Of the more than 100 people who attended the community forum Confronting the Opioid Epidemic on Nov. 21 at the Edward A. Myerberg Center’s Frosburg Room, dozens stood in line to receive training in how to prevent opioid overdoses. The hands-on overdose response training from Baltimore City health officials came at the end of the event and included instruction in administering Narcan (naloxone) nasal spray, a treatment that can, according to health officials, be 99 percent effective in stopping opioid overdose and death.
Daryl Mack of the Baltimore City Health Department said the city does Narcan training on a daily basis through its mobile units and visits to treatment centers. Naloxone has been around for decades but only recently has been in such high demand. At a recent Chase Brexton event, more than 300 people were trained.
“On our mobile units we connect people to service. We have treatment slots at centers we work in conjunction with,” he said. “If you call the [hotline] number and you want treatment, they can get [people] into treatment as early as tonight. But they have to really want it.”
The opioid-education event featured keynote speaker Joshua M. Sharfstein of the Johns Hopkins Bloomberg School of Public Health. Sharfstein offered startling statistics on the numbers of overdose deaths — more than 52,000 in the U.S. last year, a number that tops homicides, suicides and car accidents. The spike in deaths has even affected the nation’s life expectancy, which dropped last year for the first time since the scourge of the 1980s AIDS epidemic.
“And the primary reason was from the addiction overdose crisis,” Sharfstein said. “Behind those [numbers] are individuals.”
Sharfstein noted that more than 100 young people in the Orthodox community in New York died from overdose over the last year. “This is an issue that touches all groups of people at all levels,” he said.
In Baltimore, cheap heroin when combined with the much more potent fentanyl has contributed to the surge in opioid overdose deaths, with fentanyl-related deaths climbing from 26 in 2007 to 1,119 in 2016.
“Addiction is a chronic and relapsing disease. It is a disease that primarily affects the brain,” Sharfstein said, marked by compulsive use despite the harmful consequences. It is a long-term illness.
Sharfstein said a confluence of events has contributed to the current crisis in opioid addictions and deaths including a three- or four-fold increase in opioid prescriptions for pain, the emergence of cheap and pure heroin and the adulteration of fentanyl for street use.
More appropriate prescribing, while educating the public in recognizing the signs of addiction can help mitigate the addiction problem, Sharfstein said, along with multifaceted, holistic treatment approaches that combine medical and behavioral therapies.
But, beyond the specter of the horrific rise in addictions and deaths, Sharfstein told the crowd there is hope.
“In the right hands, there is a greater than 50 to 60 percent chance that people will do very well,” he said. “This is not a hopeless challenge. When people get access to treatment they can totally begin to [control] their lives.”
Diverting people from the criminal justice system and into treatment has also proven successful, he said. And reducing the stigma for addicts and their loved ones can spur more people to step out of the shadows and seek help.
“People feel a big sense of blame,” he said. “That comes from the way it’s been criminalized and over-criminalized. And that stigma people feel themselves and keeps them from seeking treatment.”
He noted that stigma in the Jewish community may be heightened because of a myth that Jews cannot become addicted. He quoted a Yiddish saying “The drunk is a gentile. They are not part of the Jewish community.” Sharfstein cited an October Forward interview of 22 rabbis on the opioid crisis.
Asher Lopatin, an Orthodox rabbi from Yeshivat Chovevei Torah Rabbinical School told Forward: “As a religion that stresses the sanctity of human life, Judaism must be at the forefront of confronting this.”
A panel discussion followed, with Sharfstein’s wife, Yngvild Olsen, medical director of Institutes for Behavioral Research, talking about how opioids affect the brain and behavior. James M. Ryan, young adult program director for Ashley Addiction Treatment, talked about the necessity of multiple and unique approaches to treatment tailored for each individual. Steve Seidel told the story of his son, Corey Seidel, who died of a heroin overdose and Michael V. recounted his addiction and 29 years in recovery.
Olsen cited research by A. Thomas McLellan defining addiction as a “chronic brain disease that has no risk factors for which we have effective treatments over the long term,” she said. “The goal mainly is helping people manage their disease in a way that they then can live fulfilling, self-directed lives.”
Seidel, a pharmacist said he struggles now with dispensing opioids to people who come in to fill prescriptions, saying the medical field and pain centers in particular overprescribe opioids and dangerous drug cocktails. He told the harrowing story of his son’s early addiction, multiple attempts at treatment and his death.
“This subject matter doesn’t bear to be sugar-coated,” Seidel said. “This is the real world. I wish it wasn’t the way it is.” He said he now dedicates his life to educating people about addiction and its consequences in an effort to save lives.
Michael V. offered his story of recovery and how 12-step programs have kept him on track and sober for 29 years. Brought up in a stable Orthodox family, he said nobody in the world would have ever thought he would become an addict. He used from age 17 to 36.
“You’ve all heard the horror story of addiction. I am the miracle on the other side of that. I am in recovery. And it wasn’t easy to get here,” he said. “My way wasn’t working for 20 years, I had to find another way. I leaned to be patient, tolerant, loving, understanding and compassionate. I learned what forgiveness was. And I learned that in order to be forgiving, I had to learn how to be forgiven. I also had to learn to be humble. To ask for help, not always be in control.”
People seemed to take away some hope from the program, and also took home Narcan training certificates. Narcan is available to the public in Baltimore pharmacies.
A young mother with young children in Baltimore County schools said she read about the event in the school newsletter. She stayed after the event for the training.
“I definitely liked the Narcan training at the end. I got the certificate,” she said. “I live in a safe, wonderful neighborhood, but they opened a methadone clinic around the corner. So if [I need to] I can help someone one day, but I hope I don’t need to.”
More than 1,500 people’s lives have been saved in Baltimore City by people who have taken Narcan training, according to Mona Rock, spokeswoman for the Baltimore City Health Department.
[pullquote]Nationwide, more than 150,000 people received naloxone kits from community outreach programs like Baltimore’s between 1996 and 2014, and more than 26,000 overdoses were reversed using those kits, according to a recent survey funded by the U.S. Centers for Disease Control and Prevention. — “Building a Ground Army to Fight Heroin Deaths,” Stateline, an initiative of The Pew Charitable Trusts[/pullquote]
“These are everyday citizens who have saved the lives of someone else,” Rock said.
Ellensue Levinson-Jeffers of Sol Levinson & Bros., a co-sponsor of the event, said seeing more young people coming into the funeral home because of overdose deaths takes its toll.
“Of course it does, we’re human,” she said. “We’re funeral directors because we have that compassion in our hearts to want to help make a difference. When someone dies that’s not the normal cycle of life, it hurts, it’s stressful. So we have to lean on each other and also do things to support ourselves, whether it’s yoga, meditation or talk with someone.”
A Baltimore City paramedic in recovery who wished to remain anonymous said he got a lot out of the program, which he thought was informative and he appreciated that Narcan training was available.
“This was a wonderful idea and they need to do it once a month, on this topic, here, Tuesday night. Because this is just the tip, if they really want to do anything,” he said. “I got clean before this epidemic happened, [otherwise] I’d be dead myself. The potency of what’s out there, for the price, the ratio is stronger than any other time in history.”
“But if I had one thing to say? Keep doing this. Over and over and over again,” he added. “This is not a one-time topic. Once a month is a minimum and in a year we’ll have a little bit of progress. And that’s better than none.”
Baltimore’s 24-hour crisis response hotline is 410-433-5175; Maryland’s is 800-422-0009.
For more information and resources, visit Jewish Community Services at jcsbaltimore.org/emotional-well-being/addiction-services
Levinson and Jewish Community Services are cosponsoring an eight-week grief support group for parents whose child has died because of an opioid addiction. Pre-registration is required. For more information, call 410-466-9200.