Beth Macy is a journalist living in Western Virginia and has just written a book on the opioid epidemic and the people and communities affected by it. Over the past several years she has interviewed and followed numerous families and community leaders dealing with this problem. Her book takes a community perspective and asks how did we get here and how can we get out.

She tells the story of Perdue Pharma who started out promoting a morphine derived drug, MSContin, for pain relief for end-of-life patients. When its patent was set to expire, they developed a spin off called OxyContin. It was then marketed to provide chronic and acute pain relief. It was also marketed as having little to no chance of addiction or abuse. Doctors were heavily influenced by their marketing efforts and before long patients were receiving robust prescriptions for pain relief. It would be many years before doctors, pharmaceuticals, and pharmacies came to grips with the errors of their ways.

      

Add to this the economic collapse of many communities in the 1990s and you have what Macy describes as the perfect storm. With the closing of many coal mines and the relocation of a variety of small industries you had a significant rise in what I would call dying communities. Such communities are characterized by high unemployment, increasing disability claims and under-challenged youth and were set up to succumb to the increased availability of opioids. With time it became harder and more expensive to obtain pills. Suddenly heroin became cheaper and more available by the influx of dealers seeking easy money and for many a way to support their own addiction. As heroin became stronger and with the introduction of fentanyl, deaths from overdose skyrocketed and addictions became harder to break.

     

Macy then looks at what can we do now. Still shocking is the significant lack of available treatment. Resources are just not there for many areas of the country. Studies show that Medication Assisted Treatment (MAT) combined with counseling, behavioral therapy, and psychosocial support has the best chance for recovery. Yet many courts and programs still insist that people seeking treatment must be drug free.   Macy writes, "The latest research on substance use disorder from Harvard Medical School shows it takes the typical opioid-addicted user eight years- and four to five treatment attempts- to achieve remission for just a single year. And yet only about 10 percent of the addicted population manages to get access to care and treatment for a disease that has roughly the same incidence rate as diabetes." We need a real commitment of resources over an extended period of time to deal with opioid addiction.

     

Macy also writes about the role of drug courts as an alternative to incarceration and the role of harm reduction. Harm reduction is based on the premise that "Users can't get sober if they're dead." Such strategies include needle exchanges, safe injection sites, and community availability of narcan.

     

Macy concludes with the importance of community-wide approaches to this disease. Progress has been made when a community works together to deal with this problem. Coalitions that include local courts, police, churches, social service agencies and health care providers provide the framework for successful intervention. Such coalitions also begin the long-term work of resurrecting depressed communities and thus dealing with one of the key underlying problems.

      

I conclude with a short description of the efforts in Dayton, Ohio to deal with their drug addiction problem. This was just published this week in the New York Times. Under the title "This City's Overdose Deaths Have Plunged. Can Others Learn From It?" reporter Abby Goodnough describes how Dayton Ohio has reduced opioid death by over 50 percent this year compared to 2017. The Dayton community has done many of the things that Macy writes about. First and foremost is a large increase in treatment programs due to increased State and Federal funding and the expansion of Medicaid under the Affordable Care Act. The community itself has formed the Community Overdose Action Team which provides a forum for community leaders and health providers to work together in addressing the needs of the Dayton community. Through this effort they have been able to start a variety of harm reduction programs including access to narcan, needle exchange, and fentanyl testing strips. Finally, the entire community effort has led to a significant increase in community-wide programs to support treatment efforts.