The ongoing opioid epidemic was the subject of a daylong discussion Wednesday among more than 300 service providers, law enforcement officers, doctors and medical experts at Casino del Sol.
Experts talked about responsible prescription writing and improving pharmacy practices and patient assessments. They also spoke about the need to educate more people about keeping their prescription drugs locked up and prescription drug abuse in general.
The Third Annual Southern Arizona Opioid Misuse Prevention Symposium was sponsored by more than a dozen organizations, including the Pima County Health Department, the University of Arizona College of Public Health and PPEP Inc.
Amy Bass, the executive director of PPEP, said a great deal of education needs to be done about trauma and how it predisposes people to addiction.
Studies have shown people who suffer childhood trauma are more likely to engage in unhealthy coping behaviors and have physical and mental health issues as adults. According to a 2012 Centers for Disease Control and Prevention study, child maltreatment cost the U.S. $124 billion in 2008 because of medical costs, productivity losses, child welfare costs, criminal justice costs and special education.
If more doctors were aware of the link between trauma and drug addiction they might ask more questions of their patients and they might change their prescription-writing habits, Bass said.
People who seek opioids and other drugs are often legitimately seeking relief from physical pain but end up finding relief from their emotional pain as well, she said.
"Emotional pain and physical pain both represent from the exact same place in the brain," meaning brain images will show the brain of someone in physical pain will light up in the same area as someone who is in emotional pain, Bass said.
"If you have emotional pain and you have a tooth pulled or you break your leg and I give you oxycontin or vicodin to address your physical pain, what is your brain doing? 'Heaven! I'm all better now. Whatever that stuff is, I need it every day to cope,'" Bass said. "It's because no one has addressed that underlying emotional pain, trauma, whatever you've experienced that has made it difficult to exist comfortably in a normal space."
John Arnold, who founded PPEP in 1967, also said pharmacies need to change their practices. As an example, he said he recently received a call to pick up multiple months' worth of a prescription he'd completely forgotten about.
While it wasn't for a narcotic drug, it could have been, he said.
Bass said the takeaway from the symposium "is that we need trauma-informed approaches across all disciplines, health, schools, law enforcement. Treatment gets it, but we need this in a broader reach across the community."
Teachers could help identity children who are in need of services well before they turn to drugs, she said.
Sometimes teachers get upset and react poorly when a middle school student doesn't turn in their homework for the umpteenth time, she said.
"They don't know that two weeks ago their father beat their mother up or vice-versa in front of that child and one of them got hauled off to jail. They don't know that their single parent just went to prison for selling drugs and they're at home taking care of the other kids. They don't know that that child is being sexually molested by a distant relative or friend," Bass said.
Parents, too, need to be aware of what's going on, Arnold said.
"We have access to all kinds of drugs now and that's the big problem with our kids now," Arnold said. "They're home, their parents aren't there, they go into the medicine chest with all of these colorful pills and they start mixing those things and they start to feel different."
Before too long, they're addicted.
"Why did they take it? They're looking for something different in their lives or there's a situation that's very difficult and conflicting in their lives and they find something that seems to cover that all up," Arnold said.
Arnold and Bass agreed that service providers need to look beyond the physical manifestations of addiction and focus on the causes, too.
They need to use assessment tools to find out if their clients have suffered from abuse, witnessed domestic violence, lost loved ones, etc.
"We're treating the symptoms, but we're not treating the cause. Someone goes in for 21-day rehab program and they come out fine, but they haven't shown you the cause so the next time the stress hits again, it reactivates that conflict that created the addiction to start with," Arnold said.
People in general also need to be kinder when it comes to substance abusers, she said. Once somebody is addicted, their brain is altered.
Pleasure from drugs
According to the National Institute on Drug Abuse, the basal ganglia adapts to the presence of the drug, diminishing its sensitivity and making it hard to feel pleasure from anything besides the drug.
The prefrontal cortex gives people the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. Repeated drug usage damages that portion of the brain so an addict will seek the drug compulsively with reduced impulse control.
"When somebody becomes addicted they are ostracized from normal society, because there's something 'wrong" with them. Yes, there's something wrong, but it's not what you think. They don't have a choice anymore. Their brain has changed," Bass said.