The growing opioid epidemic

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Kensington resident Roz Pichardo takes the contents out of her bag on April 27, 2019. Every day, Pichardo carries around harm reduction and emergency response supplies, like Narcan, a tourniquet, and a pulse oximeter. (Erin Blewett/Kensington Voice)

Kensington resident Roz Pichardo takes the contents out of her bag on April 27, 2019. Every day, Pichardo carries around harm reduction and emergency response supplies, like Narcan, a tourniquet, and a pulse oximeter. (Erin Blewett/Kensington Voice)

Opioid abuse was an epidemic in Philadelphia before COVID arrived, but sadly, things have gotten even worse. Drug overdoses rose 30% during the pandemic and in the city alone, over 1,000 people died from opioid use in 2020. Deaths have spiked among Black Philadelphians as opioid addiction has risen specifically communities of color. Experts say that fentanyl, the synthetic opioid, is largely to blame for the rising number of deaths and devastated lives. This hour, we look at the pandemic’s impact on the opioid crisis, why drug use and overdoses have increased and what treatments and resources are being mobilized. Joining us are ANDRE REID, an advocate and the founder of Lived Experience and the Philadelphia chapter of NAMA, NICOLE O’DONNELL, a peer counselor and recovery specialist, and JEANMARIE PERRONE, professor of emergency medicine and director of medical toxicology at the University of Pennsylvania School of Medicine.

 

Marty Moss-Coane [00:00:01]I’m Marty Moss-Coane, welcome to Radio Times. The pandemic has made most things worse, including this country’s opioid drug crisis. There were 93,000 overdose deaths in 2020. That’s a 30 percent increase over 2019, most of them from opioids. The country was struggling with a drug overdose epidemic before covid, which has only exacerbated the crisis because of the isolation from lockdowns, the closure of treatment centers, the impact of financial and emotional stress, and the lethality of fentanyl. A study of overdoses in Philadelphia by researchers at Penn Medicine found that fatal overdoses among Black residents spiked right after Pennsylvania’s stay at home orders while they dropped for white residents. This follows a pattern of racial disparity revealed by the pandemic. Today on Radio Times, understanding the power of drug addiction, especially opioid addiction, what it takes to get someone off drugs and why a medical approach to treatment has shown success. We have three guests, two of whom join us here in our Philadelphia studio. Andre Reid is an activist consultant with Lived Experience Consultants and the Philadelphia chapter of NAMA, which is the National Alliance of Medically Assisted Recovery. Andre Reid, nice to have you with us on Radio Times. Good morning.

 

Andre Reid [00:01:20] Good morning.

 

Marty Moss-Coane [00:01:21]Also here with us in our Philadelphia studio, Nicole O’Donnell. She’s a certified recovery specialist at the University of Pennsylvania. And Nicole, nice to have you with us.

 

Nicole O’Donnell [00:01:30]Thank you.

 

Marty Moss-Coane [00:01:30]You’re very welcome. And joining us by phone is excuse me, Jeanmaire Perrone. She’s a professor of emergency medicine, director of medical toxicology and addiction medicine initiatives at the University of Pennsylvania, and the founding director of Penn Medicine Center for Addiction Medicine and Policy. Jeanmarie Perrone, nice to have you with us on Radio Times as well.

 

Jeanmarie Perrone [00:01:52]Good morning, Marty. Thanks for having us.

 

Marty Moss-Coane [00:01:53]You’re very welcome. And to our listeners, we want to make sure that you can join us at any time during the show. You can send us an email, radiotimes@whyy.org. You can tweet us at whyyradiotimes and you can always call us. That phone number is 1-888-477-9499. I mentioned this in my introduction about how the pandemic has made things worse, but I want to speak to the three of you, frankly, about what you have seen. And perhaps, Nicole, I can start with you in terms of how you see the pandemic really exacerbating this problem of drug addiction, especially opioid addiction. What have you seen in Philadelphia?

 

Nicole O’Donnell [00:02:34]Yeah, I mean, it’s been so exacerbated by the disconnection from programs, the disparities, the people not having the technology to stay connected to other people, because in Philadelphia, a lot of our, you know, population doesn’t have the technology to stay, you know, do things virtually or do things by phone. So the pandemic money was exacerbated the opiate epidemic…

 

Marty Moss-Coane [00:03:02]…because there was money you mean?

 

Nicole O’Donnell [00:03:04]…All the stressors and then having the money.

 

Marty Moss-Coane [00:03:08]The two of them together, correct?

 

Nicole O’Donnell [00:03:10]Right. Yeah. I mean, during outreach, there weren’t as many resources out when we were in, you know, in Kensington, in West Philly, making sure people had Narcan and fentanyl test strips and make sure that they could get clean syringes. So, there weren’t as many resources out there.

 

Marty Moss-Coane [00:03:27]And I’m thinking too, Andre, about just, you know, we had to keep our distance. I mean, I think things are a little different now. People are vaccinated. Hopefully people are wearing masks, hopefully. But nonetheless, the kind of distance that you had to have to to stay away from someone who could be struggling with drug addiction, but also could be positive for the virus.

 

Andre Reid [00:03:47] I think we were dealing with a problem before it actually came. Right. So, again, when Covid came, it shut down all the systems. So as Nicole said, they had people who had relationships and with building a support system, their support systems stop. That they couldn’t go to their programs anymore and at that point, we didn’t know what we were dealing with. Right. So everything goes on hold. So the people in recovery, they lives going hard as well. So they live shut down. They can’t go to treatment centers anymore. They can’t get the services they need. So and same again, like Nicole said it exacerbated people who are already struggling, have triggers right now. I’m not saying you don’t give people money, but when he got the stimulus money, sure. I mean, he’s not getting, you know, money that was inundated into the community, you know, without having proper supports around them to show them how to, you know, deal with this this whole influx of things that was going right. So we know drug addiction comes from feelings. Right. So you shut people down. The feelings can cause the behavior which causes the usage. Right? So, a lot people into depression, loss of jobs and so was going on. People were dying around, loved ones with anxiety, all these supports, all these things that were happening to them, and then, we don’t have a support system because the treatment centers close down, you got to do it by phone. And again, if you live in a life full of poverty, you can’t keep a phone every month. For us we take it for granted.  Sixty dollars was a lot of money to keep my phone bill up.

 

Marty Moss-Coane [00:05:15]I hear you. I want to get back to the two of you. But Jeanmarie Perrone, let me get you in on the conversation. Just from your perspective, what did you see, especially during the really dark days of the pandemic, before vaccines, before we really understood what we were dealing with?

 

Jeanmarie Perrone [00:05:32]Oh, absolutely. Early March was terrible. And, you know, as things began to shut down and almost before it got really bad, it was already impacting these communities because of fear and isolation and people kind of turning their backs on the programs that existed. And then subsequently starting in April, May, what we would see in the emergency department are these people falling out of care, but then returning to use also as a result of unemployment. They would tell us later, you know, I had my last prescription for Suboxone in March, but then, you know, I just went off the rails and April, May, June, because I wasn’t working and work was a structure that helped with my recovery. And now I don’t have that. So it was it was really difficult. And, you know, for our open treatment program, kind of walk-in treatment in our emergency department, we were seeing far less people who were willing to come to the emergency department for treatment. But we were seeing far more people who are coming in after overdose. So non-fatal overdoses where we’re rising. And again, that’s the impact Andre spoke about in terms of people losing friends immediately from the very first few days of the pandemic.

 

Marty Moss-Coane [00:06:42]Is it any better now, Jeanmarie Perrone?

 

Jeanmarie Perrone [00:06:46]I believe that we have shifted a lot of resources to make them more accessible. But as Nicole and Andre both said, still, we face the challenge of if we provide telehealth services, but people still don’t have telehealth access. We’re still trying to be innovative and being able to create that virtual line to care, but we’re not able to reach everyone. So I think it’s it’s it’s the new normal, but it’s not where we were before in terms of getting people low barrier access to treatment.

 

Marty Moss-Coane [00:07:16]One of the reasons there are a number of reasons, Nicole and Andre, we wanted you on is you have this lived experience. And I think for people who don’t understand addiction, just don’t understand the sort of the pull of addiction, you’re here in part to help people understand because of your own struggles but ability to overcome your own addiction. And I wonder, Nicole, if I could just hear from you about it was heroin, right?

 

Nicole O’Donnell [00:07:40]It was correct.

 

Marty Moss-Coane [00:07:43]And you know what sort of trigger? Is addiction too strong a word, but your your tug into heroin now?

 

Nicole O’Donnell [00:07:53]It was definitely an addiction, we can call it that. It started out with pills. It started out with, you know, it was fun. And then you can’t really afford those for long. And then I ended up doing heroin because it’s cheaper and more accessible.

 

Marty Moss-Coane [00:08:08]And you also you ended up in an E.R., right?

 

Nicole O’Donnell [00:08:11]I have. Yes, I absolutely did. And that’s why I wanted to do the work that I do at Penn with Jeanmarie, because when I went to the emergency department after two overdoses, there weren’t resources, there weren’t people, you know, bedside to talk to me about, “You know, there’s a better way, you don’t have to live like this.” You know, all of these things. And that’s why I ended up at Penn, because I wanted to be the person I didn’t have bedside when I experienced my overdoses.

 

Marty Moss-Coane [00:08:39]What did you want? What did you want someone to say bedside to you as you were, you know, coming out of this this overdose?

 

Nicole O’Donnell [00:08:45]Sure, I wanted compassion. I wanted non judgment. And I just wanted a connection. I don’t know if I would have, you know, accepted some kind of treatment, but I would have liked to known that there were options for that. And I just wanted to feel not judged.

 

Marty Moss-Coane [00:09:02]Andre, from your own experience, and you also had an addiction to heroin. Yeah. What got you started?

 

Andre Reid [00:09:09] I don’t know what really got me started I think like Nicole said, recreation. All right. But now as I study it more and look at it, I really think that I was predisposed. I think it’s predisposition to drugs. Now I look at it from a brain structure. My body and my brain was just ideal for heroin and met it and it made a match. But moreso into the addiction, the horrors of our addiction. We already know what the horrors of addiction, loss of job, loss of school, loss of employment, loss of friends and families, how hard it was to come back. The connections that weren’t there, the judgment, you know, and then being African American in services that was out there, the disparities in services, disparity in health care, the treatment for health care, that bridge that bridged the gap. Are we talking about bridging the gap? And, you know, talking to Nicole about that, we talk about bridging the gap. Can you imagine the bridge I had to come over?

 

Marty Moss-Coane [00:10:06]Is that in part because when we look at race and drug addiction, we see someone like you is a criminal versus someone, you know, in need of of services?

 

Andre Reid [00:10:18]  I was telling your producer, Debbie, yesterday, the reason I can kind of see the addiction from these kids’ eyes today is because I basically came from the same world that they came from. I came from the suburbs. I was a kid. I was in college when I was young. So I wasn’t a guy in a corner selling drugs, no job, no education. So when I look at them I say… a lot of people drive by and say, well, how do you get here?… A lot of those people come from worlds, productive worlds and found themselves taken over by an addiction. So I knew that a lot of them didn’t start off on that corner where they want to have a sign and a hand asking you for a dollar. So because I knew that, I could link up and say these people didn’t start here at fifth and Girard at the corner with a sign, with a bucket in hand asking you for a dollar and when you drive past them they stinky. All these things that we look at and then we judge them, we judge them, we look at them like that. They didn’t start there. And I didn’t start there either.

 

Marty Moss-Coane [00:11:14]Was there something in your life that happened that, like we were hearing from Nicole that, you know, you were maybe ready to give up? And to give up I mean, to say that I don’t want to do this anymore?

 

Andre Reid [00:11:32] I think medically assisted treatment. I think when I began to accept the medically-assisted treatment was out there for a great reason. Right. Because that’s a prejudice as well. Methodone, suboxone, that’s what we call medically-assistant treatment. There was a prejudice behind it. But I met a good therapist at the program I was going to. With that connection, I would be able to see that if I used this medication right, it could work.

 

Marty Moss-Coane [00:11:56]You’re nodding your head, Nicole.

 

Nicole O’Donnell [00:11:59]In my experience, I had to use diverted buprenorphine because it wasn’t accessible when I got into recovery. So to get through withdrawal, that’s what I had to do. But the evidence based treatment, I’m really happy that it worked for Andre and it’s working for a lot of people, but he’s right. There is a stigma surrounding it, unfortunately.

 

Marty Moss-Coane [00:12:18]We’re almost on a break here, but what’s the stigma?

 

Nicole O’Donnell [00:12:21]We live in a world where abstinence-based was or is the gold standard, which isn’t true because it’s also not evidence based and people are dying because of it.

 

Marty Moss-Coane [00:12:32]Well, let’s take a short break and then we’ll get back to our conversation, and Jeanmarie Perrone, I want to get you back into the conversation as well. We are talking about drug addiction. And frankly, I think the pandemic and other crises that we have been dealing with in this country have really overshadowed this enduring problem that we have not just here in Philadelphia, but across the country. Talking with Andre Reid, he’s a consultant, founded Lived Experience Consultants and Philadelphia chapter of NAMA. That’s the National Alliance of Medically Assisted Recovery. We just heard about some of that. Nicole O’Donnell, certified recovery specialist at the University of Pennsylvania, and Jeanmarie Perrone, professor of emergency medicine, director of medical toxicology and addiction medicine initiatives at the University of Pennsylvania. We’re going to take a very short break and then get back to our conversation. Do stay with us. Much more after this short break.

 

Marty Moss-Coane [00:13:24]This is Radio Times here on WHYY in Philadelphia, I’m Marty Moss-Coane talking with our guests about the opioid epidemic and the role that fentanyl is playing. And I do want to get to that and what can be done to address the problem. Let me turn back to you, Jeanmarie Perrone, and help us understand this medical – I hope that’s the right word – this medical approach to addiction and what we know about it and why it seems to be working, at least for a lot of people.

 

Jeanmarie Perrone [00:14:02]It’s a tremendous successful story of pharmacology and interventions, but one that people don’t understand. I think, to to pick up on what Nicole was saying, abstinence is a really easy concept, because when we look at patients who have alcohol use disorder, we want them to go into treatment. We want them to get away from alcohol. Alcohol is prevalent everywhere, and the only real treatment, or the most common treatment that’s supported by Alcoholics Anonymous is abstinence. So you won’t drink anymore and then you won’t go down this pathway. There are some but there are very few medications that are used with alcohol treatment, in contrast to opioid use disorder, it’s very different and it responds really well to specific treatments, including methadone and buprenorphine, otherwise known as Suboxone. Suboxone specifically can reduce overdose deaths by up to 60 percent, in a patient who continues. So we don’t have that kind of data for Alcoholics Anonymous that we have this social network around Alcoholics Anonymous that continues to support the idea that you’re only really in recovery if you’re not taking anything, and that this idea that those people who resort to taking meds aren’t as strong, aren’t really in recovery, haven’t really faced the hard questions and are using this as a crutch. And we heartily disapprove of that concept and really want to foster this idea that these medications are just like insulin for diabetes. You are missing a medication that a substance that has changed your brain, just like a diabetic person doesn’t have insulin because their pancreas isn’t working. We need to put an opioid receptor agonist, as we say, back into the brain. And you may need to be on that medicine for a long time. But it is just like we wouldn’t think about taking somebody off of insulin. This is the same thing. It’s a chronic relapsing disease of the brain. We have medications that are effective. We want people to understand that treatment is available.

 

Marty Moss-Coane [00:16:02]I mean, what you’re saying is that addiction to drugs, whether it’s – I mean, there’s so many different kinds of drugs – is different from an addiction to alcohol. Is that what you’re saying?

 

Jeanmarie Perrone [00:16:13]Yes. I mean, there’s characteristics of the loss of life resources that are common to all when you have an addiction problem. But the treatment is quite different and we encourage thinking about them differently in order to get people to not feel discouraged if they’re on medication and to feel that they are also entitled to hold their head up high and not be stigmatized, that they are taking medications to assist in their recovery. And to essentially make them make them whole. And and, you know, as most of our patients say, it just makes me feel normal again. They don’t get high. They don’t have euphoria, but they just feel back to themselves. And that’s a gift.

 

Marty Moss-Coane [00:16:59]So what are in these these medications that make them so effective?

 

Jeanmarie Perrone [00:17:06]Buprenorphine or Suboxone is something that also binds to the opioid receptor, much like heroin would. However, it doesn’t have as much of the heroin affects – about 50 percent less of those effects. So it really just replaces the withdrawal and the gap of opioid dependance that you might have developed without giving you the feeling of sleepiness or extra euphoria. So it really just brings you back to a normal baseline. You would not know if somebody was on Suboxone, but they appear completely like anyone else. So it’s it is essentially replacing what has been hurt in their brain from this relapsing disease.

 

Marty Moss-Coane [00:17:49]And relapsing disease – if I can turn to you, Nicole –  from the work that you’ve done and even from your own experience, that, at least as I understand it, that relapse is part of recovery or it has been part of recovery?

 

Nicole O’Donnell [00:18:01]Sure. I mean, it doesn’t have to be, right? Everybody’s pathway is different. But if a patient is experiencing a recurrence of use, we ensure that they’re safe. Right. So make sure that they know not to use alone, make sure that they have Narcan, make sure that they know to test their drugs, make sure that they have clean syringes. So we then take a harm reduction approach to ensure that when that person wants to come back, if they want to come back, that they’re safe and able to do so.

 

Marty Moss-Coane [00:18:30]Can you talk a bit, Andre, about Narcan and some of these interventions that can help people who are in the in the midst of an overdose?

 

Andre Reid [00:18:40] Well, I think Narcan is a great drug, right. So, when people return to using, we got to know that they have to save their lives. We have to save their lives. We can’t get punitive against them and say nothing is there to save their lives. So putting Narcan or naloxone, just basically what Narcan is, spreading it in the community. I think in all communities that Narcan should be in a house like a smoke detectors. I think we should have the same type of campaign, because you never know who’s going to come in your house. You never know who might be under the influence because we are finding fentanyl in all drugs now. So, it could be as common as being in your medicine cabinet, in your kitchen cabinet, somewhere in a house where everyone knows that there’s a Narcan kit here.

 

Marty Moss-Coane [00:19:31]So how easy is it to use?

 

Andre Reid [00:19:34] It’s fairly easy. At one time it started off as you know, and you go to trainings, but now you basically read the box and find out how to use it. – it’s becoming that common now. Right, because we know it’s one of the major tools in saving lives.

 

Marty Moss-Coane [00:19:52]Well, let me go back to Jeanmarie Perrone – Andre Reid mentioned fentanyl. Is our problem fentanyl or opioids or is it the combination of the two?

 

Jeanmarie Perrone [00:20:06]The problem is has gotten much worse, primarily because of fentanyl. Fentanyl is more potent than heroin and it’s really now adulterated or intentionally put into cocaine and methamphetamine in lots of other substances where people were not opioid tolerant. So there’s a certain number of deaths that are occurring because people didn’t expect to get an opioid. And then there’s also people who don’t know that they’re using fentanyl because they’re buying pills on the street, which you imagine came from a pharmacy and it’s probably, you know, safer than heroin. But actually, these pills are being manufactured to look like commercial pills and they’re actually pressed fentanyl tablets of pure opioid. So they they think they’re buying Percocet or Xanax and they’re actually getting a very potent dose of fentanyl. So it’s just being distributed in many different ways. So people are getting exposed. And then the appetite for opioids in general has just escalated because of the overprescribing that occurred, you know, 2000s. So we’re still trying to reel back from that and and get people to not even explore some of these substances because they can be so lethal even with exploration.

 

Marty Moss-Coane [00:21:24]And how lethal is fentanyl and sort of how much more powerful is it? It’s a synthetic opioid, correct?

 

Jeanmarie Perrone [00:21:31]It’s a synthetic opioid. It’s about 50 to 100 times more potent than morphine. So it is, you know, in very small quantities. And because of that potency, it’s easier to import, and so what I’ve been told from the DEA is that fentanyl is here to stay. It’s infinitely cheaper than buying a plant based opium product like heroin. And because of its potency, it can be, you know, more easily exported and arrives here in a very potent form that can be, you know, distributed as as is happening now. So it’s not going away, is what I’m hearing.

 

Marty Moss-Coane [00:22:09]And that said, Jeanmarie Perrone, she’s a professor of emergency medicine, director of medical toxicology and addiction medicine initiatives at the University of Pennsylvania. She’s also founding director of Penn Medicine Center for Addiction Medicine and Policy. Also with us, Nicole O’Donnell. She’s a certified recovery specialist at the University of Pennsylvania. Andre Reid, the third of our three guests this hour of Radio Times. He’s an activist consultant with the Lived Experience Consultants and the Philadelphia chapter of NAMA, the National Alliance of Medically Assisted Recovery. We’re talking about the opioid epidemic, the drug epidemic here in Philadelphia and frankly, across the country. You can join our conversation. Nicole, let me go back to you and just help us understand the kinds of conversations you as well, Andre, that you have with people that you see, let’s say, on the street. We know up in, for instance, in Kensington, there’s the encampment where a lot of people are addicted to drugs. I know in West Philadelphia, there are places like that as well, maybe not on the same scale, but how do you engage someone who’s who’s using?

 

Nicole O’Donnell [00:23:30]With snacks. That’s how you engage people when I’m doing community outreach, there’s snacks and some love and some non judgment, and that’s how the conversation start. When you’re out in the community, sometimes the conversations are a little bit different. There are harm reduction conversations, here’s my card, these are options, maybe today is not your day, but give me a call when it is or if it’s not, give me a call anyway so I can make sure that you have the Narcan, the fentanyl test strips and the safe syringes. The conversations in the emergency department are a little bit different. People come sometimes seeking help or they, you know, are coming in for ramifications from opiate use disorder or, you know, addiction in general. So a lot of education happens in the emergency department. We’re seeing a lot of people come from the West Philly community that don’t know that they’re getting fentanyl. They think that they’re using pills. So a lot of education around harm reduction and, you know, educating people about fentanyl and what they’re using is what has to happen and what is is happening both in the community and the emergency departments.

 

Marty Moss-Coane [00:24:42]Andre, you want to add to that?  I should underscore that fentanyl is so dangerous and so lethal and people don’t know enough about it. That’s what I’m getting from from the three of you. Andre, can you add to that?

 

Andre Reid [00:24:55] I think the community is aware of fentanyl now. I do think they know there’s a deadly substance out there and it’s killing a lot of people. But I don’t think the community knows that it is in weed and pills like manufactured counterfeit pills. So when you look at it from a systemic perspective, West Philly will look a lot different in Kensington. because the infrastructure in West Philly is not the same. So my outreach moreso is from a systemic perspective now. After doing a lot of community outreach now looking at how do I change systems and policies to start providing the services in certain communities that  don’t even have people coming to them because they don’t even think the problem is even ocurring? West Philly doesn’t have the encampments but it does have the deaths. It has the same addiction, had the same loss of lives, destruction of homes, loss of employment.

 

Marty Moss-Coane [00:26:14]You want to add to that, Jeanmarie?

 

Jeanmarie Perrone [00:26:20]So I’m a clinician in the emergency department and, well, I think Andre is very correct that people are aware that fentanyl is bad. They’re not aware that they might be using fentanyl. So we recently started testing people for fentanyl because that was a new substance. And so when people come in and they, you know, they think they’re addicted to heroin or Percocet and we tell them, you know, you’re using drugs and only showed fentanyl, you’re not getting any other opioid, they are absolutely terrified. And that can be a good trigger to help them continue the path into treatment because they know it’s lethal, but they don’t know that they’re actually being exposed to it. So I think that’s an important opportunity to to make a treatable moment out of that concern. They think that fentanyl is something that they’re not, you know, not getting. And when, in fact, most of the people in our city are actually getting some or all fentanyl and their drugs.

 

Marty Moss-Coane [00:27:13]I mean, that’s just that is so frightening. Let me get Heather Arata to join our conversation. She’s joining us by phone. And I should say that she and her husband and her son Brendan were profiled in the Philadelphia Inquirer recently. Sadly, her son Brendan died of overdose. And Heather Arada, nice to have you with us on Radio Times. I appreciate the phone call.

 

Caller [00:27:34] Yeah. Thank you so much for having me today. I really I appreciate the opportunity. And I do want to say I appreciate the work that all the three panelists today are doing in their respective areas of expertize. And it gives me hope that, you know, we are working in the right direction for this this terrible disease.

 

Marty Moss-Coane [00:27:56]What happened to your son, Brendan?

 

Caller [00:27:59] So, Brendan was diagnosed around the age of 15 as bipolar disorder and took a long journey through his has mental illness and was treated from the time he was that age once he was diagnosed. We found that particularly in his case, he was sort of stabilized on the lower end of of the depressive state instead of the mania. They they always worked with his medications to try and figure out exactly how to stabilize him. But for many years of his life, he was suicidally depressed. He was in the psych ward in a local hospital for probably four times for his depression. And he started to self medicate for his depression, which led him to opioids and that led him to heroin. And the unfortunate statistic that you’re talking about, that fentanyl is what is killing a lot of people these days who are taking street drugs. That’s what was on Brendan’s death certificate, that he died from an adverse reaction to fentanyl.

 

Marty Moss-Coane [00:29:08]I’m so sorry to hear that. And I do appreciate your call. And I know from reading the article about you, you started the Opioid Crisis Action Network. What does that do?

 

Caller [00:29:20] So in 2018, our son died in December of 2017 and 2018, my husband and I co-founded the Opioid Crisis Action Network. What we are doing currently is raising money to help people who can’t afford treatment. So we sponsor a few people a year in recovery homes or wellness homes so they can afford the rent, get themselves back on their feet once they’re on a road to recovery and want to stay, you know, on a wellness path. And many times people have lost their jobs. They’re coming out of jail and they need the opportunity to to have some stress-free days coming up. So, we pay for a few months rent for people in recovery homes. If there’s treatments to pay for medical bills, we try and do that. Currently, we’re very small. We’re working on our 501c3 status so that we can try to expand our our scope of aid to people. And we also are working with some state legislators to try and bring some transparency around outcomes within the recovery homes. So when my husband and I were were searching for recovery homes for our son, there’s really no data that can say that this is a very good recovery home because we see this many days of of wellness in our patients. And so we’re working with some state legislators. We have a few prime sponsors of that bill. And hopefully we’ll see some movement on that in the coming months. And the second thing that that happened to our son and we’ve heard this story multiple times is he felt some urgency to to relapse. And his sister drove him to a recovery facility and they wanted to admit him, but because he wasn’t currently under the influence of any type of drugs, the insurance company would not cover his his being admitted to to the facility. And that’s a story that we’ve heard many times. There is a law that states if someone presents at your E.R. or at your facility and they are under the influence, that you cannot turn them away.

 

Marty Moss-Coane [00:31:39]Well, you know what, Heather? Hold on, we’re going to take a very short break and then get back to our conversation. Stay with us.

 

Marty Moss-Coane [00:31:49]This is Radio Times here on WHYY in Philadelphia, I’m Marty Moss-Coane and we are talking about the drug epidemic of drug overdoses have risen something like 30 percent since the start of the pandemic. And many of those overdoses are from opioids. And a lot of that is from fentanyl. We’re talking with our three guests about all of that. And we also have Heather Arata who called us in to talk about her son, Brendan, who died of an overdose a couple of years ago, and the work that she’s doing to provide housing for people who need housing and also need help and support dealing with their addiction. Heather, I do want to get back to you just to give you a chance to finish. You were talking about the importance of transparency, especially when it comes to these recovery houses or these wellness houses.

 

Caller [00:32:48] Yes, that’s correct. So basically what we would like to do is, have the state of Pennsylvania send out surveys to the homes and optional opportunity for these homes to respond and just give us information, you know, some basic kind of demographic information, how many people their house holds. And the one that’s most important to us is something that Andre is advocating for, is that that these houses support people who are in medication assisted recovery. And as Jeanmarie stated, people who are on this type of medication-assisted treatment have a much greater chance. And she stated up to 60 percent better chance of not dying from from an opioid overdose. So, it’s important to us that these homes support people who are pursuing that type of treatment.

 

Marty Moss-Coane [00:33:50]Well, Heather, I really appreciate you calling into the show. And I’m you know, I’m so sorry to hear about your son, and I’m so gratified to hear about the work that you’re doing as a result of what happened to him. So thanks for calling into the show.

 

Caller [00:34:02] Thank you. Thank you very much for having me.

 

Marty Moss-Coane [00:34:04]You’re very welcome. Andre, do you want to respond since Heather mentioned your name in terms of this, this medical treatment, which I think is one of the messages of the show that we’re doing today?

 

Andre Reid [00:34:15] I think about a lot that could have been saved had we been on this medical assistance treatment model. Have we promoted, encouraged and supported the evidence based practices for use in medical treatment? So, a lot of times people were walking in programs and they were getting diagnosed and they and they weren’t given medical treatment. So they were going out there like Nicole and Jeanmarie mentioned, on to abstinence-based, knowing that their brain had been changed – and it was almost impossible, they started faulting themselves when they would go back and when they would use, they felt like it was a moral deficiency. They weren’t strong enough. The family members would not support them because they wouldn’t think they were strong enough. Not knowing that, when you get into the studying of it, they were up against a  brick wall they couldn’t get past. So, I think of all the people who possibly could have received medical treatment, the statistics show 60 percent of lives could have been saved had we gave them that their first time stepping into treatment.

 

Marty Moss-Coane [00:35:26]Well, let me read a comment from Mike. Please be specific about how many programs are available, where the statistics, how many people are being successfully helped. Where are we, generally speaking? And back to you, Jeanmarie Perrone. I mean, again, just to kind of underscore what we’ve been talking about is that  there are treatments that show not just promise, but show success.

 

Jeanmarie Perrone [00:35:47]Oh, absolutely, and the lowest barrier treatment is being able to take something prescribed by your doctor, and that is Suboxone. So unlike methadone, which is also effective, patients who take methadone, which works, are required to go to the clinic every single day in most cases. So that is stigmatizing in and of itself. Another path is to encourage clinicians, primary care doctors, psychiatrists, family medicine doctors, anyone to take the training to be able to prescribe Suboxone from your office so that clinicians and patients can be treated in a setting that offers privacy and non stigmatizing care and mainstreams addiction care. With all the other problems that you might have, high blood pressure, high cholesterol, it can all be part of a return to health that doesn’t face this segregation of your treatment. You have to go here because you’ve got that problem. It’s all part of holistic health. So we really encourage that. And the Department of Health in Philadelphia has really supported clinicians in in taking on this additional treatment goal. And actually, clinicians love it. People, you know, it’s wonderful to see someone in recovery and to see their new journey and how quickly they can get back to all the things that matter to them. So, you know, working with Nicole and Andre, we are trying to get the word out. We are trying to get people to treatment, but also having a peer, somebody who has experience. This is an unmeasurable addition to our treatment team, and that’s Nicole being able to talk to a patient in a way that a patient’s going to trust her more than they necessarily would, you know, trust me.

 

Marty Moss-Coane [00:37:38]Sure, I understand that. I’m looking at you, Nicole. Anything you want to add to that? I mean, and there is nothing like a lived experience and being able to talk to someone sort of peer to peer.

 

Nicole O’Donnell [00:37:49]Exactly. So when I meet a patient with an overdose, it’s sad that I have to talk through the stigma of medication before we talk about the medication that could possibly save their life. There’s so much stigma surrounding it. And when somebody wakes up from an overdose, that’s the first thing they’re concerned about before accepting, you know, when we go through the treatment options and coming from a peer who is in recovery to say you’re also in recovery, like I validate you’re in recovery. That’s why the conversation’s a little bit different.

 

Marty Moss-Coane [00:38:19]Here’s a question from Bill. He says, Is it possible for someone to be so deep into addiction that there’s no hope for them? Back to you, Nicole, but also to you, Andre.

 

Nicole O’Donnell [00:38:27]Absolutely not. If someone is breathing, there is hope, right?

 

Marty Moss-Coane [00:38:31]Do you feel the same way?

 

Andre Reid [00:38:34] Definitely, if you’re alive, there’s hope. If you can hear people on the phone, if you can hear a voice of someone telling you there’s hope – it’s hopeful like me and Nicole, we’re hope as well. When you first said, “Do you mind if we disclose it?” No, we’re hope, it’s hope. Sometimes people look at me and Nicole and look at us and think we started here sitting at radio shows with good jobs and good lives. We met someone who was able to breathe hope into us. So that same gentleman, to answer that question, you’ll meet someone eventually that will breathe hope into him. We pray, right?

 

Marty Moss-Coane [00:39:10]And for you, Nicole, I mean, was there was there someone that breathed hope into your life or a series of someones?

 

Nicole O’Donnell [00:39:17]There were a series of someones. I have a family, a very supportive family. And I’m so grateful for every day. At the end, I think that what really got me into recovery is I was sick of trying not to overdose, but not wanting to wake up. That was the end. I was trying not to overdose. Right. I was trying not to die, but also really upset every time I did wake up because I woke up in withdrawal every day. That was every day at the end of my addiction. And that’s why I started to try to figure out that, you know, what I was going to do.

 

Marty Moss-Coane [00:39:49]I mean, that’s that’s a complicated thing. I mean, not wanting to overdose, but also not wanting to wake up at the same time.

 

Nicole O’Donnell [00:39:56]Yeah, yeah. That’s how the end was everyday.

 

Marty Moss-Coane [00:39:59]Every day. How about for you, Andre?

 

Andre Reid [00:40:03] Family. Right. So, you know, I’m from Baltimore, but then I have a family of choice, as we say, in South Philly. So I have two families. So, that’s the love and support that I had from my family that always saw that I was better than what I was showing.

 

Marty Moss-Coane [00:40:17]Oh, yeah.

 

Andre Reid [00:40:19] They believed in me. They believed in me, both sides of my family. I always had the hope and support from that, you know? I always had a house over my head, always had somewhere to live, so I had family supports like that. But I think it was a deterioration of my life that just, you know, just looking at my life. And I was like, Dre, what are you doing with your life? You know, it wasn’t the horrors of maybe living in an encampment, but people don’t know is that at the end, the bottom is done. You see, people have a determination of what the bottom is. The bottom is done no matter what your done is.

 

Marty Moss-Coane [00:41:00]So the bottom for you is just – that’s it. Right. There is nothing below that.

 

Andre Reid [00:41:06] Nothing. No, it doesn’t. It doesn’t have to be a place. It can just be a time in the fate of life where you come to and you just say, I’m done. You being a mansion or could be in a shooting gallery. But, you know, when that time comes, when when everything, when forces line up and you start seeing the time is done, now it’s time to get to work. And I just want to say this is very important. I think a lot of time we celebrate people in recovery from the one who gives us the, you know, from that 12 step model. But I think what Nicole and people like Jeanmarie and we do is we celebrate all people in recovery. No matter what phase you’re at, you need to be celebrated. You know, you need to be encouraged, supported and told you’re doing a great job, that person who wakes up every day is using and somehow finds his way to treatment is a person that really needs to be celebrated even moreso than to me, who, when I got clean, can make it to treatment more easily. That guy’s pushing against the tsunami of trying to get the support that he needs. So, that guy that is emailing you today, that’s hope for him. Asking you a question, too. So we got to break down how we look at it, right. Everybody who was in the process –  because it took me 20 years to get 15 years. All right, so that’s how I look at it. So when you say how we engage, I don’t engage from a point of abstinence or time. I look at the process.

 

Marty Moss-Coane [00:42:52]Let me go to you, Jeanmarie Perrone, and actually a couple of comments here about if we decriminalize drugs, you know, would this somehow affect what we’ve been talking about during this hour? How do you see that? And I realize it’s a big policy question. And, you know, anyway, I’d just be curious about how you how you wrestle with that if you do.

 

Jeanmarie Perrone [00:43:15]I mean, decriminalization is important because it’s an equity issue. And so, you know, but I don’t want to see decriminalization go with increasing use, much like, you know, marijuana legalization of marijuana. What I see happen is that, you know, marijuana now doesn’t, you know, is such a low barrier thing that kids have to try other things because marijuana isn’t illegal. So I worry that raising the bar to, you know, making drugs less of a problem, that it decreases the hurdle to start drug use and that that is just a dangerous cascade in my mind, because, you know, people can try alcohol, you know, teenagers try marijuana and alcohol. And what do they learn from that? They learn that they weren’t supposed to use marijuana, they weren’t supposed to use alcohol, and it was maybe OK for them. So then they go to the next step. And when that next step includes an opioid, there’s not really a lot of turning back. And so it’s just a lot stickier. It’s a lot more addictive. And, you know, we end up with a lot more people unknowingly going down this path. So it’s a complex issue. But I worry about the leap.

 

Marty Moss-Coane [00:44:26]No, and I appreciate the nuance that you gave us there. I’m just looking at the clock here, Nicole, if I can go back to you and also to you, Andre, in terms of when literally I’m thinking of 2020, when when we really did shut down. And this interesting study actually in Philadelphia showing that the Black residents were harder hit by the shutdown with drug addiction, frankly, than  white people living here in the city. Nonetheless, a problem across the board. But when you were able to connect with someone, let’s say, by their phone or even if they had a computer, could you see something about their life that you might not have seen if they’d come to the office or they were in your E.R.?

 

Nicole O’Donnell [00:45:09]So that’s a great question. We did go virtual in the emergency room, right. So we had the iPads. If a patient presented, I got to meet with them. And, you know, I really missed the connection. Right. Like, I miss the hugs. I missed the body language. I missed all of those things. So I don’t think that I found out anything or missed anything virtually as opposed to being in person. I missed a lot about being in person.

 

Marty Moss-Coane [00:45:36]Yeah. How about for you?

 

Andre Reid [00:45:38] When you say the increase in death among African American people,  what people need to know is that the cracks was already there. They just got exposed. So it ain’t like it’s just something that was new – disparity to health care disparity, education, disparity to poverty, no equities in the African American community. It was already there. And when you sprinkle extra problems on like Covid, where people couldn’t get services, couldn’t get employment, then you just start seeing people fall through the cracks more. But it wasn’t like it was paved over and was covered up. No, it was already there. It was waiting to be exposed. Now what is the solution to the problem, really?

 

Marty Moss-Coane [00:46:23]Yeah, to you. Jeanmarie Perrone, there’s an anonymous comment. Can you please address the high cost of Suboxone? Is that expensive?

 

Jeanmarie Perrone [00:46:34]It is covered by Medicaid, it is about a hundred and twenty dollars for one week prescription without or maybe sixty five dollars or so for a one week prescription, depending on the dose. So that is expensive, but relatively speaking, for saving a life, it’s it’s not as expensive and it is well covered by, you know, local insurances, at least in Philadelphia. I wish we could do better. But, you know, just the fact that you need a prescription is, you know, is obviously a barrier and that even if pharmacies don’t always carry it as another barrier. So fortunately, it is at least covered by the insurances that most of our patients.

 

Marty Moss-Coane [00:47:16]Nicole, you’ve got a look on your face.

 

Nicole O’Donnell [00:47:18]And there’s many, many programs that don’t require insurance in the city of Philadelphia, like a PreventionPoint does a mobile Suboxone and they don’t require insurance. So there are options if you don’t have insurance.

 

Andre Reid [00:47:30] There’s a lot of generics out there.

 

Marty Moss-Coane [00:47:34]Well, look, I really appreciate all the work that all three of you were doing and the fact that you joined us from Radio Times and special thanks to you, Andre Reid and to Nicole O’Donnell, for sharing your your life story as well, because that’s an important part of this overall story. So thanks for for joining us on Radio Times. Thank you. You’re welcome. Andre Reed is an activist consultant who founded Lived Experience Consultants and Philadelphia chapter of NAMA, again, the National Alliance of Medically Assisted Recovery. Nicole O’Donnell, certified recovery specialist at the University of Pennsylvania. Jeanmarie Perrone, thank you very much for joining us on Radio Times as well.

 

Jeanmarie Perrone [00:48:11]Thanks so much for having me.

 

Marty Moss-Coane [00:48:13]You’re welcome. Absolutely. And she’s a professor of emergency medicine at the University of Pennsylvania, founding director of the PENN Medicine Center for Addiction Medicine and Policy. Go to whyy.org to find out more about the program. And you can always download a podcast of the show wherever you get your podcasts. Tina Calacae and Al Banks, the engineers for today’s edition of Radio Times. The show produced by Debbie Bilder and Paige Murray-Bessler. I’m Marty Moss-Coane. Thanks for joining us.

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