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Friday, July 19, 2024

The opioid crisis: Indianapolis struggles to stop cycle of use and overdoses

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Nate McCarthy was born in Chicago and grew up surrounded by substance abuse. Not only was his mother addicted to drugs, but he also smoked his first joint at 11 and had his first drink of alcohol at 12 or 13. During high school and college, McCarthy sold drugs, starting with marijuana, then moved to acid and then to opioids. His goal was to help pay for college because his family couldn’t afford tuition. Eventually, he started sampling his own supply of Oxycontin and heroin. 

While living in Georgia, McCarthy went through a difficult divorce, drank heavily and lived with diminished self-worth. In the midst of the pain, McCarthy overdosed on heroin. Firefighters resuscitated him, and that’s when McCarthy decided it was time for change.

“At that particular time, I just really wanted death, to end it all,” McCarthy, 45, said. “I’ve always been a fighter, for one, so I had to really dig my heels in and say, ‘You know what? This is not me. I need some type of change ASAP to get back on my feet.’”

Around that time, McCarthy’s aunt was visiting from Indianapolis and she suggested he move to the city to be near her and away from the surroundings where his abuse began. McCarthy agreed, and on March 9 he enrolled in Pathway to Recovery. 

While at Pathway to Recovery, McCarthy received counseling and medication, and he found a supportive community that encouraged him on his recovery journey. Eventually, the confidence and self-worth that drugs stole began to rebuild. 

“I think the way people talk about it today as if it’s more or less of a disease,” McCarthy said. “But diseases, we all know, can be cured. And the cure is finding means and solutions to fight it off: making the 12 steps meeting, having a sponsor, participating, whatever the case may be.” 

McCarthy, who is African American, is part of a growing group of African Americans who are impacted by the opioid crisis, once thought to be a problem only for white families.

Opioid overdose deaths have been steadily rising since the turn of the century. Of the 70,000 overdose deaths caused by opioids the Centers for Disease Control and Prevention tracked in 2017, about 47,500, or 68 percent, were due to opioids. In Indiana that number was 1,852, which represented a 22.5 percent increase from 2016.

President Donald Trump declared the opioid crisis a national emergency in August 2017. Since then, America’s awareness of the crisis continues to grow as the world’s wealthiest country navigates its latest health tragedy, trying to make sure urgency keeps pace with the body count.

 

Who is abusing opioids?

The opioid crisis’ demographic makeup was initially different than it is today. The crisis began around 2013, mostly due to doctors overprescribing opioids. Back then, opioid abusers were largely Caucasian and from rural communities where the so-called “pill mills” were. Although overprescribing is still an issue, governments and lawsuits reeled it in enough that people who became addicted weren’t able to continue using like before. Many users then transitioned to the streets to get heroin, which is derived from morphine and has no accepted medical uses. 

Now, dealers have seized on fentanyl, a cheaper synthetic opioid with some accepted medical uses. Fentanyl is 50-100 times more potent than morphine, so less is needed. But it’s being laced with other drugs such as cocaine, leaving many unsuspecting overdose victims in its wake. This is where African Americans, who were on the purview of the first couple of waves of the crisis, are now being heavily impacted. This phenomenon also makes it more difficult to follow opioids’ trails. For example, the CDC reported a 34 percent increase in overdose deaths involving cocaine nationwide from 2016 to 2017, and it’s difficult for researchers to figure out what role synthetic opioid lacing plays in that.

A 2018 study in the Journal of Contemporary Criminal Justice found 53 percent of opioid deaths in Indianapolis occur within just 5% of the city. That area is concentrated on the near east side and extends down to the near south side. According to Brad Ray, director of the Center for Health and Justice Research at the Indiana University Public Policy Institute and one of the authors of the study, more than half of all accidental drug overdose deaths in Indianapolis are related to fentanyl, and the risk of a fentanyl-related overdose death is growing especially quickly for Black residents. He said fentanyl is being found primarily in cocaine, meth and heroin.

“It really doesn’t discriminate,” Jim McClelland, Indiana’s executive director for Drug Prevention, Treatment and Enforcement, said. “It affects people of all socio-economic levels. It cuts across all the lines, and in some areas, it’s more prevalent than others, but really there’s no place that’s really immune to it.”

Similar to other substance abuse trends, the opioid crisis largely impacts young adults. According to Caitlin O’Dougherty, CVS pharmacist tech and speaker, 90 percent of people battling substance abuse began using as teenagers. Most people admitted to Indiana’s Family and Social Services Administration’s (FSSA) public addiction treatment centers were between ages 26 and 35 in 2017, the year the most recent data was available.

The centers, which are only open to people with salaries twice the federal poverty level or below, treated 6,447 people in 2017. The gender ratio was almost even, but 90 percent of the people treated were white, while 4.5 percent were Black. For comparison, Indiana was 85.4 percent white and 9.7 percent Black in 2018, according to the U.S. Census Bureau.

 

What is law enforcement doing?

African American and other minority communities are distrustful of law enforcement, especially when it comes to drugs. The problem came to a head in the 1980s at the peak of the so-called war on drugs, which sent at least 31 million people to prison — the majority of whom have been African Americans — in response to the crack epidemic. Urban police departments know this and, coupled with the mental health knowledge they have about addiction today, have adopted new approaches. 

Part of what Indianapolis Metropolitan Police Department (IMPD) does is have its officers trained how to administer Narcan, a Food and Drug Administration-approved nasal spray that delivers naloxone, which reverses the effects of an opioid overdose.

IMPD also has partnerships with hospitals, universities and other emergency responders that help loosen the grip of criminalization on a drug epidemic that often has much to do with mental illness and a lack of community resources. The Mobile Crisis Assistance Team (MCAT) is made up of IMPD officers, paramedics from Indianapolis Emergency Medical Services (IEMS) and clinicians from Eskenazi Health. MCAT responds to crises involving domestic, emotional or substance abuse.

From there, if someone needs to be taken to the hospital, behavioral health units follow up and connect those people with social services that could help them find employment or housing.

“[We] understand that for people who are caught in this cycle, it’s not just a one-time fix,” said IMPD Lt. Catherine Cummings, who oversees the behavioral health units. “… One interaction with law enforcement doesn’t equate to getting back on the road to recovery.”

Ray, the director of the Center for Health and Justice Research, evaluates MCAT and the behavioral health units for IMPD and said local law enforcement has in some ways been even more helpful in combating the opioid crisis than medical professionals, since the law enforcement sector had to make a shift to understand factors that go into drug abuse and addiction.

“I never in a million years thought I would be collaborating with law enforcement as much as I am,” Ray said. “… I’ve been super impressed.”

Jeremy Carter, a professor at IUPUI and a co-author of the study mentioned above, said it’s important for IMPD to keep people like him — academic researchers who can find data-tested means to inform those on the ground — involved in a far-reaching effort in the community.

“There’s very little that just a police department is going to do to impact those types of activities,” Carter said. “… It’s a team effort. You’re talking about partnerships across Marion County and state health departments. You’re talking about involving the correction side.”

In county jails, the Marion County Sheriff’s Office (MCSO) has detox units for inmates experiencing withdrawal so they can be better monitored during that delicate and sometimes dangerous time in recovery. Those units started about two years ago. Deputy Chief Tanesha Crear, commander of MCSO’s Jail Division, said she’s seen a steady uptick in inmates needing help with withdrawal from opioids.

Those inmates can also go through courses such as Alcoholics Anonymous and Narcotics Anonymous, and MCSO can connect them with social services upon their release. Following an examination, they can also join a Vivitrol program after they’re released. Vivitrol can help prevent relapse to opioid dependence for 30 days at a time.

 

What are state officials doing?

McClelland identified four principles the state is using to address the opioid crisis. The first is keeping those addicted alive. For example, Aaron’s Law, which the state legislature passed in 2015, made naloxone available over the counter without a prescription. The law is named for Aaron Sims, who died of an overdose in 2013. 

The second goal is expanding access to medication. In 2017 the state legislature passed a law allowing Medicaid to cover naloxone. In addition, Indiana also passed legislation in 2018 to build nine new clinics with the goal of no one in Indiana being more than an hour away from a drug treatment center. Five clinics have been built so far.

The third principle is prevention. Through working with the Indiana State Department of Health to develop new guidelines for treating pain, state officials hope to decrease the number of opioid prescriptions.

Finally, state officials want to hold conferences and provide resources to educate people and reform the stigma that addiction is a moral failing as opposed to a health concern. Tony Toomer, Opioid Treatment Program manager for Indiana, said viewing substance abuse as a disease is a necessary part of moving forward.

“Until we change people’s perceptions of what this opioid epidemic is doing and what services are out there, we are going to have that stagnated problem,” Toomer said.

According to McClelland, Indiana saw improvements from these efforts, but the state is still not where it should be. The death rate from opioid overdoses reached its peak in November 2017 at 29.4 per 100,000 people and has decreased since then. In addition, Hoosier doctors are prescribing fewer opioids.

“The prescription rate is going down,” McClelland said. “It’s still too high, but it certainly is moving in the right direction.”

 

What are city officials doing?

The city of Indianapolis also has undertaken several procedures to curb the crisis. For example, it offers naloxone training to anyone interested and provides them with a free kit to safely administer the drug.

The city also increased options for safely disposing medication. Randy Miller, executive director of Drug Free Marion County, said a large cause of the opioid crisis is people keeping leftover pills for possible future use or disposing the pills in ways that allows others to access them. Now, the city offers both drug drop-off locations and medical disposal kits that allow people to safely discard leftover medication, both of which people can access at drugfreemc.org.

“Six years ago, we didn’t have any medication disposal options here in Marion County,” Miller said. “We were telling folks to go to Hamilton or Hancock County.”

 

Marion County safe syringe program

The Marion County Public Health Department will run the Safe Syringe Access and Support program (SSAS), which the Indianapolis City-County Council approved in June 2018 in response to a hepatitis C outbreak. The main purpose of a needle exchange program is to prevent, or at least limit, the outbreak of infectious diseases such as HIV, but these programs can also act as a door to treatment and recovery.

Madison Weintraut, program manager for SSAS, said the program takes a “harm-reduction” approach, where instead of focusing on eliminating the underlying issue, the emphasis is on limiting the consequences.

“It’s about recognizing that people may not be willing, ready or able to enter into substance abuse treatment,” Weintraut said, “but they may be willing to take some small steps to help improve their health and the well-being of the community.”

SSAS will be mobile, going into high-risk neighborhoods with what Weintraut described as “basically an oversized UPS truck.” Along with clean needles, the program will provide naloxone, immunization and testing for HIV and hepatitis C. For participants interested in getting on the path to recovery, trained peer recovery coaches will be able to point them in the right direction for help. According to Weintraut, people who participate in a safe syringe program are more than five times likely to get treatment.

Dr. Robin Parsons, chief clinical officer at Fairbanks Alcohol and Drug Addiction Treatment Center, supported the idea of a needle exchange program as the county planned SSAS because those programs link people to recovery professionals like her.

“From the treatment standpoint, our basic theory is, we can’t help them if they’re dead,” Parsons said. “So let’s do whatever we can to keep them alive.”

 

How to solve the crisis

Asking how to solve the opioid crisis may be a trick question. What does it mean to solve something this large and systemic? Does an opioid “crisis” ever get eradicated, or can it only be held in check? Is this crisis a surge in overdose deaths, addiction or something else? Experts and everyday people the Recorder spoke with gave their opinions, and the diversity in answers demonstrates how difficult and multifaceted that task will be.

What’s clear is partnerships across organizations are popular, and it’s hard to see progress without those alliances. Cummings, the IMPD lieutenant who oversees the behavioral health units, said the department’s work with academic professionals will continue to help find data-supported approaches.

“It’s a shift from saying that’s just a health care issue to coming together and saying, how can we all work together?” she said. “How do we best help the people struggling with these issues?”

There’s also a stigma around drug use and addiction that can deter those struggling from getting the help they want. Chelsea Boggs, 28, who’s a peer recovery coach at Life Recovery Center, said there’s a lot of negative judgment for recovering addicts like her.

“So they don’t open up about what’s really going on with them or admit that they need help,” said Boggs, who was addicted to heroin and has been clean for five years, “because they’re scared to get judged by someone, especially when it’s a family member or someone like that.”

Dr. Virginia Caine, director of the Marion County Public Health Department, said it may take a complete re-evaluation of the treatment process. Right now, Caine said, it’s common for those in recovery to get only one or two days of prescribed treatment such as methadone, which can be especially burdensome for low-income people.

“My goodness, how many people are very busy?” she said. “I may be a single mother. I’ve got to get on public transportation. That may take me a whole hour.”

Caine said making that prescribed treatment more readily available — either by taking it to them or prescribing more at a time — would result in more reliable access to the treatment these people need.

But what if there’s a slightly different way of viewing this that would change the approach? Ray, the director of the Center for Health and Justice Research at the IU Public Policy Institute, said he doesn’t think Indianapolis is experiencing an opioid crisis as much as an overdose crisis.

“Part of the solution is recognizing this isn’t just about opioids,” Ray said. “Part of the solution is how we see substance abuse disorders. … We don’t appreciate the true nature of addiction.”

Ray said the goal shouldn’t be to stop people from taking drugs, but instead to minimize the harm. He pointed to cars as an example of this approach.

“They’re dangerous, and we don’t ban them,” he said. “We try to make them safer.”

 

Contact staff writer Tyler Fenwick at 317-762-7853. Follow him on Twitter @Ty_Fenwick.

Contact staff writer Ben Lashar at 317-762-7848. Follow him on Twitter @BenjaminLashar.

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