Opioid Epidemic: Let’s Talk About It!
June 8, 2017
Questions and Answers
What happened in 2012 that started the epidemic in Prince William County (PWC)?
The epidemic in PWC was likely already well underway before 2012. It was truly in or around 2010 that increases in overdose deaths began to profoundly increase. This may be attributable to the anti-abuse formulation of OxyContin, the advent of Prescription Monitoring Programs, and initiatives undertaken by law enforcement. All these factors likely increased the street price of contraband prescription drugs, causing people to shift to cheaper and more dangerous opioids like heroin.
How is the “Chasing the Dragon” program funded? The film Chasing the Dragon and accompanying study guide are available for free at www.fbi.gov/chasingthedragon. The production of the film was done with a limited budget of less than $1,000. After the film was complete, about $9,000 was secured to enhance the audio so it could be played in larger theater style venues. It is now produced for about $1 for each hard copy which is distributed at various events around the country. To date the project has cost about $40,000 in total.
Do all Prince William County police officers carry Narcan?
Because of cost, storage and product expiration, Naloxone is not issued to all officers; however, the Chief has approved the purchase of Naloxone kits for the police department. All officers will be trained and certified to use Naloxone on overdose victims. There will be enough Naloxone kits on the street to enable a quick response from police officers in all areas of the county.
Is there a racial gap between who is being prosecuted for heroin possession?
Heroin use is occurring in all socioeconomic classes, races and gender. Addiction does not discriminate and the “face” of heroin addiction looks much different than we have seen in the past with substance abuse. Prosecution for possession of heroin seems consistent with regional demographics.
Are doctors who prescribe when it is not necessary being prosecuted like street dealers? Yes, they are being prosecuted. There are a couple of cases right now. We are doing investigations at this time. Doctors who are true “pill mills” are being prosecuted and we are prosecuting them under the distribution charge because sometimes they are not even seeing the patients they are prescribing for.
These kinds of offenses don’t end at our level. They end in a higher court. It is our experience that it is treated seriously when they over prescribe. We do better than most going after them.
Every doctor has to be trained in appropriate prescribing of pain medication. In order to renew their Virginia license, physicians are required to take training in how to prescribe opioids. We are training pharmacists because they recognize who is being prescribed. They need to know what to do if they become concerned about a health care professional’s prescribing practices and how to help stop that problem.
Often times you see state attorneys here. We work with them to deal with prosecution. In some cases we don’t take cases to the federal offices for prosecution, we take them to the state offices. We work with them to try to deal with the issue. We are trying to prosecute those people who are poisoning our community.
What are your thoughts about legalizing marijuana? It seems to be a gateway to heavier drugs.
Marijuana is still a schedule one drug. As defined by the DEA, it has a high potential for abuse, can be addictive, has no medical use in treatment, and is not FDA approved. It is second only to alcohol for primary drug of abuse in individuals receiving Community Services (CS) substance abuse services. The association between marijuana use and impaired brain development and schizophrenia-like symptoms in some individuals has been recognized for more than two decades. Impaired brain development can occur when young people start using marijuana.
Research and statistics from states that have legalized “recreational use” or “medical” use show a higher rate of youth 30-day use of marijuana than states that have not legalized at all. This is attributed to increased ease of access and marketing, and a decrease in perception of harm of using marijuana. Statistics from states that have legalized also show employment-related impacts and public safety issues like increase in marijuana-impaired drivers and marijuana-related emergency room visits.
The impact of legalization of marijuana will not be fully understood for several years, by that point, a panel expert fears significant damage could be done. In that expert’s experience, marijuana like other drugs is a gateway. Typically, we see persons become hooked on opioids through one of two ways. One, they were over prescribed or have misused a prescription drug; or two, they experimented with various drugs, ultimately trying a prescription pain killer which then leads to heroin or synthetic opioids. In this latter case marijuana is almost always part of this progression of experimentation. Consider that a person who is already abusing marijuana has taken a step out onto a slippery slope; and trying a prescription painkiller may not seem to be as far of a next step to the person already using an illegal drug particularly since prescription painkillers do not carry the same stigma as other illegal drugs. There are other considerations as well when assessing legalization of marijuana and its role as a gateway. One of these key considerations is the scientific research done on impact to brain development within persons under the age of 26
Why does it take 7-10 days to get into rehab/treatment?
A panel expert responded that it seems like a long time. It is a resource issue. It takes a serious amount of time and it is difficult to work with treatment sites especially if someone is uninsured. We are reaching out and finding treatment. Initial treatment could be up to 30 days depending on insurance. Resources are a serious issue in our jurisdiction.
In response to the question regarding substance abuse treatment, in Prince William County, Community Services has little funding for residential treatment and people with opiate dependence disorders often do better, in our experience, with intensive outpatient treatment, frequent random urine screening and medication assisted treatment. Also, the partnership between treatment and criminal justice is essential.
Where can I find Naloxone in my community? Call Community Services at 703-792-7800 and they will walk you through the process and explain how to use it.
For such a major health problem, how are the federal, state and local governments educating and bringing awareness to schools? The DEA has teamed up with Discovery Education to produce a range of educational materials that are now available for high schools and middle schools. Materials for elementary schools will become available this October. The FBI has made hard copies of the Chasing the Dragon film and an accompanying study guide available to school administrators, counselors, resource officers and community outreach specialists for free. The film is also downloadable for free to the public along with other materials at www.fbi.gov/chasingthedragon. State and local governments tend to have their own approaches and own materials that are custom to the needs of those communities.
PWC Community Services Behavioral Health Wellness team is very active in raising awareness in the schools and community settings. We continue to work with the schools to provide presentations in Health/PE classes, after school programs and with parents and youth in the community. There are multiple layers and options for evidence-based programs. We are in the process of firming up collaborations to provide comprehensive services in the schools for staff, students and parents.
Has the video been shown in schools in the county? If not, how can we make that happen?
We don’t’ believe it has been shown in schools. We encourage you to contact the school divisions and voice your concern about the need for prevention and education about this and other topics. It takes community voices to make community changes.
The film has not been approved for viewing within Prince William County Public Schools. Any curriculum changes or additions must go through various approving officials.
My son was arrested several times in the Operation Blue Dragon. He said that he was never offered the rapid entry program. Why?
Operation Blue Dragon was a single day operation so he should not have been arrested more than once. The Rapid Entry Program was offered to all addicts and most low-level dealers. Those with extensive history or high-level dealers may not have been referred to the program.
How can those without medical or other health insurance and without financial resources get help?
Contact Community Services at 703-792-7800. There are facilities around the state as well. We need folks to be in the appropriate treatment setting.
How can we reach the youth population in both prevention and how to help those who are experiencing an overdose? We are working on intensive collaboration with the school systems to bring more education in Health/PE classes and other appropriate classes. A social media campaign is also beneficial to raising awareness of the risks of heroin, especially mixed with Fentanyl. Research is underway looking at best practices in this area and we will be implementing more prevention activities soon. If you would like to assist in prevention efforts or want more information, please contact .
Sharing the benefits of Naloxone with people in recovery and treatment so they can help their peers who may still be using is also important. We realize that there will always be individuals who choose to use drugs, and harm reduction is the targeted strategy in that instance. Talking about the first signs of an overdose and encourage help-seeking in the event of an overdose is an important message for the community.
Perhaps the best method of reaching the youth population is through robust drug education programs made up of meaningful curricula in school systems beginning in grade school and continuing all the way through high school. These curricula should stimulate conversation that raises awareness and understanding.
If you encounter someone who is experiencing an overdose please contact 911 or direct another person to do so. CPR should begin immediately if the person is not breathing. Narcan (Naloxone) should be administered if available to persons experiencing an opioid overdose.
Can you make the drug film available as a “You Tube” presentation so community members can direct others to the film? The film is available at FBI.gov/chasingthedragon. The uncensored version of the film can be located through the link titled “uncensored version” at the bottom of this page.
https://www.fbi.gov/news/stories/raising-awareness-of-opioid-addiction
Are heroin abusers in effect, funding terrorists because of the source of heroin?
Heroin is derived from raw opium which is harvested from poppies that are cultivated in specific climates found in countries like Columbia, Mexico, Burma, Afghanistan and others. The unrefined opium is processed to differing degrees and can ultimately become heroin in various forms (such as black tar or traditional powdered heroin). Drug traffickers may attempt to profit at various points in the pipeline – harvesting the raw opium, refinement, transportation and distribution. These “networks” or “enterprises” are profit-driven for a variety of motivations. Typically greed is at the heart of it.
It is mandated by law to report to the Department of Social Services about a substance abuse born baby in the state of Virginia. What is being done for treatment for mom and baby when this is known?
As of July 2017, Neonatal Abstinence Syndrome (NAS) is a reportable disease. Neonatal Abstinence Syndrome happens when a baby is exposed to drugs in the womb before birth. A baby can then go through drug withdrawal after birth.
NAS most often is caused when a woman takes opioids during pregnancy. Opioids are painkillers (used to relieve pain) a provider may prescribe to someone who has been injured or had surgery. Prescription opioids include:
· Codeine and hydrocodone (Vicodin®)
· Morphine (Kadian®, Avinza®)
· Oxycodone (OxyContin®, Percocet®)
The street drug heroin also is an opioid. When these kinds of drugs are taken during pregnancy, they can pass through the placenta and cause serious problems for the baby. The placenta grows in the uterus (womb) and supplies the baby with food and oxygen through the umbilical cord.
Problems that can occur with Neonatal Abstinence Syndrome
Babies with NAS are more likely than other babies to be born with low birthweight (less than 5 pounds, 8 ounces), have breathing and feeding problems and seizures. They usually have to stay in the hospital longer after birth than babies without NAS.
Taking opioids and other drugs during pregnancy can cause your baby to be born with birth defects. A birth defect is a health condition that is present at birth. Birth defects can change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works.
Source: March of Dimes 2016
What efforts are being made in Prince William County, Manassas and Manassas Park schools to educate students on the dangers of opioid use? This question is best answered by those in the relevant school districts.
Why do dealers who have better resources (money) do less jail time than small time users?
Some would argue that ANYONE with more resources spends less time in jail because they are able to pay money bonds for release, which highlights a different discussion altogether. A panel expert stated that in their experience, the premise of the question is not true. Distribution cases are higher classes of felony offenses and a greater threat to society at large, and therefore the judges take bond considerations very seriously, often setting higher bonds or having them more closely supervised while on release. The police also tend to seize large amounts of cash from dealers, which hurts their ability to pay bonds. Users, on the other hand, tend to get low bonds or community supervision, or sometimes a combination of both. There are also large efforts to divert addicted users from jail and into treatment, as highlighted in the recent Operation Save a Life, where users were offered the chance upon arrest to go straight into Community Service rehabilitation in lieu of jail. However, judges do sometimes keep users in jail, often because they are a threat to themselves. Jail is by far not the best place to detox, but sometimes it’s the only place. Many treatment programs won’t take a client until they’ve detoxed, which is a vicious cycle in which to put an addict: they can’t stop using so they need detox, but they can’t get in detox because they can’t stop using. Repeat offenders, those who overdose and pregnant women tend to get held in jail simply because there is no better alternative for their safety.