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Everyone’s Crisis

IUP Experts Seek Solutions to Opioid Epidemic

Photo by Keith Boyer

On Saturday, October 21, 2017, the same day Indiana County’s coroner issued a public warning about the circulation of powerful new varieties of opiates in the county, the Pittsburgh Post-Gazette’s editorial board urged that the opioid addiction crisis be declared a national emergency.

The following Thursday, President Donald Trump declared a national health emergency, raising hopes that more resources to combat the crisis would become available.

On February 7 of this year, the Post-Gazette reported that in 2017, a record number of people—at least 652—died from drug overdoses in Allegheny County and cited the synthetic opioids fentanyl and carfentanil as driving factors.

National statistics, too, are startling. In 2016, the Centers for Disease Control connected 42,249 deaths to opioids. Some experts have projected the death toll could reach or exceed half a million over the next decade.

IUP experts are tackling the crisis from a variety of angles. None sees easy answers to the puzzle of ending it, but all agree on two points: Victims of the crisis have used multiple pathways to addiction and overdose, and finding solutions will take time.

One Thing Leads to Another

John Lewis M’02, D’06 and Eric Kocian M’02, D’10 met as students in IUP’s Criminology master’s degree program. After they earned their doctoral degrees at IUP, both went on to teach at the college level—Lewis at IUP and Kocian at Saint Vincent College in Latrobe, as well as IUP.

An exploratory study they conducted revealed that among those interviewed, the younger the age of drug experimentation, the more likely heroin was to enter the picture.

Responding to a request from a Westmoreland County law enforcement official, they interviewed people at various stages of addiction and recovery—at Narcotics Anonymous meetings, in outpatient therapy, in the Westmoreland County Prison, and at methadone maintenance clinics. Their goal was to gather information about drug-use history—including alcohol, marijuana, cocaine, prescriptions, and heroin.

Dr. John Lewis (Photo: Keith Boyer)

Dr. John Lewis (Photo: Keith Boyer)

“If you listen to the news, you hear that about 80 percent of heroin addiction comes from prescription medication, and it seems as though that’s where the story stops,” Kocian said. “We found very similar findings, but our study took a huge step back and looked at respondents’ entire lives to see what other drugs were involved. We both were surprised to hear how many different drug experiences heroin users had had. They had pretty much been doing everything and anything.”

The study revealed a statistical difference between heroin and non-heroin users in their use of cocaine, LSD, and prescription medications and the age at which they started experimenting. Heroin users were much younger. In contrast, non-heroin users did not engage in drug use as frequently and started using drugs at a later age.

Rather than viewing particular drugs as gateways to addiction, Kocian and Lewis said they prefer to view drug experiences as a primer.

“Everybody in the study used alcohol. Everybody used marijuana, but the age at which they started using them” was a significant factor in eventual heroin use, Lewis said.

With Kocian as lead researcher, the pair said they are on the verge of a new study that explores the reasons people start using drugs in the first place.

“If you were drinking alcohol at age six, we want to know what was going on in your life,” Lewis said. “Was it trouble in school? Was it trouble with family? Maybe you were watching parents who came home after a rough day, had a drink, and said, ‘I really need this,’ and then you came home from school and said, ‘I had a really rough day.’”

A Danger to Law Enforcement

Lewis is known to many alumni as an expert in policing, and he works closely with IUP’s police academy—the Criminal Justice Training Center—in addition to his duties as assistant chair of the Criminology and Criminal Justice Department.

“Heroin has always been around,” he said. “What has changed is how it’s being cut.”

Dr. Eric Kocian (Photo: Keith Boyer)

Dr. Eric Kocian (Photo: Keith Boyer)

He said so much of it is available that dealers are adding fentanyl and carfentanil to make it more potent and enticing. A 2016 Drug Enforcement Agency warning noted that carfentanil is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which is 50 times more potent than heroin. Fentanyl is prescribed to control pain related to cancer. Carfentanil is used in veterinary medicine and is no longer manufactured in the United States, according to the Regulatory Affairs Professionals Society.

Dr. Victor Garcia, Director of MARTI (Photo: Keith Boyer)

Dr. Victor Garcia, Director of MARTI (Photo: Keith Boyer)

Lewis said a lethal dose of carfentanil is about the size of two grains of salt and is deadly even to touch.

For that reason, he is in favor of law enforcement officials carrying naloxone—an anti-overdose drug commonly known as Narcan—for their own protection if they come into contact with carfentanil, as well as to revive victims.

“There is even Narcan for dogs,” he said. “It used to be that when [police officers] were dealing with any blood-borne injuries, out would come the latex gloves. Now, the gloves are used in overdose situations. I’ll tell you, when you’re in an emergency situation, the last thing you’re thinking about is pulling on latex gloves. But now, with the dangers involved, we’re seeing not only gloves but full hazmat suits, which makes responding extremely costly and much slower.”

Understanding Rural Culture

IUP is home to the Mid-Atlantic Addiction Research and Training Institute for Community and Behavioral Health, founded by retired professor Robert Ackerman in the 1980s. At IUP, it’s known simply as MARTI.

MARTI’s current director, Victor Garcia, and his associates view today’s heroin epidemic as a perfect storm, and they aim to tackle the crisis in three ways. They want to understand why opioid addiction has permeated the rural western Pennsylvania region, enhance training for those who work in the addiction counseling field, and double down on awareness and prevention through the Opioid Prevention and Community Health Initiative.

How drug use starts is not an easy thing to determine, Garcia said. An ethnography—a study of daily life and political, economic, and social dynamics of the region—is crucial to understanding how and why those in Pennsylvania’s rural communities have been so affected by the crisis. To Garcia’s knowledge, a regional ethnography has never been conducted.

“In my opinion as an anthropologist, this is a historically understudied and underserved population when it comes to drug use,” he said.

Garcia and his associates aim to identify what rural communities lack in terms of infrastructure and resources for combating addiction problems and what inhibits those wanting help from finding it. In particular, Garcia wants to focus on Indiana, Cambria, and Armstrong counties, because they have experienced the highest number of deaths in all of Pennsylvania’s rural counties. He said his “insiders”—Melissa Swauger ’97 and Christian Vaccaro M’05, both Sociology associate professors who are from western Pennsylvania—will be key in the project.

Dr. Melissa Swauger (Photo: Keith Boyer)

Dr. Melissa Swauger (Photo: Keith Boyer)

Garcia said there are several obvious obstacles to providing good immediate solutions to the opioid problem, including lack of transportation, lack of easily accessible treatment clinics, and too few training opportunities for rural counseling and medical professionals. He and the team have picked up a great deal of information from other sources—professionals who participate in MARTI’s Summer School Conference, people in the community, and an alcohol-recovery study led by Garcia and funded by the National Institutes of Health.

“Over the last five years, I have been examining how Latino immigrants go about getting help for their substance use disorders. From this work, I am developing a help-seeking model for substance use disorders—a model of how individuals go about getting help and treatment,” Garcia said. “My objective is to discover how religion and spirituality contribute to help seeking. If useful, I want to add that to the model. And this model will be the framework for the regional opioid study that MARTI is developing.”

Vaccaro and Swauger both know people who have died from overdoses, and for them, the work will be personal.

The MARTI team plans to begin the opioid study soon.

On the Front Lines: Treatment

Sociology professor Alex Heckert leads MARTI’s training programs and, most notably, a weeklong summer conference for social workers, educators, psychologists, drug and alcohol counselors, clergy, and anyone who works in addiction treatment. In recent years, Community Care, which is a behavioral health organization, and UPMC Health Plan have assisted with sponsorship and with recruiting attendees.

Heckert, with Swauger and Vaccaro, organized the last conference, and they see a growing need to help families of the addicted.

“The families are pretty crucial to getting [addicts] into treatment,” Heckert said. “We’ve seen that families get compassion fatigue, so next summer we’ll try to focus a bit on the family role.”

Dr. Alex Heckert (Photo: Keith Boyer)

Dr. Alex Heckert (Photo: Keith Boyer)

“In treatment, the focus is always on individuals, their choices, their behaviors, and what they need,” Swauger said. “But families often are lost in understanding how to treat addicted individuals, and individuals can’t get better without their larger networks of support.”

The MARTI staff also wants to include the medical community in future training sessions, assisting nurses, doctors, or any professionals who can prescribe medication.

“On the prescribing side, we’ve seen strides,” Heckert said. He points to the Prescription Drug Monitoring Program, an interstate system that gives prescribers and pharmacists access to data about patient prescription histories, allowing them to monitor for abuse. “But, when people who were prescribed three years ago can no longer obtain the prescription, they often turn to heroin, which is riskier. And they know it’s riskier.”

Building Awareness and Prevention

Erick Lauber in the Journalism and Public Relations Department is MARTI’s director of Community Health and Leadership. He also happens to have a psychology background, and his Opioid Prevention and Community Health Initiative—referred to as OPACH—is the third part of MARTI’s approach to the crisis.

Focusing on the general public, OPACH hopes to enhance existing regional efforts at treatment, interdiction, and recovery and to boost prevention, which the initiative’s literature says is the real answer to quelling the epidemic. Lauber and a wide range of community treatment and prevention experts and volunteers have come together to tackle the issues. All aim to make the OPACH Initiative a role model for outreach and collaboration.

To demonstrate to audiences the power opioids hold over addicts, Erick Lauber uses the candy Fun Dip. (Photo: Keith Boyer)

To demonstrate to audiences the power opioids hold over addicts, Erick Lauber uses the candy Fun Dip. When the candy stick is coated in sugar, it represents a neuron, or nerve cell, covered with neurotransmitters (chemicals that affect mood), triggered by opioid use. The brain begins to expect that flood of neurotransmitters, which leads to addiction. (Photo: Keith Boyer)

Lauber recently secured a grant from the Pennsylvania Commission on Crime and Delinquency to develop workshops and a media campaign aimed at reducing stigma for those who need help or are in recovery. Lauber is working with community agencies and volunteers to build awareness and strengthen existing programs.

Stigma, he said—that the general public tends to judge those who are dependent on drugs as weak—is a common reason the drug addicted do not seek assistance.

Lauber said he often asks audiences to empathize by imagining what it feels like to lose free will, to no longer have control over what the body does.

“You can’t just flip a switch,” he said. “It’s below the level of consciousness, and that’s why I talk about stigma and choice. A lot of people think dependency is caused by a lack of willpower and that it’s a choice. That’s just not the right language.”

While the opioid epidemic is tip of tongue across the country, Lauber and colleagues are concerned with more than opioids.

“The top abused chemical in the country is still alcohol—by far,” Lauber said. “It’s killing people all the time, but locally it’s not creating the same alarm as the spike in deaths we’ve seen [from opioids]. But by far, more people are in treatment for alcoholism. We want to address that, too. Our prevention campaign is triggered by the opioid epidemic, but everyone suffering from chemical dependency needs to have access to treatment, and we all need to think about it differently.”

Editor’s Note: Clinicians, social workers, psychologists, and other professionals who are interested in MARTI’s Summer School Conference should access the MARTI website for details.

On College Campuses

Ann Sesti, director of IUP’s Alcohol, Tobacco, and Other Drugs Program, reports that heroin use on college campuses is relatively low. A national study reported that fewer than 2 percent of students report using opiates.

“That doesn’t necessarily mean students aren’t using heroin, or if they are not, it doesn’t mean they aren’t abusing prescription drugs,” she said.

College campuses, generally, are places where young people are exposed to a multitude of drugs and alcohol. While she has not seen an abundance of heroin abuse on campus, Sesti said her program has orchestrated awareness opportunities in cooperation with the local Drug and Alcohol Commission by bringing guest speakers to campus and by distributing naloxone, an anti-overdose drug commonly known as Narcan, to students.

“Students report they want Narcan and training on how to use it not because of someone they know here at IUP but because they have a friend or family member at home who is a heroin user,” Sesti said. “They don’t see it so much as a risk here as they do in their hometowns.”