The Transylvania Times -

Groups Work To Prevent Addiction, Relieve Suffering

 

November 16, 2017



While drug abuse continues in the United States and the opioid epidemic continues to worsen, there are individuals and organizations working to stem the tide and provide relief.

Representatives of those organizations recently spoke at the fourth and final presentation on drug addiction at the Unitarian Universalist church.

In 2007, Fred Brason founded Project Lazarus, an internationally known program for dealing with opioid addiction, in Wilkes County, N.C. At that time, rural Wilkes County had the third highest overdose rate in the country.

Brason, whose career was in hospice and home health care, had no experience with preventing or treating drug addiction, but he knew something had to be done.

“In Wilkes County we didn’t know what we were doing, but it was our house and we had to fix it,” he said.

To Brason and some others in his community, it was apparent that the old ways of dealing with drug abuse and addiction were not working.

“If we do the same things as before, we get the same results as before. ‘When the music changes, so does the dance’,” he said, quoting an African proverb. “How do we change the public’s behavior regarding medication?”

Brason and others realized they needed a community response that provided more support for addicts and diminished the stigma of addiction. Thus, Project Lazarus was born.

Project Lazarus takes a multi-faceted approach that includes data evaluation, public awareness and action on the following seven items: hospital emergency department policies, diversion control, pain patient support, harm reduction, addiction treatment, community education and provider education.

Brason said they started by reviewing emergency room protocols for handling patients in pain and overdoses. Those reviews eventually led Wilkes County to be on the of the first to provide Naloxone, which counteracts overdoses and saves lives.

Since many legal prescription medications were being diverted to non-prescribed users, Project Lazarus began to distribute lock boxes so that family members could not steal the medications and provided drop boxes at law enforcement agencies so that residents could safely dispose of medications they no longer needed. They also launched a public education campaign so that people knew the dangers of sharing their medications or taking more medications than they needed.

Members of Project Lazarus also began looking at different ways in which pain can be treated besides medication and began to promote those practices. Brason said acupuncture, yoga, meditation, exercise and other alternatives have been successful in diminishing pain. The barrier is that many insurance companies do not pay for these different modalities of treating pain.

“The military pays for those, and guess what, it works,” he said.

The fourth item Project Lazarus members addressed was harm reduction, the concept of keeping patients safe while still abusing a substance. According to Brason, EMS and First Responders in Wilkes County had Naloxone to distribute, but they often did not arrive in time and people died in their homes. They have since then begun a syringe exchange program and distributing two doses of Naloxone to addicts in case they have an overdose.

Brason noted that Naloxone is now used in all 50 states and is available with an auto-injector or a nasal injector. Those given Naloxone are also instructed how to use these injectors and the medication properly.

Brason said some people have criticized the use of Naloxone because one out of 10 of its users eventually dies from an opioid overdose. But Brason argued that nine out of 10 are still living.

Harm reduction, however, would have little long-term impact if it were not followed up by treatment. Brason said those working with addicts need to recognize everyone is different spiritually, mentally, emotionally and physically, and their treatment has to be individualized.

“There is no one treatment that works for all, but there is a treatment for all,” he said. “We just have to make sure all of those options are available. A failure to treat is mistreatment.”

Brason said the members of Project Lazarus also undertook a community-wide education initiative and reached out to all aspects of the community – law enforcement, businesses, schools, churches, civic organizations, etc.

Brason thought that when he broached the idea of having a methadone clinic in Wilkes County several years ago he would have been run out of town. But now there are three buildings associated with the methadone clinic serving more than 500 people and the community supports the program.

Brason acknowledged that once people go through a detoxification program, they often return to the same family and friends who enabled their addiction initially and they often revert to their old, destructive habits. He said the way to change that is to build a support network and to be available whenever needed.

“We are helping them in their present hour of need,” said Brason.

Project Lazarus also worked with the medical community to make sure medical personnel had the latest information on drug addiction and contacts with mental health providers. He said that prior to Project Lazarus, some doctors did not know whom to call and often referenced patients to a 1-800 number. Now they know which individuals to contact.

Brason said mental health is supposed to be treated legally on parity with physical health, but “It’s never been enforced and never been done.”

Brason said that each of the seven items employed by Project Lazarus can be beneficial alone, but the more items employed by a community, the more success communities have. He said communities that follow all seven steps have seen a 35 percent decrease in mortality.

Brason said there are many things that drive people to drug abuse. The causes can be biological, cultural and environmental, including poverty.

He said rural counties such as Wilkes County have been hurt by international trade agreements while cities have seemed to prosper and supported that contention with a Pew Charitable Trust Study that showed from 2000 to 2014 Wilkes County ranked second in the U.S. for income loss.

“All of those are real factors,” he said.

For Brason, the best antidote for drug addiction is to focus on the reasons for demand and address those causes, which in turn will reduce demand.

“The supply will always find a way,” said Brason. “If we don't get it on the front end, then we’re hanging out in the middle trying to handle both ends.”

One local group that is attempting to drive down demand is the CARE Coalition, which was established to curtail drug abuse of any kind and is under the auspices of the Public Health Department.

Kristin Gentry, the youth and community outreach coordinator for the CARE Coalition, said, “We have a strong focus on youth.”

Gentry said the CARE Coalition follows part of the Project Lazarus template in that it is comprised of law enforcement, business, health care, education, civic, faith and other leaders whose common goal is to reduce youth substance abuse.

One of their primary strategies is to change the environment and target the root causes of substance abuse. By determining those causes, then they can work toward the goal of having youth neither needing or wanting to use drugs.

Gentry said the younger people are when they use drugs, the more likely they are to become addicted to them.

At present, the CARE Coalition is working to reduce drinking and prescription drug abuse. Gentry said in a recent survey of 6-12 graders, 30 percent said it was easy to obtain medications prescribed for others. Fifty percent of older students said they had their parents’ permission to drink alcohol.

Gentry said that in 2016, there were 75 opioid pain pills prescribed per person in Transylvania County.

“There are a lot of these medications out there,” she said.

She said one factor in reducing drug abuse is the presence of good adult role models. Gentry said parents provide an important barrier to drug abuse by paying attention to their children’s behavior and letting their children know they disapprove of drug use. Most students who do not use alcohol or drugs say they do not because their parents strongly disapprove of such use.

The coalition also is working with parents on learning the signs of substance abuse and how to talk with their children about drug abuse. She said some of those talks should begin as early as age 7.

Gentry said there are other strategies being employed, such drug and alcohol education programs in the schools and targeting “hot spots,” like prom and graduation.

She also said the community needs to value its youth and use them as resources. As with most people, youth feel better about themselves when they are helping others and contributing to the community.

Gentry said the CARE Coalition is promoting a new campaign entitled “Thrill Seeker,” which challenges youth to take healthy risks and seek natural thrills.

It focuses on having drug-free adventures, such as mountain Biking.

Gentry said while the CARE Coalition is making a long-term investment in the community and that if the CARE Coalition is successful, then in another 5 to 10 years the community should see a decline in the use of alcohol, tobacco, marijuana and other drug use.

“If we make Transylvania County better for kids, then we make Transylvania County better for everyone,” she said.

While the CARE Coalition is working on the front end to prevent drug abuse, Stephanie Prejean, a jail diversion coordinator for Meridian, is working on the back end, trying to help those who are incarcerated locally to get the treatment and support they need to be successful when they return to public life.

Prejean said she recently had a telling exercise when she asked those in her program to describe themselves without using their name or their profession. They had a difficult time coming up with positive descriptions. They gave a long list, however, of negative words and phrases that others repeatedly used to describe them: “Liar,” “cheater,” “thief,” “junkie,” “loser,” “weak,” “selfish,” “worthless,” “get out,” “don’t ever call me again,” “you make me sick,” “I’m done with you,” “what is wrong with you,” “why don't you have any willpower,” “why should I believe you,” etc.

She said that when people hear negative feedback constantly, they began to think of themselves negatively. That in turn makes it difficult for them to be successful because if their past is viewed as a failure it is difficult to see their future as successful. What people have said about them has become how they see themselves. It is a self-fulfilling prophecy.

Prejean said one person told her, “I need people to see who I am in order for me to succeed.”

That ability to “see” people, particularly those recently incarcerated, is one goal for Steve and Susan Martin, who established a prison ministry at St. Philip’s Episcopal Church.

Steve said they started the program because “somebody wanted some support.”

He said the group is not a therapy group, but just a concerned group of people, some of whom have relatives in prison, who want to help those who have family members in prison and want to assist former prisoners transition successfully back into society.

 
 

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