This article is the first in a 12-part series about the U.S. addiction crisis. In the interest of compassionate conversation and eliminating stigma, we’ve chosen language that’s cultivated by the Research Recovery Institute and hope it inspires you to as well.It's possible to read about the long-reaching effects of substance use disorder and feel rage. You can be angry at the harsh penalties kids have to suffer for their families' substance use disorders. You can be angry about how the dying experience unbearable pain when taken advantage of by the people who are supposed to help them. You can be angry at how substance use disorders harm our economy. In short, you can be mad at people suffering from substance use disorder and blame them for what you see as their "choice." But that won't solve the problem. In fact, that angry response unfairly characterizes the problem. According to the 2014 National Survey on Drug Use and Health, an estimated 21.5 million Americans over age 12 suffered from a substance use disorder. Although CDC figures for 2016 are not yet complete, deaths from overdose are projected to range between 59,000 and 65,000. That estimate makes overdose the leading cause of accidental death, ahead of both car accidents and shootings. What follows are seven impacts of the crisis that should inspire all of us to get involved. If there’s one thing that becomes apparent as we struggle to grasp the impact of the national substance use disorder crisis it's that help is needed everywhere.
Young children are affected by substance use disorder in many ways. Some babies become addicted to the substances their mothers use and develop neonatal abstinence syndrome (NAS) after their births cause withdrawal. NAS do occur as a result of illicit substance use, but can occur even when babies' mothers were using physician-prescribed opiates only as directed. Like adults experiencing withdrawal, babies with NAS experience a host of medical complications, including tremors, convulsions, breathing problems, and fevers. Babies with NAS often have low birth weight and have trouble gaining weight after birth. Some have withdrawal symptoms so severe that they need to be treated with morphine, which doctors taper off as babies' health improves. Young children feel the effects of substance use disorder in other ways, whether it be direct poisoning after ingesting dangerous substances, or indirectly, when their parents' substance use disorders make it difficult for them to provide adequate care.
Children in foster care with parents suffering a substance use disorder
In 2015, 269,509 children entered the foster care system, an increase of nearly 5,000 from the previous year. State-level data suggest that substance use disorders are linked with the growing rate of foster care. In Massachusetts, 30 percent of the children placed in foster care have a parent with a substance use disorder. In Georgia, that figure is 40 percent. In Ohio, it's 70 percent. Even kids in comparatively stable homes can have their lives upended by a sibling facing substance use disorder. Parents reasonably give more attention to their affected children, while expecting their children without substance use disorder to Parent Co. parented with Aspenti Health because they know that the first step toward change is understanding the problem.
This year, police officers in Virginia, Florida, and Maryland have required treatment after accidentally ingesting fentanyl found at crime scenes. Police dogs have also overdosed on fentanyl during raids. These exposures have led police departments to change their policies for handling potentially dangerous substances. In order to treat overdose victims, first responders wear protective gloves and masks because the substances they encounter are so potent. Some departments have stopped using field kits to identify substances, instead sending samples to state labs. Police officers now carry naloxone, not just for the public, but also for fellow officers and police animals. Even responders who follow these new protocols can suffer accidental overdose. Ohio police officer Chris Green wiped his shirt with a bare hand after returning to his station from an arrest and, afterward, required naloxone to treat a fentanyl overdose.
Illicit substances are often distributed literally as a mixed bag. First responders and police officers may not know fentanyl is present because the victim of the overdose didn't know either. In 2016, Summit County in Ohio saw 312 overdose deaths – nearly a 50 percent rise from the year before. This increase can be partially linked to batches of potent substances mixed with lesser, more common substances. Fentanyl's cousin, carfentanil, is labeled for use only as an elephant tranquilizer. When veterinarians administer it to zoo animals, they keep a paramedic on hand in case of accidental exposure because it is so dangerous to humans. When substances like fentanyl and carfentanil are mixed with more commonly-used substances like heroin, everyone – the teenager who just tried heroin on a dare, the first responder called to treat her, that first responder's two-year-old son – becomes a potential victim. According to Gary Guenther, chief investigator for the Summit County medical examiner, the county coroner had to rent refrigerated trucks three times that year in order to handle extra bodies when the morgue overfilled. In addition to the "mobile morgues" required as a result of these overdoses, coroner's offices have to spend more money on toxicology tests. They also have to spend more time on investigations, creating a backlog of cases, not just for substance use deaths, but all deaths in their communities.
Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine.
A lethal dose of heroin vs. fentanyl:
Photo from New Hampshire State Police Forensic Lab
Hospice care is an increasingly-used option for terminally-ill patients who want to die in their homes "pain-free and with dignity." But as an August 2017 Kaiser Health News report describes, substance use disorder is robbing some patients of that dignity. These patients, who are prescribed potent painkillers like morphine, hydrocodone, and fentanyl, are vulnerable to theft. The Kaiser report includes elderly patients whose medication was stolen by their children, pediatric patients whose medication was stolen by their parents, and patients of all ages whose medication was stolen by the health aides assigned to treat them. In some instances, medication was stolen by neighbors or by people posing as health aides. It's easy to judge these people harshly. But it's worth pausing to consider that these are nurses who have pledged to care for the sick and dying. These are children who have taken on the burden of caring for their dying parents. These are parents who have taken on the burden of caring for their dying children. Many of these people are as gravely ill as their charges, behaving as no healthy person would.
Contrary to popular belief, many people with substance use disorders are employed. According to a 2015 report from the Substance Abuse and Mental Health Services Administration, 9.5 percent of all full-time workers aged 18 to 64 had a substance use disorder. The rates of substance use disorders were highest among those in the accommodations and food services industry (16.9 percent) and lowest among those in the educational services industry (5.5 percent). When these workers miss work, whether from substance use or hospitalization, their workplaces suffer from their absence. Even though the U.S. economy is growing, workers of "prime age" – between 25 and 54 – are not seeking employment. Men of prime age have been even less likely to seek employment. According to an August Brookings Institute report, opioid use is part of the reason for the stagnancy in the labor force. Princeton economist Alan Krueger notes that almost half of men outside of the labor force take daily pain medication. Two-thirds of that group take prescription pain medication. These figures make the profile of substance use disorder look much different than we often imagine. The economy isn't suffering because people addicted to illegal substances don't want to work. It's suffering because people who want to work are in too much pain to work, like the dad who fell off a ladder while painting the house and whose pain is poorly managed by opiates.
A WBUR report on substance use in Cambridge includes a public restroom tour from guide "Eddie," who explains which restrooms are unlocked and which offer privacy. That privacy, however, comes at a cost: "Once you get in, you won't be interrupted – or rescued." Some business and community leaders have responded to the problem by closing their bathrooms. In 2012, after a string of overdoses on its property that its staff did not feel medically equipped to handle, Christ Church in Cambridge, Massachusetts, made the difficult decision to close its public bathroom. But as some doors have closed, others have opened. Business owners in Cambridge have used a number of creative techniques to prevent overdoses in their bathrooms. One coffee shop owner is training his baristas to treat overdoses by administering naloxone. Joshua Gerber says that just 10 minutes after he'd sent an invitation to his staff, 25 of them signed up: "You know, just thrilled to figure out how they might be able to save a life." Gerber's baristas aren't the only unlikely population impacted by substance use disorder.
As library overdoses began increasing for Librarians at McPherson Square Branch in Philadelphia, they took action and now practice overdose drills. The library staff was the first in the city to learn how to administer the lifesaving overdose antidote Narcan. Instead of waiting for permission, they asked Prevention Point Philadelphia, a needle-exchange program, to demonstrate the use of Narcan. The demonstration was held before Library operating hours, but more than two dozen librarians showed from six North Philadelphia libraries. Sandy Horrocks, a spokeswoman for the Free Library, said officials would expand the model to other libraries as needed. American Libraries, the magazine of the American Library Association, ran an article in June 2017 about, which was accompanied by a sidebar piece about needle safety. The coverage suggests that the McPherson Square Branch is not alone. Libraries all over the country are concerned about overdoses. It's insufficient to say that people with substance use disorder could be our family members, neighbors, friends, teachers, and soccer coaches. They are our family members, neighbors, friends, teachers, and soccer coaches. The profile of a person with substance use disorder is not an intravenous user without regard for his or other people's lives. It's a pregnant mother, an elder care provider, a teenager, or an injured middle-manager. Despite our awareness that people with substance use disorder could be people intrinsically involved in our lives, most of us continue to ignore the crisis. You can be angry with these people. Or you can be like a barista in Cambridge or a librarian in Philadelphia, two of the unlikely heroes who have emerged to combat this crisis. You can, as these people have, find novel ways to help. Parent Co. partnered with Aspenti Health because they know that the first step toward change is understanding the problem.