The SCORE Letter

(SCORE: Surry County Opioid Response Efforts)

Introduction to the SCORE Letter

My name is Denise Krochta. I moved to Surry County a little over 2 years ago from California. My intention was to quietly retire in the foothills of the Blue Ridge Mountains and write and enjoy nature.

Before I left California I dissolved my corporation (Addicts Family Lifeline, Inc) and discontinued my 6 year weekly podcast on Webtalk Radio (“ Addicted to Addicts: Survival 101”) with the intention of changing my focus from helping families and loved ones of addicts to doing something more uplifting in my new community.

After being here I have realized that this community too needs education, resources, and support related to what I know a lot about, addiction and the opioid epidemic. Wherever I live I believe it is important to be a part of the community and to do whatever small part I can to help improve the health and wellbeing of the community. This has made me rethink my goals here.

My husband and I raised our boys in Florida and had what we considered a very normal life. Both boys excelled in school and ended up graduating at the top of their class, applying to the Universities of their choice, each being accepted early decision (not having to apply anywhere else) and happily going off to college one right after the other. Empty nest time, we thought.

Not long after this time, addiction gripped our family and we learned how devastating both emotionally and financially it is. As a researcher I realized there was not much information for families for help and also how big the stigma was around alcoholism and addiction. Through my experience over the next few years I wrote a book to help families navigate through this grueling process and produced the aforementioned radio show hoping to help others in the same unsettled world as mine. Addiction wreaked havoc on our family and almost all lives around us. That’s what it does.

From knowing very little about the topic of addiction and prescription drug misuse and abuse I have, because of my personal experience, spent over 10 years researching about it and interviewing experts all over the country on every topic related to this health crisis.

So, I have joined the office of Opioid Response of Surry County to try to help to improve the health of our county by educating, making those who need them aware of resources, and offering support. I will be soon starting a podcast specific to Surry County which will be posted on the website, I will be taking questions from the community and answering them in a weekly column in the Tribune, and will be out in the community whenever and wherever necessary to help make this something easier to talk about and to work together to help Surry County to be an even better place to thrive than it is already.

Surry County Cares. Please check out our website surrycountycares.com for resources and support. Feel free to send questions and thoughts to me at krochtad@co.surry.nc.us. Feel free to email me anonymously if necessary if you would like to pose a question for the weekly column or get more information about what Surry County has to offer that you might not find on the website. Together we can make a big difference!

Denise Krochta is the author of the book “Sweat: A Practical Plan for Keeping Your Heart Intact While Loving an Addict”.

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Why You Should Care About the Opioid Epidemic

Dear Denise:

I don’t know anyone who uses, why should the opioid epidemic matter to me?

Sincerely,

Wendy

Dear Wendy:

This is a great question to start off this column. A question I am sure many people have interest in.

Statistics show that there is a widespread problem with regards to this epidemic in Surry County and sometimes we just don’t know what we don’t know.

Do you go to the dentist? Do you have a favorite doctor who takes care of you? When you need care is a nurse important to you? One of the main things about this opioid problem is that it is a little different than addictions we are most familiar with. This epidemic began with prescribing legal drugs by doctors. Even now, most people can’t understand this addiction because these pills are legally prescribed by doctors mostly for relieving pain. Fact, almost anything can be abused and misused. This is a perfect example. Access and opportunity play a big role in the prescription drug part of this epidemic. Many medical professionals around the country have been caught up in this epidemic. Some of the effects of abusing opioids are loosing focus, being overly tired, bad judgement, anger and control. Often it is difficult to recognize this in people who use when we only see them once in awhile. Most of the time there is no smell (like with alcohol) or overt signs of use (like stumbling or slurring words). Have you ever seen the tv programs “House” or “Nurse Jackie”? One about a doctor and one about a nurse who abuse prescription drugs but still continue care of their patients. Although these are fictional depictions that were drawn from the real world, this should be a concern for everyone who goes to a medical professional for help.

Would you like to know that the pilot flying your plane or the taxi driver taking you to your destination misuses medication? How about just being on our roads and highways at the same time someone who is using happens to be there too? Is this a concern?

Frankly, just about every human has some access to prescription pills available for abuse. Teachers, first responders, bankers, lawyers, crossing guards, etc.

Did you know that heroin users use syringes? Sometimes people who abuse pills also melt them down and inject with syringes. Have you ever seen used syringes in a public bathroom, parking lot, on the street? Do you know that they are often found on playgrounds, accessible to kids? Should this be something we all should care about?

From my own experience I know that not only people who use these drugs but also those who love them experience many bouts of low focus, distraction, lack of sleep, and energy. How does this affect productivity in the workplace? It is a very negative force and happens everywhere. Should we all be concerned?

These are just a few examples for why everyone should care about helping Surry County to combat this epidemic to bring health and well-being for all who live here.

One more thing that I feel important to mention, again learned from my own experience. Addiction carries huge stigma, with many people believing it involves low or no moral character and criminality. Most people do not share that they are experiencing this in their own families or workplace because of this. This question posed here,( “I don’t know anyone who uses, why should I care about the opioid epidemic?”), brings me to a question for you and all readers.

Do you really not know someone who uses, or perhaps you just don’t know that you know?

Regards,

Denise Krochta

Surry County Opioid Response

Dear Denise:

I don’t know anyone who uses, why should the opioid epidemic matter to me?

Sincerely,

Wendy

Dear Wendy:

This is a great question to start off this column. A question I am sure many people have interest in.

Statistics show that there is a widespread problem with regards to this epidemic in Surry County and sometimes we just don’t know what we don’t know.

Frankly, just about every human has some access to prescription pills available for abuse. Teachers, first responders, bankers, lawyers, crossing guards, etc.

These are just a few examples for why everyone should care about helping Surry County to combat this epidemic to bring health and well-being for all who live here.

Do you really not know someone who uses, or perhaps you just don’t know that you know?

Regards,

Denise Krochta

Surry County Opioid Response

Lock Your Meds

Dear Denise:

When coming into Elkin on 268 I see a billboard, big and black, that says “Lock Your Meds”. I’m not sure I get the implications or the point. It seems to me rather inconvenient and not relevant for the majority of us to consider doing this. So I guess my question is “Why”?

Don

Dear Don:

You are probably aware of the problems related to the opioid epidemic all over the the US including here in Surry County. It all started back about 20 plus years ago when there was an added vital sign, pain, that doctors had to start checking with their patients. Also, at the time, there were new pain killers coming out presented as limited to no possibility of addiction and were a “miracle” when it came to having to deal with pain. Doctors were learning about these new medications and were convinced that they were bad doctors if their patients suffered from pain, because with these great new remedies no one should suffer from pain. Unfortunately, this way of thinking still exists somewhat today.

If you watch tv at all every other commercial is about a new drug to ask your doctor about. Almost everyone takes pills for everything. This has lead to bottles of pills on everyone’s kitchen counters, bathroom medicine cabinets, bedside tables, etc.

We all know that just about anything can be abused or misused. The availability and ease of access to these drugs that turned out to be quite addictive and also abused and misused has resulted in the current opioid epidemic.

There are many ways people become addicted to these opioids but one of the predominant ways is through a doctor. Young people often have their wisdom teeth removed and are sent home with pills. They don’t necessarily become addicted to them but they do like the way they feel and some want to use more to replicate the feeling. It is not only young people who fall into this trap. Because of chronic pain, necessary surgeries, car accidents, etc, people are prescribed these pills, sometimes in bulk, every day.

The idea behind “lock your meds” is to take away this easy access. You might wonder why you might need to do this in your home when you are sure no one would be stealing your pills and locking them up sure would be inconvenient. We just don’t know these days who has been willingly or accidentally captured by this misuse and abuse but we do know that this opioid addiction touches almost everyone in some way.

Did you know that sometimes kids bring a variety of accessible pills to parties these days and they take a few at a time not even knowing what they are? Whatever is just hanging around at home. Did you ever have someone visiting your home or maybe someone come to work in your home who needed to use your bathroom? Did you know that it is common for people to attend open houses and while one keeps the realtor busy the other goes through the bathroom medicine cabinets, checks bedside tables, and peruses the shelves for whatever pills they can grab?

I know this all sounds removed from your world and environment, but we know in Surry County this is a major problem so its got to be happening somewhere where people least expect it.

One way we can be proactive is by taking away opportunity and accessibility. Locking your meds is a start. The opioid epidemic does not stop at pills here in Surry County. But, it is often the way it begins. People often move on to using heroin which is less expensive and the same high. Perhaps if we can prevent the availability of excessive use and abuse of pills, there will be less people moving on to heroin.

Please lock your meds and do your part at helping to make Surry County more healthy. For more information on this topic check out www.lockyourmeds.com. I hope this answers your question.

Regards,

Denise Krochta

You can send your questions to Denise at krochtad@co.surry.nc.us or to Denise Krochta, Opioid Response, PO box 1467, Dobson, NC 27017

What is an Overdose?

Dear Denise:

I read all the time about people suffering from overdoses, multiple overdoses. I thought if you overdose you die. Please explain.

Sincerely,

Janice

Dear Janice:

A few years ago when I was still producing my weekly radio show I asked the same question. I thought that overdose meant you died too. So, I brought an expert on my show and interviewed him to find out what I was confused about. It was kind of a complicated question then but as time has progressed is even more complicated and controversial now.

The short answer is this. When a person overdoses from drugs, and what happens can depend on the type of substance overdosed on, many things can happen. Organs can shut down, cardiac arrest can occur, the respiratory system can slow to almost stopping, kidneys can fail, etc. This doesn’t necessarily mean you will die. It means your body is in major distress and you need emergency help. Depending on the level of distress and the help available, one can be saved. Some people do die.

As I mentioned, nowadays it is more controversial than it used to be. It used to be treated as any of these issues would be. Over the years a drug has been developed and used in emergency rooms called Narcan, which can instantly reverse an opioid overdose. It can often bring a person back to a relatively normal state quickly. First responders now carry this drug and can use it on overdose victims. Recently it has become available for anyone to buy and use. Statistically, here in Surry County, just over the past year many lives have been saved by the more regular use of this drug. There are still many overdoses yet a reduced number of deaths from overdoses.

Here is where the controversy lies. There is a very big stigma still around those who use and abuse illegal substances, prescription drugs included. It is very common to believe that these people are bad people, make bad decisions and must suffer the consequences, and that these kind of people are not related to us, we would not have these kind of people in our lives. Helping people to reverse overdose is the controversy here. Some of those able to give the Narcan believe that there should be a limited amount of times we should try to keep these people alive. Some don’t like the idea of keeping them alive at all. There are those people uncomfortable with allocating government money to pay for this life saving drug to keep people with substance abuse and use disorders alive.

I understand the controversy. I don’t usually express my thoughts on these topics since I do understand both sides. But, I will admit, after working in the field of addiction for many years and meeting so many families and loved ones who suffer from addiction, I have developed a simple attitude. If someone is alive they have a chance to one day make a good decision and turn around their life and become a contributing member of society. If they are dead there is no chance for this. Sometimes it takes multiple chances.

I have been out in the community talking to lots of people in Surry County in all walks of life and have come across both ways of thinking. Some think that these people who suffer from substance abuse disorder choose this life and should suffer the consequences even if it means death. Others, like me, have hope that things will change in a person’s life and they decide to move on a more positive path.

What do you think? I would love to hear from everyone who has an opinion to understand the pulse of Surry County on this issue. Think about it, please.

Regards,

Denise Krochta

Office of Surry County Opioid Response

Evolution of the Epidemic, Part 1

Dear Denise:

I’ve read that the US is the only country dealing with an opiate epidemic and they prescribe way more pills than anywhere else, while there is some abuse and misuse of medications everywhere. How and why did this evolve into such a problem and why is it so prevalent in places like Surry County?

Sincerely,

Cheryl

Dear Cheryl:

There is quite a complicated answer to this question related to a long history going back many years and places. Because of limited space here I am going to try to give you the short overview.

Using pills to feel better or ease anxieties is not a new thing. As far back as the 1950’s there was major use of pills like valium and Librium which were attributed to helping the “ladies” deal with life. But it wasn’t until the same Pharmaceutical companies developed medications to deal with cancer pain and end of life pain later on in the 1980’s did things start to get out of control. These new formulas made from opiates were so effective that doctors saw that their patients didn’t have to die in agony and cancer patients too, could be relatively free of most pain from these drugs. Most people will have heard of morphine for this use. That was one of the original ones used.

As time went on it was thought that these drugs could be used in a limited way on chronic pain patients. After all, why should anyone be in pain if they didn’t have to be? All along this way of thinking seemed ok because it was somehow understood and accepted that there was only a minute chance that these drugs were addictive. No one had really done any major studies on these drugs and the only medical study was a very tiny sample of statistics that was not much of a study at all, but somehow it got to be the gold standard of why they felt this medication was not addictive. (That is for sure what the Pharmaceutical companies preferred everyone believed anyway).

IN the late 1980’s it was determined to qualify pain by naming it the “fifth vital sign” (the other four being pulse, blood pressure, body temperature, and respiration) although pain cannot really be measured objectively like the others. Patient surveys began to dictate the ratings of hospitals and medical practices. The marketing of these medications was very sophisticated and patient targeted and even if a doctor would want to offer other recommendations like exercise or diet changes, or other things unrelated to pills, they felt they could not because patients wanted the quick and easy fix of the pills and would rate them poorly on the surveys. In turn, the hospitals would loose their good ratings and financial support. It just all ended up in the promoting of these pills in every way. Did you know that the US is the only country that allows the Pharmaceutical companies to advertise on television? Every other ad is for some kind of pill. Ask your doctor is heard many times a day during these commercials.

Of course, it has become understood over time how addictive opiates are, now that a whole generation depends on them. They are given to teens after wisdom teeth removal, any kinds of sports injuries, to anyone in any kind of pain, really. A pill for everything, easy fix. It is part of our “instant gratification society. Opiates are in a class of their own. Generally, the more you use and more often you use them, the more you need and more often you need them. I guess I would say access and ease of use is key to the popularity both for legitimate use and illegal use.

And now we are in the epidemic which is bringing death, crime, heartbreak, and domestic disruption to Surry County and the rest of our country.

Not enough time to get into the evolution of opioids as prescribed medication to the major use of heroin and fentanyl in this letter. Still opioids but a whole different evolution.

This is a problem that needs lots of attention or we in Surry County as well as the whole US will be losing entire generations to death, mental illness, and social problems all due to these drugs.

I hope this gives you some insight into the issue. Perhaps next week we can continue on with how heroin came into Surry County.

Regards,

Denise

Evolution of the Epidemic, Part 2

Dear Cheryl:

Last week I covered the evolution from the 1950’s and beyond with pills, especially opiates, for end of life and cancer pain. We covered how about 2 decades ago pain became the fifth vital sign along with blood pressure, pulse, body temperature, and respiration. More pills became available and more pills were prescribed, legally by doctors. One of the issues with these pills is that people do trust their doctors and these were prescribed. No one really thought anything negative would result. Even when it became known that these opiates were addictive, people still trusted that they were safe because they were prescribed. As with many things in our society, some of this opiate epidemic was driven by greed. Most doctors are caring and try to do right for their patients. They followed what they knew. But some pain clinics and pain doctors found an easy way to make a lot of money and took advantage. Lots of opportunity in the environment groomed by the Pharmaceutical companies.

As the years went by and there had been so many deaths from opioid overdoses as well as this epidemic wreaking havoc in communities and families, people became educated and advocacy groups began to emerge. Families marched on Washington and sent letters to their representatives in congress. Moms, especially, researched doctors who were prescribing to their children for no reason or to others in the family, and legislation turned into new guidelines for prescribing opioids. Pills became more expensive and less available. They became harder to buy on the streets and to “doctor shop” for them. BUT, people addicted to these highly addictive opioids still craved the “high” and soon found another way to satisfy the craving with another drug more easily available and less expensive with the same “high”. The drug dealers jumped right on this and started to make heroin very easy to get. People switched to heroin and never looked back.

I would like to take a moment here to clarify something that I found surprising when I began to research this while this was happening in my family. As a mom not versed on addiction or drugs at all I had my preconceived ideas. While learning about the opioid epidemic and abuse of prescription drugs, I had this false sense of calm because my family member was only using pills, not heroin. In my mind I had this idea that pills, because they were legally prescribed by doctors (when not abused and illegally acquired) were less bad and horrendous, than a drug like heroin. Taking a pill seemed so far removed from heroin, needles, and other paraphernalia. Well, please let me set you straight, and educate those of you who, like me, were not up to speed on all of this. One common way of abusing these pills is to melt them and then snort them through a narrow tube or to inject the liquid. Yes, exactly what is done with heroin. I guess the delivery is more efficient. Hard to really understand any of this. Consider yourself educated and updated. Opioid abuse is opioid abuse no matter how you look at it.

Back to the evolution to heroin. So, heroin is very commonly used here in Surry County. The highway system around here makes for easy delivery and exchange. Also, in my research, I have learned that usually one doesn’t die from a pure heroin overdose or a single drug. Most addicts will either mix more than one drug or add alcohol to the mix. Unfortunately, the other big factor is the addition of a drug called fentanyl and another called carfentanyl, which is being added (cut into) the illegal drugs like heroin, cocaine, and meth for higher highs but much higher chance of death. It is impossible to look at the drugs and know if these drugs have been added. People are taking chances and some want the bigger high and hope to live. It is even added sometimes to pills that look just like legally prescribed drugs.

So, this is happening all over the US and Surry County is not immune to it. We at Surry County Opiate Response hope to figure out how to “heal” Surry County. We are hoping to educate the communities in Surry County so we can all work together to this goal.

Regards,

Denise Krochta

What About the Children? (Grandparents and Relatives Roles)

Dear Denise:

I am a grandma who is very concerned about her grandchildren. My daughter and her husband are both heroin addicts. I know they are not very capable of taking care of their children. I spend as much time as I can with them but due to financial and physical constraints I cannot take them full time. I am afraid for them to go into foster care. I hear it is very difficult to get your kids back and I am afraid I will never see them again. But, I am also afraid for them being with their parents. How can we help these kids?

Regards,

Dana

Dear Dana:

As I’m sure you know, you are not the only grandma who needs help. As this opioid problem has grown so has the issue of how to keep the kids safe. As you mentioned, taking the kids away from the family leads to all kinds of problems yet keeping them safe in that environment is of the utmost priority.

You don’t mention the age group of your grandchildren but lets talk a little bit here about what can be happening in these homes so those who are reading this and have no experience with this can get an overview and see just how serious this is.

Over the years I have worked helping families I have come across a lot whose children have been taken away. Usually this solves the “safety” issue temporarily but not the emotional issues. The kids are taken away from the only family they know which most of them consider their normal. They miss their families and are scared that they will never see them again. It is less of a problem with the very young children. The children around 8-14 are especially impacted. Many of them take on trying to keep their younger siblings safe as well as trying to keep their parents alive. It is a big burden for them. I have been with professionals locally who have talked about middle and high school kids who leave school early to get home before their younger siblings or skip altogether thinking that if they are home with their parents they might be able to keep them from dying. Some have been instructed not to talk about the family situation to anyone, especially at school, and have been instructed about the use of Narcan. A lot of responsibility for children. There is also the fears of violence and strangers coming and going. What will their parents be like when they get up in the morning or come home from school? Will they be angry and violent or loving and kind? Are these strangers going to harm them? Many homes with small children turn into almost unlivable situations for children. Those who use and abuse drugs sometimes can’t focus on anything but their next fix and there is no food around or attention to the kids who need to be cleaned, clothed, fed.

There are resources for children as well as grandparents that are beginning to be available nation wide. AARP has some programs that address this issue. Most local mental health facilities have resources. There are grandparent raising grandchildren support groups online (specifically for those related to addiction in the family) who might share resources.

There was an article in the New York Times this week about an elementary school in Ohio where they are attacking this problem head on because there are so many kids there with mental health issues brought on by addiction in the family. They have special classes, resources for the kids, therapists who give them tools to deal with different scenarios that might occur. Just keeping the secret creates so many problems for these young kids.

Dana, these children are victims of a terrible public health issue that is in every city and town in this nation. Surry County is no different. We have basically lost a generation to this epidemic and if we don’t take care of the kids there will be another generation lost to this. I am with you on the impact this is having on children and this should be a major priority. At the county level we are working on this and trying to be able to offer solutions. Please check out some of the resources I mentioned and watch the county website for progress. The children are our future.

Sincerely,

Denise Krochta

Suicide and the Opioid Epidemic

Dear Denise:

You have been inquiring around for questions related to suicide and opioid addiction for this special issue of the paper relating to suicide and I have a question for you. When First Responders deal with an opioid overdose either revived overdose or death, how is it determined if it is recorded as an unintentional overdose or an intentional (attempted suicide) one?

Regards,

Kevin

Dear Kevin:

Difficult question to answer but lets consider it.

First we should talk a bit about how the opioid epidemic and suicide are connected. Both are diseases of despair. Many people who suffer severe depression and feel hopeless turn to drugs to numb their pain. Depression and Substance Use Disorder are the top 2 risk factors for suicidal tendencies. People touched by the opioid epidemic, those who use and those who love those who use, don’t often talk about their feelings or reach out for help. (Having had addiction in my family I can speak here from personal experience.) Some of these conditions of despair are driven by secrecy and shame because of the stigma involved both with mental illness and substance use disorders. Negative social situations related to housing, employment, and family connections sometimes become overwhelming for those not having tools to deal with these life problems.

Those who use and misuse drugs,( more often with opioids than others),often evolve into deep despair through a series of events. For instance, they begin to use the drugs to numb their pain. They become physically dependent on the drugs needing more and more and begin to totally focus on filling these needs. Often they commit crimes, small and large, to get these drugs. They end up in jail or at least in the bad favor of those around them. They begin to feel the judgement of others and then often begin to judge themselves. As they feel worse and worse about themselves, they fall into depression and often become suicidal.

This feeling of hopelessness and despair is most prevalent in rural areas in America. The proportion of deaths by opioid overdose that are suicides is considerable. Nationwide about 30% of opioid overdoses are considered suicide.

After decades, life expectancy in America has begun to decrease in the past 3 years and this has been attributed to the opioid epidemic and suicide. Life expectancy gives us an overview of the nation’s health. This data tells us that we are losing too many Americans too early and to preventable causes.

So, back to your question. How do we know if someone overdoses whether it is an intentional act or accidental? Also, how do we know If this is someone who is a regular substance abuser or if this was an attempted suicide with pills, not abusing before but specifically for suicide? After all, people have been attempting suicide by taking high doses of medications for decades, way before the opioid epidemic was even thought about. In my experience asking these questions of some of the local experts to see if I can pinpoint how this is done I learned that we are not very good at getting these statistics yet. If the person dies and there is no note I’m told it is very difficult to know if it was intentional and it is most often considered an accidental overdose. Another scenario is this. Recently a very potent drug called fentanyl has been brought to the forefront of the opioid epidemic. It is being “laced” with other drugs (combined in the process often) and people are buying these drugs despite knowing how lethal they might be just to get the bigger “high”. So, if they know what they are taking and know they might die, they are not necessarily wanting to die, but willing to take the chance, so considered unintentional. Sometimes they buy drugs not knowing it is laced with this drug and overdose and die, considered an accidental overdose.

Both depression and substance use disorder, as I said before, are considered diseases of despair and hopelessness. We need to get better at getting rid of the stigma and judgment and learn how to help and support the people who suffer with both. Then it might be possible to identify and intervene, and get to the underlying causes, to turn this problem around in our community.

It is very difficult to know the answers. We in the office of Surry County Opioid Response don’t have the answers, but we will keep looking for them. All I can suggest, and very strongly, is always hold your loved ones close and tell them you love them as often as you can.

Sincerely,

Denise Krochta

What to Look For

Dear Denise:

What are some of the signs of drug use we can look for to get an idea if a loved one is using drugs?

Carl

Dear Carl:

There are many signs depending on type of drugs, age of drug user, relationship to person, etc. I will try to give you as much detail as possible and you will have to tailor it to your own situation. Because of my limited space in this letter I think I will answer with a couple of lists rather in a discussion manner.

If you suspect a teenager might be using drugs there are plenty of possible signs. I say “possible” because when dealing with teens many of the signs are the same as just being a teenager. The more characteristics on the list that are attributed to one person the more chance you might be dealing with a young person using drugs. Here are some things to look for in a list of lifestyle changes: isolating, acting secretive, newfound demand for privacy, mood swings, trouble at school, change of friends, becoming defiant, lack of respect for authority, avoiding eye contact, low energy, appetite changes, constant scratching (associated with opioids), wearing long sleeves in the summer, abandoning social activities, evasive answers, forgetfulness, rapid fluctuation in weight, being very protective of a backpack. As you can see, reading this list you might just think it’s just being a teenager, and that is quite possible. Looking back on my own experience I would say this. Tread lightly, be aware, ask questions, engage, and if you have to make the choice of worrying about your teen being insulted that you don’t trust them or preventing a long road to addiction and bad behavior, go for the latter. We need to do what we can to keep these kids alive and if we have to insult them in the process so be it. I wish I had asked more questions.

Here are some of the things to look for not related to habits but related to paraphernalia and other things. Odd smells, random containers with cotton swabs, pills, white powder or brown powder residue, empty plastic containers, metal/water proof container, little pcs of papers, ledgers, flashlights, phone lists (descriptions of people but not names), butane lighters, spoons, small scales, small pcs of aluminum foil, empty tubes from the inside of ball point pens, belts (for tourniquet), things taken apart and not put back together, baggies, rubber bands, coloring books and pencils (mostly female meth addicts), nickels (for calibrating digital scales), pipes and needles.

Much of what I have been listing can relate to all genders and ages, not just teens. I never really knew what the drugs looked like but you would probably recognize them if you found them. Prescription pills, heroin, and fentanyl are the most familiar opioids used. I would suggest if you want to know what heroin and fentanyl look like (the different colors and forms) as well as meth and cocaine check online. It is better for you to see them for yourself than for me to describe them.

Something else to look out for around your home and environment : Are you missing any cash? Are you missing prescription pills? Any favorite things (often small and relatively valuable like jewelry and electronics) missing? Have you noticed your teen paying an unusual amount of time at the grandparents who might be on a variety of prescription drugs? I mention all of these things for this reason. Often someone who abuses drugs will steal things, just enough for them to use but not enough for us to notice right off that they are missing. Maybe when we get to the end of a 30 day prescription we notice we only get 22 days and the rest of the pills are gone. Or, we had cash put aside and we take the cash and there isn’t as much there as we put there. When you ask about this don’t be surprised if your loved one says you must have accidentally taken more than one pill a day or miscounted, or you probably used the cash and forgot, and you must have lost the jewelry last time you wore it.

I think you have enough to start with here. For more information about signs and situations check out NIDA (National Institute on Drug Abuse) and surrycountycares.com. I hope this overview was helpful.

Sincerely,

Denise Krochta

Why Don't They Just Quit?

Dear Denise:

I know quite a few people who have gotten mixed up with opioids and have become addicted to either pills or heroin. Many of them have lost a lot. Some have lost their jobs, their families, their homes, their cars, almost everything. This doesn’t seem to make much of an impression on them. They continue to use. Why is that?

Regards,

Megan

Dear Megan:

I’ll try to explain what I’ve learned in an uncomplicated way. It is a very complicated problem. It is very frustrating to those who know and love these people suffering from opioid abuse. I often hear “Why don’t they just quit?” which is what you are asking too. I asked that too for a long time before I got an answer that at least made some sense.

Most of what we know is about how these opioid drugs affect the brain. This particular group of drugs act in the nervous system to produce pain relief and also pleasure. Some familiar opioids are Oxycontin, codeine, morphine, Vicodin, and Percocet. Opioids change the chemistry of the brain and lead to drug tolerance. Over time of regular use the body needs more to get the same effect. When someone uses high doses of opioids every day for a few months there is a loss of these tiny structures in the brain called dendritic spines. These structures help neurons to communicate with each other. Loss of these structures can lead to trouble reasoning and thinking through problems, and making decisions. After using opioids for an extended period of time most people will become physically dependent but not addicted. (Dependence is when your body becomes accustomed to the use and when you stop taking the drug there are physical and psychological symptoms of withdrawal.) A small percentage will become addicted and it overtakes their thoughts and actions in most moments and situations. Opioid addiction often causes life threatening health problems including the risk of overdose. Overdose occurs when high amounts of opioids are taken and cause respiratory distress that might lead to unconsciousness or death.

So, we learn that opioids can take away the ability to make good decisions, attack problems logically, and reason. Many times someone who is suffering from opioid abuse will argue quite vehemently about something that is totally incorrect but he really believes it and will stick to his argument. It is because his brain is not working exactly right. It is a disease of the brain.

Opioid addiction can take over a person’s life. As you have stated in your question, many people lose most of the things in their lives that they love the most but the drug takes over as a priority. Getting high is all they think about. It is very difficult to enjoy anything that gave them pleasure before substance abuse.

It’s important to know that there are many variations in genes that contribute to the risk factors for becoming addicted or not. Genetics, environment, and social interactions, and even certain personality traits contribute to whether someone will become addicted. It’s really not a choice as most people believe.

As you can see, it is not as easy to “just quit” once the opioids have begun to play a part in how your brain works. People may want to stop, return to what seems “normal”, enjoy what they previously enjoyed, but just can’t do it.

Opioid addiction is here in Surry County in a big way. Almost everyone knows and/or loves someone affected by this public health problem. Surry County is learning about the best ways to reduce and limit the problem and help to heal our county. It is a difficult task.

Thanks for your question.

Sincerely,

Denise Krochta

Surry County Statistics, Part 1

Dear Denise:

The Surry County Board of Commissioners felt it was necessary to hire an Opioid Response Director. I see you are working with him now so already expanding the department. Can you give us some facts and statistics so we can better understand why this was necessary, please?

Thanks,

Jim

Dear Jim:

Sure. I have spent some time this week with Mark Willis the Opioid Response Director for Surry County to talk about what facts might help the community to understand just where Surry County stands within the overall Opioid epidemic in the US and more importantly to us, North Carolina.

The population of Surry County is approximately 72,000. Most of our statistics for the State are numbers per 100,000. Most of our statistics are from reported EMS calls and visits to the ER. Last year nation wide overdose number is 72,000, the same as the population of Surry County. (Be advised that there are many more unreported overdoses not resulting in death and those that do result in death are often attributed to other causes.)

Surry County specifics:

In 2017 there were 237 reported ODs. In 2018 there were 372 reported ODs. Of these in 2017 there were 55 deaths. In 2018 there were 31 deaths.

From the North Carolina Division of Public Health we have these statistics. In 2018 in the entire state, the 2nd highest rates of opioid overdose ER visits (per 100,000) were in Surry County at 159. According to DHHS Surry County was ranked #2 in February of 2019, #5 in March of 2019, #1 in April of 2019, and #3 in June for “all opioid overdose ER visits” per capita in NC.

Average rate of opioid overdose ER visits for the entire state is 65 per 100,000 residents. From 2010 to 2018 there was a 130% increase in opioid overdose ER visits. One statistic I left out involves Narcan. In 2017 Narcan was administered 131 time by Surry County EMS and Law Enforcement during the 237 overdoses. As stated above, deaths were at 55. In 2018 Narcan was administered 204 times by Surry County EMS and Law Enforcement during the 372 overdoses. Narcan is a drug that is administered in the event of an overdose or possible overdose that reverses the overdose by blocking the brain’s opioid receptors. It is interesting to note that although overdose deaths decreased from 2017 to 2018 overdoses increased by 32%. We believe that much of this has to do with the administering of Narcan at overdose events.

So, why has this epidemic come to NC and Surry County? We can not always know the exact reasons people take drugs, but with opioids we know a little more than about other drugs. How Surry County became such a big part of this Opioid epidemic is a bit complicated and a topic for another letter. I promise to follow up on this in the next few weeks. Let’s just say here it is related to opportunity and accessibility, the prescription drugs “culture,” and the mindset of “instant gratification”. There are many socio-economic statistics also that come into play in Surry County which will give you a better picture as well as historic data.

In this article I have not even touched on the statistics about drug related crimes as well as the many ways substance use impacts the community.

Jim, thank you for your question. This letter will be the beginning of a series of articles to answer your overall question,” Why did Surry County need to develop an Opioid Response Effort?”

Regards,

Denise Krochta

Surry County Opioid Response

Surry County Statistics, Part 2

This week I am continuing my answer (Part 2) to Jim from last week. The question was “Why did Surry County need to hire an Opioid Response Director and staff?”

Last week I wrote about some basic statistics about use and availability of pills and just how many overdoses and overdose deaths we’ve seen in Surry County for the past 2 years.

This week I’d like to get into some of the population statistics to give you a picture of the Surry County population. This might help to explain some of the “whys” of using and misusing drugs and self-medicating.

Here is an overall view of the population. This is not the 1950s nor is it the 1960s, 70s, or even 80s. Since the decline and exit of the tobacco industry and textile industry things have really changed, not necessarily for the better. Jobs are no longer abundant. Addiction is sometimes called a disease of despair and I think there is some of that here in Surry County.

Working population : 18-55 years of age

Labor force participation rate: 54%

17% of workforce is on disability

22.7% eligible for medicaid (only about half use it)

Suicide rate is 4%

Deaths of despair 14%

15% uninsured

17.9% at poverty level

31% suffer from obesity

10.8% suffer from diabetes

98% of overdoses in Surry County are ages 18-54 (our working age population)

So, looking at some of these statistics it is possible to see that there is a lot of work to be done here. I have been out speaking to the different populations and there is a lot of hopelessness regarding positive futures and despair. 18% of the population has no high school diploma and jobs are not always available for everyone. The median pay for Surry County is $36,000 a year. The national average is $55,713

With these statistics in mind and the fact that environment, opportunity, and availability are big factures in drug activity and use/misuse, there was some new important information released to the public this week that might clear up for all of us just why there is an opioid epidemic in general and more importantly for us, in Surry County.

According to newly released data from a database maintained from DEA (Drug Enforcement Administration) that tracks the path of every pain pill sold in the United States, from 2006-2012 the country was saturated with 76 billion oxycodone and hydrocodone pills. These opioids resulted in nearly 100,000 deaths during that period. The data base allows us to track our own counties and compare to other surrounding counties as well as the State and the US. As I stated, in the entire US there were 76 billion pills distributed (worth repeating). In North Carolina there were 2,552,612,498 pills distributed. In Surry County there were 41,227,030 distributed, enough for 80 pills per person per year. (Remember that opportunity and availability are big factors in maintaining addiction). In our surrounding counties, the numbers of pills per person were all significantly lower than in Surry. (Stokes 41 per person, Wilkes 55 per person, Yadkin 35 per person).

So, over a six year period (2006-2012) the County was saturated with these prescription pills. This established a solid basis for this pervasive epidemic. Many people believe that people who misuse and abuse drugs made bad choices. Many of these pills were originally legally prescribed by doctors but subsequently led to addiction. People generally trust their doctors and follow doctor’s orders. Opioids are highly addictive drugs. Many of these addictions did not start out by choice. The highly addictive nature of these opioids and how uniquely they work on a person’s brain, is part of the reason that it is not reasonable to believe that everyone who has a Substance Use Disorder related to opioids made bad choices.

This week’s letter adds other elements to answer our question. Surry County has a major drug problem and at least 60% of it is related to opioids. These pills were big drivers of the epidemic and now, for reasons we’ll discuss in next week’s letter (part 3), other opioids that are even more addictive and dangerous are flooding the market here and elsewhere in the US. We’ll talk about what they are, where they are coming from, and why they have replaced some, not all, of the abused prescription pills.

Denise Krochta

Surry County Opioid Response Effort

Surry County Statistics, Part 3

Part 3 (from Jim: Why did Surry County need to appoint an Opioid Response Director?)

Dear Jim:

In the first two parts of this question I tried to cover statistics for Surry County with regards to population, relationships, jobs, health and wellness, abilities and disabilities. I also shared some statistics related to how the opiates began to flood the market, where they came from, and why we are in the middle of an epidemic instead of healing. I didn’t talk too much about greed and it’s impact on all of this. Feel free to look up articles about Opioids and the Pharmaceutical companies, how doctor’s were educated about pain as a vital sign and using opioids to treat chronic pain, and also look up pharmacies and opioids. All I can tell you is my opinion on this. Greed played a huge part driving this crisis and disregard of people went hand in hand with that greed.

Back about 7 years ago, maybe even earlier, a trend started to happen. So many families were loosing their loved ones to opioids that they began to mobilize. There were rallies and marches, both locally and in Washington, DC to the White House. People were demanding more responsible prescribing practices and more oversight over these drugs. After a few years prescribing guidelines and some laws were changed to make these prescription pills more difficult to get. This had an effect on the use and abuse of these drugs. What no one expected to happen was that the more difficult it was to get these prescription pills prescribed or on the streets illegally, the more the drug dealers needed to adjust and the drug users looked for alternatives. Dealers began to sell and users began to turn to heroin. Basically the same high, much easier to get, and much cheaper than the pills had become. Supply and demand. Heroin became the new “go to”. Heroin is also an opioid. For a few years this illegal drug was the main source for opioid addiction (with pills still a part of the story). Recently,synthetic fentanyl has come onto the picture. This opioid is stronger than heroin and is difficult to detect as mixed into the basic heroin. The high is higher and many people look for fentanyl. They buy it with full knowledge. Others, because it is difficult to detect a difference when heroin is “laced” with fentanyl, think they are just buying heroin only finding out from an overdose or bad reaction it was “laced”. Those who know what it is take the chance of overdose for the bigger high. You might wonder why dealers would sell this stuff knowing the odds of it killing a user, their livelihood. It goes back to supply and demand.

We need to step back and remember here how opioids, especially with chronic abuse, affect the brain. Along with the pleasure making part of the brain, they also affect the decision making part. After sustained misuse and abuse, people often feel invincible. They just can’t think clearly or reason like someone with a clear mind.

Recently another drug even more deadly than fentanyl has been introduced into the illegal market. It is a drug that is many times more potent than fentanyl, called carfentanyl. It is an opioid pain medication usually use on elephants. This is not meant for any human in any shape or form.

These are the opioids now saturating the market in Surry County. Opioid misuse and abuse makes up about 60% of the drug problem in this county. Methamphetamine is making a resurgence as well as cocaine and benzodiazepines.

We are educating ourselves, the community, and everyone we can find to educate with things like this weekly letter, news reports, seminars, and will soon be producing a podcast and a blog accessible on the Surry County website. This is a part of Surry County life that everyone should be aware of.

I believe that in order to make good decisions in relationship to fiscal responsibility vs human cost, we all need to know the facts and how they relate to our families, towns, and communities. This is not an easy task. That is why we all must play a part.

Regards,

Denise Krochta

Grief Support Groups

Dear Denise:

I heard recently that there is some kind of grief support group for those who have lost loved ones through addiction. Do you know about this group and is there one nearby?

Lynn

Dear Lynn:

I do have some information for you about this. But, first let me take this opportunity to talk a little about grief in the world of addiction.

I often hear from people who aren’t experiencing addiction in their own family but have friends or co workers who are. They complain about how the people are “enabling” their addicted loved ones and letting them take advantage of them. They often suggest that if it was their loved one they would never let this happen.

I can tell you from my own experience that unless or until this happens in your world, you really don’t know what you would do. I, mistakenly, was very critical at one point in time, when I had friends dealing with this issue and I wasn’t. Then it came into my life and it really was an education! When it is a child of yours, someone you raised and remember in many wonderful ways, it’s difficult not to think about this person in relationship to the past. One kind of grief many of us experiences is the loss of a child when the child is still alive. This person on drugs is not who you remember, who you know is “in there” somewhere. It first is frustrating to see the change and downward spiral and then it is sad and somewhat frightening. Where is my child? Who is this person? What did they do with my child? We desperately want to “find” them and bring them back but in a way we have lost them. And so we grieve. In our desperation and hope sometimes we will do just about anything to “revive” them and bring them back to the life we remember, our “baby”. In this current world of the opioid epidemic, we often grieve while they are still breathing and then have to grieve when we lose them.

When it comes to enabling I always suggest to people to do what is comfortable for them. There are so many overdose deaths these days people often fear for the lives of their sons and daughters. Rightly so. All people handle this “enabling” in their own way. They need to do what they are comfortable with and hope if death occurs they feel they have done what in their mind was best for everyone, including themselves.

When loved ones are lost to addiction we grieve in many ways. There is often guilt, regrets, profound sadness, great emptiness. This is the case when we lose a loved one, in general. Getting to your original question now, there are groups who are specific to those who have lost loved ones through addiction. These groups have become necessary because of the stigma that comes with addiction. Denise Cullen, a mom who lost her son about 10 years ago, had begun attending a grief group to get support after her son died. She quickly realized that even though everyone in the group had similar feelings of loss and despair, they were judgmental of her because her son died from “bad choices”. Most of the attendees had children who had died from illness or accidents. It was uncomfortable for her. She was already so distraught and now was being judged.

This is how the group GRASP/Unbroken No More formed. GRASP (Grief Recovery After a Substance Passing) was a small group for a few years but as the opioid epidemic has grown, so has the group. There are many chapters all over the country. You can read all about their locations and activities at grasphelp.org. The closest group to Surry County is in Lake Norman.

I hope this reference is helpful to you and that you will share it with others who might need the support.

Regards,

Denise Krochta

Siblings

Dear Denise:

My sister and I are siblings of a brother suffering from substance use disorder? Does anyone care about us?

Margie

Dear Margie:

I definitely get the frustration in your succinct question. I know why it is there and I will try to address this with guidelines for those who love you.

When family members discover that one of their loved ones is suffering from substance use disorder it is a shock.. They immediately want to do something and “save” this person. Focus is totally on this person and the goal of rescuing. As the addiction evolves, the family members become more obsessed. I know. I was one of them. It is as if there is no one or nothing else in the world.

When it is a child (even an adult child) it seems to be instinct to act in this manner. It is very much the same as a family who has a child with a disability or illness. In this instance the focus would be on the disabled or ill child.

In both of the above cases we adults seem to feel that we must protect the weaker and “needy” and the others can take care of themselves. This, of course, is a bad assumption. Everyone needs attention, love, and to feel that people care about them. When the issue is substance use disorder (addiction), there is a big stigma attached and many people resent the attention even more because they feel these people made bad choices and why are we, who made good choices, work hard, and are not needy, getting “punished” for this.

Siblings are put into a very unhealthy position. They watch as their parents suffer from fear, anxiety, anger, frustration, and sadness. They, too, love this person and have feelings of sadness and frustration as well as fear and anxiety. But often there is no one emotionally available to comfort them because they are busy being obsessed with the person using and abusing the substance. Eventually their feelings turn to anger and frustration.

I have seen this family dynamic many times over my years working with families. It is difficult to tell parents to be aware of what is happening in the family with everyone. They do understand that they need to be a part of the whole family but often they end up just being physically there without being emotionally there. Addiction robs us and not just the one using.

It is almost impossible to live through this without blame coming into the picture. If a sibling voices thoughts about being ignored and not being a part of the parents world sometimes the parent will blame them for being insensitive and not loving their sibling. The siblings often feel that the suffering loved one is ruining the family. And, again, sometimes the neglected ones begin to feel that maybe being good, making the right choices, and being self sufficient is not so good for them. Maybe the only way to get attention and be loved is not to be so good and to make some bad choices. This is dangerous.

It is important for families to talk about how they feel without judgement. Parents can’t expect the other siblings to give up their own lives, family comfort and time, and be as emotionally focused on their loved one. Even the parents are not doing themselves or the rest of the family any favors by being absent in all ways that count. I know from experience that taking care of ourselves, our families, and trying to help the suffering loved ones is a very big task. It is really the only healthy thing to do. It is not selfish. It is selfcare.

Margie, please think about these two suggestions seriously.

Again, families must talk to each other about how they feel and do it without judgement. Communication is so important.

And, everyone in the family, including parents, must consciously take time to take care of themselves, spend positive quality time with the healthy members of the family, and take time to look at the good things in their lives.

And, Yes, we care about the siblings!!

Regards,

Denise Krochta