recovery. He recommends that we look at the opioid addiction pandemic through a harm-reduction lens, rather than a punitive one. He argues that abstinence is not the only path to recovery and that we need to create healthy communities and to provide recovery support to those who need it. See Episode 13 show notes for resources

From the National Association of Social Workers, I'm Aaliyah 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 U.S. 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 Stoker, 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 Greene County, Missouri Treatment Courts through Pervert Family Health Care. And 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. It's good to be here. Can you tell us a little bit about yourself and Better Life and Recovery and your work there? So, I'm a person in long-term recovery. For me, that means I haven't used alcohol or other drugs since January 31st of 2009. And I always say because of that, I get to do a lot of positive

things in my community today. Better Life and Recovery kind of came out of my sobriety. You know, 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 a better life and recovery started that in 2012 we did one event the first year we did three events the second year and then in 2014 philip seymour hoffman died in february and i remember reading through uh comments that people have 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 give this stuff away for free so they can eliminate themselves from the gene pool.

And 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 visibility events like Recovery Day at Hammond's Field, which is our AA St. Louis Cardinal affiliate, where we did like 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 fun barbecue after, and we did a big river cleanup so in 2015 we filed for our 501c3 and 2016 we opened up the springfield recovery community center along with uh two other non-profits and last year we did over 100 events and groups we picked up three and a half tons of trash out of missouri riverways with our stream team. And I think we've painted 11 elementary school playgrounds. You know, just people in recovery and their families giving back to make their community better. David, what would you say is a major cause of the ongoing epidemic?

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, uh, cocaine, alcohol still kills more people than all of our other illicit drugs combined. And then we have, you know, poverty, abject poverty and racism, hate, anger, all those different things going on. And it's almost created a perfect storm. You know, um, you tend to see a lot of, uh, depression and, uh, anxiety whenever you see 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. So 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? So in Missouri, I'm kind of proud that we've started a medication first model through what's called the SDR, the State Targeted Response to the Opioid Crisis Grant. And basically what it allows is for somebody to go looking for treatment. 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 of 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 illegal illicit substances. You know, 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. 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? Well, you know, 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. You know, somebody doesn't have to be sober to have worth. I think people inherently have worth because they're sentient beings. So 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, you know, 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, you know, we can get them to a place where we can actually help them. We started a 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 long-term 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 and 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 kind of what going through withdrawals is like for somebody. So most people can't make it through withdrawal. So what happens now I can no longer get my medication. So I turned to street drugs because that's a, it's going to be

cheaper and B it's going to make the withdrawal stop. And if I'm going to a pharmacy and I'm getting say, you know, 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, acetyl fentanyl, you know, something that could be up to 100 times stronger than heroin. You know, a lot of people, they start off using, like I said, because it serves a purpose. Like 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 a 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 a withdrawal sets in because now their bodies become physically

dependent on it. And that kind of continues that use from there. There's a difference between addicted and dependent. And I think that's where we really need to make some, we need to really define those clearly. Like 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 people who have been prescribed. 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 prescribed suboxone for years that are going in and teaching our kids. It's no different than any other medication. You know, imagine like 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 medication's doing what we need it to do. It's working. Let's continue where we're at. And 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 make it

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. Can you talk about the ripple effects of drug addiction? There's a guy, his name is Don Cahoyas, and he uses an analogy that I really like. He says, 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 plants get that the tree is going

to get sick again and yet we do that with people coming out of treatment jails and prisons every single day so recovery supports work to make our communities healthier and 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 hang out with or sober things to do. And they end up going right back down that road that they originally came out of when we're trying to escape. Do you think getting tough on crime by threatening to sentence drug dealers to death is a real solution?

The war on drugs is a failed war. It is a fiasco. you know if it would have worked we wouldn't have the problems that we have right now and as far as death penalties for drug dealers i mean a lot of times we're not we're not even catching the people that we need to catch when we have like these zero tolerance laws basically you know 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, you know, 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, you know, people with substance use disorders instead of these kingpins that we actually need to catch. You know, I mean, that's part of the problem. The people that should be getting in trouble, 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, you know, they're looking at death sentences for people who have a disease. I started off personally an

abstinence-only person until, 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, uh, you know, Switzerland, uh, where they've started, they used to call them a safe injection facilities. And now we're talking about, uh, comprehensive user engagement sites where we actually have medical staff so that if somebody overdoses, we have somebody right there that can revive them, you know, um, getting, getting Narcan into the hands of

lay people and getting them trained you know there's so many different things that we can do and i think they almost all revolve around harm reduction treating on you know treating people with compassion love and respect even though they're using and trying to help them uh live a self-directed life and make improvements where they can for now because it's my experience that deaf 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. What would better access to addiction treatment look like? People in long-term 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. So 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? Um, yeah, I do, especially when it comes to the money that's getting thrown around right now. You know, I think when a lot of people hear $3.3 billion, I mean, when I hear a billion dollars, I think it should echo it so big, you know, 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. You know, and as long as we look at 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. You know, I think that harm reduction lens is probably one of the best things we can do. If you look at, you know, a lot of the European countries that have tried that approach, they've seen huge decreases in overdose deaths. You know, last year we lost, what, 72,000 people. You know, we lose more people every year to overdose and deaths than we did in the entire 20 years of the Vietnam conflict. You know, it's mind boggling how many people we lose. One hundred and ninety eight people a day is what we lost last year. David, I want to thank you so much for taking the time to talk to us.

Absolutely. And thank you for the time. You know, I would leave with just a couple words. Harm reduction and recovery supports. 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 at addressing the opioid epidemic, in fact, the huge pandemic that our country's in currently. 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 stream so you'll be able to participate from your office or a mobile device. So mark your calendars and check NASW's social channels for details. You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org. Don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts.

Thanks again for joining us. We look forward to seeing you next episode.