Opioid Epidemic

It’s hard to explain, but the opening lines of the 1996 British dark comedy Trainspotting does a solid job describing opioid addiction.

“Choose your future. Choose life... But why would I want to do a thing like that? I chose not to choose life. I chose somethin’ else. And the reasons? There are no reasons. Who needs reasons when you’ve got heroin?”

“It’s everywhere,”said Kyle Gautsch ’04, who has been working with Harrisburg City Police since 2005. Now sergeant in charge of investigations, he said, “Heroin has no jurisdiction or race or class. Personal friends of mine have had kids who have overdosed, and they come from a great family.

“This is not just a city issue.”

Scott Young ’90, acting chief at Lower Swatara Police Department, said law enforcement noticed a big shift in the last five years. “It’s not really one class of people. Heroin doesn’t discriminate. ...A lot of it revolves around prescription health insurance and turning to heroin for a cheaper fix.”

Governor Tom Wolf declared the rapid rise in opioid addiction a state crisis last fall, and President Donald Trump classified it as a national health emergency within the last few weeks. From law enforcement to politics to prevention and rehabilitation, several Ship alumni are playing a role in turning the crisis around.

‘It’s everywhere’

When Young worked for Franklin County Probation and Parole in the early 1990s, the drugs of choice remained marijuana and crack cocaine. These drugs appealed to certain people and embedded in certain neighborhoods, he said. “I supervised DUI offenders and inner-city drug dealers. We took the worst of the worst. Opioids were not big at that time.”

As opioid use rose, it became clear that it was affecting more people in less defined areas. “You’d see it in people who were well off and people who weren’t,” he said. “There’s not really a trend with this. It doesn’t discriminate with age, sex, race—it’s all walks of life.”

When Gautsch worked undercover investigations on vice, he, too, witnessed the shift from crack to heroin. When he made arrests as a result of his investigations, he said he often spoke to the users. “I was just being inquisitive. I’d ask, ‘How did you start?’ They’d say because of surgery, a car accident, etc. They’d get addicted to pills, but pills were expensive. Heroin is cheaper.”

Gautsch said cities like Harrisburg traditionally see higher drug use. But opioid use is different. “Drugs in Harrisburg are coming from Philly and New York down Interstates 83 and 81 and the 76 turnpike. There’s a pipeline to get drugs into the city, but they don’t stay in the city. Every community has a drug issue.”

Both Harrisburg City and Lower Swatara are now using Narcan, generically known as Naloxone, which is administered to block the effects of opioids when a user is overdosing.

With the availability of Narcan came the “Good Samaritan” law. This allows someone to report an overdose without facing charges as long as the person identifies who they are and stays with the victim until first responders arrive, Young said. First responders then provide Narcan to the drug user, confiscate any drug paraphernalia, provide an ambulance, and share resources for drug treatments. Law enforcement is not permitted to make an arrest, he said.

“Some people think, they have a problem, they chose to do this, they should suffer the consequences,” Young said. “That’s not my department’s belief; that’s not my officers’ beliefs. Everyone has family or a friend touched by drug or alcohol addiction. ...Our job as first responders is to save lives. That’s our calling.” 

Determining Solutions

The state of Pennsylvania has to take the opioid crisis very seriously, said State Rep. Mark Keller.

In September 2016, Gov. Wolf addressed a joint session of the legislature, stating that Pennsylvania loses ten residents to addiction every day, and the state has been working on solutions to the epidemic since 2014. In his remarks, he said that more than 3,500 Pennsylvanians died that year due to addiction, and the Centers for Disease Control reported that prescription opioid overdose deaths in the United States are four times what they had been in 1999.

“We’re trying to attack it,” Keller said. “We need more awareness.”

This past February, Keller joined US Congressman Lou Barletta at Shippensburg University to cohost a forum on the state’s opioid and heroin epidemic. Similar forums have popped up in communities across the state. Panelists at Ship included medical professionals, law enforcement, the Cumberland County district attorney and coroner, and drug and alcohol specialists. Keller said more than 100 people attended.

“We’re bringing it more to light and paying attention to it more,” he said. “We’re very supportive of addressing the issue.”

As a legislator, Keller said he’s cosponsored rules and regulations that he hopes curtail the growing crisis. One thing he worked to change through new legislation is creating a database of patients who receive prescription opiates so doctors can view what was prescribed when and by whom. “We have to be more cautious,” he said. “Per this legislation, to renew a prescription, you have to actually see your doctor again.”

This statewide database is now in use. Keller said legislators recognize that every person has a different tolerance to pain, and when opioids are used properly to manage that pain, the system works. He recognizes that this new legislation is more time intensive on the medical side, but it makes doctors more aware of how patients are using their pain medication.

“Every patient is different,” he said. “But opioids can lead to something else like heroin. If someone is dependent, we have to have awareness. There are resources available, and we are educating the public.”

Lifelong Recovery

When addressing addiction, treatment is discussed, but recovery often is overlooked, said Kristin Varner ’00. Treatment is a short-term solution, while recovery requires long-term behavioral changes.

As a former alcoholic in long-term recovery, Varner was thrilled to speak on Keller’s panel at Ship and share her perspective. “You’re always in recovery; you’re not recovered,” said Varner, who now is director of RASE’s Carlisle programs, training, and advocacy. “Anyone is vulnerable to slips.” 

RASE is a recovery community organization based in Harrisburg that serves a nine-county area. Its staff and volunteers all are active members of the recovery community. Varner started working with RASE after eighteen months in recovery. “What has helped me the most is understanding. Because I went through it, I can empathize with them.”

After college, Varner said she abused alcohol and did cocaine. At twenty-six years old, she was bartending in Harrisburg and living in her parents’ basement. “Things unraveled for me,” she said. “It just goes to show you, addiction crosses all paths.”

Although she said it took multiple attempts to reach long-term recovery, she explained that she never relapsed. Longterm recovery requires commitment to behavioral changes. It wasn’t until her parents kicked her out and she sought her fifth treatment facility that she truly committed to changing her life.

“Addictions are like lifestyle diseases. You have to change your life to recover, like heart disease,” she said. Substance abuse can initially be addressed with medication like Vivitrol, a once-a-month treatment that blocks the effects of drugs. But true recovery requires life changes.

“The substance doesn’t matter. The drug is not a disease. It’s about the behavior,” she said. “It takes a lot of work to identify relapse triggers.”

Prior to 2008, Varner said insurance companies claimed recovery was unnecessary and would not cover the cost. RASE helped to push through the Mental Health Parity and Addiction Equity Act, or Act 106, which passed in 2010 and provides minimum coverage to alcohol and substance abuse users.

Most people who seek treatment and recovery through RASE are externally motivated, Varner said. It could be family, friends, even finances that drive them to make the initial call. RASE offers a transitional housing program, a recovery specialist program with one-on-one coaching, and a Buprenorphine coordinator program to assist those receiving treatment with ongoing recovery, among other services.

After years of decreased funding, Varner said the state and national focus on the opioid epidemic is starting to benefit organizations like RASE. But there’s still a long way to go to fix the problem.

“People who have this disease aren’t bad people,” she said. “We have to destigmatize the disease through education.”

In addition to awareness, treatment, and recovery, Varner said prevention is key. “We live in a society where we’re told, ‘Just take a pill.’ ...We’re going to lose another generation if we’re not doing prevention.” 

Starting Early

Gautsch still remembers his fifth-grade DARE officer. Launched in 1983 in Los Angeles, the substance abuse prevention education was prevalent in schools through the 1980s and 1990s. Today, few schools use DARE or build relationships with local law enforcement, he said.

“If I have the opportunity to do public speaking, I’m always receptive to it,” he said. “We have to build rapport with kids, then teach them to follow and listen. You listen to people you have a relationship with.”

Young said that when his children’s teachers discovered that he was a police officer, they often asked him to speak to their classes. “More time and effort needs to be put into education,” he said.

Kelly Kiefer ’10-’16m is a prevention specialist in Cumberland and Perry counties. She develops and implements community-based and school programs that provide healthy coping skills for adolescents, youth, and families. “I believe a lot of the struggle with getting prevention out is that schools don’t have the time,” she said. “It’s sad, but the reality is, these are ten-to twelve-week programs. People are too busy—until it’s too late.” 

Kiefer said prevention is key to addressing the addiction crisis, but the focus has to shift away from scare tactics. Providing a one-time lecture on the horrible effects of drugs is proven to stick with kids less than seventy-two hours, she said.

“It’s all about social skill building. We have to teach kids and families how to communicate with each other. Skill building is at the root of it.”

Most of these voluntary programs last eight to twelve weeks. One ten-week program that focuses on strengthening families includes separate two-hour sessions for parents and kids with a combined component at the end. School programs are available for kindergarten through grade twelve and cover topics from risk factors to mental health to dangers at home to bullying. “We gather information ahead of time so we can provide a program that meets the best needs of the school,” she said.

As part of the Commonwealth Prevention Alliance, Kiefer also emphasizes a recent campaign through pastop.org. “There’s a stigma out there that this won’t happen to me or anyone I know. Pastop.org pushes ‘Anyone.’ It was my brother, my uncle. This is real life,” she said. “More and more, this is hitting closer to home.”

Prevention has to be part of the education on opioid and other substance abuse, she said. Because of the fear surrounding the opioid epidemic, the public wants a solution now. “People want to preach and think it will stick, but it’s a process.”

“It’s easy to keep your head in the sand until it’s a problem, but the more aware you are, the more equipped you are to deal with it. You have to be equipped with those skills at a young age,” she said.

Otherwise, Kiefer agrees with Varner—we’ll lose another generation.