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A State of Addiction: A Quiet Problem

National Institutes of Health

Cottonwood Heights is the type of community where little kids wear helmets while pedaling by on their bicycles; the homes often have two and three car garages, neatly trimmed lawns, and potted flowers decorating the front doorsteps.


There the poverty rate is low and homes flanking the Wasatch Mountains often list for upwards of $500,000. It's not the sort of place one imagines federal agents arresting a 26-year-old man they accuse ran one of the largest vendors of synthetic opioids on the darkweb. But it was here that law enforcement officials recovered about $1.2 million in cash from a home in an upscale neighborhood andsay Aaron Shamo and his associates shipped fentanyl-laced pills to all 50 states. This is just one segment of the state's opioid problem and it's hardly the most common. The truth is Utah's opioid epidemic is multi-layered and it's messy.



For some people the problem is more visible. It's sleeping in Pioneer Park. It's arriving by ambulance at emergency rooms across the state. But for a larger segment of the population, the epidemic is raging in neighborhoods just like this – neighborhoods that look and feel safe. And families are suffering in silence. That's because of the threats are not external. They're often coming from within the medicine cabinet in a pill prescribed to make you feel better.


“You have to peel back the veneer and see behind the curtain so to speak on what's going on within a society, within a community,” said Brian Besser, the District Agent in Charge for the State of Utah with the U.S. Drug Enforcement Administration. “The opioid epidemic is so fast proliferating right now, it's sweeping across the country and we have a lot of people who are quietly getting addicted to this and especially here in Utah, especially here in Utah.”


“We are losing 26-30 folks a month from this and I feel those numbers are fairly conservative,” he said. “I have traveled the state and I have talked to drug commanders and police chiefs and sheriffs, and we talk very candidly with one another. And some of them are just shaking their heads because they don't know what to do.”


Besser says that despite losing more Utahns to opioid overdoses each month than from automotive and firearm incidents combined--there's not enough awareness of the scope of the problem. He sees prescription drug abuse as deeply embedded in the Utah culture, and he argues that we need to talk openly about it here if we're going to turn the tide in this epidemic. Because right now he isn't sure that the opioid epidemic will burn out the same way he predicts it will in states back east like New Hampshire and Ohio.


“Here we have Utah which is a fairly conservative state; i's a state where we have good God-fearing folk who want to do the right thing and try to stay away from the conventional street drugs like heroin, cocaine and methamphetamine,” Besser said. “We recognize that those are bad. Prescription drugs, because they are prescribed by a doctor and they come in a bottle that you get from a pharmacy, those have been treated a little more cavalierly. Consequently, the addiction problem from that has proliferated through the years, and it's a quiet problem. That laundry doesn't get aired out on the line so easily, and there's a certain stigma or element of shame with addiction, isn't there?


“What we want to see is our good citizens and community members, if they become addicted to opioids, now more than any other time in our culture, in our country, there are resources available to these folks to get out from under this. The problem is that you just have to raise your hand.”


The opioid problem is more complex than traditional drug cases. The majority of the drugs are not illicit like methamphetamine and cocaine and many people obtain them lawfully from a physician. In 2015, more than2.6 million opioid prescriptions were dispensed in Utah – that's a rate of nearly 1 for every Utahn. In all likelihood, many of you listening may have such a bottle occupying space in your medicine cabinet right now, especially if you've recently had a baby, a surgery, or significant dental work performed. Not sure?


“Any generic version of oxycodone, hydrocodone, and morphine. So some of those brand names are Lortab, Vicodin, Percocet, Oxycontin, – these are common ones that are prescribed a lot and people don't realize that this is what everyone's talking about, this is an opioid,” said Angela Stander, prescription drug overdose prevention coordinator for the Utah Department of Health. “And they're just as dangerous as illicit heroin. It has the same effect, the same potential for overdose death.”


Earlier this year, the department launched a campaign to address the state's pill problem called “Stop the Opidemic.” The goal is to curb opioid misuse and abuse by educating the public about the risks for dependency and overdose when taking these powerful narcotics. Opioids are a type of drug that bind to receptors in the brain to produce pain relieving and euphoric effects. They are a critical tool for physicians for treating patients with acute and severe pain. They are also incredibly addictive.


“Studies have shown that in as little as seven days you can become physically dependent on them, meaning that if you stop taking those it's going to make you sick, that your body is essentially going to need these medications,” Stander said. “So very little time can take place before you're hooked or your body becomes dependent on these.”


She said it's easy for people to underestimate the power of opioids.


“A lot of people will say 'Oh yeah, I took those once after I had a surgery and they made me so sick. I hated those I would never touch them again!' But a lot of people, too, once they take [opioids] can get hooked the first time and can say, 'That had a good effect on me,'” Stander said. “So it's important to understand that everyone's at risk. There's no way to know if you're going to be that person that it makes sick and you hate that, or if it can be something that can destroy your life.”


Both Angela Stander and Brian Besser agree that there needs to be a sea change in the public's perception of prescription pain relievers. Both feel that this change can be achieved over time through education efforts with the public and with opioid prescribers and through candid conversations between doctors and their patients.


“If we are a high prescribing state then we definitely want to prescribe less and we have got to educate doctors to do that,” Stander said. “And also educate the public. Because we understand we can't just point fingers and blame this all on doctors. Because it's really hard for them to change their prescribing behaviors when we as a society are the ones demanding it, so doing a lot of public awareness and helping the patient meet the doctor halfway.”


This seriesis brought to you in part by the Association for Utah Community Health, providing training and technical assistance to health centers and affiliates across Utah. More information available here.