The New Face and Longer Reach of Opioid Dependency

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The Opioid Crisis and Unattended Death

You’ve seen the news. We’re experiencing an epidemic of opioid addiction and opioid dependence. Our President has called it a “National Emergency”, and first responders, emergency medicine practitioners and—tragically—post-mortem service providers are overwhelmed. As a society, the stereotypical “junkie” was easy to spot. Nowadays, she looks like you or me. Bankers, teachers, business owners, tradespeople. Your grandmother, who’s had a difficult time bouncing back from knee replacement surgery; your husband, who has been balancing a stressful job and clinical depression. Opioids, as we know, aren’t limited to heroin. Prescription painkillers, counterfeit synthetics flooding the black market in pill form, even methadone, the “weaning off” drug used to help chemically-dependent patients transition from dependence all contribute to the crisis, and their increased availability has allowed the epidemic to spread across all socioeconomic classes.

Following are only a few of the thousands of stories hitting the news in recent months:

Case study: Post-prescription addiction

According to a study published October 2017 in Journal of the American College of Surgeons, medical practitioners have a difficult time appropriately dosing and monitoring post-operative patients, balancing the patient’s “very real” needs for acute pain management with the addicting nature of medicine’s most effective prescription pain medications. The article reports the following:

  • Rates of nonfatal opioid overdose have risen by more than 50% over 10 years.
  • Most cases originate from an initial medical prescription
  • Post-surgical patients are nearly 4 times more likely to get post-discharge opioids as their nonsurgical counterparts.

Jeannie (name changed for privacy) Walter’s doctor prescribed oxycodone to help her manage her pain following her knee replacement surgery. The 58-year-old grandmother admits that she may have requested extensions on her prescription longer than she really needed it because it gave her a sense of well-being. “Retirement was tough for me, and I had the surgery shortly after. I had a difficult time imagining that I’d be as active as I liked.” Walter, a former public relations director, was also an avid horsewoman, nature photographer and active participant in her family’s lives. When her doctor told her it was time to switch to an over-the-counter pain management strategy, Walter began to seek out “leftover” painkillers from well-meaning friends. Unfortunately, one of those “friends” was compensating for her own medical bills by selling some of her fentanyltablets. And Jeannie ended up in the hospital. She survived, but barely. Many patients who don’t survive, especially when their fentanyl sources come from illicit manufacturers. Patients who can’t afford the $50 or so street value placed on each pharmacy-grade Oxycontin tablet often turn to heroin or the popular fentanyl/heroin mix that has saturated the street market…though the “street” might be in a middle-class, “respectable” gated community like Jeannie’s.

Case study: Body of suspected overdose victim lays in alley several days before discovery Unattended death is common among opioid-related overdoses, especially because synthetic and hybrid compounds obtained on the street tend to be inconsistent between individual batches, pills, and packets. This makes regulation of ingestion difficult for users, as may have been the case with 33-year-old Jessica Spiller, whose body was found in an alley between two houses in Rockford Illinois. Homeowner George Nalan Jr. was shocked by the discovery of Spiller who, according to the coroner, had been deceased for several days. “To have a body show up 50 feet from the back of our garage that’s a little unnerving right there,” said Nalan to CBS affiliate 23WIBR, who also reported that the mother of three had battled addiction for a decade, and opioid overdose was suspected as the cause of her death. According to reports, she was much loved by her family, admired for her singing, and an exception to the stereotypical image of the long-suffering addict. Regardless of her background, Jessica Spiller became part of the death toll brought on by the decade-strong spike in opioid overdose.

Case study: Self-medicating banker videotapes his life as an opiate addict. 

Daniel Couzins, a British man living with his wife Jennifer in New Hampshire, used fentanyl and heroin to “treat” his severe depression, and periodically videotaped his experiences. The assistant bank manager apparently believed he had control of his use, and he rationalized that his suit-and-tie image as he left for work after a night of drug use meant he wasn’t a “junkie.” But fentanyl and heroin don’t care what you wear or what you work. Daniel’s wife Jennifer, a nurse, found her husband’s dead body at their home one night, and later, she helped make a documentary incorporating her reaction to viewing his video diary entries. The Center for Investigative Reporting produces a podcast called Reveal, and reporter Jack Rodolico in partnership with New Hampshire Public Radio covered Jennifer and Daniel’s story.

First responders, funeral professionals are overwhelmed New Hampshire is at the epicenter of the opioid crisis. “Police chiefs are confronting these problems every day,” said Professor Angela Barlow to NHPR. Barlow directed recent survey on the topic through Keene State University. “And they’re having very little success at reducing the opioid crisis and addiction issues within their communities.” In West Virginia, funeral directors and licensed body removal professionals are scrambling to keep up with demand. According to BBC, “the number of body transports jumped from 2,200 in (the) fiscal year 2015 to about 4,200 during the same period in 2017” and the opioid crisis is to blame. Bodies of overdose victims often remain undiscovered for a length of time, requiring licensed biohazard teams to clean up hazardous body fluids after unattended deaths. While property insurance usually covers these services, many family members, friends, and property managers are unaware of these specialized companies and take on the emotional and biological hazards of cleaning up after deceased loved ones, further proving that the opioid crisis reaches beyond back alleys and the shadows of urban decay. Opioid dependents and addicts are all around us, exposing themselves to risks compounded by today’s issues with illegal drug trafficking, unethical pharmaceutical companies and, of course, the desire to medicate valid mental and physical pain. And for each person lost to overdose, loved ones are left behind to deal with the crisis of grief.