Attacking opioid epidemic a complex task

By Mark Bennett

Some are pregnant women. Others are graying Baby Boomers. Many are twenty- and thirty-somethings.

Tim Kelly sees all kinds of people in his job. He’s a physician at Community Health Network in Indianapolis, where he specializes in treating substance abuse disorders, a scourge affecting thousands of Hoosiers addicted to opioids.

It’s a class of drugs that ranges from the illicit, such as heroin, to prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine and fentanyl. Sometimes, they’re taken for a recreational high, but some people become dependent on the medications from regular, prescribed use.

The users often get labeled “addicts,” “junkies” or other harsh terms. Kelly describes them differently.

“These are the sons and daughters, and brothers and sisters, and spouses and parents of people who are real, living people,” Kelly said Tuesday. “And this is absolutely devastating.”

“This” is the epidemic of opioid addictions. One American dies from an opioid-related overdose every 15 to 20 minutes, Kelly explained. The situation is serious enough that Sen. Joe Donnelly chose Kelly to be his guest at President Donald Trump’s address to a joint session of Congress on Tuesday in Washington.

It’s not a vague crisis in some far-off foreign land. It’s happening right here in Terre Haute, day after day. Just ask Robert Eberhardt, the Terre Haute Fire Department’s assistant chief of emergency medical services. The department’s ambulances carry the drug naloxone, an antidote for opioid overdoses. Naloxone can be administered as a nasal spray, commonly known as Narcan, or through an IV.

Last October, Eberhardt told Tribune-Star reporter Lisa Trigg that he expected the number of Narcan doses administered by the department crews to set a record by the end of 2016. He was right. Last week, Eberhardt confirmed that THFD crews administered 107 doses of Narcan last year, far surpassing the totals of 86 in 2015 and 82 in 2014.

And it’s not getting better so far this year. Twenty-seven doses of Narcan were administered between New Year’s Day and Feb. 28. Should that two-month pace continue, the doses will total 162 by the end of 2017.

Illegal street drugs are gaining potency. The “street chemists,” as Eberhardt put it, might lace heroin with prescription fentanyl in dangerous combinations. “You get a bad batch that goes through the whole city, and you have a bunch of people dying or needing resuscitating.”

In Indianapolis, the facility where Kelly practices started a program for pregnant women with addictions. “And immediately, the program was swamped, and people were coming from Columbus, Richmond, Fort Wayne, Terre Haute, all over the state, because they couldn’t get services in their local communities,” Kelly said during a conference call with Indiana reporters, a conversation that also involved Donnelly.

The situation is overwhelming for emergency rooms, ambulance crews, police, doctors, employers and families. “I often feel like I’m bailing the ocean with a thimble,” Kelly said, “because there are so many people afflicted by this.”

Indiana drew national attention for the problem two years ago, when Scott County — a rural region near the Ohio River — suffered an explosion of HIV cases, primarily involving opioid addicts who were sharing needles. Mike Pence, then Indiana’s governor, responded by hesitantly approving a needle exchange program. Also, state health officials helped enroll hundreds of Scott County residents into Pence’s HIP 2.0 program, funded through Obamacare, which Pence vehemently opposed.

Pence, of course, is now Trump’s vice president. And Republicans in Congress claim to be poised to “repeal and replace” the Affordable Care Act, though that replacement is far from defined or settled. The Trump administration also has hinted at eliminating the Office of National Drug Control Policy, according to a New York Times report, a possibility that concerns Donnelly.

Donnelly sent a letter to Trump, urging him not to cut that office, emphasizing its importance in providing resources to communities to prevent, treat and combat opioid abuse and trafficking. The senator’s also working to preserve legislation, which he helped enact, to cope with the epidemic, including the 21st Century Cures Act.

The president, Donnelly said Tuesday, “has said that he’s all in on that effort” to fight the opioid epidemic. Still, the Times said the White House’s comment on the future of the Office of National Drug Control Policy emphasized that the new administration wants “leaner, more efficient government that does more with less of taxpayers’ hard-earned dollars.”

Kelly served on Pence’s Task Force on Drug Enforcement, Treatment and Prevention. Kelly watched his father overcome an alcohol addiction to become an alcohol counselor with the Veterans Administration. His dad’s victory inspired Kelly to enter the substance abuse treatment field.

He’s seen the strategy of attacking the opioid addiction problem from “the supply side,” including, “punishing people endlessly, trying to stop drugs at the border. We’re not against any kind of legal initiatives and law and order.” But he’s hoping to see the nation’s strategy broaden to the place “where economics and compassion line up.”

That’s the demand side of the problem. Why target that side in trying to stop the scourge?

“The people who have abuse disorders, who are battling this problem, many times they get released from jail, for example, and they’re using (again) the same day, even though they were in jail for 30, 60, 90 days, 180 days a year,” Kelly said. “They relapse very quickly.”

And then the emergency calls go out. And the jails, including the one in Vigo County, fill up.

Without proper treatment or medication, an addict’s chances of beating an opioid addiction is 10 percent. With a comprehensive effort involving “counseling and work on relapse prevention, coping skills, building a positive support network, spirituality, accountability, family involvement, then the success rate becomes very, very impressive,” he added.

It’s like the old Fram oil filter commercial on TV — pay me now, or pay me later.

“The opiate addiction is particularly tough because you either pay for the treatment of this,” Kelly said, “or you get to pay for all the collateral damage, which tends to be much more expensive.”

Mark Bennett is a writer for the (Terre Haute) Tribune-Star. Send comments to