Opiod Oppression

Published by Forum Communications Echo Press on July 26, 2022

A local family physician and her brother, a person with opioid use disorder, talked about the dangers and treatment of opioid abuse during an hour-long Listen and Learn event on Wednesday, July 20, hosted by the Alexandria Lakes Area Chamber of Commerce.

We believe that if we can control our use, someone else should be able to control theirs.

Dr. Allison Juba

It started with a pill.

Fifteen years ago, Pat Homstad of Duluth was playing basketball with some friends. He was worn out and sore after the game and one of his friends offered to alleviate the pain with something that would "make him feel good," as Homstad put it. A pill. Round, white and smaller than a dime. A Percocet 10 — 10 mg of oxycodone hydrochloride.

He was only 15.

From there, Homstad's dive into the world of opiates snowballed. He began taking more pills. At first, a few times a week, to once a day, and then multiple times a day.

He says the sensation is hard to describe but it's the "best feeling in the world... like a vat of honey being poured over your head."

It's like the Holy Ghost being ripped from you

The withdrawal has the opposite effect.

"It's the worst possible feeling you can imagine. You will do anything to not feel like that anymore," Homstad said. "Restless legs, vomiting, diarrhea, very bad diarrhea. You can't eat (or) sleep. You're going crazy. Your body's screaming at you to get more."

To combat the withdrawals, Homstad expanded his opioid use to Percocet 30s, then oxycontin, to Opana — Oxymorphone — and eventually, heroin.

He turned to crime to fund the addiction, stealing from loved ones and selling his friends "fake dope."

"When you're in that much pain and suffering... I never thought I would do any type of crime or anything like that," said Homstad. "It (withdrawal) pushes you to the edge."

Homestad says some of the worst situations was watching his friends overdose.

My body was screaming to be done

"It's very scary, especially when you see it for the first time," said Homstad "You're trying to wake them up, and they're not moving at all. They're not breathing. It's very scary. Especially when it's a close friend to you. Just seeing them take their last breath and roll back the eyes. I'll never forget it."

Homstad has overdosed a few times himself.

"There's nothing after," Homstad said describing an overdose. "Darkness. Until you get shot with Narcan."

Narcan or Naloxone is a medicine that rapidly reverses an opioid overdose. It attaches to opioid receptors and reverses and blocks the effects of other opioids.

Homstad says it puts you in complete withdrawal.

"It's like the Holy Ghost being ripped from you. It's crazy," he said.

Homstad says he wishes people knew how hard it is to quit. He went to treatment three times over his period of use.

"My body was screaming to be done," he said.

Today, he is three years sober.

He credits his sobriety to taking his treatment serious after seeing friends die, the growing support of his family and Suboxone — or Buprenorphine, an "opioid partial agonist that produces effects such as euphoria," according to National Institute of Drug Abuse. It helps diminish the symptoms of withdrawal and cravings.

As long as he takes the right dose, Homstad says Suboxone helps him feel completely normal. It doesn't get him high and it kills his "cravings" to relapse.

Homstad's sister, Dr. Allison Juba, is an Alomere Health family medicine physician and population health medical director. She's also an opioid director at the Alexandria Clinic. She discussed the pervasiveness and stigma associated with OUD as well as local treatment options for those seeking help.

OUD as defined by the Centers for Disease Control and Prevention (CDC) is a problematic pattern of opioid use that causes significant impairment or distress.

Opioids are fentanyl, heroin and prescription drugs such as oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone.

"Despite our increasing awareness and really our knowledge of the opioid epidemic in general, we continue to see that opioid overdose deaths continue to be on the rise," said Juba while kicking off the Listen and Learn event hosted by the Alexandria Lakes Area Chamber of Commerce.

In 2021, there were more than 100,000 cases of opioid overdoses, fatal and nonfatal, in the United States.

The office of Keith Ellison, Minnesota attorney general, states, "Opioid overdose deaths (in Minnesota) have increased dramatically during the COVID-19 pandemic." There were 654 opioid-involved deaths in 2020, a 59% increase from 2019.

According to the Minnesota Department of Health , people in the 15-34 age category had the greatest number of emergency room visits for opioid-involved overdoses at 2,648 in 2021.

"Previously, we had seen that a lot of our opioid deaths were related to prescribed opioids," said Juba. "Those accounted for most of our opioid overdoses."

According to a federal briefing from the Minnesota Department of Human Services, "the opioid epidemic was ignited by the overprescribing of prescriptions to treat pain that emerged in the 1990s and the inability to identify, engage and treat clients with evidence-based opioid addiction treatment."

Although dispensed opioid prescriptions have slowly decreased from 3.9 million in 2015 to 2.3 million in 2020. Opioid overdoses continue to rise due to an increase in heroin and fentanyl use, which is more accessible, affordable and of higher quality, according to the MDH.

Another number on the rise is the amount of Neonatal Abstinence Syndrome (NAS) cases. "A withdrawal syndrome that can occur in newborns exposed to certain substances, including opioids, during pregnancy," according to the Centers for Disease Control and Prevention. A total of 381 cases were reported in 2020, an increase of 151 compared to 2012. The most cases, 458, were in 2015.

Juba speculates the reason the death count due to opioids continues to rise despite treatments and medications that reduce overdoses is due to the stigma that OUD is a moral weakness and a choice rather than a disease. She also says it is due to a lack of education on available medications and how to administer them.

"It's our own human nature that gets in the way of us seeing addiction as a disease because it's something scary and vulnerable," said Juba. "We believe that if we can control our use, someone else should be able to control theirs... In the medical system, we have a tendency to withhold care."

"There are changes within the prefrontal cortex in the brain that results in impaired and executive functions that leads them (people with OUD) to issues in self-regulation, decision making and monitoring for error," said Juba. "They have a weakened ability to resist strong urges and follow through on decisions, because of the preoccupation and craving with trying to get rid of that dysphoria."

Juba says the ideal goal for managing a chronic disease is ultimately to have most of it managed with primary care. She says medications like Buprenorphine combined with psychosocial therapeutic interventions significantly improved clinical outcomes.

Those outcomes include fewer overdoses and infectious diseases associated with IV drug use, less criminal activity, and better birth outcomes for babies whose moms who have a history of opioid use disorder.

"Opioid Use Disorder is something that we have evidence-based treatments for including medication that has shown to reduce these overdoses and deaths," said Juba.

She recommends healthcare facilities provide additional options to reduce complications associated with substance use like increasing access to Narcan and fentanyl test strips while adding local needle exchanges, safer smoking kits, and access to HIV and hepatitis C testing.

Alexandria clinic has become a Naloxone access point with free Naloxone kits available to anybody. No questions asked.

To combat stigma and societal barriers, Juba suggests changing the language. She says negative language associated with substance use reinforces biases and discrimination.

Use 'opioid use disorder' rather than 'drug habit' or 'opioid/heroin abuse.' Replace 'addict,' 'junkie' and 'abuser' with 'person with opioid use disorder.' Instead of 'clean or dirty urine, say 'positive' or 'negative UDS.' And lastly, use 'person in recovery,' not 'clean,' 'sober,' or 'former/reformed addict.'

Lastly, she suggests decriminalizing opioids and references Portugal's success after it did in 2001. Ten years later, the country saw an 18% decline in drug use and a decrease in drug-induced deaths five times lower than the European Union. HIV infection rates also dropped from 104.2 cases per million to 4.2 cases per million.