“How do you eat an elephant? One bite at a time.”
That was the advice Dr. Jerome Adams, U.S. surgeon general, gave to public health and law enforcement officials Monday during his first official visit to Southern Maryland as the nation’s top health official.
The elephant in the room of Building B on the campus of College of Southern Maryland in Prince Frederick was the escalating opioid epidemic penetrating communities across the region, the state and the nation.
To Adams, addiction is personal — he said his grandfather died from tobacco use, and a brother of his is in state prison in Jessup because of drug abuse that was tied to unrecognized, untreated mental health issues.
“Addiction is when you know something is bad for you and you just can’t stop doing it,” Adams said. “It’s not a conscious choice.”
Noting he has heard the frustration from law enforcement sometimes saving the same individuals over and over again, Adams said that is a testament to the fact that addiction is a disease.
Not too long ago, someone in recovery said to him that “telling me not to do drugs is like me telling you not to breathe. Take a deep breath and see how long you can hold it,” Adams recalled. “At some point, your body is going to take over because your brain changes when you are addicted and is going to force you back into those same habits unless you get the proper medical treatment for it.”
Acknowledging the health professionals, law enforcement representatives, state’s attorneys, school and county government officials gathered in the room Monday, Adams said it’s important to work together in prevention, enforcement and treatment as part of the opioid intervention plan.
It’s going to take all three fronts to tackle the problem, he said. Otherwise, it “would be like playing whack-a-mole.”
Adams also encouraged more engagement with the faith and business communities.
Business leaders, he said, are saying that they couldn’t find enough people who could pass drug tests to work for their companies.
The best way to address the crisis, in Adams’ mind, is to do it through partnerships, as suggested in his motto — “better health through better partnerships.”
In addition to understanding addiction as a disease, Adams said it is also “a symptom of trauma,” including childhood trauma and physical trauma.
“We talk about addiction as a disease of despair, and we know all too often it is,” he said.
Half of all U.S. adults had one adverse childhood experience, such as having an unstable home environment, being physically or sexually abused or having a parent taken away from them, he said. “With each adverse childhood experience you have, your risk of addiction goes up 400 percent.”
Children who lose a parent to addiction and newborns with substance dependency are much more vulnerable to becoming addicted to drugs themselves and running into trouble in the criminal justice system, what Adams called “a hidden epidemic” as a result of the opioid crisis.
And the impact of the epidemic on children goes beyond individual families.
“We are, in the school districts, dealing with the victims of opioid addiction,” Charles County schools Superintendent Kim Hill said. “When substance-exposed infants are gonna come into public schools and have challenges the minute they hit pre-K, and then the public schools are going to be blamed as ‘failures’ because we are not able to educate all children.”
Put in a difficult spot, Hill said the school system wants to help but would need the recognition that children are caught in the middle of the crisis.
In Calvert County, the health department initiated a program called Healthy Beginnings that provides services to pregnant women who have substance disorders.
Dr. Laurence Polsky, Calvert County’s health officer, said the program has assisted more than 80 women in less than four years and helped minimize the number of children entering the foster care system.
Another vulnerable group that the health department focuses on, Polsky said, is people released from prisons or detention centers, a population with high risk of recidivism, especially when they have no job and no one to turn to.
Polsky also proposed two potential federal policies that could make an impact in the long run. One is to train a sustainable workforce to adequately deal with mental health issues and the other is to invest more on research.
“We don’t have enough psychiatrists, especially in rural areas,” Polsky said, noting what the federal agencies should be looking at is funding fellowships for pediatricians, family doctors and general and internal medicine doctors where they can do one- or two-year behavioral health fellowships.
The second suggestion he made was intended to address the reality that current treatments and medications are not adequate. “We are sitting at the threshold of technology and genetics revolution,” Polsky said. But “the understanding of behavioral health treatment in 2017 is similar to our understanding of cancer treatment in the 1960s.”
During his medical training, Polsky said the drug of the decade was crack cocaine. Later, it was meth.
“We don’t know what the next decade is going to bring,” he said. “But we will continue to see this over and over again. We need to come up with better ways to treat substance use and its link to mental health problems.”
From a law enforcement perspective, Calvert Sheriff Mike Evans (R) said cutting the supply needs to be part of the solution. “The supply is still coming in very strongly,” Evans said. “We do need more money to stop the drug from coming into our county and state.”
St. Mary’s Sheriff Tim Cameron said the good news is that the people gathered in the room are not strangers, as they have been working together for a decade on tackling the problem.
“Our challenges are quite simple,” Cameron said. “It’s funding, training, Naloxone — which is very expensive — and personnel,” and access to treatment.
Kathleen O’Brien, executive director of Walden, said not only is treatment needed, but also quality treatment and quality workforce.
Including O’Brien, some also mentioned the importance of having a continuum of care.
After someone is administered Naloxone after an overdose and sent to the hospital, no one follows up after they are discharged from the hospital, Charles County Director of Emergency Services William Stephens said. “We’ve got no continuum of care.”
Birch Barron, deputy director of the state’s Opioid Operational Command Center, reminded the audience of “compassion fatigue,” a term heard often after natural disasters like hurricanes and floods.
It could be law enforcement officers picking up the same people 20 different times for the same thing, or an EMS volunteer responding to the same individual overdosing again, or a health worker going to the 20th meeting that looks like Monday’s event while knowing things are not moving forward fast enough, he said.
But it is important, he said, to continue to elevate the conversation.
“Make sure this is something that we don’t pay attention to just for a narrow window of time and turn and avert our eyes and pretend like it’s not happened because it’s fixed,” Barron said. “This crisis is going to take a long time to fix.”
Rep. Steny Hoyer (D-Md., 5th), who invited Adams to the roundtable discussion, quoted a line from Spiro Agnew during the former governor’s inaugural address in 1967 that “the cost of failure far exceeds the price of progress.”
He said the opioid crisis is a nonpartisan issue, and investment on a federal level is needed.
“We need to be energized, because this crisis will cost us much more,” Hoyer said. “We can’t afford the fatigue.”
Noting Adams as “a native son of Southern Maryland,” Hoyer said: “The surgeon general can make an extraordinary impact. And my belief is that Surgeon General Adams will do exactly that.”
In his closing remarks, Adams challenged everyone in the room to find that bite of elephant they could take and work with others in dealing with the crisis.
As of Monday, the tri-county area has had 85 overdose deaths, according to local sheriff’s offices. The number of fatal overdoses in St. Mary’s nearly doubled from 15 in 2016 to 26 so far this year. Calvert has had 29 fatalities, surpassing its 28 in all of 2016. Charles County has seen 30 deaths, lower than its 2016 number of 45.
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