Opinion: How Did Opioid Abuse Overtake The Berkshires? And What Is Next?
Impact of Opioid abuse went unnoticed for years in the Berkshires
by Ralph Brill Associates
I am not a Doctor, Medical Scientist or Medical Reporter.
However, it should be very clear to all by now, that The Berkshires is a hot bed of Drug Abuse. It not only has the Highest Elevation in the State (Mt. Greylock at 3,492 Feet) but, it has More People High. How did this Mecca of Museums and Culture, Safe New England American Images and Safe Music become a 21st Century Drug Den?
The Berkshires is located in the picturesque Taconic Mountain Range about 150 miles from the “Unsafe” Bronx and about 3,000 miles from “Dangerous” Tijuana, Mexico. Curiously, at almost no time are we more than a few miles away from a Drug Store and their endless supplies of Opioids. Our 946 sq. miles of Scenic Country Landscape is dotted with all of the Major Drug Store Brands. Our 130,000 Residents have been able to purchase Opioids Legally within minutes from their front doors. For years, No One Monitored this Very Dangerous Situation!
About thirty years ago, Opioids began to be prescribed as Painkillers for later stage cancer patients. By 1990, Millions of Prescriptions for Opioids were filled in the U.S. By 2010, that number had grown to 254 Million Opioid Prescriptions. By 2015, that number matched the population of the United States. More than 30 Million Americans had used Pain Relievers for Nonmedical Purposes. About 2 Million Americans suffer from Opioid Abuse and more than 500,000 suffer from Heroin Dependency or Addiction.
In MA, in 2000 there were 338 Unintentional Opioid-Related Deaths. By 2015, that number jumped to 1,526 for a total during this period of 10,743 (more than the population of Williamstown) and more than 200,000 Non-Fatal Overdoses according to the MA Dept. of Public Health. It is an Epidemic in MA and The Berkshires is one of the Main Hot Spots for a total of 142 Deaths. In some parts of the U.S. there are reports that Local and State Interventions are reducing the Abuse and Diversion of Prescription Opioids and this is having a Positive Impact. Finally, MA Laws and their Prescription-Drug Abuse Intervention Strategies are now in place. These Laws are just weeks old and we will see how things progress in The Berkshires!
It appears that there are two main populations in The Berkshires who are addicted to Opioids: the Professional Class and the Underemployed. How did we get here? The National Institute of Drug Abuse includes the following as causes for the Drug Abuse Epidemic: Large Increase in Prescriptions Written by Doctors, Aggressive Pharma Marketing and Increased Social Acceptability of Drug Use. According to Dr. Alex Sabo of Berkshire Medical’s Department of Psychiatry, the Added Stress of Poverty in The Berkshires is another reason for our High Rates of Drug Abuse. There is Low Self Esteem among a Large Population whose Low Paying Seasonal Jobs are to Care For and Clean Up after the Wealthy Tourists who are just passing through.
The Death Rate From Opioid Abuse In Massachusetts Is More Than Twice The National Average! In The Berkshires It Is No.5 In The Nation! Not 15th Or 25th, But 5th !!!!
The Professional Class has typically received Pain Killing Opioids from their Doctors after an Injury or Surgery. Often, the Doctors would Prescribe 100 Pills, when their Patient only needed 10 Pills. Often, well after the Pain was managed, the Patient would take the Extra Pills because their Brain Remembered the Good Feelings. Now, they were Hooked and went back to their Doctors for another 100 Pill Prescription! The Underemployed, feeling Useless and Depressed typically got their First Pills from Friends and over time became Hooked! How many Drug Stores are in your Neighborhood? How many Drug Stores are in your friends’ Neighborhoods in other parts of New England? In the 6 Miles from North Adams to Williamstown along Route 2 there are 6 Drug Stores with More wanting to locate here. (Maybe a More Visible CVS at Eagle and Church?) It is Very Profitable to have a Drug Store in The Berkshires. We don’t have a lot of People here, but Our Population Loves Pills. Unfortunately, we don’t have many Locally Owned Drug Stores here anymore. They were purchased or put out of business by the National Chains and the Profits to a
great extent are now sent out-of-state to their various headquarters – so, our treasury wealth is being depleted as well.
In 2013, the U.S. Department of Health declared the Prescription Opioid Overdose Deaths an Epidemic. For some strange reason, it took Gov. Deval Patrick another year of Overdose Deaths in MA before he declared a Public Health Emergency. We had/have the Brien Center, Northern Berkshire Community Coalition, North Adams Hospital, Berkshire Medical Center and Fairview Hospital watching Our Behaviors. What happened? Why did they not put out Bright Red Flags in 2012? From 2000 to 2014, around 500,000 Americans Died from Drug Overdoses. Around 140 Americans Die Every Day from an Opioid Overdose. Our Death Rate from Opioid Overdoses IS MORE THAN TWICE the National Average. How did things get so Deadly in The Beautiful and Cultured Berkshires? San Francisco-based Castlight Health on 20 April 2016 designated The Berkshires No. 5 in the Country for Opioid Prescription Abuse. Where was The Eagle? Where was Williams College? Where was the Berkshire Chamber of Commerce? Where was the Brien Center? Where was the Berkshire Public Health Alliance? Where were our Politicians? Where was David Phelps and his Berkshire Health Systems? All of the above have Failed Us! Why is it taking Outsiders To Point Out Our Epidemic?
Berkshire County Unintentional Opioid-Related Overdose Deaths: 2010, 3; 2011, 6; 2012, 15; 2013, 21; 2014, 28; 2015, 30 – MA Dept. of Public Health
Along those 6 Miles in the Northern Berkshires, around 225,000 Opioid Painkiller Prescription Claims were Registered with the Centers for Medicare and Medicaid Services for 2013. That means that the Patients had to be at least 65 years old or be disabled. The Medical Prescribers were a mix of Physicians, Physician Assistants and Nurse Practitioners. The average number of Prescription Claims for 2013 per Medical Professional was around 2,257. Several Physicians Exceeded 10,000 Prescription Claims for 2013 and Several Physician Assistants and Nurse Practitioners Exceeded 7,000 Prescription Claims for 2013. (10,000 Claims equals approx. $500,000.) These Numbers were Typical for Pittsfield and North County Neighborhoods. South County Abusers selected friendly Pittsfield Doctors. Imagine what the Prescription Claim Numbers were for Patients 14 years old to 64 years old! These Numbers are for a mix of Painkillers including Vicodin, Percocet and OxyContin and could have been used for everything from Tooth Aches and Neck Pains to Cancer Pains. Women are more likely to use Prescription Opioids then Men.
In the 1990s, Opium or Morphine Pills were Prescribed for Patients so as to Manage Severe Pain. The easy access to these Pills brought most of the Big International Pharmaceutical Companies into the Marketplace. Many Thousands of Nonmedical Use Prescriptions of these Painkillers began to generate $Billions in Revenues for Big Pharma. CT based Purdue Pharma was a small player in this world until they Rebranded Oxycodone as OxyContin – “an Almost Safe Addiction-Proof Opioid Painkiller.” Purdue was able to accomplish this by inventing the first Time Release Opioid Painkiller Pill. Purdue made more than $30 Billion with their OxyContin whose claims were Safe Pain Management. Did they know, that without too much trouble, Drug Addicts were able to Bypass the Time Release Structure by Crushing the Pill and Snorting It or Adding Water to the Powder and Injecting it? Even though Purdue continued to promote OxyContin as Safe, they must have known that Hundreds of Thousands of New Users became Addicts – which they did in The Berkshires and around the Country. Purdue continued to Aggressively Market their OxyContin. Thousands more were Hooked and Died of Overdoses. In 2007, the Feds Fined Purdue more than $600 Million in Penalties for “Defrauding and Misleading the Public.”Typical OxyContin Warning: “Swallow OxyContin extended-release tablets whole; do not chew, break, divide, crush, or dissolve them. If you swallow broken, chewed, or crushed extended-release tablets, you will receive the entire dose of OxyContin at once, instead of slowly over 12 hours. This may cause serious problems, including overdose and death.”
All of the Big Pharma continued to Sell the Benefits of their Painkillers to Physicians around the world generating more $Billions. It is believed that Purdue continued to do it better than the others, by Offering Incentives to Pain Management Centers and Physicians which may have included Trips, Money, Cars, etc. Purdue’s Salespeople would provide Free Coupons to Physicians and leave Boxes of Samples in their Offices. These Incentives seemed to have been Habit Forming to our Health Care Providers. Why wasn’t Berkshire Health Systems monitoring things or were they somehow benefiting?
While this was taking place, Purdue’s Scientists developed a New Version of OxyContin which prevented users from deconstructing their Pills. The Addicts weren’t interested in the New OxyContin and continued to Buy the Original OxyContin on the Streets for the New Price of $25 per Pill. The Abuse Proof Pills could be purchased on the Streets for $10 per Pill. Over time, the Original Pills became more difficult to obtain and so the Addicts went back to the cheaper Heroin and this is where we are today.
Typical Internet Instructions for an OxyContin Time Release Pill Injection:
1. Scrape the coating off and crush the pills as finely as possible.
2. Use about 1cc of hot tap water, dissolve the powder as much as possible.
3. Once you get all of the clumps covered with water, heat it gently.
4. When you see enough clear water to insert the point, stop heating.
5. Draw what is in solution through some cotton filter into your syringe.
It is clear to me, that we have not been good about Monitoring the Pain Management Ecosystem in The Berkshires. I’d say we Failed Big Time! Besides Neighbors Needlessly Dying, a loss we cannot afford as our Population is already shrinking from other causes. Also, a Warped Economy took over our Landscape as the Health System Got Richer, the General Population Got Poorer. The Berkshires received State and National Attention as one of the Main Opioid Abuse Centers. This wasn’t a secret to our Health Care Providers. Where were our Community Leaders and Politicians who are supposed to Protect Us? Although Berkshire County was Founded in 1761 – it was Abolished in 2000 by Boston. Therefore, we have No County Leadership in the areas of Health or Economic Development and thus we are in Very Bad Shape in Both Sectors – among the Worst in Health (No. 11 of 14 MA Counties) and a Basket Case as far as Economic Development goes except for Drug Tourism from Surrounding States. Human Resource Specialists know that it costs Employers nearly twice as much ($19,450.) in Medical Expenses per Employee on average to locate in Communities with a High Number of Opioid Abusers. That’s Us! Why weren’t our Leaders focused on this? Who could afford to locate their Business here?
It has taken more than 10 years, but the MA Legislators finally Approved H.4056 which attempts to limit First-Time Prescriptions of Opioids. The Senate took up this Bill and Gov. Charlie Baker Signed An Act Relative To Substance Use, Treatment, Education and Prevention on 14 March 2016. This is an Important Bill and it is hoped this will slow down the Commonwealth’s Opioid Abuses. The Governor wanted a Three-Day Limit of Opioid Pills so that access to Extra Pills would be better controlled – the Democrats and the Massachusetts Medical Society wanted a Seven-Day Limit and that’s what is now in this Bill – the first Pill Limit Bill in the Nation. It appears that about one third of Doctors don’t know how to Manage Opioids, so this Bill Requires Additional Training for Doctors and Medical and Dental Students about Opioid Abuses. For the first time, this Bill allows for Patients to accept a Lesser Amount of an Opioid Prescription than what their Doctor Prescribed. Among other requirements is High School Education about Opioid Addiction. Also, as Painkiller Fentanyl was found in more than half of the Opioid Abuse Deaths, it is now a Crime to traffic in Fentanyl. Hopefully, these New Requirements will begin to bring the MA Epidemic Under Control.
“I am proud to sign this legislation marking a remarkable statewide effort to strengthen prescribing laws and increase education for students and doctors.” – Governor Charlie Baker, 14 March 2016
IDEAS AND THOUGHTS WORTHY OF CONSIDERATION
1. Neighboring Cities seem to have managed their Opioid Abuse Problems better than The Berkshires. Our Doctors are Highly Educated. So, Why is The Berkshires suffering so? Is it the Currier and Ives Stagnant Lifestyle? Is it that Obamacare has Reduced Doctors’ Income more so in The Berkshires?
2. All MA Counties saw a Rise in Opioid Abuse Deaths in 2015 – except one: Hampshire County. It is believed that the fact that Northampton has a Needle Exchange Program has made this difference. Shouldn’t The Berkshires learn from Northampton and similarly Reduce Our Opioid Deaths? As Heroin is expected to Increase in The Berkshires, let us learn from Tapestry Health’s Needle Exchanges in Holyoke and Northampton. More than 76,000 Clean Syringes were given out to Active Heroin Users and 90,000 Used Needles were collected from 1,100 Clients. Free Condoms are also given out. Without these types of Needle Exchanges and other Creative Workable Programs, we can expect to see an HIV and Hepatitis C Epidemic take over The Berkshires next. Are we ready for those Awards?
3. Healthcare is the Biggest Industry in The Berkshires.
Tourism is second. While we were winning Awards as among the Top Opioid Abuse Centers, More Nurses and other Healthcare Workers were employed. Very Little Was Done To Stop Our Epidemic. No incentives! Overdose Deaths are one thing, but there were Thousands that needed other Medical Services for Injuries, Mental Health Issues, Babies born from Addicted Mothers, etc., etc. Millions of Dollars that could have gone to other Healthcare Services for the Broader Population have been directed to Opioid Abuse Matters. It is always More Difficult and More Expensive to fix things after they have plagued our Community for these many years. Every day, our Berkshire Emergency Service Teams are attending to Opioid-Related Incidents and they are finally administering life-saving doses of Naloxone. Statewide, it came to around 1,000 Incidents a month for 2015.
4. MA has some of the Top Medical Schools and Hospitals in the Country. Why is it in 2016 that our Highly Educated Medical Professionals are One of the Main Problems in our Opioid Abuse Ecosystem? Is it the Education? Big Pharma Incentives? Fifteen Minutes per Patient? Etc?
5. Many Communities in MA clearly saw the rise in Opioid Abuse Incidents and added Dedicated Hospital Beds for their Specialized Treatments. Governor Baker’s March 2016 Bill provides Funding for these Beds. Among the last to do anything about our Epidemic, the Berkshire Health Systems announced that they were creating a 30-Bed Specialized Treatment Unit in Pittsfield – the Epi-Center – a month later. Many of the Staff from the Closed North Adams Hospital have asked Why a 30-Bed Specialized Treatment Unit is not also being established for the North County Community at their Hospital? A Very Valid Question. The grass roots Joshua Bressette Recovery Assistance Group will be opening its doors soon in North Adams. Our Health Monopoly – Berkshire Health Systems did announce a $500,000 Investment in the Brien Center to help its Pittsfield Drug Recovery Center. Why not also $500,000 for a Drug Recovery Center at the North Adams Hospital? MASS MoCA’s Joseph C. Thompson and Williams College’s James G. Kolesar are on the Board of Trustees of Berkshire Health Systems. Will they make the case for their North County Community or are they there to just protect their Visitors and Students? We can check the Board Meeting Minutes.
6. Medical Marijuana was Approved in MA in 2012, yet The Berkshire Leaders have prevented a Legal Dispensary from being established here. Those Thousands of our Neighbors who are suffering from various Pains and Health Problems have to travel to Northampton. I don’t get it? The Brien Center has allowed Opioids to explode in The Berkshires, but they are now lecturing against the likelihood of Recreational Marijuana in The Berkshires. I say, it sounds like Big Pharma is indoctrinating them. Two of the Healthiest Millennial Growth States are Colorado and Washington – both States have Approved Recreational Marijuana without any major problems. Further, the Castlight Report points out that those States with Medical Marijuana have about 50% Fewer Opioid Abusers than those States Prohibiting Medical Marijuana. If The Berkshires allowed for a Dispensary, there is a very good chance that there will be an immediate drop in Opioid Abusers. Isn’t this worth a trial?
7. The Berkshires needs to immediately introduce some New Ideas to turn around our Opioid Abuse Landscape. My suggestion is a Drug Shoot-Up Room. These Rooms are functioning very well in Canada, Australia and The Netherlands. This is how they work: Professionally Supervised Rooms are available to Addicts who are provided Sterile Needles who then Shoot-Up. The Addicts then go to a Second Room where they can relax with Magazines, have Tea or Coffee and Professional Staff is there to Talk To. In The Netherlands, the Nurses hang plastic bags that contain Heroin Fumes to Inhale. The Average Client is a 60-year old Male. The results are encouraging as Addicts are Not Overdosing and Street Crimes are Much Reduced. California, New York, Maryland and Washington are exploring Shoot-Up Rooms. Let’s learn how to be a Leader in Addiction Management.
8. On 26 May 2016, the U.S. Food and Drug Administration Approved the implantable Probuphine which provides for a constant six month low-level dose of Buprenorphine and thus provides a new treatment option for Addicts in Recovery. It is hoped that this new Patient Treatment will go a long way in managing this Country’s Opioid Abuse Epidemic. The Desire for Opioids is Decreased with this treatment. Will our Berkshire Doctors come on board?
9. How about getting a Grant to explore Traditional Chinese Medicines in the Treatment of Opiate Addiction? Chinese Medicines have been practiced for more than 2000 years. Over the past 200 years, various Plants, Animal Parts and Minerals together with Acupuncture have been used effectively for the treatment of Opiate Addiction. 10 Chinese Traditional Medicines have been Approved by the Chinese State Food and Drug Administration. Should The Berkshire Medical Community decide to explore adding Chinese Medicines to their New Arsenal, this should be a Positive Strategy that might expand Addiction Management Options. This also could send an Important Message to Young Doctors who might sense a New Medical Innovation Center and want to move to The Berkshires. I would like to establish a Chinese Medicinals Greenhouse in Adams.
10. Young Non-Violent Drug Dealers in Berkshire County are a resource worth examining. The reality is that it has become very difficult to attract and nurture Entrepreneurs in The Berkshires. These often Minority Drug Dealers have learned about Marketing, Security, Product Quality, Finances, etc. on the Streets as Teenagers. Given a Different Business Challenge, they probably can translate those Skills into other Productive Fields with More Knowledge and Confidence than a newly minted MBA. I suggest that the Berkshire Community College establish a World-Class Program around this Challenge.
11. In 2015, Williams College Economics Professor Stephen Sheppard gave an upbeat talk to the Berkshire Chamber of Commerce about the $Billion Impact of Non-Profits in The Berkshires. I didn’t get it then. Now, I get it! His Talk and Report stated that Non-Profits in The Berkshires in 2012 Increased Economic Activity by $2.3 Billion. Of the 373 Non-Profits identified, around 50% were involved with Health and Human Services. What Professor Sheppard Didn’t Say is that during this same period, the Opioid Epidemic Exploded in The Berkshires and None of those $Billions were applied to Solving Our Homegrown Opioid Abuse Problems. What Professor Sheppard also didn’t say is that this was also the same period that Williams College Professors and Alumni were the majority of the Board of the North Adams Hospital and were directing the Bad Management and Bad Investment Decisions which led to the Hospital’s Bankruptcy and Loss of Hundreds of Jobs, thus Devastating the Economic and Social Structures of The Northern Berkshire Communities. If you believe Dr. Alex Sabo’s Statement that the Poverty in The Berkshires is A Reason for our High Rates of Drug Abuse, then I suggest that you connect some of the dots to this Hospital’s Bankruptcy and Closing.
Hopefully, this Notice helps to tell the complex Opioid Abuse Story in The Berkshires in a more complete fashion than can be found anywhere else.
RALPH BRILL ASSOCIATES
Ralph Brill, President