“Dreamland in Denver”

Thursday, March 01, 2018 12:20 PM

Stakeholders gather for evening of powerful talks on opioid epidemic

by Kate Alfano, CMS Communications Coordinator

Correcting myths and challenging preconceptions about the use and abuse of opioid pain relievers were two outcomes of an event held at the University of Colorado Anschutz Medical Campus in January. “Dreamland in Denver,” organized by the Colorado Consortium for Prescription Drug Abuse Prevention and the Emergency Medical Minute, featured a series of TED talk-style presentations to illustrate the escalation of the opioid epidemic and the necessity for a multifaceted response. Nearly 600 stakeholders from across the spectrum of the epidemic were in attendance, including many leaders from the Colorado Medical Society, and CMS joined the list of sponsors in supporting the event.

The first speakers were Admiral (Ret.) James Winnefeld, former vice chairman of the Joint Chiefs of Staff, and his wife Mary, who shared a powerful cautionary tale about how opioid addiction can affect any family. They lost their youngest son, Jonathan, in September 2017 from an overdose of heroin laced with fentanyl following a years-long battle of drug addiction. He died just three days after his parents helped him move into the dorms at the University of Denver to start his freshman year of college.

Losing a child to the opioid epidemic is “a club none of you ever want to be a part of,” Mary Winnefeld said. “Unfortunately, membership in this club is growing every day.”

In 2017, an estimated 66,000 Americans died of an overdose. The couple has founded Stop the Addiction Fatality Epidemic, or SAFE, to raise awareness of the opioid addiction and use effective, evidence-based action to prevent overdoses and to mitigate the opioid epidemic.

Albert “Alby” Zweight, JD, current presiding drug court magistrate for the 2nd Judicial District in Denver, shared his story of heroin addiction in his 20s, which he says uniquely qualifies him to run a “therapeutic court” focused on second chances. “Opioids are a problem, but we have an addiction epidemic,” he said. “We must understand addiction in a different way. No one wants to be an addict. Addiction blinds people. Addicts use drugs because they are suffering and they are doing things to keep from feeling awful. Drug courts are important, medication-assisted treatment is important, treatment is so important. These are the only ways out of this epidemic.”

Robert Valuck, PhD, RPh, FNAP, chair of the governor’s Consortium for Prescription Drug Abuse Prevention, presented his list of 10 fallacies that fueled the opioid epidemic. “Pain is physiologically important. The thought that we can get a patient to zero pain [on the pain scale] is a myth,” he said. “We have to quit using the word ‘painkiller’ because we can’t ‘kill’ pain. We need to figure out how to manage and treat pain.”

He also “busted” myths about opioids’ effectiveness and safety compared with other medications and treatments. “It’s almost an urban legend that opioids are ‘the good stuff,’ the best pain relievers there are,” Valuck said. “That’s wrong.” He also emphasized the importance of understanding drug interactions; a substantial number of accidental overdose deaths occur when opioids are mixed with benzodiazepines.

Donald Stader, MD, section chair and associate medical director of the Department of Emergency Medicine at Swedish Medical Center in Englewood and CMS liaison to the Opioid and Other Substance Use Disorders Interim Study Committee, addressed medicine’s role in creating the opioid crisis. While acknowledging pharmaceutical companies aggressively marketed the drugs and the government created penalties for doctors who didn’t control pain, Stader said doctors ultimately drove this epidemic through the prescription pad. “Our calling is to be healers, not harmers, and to fulfill the sacred calling that we will do no harm,” he said. “We can do better.”

Finally, keynote speaker Sam Quinones, investigative reporter and author of “Dreamland: The True Tale of America’s Opiate Epidemic,” gave his unique perspective of how drug dealers, pharmaceutical companies, doctors and economic decline combined to create the epidemic. In his view, the loss of community institutions, jobs and the fraying of America’s social fabric are major contributors to the opioid epidemic. The connections that hold communities together have withered, contributing to isolation which feeds addiction.

“There’s an opportunity to turn away from the isolation that made us ill,” Quinones said. “We’re seeing in county after county that taskforces are bringing together different voices to leverage their talents. There is no one solution; there is a mosaic of solutions.”

In an interview with Colorado Medicine before the event, Quinones said he does not place blame for this epidemic on doctors. “You can’t effect a change like we saw in this country with a few scandalous outliers. It has to be the mainstream that adopts this idea. I believe if you take out all the pill mills and all the docs who have been prosecuted, you still wouldn’t come up with the enormity of the supply that was unleashed on the country year after year after year, increasing through the late 1990s into the 2000s and into this decade.”

“I think doctors were pushed, pressured, cajoled into doing this, and a lot of that came from us – American health consumers. We wanted easy [solutions], we wanted to be fixed, we didn’t want to be accountable for our own core health decisions.”

Quinones sees a role for insurance companies to once again pay for new and a wider variety of non-opioid pain strategies. But ultimately, he said, it comes down to talking to patients: Establish realistic expectations of pain, what medications can and can’t do, and non-medication strategies. Have patients reclaim their wellness, getting back to what he calls “American self-reliance.”