Crain Content Studio, the marketing-storytelling arm of Crain’s Detroit Business, worked with Children’s Hospital of Michigan Foundation to convene, moderate and report on a roundtable discussion among experts in education, medicine and government about the problem of addiction among young people. The discussion took place on Jan. 16, 2019 and was originally published on crainsdetroit.com on March 11, 2019.
In 2017, the U.S. Department of Health and Human Services declared a public health emergency when 11.4 million people reported misusing opioids and 47,600 people died from opioid overdoses.
In Michigan, 1,941 people died from opioid overdoses that year, a 13.9 percent increase over the number of opioid deaths in the state in 2016, reports the Michigan Department of Health and Human Services.
Addiction is rampant in our society. According to the Center on Addiction, one in four Americans who began using any addictive substance before age 18 is addicted. Still, substance abuse experts are waging an uphill battle against the stigma surrounding addiction, describing a deep-seated culture of shame and fear that prevents parents, schools, and business leaders from engaging in meaningful dialogue on the subject.
The Children’s Hospital of Michigan Foundation in Detroit is trying to erase this stigma and change the culture and conversation around addiction and recovery.
As part of its efforts, the Foundation partnered with Crain Content Studio, the marketing-storytelling arm of Crain’s Detroit Business, to unite parents and experts from government, academic, and medical fields to discuss prescription drug addiction and how businesses can play a part in ending the crisis.
“Most of our initiatives for adolescents and young adults tend to be in mental health and in opioids and addiction. We strive to be a catalyst for change,” said Lawrence J. Burns, President and CEO of Children’s Hospital of Michigan Foundation. The $120 million independent nonprofit partners with more than 40 organizations to further its efforts to help children and young adults.
Children’s Hospital of Michigan Foundation has partnered with Detroit Red Wings announcer Ken Daniels and Lisa Daniels, who formed The Jamie Daniels Foundation in memory of their son, who died of an opioid overdose in 2016. The Children’s Hospital of Michigan Foundation will help The Jamie Daniels Foundation with fund development, financial management and generating awareness about opioid abuse. The Daniels’ foundation provides resources and support to the increasing numbers of people battling addiction.
Wreaking havoc on families and businesses
Ken Daniels once saw a billboard that rang all too true. It read: “The brain isn’t the only organ impacted by addiction. It also breaks hearts.”
Daniels and his family are well acquainted with the heartbreaking consequences of youth drug addiction, a widespread problem as devastating as it is complex. Jamie Daniels was a smart kid. He did well in school and had a family and friends who loved him.
And yet at age 15, Jamie deliberately faked symptoms of attention-deficit/hyperactivity disorder and failed clinical tests to obtain a prescription for Adderall, the stimulant drug used to treat the condition, said his mother, Lisa.
Though she harbored grave doubts about her son’s diagnosis and need for Adderall, Lisa followed professional recommendations, carefully dispensing the medication to Jamie at the prescribed dosage. “I thought I was in control of it,” she said.Source: National Institutes of Health-funded study by the Institute for Social Research at the University of Michigan
TEEN DRUG MISUSE
Source: National Institutes of Health-funded study by the Institute for Social Research at the University of Michigan
Percent of the estimated 3.6 million U.S. high school seniors who misused prescription and over-the-counter drugs in 2018:
5 percent: Sedatives, such as Valium and Xanax
4.6 percent: Adderall
3.4 percent: Opioids, such as Oxycontin and Vicodin
3.4 percent: Cough/cold medicine
0.9 percent: Ritalin, a stimulant used to treat attention-deficit/hyperactivity disorder
While attending Michigan State University, Jamie began abusing opioids as well as Adderall and other drugs.
Jamie eventually completed two stints in rehab with his parents’ support. He moved into a sober living home in Florida and was under a physician’s care for depression and anxiety, conditions common in people suffering from addiction.
Until he was convinced by an acquaintance to switch to a less reputable recovery facility and doctor, Jamie was clean and on the road to recovery.
Less than two weeks after making the switch, 23-year-old Jamie died from an overdose of heroin laced with Fentanyl, a synthetic opioid 80 to 100 times stronger than heroin.
“There is a hole in my family’s heart that will never be filled,” said Ken Daniels. “And in the time we’re sitting here, we’ll lose eight more people (to addiction). So, we have to continue to talk about it. We need to talk about this in the home. We need to talk about it in the schools and at work; and hopefully in the long term, we can end this crisis.”
Young adults aged 18 to 25 comprise the largest segment of the population misusing and abusing prescription drugs, such as opioids.
But drug addiction doesn’t just impact families. Opioid addictions, specifically, cost businesses, educational and social institutions, criminal justice systems, and health care organizations billions of dollars yearly.
Altarum, an Ann Arbor-based nonprofit health research institute, estimates the economic burden of opioid addiction:
- $800,000 per opioid overdose death in lost earnings and productivity
- $1 trillion in costs to individuals, businesses and governments since 2001
- $215.7 billion in health care costs for emergency and ongoing care from 2001 to 2017
In addition, employees with substance-use disorders miss an average 14.8 days of work a year — almost 50 percent more days of work than the typical employee average of 10.5 days, according to the National Safety Council. And about 70 percent of U.S. employers in construction, entertainment, recreation, and food service industries employ twice the average number of workers with substance use disorders than employers in other industries.
Children’s Hospital of Michigan Foundation and its more than 40 partners are strategizing ways to end the addiction crisis. Solutions include ending the social stigma associated with addiction and recovery.
Despite the availability of accurate information, the perception persists that addiction is the result of an inherent character flaw, moral failing, or conscious decision and affects only a certain segment of society.“Nobody goes into their first use thinking, ‘Someday I’m going to be an alcoholic,’ or ‘Someday I’m going to abuse drugs,’” said Brian Spitsbergen, director of Community Relations for Growth Works Inc., a Plymouth-based facility that provides substance dependency and abuse treatments and solutions for adults and youth.
“There’s no one path to recovery that’s going to work for everybody, because every person is different and every brain is different,” Smith-Butterwick said. “So we are trying to do as many different things as we can to reach as many different parts of the population as we can.”
In 2017, Michigan lawmakers enacted opioid-related legislation that includes requiring the Michigan Department of Education, with direction from the Prescription Drug and Opioid Abuse Commission, to provide school districts with models for how to instruct students on the dangers of prescription opioid abuse.
The American Medical Association classifies addiction as a disease, and its task force reports that people who misuse and abuse opioids suffer from a chronic medical condition, like type-2 diabetes or high blood pressure.
Dennis Martell, director of Health Promotion at Michigan State University, added that addiction is not an epidemic.
“It is endemic,” he said. “It’s part of our culture. It’s always been around.”
Spitsbergen, who has been sober for more than 32 years, agreed. “Ten percent of the population will meet the criteria for a substance use disorder in their lifetime,” he said. “It can happen to anyone. That’s the persuasive power that addiction has. It isn’t about the gutter.”
There could be two middle school-aged children who go to the same church and same school and have the same family life, Spitsbergen said. But their responses to their first experience with alcohol could be completely different.
“Because of things that might happen in their brain state, their lives might never be the same,” he said.
The stigma surrounding addiction is so prevalent that parents often don’t participate in potentially beneficial events, said Robert Shaner, superintendent of Rochester Community Schools. He noted only 125 parents attended a recent information session on vaping, opioids and other dangerous drug trends provided by the parent-teacher association for his district, which has 15,400 students.
“People almost treat addiction like they don’t want to ‘catch it,’” Shaner said, adding that some parents think, “‘If I’m not around the people it happened to, it’s not going to happen to my kid.’ Nobody wants to say they’ve got it, and no one wants to say they’ve been treated for it. This is a non-partisan, equal-opportunity killer that we have to attack as a community.”
The challenge of easy access
“There’s no pain greater than losing a child,” Shaner said, adding that the heaviest burden a school administrator must bear is to help parents bury their children.
“Over the past six years, we’ve done this because of opiates well over a dozen times,” said Shaner. “Recently, we had five graduates from one high school lose their lives to opioid addiction. They didn’t start as street junkies; they didn’t start out looking to be addicts. Some of the addictions were caused by self-medicating because of mental health issues, some started because of athletic injuries, and for some it was having access to the drugs.”
The U.S. Drug Enforcement Agency says most teens find prescription and OTC drugs in their home medicine cabinets or on a kitchen shelf. And among those 12 and older who misused opioid pain relievers:
- 40.4 percent got the drug from a friend or relative for free
- 35.4 percent received a prescription from a doctor
- 8.9 percent bought the drug from a friend or relative
- 6 percent bought the drug from a dealer or stranger
Students as young as middle-school age hold “bowl parties,” said Carmen McIntyre, a physician who serves as associate chair for community affairs for the Department of Psychiatry and Behavioral Neuroscience at the Wayne State University School of Medicine.
“Everybody’s supposed to bring meds out of their parents’ medicine cabinet,” she explained. “They just take a few pills from each bottle so (parents) don’t notice anything. And then they put them all into this big bowl to share.”
McIntyre said children attending these parties also steal Narcan, a drug used to reverse the effects of an opioid overdose, though in her experience children panic and flee the scene rather than stick around and help the youth who overdosed.
When he was a high school principal, Shaner made a point of talking about drugs with his students. “I would say—and I don’t consider this a scare tactic—‘If you love your parents, don’t do these things. You don’t want them to feel that pain, if you truly love them.’”
One of the programs that Shaner, a former law enforcement officer, has helped implement in his district is a prescription drug drop-off program at parent-teacher conferences.
Prescription take-backs are a proven means of reducing the supply of unused, prescribed narcotics, preventing them from circulating among household and community members. Such programs allow members of the community to safely dispose of unused medications at designated locations staffed by law enforcement.
The prevention efforts of Michigan Opioid Prescribing Network, known as Michigan OPEN, include educating medical professionals, law enforcement and others on how to hold opioid collection drives in a manner that encourages participation and does not make community members feel uneasy or like criminals. So far the organization has helped organize drives in 60 cities, getting about 3,000 pounds of pills and 40,000 to 45,000 opioids off the street, said Chad Brummett, associate professor and director of the Division of Pain Research at the University of Michigan Medical School and co-director of Michigan OPEN.
10 WAYS THE BUSINESS COMMUNITY CAN HELP FIGHT DRUG DEPENDENCY AND ADDICTION
The experts say there’s considerable work to be done to reduce overdose deaths and prevent and treat addiction, but they can’t do it without the help of business leaders.
“If you’re thinking about something that takes away from your (company’s) bottom line, mental health and addiction are exponential problems,” Shaner said.
Roundtable participants shared their expert advice.
1. Advocate for more mental health services and counselors at schools: The largest percentage of prescription drug abusers are young adults aged 18 to 25 who are also beginning their careers with area businesses. “We all know K-12 education is important in solving the (opioid) problem, so we ought tobe funding it and supporting it in the right way,” Shaner said.
2. Sponsor youth peer programs: Eric Hipple, a former Detroit Lions quarterback and director of Outreach for the After the Impact program, suggests businesses underwrite programs that take a deeper dive into the problem of drugs and facilitate conversations and peer support among youths.
3. Support organizations that help: Provide meaningful support to nonprofits working to prevent and treat addiction. “Politics trump data, but business trumps politics,” said Martell.
4. Provide job training: People in recovery can’t return to the workforce without skills, said Smith-Butterwick. Helping recovery organizations incorporate job training would help recovering addicts support their recovery financially.
5. Make educating workers a priority:Hold human resources-developed programming on identifying, preventing, and treating opioid abuse.
6. Teach coping skills: People who develop a substance use disorder may begin using as a means of easing physical or emotional pain.Teaching alternative coping skills, such as meditation, can help promote healthy living.
7. Partner with insurers: Commit to offering employees robust, extended mental health treatment and addiction recovery services and challenge insurers to craft a benefit plan that reflects your commitment.
8. Become recovery friendly: Be mindful and welcoming of employees who suffer from addiction and/or are in recovery when planning social events. “They can’t tell anybody in the office, ‘I’m in recovery’ because it’s not comfortable,” said Smith-Butterwick. She recommends planning company events that don’t include alcohol.
9. Support employees in recovery:Workers often fear they will lose their jobs if their drug use is discovered. Instead, encourage and facilitate confidential addiction referral and recovery services for employees.
10. Engage in a community of businesses approach: Brummett emphasized the advantages of businesses combining resources as a community to financially support nonprofits dedicated to preventing and treating addiction. “Unfortunately, state and federal dollars will dry up, and we will still have issues with opioids, pain and mental health,” he said.
The number of medical professionals overprescribing potentially addictive medications drastically increased in the 1990s. The National Institute on Drug Abuse reports the number of opioid prescriptions dispensed at U.S. pharmacies tripled from 76 million prescriptions in 1991 to 219 million prescriptions in 2011.
McIntyre said one of her patients died from an overdose two days after another physician — who was aware the patient suffered from addiction — injected her with the benzodiazepine Valium and gave her a prescription for 120 Valium in pill form.
McIntyre also cited her own experience with a pharmacy dispensing 100 Vicodin to her following a dental procedure. She pointed out to pharmacy staff that her dentist likely prescribed 10 Vicodin, not 100, but said the pharmacy refused to take back the medication after it had crossed the sales counter.
Brummett said regularly prescribing opioids following dental procedures “just doesn’t make sense.” The more doses doctors prescribe, he said, the more patients take, regardless of whether their pain is reduced.
Those aged 13 to 30 who filled an opioid prescription immediately before or after having their wisdom teeth extracted were about three times as likely as their peers to still be filling opioid prescriptions long after they needed them, according to a Michigan OPEN study.
“If you think about surgery (alone), the two factors that determine whether and how many opioids a person is going to get are the surgery they’re having and the surgeon caring for them,” explained Brummett.
Not prescribing opioids to the 80 percent to 90 percent of people who don’t need them could significantly reduce exposure and access to the drugs, both primary and secondary, Brummett said. Consequently, in 2017, Michigan OPEN released the first evidence-based prescribing recommendations in the country.
Health care providers in and outside the U.S. don’t know how much of the prescribed drugs patients actually use, he said. “Unless you ask people, they don’t tell you. The only metric you have is whether or not they refill.”
Brummett said having conversations about prescribing recommendations helps create a culture of opioid stewardship that opens the door to progressively more detailed conversations, such as how to deal with chronic users, including the 6 percent to 10 percent of patients who undergo surgery and begin taking opioids as a result.
McIntyre added, “We don’t need to just talk about prevention, we need to talk about developing as normal human beings. We have to start teaching people that after surgery, (you’re) supposed to have pain. Part of the purpose of pain is to slow you down so your body can heal.”
To learn more about combating addiction and ending the opioid crisis, visit The Children’s Hospital of Michigan Foundation at chmfoundation.org.