Lenten luncheon 3: Justice and the opioid epidemic

Yesterday, the third in a series of five on the Lenten luncheons presented by the Grand Island Ministerium. The theme for this year's is justice. The topic for this week was "Justice and the Opioid Crisis." It was presented by Father Earle King of Saint Martin-in-the-Fields Episcopal Church.

I will present this in an FAQ (frequently asked questions) format.


In the past few years, deaths from opioid overdose have increased? What sort of statistics are available about the extent of this epidemic?

In Erie County, there were 103 opioid-related deaths in 2012. By 2016, the number increased three-fold to 2016.

In the United States, in 1999, there were 17,000 opioid deaths. By 2012, the number was up to more than 40,000, according to the Centers for Disease Control and Prevention. By 2016, that number increased to more than 64,000.


Could this change?
"There is some guarded hope that the numbers of opioid deaths are dropping."

Wait! What are all of these drugs? Let's start with opium. What is opium and where does it come from?
Opium comes from a poppy plant that grows mainly in Burma, Afghanistan, and Colombia. In fact, 90 percent of all of the opium comes from Afghanistan.

OK. It comes from a plant. Why can't we just grow it in our backyards?
It needs a warm, dry climate to grow. Grand Island doesn't qualify as either. 

What are opiates? What are they used for?
"Opiates are drugs containing or derived from opium. They tend to induce sleep and alleviate pain. The standard for pain relief is morphine. It is fantastic, and, medically, it is good. Codeine is primarily used for cough relief," Father Earle said.

(Aha. Sleep inducing. Hence, when Dorothy, the Tin Man, the Cowardly Lion, and the Scarecrow came across the large poppy field on their way to Oz, Dorothy and the Cowardly Lion gave in to the urge to lie down amidst the flowers and go to sleep. The Wicked Witch of the West enjoyed that too much... until the Good Witch of the North sent snow, which woke up the sleepy heads.)


What is the difference between an opiate and an opioid?
They are similar but opioids are produced synthetically. The first opioid to be produced was heroin in 1874. It was originally used for pain relief, but there were too many problems with it. Apparently, it was too highly addictive to be used safely. It was banned. Other drugs, all used for pain relief, have been developed by drug companies.
Opioids include oxycodone, oxycontin, hydrocodone, and vicodin. All are highly addictive. 

What are fentanyl and carfentanil?
Fentanyl: another opioid. It doesn't take much to kill you. It is very potent, more so than heroin. Even more potent is carfentanil. It's actually elephant tranquilizer. It is so potent and so dangerous that veterinarians wear haz mat suits when they tranquilize an elephant with carfentanil.

Well, if all of those things are so toxic, why do people take them?
Father Earle said that, in the 1990s, there was a new philosophy about treating pain. "We worried more about treating pain than about addiction." Pain is treated with medications known as analgesics, which can range from acetaminophen to opioids.

Who were some of the people who were prescribed opioids?
People who have chronic back problems, people going through major surgeries, and people who have other conditions that result in very serious pain. If you rate pain on a zero to ten scale, with zero being no pain and ten being the most excruciating pain possible, the people who take opioids would most likely be people who claim that their pain level is either nine or ten. 

What was the result? What percentage of people who were prescribed opioids become addicted?
Anywhere from 22 percent to 29 percent of the people who are prescribed opioids become addicted to it. Father Earle described that statistic as "pretty high."

Let's talk about justice. What does that look like for people of faith?

Father Earle recommended getting informed about the opioid issue. One way that he suggested is by going to a training. If you want to attend a training in Grand Island, the next one, which will be sponsored by the Grand Island Kiwanis, is scheduled to be held some time in May. You're invited to check the Grand Island Kiwanis' Club on Facebook (look for Kiwanis GrandIslandny). Upcoming training sessions include:

• 6-8 p.m., March 20th at the Hamburg United Methodist Church, 116 Union Street, Hamburg.
• 5:30 to 7:30 p.m., April 26th, at the Buffalo & Erie County Public Library (downtown), 1 Lafayette Avenue, Buffalo.
• 6-8 p.m., May 9th, at the Unitarian Universalist Church, 695 Elmwood Avenue, Buffalo.

Here is a link to a Erie County Department of Health web page that focuses on the opioid epidemic.

OK, let's continue asking questions about ethics.  What about the behavior of drug companies? What about the way that they advertise these highly addictive drugs?
Father Earle talked about one of the drug companies, Purdue Pharma. This is the company that, in the 1990s, invented Oxycontin. They asserted that it was less addictive because it was "time released." 

"They advertised to doctors who were not pain specialists. The more drugs they handed out, the more rewards they made. They made more than $35 billion. They pleaded guilty in federal court of misleading the public and they paid $600 million in fines."

More information about Purdue Pharma and its legal issues can be found: in this Wikipedia article, titled Purdue Pharma.

What demographic group is most likely to become addicted to opioids?
White males between the ages of 20 and 40.

What is the difference between opioid addiction and alcoholism?
It is OK to let alcoholics "hit bottom" before seeking treatment. Opioid addiction is different from alcoholism for two reasons. Father Earle explained that the addict is likely "to take an overdose and die before hitting bottom." 

Another difference is that you know what is in that bottle of alcohol. You don't know what you're getting when you go out on the streets and purchase heroin. There is no standardization in illegal drugs. 

What is available for opioid addicts seeking help?
Father Earle's answer to this was more questions.
Are there enough drug rehabs?
Who should pay for drug rehab? Drug companies? Insurance companies? Government? 
Father Earle mentioned an Amherst lawsuit against drug manufacturers, concerning the expense of rehab on the town.

What should churches do?
More people should be trained to administer Narcan, which blocks the effects of an opioid overdose. If this medication is given to someone who has not taken an overdose, it will have no effect at all. It is a safe drug.

Librarians are being trained to administer Narcan. They keep Narcan in the libraries. People have been known to go into a library to take their drug of choice.

Narcan could be kept in churches, and church members could be trained in its use.

"It's like having a defibrillator in a church," said Father Earle. "It's a way to save a life."

Next week's Lenten luncheon will be presented by Saint Timothy Lutheran Church.