Heroin forum offers insight into problem facing county

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By Kristin Beck

Five experts on the heroin problem in Northern Kentucky – an area, the speakers pointed out, includes Carroll County – spoke to nearly 200 community members, law enforcement officers and local government officials at the heroin town hall meeting Thursday, March 6, at the General Butler State Resort Park Conference Center. Champions for a Drug Free Carroll County hosted the event.

The unveiling of the Carroll County plan to diminish heroin also was advertised for the meeting. While the plan was listed in the program distributed, it was not discussed during the meeting. To read the plan, see page 13.

Champions Coordinator Hayley Franklin said the Carroll County plan was mirrored from the Northern Kentucky ASAP Prevention Alliance. The difference between the plans is Champions is not allowed to treat people with its coalition, so they will point people in the right direction on how to receive treatment, Franklin said.

Franklin and other Champions members attended a November meeting hosted by the Heroin Impact Response Team unveiling Northern Kentucky’s collective response to the heroin epidemic. Afterward, Champions decided Carroll County needed a plan like that and began developing it during their meetings, Franklin said.

When asked how she hopes to put the plan in action, Franklin said Champions will do this through the coalition meetings, held the fourth Thursday of the month at 11:30 a.m. at the Carroll County Public Library.

“We touch on this more and get the word out there,” she said. “It’s all over (our) advertisement. We put it in the paper and things like that. This is to get people to know what steps we can take.”

Franklin said she was really excited about the turnout for the town hall meeting. “I was hoping there would be standing room only, and there were some people standing in the back. It was about 200 seats, so almost every seat was filled, and I’m pretty happy with that.”


Casey’s Law

Charlotte Wethington did not have any evidence that her son was addicted to drugs, but she had a gut feeling that something wasn’t quite right. Her instincts proved to be correct, as her son Casey would overdose three times and eventually die at age 23 after the third time.

“If you think there is something wrong, there probably is and you need to act on it now,” she said. “Don’t wait for proof. I thought that I needed to be sure that Casey was doing something, that I should have accused him and I know that I never wanted to damage his self-esteem or make him feel like I didn’t love him or trust him or believe in him. But that had a horrible consequence because I waited and I waited too long. And not only that, but I was told time after time after time from the people that I went to for help, who were the professionals who were supposed to have the answers, that he had to want to lose enough and hit bottom.”

Wethington said she was willing to bet everyone in the room had heard those words before, but questioned, “What is enough?” and “What is bottom?”

“Let me tell you this tonight,” Wethington said. “There is nobody, nobody that wants to be addicted. Trust me. Nobody wants to be doing what they’re doing.”

Casey had several risk factors for addiction, including a genetic predisposition because there was substance abuse on both sides of his family, and he was a risk taker, Wethington said. “I was clueless,” she said. “Casey even said to me one day, he said, ‘Mom, where do you live?’ because he knew I wasn’t living in reality. I was living somewhere else. I always wanted to be like June Cleaver, but we didn’t quite make it. … And I don’t know that anyone is.”

Once Casey finally asked for help, the family was unable to get him a bed in a drug detox facility, she said. He was eventually arrested, and Wethington thought he would finally receive help through the court system. He was released under his own recognizance to receive a summons within 90 days, but it did not come until the day of his funeral, she said.

When she called the courthouse, Wethington said she wanted a judge to order treatment for her son, and she was told that that was not how the system worked. She said she did not know if she had an epiphany or not, but she decided if anybody was going to change the system, maybe it should start with her.

The Matthew Casey Wethington Act for Substance Abuse Intervention or Casey’s Law (KRS 222.430 – 222.437) became effective for the state of Kentucky on July 13, 2004. It allows parents, relatives or friends to petition the court for involuntary treatment on behalf of someone with a substance abuse disorder, regardless of age and without criminal charges.

The family was unable to donate Casey’s organs because he had been an IV drug user, but Wethington said he is saving many more people through Casey’s Law. “I think God had a much bigger plan for us and for Casey’s life because he is saving many more people than he would have ever been able to do by an organ donation. Through Casey’s law, I know there are people living today that might not be if it hadn’t been for Casey’s law.”

Go to CaseysLaw.org to download a petition and start the process, she said. The person needs to agree to undergo two evaluations, and the petitioner must pay for the treatment, she said. However, the petitioner is in charge of choosing the facility and the evaluators so they can control how much they spend. There are 14 recovery centers in Kentucky – half for men and half for women – that are free, she said.

“There are options out there, and people will say, ‘If they don’t want to, it’s not going to do any good. You’re just wasting your time,’” Wethington said. “… Here’s the deal. Treatment works, but you have to stay in treatment for it to work. You’ve got to be present. If someone goes into a treatment facility on their own, which is wonderful I’m not saying anything against it, but if they go in on their own, just remember they can walk out the door on their own too. There (are) no locked doors, and so with Casey’s Law, if they leave against court order, the judge may hold them in contempt of court and put them in jail for a time to be determined by the judge. This is without any criminal charges.”

Wethington encouraged everyone to talk about Casey’s Law and about their personal situation with others because they may be talking to someone in the same situation. “We’ve got to take it out of the closets, she said. “Stop making it a secret and bring it out into the open.”


Addiction is a disease

In 1997, Dr. Mike Kalfas said Northern Kentucky was a pill area and only a few people were addicted to heroin.

“I watched heroin come into Northern Kentucky, and I watched it grow and fester like a boil and watched what it’s turned into. I saw it from the beginning,” said Kalfas, who worked 15 years as the Medical Director at St. Elizabeth Drug and Alcohol Treatment Center and is board certified in addiction medicine. “… We’re dealing with a disease.”

Counselors talk about a contemplative person, meaning someone who wants treatment and sees their illness as a disease, Kalfas said. These people are “a joy to help” because they soak in everything you tell them.

A pre-contemplative person is agreeable to treatment because they want to avoid the consequences. Deep down, they want to use, he said. They may say things like, ‘If heroin were legal, I wouldn’t have a problem’ or ‘It’s not my problem, it’s everyone else’s problem,’ Kalfas said.

The method for treating alcoholics was to treat them once they reached the contemplative stage, or rock bottom. “With heroin dependency, they don’t live to get contemplative, that’s the problem,” he said. “They die in the pre-contemplative stage, so we need to adjust our thinking. That old idea that they’ll come in when they’re ready just doesn’t work.”

Kalfas explained that there are mu receptors in the brain, and drugs like heroin or morphine stimulate them hundreds or even thousands of times more than natural chemicals in the body. Mu receptors create a sense of euphoria, he said, and 20 percent of people have a genetic predisposition that when mu receptors are stimulated, it is difficult to stop. People will become physically dependent on drugs; the more mu receptors are stimulated, the more they like it and the more the body makes, he said.

When receptors go empty, the brain reacts “like a child going into a temper tantrum” as the body goes into withdraw, Kalfas said.

There is a difference between dependency and addiction. Dependency means becoming tolerant to a drug over time, Kalfas said, using as an example, emphysema patients dependent on steroids to breathe. However, continued use despite negative consequences – such as going to jail or overdosing – crosses the line into addiction.

Those who are addicted will suffer from withdrawal symptoms for about a week, but the mu receptors are still there, he said. It takes six months to a year for them to return to normal. Because of this, only about 2 percent of addicted persons who go into detox succeed without additional help, Kalfas said. National studies show less than 5 percent of people who detox, go to outpatient therapy and receive the best counseling for six months will be clean unless medication is added, he said.

He mentioned a number of medications available to assist with recovery, including suboxine, vivitrol and methodone – when used appropriately and safely. He is a suboxine prescriber and said the length of time someone takes the medication varies. Some get off of it in less than a year, but one man he prescribed the medication to in 2003 is still on it, but has not had a relapse in eight years.

“I’m asking you to consider this as a disease, and the biggest thing is, don’t stand in the way of treatment,” Kalfas said. “… Don’t fight the treatment. Demand that our officials make the treatment appropriate.”

Kalfas said he is not an advocate of “giving people a free pass when they break the law,” but he does not think it should be a felony to be addicted.


The problem is growing

Ashel Kruetzkamp, director of nursing in the emergency room at St. Elizabeth Healthcare in Ft. Thomas, who has been working there for 18 years, said heroin is not a new problem, but has increased recently. “It has been becoming a problem, and it’s not just the overdoses that we’re seeing either,” she said.

Kruetzkamp said the hospital is seeing a huge increase in Hepatitis C, infections from IV drug use, heart infections and aspiration or lung infections. Unlike prescription pain medication that is regulated by the Food and Drug Administration, users never know what they are going to get with heroin. The amount can range from very high to very low, and dealers are cutting it with a variety of substances, including dry wall and baby powder, she said.

St. Elizabeth Healthcare encompasses six hospitals in Northern Kentucky, five with ERs. According to Kruetzkamp’s research, in 2011, there were 252 heroin overdoses. That number grew to 447 in 2012 and 545 in 2013. There were 45 overdoses in January 2014, she said. These numbers represent known heroin overdoses; there are more overdoses than that that are accidental or related to another drug, she said.

In addition to educating communities, Kruetzkamp said she is trying to educate the health care providers. She said she made her share of mistakes and listened to the myths over the years, but she has learned and wants to share her knowledge with others. She wants them to understand that addiction is a disease, and health care providers need to be more kind and compassionate in the ER.

Kruetzkamp used the example of diabetes patients, who also are not compliant and have high blood pressure and high blood sugar, but doctors and nurses are nice to them and give them resources to help. However, health care providers treat people with drug addictions so much differently.

Kruetzkamp said she did not get drug addiction education when she was in school, and she said it was important to educate professionals in it.

She also told everyone people are still not calling 911 for overdoses. A few times per month, the hospital will treat someone who was dropped off at the door. By the time the patient receives Narcan or Naloxone, they could have a brain injury and not be able to function normally again, she said.

Please encourage people to call 911, she said.


Legislation, things you can do

Jason Merrick, chairperson for the NKY People Advocating Recovery, shared his story of 25 years of active addiction. He is currently in long-term recovery and hasn’t had any drugs or alcohol for more than five years.

“I’m one of the lucky ones,” he said.

On April 16, 2009, Merrick checked into the Grateful Life Center and lived there for 13 months. He wanted to get involved and help people, so the day he moved out, he was hired as a part-time residential monitor at GLC and still volunteers on the weekends. He also enrolled at Northern Kentucky University in the social work undergraduate program.

Wethington also approached him about becoming a member of PAR, a member-driven organization with a mission to eliminate barriers to recovery.

Merrick said the most critical component of the heroin epidemic in the region is addressing the number of people who are dying. The group advocated the passage of state legislation last year allowing doctors to prescribe the opioid-overdose antidote naloxone. This year, they are supporting Senate Bill 5, which would give access to naloxone to First Responders and other agencies involved with high-risk populations, such as treatment centers, and family members of those at high-risk for an overdose, with the proper training.

Kalfas said some people oppose naloxone because they think it will make people cavalier now that they have the antidote. However, he said this assumes addicted people who shoot heroin think ahead of time that they might die. “All an addicted person is trying to do when they use is not to go into withdrawal. That’s what they fear more than anything.”

Kalfas said studies have shown a decrease rather than increase in deaths from using naloxone.

Bonnie Hedrick from the Northern Kentucky ASAP Prevention Alliance, said one way to help address the drug problem is to start working with adolescents sooner. “Carroll County Champions is doing that, and what I want to do is to encourage you to get involved in that group and deal with the prevention aspects of this horrible disease,” she said. “… Kids are not often starting with heroin. They start with alcohol.”

She also pointed out that treatment options for adolescents are “just horrible,” and there is not a treatment facility for adolescents in Northern Kentucky.

If you are a parent of a teenager, look for signs of heroin or opiate addiction or prescription drug use, she said. A list of early signs of addiction can be found on the website, DrugFreeKNY.org. She also advised parents to monitor where their children are going, and if they go to a party, find out if it is supervised. 

Hedrick encouraged the audience to think more broadly about the drug issue. Help create a better environment for children to live, learn and grow. Champions is about creating better climates in the classroom and working with counselors to identify and refer children who are struggling and need behavioral intervention, Hedrick said.

She also told the audience to secure medications because children are taking prescription drugs from their own homes. Dispose of them through the appropriate channels when no longer needed, she said.


Carroll County plan to diminish heroin

Mission statement: To work with the community to reduce and prevent substance use among youth, their families and those in future generations.

Prevent: Encourage youth toward healthy lifestyle choices
Provide resources for schools to promote social and emotional health for students and staff.
Strengthen collaboration and provide resources for community coalitions to promote family health.
Develop a regional youth panel to provide solutions to adolescent substance use.

Protect: Establish  programs that prevent the spread of infectious diseases
Establish naloxone distribution programs to reduce overdoses.
Encourage formation of programs to protect the general public, first responders and the people using IV drugs from developing infections and infectious diseases.
Educatie people using IV drugs about infectious diseases.

Treat: Get people the appropriate treatment they need
Encourage physicians to assist in Medication Assisted Treatment for addiction.
Establish case management model for tracking and supporting long-term sobriety and recovery.

Support: Treat recovery in a comprehensive manner
Encourage formation of additional support groups for heroin addiction.
Increase Carroll County’s supported employment and housing capacity.
Expand peer support services for persons with mental illness and substance abuse