ISSUES AND ANSWERS: Lt. Gov. Bethany Hall-Long on addiction

Delaware Lt. Gov. Bethany Hall-Long, a member of the nursing faculty at the University of Delaware, faculty, shared her views on addiction and the opioid crisis with the Delaware State News. For another perspective, see Monday’s Delaware State News:

What’s the state of access to addiction services in Delaware and particularly downstate?

Delaware needs to improve access to comprehensive mental health and addiction services. Patients and families should be able access the resources available in one stop, from monitoring the detox of a patient at the most intense level to outpatient care at the other end. Confusion on where to turn often exists because there is no one singular agency delivering the total resources we provide.

Many Delawareans go out of state based on the severity of their addiction, or age, or the particular expertise required for their treatment. In turn, due to preapprovals and length of care coverage, insurance can sometimes restrict the patient to the lowest level of care, which often times does not match the severity of their illness. Lengths of stay are reduced and patients are placed in a lower level of care before they are ready. It is insufficient.

The addition of a much needed detoxification facility in Harrington that opened in 2015, and the new 90 bed SUN behavioral health hospital in Georgetown that is slated to open in 2018 will help address access, especially downstate.

There is a lot of work to do to make sure that anyone who is in need of treatment services downstate is able to get them. That is one of the many focal points of our newly formed behavioral health consortium.

What are the best short-term solutions or resources needed to address addiction in Delaware?

Lt. Gov. Bethany Hall-Long

The Behavioral Health Consortium will develop a number of clear goals for Delaware, both short and long term. The short term goal is to reduce the incidence of addiction and the overdose deaths by maximizing the use of public and private resources. The short term solutions require resources to improve and expand access; support for families who are struggling; and coordination among the siloed providers to build a continuum of care by setting aside vested interests for the common good. We cannot lose sight of the long-term goal which is to reduce addiction rates and offer comprehensive mental health services.

A few years ago, I sponsored a bill that allowed community members and law enforcement to have access to Naloxone in Delaware. Naloxone immediately reverses the effects of an opioid overdose when administered without causing any additional harm. We are still seeing far too many overdose deaths, but this initiative has saved countless lives, and allowed individuals who may have otherwise died, to get into treatment. I believe expansion of naloxone will help us continue to reduce those numbers and help get people addicted to opioids into treatment.

How is the Behavioral Health Consortium playing a role in this issue?

The Behavioral Health Consortium is serving in a leadership capacity to offer a roadmap to address the systemic issues that have resulted in a siloed, fractured system that has not tackled this crisis. A goal of the consortium is to reduce the opioid epidemic through improved and expanded access to substance use and mental health treatment and recovery.

The community advocates, individuals in recovery, law enforcement, healthcare professionals, and state leaders who comprise the consortium will forge a plan for action to address prevention, treatment, and recovery for mental health, substance use, and co-occurring disorders. We will be working to directly create a unified short-term and long-term plan for Delaware to save lives and expand resources for those in need.

What’s a realistic timeframe for cutting the opioid crisis in half?

There is not a magic bullet to lower or cut in half the rates of overdose deaths. Each one of these deaths represent a face, a lost life, lost dreams and a devastated family left behind. It is what drives me and the members of the consortium every day to make progress. We are encouraged by the fact that this year the opioid death rate has decreased to date from last year for the first time. At the same time, the use of Naloxone has increased.

To cut the opioid crisis in half, Delaware will need to provide greater access to treatment; more treatment options with longer stays and after care options for sober living, mend the fractured delivery system to offer a continuum of care; and expend resources on prevention.

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

It’s important to remember that prescription medication plays a significant role in medicine, pain management, and even addiction treatment. However, in recent years, there has been widespread abuse of the system which included over prescribing of opioids, doctor shopping and the proliferation of ‘pain management mills’. This led to increased rates of addiction and illicit drug use. In response, we created the Prescription Drug Action Committee (now the Addiction Action Committee), which has worked very hard to create a balance between proper prescribing and abuse of prescription medication.

I was pleased to sponsor the legislation that created the Prescription Monitoring Program (PMP). That program has been successful in monitoring prescribing habits as well as the opioid use of patients. This year the Division of Professional Regulation tightened regulations in a number of areas, specifically the length of time for first time opioid prescriptions. Just since April 1 of this year, the state has seen a 12 percent decrease in opioid prescriptions in Delaware (according to Division of Professional Regulation).

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 a number of indicators and warning signs that someone might be using illicit drugs. Those signs include altered sleep habits, weight changes, frequent sickness, poor hygiene, drastic changes in personality, and increased trouble in school with behavior or performance.

Most prevalent is change in their behavior, performance, social connections, withdrawal, reactivity, slurred speech, measurable differences in healthy functioning and growth. Often times, a family goes into denial which feeds the progression of the disease.

If you believe a friend or loved one might be using, it’s important to find the right time to talk with them about it in a constructive way. Helpisherede.com has some useful tips for starting that discussion and places to get help. You can also contact NAMI of Delaware (888-427-2643), the Mental Health Association in Delaware (800-287-6423), atTAck addiction (302-834-7688) or contact your child’s health care provider.

What are the typical pathways to opioid addiction?

There is no typical pathway to addiction. The current trend is both the authorized and unauthorized use of prescription drugs (pain meds) to heroin. The major issue with heroin is the abundant supply, easy access, and cheap cost. The path to addiction can also occur from the use of other mind or mood altering substances that lose their potency overtime so there is a progression toward stronger substances.

Some people who use are self-medicating as a way to cope with an undiagnosed mental health disorder such as anxiety or depression. This is why it is important for us to be able to better screen for mental health disorders as early as possible. We have also seen many cases of individuals who were in a serious accident or just received surgery and are prescribed opioids to take home. As part of their pain management, they become addicted.

What typically triggers relapse?

Relapse is sometimes triggered by the lack of a recovery plan, minimal to no resources to maintain abstinence such as support, sober living, not addressing trauma and other factors, genetic and family system issues, and high risk behaviors that lead to using again. People need coping strategies and healthy resources to live in recovery. There are many causes for relapse. Quality treatment with a solid after care plan and placement in a sober living environment to accrue ‘clean’ time greatly increase the length of time for being ‘clean and sober’.

Addiction is a chronic disease, and like many chronic diseases, the causes for a relapse greatly depend on the individual, their treatment, their community, and the support system around them. Relapse is not uncommon for those who struggle with addiction, however it is important to remember that no matter how many times someone relapses, it is always possible to overcome addiction.

How are people learning where to obtain the illegal drugs? And what can be done to cut off these transactions?

The progression of the illness is a matter of survival for substance users so they find out where to buy it on the street or to access prescription drugs from a pain management mills. These mills have been a problem that the state is addressing. As an addict’s life changes and they get into the throes of addiction, their lifestyle becomes wrapped around their addiction.

People can obtain drugs from any number of places. A family member’s medicine cabinet, a friend, or on the street. The most important thing we can do as a state is focus on prevention. We have to better educate our children and screen students in schools for signs of mental illness or trauma that may lead to substance use. The better our prevention efforts, the less likely people will be to abuse illegal drugs in the future.

How can you best help a loved one who is showing signs of heavy drug use and addiction?

I have sat with parents, husbands and wives, and grandparents who lost a child or family member to overdose. I have talked to parents and family members struggling with getting help for their child who is suffering with addiction. The grief and pain of addiction has led me to conclude this is a family disease because it affects everyone.

It is imperative that you seek professional help to conduct an intervention for the loved one to enter a treatment facility. It is also important to address the behaviors and symptoms you see. Family members should communicate with compassion, empathy, and honesty that they are ill and need help. During the process, it is also essential that family members access resources for themselves and their family — a family receiving services positively impacts outcomes for everyone, especially the person addicted. Lastly, do not give up, keep fighting to get the services and help needed.

Helpisherede.com has some great tips on how to start the conversation and who to call if the person wants to get help.

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. It interrupts overdose. There would be so many more deaths from overdose. But Narcan does not address addiction. It saves lives. We want to reduce the number of opioid deaths from overdose and Narcan is a way to do this.

I sponsored the bills that allowed Narcan (Naloxone) access to community members and law enforcement. In the years since, multiple law enforcement agencies and first responders and school nurses willingly carry it. Narcan has the ability to revive someone who has overdosed on opioids in a matter of minutes without causing additional harmful side effects. As a result, hundreds of lives have been saved in Delaware, and allowed individuals who may otherwise have died, to get into treatment and have a second chance at life. I look forward to continuing my advocacy for increased Narcan access in Delaware.

How harshly should the state prosecute nonviolent drug users?

For many years, states across this nation, including Delaware, imposed harsh minimum mandatory sentences for low level, nonviolent drug offenses. The thought was that the threat of locking them up for extended sentences would be enough to deter the criminal activity that goes along with substance users trying to feed their habit. And for those it didn’t, prison would keep them off the streets.

We learned that theory was flawed. Drug addiction is a brain disease. It is a chronic disease. With over 80 percent of Delaware inmates struggling with a mental illness or substance use disorder, our prison system has unfortunately become Delaware’s de facto treatment provider. Prison is not the right place for treating addiction and mental illness. For nonviolent drug users, we have to place the focus on prevention and treatment, rather than incarceration.

We have to provide those who are addicted with treatment, not incarceration. Law enforcement agencies throughout Delaware realize this as well. In places like New Castle County, Dover and other local municipalities, programs such as Hero Help and the Angel Program are offering treatment centers in place of jail to offenders when they surrender their drugs. This is the approach we need to pursue.

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