Finding Fixes

This is the last episode of Season 2. For people addicted to heroin and other drugs, how do we keep them safe and prevent them from overdosing? We look at the idea of harm reduction and focus specifically on needle exchanges. Those are hundreds of places across the US that hand out clean equipment, the overdose reversal medicine Narcan and other help to people addicted to heroin and other drugs. But needle exchanges are still controversial in many parts of the country, including Tacoma, Washington, where Finding Fixes contributor, Amber Cortes, brings us the story of the oldest needle exchange in the United States. That exchange started during the AIDS epidemic. Now, it and needle exchanges like it are finding they have what it takes to respond to the current opioid epidemic.

Addiction is a family disease and family members of people with addiction need help, too. Research shows that helping family members helps their loved one who has an addiction. We look at an approach that is more effective than an intervention or Al-anon to get family members into addiction treatment. It’s called CRAFT, or Community Reinforcement and Family Training. STORY: A book group turns into a support group for parents of addicted children. They turned away from "tough love" and, without knowing it, stumbled on evidence-based ways to help addicted family members access treatment. Also, we have an update on the chronic pain patient at the mini boot camp for pain, Kimberly. We check up with her a month after the program ended.

Emergency rooms are the last safety net for the sickest, most marginalized people. People with addiction often end up in emergency departments following an overdose, during withdrawal, or with other health problems. A new approach is linking people with addiction to drug treatment from a hospital emergency department, instead of just sending them out the door when they’re well again. Two doctors, one emergency department, a social worker, and a person with addiction in recovery show how emergency rooms can become the gateway for people with addiction to access evidence-based drug treatment and other help they may need.

Trauma and pain and addiction are tightly woven together. But, post-traumatic stress disorder (PTSD) is treatable and treating the wounds of trauma can help treat pain and addiction, too. We must pay attention to the toxic effects of trauma if we really want to help people stay away from drugs, if we want to really help people with chronic pain.  In this episode, we hear personal stories from three women that show just how tightly woven together trauma, pain and addiction are. Also, we hear their stories of post-traumatic growth, and their strategies for moving beyond the pain of the past to fully embrace the present. Links to resources for help with PTSD or sexual assault: The National Sexual Assault Hotline: 800.656.HOPE (4673) Find a clinician who can help with PTSD The VA has a tool to help choose what kind of treatment you want for PTSD The VA’s PTSD coach website  The VA has a lot of apps to help people getting treatment for PTSD

Medical marijuana is now legal in dozens of states. Some chronic pain patients now rely on it in place of opioid painkillers. But, in the absence of formal medical guidance, many patients are going it on their own, with informal guidance from their peers. Some experts are not convinced though. They caution against potentially harmful side effects. Reporter and Finding Fixes contributor, Anne Hoffman brings us this intimate look at medical marijuana. 

What's the appropriate role of opioids in treating chronic pain? For years doctors have used opioid painkillers as the go-to solution for all kinds of pain. Now that U.S. society is saturated with these pills and so many people are dying of overdoses, medical consensus and even laws are changing. Doctors are getting the message to cut back. But some patients with chronic pain say they’re being cut off – all of a sudden – from the medicine they depend on.  So what’s the solution? Answering that question means we have to re-examine what we *think* we know about chronic pain.  On this episode we zoom out and get a more complete picture of chronic pain, so we can understand where opioids fit in. We find out about one solution that helps people feel better while voluntarily scaling back on opioid painkillers. Doctors, nurses, and therapists are working to give their patients with chronic pain a whole new set of tools.

SOLUTION: The more opioids you get after surgery, the more likely you are to be dependent on them down the road. And it doesn't take very long to become dependent on opioids – days to weeks. The solution Washington State and others have enacted are tighter guidelines advising doctors how many pills can be dispensed following surgery, getting them to counsel patients on the risks of the medication, and encouraging them to recommend alternatives for pain relief. STORY: How changes in Washington State law around opioid prescribing played out through two major surgeries. Reporter Eilís O’Neill follows a mother, Megan, through the birth of her second child. Two and a half years earlier, when her first child was on his way, Megan had a totally different experience.

SOLUTION: The best ways to prevent young people from getting addicted don’t necessarily focus on the drugs themselves (forget “Just say no.”) Research shows the more young people are surrounded by risky environments, including stress, poverty, and violence, the more likely they’ll get addicted. But other factors in their environment can protect young people and stand in the way of addiction, such as mentors, clear limits and expectations at home, and supportive communities and schools. STORY: The community of Bellingham, Washington, near the U.S.-Canada border finds that the more people focus on strengthening communities and families, the better young people are at staying away from tobacco, alcohol, and other drugs. Data shows it’s making a dent.  We meet soccer moms and dads, and hear from young people themselves, including an outspoken group of eighth-graders and their mentor, Chelsea. 

Our team is hard at work on Season Two, which drops fall 2019, but in the meantime we wanted to answer a question a lot of people ask us: Why are we making this podcast? Why make a podcast about solutions to the opioid epidemic? On this bonus episode, we bring you excerpts from interviews producers and co-hosts Anna Boiko-Weyrauch and Kye Norris did in October 2018 at KUOW with producer, Brie Ripley. 

For Shannon McCarty, two things were crucial in her recovery: connections and timing. It started with timing – a key encounter just when she wanted to get off the drugs. And then it was the connections that kept her going. A police officer she could depend on. A sister who stayed in touch. A dog who gets her out of the house a few times a day. Shannon’s story helps us understand how solutions to the opioid epidemic can be incredibly personal.

SOLUTION: Make incarceration an opportunity to get help and start healing. Make detox easier, get people with addiction drug treatment behind bars, and connect them to help as soon as they’re released. STORY: Opioid withdrawal is like the worst flu you’ve ever had. Now, imagine you’re responsible for dozens of people as sick as can be. What do you do? We tour the Snohomish County jail, which has become a defacto detox center and where inmates used to die from lack of medical care. The jail turned things around, and today they’re trying to make the jail a place of healing. This season we’re in Snohomish County, Washington which has an oversized share of overdose deaths in the state and is now treating the opioid epidemic like a natural disaster. MORE INFORMATION AND RESOURCES: Snohomish County overdose and addiction treatment resource guide. http://snohomishoverdoseprevention.com/treatment-and-support/ An article on other jails across the country that use medication-assisted treatment do it too. http://www.wbur.org/commonhealth/2017/08/08/sudders-med-assisted-opioid-treatment-jails More about the Rhode Island prison system’s comprehensive approach to opioid use disorder, which helped decrease the state’s overdose death rate by 12 percent in one year. https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304666 Research: Treating inmates’ addiction behind bars can be effective in helping them continue drug treatment after they’re released. https://www.ncbi.nlm.nih.gov/pubmed/21955033 The National Institute on Drug Abuse presents evidence in support of using medication to treat inmates’ opioid addiction. https://www.drugabuse.gov/treating-opioid-addiction-in-criminal-justice-settings Research: Detroit found heroin users spent about $60 dollars a day on average on drugs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115458/  

SOLUTION: Create teams of social workers and police officers who help homeless people with addiction get drug treatment and housing. Break the cycle of drug use, crime, and jail time by reaching out to people on the streets and in the woods, and asking them what help they need. STORY: Marshmallows in Kevlar and a foul-mouthed social worker. Coffee dates, mac n’ cheese, and body wash. The county reimagines police work and helps hundreds of people get into detox, drug treatment, and stable housing. This season we’re in Snohomish County, Washington which has an oversized share of overdose deaths in the state and is now treating the opioid epidemic like a natural disaster. MORE INFORMATION AND RESOURCES: Snohomish County overdose and addiction treatment resource guide. http://snohomishoverdoseprevention.com/treatment-and-support/

SOLUTION: Get government to work more effectively. Use a disaster response playbook to organize county government around the opioid epidemic. Approach addicted people with compassion, as you’d approach a person with any other medical condition. STORY: Addiction hits home for the top dog of a disaster-prone county. An old-school cop gets a wake-up call and learns “handcuffs and a trip to jail” just won’t cut it anymore. Also, we learn what a landslide can teach us about tackling the opioid epidemic. This season we’re in Snohomish County, Washington which has an oversized share of overdose deaths in the state and is now treating the opioid epidemic like a natural disaster. LINKS TO MORE INFORMATION AND RESOURCES: Snohomish County overdose and addiction treatment resource guide. http://snohomishoverdoseprevention.com/treatment-and-support/ Here’s what we refer to as FEMA’s emergency response playbook (the National Incident Management System (NIMS), which outlines the structure of a Multi-Agency Coordination, or MAC, group) https://www.fema.gov/media-library/assets/documents/148019

Download instructions on how to recognize the signs of an overdose and administer Narcan to stop it. Drawn by Julia Drachman. 

SOLUTION: Get the overdose reversal drug, naloxone (aka Narcan) into the hands of everyone who needs it, and train them how to use it. Family, friends and people with addiction themselves can play a big role in stopping overdose death. STORY: A life lost, a life saved. The main character of this episode isn’t a person. It’s a nasal spray. Naloxone (aka Narcan) saves lives from opioid overdoses (heroin, painkillers, fentanyl). Across the U.S., people are dying from opioids, but their deaths are preventable. We walk you through how to save a life using the overdose antidote. LINKS TO MORE INFORMATION AND RESOURCES: Snohomish County overdose and addiction treatment resource guide. http://snohomishoverdoseprevention.com/treatment-and-support/ Learn to administer Naloxone through an online training. http://stopoverdose.org/section/take-the-online-training/ Learn more about Naloxone and the different forms it comes in. http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/administer-naloxone/  Research: Family members can be life savers. https://onlinelibrary.wiley.com/doi/10.1111/dar.12551 Research: One study found 61% of drug overdoses occurred at home. https://www.tandfonline.com/doi/abs/10.1080/10903127.2017.1315203

SOLUTION: Treat addiction using evidence-based medication, like buprenorphine (aka Suboxone). Expand access to treatment through telemedicine. STORY: At a clinic in Everett, Washington, a nurse pushes his patients to work hard, and the patients embark on their road to recovery. Do they have a chance? (Yes, and we’ll tell you why.) This season we’re in Snohomish County, Washington which has an oversized share of overdose deaths in the state and is now treating the opioid epidemic like a natural disaster. MORE INFORMATION AND RESOURCES: Snohomish County overdose and addiction treatment resource guide http://snohomishoverdoseprevention.com/treatment-and-support/ Overview of the evidence for medication-assisted treatment (MAT) for opioid use disorders, by the Alcohol and Drug Abuse Institute of the University of Washington. http://adai.uw.edu/pubs/infobriefs/MAT.pdf Research: Buprenorphine is an effective medication that can retain people in treatment.http://www.cochrane.org/CD002207/ADDICTN_buprenorphine-maintenance-versus-placebo-or-methadone-maintenance-for-opioid-dependence Research: Patients on buprenorphine were 30 percent more likely to avoid a relapse and 50 percent more likely to stay alive than patients in drug treatment without medication. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2010.0532 Research: Four years after starting Suboxone, over 60% of patients were not using illegal drugs. https://www.sciencedirect.com/science/article/pii/S0376871615001143 http://adai.uw.edu/pubs/infobriefs/MAT.pdf

Finding Fixes is the first podcast dedicated to solutions to the opioid epidemic. Each episode we dive into one solution.  The first season we're in Snohomish County, Washington, which is treating the opioid epidemic as a state of emergency like a natural disaster. As communities across the country struggle with rampant opioid overdoses, we seek to fill a gap:  What are people doing that works? How can my community tackle the epidemic? We are journalists in Seattle with decades of experience, and we hope you'll join us as we explore solutions.  www.findingfixes.com