The Opioid Epidemic

Dr. Hollenbeck on the Opioid Epidemic and her related work…

 

In December 2016 I was privileged to be sent by the VA to become part of Cohort XV of the Harvard University National Preparedness Leadership Initiative (NPLI), a joint executive education program with the Harvard School of Public Health and the Harvard Kennedy School of Government. I became part of a small team led by a chemist at the Dept. of Homeland Security, that also included an Air Force colonel from Alabama, a physician at the Center for Disease Control (CDC), an Irish emergency room physician, a Massachusetts state policewoman, a Cambridge, Massachusetts police deputy superintendent, and a Harvard faculty mentor. Our project, called “Push2Breathe” (P2B), a moniker supplied by teammate Col. Brian Hastings, aimed to develop a template/toolkit for a medium-sized city to rapidly introduce having their police officers carry the opioid antagonist naloxone to reverse opioid overdoses at the scene. Giving naloxone either by intranasal spray, or auto-injection into the thigh, will immediately halt the respiratory depression that is what kills people in opioid overdoses. It literally restores the breath of life with a push, and gives another human being another chance to get the rest of the help they need. A teammate noted “Ah, there’s the writer in her” when I contributed the term “Diamond Moment” for that naloxone deed.

 

We chose Jackson, Mississippi, where I live and work as a VA physician, as our pilot project city. I started with trying to get naloxone kits—no easy feat as they are expensive, and we were not a nonprofit or state organization that could apply for federal grant funds. No cash, no kits, no project. I researched the states and programs that had large established naloxone programs, and my Internet detective work led me to a wonderful network of committed people very willing to help me. The chief investigator of the West Virginia program is the one who told me that a pharmaceutical company called Kaleo donated their Evzio (naloxone auto-injector) kits—and that felt like a gift from heaven. And when the executive at Kaleo said they would definitely help, the Jackson P2B pilot was airborne.

 

Committed Mississippi public health department officials, emergency response personnel (including a physician from the University of Mississippi Medical Trauma Center) came together to lend their support, as did the leadership of the Jackson Police Department. I found people from multiple backgrounds and agencies who wanted to know what they could do to help; they believed, as I do, that some things can be done quickly, simply, and well even in a bureaucracy. They delegated tasks, cleared legal hurdles, helped write standard operating procedures that referenced Mississippi state law protecting police who administered naloxone, and coordinated and scheduled the training that I did with the police department. The Kaleo executive worked with me as I filled out the donation request and other formal paperwork, and 200 kits arrived. By mid-May 2017 two hundred Jackson police officers carried the kits on patrol—a way to protect and serve in yet another way.

 

From July 11^th through July 13^th of 2017 I attended the Mississippi Heroin & Opioids Drug Summit, a stellar constellation of state and federal agencies and private medical and treatment professionals and licensing boards all committed to fighting the opioid epidemic. Prescription narcotics, heroin, and synthetics such as fentanyl are the biggest villains—but this epidemic, that now slays more US citizens each year than motor vehicle accidents, knows no boundaries and has no bias. It has already killed more people than all the combined wars to which this country has sent its human treasure. A high school football star can injure his knee, have surgery, and be the unlucky person for whom the prescribed narcotic becomes what I call the “sweet devil”. And first responders are also at risk: minute traces of fentanyl “dust” that they can be exposed to are a new weapon the criminals use to assassinate these courageous people, and cruelly, even their drug-sniffing dogs.

 

The keynote speaker at the Mississippi Drug Summit was Sam Quinones, whose book (which I highly recommend) “Dreamland: The True Story of America’s Opioid Epidemic” reviews how we got to this dark place as a nation. Over ninety-percent of the world’s narcotic prescriptions are swallowed by people in the United States. His book nails the pharmaceutical companies that lied their way to profits, and the pressure on a generation of doctors (younger than me) to aggressively treat pain with pills or be considered immoral by the public. It also covers the cultural conversation we need to have as a country: Is life supposed to be completely pain-free? And don’t we have an individual responsibility to make other changes in our lifestyles that can help decrease pain in all its ramifications, instead of reaching for a pill? I know that over decades in medicine I have seen a phenomenon that I call “Botox Brain”: the wish for all the emotional ups and downs and good days and bad days in life to be “all smoothed out” by something small in a bottle.

 

“Dreamland” also notes how the VA in 1999/2000 introduced the idea of pain as “the fifth vital sign”, a false concept because a vital sign (e.g. blood pressure) is something you cannot live without—but then all hospitals and healthcare systems across the country adopted it. The VA has accepted responsibility for the overprescribing of narcotics to Veterans and does have current programs in place that are showing success, looking again at multi-disciplinary approaches to pain because we do feel it in body and soul. “Dreamland” relates the tragic irony of US military Veterans surviving battle wounds only to come home hooked on morphine and then die in their hometown of an opioid overdose. I know from being embedded with the Veterans in the front lines of care that they want the best kind of help for their multiple types of wounds—and not just another pill. We cannot have a generation of brave warriors become addicts instead of living the lives that they have the talents for, lives which they long for, and the lives which they deserve after signing up to put it on the line for their country.

 

Making contacts at the Mississippi Drug Summit I hope to continue and expand the work of “Push2 Breathe”, working with Kaleo Pharmaceuticals’ donations of kits but also asking local businesses and philanthropists to help sustain our effort. I continue to be an “evangelical”-type of traveling saleswoman on the need to stop opioid overdose deaths at the scene so that anyone who is an addict gets a chance to reach comprehensive help—the kind that the community harm reduction coalition so impressively on display at the Mississippi Summit will offer. Just as with the Jackson Police Department being in the forefront in this state with officers carrying naloxone, I see that the state of Mississippi is leading the way in how a community can combat this threat to all of us.

 

On July 14, 2017 I was notified I was nominated for the “Class of 2017 Mississippi Healthcare Heroes”. If I end up as a member of that class I will continue to make it clear no one does major work alone.