Best Way to Fight Opioid Epidemic Is to Accept it, Advocates Say
Carla Cardelle waited in a New York hospital to be seen by a doctor for five hours before she realized no help was coming.
“I knew I had a urinary tract infection,” Cardelle told InsideEdition.com. "I started calling out, ‘I need some help here.’ So, the doctor comes and tells me, ‘Listen, if you’re here for pain meds, we're not giving you any.’ I said, ‘Who told you I’m here for pain meds?’ It was clearly because they knew of my drug history.
“That killed me right there. But I waited anyway, because I needed some help.”
Cardelle was an addict. She smoked crack cocaine and shot up heroin. But on that day years ago, she needed help for a UTI. She said she waited about four more hours before giving up and leaving.
“I never went back,” Cardelle said. “I ended up getting a very, very bad kidney infection, which had to be treated for a couple months.”
Cardelle’s story is not unique. Many say the stigma follows drug users in all aspects of life.
A 2014 study by researchers at Johns Hopkins Bloomberg School of Public Health found that Americans are more likely to have negative opinions of people with substance use disorders than they are of those with mental illnesses. Participants were less likely to approve housing, insurance or employment policies that supported people affected by addiction compared to those affected by other mental illnesses, the study showed.
“It’s anywhere that drug users go,” Cardelle said.
But many on the frontlines of the opioid epidemic say such stigma is counter-intuitive when trying to curb the crisis. Instead, they say, harm reduction is one of the more effective ways to take on the issue.
Harm reduction accepts that drug use is part of our world and sets out practical strategies that aim to reduce the negative consequences associated with it. Advocates say harm reduction is hinged on the belief in, and respect for, the rights of people who use drugs.
"We do have a responsibility to teach people how to be the best [drug] user they can be," Kailin See, a director at the Washington Heights Corner Project, told InsideEdition.com.
Those who support harm reduction as a strategy work to minimize the harmful effects of drug use, rather than ignore or condemn them.
“We see it very much as one of the tools in the toolkit to addressing addiction; it’s not the only tool, but it’s a very important tool,” See said.
Part of the Washington Heights Corner Project’s mission is to improve the quality of life for people who use drugs and reduce the risks associated with drug use and overdose.
“We do a lot of outreach activities — haz-waste collection, public safety, interaction with the participants, community engagement,” See said. “All of the stuff that you have to do when you're trying to practice harm reduction.”
The strategy has a tendency to go in and out of fashion, depending on what else is going on in the world, she said.
However, "I think we’re starting to see a real appetite in the states for taking a really firm harm reduction approach to resolving some of these issues," she said.
Part of this approach includes the use of Narcan, or naloxone hydrochloride, to block and reverse the effect of opioids in the event of an overdose. See has used the antidote to revive around 100 people who suffered opioid overdoses and now teaches others how to do the same.
The people coming in to WHCP to request training on how to use Narcan are as varied as those affected by the epidemic.
“We’re seeing that the person who’s coming in to request Narcan and overdose training is broadening every day,” See said. “We are now seeing the family and friends of people who are using drugs; we’re seeing parents who are concerned about their teenagers and their children; we’re seeing people that are out of jail and rehab recently who are really hoping that they’re going to maintain their sobriety but are really aware that they might not be able to.
“High schools, EMTs, the NYPD, doctors, [they all] are really wanting to know how to integrate this into their medical training, medical schools, universities — we just did a massive training with Columbia University where we trained their entire security staff,” she added.
But making Narcan readily available is a controversial issue.
While advocates look at Narcan as an integral part of the fight to curb the epidemic, critics have said it’s a safety net that encourages bad behavior.
As a result, some police departments have said they won't be using it.
“I’ve seen reports to where people have been Narcaned 20 times,” Ohio’s Butler County Sheriff Richard K. Jones told WXIX-TV in July. “Not 20 at one setting, but 20 separate times where the life squads and fire trucks and the police have to go out. But in Butler County, not so.”
He said his deputies would never use Narcan under his watch, saying only emergency medical technicians on ambulances will carry and use the antidote. Jones told the Cincinnati Enquirer that people who overdose are often hostile and violent with police after being revived.
“They never carried it,” he said. “Nor will they. That’s my stance.”
And in Maine, Gov. Paul LePage has sought to charge people who overdose and are revived by Narcan more than once.
LePage’s bill, “An Act to Require That Municipalities and Counties Recover the Cost of Opioid Antagonist Treatment From Repeat Recipients,” would subject communities to a $1,000 fine if they didn’t try to recover the cost of naloxone administered to a person a second time.
But local doctors and advocates said the bill would make it harder to stop the epidemic, which claimed the life one more than one person a day in 2016.
“My comment is to ask whether we will make the same requirement of people with other chronic diseases,” Dr. Noah Nesin, said to the Bangor Daily News in May, when LePage first proposed the bill. “If the answer is no, then the bill is simply an attempt to codify our society’s bias about addiction into law. If a person suffers more than one cardiac arrest, will they have to pay for the second use of a defibrillator?”
LePage has vetoed at least two bills regarding the antidote, saying it “does not truly save lives; it merely extends them until the next overdose.”
In July, he walked back his statement, saying: “I believe Narcan will save lives. However, if you allow it to go 12, 13, 14, 15, times with the shots, the odds are against you. We have to say when we give you a shot: ‘You have to go to rehab or pay for it.’”
The bill LePage sponsored ultimately failed.
See disagreed with LePage's stance and others who look at Narcan as a negative influence in the opioid epidemic, saying that outlook makes it that much more difficult for people who need help to seek it.
“It discourages people from seeking help,” she said. “It discourages people from seeking treatment. It discourages people from being honest about their drug use, which puts them at risk for overdose. It marginalizes people, it isolates people and it tells the general public that drug users aren’t people that deserve care and love and that they don’t deserve life.”
She also shot down the notion that Narcan encourages a person to continue using.
“I say that if you’re not breathing, there’s no hope,” See said. “If you die from your overdose, you don’t have a chance to go to detox or treatment. And I say that, after an overdose event, there’s often a window in someone’s life where they may be inspired to make changes and that window—that moment where you might want to make changes—that’s not possible without Narcan.”
The team at the Washington Heights Corner Project often goes out into the surrounding community to leave Narcan kits in areas known to be popular with drug users.
This includes Cardelle, who began working for the Washington Heights Corner Project as a bilingual outreach specialist after they helped her get clean.
“No matter who you are, where you come from, what you do, how much drugs you use, you are welcome with open arms,” Cardelle said of the project’s outlook. “They don’t call you a drug addict. They call you by your name.”
It’s part of their efforts to build trust within the community, where many feel they cannot go to authorities without fearing repercussions for their actions.
"People are going to use anyway," Cardelle said. "What we are trying to tell people, or explain, or teach people, is how to use safely."
See believes that in order to meaningfully address this issue, authorities must overcome the stigma associated with drug use.
“It’s not just street-entrenched homeless drug users overdosing anymore," she said. "Everybody is at risk of overdose — your kids are at risk of overdose. It’s an epidemic and it’s so far-reaching now, that in some ways, the attention that we’ve been trying to bring to this crisis, we are now able to bring because it’s impacting everybody.”
Still, See said, the problem could become far worse if authorities don’t do what’s necessary, including accepting harm reduction as a way to combat the issue.
“I started working in this field in Canada in 2006,” See said. “I worked through the Fentanyl crisis in Vancouver, where it is still ongoing. I don’t think that people realize how bad it got. There was one point in Vancouver where the morgues were full. Harm reduction seems to come in and out of fashion... there are causalities when that happens. So in a lot of ways, I think America can look at Canada as a cautionary tale.
“You have to commit to putting these interventions in place and you have to make them robust and they have to be real and they have to be impactful,” See added. “You have to enact them quickly, because if you don’t, people die.”