‘This is a crisis…no joke’ — Lake Region Substance Abuse Coalition tells forum attendees to be part of the answer
By Wayne E. Rivet
As Peter Leighton looked out over the audience, he remembered his days on the Lake Region High School stage.
Those were simpler times.
Today, Leighton finds himself on the front line, battling a crisis that is stealing life from people of all ages and all walks of life.
One death per day in Maine is caused by an opioid overdose.
Last year, 378 people in this state died due to opioid overdoses. Years ago, drug addiction was seen as an inner city problem. As Dr. Peter Leighton has seen, the epidemic has stretched to all corners of the map, including the community he loves, the Lake Region.
“I always tell people that I survived Lake Region High School,” he told about 50 people in the auditorium last Wednesday night as part of a special Lake Region Substance Abuse Coalition public presentation about the opioid crisis. “When I left this area at the age of 18, I figured I would never come back.”
His life changed. He started a family and found the Lake Region was where he truly wanted to be.
“I have a lot of passion for this area. I really love this community,” said Dr. Leighton, who grew up in Sebago and graduated from LRHS in 1991.
After starting a medical practice at Central Maine Medical Center, where he was a hospitalist for six-plus years, Dr. Leighton really wanted to be in primary care, so he moved to Bridgton in July 2013.
Today, he has a robust practice with Bridgton Hospital Internal Medicine. When he had his first interview here, one of the first questions posed to him by another doctor — Dr. Craig Smith of North Bridgton Family Practice — was whether he would prescribe suboxone.
“I had heard about suboxone. I took care of a few patients in the hospital who were on it. It’s kind of a mystery drug to me, as it is with a lot of doctors even to this day,” he said.
Suboxone is a “weak” opiate that is used to help subside cravings people may have for stronger drugs such as heroin, as well as aid them from the effects of withdrawal.
“It’s also very safe, and almost impossible to overdose on,” Dr. Leighton said. “I know coming back to this area, I had an interest in working with people who have addictions.”
To prescribe suboxone, physicians first must gain a waiver. In this area, four providers — Dr. Craig Smith, who started the suboxone move in the Lake Region, Dr. Jen Smith, Dr. Eric Slayton and Dr. Leighton — are working with 300-plus patients and using suboxone.
“This is a crisis, an epidemic,” Dr. Leighton said. “It’s no joke. I can’t tell you how many patients I’ve seen that are absolutely broken. They’ve lost everything. All different types of people from all different backgrounds. They’ve lost their homes, they’ve lost their kids, their jobs, trust and relationships of family members and friends. They are desperate to get off opiates.”
Working in conjunction with Lake Region and Fryeburg Area Adult Education, the Lake Region Substance Abuse Coalition (LRSAC) presented the two-hour information session featuring eight speakers with hopes of developing more awareness and understanding. After each informational session, audience members could write a question on an index card to be answered by a specific speaker. Several people took advantage of the Q&A opportunity throughout the evening.
“More than just having the information, we need to apply it,” was a message on a fact sheet handed out.
Three key words are used by LRSAC in its fight against this crisis — hope, resilience and recovery.
The statistics are staggering. Nationally, of the 20.5 million Americans 12 and older that had a substance abuse disorder in 2015:
- 12.5 million people are opioid-dependent
- 2 million had a substance abuse disorder involving prescription pain relievers
- It is estimated that 23% of individuals who use heroin develop opioid addiction
- Drug overdose is the leading cause of death in the United States — 52,404 lethal drug overdoses in 2015; 78 people die from overdose daily
- 591,000 had a substance abuse disorder involving heroin.
While listening to MPBN, Dr. Leighton heard a report that struck him. The state medical examiner was seeking an additional $300,000 in funding to keep pace with the rising number of toxicology screenings related to drug overdoses.
He also cited the special report published by the Portland Press Herald regarding the opioid crisis, which included photos and stories of people who have died due to drug overdoses.
“Many are young and should be contributing to society, but instead they are dead,” he said.
As part an effort to “get the word out” since there is a “tremendous amount of misinformation and ignorance regarding dependence,” Dr. Leighton said, spoke with Bridgton Chief of Police Richard Stillman regarding how best to develop more community awareness.
The vehicle is LRSAC. Dr. Leighton told the crowd that a lot of people want to help, but simply don’t know what to do.
LRSAC held its first meeting in December 2015. People from all walks of life took part, including doctors, counselors and law enforcement. Various committees were formed targeting specific areas from community awareness to law enforcement. Ideas are discussed, such as providing rides to patients to appointments, since many lack transportation and are unable to seek needed counseling and medical services.
“This isn’t talk about the problem and go home. Come back, and talk about the problem and go home. It’s about action. A real grassroots effort,” Dr. Leighton said. “My hope is you learn something here tonight, but more importantly, you do something about it. We can’t do this alone. We really can’t. We need to get these patients into treatment.”
When Dr. Leighton spoke before officials in Augusta, he wanted to make the opioid crisis “real” to the group. As he spoke about cases he has handled, Dr. Leighton saw officials’ eyes widen — “like deer in headlights.”
“These are not drug addicts or homeless bums. These are people with a disease. In medicine, we treat opioid-dependence as a disease, just like diabetes. There is no judgment. They need help,” Dr. Leighton added. “There is a lot of shame. A lot of people in the shadows that don’t want to talk about it, but we need to because people are dying every day from this. If not, they are coming damn close. The number of Narcan administrations per day is astronomical. Sometimes, they are not lucky enough to have someone there to save their lives from an opiate overdose.”
Before handing the microphone to Bridgton Police Officer Phil Jones, Leighton asked the audience to try to look at drug addiction
“I never call it opioid addiction. I never use the term addicts. I never say a dirty urine, it suggests a person is dirty. I use ‘inappropriate’ urine screen. We talk about people with a medical problem. They are moms and dads, brothers and sisters. They are real people,” he said. “I have a special place in my heart for this group of the population.”
Change in approach
When people think about drugs and police, they envision a scene from a TV series or movie.
“It’s not like that,” Bridgton Police Officer Phil Jones said.
However, the opioid epidemic is certainly real. Officer Jones has been on the Bridgton Police Department for the past 10 years, and says most calls for service often have an opioid connection.
“When we get a call, it isn’t always a person with drugs in their hands. It’s a domestic assault or family disturbance. We separate and create a safe environment. Oftentimes, there is a dependency issue that people are struggling with.”
One effort police have made to address the opiate problem is to offer a drop-box, where people can dispose of no longer needed or expired medication. There are no forms to fill out. Officer Jones feels the drop-box is a “powerful” tool to keep drugs out of the wrong hands, while also disposing the medication properly — not flushing it down the toilet.
“It gives us a chance to get those narcotics to the DEA for proper disposal,” Officer Jones said. “What we are finding that there is a significant amount of elder abuse related to the opiate crisis. Some elderly are prescribed very significant prescription drugs, and their grandchildren or neighbors are sometimes manipulating them to get ahold of those drugs. When that source dries up, then they look to some street-level drugs like heroin.”
Officer Jones noted that more information sharing is occurring these days amongst various departments and agencies in regards to drugs and narcotic activity.
A change Officer Jones has seen, compared to when he first started out 10 years ago, is that the end of the road isn’t simply a charge, a summons and a report to the district attorney’s office.
“Now, there is a follow-through in which we are connected with community members or groups like this Coalition that can help lead people to treatment and counseling,” Officer Jones said. “We’re taking people and connecting them with avenues that hopefully they can get some help.”
Falling into the trap
Dr. Jen Smith has been in practice here in the Lake Region for the past 12 years, and has been prescribing suboxone for about six years.
“It wasn’t something I was anticipating doing when I moved here,” she said. “But, I am really happy to be part of it. It’s very rewarding, working with some great people.”
Dr. Smith spoke about the effects of drugs on the brain, and how suboxone works.
Addiction, she said, is a chronic, relapsing brain disease because the drugs change how the brain works.
“It can be long-lasting,” she said. “Its hard to get away from the stigma that these are simply bad people making bad decisions and why can’t they just stop?”
Research shows addiction is a brain disorder. Certain risk factors push some people to drug use. Most research points to biology/genetics and environmental factors.
From the genetics side, some people can take pain medication following a surgical procedure and then stop. Others, however, digest it differently and a dependency forms.
Environmental factors can include family members using drugs or easy access to drugs, childhood neglect, violence and abuse, mental illness and adverse personality characteristics, such as cynicism, a high level of anger toward self and others, engaging in delinquent behaviors and social incompetence, which leads to loneliness. Of course, there is peer pressure, as well.
“We see a lot of patients who started using drugs in their teen years,” Dr. Smith said. “That use does have an effect on brain development.”
Most drugs of abuse increase the level of a hormone that “makes you feel good.” Drugs produce an unusual high level, which leads to a euphoric “high” people seek.
“Without the drug, people become withdrawn and depressed, so they take more,” she said.
Dr. Smith explained how suboxone works and its effectiveness.
“If we get people into treatment and counseling, and put them on suboxone so they feel ‘normal,’ we can help them get their lives back,” Dr. Smith said.
Dr. Smith explained like other chronic diseases that require a lifetime dose of medication to address the illness, suboxone can be used for as long as an individual needs it to fight drug addiction.
“Some people wean off it, but there are some individuals who have been doing drugs since their early teens and may stay on a low dose of suboxone for their lifetime,” Dr. Smith noted. “There is more research to do in this area, but I think as we move toward this being a medical model and recognize this as a chronic illness, it will be more acceptable as long-term treatment, just like high blood pressure and diabetes where those people don’t get off their meds.”
Other speakers addressed dependency counseling, prevention and intervention, as well as recovery (see a follow-up story in next week’s edition).
LRSAC was scheduled to hold another informational forum last night at the Naples Public Library. The group plans to continue its public awareness efforts and encourages individuals to attend a LRSAC meeting.