This message is personal for me, and I am guessing it is for you too.

I try to focus my conversations in these emails on housing and homelessness, but I am tired—and, I admit, angry—about what is happening in our community and across this country as a result of the opioid epidemic.

I am mad that there are those who, for whatever reason, are able to justify hurting others to get what they want—and that includes corporations looking the other way when their products kill people because they also make a huge profit.

The number of people overdosing in our country now exceeds both traffic fatalities and gun homicides and suicides as the leading cause of accidental death.

Overdoses increased from 16,849 in 1999 to 63,632 in 2016, according to the Centers for Disease Control and Prevention, and while the number of people who die has stabilized in the last year or two, that is not due to a lowering of overdoses, but to an increase in the number of potential deaths avoided by the use of NARCAN and similar products.

It is hard to believe that anyone in this country has not been affected by addiction at this point. I have watched as friends died and witnessed family members brought back after overdoses. Addiction has taken over the lives of my stepmother, brother, stepsister, niece and nephew to a point where we as family no longer even recognized the people we once knew and loved. While I am especially proud of my brother for doing the hard work to overcome his addiction and mend his relationships, I still know what he and his immediate family lost during those years including wealth, security and trust. And, while I cannot tell you how beautiful it is to see my brother help others lost in this same disease, I wish there was a way to turn back time and prevent any of them from the loss of addiction in the first place.

Photo illustration courtesy of FiveThirtyEight; Getty Images

We now hear news stories about rural communities here where more prescription opioid drugs have been prescribed than people who live in the community, so the epidemic is not just an urban issue.

And as pharmaceutical companies pushed for increased prescribing of opioids, little thought was given to what happened to many as they left hospitals or recovered at home with an ongoing desire for the drug or something similar that could be bought from a local drug dealer.

Wealth does not isolate families from addiction because those with income will give or sell anything they have to get high (or just stop feeling dope sick), leading those who seemed financially stable to homelessness and risky behaviors. And the greatest increase in those who overdose in the United States are healthy young men, unlike most other diseases.

I am not just mad about the rising number of people dying, but about how little we as a society are doing to prevent more deaths and suffering. While 70% of those diagnosed with hypertension and diabetes receive treatment, only 10% of people with addiction receive any treatment. When those with addiction problems do receive treatment, they are most often directed to non-evidenced-based AA and NA programs, which do not include medically-assisted treatment necessary for many to address opioid addiction and often do not provide the supports for dually-diagnosed persons with mental health issues to address their addiction issues with mental health concerns equally prioritized.

I am not alone in my anger and frustration with what to do. Everyone I speak to in the realm of homeless services has seen a change in the vulnerability and dependency of many in homeless shelters and services. We see people in shelters and especially on the streets being preyed on by dealers and traffickers. So program models have had to change to adapt to the needs of the addicted and those who prey on them. Homeless advocates have had to become advocates for more recovery options and have added services to address the needs of an increasingly vulnerable population.

So how do we direct this anger and feeling of hopelessness? Here is what the experts say:

1. Reduce overdose deaths by providing easy access to naloxone (NARCAN). Naloxone, now available as a nasal spray, immediately blocks the deadly respiratory suppression caused by heroin, methadone and narcotic pain pills (like OxyContin, Percodan and Vicodin), and while it does not address addiction, it definitely saves lives. Everyone who works in the homeless field should have easy access.

2. Identify and crack down on prescribers who are providing large quantities of narcotics. Forty-six people die each day in the U.S. just from prescription drugs and many who die of other opioids trace their addiction back to prescription use. While Kentucky has the KASPER database to identify over-users, advocates should push for increased use of the database to crack down on over-prescribers. Until these doctors and pharmacies are shut down and held accountable, this crisis will continue. We must hold the federal and state government responsible for identifying criminal prescribers and shutting them down as well as training professionals who are overprescribing because they do not understand the risk. This will also mean changing federal policy at the Food and Drug Administration to not continue to release new opioids that threaten the lives of our family and friends.

3. Make problem drug and alcohol use screening a standard of care. My brother re-entered addiction after he received opioids during an elective surgery even though he informed the doctors of his addiction. Screening, brief intervention and referral for treatment, or SBIRT, is a proven intervention that is generally covered by insurers, including Medicaid and Medicare, and it should be used universally.

4. Increase the availability, affordability and access to drug treatment programs. Approximately 90% of individuals who could benefit from treatment are not getting it. The Affordable Care Act requires parity for mental health and substance use disorders. We need to demand that these services be available to everyone in need when they are ready and that they are evidenced-based and provide choice to fit the particular need of the client and their addiction(s), not the needs and desires of the insurers.

5. Believe in recovery. This is the hardest of the five steps for me when considering my own family and friends. People with substance use disorders recover every day, but it is hard for me to remember when they are neglecting their children or hurting other people I love. Persons affected need to find the time and type of recovery that works for them and until then, isolation can increase the likelihood of suicide. We all have to draw lines to protect ourselves and others when necessary, but you can still let persons affected know you believe they can recover when they are ready—and that you will be there. You can be the hope that saves a life. If you are, be sure to find the support you need to get through this. If you can’t in this case, do whatever you can to support the person who is. 

Natalie

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The Coalition for the Homeless's mission is to prevent and end homelessness in Louisville through advocacy, education, and the coordination of our 30 member agencies. We have been the lead advocate for Louisville's homeless since 1986, when we were founded by community leaders after several people died on Louisville's streets.

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