A generation ago ordinary citizens started learning CPR and regular folks started saving lives.
For this generation, it’s free Narcan kits that are saving lives in the hands of ordinary folks. Unfortunately, though, it’s opiate overdoses we are treating, not heart attacks.
What’s Going On?
“On average 24 overdoses—mostly opioids—are reported every month in Chautauqua County, but we believe this is significantly under-reported,” Stephen Kilburn told the Gazette last week. Kilburn is the director of the Rural Communities Opioid Response Program, planning the implementation of a new $1 million, 3-year federal grant to Chautauqua County.
The lead agency in this program is the Chautauqua County Department of Mental Hygiene, spearheading the Chautauqua Substance Abuse Response Partnership (CSARP). See page 11 for a list of the 11 partner agencies.
There is some good news on the addiction front, according to Kilburn. “The consequences of this disorder (in medical terms, SUD—substance use disorder) in Chautauqua County are many. In 2017, overdose deaths were known to number 30. In 2018, the number of overdose deaths decreased to 20.” Final statistics for 2019, based on 911 and ER calls, are not in yet.
“We are tempted to be encouraged by the 30 percent decrease in overdose deaths,” Kilburn said hopefully, “but we don’t want to be overconfident based on a sample of only two years.”
“Specific, accurate data is not available, but a reasonable (though unfortunately conservative) estimate for Chautauqua County is assumed to be 1,500 individuals with an opioid-based substance use disorder,” Kilburn reported.
“We credit the use of Narcan overdose reversal kits for at least some of the lives saved,” Kilburn added. The simple, pocket-sized kits are available—and almost always free—at any Chautauqua County pharmacy to anyone who requests one, no questions asked. About 2,900 kits have been distributed in Chautauqua County since 2017.
“What we do know is that addiction affects individuals without regard to class, income, gender, or education,” Kilburn added. “It is in all of our interest to address this problem. My purpose is to share with the public matters of public health—a conversation about addiction—not about the law. This is an extremely powerful subject.”
But That’s Not All
“While my work will concentrate on addiction to opioids and similar substances,” Kilburn said, “I want the public to be aware that by far the greater addiction problems in terms of public health, mortality, and quality of life are alcohol and tobacco. Those addictions should not be overlooked or accepted just because they are so common. Instead, they should be treated because they are so deadly.”
Kilburn also noted that 17 percent of Chautauqua County’s 8th , 10, and 12 th grade students report binge drinking at least once in the 30 days before a recent survey, and 15 percent have vaped marijuana. In addition, neonatal withdrawal syndrome—resulting from maternal opioid use during pregnancy—is seen in Chautauqua County newborns at four times the statewide average rate.
An Epidemic Worth Stopping
While opioid addiction is not a typical heart disease to be treated with CPR, the public is coming to realize that it may instead be a “disease of the heart and mind” that deserves treating. Every life saved is a life that can recover, an outcome to everyone’s advantage, according to Kilburn. “We won’t arrest our way out of this problem,” he said.
“As a county with a history of dedication to hard tasks, we are facing this challenge together,” Kilburn said with clear optimism. “Our county’s record of mutual cooperation and respect among care-givers, ordinary citizens, and stakeholders, positions us well for success.”
In discussing the issues of substance abuse and opioid addiction, previous Chautauqua County executive, Vince Horrigan, said, “I want to praise Chautauqua County and the people working in this field at all times for the consistency and dedication of their help in this ongoing work.”
Both the medical and psychological parts of substance use disorder and addiction are important to Kilburn who holds an MDiv (Master of Divinity) degree and serves as the pastor of the Community Church in Sherman, NY. He is also an experienced addiction counselor.
Kilburn also administers a National Institute on Drug Abuse (NIDA)research grant studying what works best in the fight against addiction in 16 selected counties across New York State.
The Narcan Weapon
Narcan, the registered trade-name for a medication called naloxone, blocks the effects of opioid drugs. When opioids kill, it is usually by putting the breathing center of the brain into a deep sleep, causing the victim to simply “forget” to breathe. An opioid death is a death by suffocation.
Narcan has no significant effect other than reversal of opioids. It is safe and cannot harm anyone given the drug for any other purpose. It is easy and convenient to use as a nasal spray. When given to opioid-dependent victims, however, it can cause opioid withdrawal symptoms. The effect is usually seen within minutes.
Training for the use of Narcan in treating a suspected opioid overdose is very easy and takes no more than two minutes, according to Steve Kilburn.
Prevention: Better Than Cure
“Prevention works,” Kilburn stated emphatically. “Measures aimed at prevention have been shown to reduce the prevalence of substance use disorder. In Chautauqua County we have a higher rate than the national average. In part, we have discovered that our youth underestimate the dangers of opioid use.”
Addressing the problem of substance abuse disorder and opioid addiction, however, requires the medical community and the public to improve access to services, requires constant adjustment to changes in the nature and availability of addictive drugs—whether street or prescription varieties—and requires an increase in the workforce committed to addressing this problem.
The Health Resources and Services Administration (HRSA) Rural Communities Opioid Response Program-Planning Grant administered by Kilburn has identified eight key objectives for the next three years to expand or create in ways that will continue after the grant project has been completed.
Mental Health Association (MHA) outreach
Physician referrals to programs of care.
Suboxone and Vivitrol treatment (see below)
MHA’s job referrals for individuals in recovery
Develop or expand:
Services in county correctional systems
Public training and awareness of SUDs
Public awareness of treatment for DUDs
“We aim to create lasting changes that will continue after the grant funds have been expended,” Kilburn explained.
When Prevention Fails
When prevention does not work and a person becomes addicted, treatment is needed. However, treatment sometimes seems to fail, too. But such treatment failures should be considered temporary, according to Kilburn. It is more realistic to call it “a short-term successes on the way to permanent success.”
“We now have a variety of useful treatment programs available,” Kilburn announced. “The most successful is medical treatment, three of which head the list. Each has a slightly different safety and benefit profile.
Methadone: A “safer” but still addictive opioid that blocks the euphoric effects of other opioids.
Suboxone: A combination of Narcan and buprenorphine. Use and effect similar to Methadone.
Vivitrol: Also called naltrexone, it is an opioid antagonist in some ways similar to Narcan.
These agents all present different benefits, side effects, and safety margins, some requiring special administration and maintenance protocols. The CSARP program aims to improve availability of these treatment options.
Another important avenue of approach is called Harm Reduction. Substance abuse disorders, especially when it involves injectable opioids, exposes individual to a very high risk of such conditions as hepatitis C, HIV, and other blood-borne diseases. For individuals not yet committed to recovery, or in a temporary relapse, harm reduction can include such measures as providing clean needles and other safety measures like the free Narcan opioid reversal kits. A life saved is a life may yet achieve success.
Steve Kilburn stated in his Executive Summary of CSARP’s work, “As in communities across the nation, Chautauqua County has been severely afflicted by addiction, including most recently by the opioid crisis. The social and economic costs have been immense, the personal and family tolls incalculable, and, above all, the tragic permanent loss of life is heartbreaking. No resident in our county has been unaffected by this terrible epidemic.”
The Jamestown Gazette invites all of our readers to engage in and support this vital, lifesaving work in 2020 and beyond.
CSARP – Partners in Chautauqua County
- County Department of Mental Hygiene
- County Department of Health and Human Services
- Chautauqua Center
- Prevention Works (formerly CASAC)
- Brooks-TLC hospital system
- UPMC Chautauqua
- United Way of Southern Chautauqua County
- Chautauqua County Health Network
- The Resource Center
- Evergreen Health Services