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Rural Hoosiers seek answers to counter state opioid crisis

LEBANON, Ind. — A crowd of approximately 400 people filled the Boone County fairgrounds exhibit hall for the Ag Industry and Rural Community Opioid Addiction Symposium on a Friday earlier this month.

Their backgrounds and interest in the topic ran the gamut: law enforcement, public health, city and state officials, farmers, parents, grandparents, health care providers, former addicts, behavioral health workers, businesspeople, concerned citizens. One speaker posed the question: How many have been personally affected by the opioid crisis?

Roughly two-thirds of the crowd raised their hands. If people haven’t been personally touched by the life-shattering effects of addiction, they know someone who has. Communities have been hit hard by overdoses, suicides, jail booking, broken families, lack of foster care, aging grandparents raising grandchildren, dishonesty, theft and prostitution for drug money, abuse, lost jobs, lost opportunities, lost dreams, lost hope.

Where did this crisis start?

Speaker Sam Quinones was a Los Angeles Times investigative reporter who was compelled to quit his job to look for answers. He provides his summary in the 2015 acclaimed book Dreamland: The True Tale of America’s Opiate Epidemic.

He said two factors have been at play: the first in the 1980s, when young doctors fresh out of medical school started a revolution to aggressively treat pain, followed by the rise of black tar heroin pouring into the United States.

Pain management was introduced with the idea was that patients were never to be uncomfortable and always feel good. Pain became the fifth vital sign, with wall charts and smiley faces helping patients indicate their level of pain. “Doctors were to always listen to the patient, and they could be sued for not treating pain,” Quinones said.

He observed that the patient was no longer accountable for their own health. Painful conditions brought about by bad lifestyle choices were simply treated with a pill and the bad choices could continue. The patient was just a victim of those choices.

“We learned that there were consequences of our own bad behavior, but there was a pill for it,” he said.

Purdue Pharma’s OxyContin was one of the biggest players, he said. Pain pills were peddled to health providers by highly-paid sales reps who wined and dined doctors and staff, and offered perks from calendars and hats to entertainment tickets and trips.

Opioids include oxycodone (brand name OxyContin), hydrocodone (Vicodin), codeine, morphine and others, plus synthetics such as fentanyl, and they became the “silver bullet for all adult problems,” Quinones said.

The rise in prescription opiates coincided with the rise in black tar heroin coming out of Mexico and Latin America. Cartels simplified the drug deal process to be as easy as pizza delivery to the home, he said. “The pain relievers are a bridge to heroin, and when the pills stop, patients reach a desperate level and look for a cheap alternative.”

Quinones added that heroin turns people to self-gratification and narcissism, isolating themselves from family and social situations.

Brown County farmer Doug Payne agreed. He was addicted to heroin for years, but became sober in 2007. “Addiction doesn’t care how your parents raised you,” he said. “As addicts, we have to surround ourselves with what makes us feel good.”

Feeling blessed to be alive and now a parent and wrestling coach, he warns other parents to be proactive if their child’s behavior is suspicious, and to know the story in the child’s cell phone: read the texts, look at the photos, know who their friends are.

“The phone is not theirs,” he said. “It’s our job as parents to watch out for our children, and this stuff is killing our kids.”

State Sen. Jim Merritt (R-District 31), who has championed opioid legislation in the past few years, echoed those thoughts. “What are the parents asking? What may be missing: foil, spoons, cash in a purse? What kids are hanging out here?”

What is the answer? In terms of saving lives, naloxone is carried by an increasing number of people who come in contact with opioid addicts: law enforcement, first responders and correctional officials, right on down to family members who carry it in the event of an overdose. Naloxone, or Narcan, rapidly reverses the effects of an overdose.

But as a behavioral issue, Quinones believes the isolationism people have created for themselves in the American culture has contributed to the problem.

“We’ve spent the last 30 to 40 years destroying community, isolated and separated from each other,” he said. He cited empty parks, empty churches, empty streets where children used to play together and family members sitting in silence with their own electronic devices.

If isolation is a cause, then the answer lies in community, Quinones said. If every sector of the community filled just one piece of the puzzle to restore addicts to a meaningful life, there would be a “mosaic of solutions … I believe the antidote to opioids is not naloxone. It is community.”