Healing or Dealing?

After many years of successful mooching, I recently bought a house. Much to my disappointment, the bills have started to roll in and they’re all in MY name. Needless to say, Netflix documentaries have become my singular source of entertainment (read: I’m using my dad’s Netflix account to avoid a cable bill). This weekend, I watched a particularly relevant docu-drama called Dr. Feelgood which took on the prescription painkiller epidemic and targeted Dr. William Hurwitz, the doctor convicted of narcotics distribution for over-prescribing opiate medication in Virginia.

It turns out, asking physicians to share in the responsibility of preventing prescription drug abuse is not new to the current epidemic. The case of Dr. Hurwitz is an interesting one; he was a physician working with patients in chronic pain, and prescribing alarming doses of narcotic pain medication to these patients. Dr. Hurwitz was aware of the tolerance which builds from narcotics, and would account for this by prescribing higher doses.  For one patient, Dr. Hurwitz was prescribing more than 1,600 pills. Per day.

My recent move and financial frugality (thanks, dad) actually created space for some valuable research questions (you’re welcome, Joe). Should Dr. Hurwitz and others like him be held liable for this kind of prescribing of narcotics? Who is actually to blame for the role prescription medication plays in the heroin epidemic? How should physicians treat the one-in-three people who experience chronic pain?

“Of course he should be held accountable, Jackie!” I can hear you yelling at your computer screen. “1,600 pills per day for one person is criminal!”

Sure, a thousand plus pills per day is probably irresponsible prescribing, but let’s take a closer look at Dr. Hurwtiz’s attitude toward chronic pain and the context for narcotic medication in the 90’s.

First of all, there is no test to verify pain. Physicians ask patients to scale from one to ten the intensity of their pain, but there’s no objective measurement to prove this patient is truly an eight on the scale.  Doctors have an ethical responsibility to do no harm, and allowing a patient to stay at an eight on the pain scale seems to creep into harmful territory. “But, they could be lying! What if they aren’t in pain and they are drug seeking! What if their ten isn’t really a ten?!”

I hear you yelling.

It’s complicated. For a clinician specializing in substance use disorders, any hint at drug seeking behavior becomes therapeutic fodder. For a chronic pain specialist like Dr. Hurwitz, an eight on this scale becomes an assumption of a pretty uncomfortable patient.  Dose is irrelevant” Hurwitz defended. “The right dose is whatever produces tolerable side effects."

It gets even more complicated. In a 1986 groundbreaking study by Portenoy and Foley, 38 patients on opioid analgesics for non-malignant pain were studied to determine if this course of treatment was safe and effective. This study, which is cited often in this debate, found that opioid maintenance therapy is not only safe but a “more humane alternative to the options of surgery or no treatment in patients with intractable non-malignant pain and no history of drug abuse” (Portenoy & Foley, 1986). By the time Dr. Hurwitz got settled in his career, narcotic medication was the gold standard for pain management.

It gets even more complicated. Opiates are incredibly effective in relieving pain, and have always had social consequences. A response to “Narcomania,” the 1914 Harrison Narcotics Tax Act essentially forbid the use of opioid medication except in very extreme circumstances. Portenoy’s 1986 paper reassured the community that fears of addiction caused by prescription opioids were unfounded, and that no dose is too high. Thirty years later and wiser, the Federal government issued guidelines recommending opiates be prescribed for no more than 3-7 days (CDC, 2016). It seems that the metaphoric jury is still out about how to responsibly treat chronic pain, and what (if any) role opioid medication should play.

It gets even more complicated. The case against Hurwtiz accuses the doc of prescribing large doses and quantities of narcotic medication, with the express knowledge that his patients were selling, at least in part, their prescription pills. “He crossed the line from a healer to a dealer,” remarked Assistant U.S. Attorney Gene Rossi during his closing arguments on April 18, 2007. At least twelve of Hurwitz’s former patients were convicted of drug crimes as of his 2007 trial.  Hurwitz was sentenced to 25 years in prison, which was ultimately overturned (though he was stripped of his medical license).

This part is less complicated. We know more now than we did in the 90’s and we’ve learned a great deal since Portenoy’s 1986 study of 38 pain sufferers. We know that for every one-in-three chronic pain sufferers there are four-in-five heroin users who started with the misuse of prescription pills (ASAM, 2016). We know that drug overdose is the leading cause of accidental death in the United States, and we know that the opioid epidemic is the driving force behind these overdoses (MMWR Wkly Rep, 2016).  We know that more than 20 million Americans suffer from a substance use disorder. We know that prescription drug overdose deaths have tripled over the last few years (ASAM, 2016), and we know that these overdose deaths are trending upwards, not down.

We know we have to do something.

With this new information comes a spirit of collaboration among mental health and addiction professionals, physicians, and the community at large. Responsible prescribing and education about what it means to truly “do no harm” are important pieces of a very large and multifaceted puzzle. Conversation, education, and yes, maybe even Netflix documentaries, are vital to this fight against the opioid epidemic.

 
Jackie Williams,  Clinical Services Coordinator

Jackie Williams, 

Clinical Services Coordinator

 

'Hidden in Plain Sight' returns to Salem County

By Donald Noblett

WOODSTOWN -- The SCRATCH Coalition and Salem County Municipal Alliances for Prevention of Substance Abuse (MAPSA) have partnered to bring another Hidden In Plain Sight awareness presentation to Salem County on Thursday, April 27 from 6 to 8 p.m. at the Salem County Vocational Technical School, 880 Route 45, Woodstown.

Hidden in Plain Sight seeks to educate parents, educators, youth workers and other adults about the latest drug trends. It also teaches participants how to spot potential inappropriate youth behaviors that could be taking place right in their own towns.  Participants walk through a mock teenager's bedroom doing their best to spot any item that could indicate inappropriate youth behaviors. There are over 70 items to identify, which may come as a challenge to some participants. Learning how to spot the signs of potential substance abuse empowers local families to proactively protect their homes and loved ones.

Live Healthy Salem County is generously sponsoring the event after adopting it as their spring substance abuse initiative. Cumberland County MAPSA Coordinator Ashleigh Huff and Sgt. Elliot Hernandez from the Salem County Prosecutor's Office will facilitate the two-hour presentation. 

"The SCRATCH Coalition is excited to bring this presentation back to Salem County," said Donald Noblett. "Requests for the Hidden In Plain Sight presentation have continued to come up as I work alongside individuals living and working in Salem County. I encourage any adult to attend the eye-opening program."  

RSVP if you plan on attending, or direct any questions about the Hidden In Plain Sight presentation to Donald Noblett, SCRATCH Coalition Coordinator, donald@southwestcouncil.org856-794-1011, ext. 316, facebook.com/SCRATCHcoalition.

To plan your own Hidden In Plain Sight event contact: Ashleigh Huff, Cumberland County MAPSA Coordinator at ashleighhu@co.cumberland.nj.us or call 856-459-3082.

The Importance of Vaping Education

By Michael Regenelli

Vaping and electronic cigarettes
have become an increasingly common sight over the past few years, yet many people, parents and teachers included, don’t know much about them. The CCHCC and Southwest Council Coalitions will seek to address this by providing brief trainings regarding vaping to school personnel and parents. Our first training was held at CCHCC’s meeting on November 14.

These 20-30 minute trainings begin with a brief history on the origin of vaping. Next, current information about vaping devices and how they work is provided. Attendees have an opportunity to gain hands on experience with identifying various kinds of vaporizers. The training also explores the growing trend of vaporizers being used with drugs other than standard nicotine solu- tions; most commonly marijuana extracts. Finally, the presentations address myths and facts surrounding vaping.

Participants can expect to leave the presentation equipped to answer questions about the health effects of vaping, and signs that a student or child is vaping, as well as laws surrounding vaporizers and their use. The Southwest Council coalitions plan to offer this training to school systems as part of in service training hours. The goal will be to increase staff members’ ability to combat student vaping. For more information about these presentations and their availability, please contact Michael Regenelli (856) 794 -1011 ext. 303, Donald Noblett (856) 794-1011 ext. 316, or Candice Carter (856) 494-4950 ext 16.

THE SOUTHWEST COUNCIL AND JOSEPH WILLIAMS, EXECUTIVE DIRECTOR CELEBRATE 25 YEARS OF SERVICE TO THE COMMUNITIES WE SERVE

Joseph Williams, 

By Alexis Regenelli

A quarter of a century ago, The Southwest Council was established to provide prevention services to the communities of southwestern New Jersey. We are proud to say that our Executive Director, Joseph Williams, is also celebrating 25 years with the council this month. The staff & Board of Directors wish to thank Joe Williams for his 25 years of service to the community!

Following is an expression of Joe’s pride in The Southwest Council.

“Since 1991, The Southwest Council has been providing substance abuse prevention, education, and early intervention services to the residents of Cumberland, Gloucester and Salem Counties.

The agency’s positive impact has been made possible only through the efforts of dedicated individuals, including our volunteer Executive Board of Direc- tors, our staff, and the many volunteers who assist us on a daily basis.

The Southwest Council is committed to growth and expansion based on the needs of the communities we serve. We have extended our services over the past several years to include regionally based coalitions. These coalitions have enhanced our capacity to focus on parents, military families, and older Americans through increased prevention services. The success of our grassroots coalition efforts would not be possible without the agency’s dedicated staff and the engagement of individual community members.

Through the collaborative efforts of many, we have been able to provide evidence-based services to schools, colleges, faith-based organizations, families, individuals, community alliances, professionals, and more. It is the focus of the agency to employ environmental strategies geared toward changing community norms which favor substance abuse throughout the southwestern portion of the State of New Jersey. 

Along with the coalitions, the agency has added treatment services which have allowed us to provide quality services throughout the region. Our sustainability plan included the purchase of our own building and expansion in the central part of Gloucester County with fully-staffed offices located in Mantua, New Jersey. We are proud of the dedicated staff who embrace our mission as we hold true to our vision! We will continue to provide employees - with the highest skill and experience - to teach, counsel and assist those who call upon us for ser- vices. Our work is not complete. We are committed to expanding services where the need is great. We will foster partnerships that enhance our goal, and we will ensure that the services provided are of the highest quality possible. Moving forward, we will continue to provide science-based programs, quality treatment services, and effective community-based efforts to meet the needs of the community. We truly hope we can count on your support in the coming years. ”

3rd Annual Tree of Hope

By Matthew Rudd

For the third year in a row, The Southwest Council, Inc. hosted its annual Tree of Hope Coffeehouse Event. Tree of Hope celebrates freedom from addiction, encourages individuals who are in recovery, and commemorates those who have lost their lives to overdose. It also serves as an opportunity to renew the passion of those working in the field of addiction services during the holiday season. This year’s coffeehouse featured refreshments, live music, personal stories, and information about resources available to the community.

About 150 people attended the event including various members of the local government; Cumberland County Prosecutor Jennifer Webb -McCrae, and Freeholder Director Joe Derella. Both Webb-McCrae and Derella spoke on the need for continued gatherings of this type. They also discussed the importance of incorporating the recovery community into efforts of prevention.


There was no fee to attend the coffeehouse; with voluntary donations collected to support recovery services in the area. Commemorative ornaments were available for individuals to write names of their loved ones either suffering from addiction, in recovery, or whose lives were lost to overdose.

We would like to extend a special thanks to the following organizations who participated and collaborated with The Southwest Council in the planning and implementation of the event: Hendricks House, Recovery Unplugged, Cumberland Recovery Support Services Task Force, Behavioral Crossroads, Recovery Centers of America, and especially Cum- berland County Community Church in Millville for providing the venue. Stay tuned in 20107 for info. about next year’s Tree of Hope!