ISSUES AND ANSWERS: Stacy Robinson on Delaware’s opioid crisis

Stacy Robinson, co-chairwoman of the Sussex County chapter of Attack Addiction, and a school nurse at Sussex Central High School, shares her views with the Delaware State News today on addiction downstate.

What’s the state of access to addiction services in Delaware and particularly downstate?
Downstate access is very limited. We have no rehabilitations in the county, although there is talk of one of the police barracks being utilized as a rehabilitation once the state police move out. The only detox is Harrington, which is really in Kent. We have Sun Behavioral being built in Georgetown, but again, it is not open yet. Right now, we are on a rehabilitation island in the area.

What are the best short-term solutions or resources needed to address addiction in Delaware?
This is not a problem that can be solved with short-term solutions. We need to establish long-term, community based education and family resources that span the generations, towns and provider levels. We need our primary care doctors to be better educated on prescribing practices and rehabilitation and recovery options. We need schools to implement better educational programs that cover all grades and progress based on need and knowledge level. We need people to come out and get involved with the representatives and government officials to lobby for greater resources and funding for our communities and our families.

What’s a realistic timeframe for cutting the opioid crisis in half?
A realistic timeframe? How about 20 to 30 years ago before we ended up here. It is an overwhelming task now.

How do you balance restricting prescriptions to cut the crisis but allow doctors to still provide adequate care?

Stacy Robinson

As a nurse, this is a question that I get often. Restricting prescriptions is a tough ethical question. Here is my opinion, and it is an opinion only: Aside from issues with cancer and long-term chronic pain, there is little need for opioids in basic medicine. Pain is a process that is necessary for healing. Pain is meant to let you know that your body is having a problem. It is unrealistic in many situations to assume that you can be “pain free,” and it is unrealistic for medical providers to make that promise. Short-term pain medication, with frequent evaluation, can cut the uses of opioids dramatically. My mom had a kidney stone. She was given a supply of Percocet for three days. Beyond two days, she would need to be seen again, because her problem was not resolving as expected. This makes sense. Chronic pain sufferers have expressed disdain at the inability to receive months of opioids at a time for their issues. My thought is that if you truly need the medication, and you know there are overwhelming safety issues with misuse and diversion, wouldn’t the responsible thing be to fill your prescriptions on a shorter term basis? Unfortunately, the abusers have ruined it for the rest. It’s sad, really.

What are some warning signs that your children may be on drugs? What should parents be watching for from various age groups, adolescent to teens and college-age?
There are many signs that your child is using drugs. They are behavioral, emotional, and physical. Some of the biggest are: secrecy, changes in friends and behaviors, dropping out of school and social activities, highly emotional or emotionally inappropriate, financially needy, physical changes such as weight loss and hygiene problems, and illnesses that are unexplained and follow a pattern, such as every Monday morning, or flu-like symptoms that occur with a frequency. Body odors and eye appearance are big ones as well.

What are the typical pathways to opioid addiction?
There is not a typical pathway. Some are casual users of alcohol and marijuana, and that progresses. Some are prescribed by a physician. Some are using others’ prescribed medications. Fifty percent of the population has the genetic predisposition to addiction. The typical pathway might be the least likely for any one person.

What typically triggers relapse?
Relapse is not uncommon in opioid abuse. 15 percent of users who have been substance free for five years will still relapse. That is a big number. The usual trigger for relapse is craving. Drug use permanently damages the brain’s ability to regulate the survival and pleasure mechanisms in the brain. Once this mechanism has been wiped out, it will always be wiped out. The recovered substance users I know who remain sober are ones who are actively involved in programs and outreach that keeps them in contact with other sober individuals and groups aiming toward sobriety and change in the addiction field.

How are people learning where to obtain the illegal drugs? And what can be done to cut off these transactions?
Word of mouth. Friends. They can see it in the parking lots of Wawa and Royal Farms in our area. It isn’t hard. Cutting off these transactions means cutting off the supply to stop the demand. As long as there is demand, someone will be there with the supply.

How can you best help a loved one who is showing signs of heavy drug use and addiction?
Educate and take care of yourself first! The No. 1 rule of thumb with substance use disorder is that until the user wants to be sober, no one is going to make them do it. In the meantime, you must be ready with resources and a well-stocked arsenal of information to provide help the moment that person asks for it. The window won’t be open for long, and getting someone help immediately is the crucial thing!

How do you see growing access to Narcan as helping the crisis? Is there a downside to providing the drug in widespread markets?
Narcan saves lives,. There is no downside, as far as I am concerned.

How harshly should the state prosecute nonviolent drug users?
They shouldn’t be punished. They have a disease, and the state should be treating them first!

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