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Beyond the Stigma: We're all fighting the opioid battle, says U.S. Surgeon General

By SHAWNE K. WICKHAM
New Hampshire Union Leader

October 06. 2018 9:03PM
U.S. Surgeon General Dr. Jerome Adams demonstrates how to administer naloxone, the opioid overdose reversal drug, at a forum in Concord on Friday sponsored by Dartmouth-Hitchcock. (Shawne K. Wickham/Union Leader)



CONCORD - It's not every day you get instruction in how to administer Narcan, the overdose reversal drug, from the nation's top doctor.

That's what happened Friday, when Dr. Jerome Adams, the U.S. Surgeon General, presented the keynote address at an opioid forum sponsored by Dartmouth-Hitchcock titled "Our Families, Our Children, Our Future."

Adams, a board-certified anesthesiologist and the former health commissioner in Indiana, said one of his top priorities to address the opioid epidemic is increasing awareness of naloxone, also known by the brand name Narcan.

Last year, 488 people died from drug overdoses in New Hampshire.

"Here's the shocking and dirty little secret," Adams said. "Over half of those individuals are dying at home. They're not dying in a back alley; they're not dying in hospitals; they're not dying in ambulances."

That, he said, "means we're not going to be able to respond to this opioid epidemic just by relying on law enforcement or the medical community."

Everyone who is around someone at risk should carry naloxone and know how to administer it, Adams said.

He showed how simple that is, demonstrating both injectable and nasal forms of the drug.

Adams said he never dreamed he'd be surgeon general. "I also never dreamed that my time in this role would be marked by how many mothers, fathers, sisters, brothers, sons and daughters I'd meet who've lost a loved one to an opioid overdose," he said.

Adams said he also wants to focus on getting prevention messages to kids, starting in elementary schools, but it starts with a conversation, he said.

Page from predecessor

He's taking a page from a predecessor, C. Everett Koop, who in the late 1980s sent a pamphlet with information about HIV and AIDS to every household in America.

"The opioid crisis calls for a similar approach," Adams said.

His office has created a digital postcard (found at surgeongeneral.gov) with facts about addiction and steps to prevent opioid misuse.

Adams asked the providers and advocates who packed the conference room to share the postcard through their social and professional networks.

"There's nothing more powerful than one of you armed with the facts," he told the audience. "And there's nothing more dangerous than one of you out there perpetuating myths."

Finally, Adams said, he wants to work with communities to "de-stigmatize addiction."

"I've often said stigma is our biggest killer," he said.

Adams urged anyone who's been affected by the opioid crisis to "share your story." That's how you can tear down the stigma surrounding this chronic disease, he said.

Then, he took his own advice, telling the forum audience that for him, this fight is personal. His younger brother is serving a 10-year prison sentence for stealing to support his addiction, he said.

"Like so many others, he suffered from unrecognized and untreated mental health issues ... and unfortunately, he turned to substances to self-medicate," Adams said.

"If this can happen to the family of a surgeon general of the United States, it can happen to anybody," he said.

Adams said he recently brought his two sons, ages 12 and 14, to visit their uncle in prison, in part to show them the impact of the opioid epidemic, but also, he said, "I wanted my baby brother to know I hadn't forgotten about him and I wasn't embarrassed of him."

Adams said he feels "blessed" to be in this role. "I believe God put me here for a reason, and I'm proud to serve," he said. "But it is not fun to go to every community in America and the thing you remember about it is someone holding up a picture of their loved one they lost to the opioid epidemic."

Working across the state

Other forum participants shared the work that providers, policymakers and advocates are doing across the state to help people overcome addiction and find recovery.

Cheri Bryer shared how she went from a healthy teenager who was captain of her cheerleading squad to experimenting with drugs and falling into opioid addiction.

"All the best parts of me slowly got sucked away by the pull of my addiction," she said.

When she found out she was going to be a grandmother, Bryer said, she finally committed herself full-time to finding recovery.

"I've risen up a better, stronger person, and I'm full of a passion to give to someone what has been graciously given to me."

Bryer is now a recovery coach in Dartmouth-Hitchcock's Moms in Recovery program, which supports women struggling with addiction.

"I hold their hands and cry with them for the pain and destruction this disease puts in their lives," she said. "The truth is that we are all worthy and as long as we're breathing, we deserve another chance."

Jeffrey Meyers, commissioner of the state Department of Health and Human Services, discussed the system of care that his department is creating with an influx of $45.8 million in federal funding.

The state plans to set up a "hub-and-spoke" model that will serve individuals in their own communities, which will provide medication-assisted treatment, counseling and support for housing and employment.

Currently, Meyers said, people travel from all over the state to Manchester and Nashua to access help through the Safe Station programs at city fire stations.

"Safe Stations has played, and will continue to play, a very significant role in the delivery system," Meyers said. "We're not designing this for that to go away."

"But Manchester and Nashua cannot be the front door for the entire state to respond to the opioid crisis," he said. "And somebody living in Berlin, Colebrook, Littleton, Dover or Keene has to be able to access services on a regional basis. That's what we're trying to accomplish."

Anna Thomas, the public health director in Manchester, talked about the work being done to support families in the city, including programs in schools that teach youngsters leadership skills and resiliency.

Thomas said there was a reason doctors used to make house calls. "It was so that practitioner could get into a home and see what that family is living with - or without," she said. "I think we need to go back to our roots and roll up our sleeves and get into people's homes and neighborhoods."

In the midst of the opioid crisis, Adams said he sees signs of hope "in places like New Hampshire that represent some of the worst statistics but also some of the best examples of hope."

"Recovery is possible," he said. "If we all do our part, we can turn this tragedy that is the opioid epidemic into an opportunity."

"My dream is that we look back 10 years from now and say that was the time we finally stopped fishing people out of the stream on the back end and partnered together to prevent them from falling into the stream in the first place," he said.

Beyond the Stigma, a series exploring solutions to the state's addiction and mental health challenges, is sponsored by the New Hampshire Solutions Journalism Lab at the Nackey S. Loeb School of Communications and funded by the New Hampshire Charitable Foundation, Dartmouth-Hitchcock Medical Center, NAMI New Hampshire and private individuals. Contact reporter Shawne K. Wickham at swickham@unionleader.com.


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