This is such a touching article. If only we could capture this empathy and stick it in a syringe, we could vaccinate people from drug-related hatred at birth.
First published on wweek.com, by Erin Fenner on March 13, 2013
Dr. Gary Oxman spent his career trying to save people who don’t care whether they live or die.
Oxman—who just retired as health officer for Multnomah, Clackamas and Washington counties—has long wanted to do more to rescue drug users.
He was one of the earliest supporters in Portland of free needle exchanges, aimed at stopping the spread of HIV among addicts who share syringes. That idea, first floated in the late 1980s, was often met with derision: Why should we condone the use of dangerous drugs by making it safer for addicts to keep shooting up?
Oxman helped champion a needle-exchange program in Portland, and he says it’s the reason the city never saw the explosion of HIV among drug users as other communities did.
“Pure and simple,” Oxman says. “Something that went very right.”
But Oxman, who retired last month, has been unable to reverse another epidemic: opiate addiction.
In Oregon, unintentional drug overdoses now kill more people than car accidents. The drugs that are driving up those numbers and killing most often are opiates—heroin and prescription pain medication, including methadone. In 2011, Oregon saw nearly 300 people die because of opiate overdoses—the highest year yet for heroin deaths. The rate of people dying from opiate-related overdoses has more than tripled in the past decade.
In fact, Oregon has the highest rate of opiate abuse among people under 25 than anywhere else in the country. More than half the drug overdose deaths in Oregon are linked to prescription opiates such as OxyContin and Vicodin.
In Multnomah County, the top killer is heroin. Nearly half of drug users addicted to heroin here say they got hooked first by taking prescription pain pills.
Gov. John Kitzhaber has called the state’s addiction to these drugs “calamitous.”
Oregon has tried to battle drug addiction with education and treatment programs.
But Oxman wants the state to go further.
He wants to expand the use of another drug that will snap users out of an overdose of heroin, methadone or pain pills. It’s commonly called Narcan, and for more than four decades paramedics and emergency-room personnel have injected it into people dying of opiate overdoses to give them a chance to hang on.
Across the country, recovery agencies and treatment centers have been making Narcan (also known by its generic name, naloxone) available to drug users’ friends, families, counselors and even addicts themselves—giving them a chance to deliver a life-saving dose before paramedics arrive.
Considered radical when it started, the wider use of Narcan has saved as many as 10,000 lives by reversing the effect of overdoses. But Oregon—once in the forefront of helping protect the health of drug addicts—has not joined in.
Now, Oregon senators are considering a bill to make it easier to distribute Narcan. By doing so, lawmakers will shift the state’s efforts to fight drug overdoses not just with education, prevention and treatment, but by giving addicts a safety net even as they practice self-destructive behavior.
“These overdoses are individual and community tragedies,” Oxman says. “They can be treated, and so we don’t need to have people dying needlessly.”
A native of Minneapolis, Oxman came to Oregon after graduating from the University of Minnesota Medical School in 1978. When he was in private practice in the early 1980s, he recalls seeing patients he suspected were describing problems with pain that didn’t exist.
“They were trying to manipulate me into giving them opiates,” Oxman, 60, says. “That’s always been there in the community. It’s just way worse now than it was a few decades ago.”
Oxman was named Multnomah County medical director in 1984, and the county’s public health officer three years later. Around 2000, Oxman helped reverse the spike in heroin deaths, in part by targeting addicts themselves with information about how to use the drug more safely.
The overdoses the Portland area sees now are not driven by heroin alone. The long line of drug deaths often begin at the prescription pads of doctors. Nearly half of the prescriptions tracked by state officials last year were for opiates. That amounted to 3.7 million painkiller prescriptions—nearly one for every resident of Oregon.
Drug users say painkillers lead to addiction—43 percent of heroin users in Multnomah County say they were first hooked on prescription painkillers. (Heroin is often cheaper and easier to get than prescription drugs.) These drugs have created a widespread occasion of death. More than 60 percent of current opiate abusers say they’ve seen someone overdose in the past year.
“The docs are sort of trapped in this situation where patients are in pain and there’s no logical alternative,” Oxman says. “It’s not bad doctors. It’s the structure of the health-care system that’s really driving this.”
Tom Burns, director of pharmacy programs for the Oregon Health Authority, says in many cases physicians and dentists over-prescribe pain meds to avoid having to write repeat prescriptions. But Burns says the state has no intention of challenging physicians’ autonomy when it comes to making medical decisions. “We’re not Big Brother,” Burns says.
Instead, the state has tried educating doctors. In 2009, the Oregon Legislature created the Oregon Prescription Drug Monitoring Program, intended to help physicians track their patients’ prescriptions, no matter who writes them. A medical professional who’s concerned about a patient’s use of OxyContin, for example, can log on and see if the patient has been “doctor shopping” by getting prescriptions from other sources.
Ryan Lufkin is a deputy district attorney in Multnomah County who focuses primarily on drug crimes—he estimates he’s handled 1,100 drug cases in the last three years. He says too little money spent on recovery and treatment programs makes matters worse.
“The solution that seems to be the gold standard from a criminal-justice perspective is a treatment bed straight from a jail bed,” Lufkin says. “The ultimate goal is not conviction, but treatment.”
Last fall, Vero Majano came to Portland to help organize a film festival at the national convention of the Harm Reduction Coalition, an organization that works to help protect the health—and the rights—of people who use drugs.
Majano manages a drop-in center for the homeless in the Mission District of San Francisco. A social activist for years, Majano says most people don’t understand the goal of harm reduction—in part because they demonize the drug-using community.
“There’s this thing around drug use being evil,” she says. “So the idea is that drug users are also bad. If people were to look at trauma, how people self-medicate—people use [drugs] for good reasons.”
Majano’s views reflected the message at the conference, which drew hundreds from around the country: Drug users should have no fewer rights to have their health and welfare protected than anyone else.
Yet proponents say society should do more than simply jail people who use drugs, or try to combat addiction through education and treatment programs. It also means helping keep addicts alive and healthy, even when they show no signs of stopping their drug use.
Take the case of Jake Rhew.
He had a good heartâa compassionate soul,â Rhewâs stepmother, Kathy Thomes-Rhew, says.
Before he was out of high school, Rhew got hooked on pain pills and stole medication from his family.
Rhew earned a GED diploma and enlisted in the Army National Guard, only to get kicked out. He moved to his father’s house in Troutdale, stole to buy drugs, and tried to hide track marks on his arms. From 2009 to 2011, Rhew was arrested and charged five times for theft and once for possessing heroin.
“Jake was desperate,” Thomes-Rhew says. “It wasn’t the Jake we knew, and that’s what heroin can do to a person.”
Rhew often recorded his battle with drugs on his Facebook page. “5 months sober,” he wrote in June 2010. Two weeks before his last overdose, he wrote, “Damn going to sleep is a lot harder then [sic] passing out.” And three days before he died, he posted a photo of himself: short-cropped blond hair, broad nose, clean white T-shirt, cautious smile. “Lookin’ good Jake,” a friend wrote.
On Aug. 23, 2011, Rhew, 29, was living at the men’s residence center run by Volunteers of America in Northeast Portland when he and another client slipped into a bathroom to shoot heroin. Rhew was already in full nod by the time the center’s staff found him.” Click the link below to read the entire article…