Most Americans know someone who are suffering.

Overdose fatalities are projected to exceed 64,000 in 2016, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC). That’s a 21 percent increase over 2015 – the deadliest annual jump ever recorded in the United States.

As families hold more funerals, a diverse army is mobilizing to stymie the epidemic. More than ever before, steps are being taken to curb the abuse of opioids – responsible for nearly two-thirds of all drug overdose fatalities. This includes opioid prescription painkillers (i.e., Oxycontin®, Vicodin®), heroin and highly potent street fentanyl.

“A Public Health Emergency”
President brings urgency to opioid crisis but no new funds

President Trump declared the opioid crisis to be “a public health emergency” at a White House ceremony on Oct. 26, 2017. What remains to be seen is whether that declaration will mobilize the money needed – billions of dollars – to blunt the epidemic.

In August, the president promised to officially declare a “national emergency” on opioids. That designation would have treated the drug epidemic as we do extreme hurricanes or other natural disasters – triggering emergency funds and manpower from the Federal Emergency Management Agency (FEMA).

What President Trump did instead – declare a “public health emergency” – was more tailored to the opioid crisis, according to Administration officials. The White House says it will work with Congress to increase federal funds for addiction treatment, and redirect existing grants to better fight the epidemic.

Senior officials also said they will expand access to telemedicine so that doctors can treat more patients in rural areas, and launch an ad campaign to convince young people not to try opioids. Other steps include making it easier for addiction professionals to be hired, and requiring training in safe opioid prescribing practices.

“We cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction,” President Trump said.

Critics noted that without committing new funds, the president’s declaration is empty.

“How can you say it’s an emergency if we’re not going to put a new nickel in it?” Dr. Joseph Parks, medical director of the National Council for Behavioral Health, told the Chicago Tribune. “As far as moving the money around, that’s like robbing Peter to pay Paul.”

“Illicit fentanyl and fentanyl analogs are the next grave challenge on the opioid front,” reports the President’s Commission on Combating Drug Addiction and the Opioid Crisis.
Source: dea.gov

Addiction scientists, state governors and health experts shared their ideas in 2017 with the President’s Commission on Combating Drug Addiction and the Opioid Crisis, led by New Jersey Gov. Chris Christie.

“We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation,” the commission stated in its interim report on the crisis, released July 31, 2017. The report acknowledges that people are increasingly turning to dangerous street opioids such as heroin and fentanyl, as access tightens around prescription opioids.

Here’s a brief summary of the commission’s key recommendations to defeat America’s opioid epidemic, which claims 91 lives each day:

• Declare a national emergency to fight the opioid crisis. “You, Mr. President, are the only person who can bring this type of intensity to the emergency . . . ” the commission wrote, urging in July for an immediate declaration.
• Grant Medicaid waivers that eliminate the IMD exclusion, in order to rapidly expand treatment capacity in each state. “This is the single fastest way to increase treatment availability across the nation,” the report stated.
• Require training in substance use disorders and opioid prescribing at medical and dental schools
• Immediately fund greater access to Medication-Assisted Treatment (MAT) such as naltrexone and buprenorphine, which have been proven to help prevent drug relapse and overdose deaths
• Expand access to naloxone (Narcan®), which can quickly reverse an opioid overdose. The commission wants to equip all first responders with the antidote, and require a naloxone prescription to go with high-risk opioid prescriptions
• Rapidly develop sensors that can detect fentanyl, the highly potent synthetic opioid, and distribute them to law enforcement agencies nationwide
• Support federal legislation to stem the flow of deadly synthetic opioids through the U.S. Postal Service
• Increase federal funds to enhance prescription drug monitoring programs (PDMPs), the statewide electronic databases that track a patient’s opioid history
• Change privacy laws to allow information on substance use disorders to be shared by healthcare providers, so that patients with addiction are not prescribed drugs with high-abuse potential
• Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) to prohibit health insurers from imposing less favorable restrictions on addiction and mental health treatment than they do for medical or surgical diagnoses. “Not providing real parity is already illegal. The Commission urges you to direct the Secretary of Labor to enforce this law aggressively . . .” the report states.

You can see the commission’s complete interim report on fighting the opioid crisis here. The final report will be released in November 2017.

Here’s a look at some of the other key actions underway to restrict opioid access, get more people into treatment, and save the next generation from addiction.

Lifting Barriers To Overdose Rescue

Don’t run. Call 911. That’s the message authorities want people to heed if they witness a drug overdose. Most states now have Good Samaritan laws that exempt people from prosecution if they report a drug overdose.

And rapid changes in state laws are making it easier to get naloxone (Narcan), the life-saving antidote that can rapidly reverse an opioid overdose.

Under new state protocols, naloxone is available without an individual prescription at Walgreens in 45 states; at CVS Pharmacy in 43 states; and at Rite-Aid in 24 states (as of Oct. 2017. About half of Rite-Aid stores are in the process of being sold to Walgreens).

A shot of naloxone – either injected into a muscle or sprayed into the nose – can stop an opioid overdose within minutes. Essentially, the opioids are bumped off the brain’s opioid receptors, reversing the effects of overdose and enabling the victim to breathe more normally. This buys time to get the person emergency medical help.

Once available only to first responders and medical professionals, naloxone is increasingly given to lay people through “standing orders” at health departments and local nonprofits, in addition to pharmacies.

A staggering 26,463 overdose rescues were made between 1996 and 2014 by people who received naloxone kits from community groups, according to the CDC. That number is likely far higher today, given the rise of opioid overdoses and increased access to naloxone.

To save more lives, health experts are urging the Food and Drug Administration to make naloxone universally available by changing its status to an over-the-counter medication.

Above: Naloxone awareness campaigns in New York, Ohio and Utah.

As the death toll from overdose escalates, most states have also adopted Good Samaritan laws. These vary by state, but generally provide immunity from prosecution for people who observe an overdose, call 911 and remain on the scene until help arrives. States that do not have Good Samaritan laws (as of Oct. 2017) are Arizona, Iowa, Idaho, Kansas, Maine, Missouri, Oklahoma, Texas, and Wyoming.

Advil, not Vicodin – The New Normal
Crackdown Intensifies on Opioid Prescribing

America is the world’s biggest consumer of sugar, crude oil – and opioid narcotics. In 2015, the United States held a colossal 99.7 percent of the total hydrocodone use worldwide, and 69 percent of the global oxycodone consumption.

America is also the top consumer of morphine, hydromorphone and fentanyl, according to the International Narcotics Control Board.

In the wake of the opioid crisis, dentists and oral surgeons are re-thinking their reliance on opioids such as Vicodin and Percocet to manage post-operative pain.

Research shows that Advil combined with Tylenol provides better pain relief, with fewer side effects, than opioids after wisdom tooth extractions.

The explosion of prescription drug abuse and fatal overdoses has led to fewer opioid prescriptions being written in the United States. But rates are still far greater than in other countries, and doctors wrote three times as many opioid prescriptions in 2015 as they did in 1999, according to the CDC.

More aggressive measures are evolving to restrict opioid access:

• CVS Pharmacy, which manages drugs for 90 million people in the United States, says it will limit opioid prescriptions to 7 days for patients taking them for the first time. Beginning in Feb. 2018, CVS will also cap the daily opioid dosage and require use of immediate-release formulas before extended-release opioids are dispensed.
• Attorney generals from 37 states sent a letter in September urging health insurance companies to prioritize coverage of alternatives to opioids. This includes therapies such as acupuncture, chiropractic care, massage and non-opioid pain medications.
  • “Although the amount of pain reported by Americans has remained steady since 1999, prescriptions for opioid painkillers have nearly quadrupled over the same timeframe . . . The status quo, in which there may be financial incentives to prescribe opioids for pain which they are ill-suited to treat, is unacceptable.”
    – Letter from Attorneys General (37 states) to America’s Health Insurance Plans (AHIP), 9-18-17
• Physicians for Responsible Opioid Prescribing (PROP) petitioned the FDA in August to remove OxyContin 80 mg and other ultra high-dosage opioids from the market.
• The first-ever national guidelines on opioid prescribing – which have been highly influential – were introduced by the CDC in 2016. These stress that non-opioid therapies such as ibuprofen (Advil, Motrin) should be the preferred, first-line treatment for pain. Exceptions are active cancer, palliative and end-of-life care.
• When opioids are indicated, doctors are urged to use the “lowest effective dosage.” “Three days or less will often be sufficient; more than seven days will rarely be needed,” the guidelines state.
• Following the CDC’s lead, many state legislatures are putting limits on prescription opioids. At least 11 states (as of Oct. 2017) restrict the initial prescription of opioids to between 3 and 7 days, depending on the state. Some insurance companies are also setting a limit on opioid prescription coverage, and federal legislation has been proposed to limit initial opioid prescriptions to 7 days.

The American Medical Association (AMA) does not mandate how doctors prescribe, but endorses the new CDC guidelines.

“Unless the benefits are expected to outweigh the risks and opioids are clinically indicated, we recommend following the CDC guidelines of start low, go slow,” said Dr. Patrice Harris, chair of the AMA Board of Trustees, speaking at the 2017 AMA State Legislative Strategy Conference, as reported by AMA Wire.

When properly prescribed, opioids can mitigate pain for people with serious, debilitating conditions. But prolonged use can increase addiction risk and distort pain receptors, making a person actually more sensitive to pain stimuli. For an in-depth look at alternative therapies for managing pain, see this article from DrugRehab.org:

Increasingly, doctors and dentists rely on another weapon to curb opioid abuse: the prescription drug monitoring program (PDMP). These statewide electronic databases show what controlled substances a patient has received in the past six months (including dosage, quantity and prescriber).

Consulting the PDMP, a clinician can identify people who may need intervention for addiction, such as patients who are “doctor shopping” – getting opioids from multiple doctors. The PDMP also targets “pill mills” that illegally dispense vast quantities of opioids.

“In 2015, we saw a 40 percent increase compared to the previous year in consultation of state PDMPs,” said the AMA’s Dr. Harris, in her conference speech. “That was both in states that had mandatory checking and states that did not.”

Every state now has a PDMP (Missouri, in July, became the last state to launch the program) but many are voluntary. In Ohio and Kentucky – two states that require doctors to check the PDMP – opioid prescribing rates have fallen dramatically (85% drop in Ohio and 62% drop in Kentucky, between 2010 and 2015, according to a CDC report).

A ‘Game Changer’:
Police champion initiatives that favor treatment, not incarceration

New programs such as “Hope Not Handcuffs” and the nationally acclaimed Gloucester ANGEL Initiative herald an encouraging new trend: police are diverting more people with drug addiction into treatment centers instead of jails.

More than 230 law enforcement agencies in 30 states have partnered with the nonprofit Police Assisted Addiction and Recovery Initiative (P.A.A.R.I.) to help people battling substance use disorders. Rather than arrest, P.A.A.R.I. aims to :

• Encourage people with opioid addiction to seek recovery
• Help distribute life-saving naloxone to prevent and treat overdose
• Connect those in need with addiction treatment programs and facilities
• Provide resources to communities that want to do more to fight the opioid epidemic

“Having law enforcement demand access to treatment is a game changer in the struggle to recognize addiction as a disease, not a crime,” David Rosenbloom, Ph.D., an addiction expert and professor at Boston University School of Public Health, said in an interview with DrugRehab.org in January.
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“Thousands of individuals suffering from addiction are walking into police stations all over the country and getting immediate help into treatment and recovery because the cops won’t take “no” as an answer,” Rosenbloom said. “All too often, these same people have been turned away from emergency rooms and treatment programs that have stigmatized them as nuisances and ‘bad patients.’”

For decades, a punitive approach has been the status quo for drug-related offenses – and stigmatized people with addiction. Just ask anyone affected by the crack cocaine epidemic of the 1980s.

The consequences of criminalizing addiction are “far worse than anything caused by the individual users themselves,” writes J. Robert McClure, president and CEO of The James Madison Institute (a Florida think tank), in an article for The Hill.

“Research has shown that the child of a prison inmate is seven times more likely to be incarcerated in the future than is the child of someone who does not spend time behind bars,” McClure writes. “By incarcerating small-time users, we have broken up families, greatly increased the likelihood that spouses and children will fall into the social services safety net, and set up a generation of children for failure.”

In its mission statement, P.A.A.R.I. says it works to “remove the stigma associated with drug addiction, turning the conversation toward the disease of addiction rather than the crime of addiction.” The organization helps police departments start programs such as the Gloucester ANGEL Initiative, created in 2015 by Gloucester Police Chief Leonard Campanello. Under his plan, people with addiction who reach out to the police for help are not arrested, but immediately taken to a hospital or placed in a treatment program.

Hope Not Handcuffs, created by Michigan-based Families Against Narcotics, partners with police, county health departments and treatment centers to connect people with recovery options. The Arlington Opiate Outreach Initiative in Arlington, Massachusetts, and the Hope Squad in Raleigh, North Carolina are similar programs that provide support without judgment to people with addiction.

Shattering the stigma:
A cultural shift is underway

It was a watershed moment for public perceptions about addiction. The 2017 Associated Press Stylebook – used by thousands of journalists worldwide – states that the word “addict” should no longer be used to describe a person with addiction. Instead, the AP recommends phrasing such as “he was addicted, people with heroin addiction or he used drugs.”

There’s good reason to change the language that surrounds addiction, according to the Office of National Drug Control Policy:
“Research shows that use of the terms “abuse” and “abuser” negatively affects perceptions and judgments about people with substance use disorders, including whether they should receive punishment rather than medical care for their disease. Terms such as “addict” and “alcoholic” can have similar effects. As a result, terms such as “person with a substance use disorder” or “person with an alcohol use disorder” are preferred.

The neutral, first-person language is part of a cultural shift taking root in America. More people are beginning to see addiction the way scientists do: as a disease, not a moral failing.

Reducing harmful stereotypes (such as words like “junkie”) will get more people the care and support they need, health experts say.

“We must help everyone see that addiction is not a character flaw – it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer,” said U.S. Surgeon General Vivek Murthy, M.D., in the first-ever report on addiction issued by a surgeon general.

There are signs the stigma is changing. Families across the economic spectrum are putting a human face on the epidemic, lobbying for greater access to effective drug treatment that eluded their loved ones.

Public rallies for recovery, social media campaigns to confront stigma, and the explosive growth of recovery community organizations (RCOs) fuel the momentum.

Drug overdose deaths are not shrouded in secrecy anymore. Many surviving family members write candid obituaries and hold public vigils to honor lives claimed by addiction.

College students with substance use disorders are much more likely to find structured support on campus. The number of collegiate recovery programs, which may include sober living dormitories and on-site counselors, tripled between 2013 and 2015, according to the Association of Recovery in Higher Education (ARHE).

People are also shedding the stigma of addiction by going public with personal accounts of recovery. They share their journeys on websites such as I Am Not Anonymous, Faces and Voices of Recovery and Heroes in Recovery.

DrugRehab.org has one of the largest collections of online recovery profiles. More than 100 men and women from all walks of life illuminate their paths to long-term recovery. They describe what worked for them, and offer advice to encourage others who are rebuilding their lives.

Above: Some of the men and women in long-term recovery who share their stories to inspire others and erase stigma, as part of the “Profiles in Recovery” series on DrugRehab.org.

Despite a gradual shift in how Americans view addiction, only about 10 to 11 percent of people with a substance use disorder currently receive any type of specialty treatment, according to multiple government sources.

Lack of screening and the inability to access or afford care – as well as the long history of discrimination and stigma associated with addiction – are some of the reasons why more people don’t seek help.

Now more than ever, advocacy groups are fighting to change public policy and society’s attitudes, so that more lives can be saved.

“We envision a world in which recovery from addiction is a common, celebrated reality – a world where individuals will not experience shame when seeking help.

We are passionate about sharing our stories of recovery in the hope of inspiring others to join us on the rewarding yet diverse path to wholeness. Together we will demonstrate the power and proof of recovery from addiction.

— from the national advocacy group Faces and Voices of Recovery

Taking this simple step to saves lives

Left: A pill drop-off event in Indiana, sponsored by the 525 Foundation, part of a nationwide effort to curb opioid abuse. Right: A drop box station at Walgreens, where consumers can get rid of unused drugs.

How do we keep powerful narcotics out of the wrong hands? Community pill drops are part of the solution.

You may have seen the new drug disposal kiosks at your local pharmacy. In response to the opioid epidemic, both CVS and Walgreens have added hundreds of drop boxes in their stores for free disposal of expired, unused or unwanted medications.

The goal is to reduce accidental poisonings, theft and drug diversion. Some teens, for example, raid the family medicine cabinet looking for opioids to share at house parties.

“Nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before starting to use heroin,” reports the National Institute on Drug Abuse. Most experimented with prescription opioids after obtaining them from a relative or friend, often without their knowledge.

When prescription opioids are not stored safely, there’s also a much higher risk of harm to young children. A study published in the journal Pediatrics in 2017 shows that a child’s risk of overdose more than doubles if the mother was prescribed opioids (such as codeine, oxycodone or methadone). Safe storage of medication – and prompt disposal of unused pills – is essential to prevent misuse or accidental poisoning, experts say.

Walgreens says it has collected more than 155 tons of unwanted prescription drugs since adding the kiosks in 2016. CVS says it has donated more than 800 pill disposal units to police departments nationwide, in addition to offering in-store kiosks.

You can also drop off leftover medications at many police stations or one of the “Take-Back” events sponsored by the U.S. Drug Enforcement Administration (DEA). To find a collection site near you, and learn more about proper drug disposal, click here.

Holding Big Pharma Accountable

State by state, opioid addiction has ravaged local communities. Now they’re fighting back by taking on the drugmakers and distributors – accusing them of flooding their counties with highly addictive pain pills.

A wave of lawsuits, filed this year by at least two dozen state and local governments, claims the pharmaceutical industry committed fraud: aggressively marketing their drugs as they misled doctors and the public about the addictive nature of opioids.

A typical complaint details the misery of a community hooked on painkillers:
“Like thousands of children born every year Plaintiff BABY DOE was born addicted to opioids. The first days of his life were spent in excruciating pain as doctors weaned him from his opioid addiction. Plaintiff BABY DOE’s mother fell victim to an epidemic that has ravaged Tennessee, causing immense suffering . . .”

Purdue Pharma, the maker of OxyContin, has paid more than $678 million since 2007 to settle lawsuits accusing the company of false branding practices (Purdue Pharma claimed OxyContin was not addictive). Three executives were found guilty of criminal charges.

“Purdue Pharma ignored the devastating consequences of its opioids and profited from its massive deception. It’s time they are held accountable and pay for the devastation they caused,” said Washington state Attorney General Bob Ferguson, announcing a lawsuit that blames Purdue Pharma for fueling the opioid crisis in Washington. Opioid sales there rose more than 500 percent between 1997 and 2011.

In West Virginia – the state with America’s most overdose deaths – one lawyer is using a novel legal strategy to enact change. Personal injury attorney Paul Farrell is going after the distributors – the middle men who move opioids from the drugmaker to the pharmacies – by declaring them a “public nuisance,” a hazard to human health and safety. You can hear NPR’s interview with Farrell here.

A massive civil probe is also underway to investigate opioid marketing practices. Forty-one states have banded together and issued subpoenas for five pharmaceutical companies and three opioid distributors, to determine their role in the epidemic.

One of the areas hardest hit by opioid abuse is Cherokee Nation, which comprises 14 counties in Oklahoma. Like the states, Cherokee Nation is fighting back, with a lawsuit against multiple drug distributors and three retail giants: CVS, Walgreen’s and Wal-Mart.

“These drug wholesalers and retailers have profited greatly by allowing the Cherokee Nation to become flooded with prescription opioids,” the petition states.

Cherokee Nation accuses drug distributors of fueling the black market for opioids by turning a blind eye as they filled suspicious orders from pharmacies. Those pharmacies routinely ignored “red flags,” such as a patient trying to fill multiple prescriptions from different doctors or traveling far from home to get a prescription filled, the petition said.

Opioid abuse has claimed more than 350 lives in Cherokee Nation since 2003. The lawsuit chronicles babies born dependent on opioids, children losing their parents by death or court order, and American-Indian students using heroin and OxyContin at rates 2-3 times higher than the national average. “These impacts are so severe, cumulatively, that Defendants’ conduct threatens to decimate Cherokee Nation,” the petition noted.

because of her sons’ overdose deaths, Indiana mother says

In the summer of 2015, Becky Savage was blindsided by the cruelest discovery.  The Granger, Indiana, mother of four boys had popped into her son Jack’s room while doing laundry.  Picking up dirty clothes, she chatted away at her teenager.  “Jack, it’s time to get up, Dad needs your help today,” Savage recalls saying.  She couldn’t wake him.

Finding no pulse, Savage jolted into action.  She called 911 and pulled Jack to the floor, using her skill as a registered nurse to perform CPR.  She screamed to get help from her son Nick, who was home from college, in bed downstairs.  There was no reply.

A frenzy of sirens brought first responders to an astonishing scene.  Nick – like his younger brother Jack – was also lifeless.

Both boys were pronounced dead that day, June 14, 2015.  Nick, 19, and Jack, 18, were victims of an accidental overdose involving alcohol and oxycodone, which they had taken at a graduation party the night before.   

Nick and Jack were honor students and respected athletes who led their high school hockey teams to state victories.  They were, by many accounts, bright and kind-hearted young men at the gateway of their adult lives.

“They had never been in trouble for drugs or alcohol before,” their mother says.  “It was so out of their character, that’s why we were in such shock.  We talked to our kids about alcohol and drugs, but if never crossed our minds that they would be taking a prescription pill that didn’t belong to them.”

Mike and Becky Savage share their family’s story at a town hall forum on underage drinking in Mishawaka, Indiana.  

Photo credit:  WNDU.

Reeling from grief, Becky Savage and her husband Mike retreated.  “It’s so hard.  For a good year, we didn’t talk about it publicly,” she says.  That changed as America’s opioid crisis worsened, and the couple was asked to speak at a local forum on substance abuse.  They considered how Nick and Jack’s fate might save lives.

The couple launched the 525 Foundation (named after the boys’ hockey numbers, 5 and 25) to spread urgent warnings:  you don’t have to be a drug addict or frequent user to die from drug overdose.  Mixing booze and pills is extremely dangerous, sometimes fatal.  When you’re offered a pill at a house party, you have no idea how your body will react, or how potent it could be.  Even one pill could end your life.

More than 13,000 people have heard Nick and Jack’s story since the Savages began visiting high schools, civic clubs and parent groups in 2016.  

“The deaths shook our community to the bone,” says Margaret Goldsmith, Director of Youth Services for the Alcohol & Addictions Resource Center (AARC), a nonprofit in South Bend, Indiana.   AARC co-sponsored a recent pill drop-off event with the 525 Foundation, and worked with area high schools to arrange the Savages’ talks.

“Becky and Mike’s story is powerful because they lost two sons and openly talked about it,” Goldsmith says.  “Nick and Jack were great kids with great futures and they were not addicted.  They made a poor choice.”

Teens falsely assume that prescription drugs cannot harm them because they come from a doctor, notes Goldsmith.

“Since opioid deaths and heroin addiction begin, in most cases, with the first pill being from a prescription, we need to change the culture of saving unused medications,” she says.  “Parents need to make sure their medicine cabinets are clear of these drugs and explain to their children that prescriptions are meant for a specific purpose and not to be saved and used at the discretion of the patient.” 

Abuse of opioids – including prescription painkillers, heroin and street fentanyl – is driving an unprecedented rise in drug overdose deaths.  In the United States, 33,091 people died from a drug overdose involving an opioid in 2015, according to the most recent data from the Centers for Disease Control and Prevention (CDC).  That’s 91 deaths every day – an all-time high – and a 15.5 percent increase over opioid-related deaths in 2014.  

Opioids play a role in more than six out of ten drug overdose deaths, the CDC says.

“If we can just reach one kid in every crowd we talk to, that’s a success story,” Becky Savage says.  “I really feel like had Nick and Jack heard a story like theirs, they might have made a different decision that night.”

The house party in Granger, Indiana, that Nick and Jack attended was hosted by a 17-year-old girl and her younger sister whose parents were out of town.  Teens celebrating recent graduations smuggled in alcohol and prescription narcotics.

One of the guests that night – an all-state linebacker who had earned a college scholarship – was revived by paramedics after having a drug overdose.  That same guest was later charged with felony drug possession for bringing a bottle of oxycodone to the party.  He lost his scholarship and was sentenced to 90 days in jail, plus probation.  But investigators could not prove who gave Nick and Jack the oxycodone they ingested.

“We have been told it was probably one pill that killed them,” Becky Savage says.  “We don’t know the strength.”
St. Joseph County – which sits on the Indiana-Michigan border and includes Granger –

recorded 59 drug overdose deaths in 2016.  Authorities there currently respond to 2-3 overdoses each week, says Dave Yoder, Chief Deputy Coroner and EMS Division Chief.

“We work closely with the County Drug Unit to identify and track buyers and sellers,” Yoder says.  “The vast majority of our cases involve illegal opioids, many in a mixed combination of heroin/fentanyl or methamphetamine.”  

Yoder adds that carfentanil – the highly potent synthetic opioid used to sedate elephants – has been involved in several local overdose deaths.

“What kids and parents need to realize is that the potency of the opioids is stronger then ever and varies from one dealer to another,” Yoder says.  “First-time experimentation may be the last, with death in minutes.”

Becky and Mike Savage say they’ll continue their quest to spare other families from the emotional earthquake they’ve endured.  “You have to focus on the things you can change, not on what you can’t, or I would just be consumed by grief,” Becky Savage says

When she speaks to students, “they’re engaged, they’re listening, asking great questions,” she notes.  Some have asked for help for addicted parents, or a friend who’s making poor choices.  One shared the anguish of a sibling’s overdose.  Savage reminds teens that Good Samaritan laws save lives, and that it’s okay to call 911 when someone is in trouble.

She’s carrying that message beyond Indiana.  School districts in Pennsylvania, Ohio, Kentucky, Michigan and Illinois have asked to hear Nick and Jack’s story.  The Savages also are planning to speak at several college campuses.

“I knew that Nick and Jack were going to do great things in this world,” their mother says.  “They were both smart and outgoing and invested in their communities, and friends and family.  And to think that their story ended the way it did just doesn’t sit well with me.

“I’m going to do my darndest to make sure their story has a happy ending,” she says.  “They’re going to save someone else’s life.  Somebody will make a better choice because of Nick and Jack’s story.”

Source

The 525 Foundation
OPEN – How to Respond to an Opioid Overdose
OverdoseDay.com – Facts About Opioids

Photography credits: Left: Savannah Wishart Photography; Right: Stacey Newgent

A painful past can often take cover in the deep recesses of the mind.  Bad memories are suppressed so they can’t torment our psyche.  But the body remembers it all, and keeps the “issues in our tissues.”

That’s a key tenet of Yoga of 12-Step Recovery, or Y12SR – a growing movement that aligns the practice of yoga with the work of addiction recovery.  Donation-based Y12SR classes meet in church basements, rehab centers and yoga studios nationwide; an estimated 900 leaders have been trained as facilitators, according to the organization.

“Y12SR connects the dots between yoga philosophy and practices, the 12-step programs, and breakthroughs in neuroscience and trauma healing,” says founder Nikki Myers, who launched Y12SR in 2004 at her CITYOGA School of Yoga and Health in Indianapolis.

Myers’ own remarkable path to recovery inspired the program.  Today she is 17 years sober – the survivor of a traumatic past that includes childhood sexual abuse, crack cocaine addiction and prostitution.

“The 12-step program and Yoga saved my life,” Myers writes on her website.  “One is my lifeboat, the other my launching pad.”

Energy in Motion

Savannah Wishart Photography

Y12SR is not a substitute for 12-step programs such as Alcoholics Anonymous, Myers says, but another tool in the recovery arsenal.

A typical meeting includes a group discussion around topics rooted in 12-step culture – such as surrender, gratitude or acceptance.  The other half of class is devoted to a trauma-informed yoga practice, designed to unleash stifled energy on the mat.  Timeworn recovery slogans such as “keep coming back” are turned into yoga affirmations that can be felt – as in, keep coming back to the mountain pose to quiet the mind when stressed.

“I have found personally – and with the thousands of folks I’ve worked with –

that there’s a level of release held in the body, that may not even be associated with anything you can get at in talk therapy,” says Myers, who is certified as a yoga teacher, addictions counselor and somatic trauma therapist.

Releasing our pain at the cognitive or intellectual level is not enough, Myers says.

“Your body knows everything,” Myers says.  “Emotions are energy and actually energy in motion.  When energy doesn’t move – when it’s held or repressed or denied and it can’t move – it becomes something else.  For example, anger will turn into rage.”

“There’s nothing good or bad or right or wrong about energy,” Myers adds.   “Energy is energy.  The idea is that energy we allow to move is a gift.  Anger that’s allowed to move can become strength and motivation.  Fear not allowed to move can become panic and paranoia, but fear allowed to move can become protection and wisdom.”

Today there are an estimated 250 weekly Y12SR meetings worldwide; it’s difficult to know exact numbers, since facilitators are independent and many meetings are anonymous.  Through a partnership with the nonprofit Give Back Yoga Foundation, Y12SR reaches underserved communities, and classes are held in the United States, Canada, Sweden, United Kingdom and Nicaragua.

The rise of Y12SR coincides with the worst addiction crisis in U.S. history.  Drug overdoses claimed the lives of 52,404 people in 2015 – more than car accidents or gun deaths, according to the Centers for Disease Control.  That number is projected to reach another all-time high when overdose fatalities for 2016 are released in December.

Myers calls addiction “the disease of the lost self.”  Users turn to drugs and alcohol to fill a void or numb their anguish, but healing can only come from the inside, she notes.  Y12SR helps people re-integrate all the parts of themselves, Myers says, and combining yoga and 12-step work “gives us a much broader and deeper set of tools to address the physical, mental and spiritual problem of addiction.”

Body Work:  The Missing Piece

Shelley Richanbach, a woman in long-term recovery and the founder of Next Steps for Women, adopted a Y12SR practice in 2013.

“For me, the largest missing piece in the 12-step program is the body, our home,” says Richanbach, a certified alcohol and drug counselor and peer facilitator in California.

“The body is the center for where all of our feelings originate, beginning with sensations.  These sensations we are often unaware of because we are often living completely outside of our bodies and our minds,” Richanbach says.  “While the 12-step program offers community and story sharing, there is but a brief “moment of silence” offered, if at all.”

Richanbach says Y12SR helps people tap into deep inner wisdom and “find the revelation that perhaps my higher power is right here inside of me.”

“The time on the mat offers the body the potential to release trapped memories and trauma,” she adds.  “The asanas (poses) offer metaphors for re-inhabiting our bodies, allowing us to recreate and embody the lives we want to live.”

Yoga and wellness practices have “profoundly” benefitted Brian Aubin, a 25-year-old native of Long Island, New York.  Diagnosed with Asperger syndrome in his late teens, Aubin struggled with anxiety, depression, drug and alcohol addiction and suicidal tendencies.

He began to explore holistic health practices such as Ayurvedic diets, meditation and yoga, which he credits for helping him feel “more grounded, and much less anxious and depressed.”  Today Aubin is sober and certified in many forms of yoga; he teaches Y12SR classes at two locations in Long Island.

“I love the way Nikki teaches and presents,” Aubin says.  “I’m grateful I discovered her training so I can use the methods she teaches and help people in recovery.”  One of Aubin’s students describes Y12SR as “a stretching of the mind, body, and soul spirit – where insanity was transformed into serenity and peace.”

That sense of calm – feeling centered and grounded – creates a space, Myers says, that allows people to stop and consider their choices.  She remembers a young mother who had been taking Y12SR classes after she was released from prison and had regained custody of her children.

“She shared that she had a really stressful, crazy week and one day in particular was more stressful,” Myers recalled.  “She had gone to pick up her kids and they were super hyperactive, a little wild.  She said, ‘I felt this anger coming up from the bottom of my feet, I could feel the heat in my body.’”

That’s when the mother paused to tap her insights from Y12SR.   Myers recalls: “She said, ‘I stopped.  I heard this voice in my ears say, ‘let’s stop and ground and take a big deep breath with Mary Jo (her Y12SR instructor).  And then I took the breath, and then I didn’t beat my kids.’”

The Gift of Recovery 

Myers does not try to shed her past – despite its stark contrast to her life today.

A great-grandmother, she is a business owner with an MBA degree, a former software industry professional, a certified yoga teacher, addictions counselor and trauma therapist who studied with Dr. Peter Levine, the acclaimed somatic therapy master.  As the founder of Y12SR, Myers travels internationally, training others in the method three weekends each month.

But Myers is quick to mesh those parts of herself with the rest of her identity.

She is a survivor of domestic violence, a victim of childhood sexual abuse, a woman who was addicted to crack cocaine, alcohol and other drugs.  She worked in the commercial sex industry and once lost custody of her children while in the throes of addiction.

Finding herself “absolutely tired of being sick and tired,” Myers sought help in her early 30s, and was introduced to the 12-step program at a treatment center.  She achieved eight years of sobriety before her first relapse.

Myers found her way back to the 12 steps and immersed herself in the practice of yoga, starting an Ashtanga practice and studying everything she could find about yoga philosophy.  She stopped her 12-step work after deciding that yoga was all she needed for recovery.  Myers relapsed again four years later.

It was that second relapse that convinced Myers she needed to unite the cognitive approach of 12-step programs with the somatic (body-based) healing that yoga can provide.

“The ancients, the yogis say that we are not one body,” Myers says.  “Really there are five bodies – our physical, emotional, our thinking, our character or personality, and the spiritual heart.  And I assert that sustainable addiction recovery has to address all five of those.”

Today it’s been 17 years since Myers’ last relapse, and she continues her renewal.

“The gift of recovery for me has been developing a deep relationship with myself and with the spirit and other people in my life,” Myers says.  “The environment has been beyond anything I could have ever imagined.”

* * * * *

Early findings published in the journal Neuropharmacology reveal the compound to be a safer, superior alternative to morphine when tested in rats.

“We have shown that it produces pain relief of equal or greater duration relative to morphine, but with substantially reduced side effects,” says lead researcher James Zadina, Ph.D., a Professor of Medicine, Neuroscience and Pharmacology at Tulane University School of Medicine and the Director of the Neuroscience Laboratory at the Southeast Louisiana Veterans Health Care System.

Compared with rats who were given morphine, the rats who were given the novel compound were far less likely to build up a tolerance to the drug.  And that outcome lowered the risk of abuse and overdose, since tolerance often requires higher and higher doses to feel the same euphoric high or pain-numbing effect.

Zadina says that in additional tests, his research team “found that morphine – but not our compound – produced effects associated with reward and drug-seeking.”

The new compound also relieved pain without other harsh side effects such as respiratory depression, a substantial slowing of breathing that can cause fatal overdose.  In contrast, rats given a similar potent dose of morphine had “significant respiratory depression,” according to the study.  Motor impairment – which can reduce quality of life among older adults taking opioids – was significant in the morphine-fed rats, but not in those on the experimental drug.

For years, scientists at Tulane and elsewhere have been trying to isolate the pain-relieving powers of opioids from their risky side effects.

“We believe that the profile of our compound, given the importance and extent of the reduced side effects, is unprecedented,” Zadina says.

20 Years in the Making

What Tulane researchers have created is a synthetic version of endomorphin – a pain-relieving neurochemical that occurs naturally in the body.

Zadina led the discovery of endomorphins in the brain in 1997.  Since then, he and his team have attempted to engineer variations of endomorphin that are more stable and effective as a drug than the compound in the brain.  The goal of these synthetic versions is to maximize pain-relieving properties while minimizing negative side effects.

“We have been working about 20 years, since the discovery of endomorphin, to achieve these goals,” Zadina says.  “Our motivation is to address two separate but related major issues in our society:  the need for effective pain relief for the large number of people in pain with inadequate treatment, and to reduce the devastating epidemic of opioid overdose deaths.”

Endomorphins bind to the same receptor – technically known as the “mu” opioid receptor, or MOR – as morphine, heroin and other opioid drugs.

But there’s a key difference between morphine and Zadina’s synthetic painkiller.  Unlike  morphine, the novel compound did not activate glial cells in the spinal cord, which play an important role in generating pain.

Research shows that when glial cells are activated by opioids such as morphine, they produce an inflammatory effect that triggers more pain sensations.  This contributes to drug tolerance and addiction.

Glia cells were dubbed the “bad guys” in pain control at a research conference sponsored by the National Institute on Drug Abuse:

“Glia (microglia and astrocytes) in the central nervous system are now recognized as key players in pain amplification, including pathological pain such as neuropathic pain; compromising the ability of opioids, such as morphine, for suppressing pain; causing chronic morphine to lose effect, contributing to opioid tolerance; driving morphine dependence/withdrawal; and driving morphine reward, linked to drug craving and drug abuse.”

— “Glia as the ‘Bad Guys’ in Dysregulating Pain & Opioid Actions . . .”

Linda R. Watkins, Ph.D., Frontiers in Addiction Research Conference, National Institute on Drug Abuse

Zadina’s compound targets the mu receptors, without activating the glial cells.  “Our compound binds to the same receptor (the mu opioid receptor) as most clinically used opioids.  But we believe it is acting differently at this receptor to produce a different response in these cells and/or the network of cells that are affected by it,” Zadina says.  “For example, glial cells appear to play a critical role in the effects of drugs, and we know that our compound does not have the same effect as morphine on glial cells.

An Urgent Need

As Zadina pursues the next step in his research – FDA approval for human clinical trials – the need for a non-addictive painkiller remains critical.

A staggering number of Americans – estimated at 100 million – suffer with chronic pain, according to the Institute of Medicine (IOM), part of the National Academies of Sciences, Engineering and Medicine.  Living in constant physical agony can exacerbate depression and other mental health conditions.  And while opioid drugs can mitigate severe pain, they may also cause addiction and other debilitating issues – for example, falls and fractures in older people who are vulnerable to the sedating effects of opioids.

Abuse of opioid painkillers is at an all-time high, and driving a disastrous epidemic of overdose deaths.

In 2015, drug overdose claimed the lives of 52,404 people in the United States –  more than car accidents or gun deaths, according to the Centers for Disease Control.  Most overdoses involved an opioid such as prescription painkillers (i.e., Oxycontin, Vicodin), illicit fentanyl products or heroin.

Unfortunately, the crisis continues to worsen.  A New York Times analysis projects an estimated 62,497 total drug overdose deaths in 2016 (official government figures won’t be available until Dec. 2017, so the estimate could vary).  That would be another all-time high, and larger than the total U.S. military casualties in the Vietnam War (58,220).

Amid this epidemic, researchers are working to bring safer painkillers to market.

“Scientists are pursuing many different avenues,” says Theodore Cummins, Ph.D., a pain researcher and professor and chair of the Department of Biology at Indiana University – Purdue University Indianapolis (IUPUI).  “Some, like the researchers at Tulane, are working to make opioid-like drugs that are not addictive and do not have the side effects that current opioids do.  Others are working on completely different targets, trying to identify drugs that work on different proteins such as sodium channels.”

Sodium channel blockers have been used for decades to treat pain.  Dentists often use novocaine, a sodium channel blocker, to numb discomfort, and anesthesiologists use lidocaine for peripheral nerve blocks.  However, the current drugs have limitations because they can block pain fibers, heart muscle and brain activity, Cummins explains.

“Numerous university researchers and pharmaceutical companies are trying to develop sodium channel blockers that only target activity in the pain fibers,” he says.  “Selective blockers have great promise to target pain without systemic side effects that would compromise heart or brain functions.”

Today’s sodium channel blockers can ease inflammatory pain and other localized pain conditions.  But they’re not ideal for general, more widespread pain, Cummins says.

“It is hoped that newer drugs in the pipeline that specifically block sodium channels in pain nerves can be used to target widespread pain,” he says.  “But it could easily be another five years before these get to patients.”

Zadina’s compound uses a different mechanism and site of action to relieve pain.

“The sodium channel blockers target peripheral mechanisms – they can be very effective at blocking pain signals . . . from entering the central nervous system,” Zadina says.  “We focused on the mu opioid receptor, however, and this target for our compound is present throughout the peripheral and central nervous system where pain is regulated. This is in part why opioids remain the gold standard for alleviating pain.”

Cummins called the new endomorphin drug promising, noting, “it will be crucial to see if the reduced craving and tolerance observed in rats can also be seen in humans.”

That may take some time.  Tulane researchers hope to initiate human clinical trials within a few years, but the time frame for getting a drug from lab to market is uncertain.

“Recent statistics indicate that it takes on average eight years to develop a new drug,” Zadina says.  “We will move as quickly as possible and our hope is to succeed faster, but predictions about this are difficult.”

For More Information Related to This Article, Be Sure To Check Out These Additional Resources From DrugRehab.org:

• How Prescription Opiates Can Lead To A Heroin Addiction
• Opiate Epidemic Is Changing Pain Management
• Using Naltrexone To Treat Opioid Addiction
• Signs Of Percocet Abuse
• Prescription Drug Abuse Support Groups

Sources

SAFE OPIOID USE:  AMERICA STARTS TALKING CAMPAIGN

Includes do’s and don’ts for the safe use of prescription opioids, how to handle an opioid emergency and tools to help you communicate effectively with your doctor or pharmacist:

http://america-starts-talking.com

8 OPIOID SAFETY PRACTICES FOR PATIENTS & CAREGIVERS

http://www.painmed.org/files/eight-opioid-safety-practices-for-patients-and-caregivers.pdf

FIND A PAIN SPECIALIST

Helpful resources from the American Board of Pain Medicine and the American Pain Society:

http://imis.abpm.org/abpmimis/abpm/directory.aspx

http://americanpainsociety.org/education/clinical-centers-guide

ONLINE PAIN MANAGEMENT TOOLS

http://theacpa.org/Pain-Management-Tools

ARTICLE:

“Beyond Opiates:  A Whole-Body Approach to Managing Chronic Pain”

An analysis of more than 377,000 ER visits – made by Medicare patients between 2008 and 2011 – illuminates the risks:

• Patients who were assigned to a “high intensity” or frequent opioid prescriber were three times more likely to get an opioid painkiller than other patients with similar health problems.  This was the case even within the same ER.
• Long-term opioid use was “significantly higher” in patients who saw a high-intensity prescriber vs. patients treated by low-intensity prescribers.

The study from the Harvard T.H. Chan School of Public Health and Harvard Medical School was published earlier this year in The New England Journal of Medicine.

“Our work shows that patients who see an ER doctor with a high opioid prescribing rate are more than 30% more likely to develop long-term opioid use over the next year,” says lead author Michael L. Barnett, M.D., Assistant Professor of Health Policy and Management at Harvard and a primary care physician at Brigham and Women’s Hospital in Boston.  “This is related to a higher chance of getting just one prescription, and these patients were not on opioids before they visited the ER.”

An estimated one in 48 people who were prescribed an opioid in the ER and “might not otherwise use opioids” will become a long-term user, the researchers noted.  The consequences can be dire – from opioid-related falls that diminish an older person’s quality of life, to physical dependence and addiction.

“It is a stark reminder that even single prescriptions for an opioid can lead to addiction,” says Howard Mell, M.D., a spokesperson for the American College of Emergency Physicians (ACEP).

Mell, who practices emergency medicine near Chicago, notes that while the risk of addiction from a single opioid exposure is real, the vast majority of those prescriptions occur outside of the ER.  Primary care doctors, for example, prescribe more than 70 percent of opioid pain relievers, according to the National Institute on Drug Abuse.

And follow-up prescriptions by other clinicians who see the patient after an ER visit “are necessary for long-term opioid use to take hold,” the Harvard researchers state.

Since ER doctors are on the front lines of America’s opioid crisis, Mell says they are keenly aware of the problem – and taking steps to minimize addiction risk.

“When you see a story about another teenager who overdosed and died, it was an emergency room doctor who had to break the news to the parents.  It’s probably the worst part of my job,” he says.  “A lot of our current research is on ways not to use narcotics.  We’ve looked at the increased use of non-steroidal anti-inflammatories, or using intravenous lidocaine in cases of renal colic (kidney stone pain).  I think the overwhelming majority of emergency physicians right now are using opioids as a last resort.”

High Intensity Prescribers:  Opioids for 1 in 4 Patients

The Harvard study examined the prescribing patterns of more than 14,000 ER physicians from 2008 to 2011.  Doctors were classified as “high-intensity” prescribers if they gave opioids to one out of every four patients; the “low-intensity” prescribers gave opioids to one out of every 14 patients.

Even within the same hospital, rates of prescribing varied widely.  Doctors treating similar conditions in the ER sent between 7.3 percent and 24.1 percent of patients home with opioids, according to the study.  Researchers were limited in their ability to quantify drug overuse, since they couldn’t observe whether an opioid prescription was appropriate.

When long-term health outcomes were analyzed, the doctor’s prescribing patterns made a difference.

Patients seen by high-intensity prescribers were 30 percent more likely to be chronic opioid users when researchers followed up a year later (chronic opioid use was defined as being supplied at least 180 days of opioids. Medicare beneficiaries who were taking opioids for chronic pain, prior to their ER visit, were excluded from the study).

Hospital visits for falls or fractures related to opioid use were “significantly higher” among patients treated by the high-intensity opioid prescribers, the study said.

Another finding:  older adults treated by low-intensity prescribers did not show increased re-visits to the ER, which indicates that their pain may have been adequately treated.

“I think ER physicians can use these results to better communicate the risks of opioid medications to patients – particularly the risk of long-term use or falls/fractures – and present non-opioid pain medicine as a reasonable alternative treatment strategy as often as reasonable,” says Barnett, the study’s lead author.  “Clearly, there is already substantial variation in how ER physicians prescribe, so many physicians could likely offer opioids less frequently without undertreating pain.”

Still Soaring:  Overdose Deaths

The study’s findings arrive amid the nation’s worsening drug epidemic.  As many as 65,000 deaths from drug overdose are projected for 2016, according to a recent New York Times analysis (official government figures won’t be available until Dec. 2017).  That would be an all-time high and the largest annual increase in U.S. overdose fatalities.

Most overdoses involve an opioid such as heroin, illicitly manufactured fentanyl products, or prescription narcotics such as Oxycodone, according to the Centers for Disease Control.

Source:  The New York Times

While people over 65 have the lowest rate of death from drug overdose, several studies point to a growing prevalence of opioid misuse among older adults.  A report by Stanford University, published in JAMA Psychiatry in 2016, notes the Medicare population “has among the highest and most rapidly growing prevalence of opioid use disorder, with more than 6 of every 1,000 patients diagnosed (vs. 1 of every 1,000 commercially-insured patients) and with hospitalizations increasing 10 percent per year.”

Adults ages 45-54 have the highest rate of drug overdose deaths.  Source:  Centers for Disease Control and Prevention

Older adults are especially vulnerable to falls and fractures that can be triggered by the sedating effects of opioids.  “Multiple studies have shown increased rates of falls, fractures, and death from any cause associated with opioid use in this population,” the Harvard study notes. “Even short-term opioid use may confer a predisposition to these side effects and to opioid dependence.”

Overall, about a third of people ages 65+ will be involved in a fall this year (of any origin)  that reduces quality of life, according to the American College of Emergency Physicians.

No Paradigm for Pain

The inconsistency in ER prescribing patterns is complicated by each patient’s unique medical and genetic history, and how they experience acute pain.

“There is no standard approach to treat acute pain because there are so many diverse causes of acute pain and little evidence to guide physicians’ decisions one way or another,” Barnett says.

Mell notes that on some shifts, “it seems like a Hollywood writer scripted my day, and I have 10 different patients with 10 different conditions – all of which are painful and I have to decide which drug is the most appropriate to use in each case.

“There would be no way to have a guideline, per se, to cover all of the possible instances of acute pain . . . But emergency doctors are the experts at this.  So that’s the good.  That’s what we do.”

He also points to a study showing emergency room doctors are experts at detecting drug-seeking behaviors.  They can often predict who is abusing opioids based on markers such as multiple ER visits for the same complaint, requesting a medication by name, or having symptoms out of proportion to the doctor’s examination.

An ER physician’s background also comes into play when prescribing narcotics.

“We’re all trained differently and because we’re all experts in pain management, everybody’s got a slightly different approach,” Mell says.  “It has to do with when they (doctors) were trained, and how they are dealing with evidence to adapt their practice over time.”

Addressing the profession as a whole, a 2016 article in the New England Journal of Medicine notes that very few medical schools offer adequate training in pain management, and “still fewer offer even one course in addiction.”  The authors – leaders at the National Institute on Drug Abuse and the nonprofit Treatment Research Institute – stress the need for more provider education:

“Many motivated, well-intentioned physicians do not know whether to prescribe opioids for pain management and, if so, which ones and for how long. Still fewer understand the pharmacologic or clinical relationships among tolerance, physical dependence, and addiction. This education is particularly critical for primary care practitioners, who prescribe more than 70% of opioid analgesics.”

In 2016, the Centers for Disease Control and Prevention (CDC) issued guidelines for physicians on opioid prescribing.  But as Barnett notes, “there is still lots of room for variation within those guidelines, which primarily address chronic, not acute pain.

“What we know is that every time we prescribe opioids, there is a risk of generating addiction,” Mell says.  To help patients understand those risks, the American College of Emergency Physicians has launched an educational campaign, “Emergency Care for You.”  This includes a flyer on how to properly take opioids if prescribed by an ER doctor, with a reminder that “prolonged use of opioids can actually do the opposite of what they are designed for and create – rather than treat – pain.”

“As a rule, I don’t prescribe opioids other than for truly painful conditions, in very short courses – something like a broken bone,” Mell says.  “And I kind of remind people, ‘it’s going to hurt.  You’re going to be in pain.’”

* * * * * *

Related Resources for Our Readers:

Flyer:  Emergency Care For You campaign

“Pain Management and Opioids in the Emergency Department”

Video:  The 7 Step Challenge to Prevent Falls

From the American College of Emergency Physicians
Article:  Beyond Opiates:  A Whole Body Approach to Managing Chronic Pain

Top Left: Marissa and Blu Robinson, co-founders of “Addict II Athlete.” The non-profit helps people in recovery replace harmful habits with running and other forms of exericse. Top Right: Members of the sisterhood of Addict II Athlete take strides together. Bottom: Inmates in the substance abuse treatment program at Utah State Prison participate in a 5k Race sponsored by Addict II Athlete (Source: Utah Dept. of Corrections).

There are no war stories about hitting rock bottom at this Utah fellowship for people in recovery. Group members lean on each other, united by their desire to heal from drug and alcohol addiction. But they don’t fit a 12-step mold.

When they talk stigma, it’s about changing public attitudes. When they mention surrender, it’s often about wanting to give up in the final stretch of a grueling marathon – then finding the will to finish. They cheer each other’s fitness milestones. They recite a “Champion’s Creed” and help the newbies go from the couch to their first 5k.

“Addict II Athlete,” as the group is known, advances sobriety through physical fitness. The non-profit organization has about 800 members throughout Utah who bring awareness to the recovery movement and raise money for local charities with races and other events. The Utah State Prison has also adopted Addict II Athlete, incorporating the platform into its Con-Quest substance abuse treatment program for inmates.

“All I knew in my heart is that I needed change and that getting into shape seemed to be a great place to start,” says Tim Sedgley of Springville, Utah, who joined Addict II Athlete about a year after his release from prison.

Battling drug addiction and depression, Sedgley figured his sedentary lifestyle wasn’t helping.
“I remember thinking, ‘I just want to be able to run a mile without stopping’” he recalls.

Sedgley met that goal, then kept going. “I have completed two 50-mile ultra-marathons, a trail marathon, and many 5k, 10ks, and half marathons,” says Sedgley, a former high school dropout who earned his GED in recovery and is now working toward a bachelor’s degree in psychology. He has remained sober since joining Addict II Athlete in 2012.

Most men and women don’t consider themselves to be athletic when they join the group, says Blu Robinson, a Utah County mental health and substance abuse counselor who founded Addict II Athlete with his wife Marissa in 2011.

“There are no expectations that you have to be bigger, better, faster or stronger,” Robinson says. “I have seen faster athletes sacrifice their own race to walk alongside a newcomer. It’s what unifies and strengthens the team. It’s a metaphor to recovery, as no one ever finishes alone.”

Moving Past the Pain of Addiction

Each week, members of Addict II Athlete attend free support group meetings, followed by about 30 minutes of team recreation such as running, CrossFit, yoga or walking.

Volunteer coaches remind participants that the trials of running a half marathon are nothing compared to the agony of detox, prison life, or having their children taken away because of the addiction.

“No pain while working out will ever compare to that,” Robinson says. “So really, they are the experts of overcoming adversity. We talk about their life having the ability to inspire others –
to persevere and gain understanding that we have and can do hard things in life . . . and slowly, we move them from addict to athlete.”

Transformation occurs alongside family members and loved ones, who are welcomed into the fellowship – where they are known as “Muggles.” Children of parents in recovery join the “Minor League” program. “We assist them in sporting events, swimming lessons, service-oriented activities, and even sponsoring them in their own pursuits,” Robinson says, adding that donations cover athletic shoes and race entry fees for participating youth.

Service to the community is an integral part of Addict II Athlete. The team registers for one non-profit race each month, and raises funds for items such as adaptive wheelchairs to help disabled children cross the finish line, too.

Giving back is especially poignant when the cause relates to addiction-sensitive issues such as drunk driving or adoption. “When our team participates in these kind of activities, we always call ahead to ensure that the organizer knows who we are and why we want to participate,” Robinson notes. “It’s quite emotional to say the least.”

Finding Purpose in Prison

Nearly 90 percent of inmates in the Utah prison system have a substance use disorder or history of drug and alcohol problems, says Deputy Warden Greg Hendrix. He estimates that up to 300 offenders, male and female, have participated in Addict II Athlete.

“Every spring, we have a tradition of running a 5k. This has been an exciting part of Addict II Athlete in the prison setting,” Hendrix says. Inmates with running experience mentor the less experienced athletes, helping them rally toward a goal.

“Many of the runners that finish first will keep running to support those that are much slower,” he says. “(They) will return to the track on the final lap to help bring in the last runners. It has been great to see that kind of support.”

What endures from the Addict II Athlete experience, Hendrix says, is the team mantra that inmates embrace: “Erase and Replace.”

“This means they are erasing substance-using behaviors with new coping skills or rediscovering coping they used in the past,” he says. “They are finding that passion that kept them healthy before – or they are discovering, for the first time, a different passion.”

As they transition to life outside prison, inmates can use Facebook to find the nearest Addict II Athlete chapter. Sharing the joys of exercise with a sober support group “will increase their likelihood of staying sober and finding a lifestyle they want to live,” Hendrix notes.

Champions of Sobriety

Robinson knows firsthand how fitness can build connections and renew a broken spirit. Growing up, he endured physical abuse by multiple stepfathers, and lived with poverty and instability – moving 23 times in his youth. To escape his toxic childhood, Robinson began using drugs at 15 – following a path to addiction that was also taken by several of his siblings.

He committed to recovery in his 20s, and met his wife Marissa, a therapeutic recreation specialist, when both were working at a center for troubled youth.

“In my own life, my own sobriety, I knew that one major outlet I used was recreation –
mountain biking and specifically running,” Robinson says. “I knew that exercise increased self-esteem and decreased depression.”

So Robinson had the idea to create a pilot project, training some of his therapy clients to run their first 5k. As they gathered for warm-up stretches, the five volunteers were often anxious about their days ahead: meetings with judges and probation officers, temptations to use drugs.

“We’d begin processing these stressors before we would run, and on our return I would always ask how they felt,” Robinson says. “And every time, they experienced and expressed feeling better.”

One team member gave the inaugural group a shirt that read ‘Addict II Athlete’ – shedding the anonymity of their disease. “These individuals put their shirts on and ran their hearts out,” Robinson recalls. “Each one of them finished, each had family members who cheered for them, and couldn’t believe what they were doing.”

Today, Addict II Athlete has chapters in six Utah counties (two are pending) and Robinson hopes to expand to more states in the future. He sees Addict II Athlete as a meaningful complement to other recovery strategies and support, such as 12-step programs.

“We counsel our athletes to participate in the 12-step programs to gain a better understanding of the spiritual component of sobriety,” he says. “They use the team for support and recreation, and then do their own work with therapists and treatment programs to have a triad of sobriety and recovery.”

When they are feeling vulnerable, members of Addict II Athlete can invoke the Champion’s Creed. “Any one of our athletes will yell, ‘Athlete who am I?’ and the team in unison will respond ‘I am a champion!’” Robinson says. “It’s erasing their thoughts of being lowlifes, being addicts, being bad parents, bad spouses or bad children and showing them who they truly are: extremely powerful people with the ability and stamina to knock out the addiction. They are in fact champions of sobriety.”

Sedgley, who joined Addict II Athlete after prison and became an ultra-marathoner, says the experience goes beyond physical fitness.

“The real changes started when I found others accepting me onto the team,” Sedgley recalls. “They asked me how I was doing. I was invited on runs with the team, and also asked to help with service projects.”

“This team has given me confidence in myself, trust in others, and has helped me put my life into perspective,” Sedgley adds. “When I look back on my journey, I see that the game changing play was when I joined the team.”

For More Information:

Visit Addict To Athlete at: http://addicttoathlete.org or on Facebook at https://www.facebook.com/AddictToAthlete/

* * * * *

Now in its 10th year, Camp Mariposa is a haven for children ages 9-12 who are impacted by a family member’s drug or alcohol abuse.

Many participants at the free weekend camps have been shuttled through foster care or live with relatives due to a parent’s addiction. Some have endured homelessness, abuse and chronic neglect – or bear the stress of having parents in prison.

At Camp Mariposa, these children learn that they are not responsible for a loved one’s addiction. They’re taught how to forge a different path than what they have known, and they meet others who share their pain.

“Being with kids that had the same experience as me was the best. It let me open up about things and know that they understood. I didn’t feel ‘different,’” says Parker, whose aunt enrolled her in Camp Mariposa. Parker was 11 when she and her sister began attending the overnight weekend camps; today at 14, she’s back as a junior counselor. “I like that now I get to be a role model and good example for the younger kids,” she says.

Camp Mariposa was created in 2007 by the Moyer Foundation, a non-profit led by retired Major League Baseball pitcher Jamie Moyer and his wife Karen. Helping children and families suffering from grief or addiction is the focus of the couple’s philanthropic work. Their other signature program is Camp Erin, the largest network of bereavement camps for children in North America.

In 2016, nearly 1,200 campers impacted by family addiction attended Camp Mariposa. Most take part in multiple camp weekends, held every other month.

“It is crucial that kids come to as many sessions as possible to reap the benefits of what can help them the rest of their lives,” says Karen Phelps Moyer, co-founder and vice president of the foundation and the daughter of former Notre Dame Basketball Coach and ESPN analyst Digger Phelps.

“I have seen firsthand siblings and cousins come to camp and be empowered to know that they can be different,” she says. “I have witnessed families come back together while broken, and learn to live on and live well.”

Karen Phelps Moyer, right, bonds with campers during art therapy at Camp Mariposa.

Support from charitable donations and a three-year grant from the U.S. Department of Justice has expanded Camp Mariposa to 10 states. That includes areas with America’s highest rate of drug overdose deaths – West Virginia, New Hampshire and Kentucky.

Inspiration for the camp came when Phelps Moyer, the mother of eight children, stepped up for a relative in need.

“I had temporary custody of my niece whose mother was battling addiction,” she says. “I knew first hand there were no services for this age group.” After doing some research, Phelps Moyer connected with addiction pioneer Claudia Black, Ph.D., whose body of work since the 1970s has examined the impact of addiction on young and adult children.

Black, a founder and current advisory board member of the National Association of Children of Alcoholics, helped design the therapeutic model for Camp Mariposa. The camp partners with local, accredited mental health and youth organizations to give children safe adventures, and the skills and confidence they need to prevent an addiction of their own.

Exposed Kids:
4x More Likely to Get Addicted

An estimated one in five children in the United States lives with an adult who abuses drugs or alcohol, according to a 2016 clinical report from the American Academy of Pediatrics, “Families Affected by Parental Substance Use.” And that can trigger a heap of tragic consequences.

“The research clearly demonstrates that children impacted by addiction in the family are at a much higher risk for their own substance abuse, depression, anxiety, primary health care problems, low academic performance, school absenteeism,” says Black, the clinical architect of Camp Mariposa. “They are more likely to enter foster care and remain in foster care for longer periods of time. And the list goes on.”

An estimated 50 to 80 percent of all substantiated child abuse and neglect cases involve some degree of substance abuse by the child’s parents, according to the U.S. Department of Health and Human Services.

And young people living with an addicted family member are four times more likely to develop their own addiction, according to the Moyer Foundation.

But “protective factors” – such as healthy social connections, the support and guidance of a grandparent, or therapeutic intervention – can buffer addiction risk for the next generation.

“The research also tells us that that risk can be lessened with protective factors, and those protective factors are more influential than the risk factors,” Black says. “And that is what Camp Mariposa offers – the development of protective factors.”

“Through experiential play activity, it provides (campers) with new coping skills in problem solving, asking for help and regulating their emotions. It is shame-reducing, helping them to challenge negative beliefs about themselves and begin to trust in their own worth and value.”

High-risk children gain a sense of belonging at camp, while having fun, Black adds. “The entire experience supports them in their resiliency.”

Don’t Trust, Don’t Talk, Don’t Feel:
Rewriting the Family Rules

Camp Mariposa challenges the unspoken, dysfunctional rules in addicted families – identified by Black as “Don’t Trust, Don’t Talk, Don’t Feel.”

“At Camp Mariposa, children first learn it is okay to trust the other children and adult mentors at camp,” says Brian Maus, who oversees the national camp network as Director of Addiction Prevention and Mentoring Programs for the Moyer Foundation. “We then provide the tools and activities for children to be able to identify their feelings. Finally, we create a safe environment where children are able to talk about and express those feelings – often for the first time.”

Finding connection at Camp Mariposa

To reduce feelings of isolation and get the most benefit, children are asked to make a one-year commitment to attend most camp weekends. The peers who join them – and often, their mentors and counselors – can relate to growing up in an addicted home.

“The children who attend Camp Mariposa often talk about the friendships they have made at Camp Mariposa and how the other kids and adults are like a second family to them,” Maus says. “There is tremendous healing that occurs in these relationships that are built over the period of several years.”

Positive risk-taking activities such as ropes courses help campers build confidence and trust. “It is an amazing experience to see a child who is afraid of heights walk on a rope suspended in the air between two large trees,” Maus says. “They are literally connected by a rope to the other campers and adults whom they have come to trust.”

Campers also learn that their feelings matter. They’re free to express anger or sorrow about a family member’s addiction through journaling and other initiatives such as art therapy and drumming. They learn deep breathing techniques and other mindfulness practices to cope with stressful feelings at home.

All campers are invited to write letters to “ADDICTION” and read them aloud on Saturday night, before they toss the letters onto a campfire. “For many of the youth who attend Camp Mariposa, this is a highlight of each weekend that offers them the opportunity to release their feelings in a safe and supportive environment,” Maus says (one camper wrote, “Drugs hurt you. They ruin your life and they sometimes can kill you. Well, drugs hurt my Mom and I think that’s unfair.”)

Signs of Suicide:
Helping Campers at Risk

Children living with an addicted family member have an elevated risk of mental health problems. An estimated 25 percent of Camp Mariposa youth screen positive for depression and suicidal thoughts.

Two years ago, the camp added to its curriculum an evidence-based program, “Signs of Suicide” to confront the issue. Any camper who scores positive for depression and suicide risk undergoes a more formal assessment with Camp Mariposa clinical staff. If concerns remain, a parent or guardian is notified and the camper is connected to a local therapist. Children also participate in guided mental health discussions and learn to recognize danger signs in themselves and others through the acronym ACT:

Acknowledge – that there is an issue with you or someone you care about;
Care – Express your concern to that person or yourself;
Tell – a trusted adult

“Several campers have said that they have been able to help friends or family members who were struggling with depression after participating in the Signs of Suicide program,” Maus notes.

Going Home Stronger

At least half of campers’ parents are battling an active addiction, Maus estimates, although they are not asked about recovery status. Camp Mariposa appears to be having a preventive effect on the next generation.

A new, multi-year study with Louisiana State University Health Sciences Center – School of Public Health is examining long-term substance use among Camp Mariposa attendees. “Very preliminary data from the beginning of this year indicates that almost 90% of campers and junior counselors (ages 13-17) have not had more than a few sips of alcohol, smoked marijuana or used any other substances to get high,” Maus says.

Teenagers who age out of the program are given the opportunity to remain involved with Camp Mariposa as junior counselors. Lessons learned at camp – and human connections – are reinforced throughout the year at social gatherings for alumni, younger siblings and family members.

“All of the local Camp Mariposa directors are in contact with campers and their families in between camp weekends,” Maus says, adding that referrals are made for therapy and support services as needed.

In Philadelphia, The Moyer Foundation is testing a 10-week after school program (The Mariposa Community Program) that applies the core therapeutic and educational principles from camp. The goal is to help more at-risk children learn to change their trajectories.

“The word ‘Mariposa’ means butterfly in Spanish,” Maus notes. “The name reflects both our philosophy and experience that children transform as they participate in Camp Mariposa.”

The camp’s influence may be reaching adults as well. This is what one parent had to say after learning how campers expressed their feelings about addiction:

“Hearing the thoughts of these children motivates me to remain sober and allow the change and transition of recovery to take over. This motivated me to continue doing right in order to give my child a fair chance at life.”

* * * * *

For More Information Related to “An Oasis for Children of Addiction” Be Sure To Check Out These Additional Resources From DrugRehab.org:

• Social Learning Theory Of Addiction Treatment
• How Do I Get My Loved One Into Rehab?
• Will I Lose Custody Of My Child If I Go To Drug Rehab?
• The Effects of Parental Substance Abuse on Children
• Abused Children And Addiction
• Drug Addiction And Babies: Long Term Effects

You enter a barren house that harbors a slew of public health hazards. Peeling wallboard and blackish mold taint the bathroom. A young man sits on the dingy floor next to the toilet, smoking crack cocaine.

Your heart races. Your mind becomes fixated on the familiar popping noise of the crack pipe. You feel a powerful urge to use.

At that moment comes a reassuring voice: “You’re doing great, keep going.”

It’s your therapist, guiding you through a virtual crack house that feels remarkably real on your headset. From the safety of the clinic, you move about the 3-D avatars and rate your cravings as they rise and fall. When the urge to use subsides, the therapist plays a novel tone: beep boop boop. beep boop boop. Your brain starts to associate the tone with learning not to use drugs – a reminder that you don’t have to give in to temptation.

More people are facing their fears – and changing deep-rooted behaviors – by engaging with virtual reality environments.

“I think virtual reality may be able to help people get better, faster,” says Zachary Rosenthal, Ph.D., Clinical Director of the Cognitive Behavioral Research & Treatment Program at Duke University.

Rosenthal and his team pioneered the crack house simulation, with technical support from a software company and funding from the National Institute on Drug Abuse.

It’s one of many cyber worlds that could help people improve their mental health and confront such problems as drug and alcohol dependence, crippling phobias and post-traumatic stress disorder (PTSD).

People with a fear of flying, for example, could work through their anxieties on a virtual plane – an idea that’s shown success in clinical trials. A binge drinker might confront cravings at a virtual bar, authentically crafted down to the person’s favorite brand of hard liquor.

Some users get so immersed in the experience, in fact, that they grab at the air for a virtual beer or other computer-generated image. Researchers can even stimulate the senses with “smell machines” that send a whiff of marijuana or cigarette smoke into cyberspace.

“We went to actual crack houses,” Rosenthal says of developing the virtual cocaine intervention. “We wanted to get into the world to see what it actually looked like.” The Duke team sent video footage of North Carolina drug enclaves to its technology partner, Psychology Software Tools, and collaborated on storyboards and 3-D simulations.

The ultimate goal is to help users learn coping skills in a controlled, life-like environment – so they can better transfer those skills to real high-risk situations.

Next Generation Tool to Advance Addiction Care

Despite its ability to mimic daily life, virtual reality does not replace the expertise of a therapist, researchers say. The technology is still being tested with substance users and is seen as a complement to traditional treatments such as cognitive behavioral therapy.

“I believe virtual reality has great potential to help those receiving treatment for substance use disorders,” says Amy Traylor, Ph.D., assistant professor of social work at the University of Alabama, where she operates a virtual reality lab. “While it is not a stand-alone intervention, virtual reality may one day be used be used to enhance current treatments and provide assessment information.”

Rosenthal pairs virtual reality sessions with “extinction reminders” – the unique beep boop boop tones played when drug cravings wane and healthier responses are learned. It’s similar to the famous “Pavlov’s Dogs” experiments in which dogs learned to associate a bell (a neutral stimulus) with food – eventually drooling at the sound of a bell, even when no food was present.

Participants in the crack cocaine trial associated the unique tones – which they received on their cell phones between clinic visits – with the memory of the therapeutic experience. Hearing the tones reminded users that they were able to “ride out” their cravings in the virtual crack house, until the urge to use drugs was gone.

“Virtual reality allows us to train the person’s brain to respond differently,” Rosenthal notes. “The point of our intervention is to elicit cravings and extinguish cravings . . . what we’re finding is that these phone calls do seem to decrease cravings better than control phone calls (with no unique tones).”

A recovering cocaine user who participated in the trial told MTV News: “When I have a craving and I hear the tone, I think to myself, ‘I do not have to do this.’”

Tailored to Your Triggers

One limitation of typical addiction treatment is the clinic’s neutral setting. Clients role play coping skills in an environment that lacks the “cues” to trigger real life cravings – interacting with drinkers at a party, for example, or watching a drug deal unfold at a convenience store.

“There aren’t the sights, sounds and smells present that they associate with use,” says Traylor.

“It’s kind of like practicing a speech in an empty room . . . you can practice and start to feel comfortable and confident in yourself, but once the room fills with people, the environment is changed and that might create a level of anxiety for you that makes you completely forget everything you’ve practiced.”

Since it could be dangerous, impractical and unethical to expose a client to actual drug use, that’s where virtual reality can help, Traylor says.

The patient is transported, in a safe and supervised setting, to realistic scenarios “that may trigger the physical and psychological signs of craving,” she says. “This way, they could actively practice skills to reduce cravings, anxiety, or other unpleasant feelings in the type of environment in which they might be expected to need those skills.”

A major benefit of virtual reality is its vast potential to customize and reproduce addiction cues that have special meaning for the user.

“We tailor each virtual world to that participant’s drug use history,” Rosenthal says. “For example, I remember having a patient who said, ‘I never use in abandoned crack houses, it’s disgusting . . . I typically go to a motel.’ So in our virtual world, we have both a motel and an abandoned crack house.”

Clinicians can also change and layer the intensity of the cues in the virtual space. “For some people, all it takes (to spark a craving) is to see the drug paraphernalia on the kitchen table,” Rosenthal says. At the highest intensity level, virtual avatars might be playing cards and watching television inside an apartment, when a drug dealer knocks on the door and the group begins smoking crack.

“We can tailor the environment to the person to an extent, and we can bring that person to the same environment and reproduce it over and over again, and extinguish the conditioned response (craving) to the same stimuli,” Rosenthal says.

That ability to replicate a high-risk scenario makes virtual reality a helpful assessment tool in addiction treatment, Traylor says.

“Because the virtual reality environments can be the same from one session to another, clinicians can see how their clients’ craving levels change when exposed to the exact same environment,” she notes. “Conducting these assessments also allows clients the opportunity to identify triggers and environments that they had not previously realized were leading them to crave.”

A Learning Curve

Evidence is emerging that shows virtual reality’s promise as a platform for behavior change.

While more controlled studies are needed, the current research indicates the technology is effective in treating social phobias and PTSD. Virtual reality has also been shown to boost confidence for people in recovery from addiction, as they apply coping skills learned in the virtual world to their everyday lives.

Patrick Bordnick, Ph.D., a pioneer in the field (and Traylor’s mentor), conducted research on how virtual reality impacts cravings for alcohol, marijuana and cigarettes. His 10-week study of 46 adult smokers found that rates of smoking and craving for nicotine were “significantly lower” among participants exposed to virtual reality treatment and nicotine replacement therapy (i.e., gum, patches) vs. those who received only nicotine replacement therapy. Self confidence and coping skills were also significantly higher for the virtual reality group.

Bordnick also demonstrated that virtual environments can trigger addiction cravings and increase attention to cues (a pre-requisite for learning to control alcohol and drug cravings).

One study exposed 40 people with alcohol use disorders to virtual reality worlds that contain drinking cues (i.e., a sports bar). Their cravings increased in those settings, and participants said the environments were realistic and compelling. When marijuana users were exposed to virtual settings with drug cues (i.e., a party room where people were smoking marijuana), they experienced “significantly higher” cravings than participants who entered virtual worlds with neutral settings (a digital art gallery with nature videos).

Given the urgency of America’s addiction epidemic – 143 drug overdose deaths occur each day – virtual reality could have a positive impact. But most clinicians are not yet familiar with the technology, and research is lacking on its effectiveness for large groups of people.

“A significant limitation of virtual reality is that it’s complicated technology that has a cost to it and a learning curve,” Rosenthal says. “Counselors across this country may not be ready to begin using virtual reality in their daily practice.”

Rosenthal hopes to publish his virtual crack house study; he says the research shows a small but statistically significant decrease in cocaine cravings among the participants.

“I think virtual environments have enormous potential to be used as a way to know whether someone’s getting better,” he says, “as well as a platform to help people change.”

* * *

Dick Beardsley is blessed with epic endurance. He’s weathered grueling competitions and surreal setbacks – including a horrific farm accident, multiple car crashes, near-fatal opiate addiction, a felony drug arrest, and chronic pain in the wake of 19 surgeries.

Beardsley doesn’t give up easily. In fact, at age 60, he still runs 50 miles a week. He’s rebuilt his life in recovery, one stride at a time.

“I can sum it up in one word: HOPE,” Beardsley says of his ability to face hardship. “You can live 40 days without food, seven days without water, a few minutes without breathing, but you can’t live one second without hope. I really believe that.”

Beardsley is one of America’s fastest-ever distance runners – known for his famous “Duel in the Sun” with world record holder Alberto Salazar at the 1982 Boston Marathon. The two men raced nearly side by side for 26.2 riveting miles – until Beardsley the underdog lost by a mere 1.6 seconds. To many fans, it remains one of the greatest finales in sports.

Only a few American athletes in the past 35 years have topped Beardsley’s best marathon time: two hours, 8 minutes and 53 seconds. He also made the Guinness Book of World Records as the only person to run 13 consecutive personal bests in the marathon.

But a different kind of battle – one more common to his fellow Americans – would be the most daunting for Beardsley: addiction to prescription drugs.
First, the chronic pain arrived. After retiring from competitive racing in 1988, Beardsley survived not one but four life-threatening accidents.

Working on a Minnesota dairy farm in 1989, Beardsley got caught in the power auger on the back of a tractor. The spinning machinery pummeled his left leg and head, and broke his ribs and right arm. Five months of intensive rehabilitation followed. Three years later, Beardsley suffered spinal cord damage when his car was blindsided by a speeding motorist. In January 1993, while going for a run in a Fargo snowstorm, Beardsley was the victim of a truck driver’s hit-and-run. Driving in a blizzard a month later, he further injured his neck and back when his car flipped several times and landed upside down.

Opiate painkillers were prescribed to dull the agony of his broken body. Beardsley buckled under their grip.

“I was taking upwards of 80 pills of Percocet, Demerol and Valium a day,” he recalls. “I would have to take a bunch of Pepto Bismol to try and coat my stomach.”

When he couldn’t obtain more drugs, Beardsley began forging prescriptions. His desperation culminated in a very public arrest at a local pharmacy.

“I knew I needed help but was so ashamed to tell anyone,” Beardsley says. “I really believe if I hadn’t got caught when I did, I would have died within a few days.” Instead, he was ordered to get treatment and did so well that the judge asked him to share his story with others fighting addiction. He’s been doing that ever since – for 20 years now.

Today, Beardsley embraces life in recovery with his trademark optimism.  He’s a popular Minnesota innkeeper and fishing guide, a best-selling author, motivational speaker and running coach.

We asked Beardsley to share his extraordinary journey, and his thoughts on overcoming adversity and breaking free from addiction.

10 Questions For Running Legend Dick Beardsley: Celebrating Two Decades of Recovery from Addiction

How did you become addicted to opiate painkillers?

After a bad car accident in 1992, I needed more and more pain meds. Over the next couple of years, I had more operations and the need for more meds. But by 1994, I was really not needing them for the pain but continued to use them.

I was very much in denial and made every reason under the sun on why I needed to continue taking them . . . I was very good at telling the doctors why I needed the drugs.

At the height of your addiction, you were arrested for forging prescriptions for narcotics. Did you face stigma after your arrest, and was this incident a turning point in your recovery?

Without doubt! Because of the runner I once was, my arrest made papers around the country. I’m from a small town in northern Minnesota where everyone knows everybody. So needless to say it was huge news in our town.

When I got caught, I knew I was in a lot of trouble but I was so thankful and blessed that I was still alive. I knew the only chance I had at that point was to take total responsibility and be truthful to everyone in what I was doing.

Did you experience drug cravings after entering recovery? How did you overcome these?

When I first got into the hospital after my arrest, the doctors put me on methadone and I became addicted to that – even under the care of doctors. When they tried to wean me off, the withdrawals were so bad that I asked God to either take me right then or please God help me through this.

Once I got over the withdrawals, the thought of going through that again made me almost sick to my stomach. I never craved the drugs after that. But saying all of that, I still with 20 years of sobriety can’t for sure know that if I came across a bottle of Percocet that I wouldn’t take them. That is very scary to me!

Have you been in touch with your former running rival, Alberto Salazar, since the famous “Duel in the Sun?” at the 1982 Boston Marathon?

Yes! Alberto and I have become good friends over the years and have done a number of engagements together over the years. He was one of the first people to reach out to me after my arrest.

What treatment and resources worked best for your recovery?

After I went through my initial treatment of about three months, I was in aftercare for a year. That really was a plus for me! I also went to a NA/AA meeting at least once a week for the following year. I had an incredible drug counselor who knew when to give me a hug and also when to call me out when she didn’t think I was telling her everything. She had so much to do with my recovery!

Sharing my story also was very beneficial in my recovery and still is to this day. I never take my recovery for granted. The minute I think I have this disease of addiction whipped, I’m in big trouble and better seek immediate help!

Do you still experience physical pain from your near-death farming accident and auto accidents? How are you able to continue your running program despite multiple surgeries?

I still experience some pain but I’ve gotten so used to it that it really doesn’t bother me anymore. I so love running and what it does for me! Even with two knee replacements, I still run about 50 miles a week but I’m slower than molasses in January now! But that doesn’t bother me at all. Every day I’m out on a run, I feel so very blessed!

What advice can you give to people who want to conquer addiction, but are struggling with relapse or despair?

Never, ever give up. Take little baby steps. As you know, the saying is “One day at a time.” There were moments I took it one minute at a time.

You do whatever you need to do to stay clean. I know at first it’s very difficult, you felt better when you were on the drugs. But know that if you continue down the path of sobriety, you will see how much better you really feel and you will find no drug in the world can make you feel like that.

After I had a year of recovery under my belt, I would go back to my treatment center every few months to share my story. I would occasionally see people who were in my treatment group back in the room. Most tried to avoid me; I’m sure they were embarrassed that they were back. After my talk, I would always seek them out and tell them I was so proud of them that they were back getting help and if there was anything I could do to help, to let me know.

You have a marathon named after you. Tell us about this event.

The Dick Beardsley Half Marathon was started in my hometown of Detroit Lakes, Minnesota in 1995. In 2015, we also added a full marathon.

This past year, our 5k which is also part of our races was renamed the Andy Beardsley Memorial 5k. In October 2015, I lost my son Andy to suicide. He was an Iraqi war veteran and suffered from PTSD. He was 31 and was a wonderful young man who was so proud to have served his country. Needless to say I miss him very much!

Our next race is Saturday September 9th. It will be our 22nd race!

What is most valuable to you in recovery?

To be able to share my story with others – hoping that by telling my story, it perhaps might save some else’s life! The good Lord gave me this incredible gift of being a good story teller.

I really believe that when I had my farm accident, it was a miracle I didn’t die. At that time, there had been a rash of farm accidents around Minnesota.

Because of the runner I once was, my accident received a lot of media attention. The University of Minnesota Extension program heard about it and started a farm safety task force. I went all over Minnesota on their behalf – telling my story to FFA and 4-H clubs, and farm organizations. Knowing that someone’s life may perhaps be saved telling my story is a wonderful feeling.

The same thing is true with my drug addiction. I should have never survived all the drugs I was taking. I really feel that God let me get so close to death and then said ‘Ok enough is enough, I’m going to get you better and I want you to share your journey to help others.’

In your opinion, how can we change the stigma of addiction and mental illness so that more people will seek effective treatment?

I firmly believe the more we continue to talk about addiction and mental illness, the more the general public will understand it and the less of a stigma it will be. Unfortunately we still have a long way to go but we are heading in the right direction.

Follow Dick at dickbeardsley.com
Co-Author, Staying the Course, A Runner’s Toughest Race
Dick Beardsley Foundation

Researchers at the University of Montreal have identified four personality risk factors that are associated with adolescent drug and alcohol abuse:

• Anxiety Sensitivity
• Hopelessness
• Impulsivity
• Sensation-seeking

These insights could describe the high school honor student who has no conduct issues, but uses drugs to cope with crippling anxiety. Or the teen who turns to opiate painkillers to escape feelings of failure and depression.

Impulsiveness – a trait often associated with Attention Deficit Hyperactivity Disorder (ADHD) – may spur a child to use cocaine or other stimulants, without thinking of the consequences. And even if they are immune to peer pressure, teens identified as sensation/thrill seekers are more prone to binge drinking and alcohol dependence, the studies reveal.

“We were able to show in longitudinal research with youth that personality is a risk factor for escalations in substance use,” says Sherry Stewart, Ph.D., a professor of psychiatry, psychology, and community health and epidemiology at Dalhousie University in Nova Scotia, Canada.

Teens with high-risk personality profiles may be drawn to particular drugs that meet short-term needs, Stewart notes. “For example, anxiety-sensitive young people get into trouble because they use substances for risky reasons like managing their anxiety or trying to fit in with their peers,” Stewart notes. “Personality-targeted interventions provide young people with coping skills for better managing their personality vulnerability and thereby reduce their risk for substance use/misuse.”

Keeping Kids Safe: A Jump Start

Stewart helped create the Substance Use Risk Profile Scale (SURPS), which can identify up to 91 percent of children at high risk for future drug and alcohol problems. The self-report questionnaire is being used in a new intervention known as “Preventure,” the first anti-drug program to target personality traits.

Developed by fellow Canadian researcher Patricia Conrod, Ph.D., a professor of psychiatry at the University of Montreal, Preventure has been tested in thousands of adolescents in Canada, Australia and Europe (funding is being explored to bring Preventure to the United States).

The results of eight randomized trials are encouraging.

A two-year study of nearly 2,700 British ninth graders showed that Preventure cut the odds of binge drinking significantly – by 43 percent – among those teens at high risk for addiction.

Preventure also reduced the odds of overall drinking by 29 percent (whether a student was at high risk for addiction or not) and delayed a progression to more severe drinking patterns. (“Effectiveness of a Selective, Personality-Targeted Prevention Program for Adolescent Alcohol Use and Misuse,” Patricia J. Conrod; published in JAMA Psychiatry, 2013).

In Australia, 438 high-risk teens participated in a Preventure trial conducted at 14 high schools between 2012 and 2015. Compared to a control group, the Preventure teens had a significant reduction in alcohol use, binge drinking, and alcohol-related harm (“The long-term effectiveness of a selective, personality-targeted prevention program in reducing alcohol use and related harms: A cluster randomised controlled trial,” Newton N.C., Conrod, P., et. al., Journal of Child Psychology and Psychiatry, 2016).

As a personality-based intervention, Preventure has also been shown to delay the onset or severity of mental health problems – including depression and panic attacks. The program reduced truancy in teens who completed training for anxiety-sensitive traits, and cut shoplifting rates among youth attending workshops that targeted high impulsivity (“Brief interventions targeting personality risk factors for adolescent substance misuse reduce depression, panic and risk-taking behaviours,” Natalie Castellanos & Patricia Conrod; Journal of Mental Health, 2009).

Similar findings of reduced depression, anxiety and conduct symptoms were noted in a Preventure trial of 1,024 London adolescents in 2013.

“We have shown that we can achieve reductions in symptoms of these mental health problems and other risk-taking behaviors with the Preventure program,” Stewart says. “The anxiety-sensitivity intervention reduces panic, the hopelessness intervention reduces depression, the impulsivity intervention reduces behaviors like shoplifting.”

The largest Preventure trial is nearing completion at 31 high schools in Quebec, and will evaluate the program’s impact on mental health outcomes, Stewart says.

Managing Their Risk:
How Preventure Helps Teens Handle Extreme Personality Traits

Preventure starts with the 23-item SURPS questionnaire, which identifies teens with high-risk personality profiles (anxiety-sensitivity, hopelessness, impulsivity, sensation-seeking).

“When we do a school-wide screening, about 45 percent of students tested meet criteria for elevations in at least one of the personality risk factors – and thus are eligible for the intervention,” Stewart says.

High-risk youth are invited to attend two 90-minute workshops with students who share similar personality profiles. These targeted group sessions, led by specially trained teachers or mental health practitioners, apply the principles of Cognitive Behavioral Therapy (CBT) and motivational approaches to deter substance use.

Students examine how their specific personality traits can lead to risky behaviors, and why faulty thinking patterns may contribute to drug use and mental health issues. A child with anxiety sensitivity, for example, may worry that a racing heart means an impending heart attack, or that a lack of concentration means they are “going crazy,” Stewart says. When they get nervous, anxiety-sensitive teens may believe others will notice and reject them.

Preventure helps these students “get more accurate information on the anxiety response, learn to identify and challenge their tendency to predict the worst and to catastrophize about the meaning of physical sensations,” Stewart says.

High-risk teens consider how their typical emotional and behavioral reactions hinder their personal goals. They learn new coping skills to manage their personality traits and are encouraged to approach, rather than avoid, anxiety-provoking situations, Stewart says.

“By learning not to fear their anxiety-related sensations, they have a lessened need to use substances to manage their anxiety, or to fit in with peers,” she notes.

Using evidence-based CBT, Preventure shows teens who feel hopeless how to squash negative self-talk. Impulsive youth learn how to manage their tendency to act quickly for immediate rewards without thinking about consequences. As seen in the research trials, this intervention has been shown to reduce drug use and other risky behaviors such as shoplifting.

“For the sensation seekers, we help them find alternative, safer ways of meeting their need for excitement than through drug use,” Stewart adds.

To ensure accurate self-reporting, the Preventure screening is confidential, and the program uses separate staff for the screenings vs. the interventions (so that teens won’t exaggerate gains in order to please a therapist). “And we will include a fake “drug” in the list of drugs we ask about, to detect those who may be exaggerating their substance use,” Stewart says.

A Critical Time for Brain Development

While Preventure could improve the trajectory for teens at risk of addiction, the majority of young people do not develop drug or alcohol problems, research shows.

An estimated 2.2 million American adolescents (ages 12 to 17) are current users of illicit drugs which represents 8.8 percent of the adolescent population, according to the 2015 National Survey on Drug Use and Health.

Alcohol is the substance most widely used by adolescents, followed by marijuana. About 2.4 million adolescents, or 9.6 percent of that population, say they are current alcohol users, and binge drinking is reported by 1.4 million adolescents (5.8 percent of people ages 12 to 17).

Like tobacco use, alcohol consumption has notably declined among the nation’s youth over the past two decades. That’s the evidence from the Monitoring the Future report, an annual survey of nearly 45,000 students in grades 8, 10 and 12. Illicit drug use among these age groups was down slightly in 2015, according to the report, which is funded by the National Institute on Drug Abuse.

Despite these promising trends, experts say adolescence is a crucial time for brain growth and remains the period of highest risk for the onset of future drug and alcohol problems.

In other words, drug abuse can interfere with normal development of the teenage brain. And that puts a young person at higher risk for a substance use disorder.

“Adolescents are more vulnerable to alcohol and other drugs than adults because the parts of the brain responsible for judgment, decision making, emotion and impulse control are not yet fully developed,” says Amy Schreiner, Ph.D., associate research scientist and project director at the National Center on Addiction and Substance Abuse at Columbia University. “This developmental process will not be complete until the mid-20s and makes teens more likely than adults to take risks such as experimenting with nicotine, alcohol or other drugs.”

Indeed, teens are taking risks with addictive substances. Nearly half of high school seniors report having been drunk at least once in their life; 24 percent took illicit drugs in the past month; and two out of three students have consumed alcohol by the end of high school, according to the 2015 Monitoring the Future survey.

As they enter young adulthood (ages 18-25), the fallout is more dangerous. Young adults have the highest rate of substance use disorders, and report an alarming amount of binge drinking –involving 39 percent of the population ages 18-25.

Each year, more than 1,800 college students die from alcohol-related causes, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Heavy drinking also contributes to sexual assaults and other injuries, and jeopardizes academic performance, research shows.

Early intervention, such as the personality-based Preventure program, could shatter these trends by helping high-risk adolescents.

“There is definitely a benefit to implementing effective interventions that target youth with known risk factors as a part of broader prevention efforts,” Schreiner says. She notes multiple personal characteristics and life circumstances that put teens at risk for substance use – including genetic predisposition; family history of substance misuse or addiction; childhood abuse, neglect or trauma; mental health disorders; certain temperament traits and low self-esteem; bullying and poor academic performance.

“Research is continuing to shed light on ways risk factors interact with each other and the environment,” Schreiner says. “This work will help inform the most effective means to identify and target at-risk teens.”

Rising above a field in the scenic Illinois Valley, a billboard catches the eye.  Its towering image shows a fair-haired boy, grinning for his kindergarten school picture.  Beside the happy photo is a solemn plea:

“Every Overdose is Someone’s Child.  Don’t Judge.  Educate.”

Lori Brown authored that message after losing her son, Justin “Buddy” Pratt – the boy on the billboard who grew up, worked in a factory, loved to fish and explored the outdoors with his dog Meeko.  Justin also secretly battled addiction and was found dead in his apartment after a heroin relapse at age 26.

“In my eyes, he didn’t reach out for help because he didn’t want to be categorized with a mental illness or substance abuse label,” Brown says.  Her crusade to end the stigma of addiction and save others echoes a battle cry that’s growing stronger nationwide.

Bonded by the stunning loss from America’s addiction epidemic – drug overdoses continue to rise, killing a record 143 people each day – more voices are rallying for change.

They’re launching social media campaigns to confront misguided perceptions, and shedding anonymity as they share their own recovery stories on sites such as I Am Not Anonymous and Faces & Voices of Recovery.  To shatter the stigma of addiction, parents are going public with their sorrow, stating drug overdose as the cause of death in a loved one’s obituary.

Nonprofits are popping up such as Brown’s organization, “Buddy’s Purpose,” which hosts recovery events and trains people in naloxone (Narcan), the lifesaving medication that can reverse an opioid overdose.  Based on her conversations with families of opioid users, Brown estimates that 10 lives have been saved as a result of the training by Buddy’s Purpose.   College campuses are also providing more formal support for students with substance use disorders; the number of collegiate recovery programs tripled between 2013 and 2015, according to the Association of Recovery in Higher Education (ARHE).

“I’m so glad that there seems to be a recovery movement happening.  When we get to a point where people aren’t afraid to come out and talk about it, no matter what, that will be great,” says Crystal Oertle, a single mother in Ohio who is in recovery from prescription painkillers and heroin addiction.  What has made a difference as much as the personal recovery stories, Oertle says, “is the mothers and other family members telling about daughters and sons who have paid the ultimate price from this disease, and overdosed.”

Like Cancer or Diabetes:  A Disease, Not a Character Flaw

2016 was a watershed year for addiction awareness, led by grassroots advocacy and a series of “firsts:”

• The first time addiction became a central topic of a U.S. presidential campaign, with candidates sharing their personal family struggles related to drug problems and overdose

• The passage of the first and most comprehensive federal legislation to address addiction (the Comprehensive Addiction and Recovery Act of 2016);

• The first-ever report on addiction issued by a U.S. surgeon general.

“For far too long, too many in our country have viewed addiction as a moral failing,” wrote Surgeon General Vivek Murthy, M.D., in his landmark report, released Nov. 17, 2016.

“This unfortunate stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help . . . we must help everyone see that addiction is not a character flaw – it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”

Deadliest Year on Record, Again

More Americans are now dying from drug overdoses than from car accidents or gun homicides, according to the U.S. Centers for Disease Control and Prevention (CDC).  And the toll is climbing.

In 2015, a total of 52,404 people died from drug overdose (143 per day) the deadliest year ever for the epidemic.  The previous record was the year before, 2014, which had 47,055 overdose fatalities (129 per day).  Most drug overdoses involve an opioid such as heroin, illicitly manufactured fentanyl or prescription narcotics, the CDC notes.

America’s struggle with painkiller addiction includes the high-profile death of music icon Prince, who overdosed on fentanyl in 2016.  More powerful than heroin, fentanyl use has skyrocketed in the United States.  Overdoses caused by synthetic opioids such as fentanyl rose 72.2 percent from 2014 to 2015, according to the most recent CDC data available.

A Cultural Shift?

Despite mounting death rates, only about 10 percent of people with a substance use disorder receive any type of specialty treatment, according to the Surgeon General and other sources.  Fear of shame and discrimination is a key reason, along with the lack of screening for addiction and inability to access or afford care.

Oertle remembers the “No Junkies” sign on the pawn shop in her small Ohio town.  “The other time I felt really stigmatized was at the hands of a doctor who was supposed to be helping me with my addiction,” she said.  Oertle overheard the doctor treating another patient for opioid addiction and tell his nurse, “she would be better off overdosing under a bridge somewhere.”  Oertle decided to seek help elsewhere.

One place that could be a turning point for recovery is the local police station.  “Having law enforcement demand access to treatment is a game changer in the struggle to recognize addiction as a disease, not a crime,” says David Rosenbloom, Ph.D., an addiction expert and professor at Boston University School of Public Health.

“Thousands of individuals suffering from addiction are walking into police stations all over the country and getting  immediate help into treatment and recovery because the cops won’t take “no” as an answer,” Rosenbloom says.  “All too often, these same people have been turned away from emergency rooms and treatment programs that have stigmatized them as nuisances and ‘bad patients.’”

Changing the language of addiction to remove any implicit moral judgment is also gaining momentum, experts say.  In late 2016, the White House Office of the National Drug Control Policy (ONDCP) released guidelines that favor language consistent with current diagnostic practice.  For example, the ONDCP recommends referring to a “person with a substance use disorder” instead of using the words “addict” or “substance abuser.” The latter are pejorative terms that have been shown in research studies to be viewed negatively by clinicians and more worthy of punishment instead of treatment.

More accurate portrayals of addiction in movies and television could also reduce stigma that hinders treatment, experts say.

Each year, the Entertainment Industries Council hosts the “PRISM Awards” honoring productions with realistic portrayals of substance use disorders and mental health concerns.  Recent nominees include the film “Danny Collins,” which features Al Pacino as an aging rock star who struggles with drug and alcohol addiction, and the CBS show “Mom,” about a single mother (Anna Faris) who rebuilds her life in recovery (her mother, played by Allison Janney, is also in recovery).

“I have seen on-screen depictions of substance use disorders substantially increase over the past 20 years,” says Marie Gallo Dyak, President & CEO of the Entertainment Industries Council.  “We have entire TV shows featuring addiction, treatment and recovery as major story lines for entire seasons.”

“This is very encouraging,” Dyak says, noting that “it’s the stories that reach families in their homes,  with repetition that establishes an affinity to characters and their life situations, that have the potential to motivate the audience to seek help.”
“The distribution of health information is most effective when we have parallel movement among media and public policy,” Dyak says.  “It is in the power of language and portrayals:  what we hear, what we see.”

Lori Brown, who started “Buddy’s Purpose” in memory of her son, says we’ve made a “small dent” in changing the national conversation about addiction.  Too many people still believe substance use disorders are the result of a character deficit or moral weakness, instead of a chronic but treatable illness, she says.  “I think we have a long way to go to get to where we need to be.”

During her own family’s struggle, Brown says she felt isolation.“I don’t believe people shunned me.  I believe people avoided me because they did not know how to deal with the delicate situation,” she says. “I think it (addiction) should be treated like any other disease.  If your neighbor’s child has cancer, what are you going to say?  ‘I’m going to prayfor you, if you need anything, I’m there.’” Brown says.  “We need your support, your prayers, your acceptance.

The Crystal Man dazzles the audience with his aerial magic. Suspended in mid-air, he spins like a glittering disco ball – bouncing the light off his gem-studded bodysuit. Moving nimbly, he contorts his spine into mind-bending art and levitates above the crowd.

The jaw-dropping performance is from Joe Putignano, the original Crystal Man in “Totem,” produced by the legendary Cirque du Soleil. Millions of people have seen Putignano star in Totem or perform on Broadway, dance on Saturday Night Live, or bring acrobatic thrills to The Metropolitan Opera House.

It’s a stunning comeback for Putignano, a man who defies gravity and the odds of being alive.

Often homeless as a young adult, Putignano survived a free fall into drug and alcohol addiction that lasted 10 years. He was expelled from college and left a promising gymnastics career. Cycling through relapse, Putignano was twice declared dead after heroin overdoses.

“I lost everything to drugs and alcohol. Addiction is the most powerful force I’ve ever encountered,” Putignano says. He tried hard to get clean, but withdrawal was brutal.

“The darkest times I had experienced were the nights when I didn’t want to use, but I had no choice or I would have been ‘dope sick,’” Putignano recalls. “I was in the worst kind of purgatory I could imagine. Addiction is that shadowy place in between life and death. It is a silent, unspeakable hell.”

From Olympic Hopeful To Heroin Street Addict

Growing up in Boston, Putignano was enthralled by a performance he saw on television: a floor routine by Mary Lou Retton, the first American woman to win an Olympic gold medal in gymnastics.

“I was about eight years old, watching an old television set. I believe it was the 1984 Olympics and it was the first time I saw gymnastics,” Putignano recalls. “In this moment, I believe God came and whispered to me: ‘mimic this, this is your passion.’ I immediately took the cushions off the couches and began trying to flip on them. I was obsessed from that moment on.”

Putignano had a natural talent and soon became the state’s top gymnast in his age group.

He was invited twice – at age 11 and again at 13 – to join the nation’s top athletes at the U.S. Olympic Training Center in Colorado Springs.

But intense pressure to be the best – and Putignano’s struggles with self-doubt and sexual identity (he came out as gay at 19) – fueled his substance use.

He experimented with drugs at all-night “rave” parties and became addicted to prescription opioids after getting Percoset for a dental procedure. That progressed to a harrowing, nine-year odyssey with heroin.

“I no longer cared what happened to me or what I did, and I was living like an animal,” Putignano says. “I became a prisoner inside my own body, controlled by something that I could not stop.”

Putignano spent much of his 20s living in homeless shelters and rehab facilities. “Addiction separated me from all those who had loved and cared for me,” he says.

Reviving An Abandoned Dream

A turning point came when a rehab therapist motivated Putignano to get clean for his first love: gymnastics.

“I went to my fourth rehab and met with a counselor who was brutally honest,” Putignano says. “I didn’t realize then that she had the perfectly chosen words which unlocked the key to my addiction. It is difficult for me to talk about this because it seems conceited and full of ego, but what she said was, ‘Joe, you have a gift and I’ve never met anyone like you before. You command the attention when you walk into a room, and I know for certain, you are meant for great things.’”

“For some reason, I felt her words vibrating off my bones, and I knew then, I had to return to gymnastics because that was where my true passion lived,” Putignano says. “Instead of shooting up, I started doing splits and handstands.”

So at age 27, Putignano began working out with fervid devotion, trading addiction for an obsession with exercise.

There would be more battles with drug relapse, but Putignano was resolute about turning his life around. What finally worked was medication-assisted treatment, with the support of 12-step fellowship to deepen his spiritual growth.

“It didn’t matter if it was AA or NA, but I needed a place that could help me identify this ever-growing pain – the God-sized hole,” Putignano says. “12-Step taught me how to be a sober man, and to live in a world that I had so much trouble existing in. I believe, like many say, that I was always searching for a spiritual solution, and that my alcohol and drug use was a low-level search for spirituality.”

To ease drug cravings, a physician gave Putignano the naltrexone implant, which blocks the euphoric high from opioids. He later transitioned to a monthly injection of naltrexone to help prevent drug relapse.

“I still owe the greatest importance to naltrexone for helping me recover,” Putignano says. “I was so sick that I could not stop and I was desperate. I didn’t believe it would work but it did and when I tried to get high, nothing happened.”

“Imagine the kind of freedom and anger one feels at the same time when they want to get high, but can’t,” Putignano adds. His recovery continued moving forward.

Putignano got several big breaks while working on his progress. He was invited to join the cast of the Broadway musical The Times They Are a-Changin,’ a show by famed choreographer Twyla Tharp. Putignano also performed as an acrobat in La Damnation de Faust at The Metropolitan Opera House. And he captivated audiences with Cirque du Soleil, touring nine countries as “Crystal Man” in the evolution-themed production of Totem.

Putignano’s last relapse occurred on March 24, 2007, after he was prescribed Vicodin for another dental procedure and briefly returned to heroin. That was more than nine years ago, and Putignano has been clean and sober since. He even avoided opioids after surgery for a shoulder injury, opting instead for acupuncture and a nerve block for the pain.

A Recovery Advocate, Author Of Accrobadict

As drug deaths continue to rise in the United States – killing more Americans than car accidents – Putignano hopes his journey can illuminate a path for others. He’s written a memoir, Acrobaddict, and has become an advocate for recovery.

“In the beginning, the gift of sobriety feels as if it is wrapped in thorns and barbed wire, as the early days are very raw and painful,” Putignano says. “But once you get to the gift and see what it is, recovery is so beautiful that it is indescribable.”

His best advice for people in recovery is to never give up on themselves. “I believed for myself that sobriety was impossible, but the disease convinces the addict that this is the case. It lies to us,” Putignano says. “Never giving up is the light that slowly cages this power. I say “cage” because for myself, it still lives in me. Some days, I can hear it banging away trying to get out. And others, it is as if I am in remission and I don’t hear a peep.”

Addicts and alcoholics who survive this “painful, long and arduous war,” as Putignano calls it, “have a resilience that is almost God-like. Knowing this will help us get through anything, in addition to conquering most of the obstacles that stand in front of our dreams.”

After a rocky first year in recovery, Buckman decided to start his own tradition. He hosted a Thanksgiving Day Open House for members of his 12-step support group on Long Island, New York. The event became “a very big occasion,” Buckman says, with an abundance of food donated and many guests lingering into the evening.

That was more than 25 years ago. Today, Buckman’s holiday ritual lives on, even though he has since moved away. Now Board Chair of the national advocacy group Faces & Voices of Recovery, Buckman says he returned to Long Island recently and “sure enough, 25 years later, we were still providing this welcoming space for those in need.”

What’s your game plan for the holidays? How do you sustain your sobriety and deal with stressors and temptations? We asked men and women in long-term recovery to share their insights, which we’ve included in these eight strategies for a healthier holiday season:

1. Be the Boy Scout of Sobriety.

The scout’s motto – “be prepared” – is a fitting adage for anyone in recovery. “When I first got sober, the holidays filled me with fear and loathing. It wasn’t really the Hallmark channel at our house,” says Dana Bowman, a part-time English professor and the author of “Bottled: A Mom’s Guide to Early Recovery“. “Now, with a few years of sobriety in me, I actually look forward to all this festivity, but I always have a few tools handy to keep my Christmas spirit intact.”

Bowman never attends a party without a can of sparkling water in hand, food in her stomach and keys in her pocket. Her exit strategy includes a code word (“squirrel”) that she shares with husband Brian when she wants to leave. That strategy came in handy at Brian’s recent office party, when an inebriated guest bumped into Bowman and spilled a full beer onto her. “I took one look at Brian, and through gritted teeth, uttered the code word: SQUIRREL!,” Bowman laughs. “I think that lady thought I was nuts. She started looking around and saying, “Wha-? Whatssit? Where?!”

Planning time for meditation and self-care can also ease your holiday stress. And of course, knowing your limits and how to say “NO” frees up time for more joyous pursuits.

“Think everything through before you do it. Do you really want to be at that holiday party? Do you need to be? Always have a plan before you go, how you’ll get there and how you can leave when you want to,” says Kelly Fitzgerald, a.k.a. The Sober Señorita, who has been in recovery since 2013. “Think about what your triggers might be beforehand and try to deal with them as they come.”

2. When they ask, “Why aren’t you drinking?” try this:

Most party guests won’t know or care whether you’re drinking. But if you do face the query, a quick comeback can put you at ease. Here are some of our favorite responses to the question, “Why aren’t you drinking?,” from the readers at the non-profit New Zealand website, livingsober.org:

“I feel better when I don’t drink.”

“It doesn’t suit me anymore.”

“I’m good, thanks.”

“My doctor has told me I can’t drink for health reasons.”

“I’m driving.” “I’m working (early) tomorrow.” “I’m on antibiotics.”

“Every time I have a glass of wine, a fairy dies.”

“No thanks, if I have one, I’ll want 23 more.”

“I don’t have a stop button when it comes to alcohol.”

“Is it compulsory?”

“I prefer to wake up with a clear head in the morning.”

“Wine was interfering with my sleep. And nothing is more important than my sleep”

“I’ve just lost the taste for it. Doesn’t interest me anymore. I’d love a sparkling water, though, if there is one.”

“I used to drink. I don’t drink any more at all.”

“I realized that I had exceeded my lifetime quota of alcohol, so I quit.”

3. Shore up support.

Giving others a heads-up about your goals creates accountability and bolsters support, says Paul Churchill, host of the popular “Recovery Elevator” podcast. Churchill suggests sending an email such as this one to people you’ll see at holiday events:

“I’m looking forward to seeing everyone at Thanksgiving dinner this Thursday. I just wanted to let everyone know I will not be drinking at Thanksgiving so please don’t offer me a beverage and if you see my with a drink, please roundhouse it out of my hand.”

“This email will do more for your sobriety than you will ever know,” Churchill says.

Remember to check in with your sponsor, therapist or support network throughout the holiday season. There are even mobile apps that will keep your sponsor on speed dial or warn close friends and family when you’re in danger of drug relapse. Sober Grid is a popular iOS app with a “Burning Desire” button that lets others know when you’re in distress or craving alcohol. You can also find a ride to recovery meetings in your area and connect with sober friends while traveling, using the app’s geosocial networking features.

4. Explore the growing sober social scene.

Sober clubbing into the wee hours? It’s a new trend in some major cities, with pre-dawn parties that combine yoga, dancing, camaraderie, and organic energy drinks. Being in recovery today means having social options beyond movie nights and bowling alleys.

“When I got sober, I still wanted to be social, but I didn’t want to necessarily go to an open bar at a nightclub,” Fitzgerald says. “I was able to find dinner and show-type events that suited my sober lifestyle.”

Alcohol-free parties sponsored by Daybreaker.com are spreading from Austin to Vancouver, attracting hundreds of partygoers at each event. “At Daybreaker, we dance our faces off before work and feel gloriously healthy while doing so,” the organizers say on their website.

Finding sober travel companions is also getting easier. Sober safaris, booze-free cruises, and the popular Sober Club Med (on the Mexican Riviera in 2017) are among the trips you can take with Sober Vacations International.

In some states you can attend sober concerts organized by sobernightlife.net, whose rallying cry is “Just because you’re sober doesn’t mean the fun is over!” Non-profit organizations such as Young People in Recovery and collegiate recovery programs sponsor sober tailgate parties and other fun events, often open to non-members.

Perhaps the next new trend will be the “dry bar” – welcoming revelers with live music, sports on the big screen, and all the features of a friendly tavern, sans alcohol. A handful of dry bars have been popping up in recent years, including The Other Side in Crystal Lake, Illinois, and Lights Out in Lancaster, Pennsylvania.

5. Get outside yourself.

Helping others is a powerful way to help yourself in recovery. Research shows that service work in a 12-step program such as Alcoholics Anonymous (AA) can actually reduce drug cravings, according to studies at Case Western University.

“Getting active in service in the 12-step program cuts the risk of returning to the drink-trouble cycle in half — and particularly benefits young adults with social anxiety,” says Dr. Maria E. Pagano, Associate Professor of Psychiatry at Case Western and Principal Investigator of the “Helping Others Live Sober” research project.

“AA can also stand for ‘attitude adjustment,’” Pagano says. “Helping others helps transform the self-centered thinking at the root of the illness to an attitude of gratitude.” Author and screenwriter/producer Robert Hammond says giving back helps him appreciate the blessings of recovery.

“My most powerful Thanksgiving came just a few days after I returned from helping people recover from Hurricane Katrina in New Orleans,” says Hammond, who has two decades of sobriety. “That really put things in perspective. As I visited my family the following week, I had a deeper appreciation for my own situation and a sober, more loving experience with the people in my life.”

You can cultivate gratitude by reaching out in creative ways, such as Buckman’s Thanksgiving Day feast with a “family of choice.”

“No matter how many problems you may think that you have, you can always find something within your situation for which to be grateful,” Hammond notes. “When I used to complain to my sponsor, he would tell me something like, ‘Why don’t you go down to the local jail and talk to an inmate facing a life sentence or find someone in a hospital suffering from a terminal disease? Or go to the local homeless shelter or soup kitchen and talk to a homeless person . . . See if you can get them to feel sorry for you.’”

6. Join a marathon meeting.

Connecting to extra peer support can make it easier to stay sober during the holidays. Many 12-step groups such as Alcoholics Anonymous or Narcotics Anonymous offer all-night “marathon” meetings – either online or in person. Meetings typically start the day before Thanksgiving, Christmas, and New Year’s. An effective way to locate your nearest marathon or regular 12-step meeting is at meeting finder. You can also join a marathon meeting online at intherooms.com.

Or try a mobile app such as Cassava, Meeting Guide, or 12 Steps AA Companion to find recovery support near you. If you’re looking for a secular alternative, you can find a peer meeting at non-profits such as Smart Recovery, LifeRing and Secular Organizations for Sobriety (SOS). Online chat forums are also available to support your recovery.

7. Embrace mocktail hour.

Faux cocktails are on the rise, thanks to the mixology movement and more people wanting to lose the booze. Whether they abstain for recovery, pregnancy, health or religious reasons, adults today are thirsty for refreshing, alcohol-free drinks. And with a mocktail in hand this holiday season, you won’t have to field as many offers for booze.

Some mixologists even take elaborate steps to invent complex non-alcoholic drinks. Bar Tonique in New Orleans, for example, makes a Celery Soda with house Gum syrup, lime juice, Bitter Truth Celery Bitters and charged water. Acorn Restaurant in Denver blends complex bitters with grenadine, blackberries and coconut water for a popular mocktail.

To help you master the mocktail, we’ve put together this collection of recipes that mimic classic bar drinks.

Want to continue your holiday eggnog tradition? Here’s a creamy, alcohol-free version from A Sweet Pea Chef. Or try this easy gingerbread eggnog that contains no eggs, from Cafe Johnsonia. You can also make a healthy, booze-free Driver’s Punch: BBC Good Food.

8. Treat your recovery as a gift.

“Self-pity and self-absorption are the true culprits for ruining any holiday – or other time of the year,” says Julie Orlando, who often drowned her sorrows in alcohol after losing her toddler to a rare genetic disorder. Orlando credits Women for Sobriety with helping her recover from alcoholism; she’s been sober now for more than 16 years. Orlando says she’s come a long way from the early days of recovery, when she would unleash an inner beast she calls “Soberzilla.”

“The mental war on the compulsion to drink and feeling like we are missing out on something, or that we are being punished, really has no place in our heads,” she notes.

Treating your recovery as a gift, one that’s never taken for granted, will strengthen your resolve, Orlando says.

“I can’t drink, so I don’t — and I don’t pretend or toy with the idea that I can. Truth is truth, whether it is a holiday or a Monday, I cannot drink one, ever,” Orlando says. “Truly, the respect I have earned for putting “Soberzilla” to bed for good and accepting myself for who I am and for a disease I am responsible for is really worth it.”

Death from opioid abuse – including heroin and prescription painkillers – is at an all-time high in the United States. But a new treatment option could be a “game changer” in the fight against opioid addiction, experts say.

Probuphine®, a tiny implant inserted into the arm, delivers a constant low dose of buprenorphine – a medication already used to treat opioid addiction – for six months.

The implant offers advantages over taking a daily pill or sublingual film of buprenorphine. Treatment compliance is far less of a challenge, since patients can’t skip, forget or abuse their medication. They also don’t have to deal with getting a prescription refilled. Some doctors say the implant is safer and easier to tolerate because it delivers even levels of buprenorphine into the bloodstream. The long-acting implant also reduces the risk of accidental ingestion by a child, and diversion of buprenorphine for illegal resale.

“For my patients who received the Probuphine, the overwhelming opinion was that it helped them feel more like a ‘normal person,’” says Michael Frost, M.D., one of the first physicians in the United States to administer Probuphine.

Frost, a board-certified addiction medicine specialist in Pennsylvania, was a principal investigator in the most recent clinical trial for Probuphine.

“None of my subjects relapsed during the course of the study,” says Frost. “They all universally felt that having the implants allowed them to focus less on the daily ritual/need to take medication and more on other aspects of their recovery and their lives such as family, career etc.”

78 Opioid-Related Deaths Daily:

Can Probuphine Ease the Toll?

Nationwide, just a handful of patients have received the new Probuphine implant, which was approved by the U.S. Food and Drug Administration (FDA) on May 26, 2016, after years of testing and debate.

Some experts raised concerns that the implant would deter patients from doing counseling, behavior therapy, or other changes needed to prevent relapse. At an FDA advisory hearing in January, others questioned whether buprenorphine pills would be required in addition to the implant, if the dosage was ineffective (Probuphine is intended only for patients already stable on low doses of oral buprenorphine). Another issue concerned potential relapse after the six-month implant is removed, and how to get back on track.

But after reviewing the clinical evidence – and hearing testimony from addiction experts and people in recovery – the FDA advisory panel voted 12-5 to recommend approving Probuphine. Health officials hope the implant’s long-acting effects can blunt the nation’s epidemic of opioid abuse.

“Probuphine has the potential to be a game-changer in how we address the opioid crisis,” says Jack Stein, Ph.D., Director of the Office of Science Policy and Communications at the National Institute on Drug Abuse.

An estimated 78 people die each day in the United States from opioid overdose, and fatalities from all drug overdoses are now the leading cause of injury death in America, surpassing car accidents. Drug overdoses claimed the lives of 47,055 Americans in 2014 – more than any previous year on record – and opioids accounted for 61 percent of those deaths, according to the U.S. Centers for Disease Control and Prevention (CDC).

Stein says the implant adds “yet another effective medication to the clinical toolbox, particularly among patients where compliance may be a challenge such as those involved in the criminal justice system.”

People with opioid use disorders can receive the Probuphine implant at a doctor’s office; the entire procedure takes about 15 to 20 minutes. But finding a physician to administer Probuphine is challenging, until more providers are approved. Doctors are required to be specially trained and certified in the procedure, since the implant must be surgically inserted and removed.

To date, more than 1,100 physicians in 44 states have been certified to provide treatment with Probuphine (mostly addiction medicine specialists and psychiatrists), according to Braeburn Pharmaceuticals. The company owns commercial rights to Probuphine in the United States and Canada under a 2012 license agreement with Titan Pharmaceuticals.

Braeburn estimates that more than 4,000 U.S. doctors will be trained in the implant procedure by the end of 2016.

A Probuphine provider list can be seen at http://probuphinerems.com/probuphine-locator/.

Implant Candidate:

Stable, Already In Treatment

Not everyone is a candidate for the implant. Probuphine is intended for maintenance treatment of drug addiction; in other words, opioid users who are already stable on low-dose buprenorphine.

“It is important to understand that the implant is approved only for individuals with opioid dependence who have already been treated with, and are medically stable on, existing orally absorbed buprenorphine formulations,” Stein says, “thus giving physicians a valuable new therapeutic tool for this subset of patients.”

Probuphine is the only implantable treatment for opioid dependence, and was developed using proprietary technology from Titan Pharmaceuticals. That technology – known as ProNeura™ – is a drug delivery platform that consists of a slender rod (the implant) made from a mixture of ethylene-vinyl acetate and a drug substance (buprenorphine in this case). The delivery system releases the medication from under the skin, slowly and continuously – similar to how intravenous drugs are administered.

Researchers at the Massachusetts Institute of Technology (MIT) developed the implant concept; Titan licensed the patent from MIT in 1996.

“The implant technology allows the formulation to release the drug slowly over an extended period of time, without the up-and-down drug levels in the blood that happen with oral formulations,” says Kate L. Beebe, Ph.D., Executive Vice President and Chief Development Officer at Titan Pharmaceuticals.

The Evidence on Probuphine

Probuphine implants have been tested since early 2000, Beebe says. Clinical trials began with a small study in Australia, since the FDA had not yet approved buprenorphine (in any form) for treating opioid addiction in the United States.

“The study that we did was in 12 adults who were chronic heroin users,” Beebe says. “The results were that these implants were able to release constant, low levels of the drug consistently over six months – and the implant effectively controlled patients’ withdrawal symptoms and opioid cravings.”

Both heroin and prescription drug users were enrolled in the first U.S. study of Probuphine, published in the Journal of the American Medical Association (JAMA) in October, 2010. In that study, 163 opioid-dependent adults were either given the Probuphine implant or a placebo implant for six months. Then urine tests were conducted to determine opioid use.

“There was a more significant reduction in opioid use with people who were treated with the implant, compared to placebo,” Beebe says.

Specifically, the study showed that 40.4 percent of the implant patients tested negative for illicit opioids at four months, compared to 28.3 percent of the placebo group.

Patients who received the real Probuphine implants also had fewer withdrawal symptoms, less drug cravings, and greater change on clinical measures of addiction severity, according to the study results. Patient retention was also higher: 65.7 percent of patients on Probuphine were able to complete the six-month study, vs. only 30.9 percent of the placebo group (many dropped out because of opioid cravings and withdrawal symptoms).

A more recent study compared the effectiveness of the Probuphine implant with the current standard of care for opioid dependence: sublingual tablets containing a combination of buprenorphine and naloxone (brand name: Suboxone).

The six-month study, conducted by Braeburn Pharmaceuticals in consultation with the FDA, tested 177 clinically stable patients who received either Probuphine or the sublingual Suboxone tablet. Results showed that 88 percent of the implant patients tested negative for opioid use for the six months, vs. 72 percent of patients on sublingual tablets. Opioid cravings and withdrawal symptoms were comparable in the two groups, and the implant insertion and removal was “generally well-tolerated,” the study reported (23 percent of Probuphine patients had what clinicians deemed a “mild” reaction at the implant site).

“One key advantage of Probuphine over a daily pill is giving an individual who’s fighting this disease freedom from having to think about taking a pill every day,” says Beebe. “For people who are really struggling with addiction, situations can happen where they’re in the wrong place at the wrong time and there’s temptation to use. (Probuphine) gives them protection against that.”

The Probuphine Implant: A Closer Look

What is the Probuphine implant and how does it help opioid addiction?

Probuphine is the first implant designed to treat addiction to opioids such as heroin or prescription narcotics. Multiple clinical trials have demonstrated that the implant, approved by the FDA in May, is effective at reducing opioid cravings and withdrawal symptoms.

The implant is inserted into the upper arm and delivers a constant, low dose of the medication buprenorphine for six months at a time.

Oral forms of buprenorphine have been used to treat opioid dependence for more than a decade. Buprenorphine works by binding to opioid receptors in the brain, which prevents debilitating withdrawal symptoms when someone stops taking opioid drugs.

Who is a candidate for Probuphine?

Patients with opioid use disorders who are already stable on low-to-moderate doses of oral buprenorphine (8 mg. or less daily) are candidates for the implant. This is a long-acting maintenance treatment and is not appropriate for those just entering addiction treatment.

How much does the Probuphine implant cost? Is it covered by insurance?

The cost of the Probuphine implant is $4,950 for a six-month course of treatment.

Braeburn Pharmaceuticals, which oversees the U.S. commercial launch of Probuphine, says insurers have expressed “strong interest” in discussing coverage for Probuphine. Braeburn notes that United Healthcare and several Blue Cross/Blue Shield plans approved insurance reimbursement for the first patients implanted.

“Now that the FDA has approved Probuphine, Braeburn’s top priorities are to train and certify healthcare providers to make Probuphine available to patients across the country and to establish insurance coverage as quickly as possible,” Braeburn President and CEO Behshad Sheldon said in a statement.

How big is the implant and what happens during the insertion procedure?

The Probuphine implant consists of four slender rods, about the size of a matchstick. Each implant delivers the equivalent of 80 mg of buprenorphine over six months.

A specially trained physician inserts the implant, typically on the inside of the upper arm, using a local anesthetic. This can be done in an office visit and takes 15 to 20 minutes.

A patient may experience mild tugging or pulling as the implant is inserted (or removed). There may be some pain or swelling initially but “typically patients tolerate this very well,” says Kate Beebe, Ph.D., Executive VP and Chief Development Officer at Titan Pharmaceuticals. “In our clinical trials, it was not a deterrent for people wanting to receive future treatment.”

What are the risks/side effects?

As with other forms of buprenorphine, side effects of the implant in clinical trials included the following symptoms: headache, insomnia, upper respiratory tract infection, nausea, anxiety, back pain, depression, constipation, and vomiting.

Patients may also have a reaction at the implant site, such as pain, itching and redness. Rare but serious complications including nerve damage or potentially fatal embolism could result from improper insertion. Due to those risks, Probuphine can be administered only by physicians who complete a live training program on the insertion and removal procedures and become certified before performing the procedure.

What happens after the six-month treatment period ends?

After six months, the implant is removed (it’s not biodegradable). If further intervention is needed, new implants may be inserted in the opposite arm for an additional course of treatment. The FDA is requiring studies on the long-term use of Probuphine.

How do I get the Probuphine implant?

Probuphine will not be available in local pharmacies; the implant can only be prescribed and administered by a trained and certified physician. Braeburn Pharmaceuticals is working to train at least 4,000 doctors in this treatment option by the end of 2016.

To locate a Probuphine provider, go to: http://probuphinerems.com/probuphine-locator/

What else do I need to do for my recovery?

Opioid addiction is a chronic, relapsing brain disease that requires vigilance to prevent relapse. The Probuphine implant is intended to be part of a comprehensive treatment program that includes a combination of medication, psychosocial support and counseling.

Medical students confront the opioid crisis, extol the rescue medicine naloxone.

Every 19 minutes, someone in America dies from an opioid overdose. But a simple lifesaving act – giving a shot of the antidote naloxone – can quickly revive many drug users from the brink of death.

Now a group of Harvard medical students wants everyone to know about the naloxone rescue.

“White Coats for Recovery,” as the group calls itself, is tapping social media to show people how to buy and use naloxone, commonly known as Narcan®. The antidote blocks the path of opioids such as heroin or narcotic painkillers, and can restore breathing back to normal during an overdose – if administered in time.

Naloxone is credited with reversing more than 26,000 opioid overdoses between 1996 and June 2014, according to the Centers for Disease Control and Prevention (CDC).

“We recognized an opportunity to make a small, concrete contribution to the much broader fight against the opioid crisis,” says Siva Sundaram, a student at Harvard Medical School and member of the HMS Center for Primary Care Student Leadership Committee, which launched the social media campaign.

Naloxone was long available only to hospitals and advanced emergency personnel. But new laws in at least 25 states expand naloxone access to police officers and first responders, as well as laypersons who might experience or witness an opioid overdose. While regulations vary by state, today naloxone is dispensed over-the-counter by many pharmacies, health clinics and addiction treatment centers.

“Providing naloxone kits to laypersons reduces overdose deaths, is safe and is cost-effective,” the CDC notes in its report, “Opioid Overdose Prevention Programs Providing Naloxone to Laypersons — United States, 2014.”

An overwhelming 82.8 percent of reported overdose reversals in 2014 were done by active opioid users who carried naloxone; another 9.6 percent of reversals were administered by loved ones who witnessed an overdose, the CDC reports.

To test the availability of naloxone at local pharmacies, Sundaram and his classmates are working with a pilot study at Boston Medical Center. The students try to buy the antidote without a prescription and post photos of their purchases on the White Coats for Recovery Facebook site.

“Our experiences have definitely varied,” Sundaram says. “In some cases, the pharmacist was familiar with the process of providing the drug under the statewide standing order (which allows people to purchase naloxone without a separate prescription) and provided appropriate counseling on how to administer it,” he says. “In other cases, the pharmacist was confused about the procedure and refused to bill the student’s insurance without seeing a separate prescription. Sometimes, there simply hasn’t been any naloxone in stock.”

Ultimately, White Coats for Recovery hopes to stem the explosion of drug overdose deaths and inspire future doctors to provide compassionate, effective care for people with addiction, Sundaram says.

Drug overdoses claimed the lives of 47,055 Americans in 2014 – the equivalent of about 129 Americans each day – according to the CDC. That’s more than any previous year on record, and drug overdoses now surpass car accidents as the leading cause of injury death among people 25-64.

Opioids such as prescription painkillers and heroin accounted for 61 percent of the overdose deaths in 2014, the CDC says. And the toll increasingly impacts American society: 41 percent of adults say they personally know someone who abused prescription opioids in the past five years – and one in five say that abuse led to a fatal overdose, according to a STAT-Harvard national poll conducted in March, 2016.

Many Americans blame the opioid crisis on unsafe prescribing practices by the medical profession. Providers wrote nearly 207 million opioid prescriptions in 2013 – up 172 percent from 1991 – according to the National Institute on Drug Abuse.

More than one in three adults believe doctors who inappropriately prescribe painkillers are to blame for the epidemic, according to the poll by STAT-Harvard.

“Through excessive and careless prescription of opioid painkillers, the medical establishment has helped create this crisis. Yet we, as current and future physicians, dentists, and other healthcare professionals, can be part of the solution as well,” notes White Coats for Recovery on its Facebook page.

Sundaram and his peers want skills-based training in effective addiction screening, diagnosis, treatment and prevention. This spring, they organized their own trainings on how to use life-saving naloxone.

“There have always been individual students interested in addiction medicine, and in most medical schools, there definitely are opportunities for good training in addiction medicine (elective courses, specialists to shadow, etc.) – but students have to seek them out,” he says.

Similar concerns were expressed in a letter to the Deans of Massachusetts medical schools by an advocacy group, The Student Coalition on Addiction, which represents all four of the state’s medical schools:

“. . . Although substance use disorders are common and pervasive, we are concerned that medical students may lack adequate training in and exposure to addiction medicine . . . It is crucial that future medical professionals be trained in evidence-based strategies to care for those who are already affected by addiction. Improvements in safe prescribing practices alone will come too late for the 185,000 individuals in Massachusetts already struggling with addiction, and the more than 1,000 people in the state who died from opioid overdoses in 2014.”

Lack of addiction training is a universal problem in medical schools, according to Kelly J. Clark, President Elect of the American Society of Addiction Medicine.

“Physicians are not adequately trained to diagnose and treat addiction,” says Clark. “As a psychiatrist, I had four years of medical school and four years of psychiatric residency training. My total formal training in addiction was in residency – two months of the four years!”

To reduce the surge of addiction, Clark advocates greater access to medication-assisted treatment such as buprenorphine (brand name Suboxone), which has been shown to be effective in reducing opioid cravings and overdose deaths. She also supports legislation that would increase the number of patients that a physician can treat with buprenorphine (currently limited to 100 patients per doctor).

“As a nation, we need to very quickly understand that addiction is a chronic brain disease,” Clark says. “Like all chronic illnesses, it requires being addressed from a biological, psychological, social, and spiritual approach that allows each individual to best manage their condition over time and live the fullest possible life.”

Understanding addiction as a chronic brain disease will help shed the stigma that keeps people from getting help, Sundaram notes. Even among doctors, that stigma exists, he says.

“Some physicians share the same inaccurate and unhelpful belief that so many Americans do: that addiction is primarily a moral failing,” Sundaram says. “But even among those who think of addiction as a medical illness, I believe there is a widespread sense of hopelessness and ineffectiveness. Many physicians see patients struggling with addiction as the ones who just won’t get better, who won’t or can’t help themselves enough to be helped.”

The Obama administration is asking medical schools to adopt the CDC’s first-ever physician guidelines to curb opioid prescribing. The protocols advise doctors to first try alternatives for treating chronic pain – such as ibuprofen, aspirin or exercise therapy – and to limit opioids to three days, rarely more than seven (the guidelines do not apply to cancer or surgical patients or end-of-life care).

Reforming opioid prescribing is an important step, Sundaram says, but not enough to stop the epidemic of drug abuse. Providing long-term, evidence-based care for people battling addiction is critical, he says.

“Addiction is a treatable illness. It may not have the cure rates we like to see, but just like with diabetes, there are treatments that can help people live better lives,” he says. “We just need to train physicians in the wide range of evidence-based interventions they CAN implement: from Motivational Interviewing to prescribing medications like Suboxone to simply screening patients for substance use disorders.”

More emphasis and funding for addiction treatment – instead of incarceration for drug offenses – is a key component of the Comprehensive Addiction and Recovery Act (CARA), passed by Congress on May 13, 2016. The legislation also strengthens prescription drug monitoring programs and expands access to naloxone to reverse opioid overdoses.

Clark, the incoming president of the American Society of Addiction Medicine, praises the student campaign to put naloxone in the hands of more people.

“It’s wonderful to see both a lack of stigma toward people with substance use disorders as well a passion for public health among doctors in training,” she says.

FREE RESOURCES:

FACT SHEETS ON OPIOID ADDICTION AND NALOXONE USE

OPIOID OVERDOSE TOOLKIT: 5 ESSENTIAL STEPS FOR FIRST RESPONDERS

MEDICATION-ASSISTED TREATMENT FOR OPIOID ADDICTION BROCHURE

FIND THE NEAREST NALOXONE DISTRIBUTION PROGRAM

ADDICTION HELP HOTLINES:

1-800-NCA-CALL (800-622-2255) 24-hour helpline sponsored by the National Council on Alcoholism and Drug Dependence.

1-800-662-HELP (4357) 24-hour National Drug and Alcohol Abuse Hotline offering information and referral services to people seeking treatment and other assistance; sponsored by the Center for Substance Abuse Treatment (CSAT)

1-833-473-4227 24-hour hotline providing free, confidential referrals to treatment programs and rehab clinics nationwide. Sponsored by DrugRehab.org; counselors available 24/7.