DOBSON — Surry County’s new opioid response director Mark Willis brought out the big guns at his first community forum Friday.
At the first of what may become periodic forums on the opioid epidemic, Willis invited a former deputy director of the Office of National Drug Control Policy as a guest speaker via Skype.
The half-day forum was dense with information. Other speakers will be covered in a future edition.
Dr. A. Thomas McLellan, who is now chairman of the board of directors at the Treatment Research Institute, was deputy director from 2009-2012 under President Barack Obama.
Speaking remotely from his home in Sarasota, Florida, McLellan addressed the capacity crowd in the grand hall of the Shelton-Badgett North Carolina Center for Viticulture and Enology at Surry Community College. He gave information from a 2016 Surgeon General’s report on reducing misuse and addiction, a report for which he was senior editor and which has been reviewed by 2,000 experts.
McLellan began by congratulating Surry County for tackling the problem and saying, “This is a story that’s going to have a happy ending.” Then he said he was going to be giving out a lot of facts and some of his opinions, but said he would state which were which. He did.
One of those opinions was that the best solution to the opioid epidemic is a three-pronged approach of prevention, early intervention and expanded treatment.
Three terms are often confused in the discussion, said McLellan, “use, misuse and addiction.”
“Use,” said McLellan, “is if you use a prescribed medication or take a drink of alcohol. The same factors that drive any other commodity are in play. Make a commodity more available, for instance, cheaper, easier to get, more accessible, and use will increase.”
“Misuse,” he said, “is use under circumstances or at doses that can cause serious and immediate harm.” An example being if a woman drinks two drinks of alcohol a day, that’s use. If a pregnant woman drinks two drinks a day, that’s misuse, because the alcohol can cause harm to the fetus.”
“Misuse is what’s going to kill kids this Friday,” he warned.
“Addiction,” McLellan said, “is not just more misuse. It is separate neuro-biological processes. It is compulsive use driven by progressive brain changes.” It expresses itself on genes, and if you have a family history of addiction, you are more at risk.
“Addiction is a progressive brain disorder. We can’t cure it. It cannot be cured. But like any other chronic problem, such as diabetes or hypertension, it can be managed.”
McLellan said historical definitions of addiction are inaccurate — addiction is a character disorder and that addicts need tough love, must learn to follow rules and ‘get with the program’, addiction comes from bad choices and a deviant lifestyle so treatment should come only from recovering people who can break through this lifestyle, addiction equals physical dependence and only “hard drugs” produce addiction.
He summarized the definition of addiction as “diminished control over use,” with the diagnostic criteria for substance use disorders being “using in larger amounts or for longer than intended, wanting to cut down/ stop, but not managing to.”
McLellan said substance use among adults in the USA resembles a pyramid, and provided a graphic to illustrate the point.
At the bottom are most people who indulge in little or no use. Then there are the people who use. A smaller but still large group, 40 million people, misuse. A group about half that size, 21,400,000 are addicted and at the top of the pyramid, the smallest group of all, 4,100,000 people in treatment.
McLellan explained the way opioids work. They have an analgesic effect, reducing pain. They have a calming effect and they reduce respiration. Over time, tolerance to the euphoric and analgesic effects develops and increased use is required to get the same effect. Tolerance to the depression of respiration also develops, but not as much.
Analgesic and euphoric tolerance remains after withdrawal and detox, so consuming opioids after withdrawing will require the same amount to get high or reduce pain as previously. But the tolerance to depressed respiration does not survive withdrawal.
“So after withdrawal, coming out of jail or treatment, the same dose as taken before will cause overdose. They simply stop breathing.”
“At most risk of overdose are people who have recently been detoxed. They are at most elevated risk even though they are not active users.”
Prevention is very effective when done the right way, but it’s often delivered the wrong way, said McLellan.
“One eighth-grade health class that says, ‘Drugs are bad. Don’t do it,’ doesn’t work. It must be done throughout adolescence (a period he defines as age 12 through 25). “The brain continues to mature until 25. It’s slower in males than females,” McLellan said, then paused for the laugh that came from his audience more than 700 miles away.
“If you can stall drug use until 25, you can virtually eliminate addiction,” said McLellan. Don’t give one drug lecture. Communities are the ones to deliver preventive intervention. Reduce the number of people who ever use, delay the ones who do, and you reduce all the things that hurt adolescents, pregnancy, drop-outs and delinquency.
“You don’t just tell your child to stay out of the sun to prevent skin cancer,” said McLellan. “You slather him with sunblock.”
He recommends a similarly pro-active model for substance abuse, saying, you can usually tell if your kid has started doing drugs. Questions asked at that point are usually effective.
“If you catch them early in the cycle of misuse, it reduces the likelihood they will transition to addiction.
“There is no such thing as short-term treatment for opioid addiction,” insisted McLellan, adding that it was inaccurate and dangerous to say it could be done quickly without medication.
McLellan referred to the notion that ‘using methadone or another medication is simply substituting one addiction for another’ as stupid polemics.
The best kind of treatment is responsible medication to prevent overdose, lifestyle change through groups like Narcotics Anonymous (NA) or Alcoholics Anonymous (AA), combined with monitoring.
McLellan said that doctors have one of the highest rates of opioid addiction, but they go through a four-year program that has a 70- to 80-percent recovery rate.
McClellan then did a brief overview of the medications used in controlling addiction and before opening the floor to questions, he concluded with:
“It is possible to prevent substance abuse. Intervene early before misuse turns to addiction. It is possible to treat addiction.”
Reach Bill Colvard at 336-415-4699.