Commentary

Steve May: A public health emergency

Editor's note: This commentary is by Steve May, who is a licensed clinical social worker working in addiction medicine for the last 15 years, treating addicts, alcoholics and their families in a variety of settings. He was a Democratic candidate for the state Senate in the Chittenden District in 2018.

[P]ardon me, but this is a public health emergency.

In case you hadn’t noticed, people are dying out here. There is a body count. And the victims are your children. They are your siblings and your friends. And yes, they are even your parents. The scope of this scourge knows no bounds. There are those august voices of officialdom who would like you to believe that simply because things have gone from catastrophic to a state of “less worse” that this event has been addressed. It hasn’t. Last week saw more shiny microphones -- surrounded by people who wanted to show their newest graphs and grandest statistics.

Let’s be absolutely clear: Vermonters are continuing to overdose and die as a result of a chemical reliance on a painkiller. In the overwhelming number of those cases, that reliance on a painkiller began with a real honest injury treated by a Vermont doctor. Based on prevailing wisdom and the information available, doctors prescribed pain medications and and, over time, dependency of one kind of another developed.

What we are left with is an approach that can at best be called lopsided. In our effort to make overdose less lethal, we have flooded the state with Narcan, because in our desperation to save our loved ones from themselves, we seek more time until we have an outcome better than a reversal drug. We have made it more and more difficult to get opiate painkillers to patients who legitimately have an ongoing pain concern.

Limiting opiates, restricting opiates and attacking the provision, use and supply of opiates has the net effect of declaring war on opiates without ever taking into consideration of why or how these drugs were to have been used in the first place. Painkillers came into existence to address physical pain. Addressing physical pain is an important area of medicine. Restricting the use of an entire class of drugs without being prepared to speak to the void created when those medicines were restricted borders on malpractice. As a matter of public policy, we need to have a much broader conversation about pain and pain management as the next logical step.

This is no garden variety public policy problem -- it can’t be. The fact that in 2019 we treat pain as a medical concern with the same level of sophistication as our grandparents treated cancer should be mortifying to anyone who sets eyes upon this. If you aren’t outraged that a medical provider will ask you at triage whether your pain level is more closely associated with a smile or a grimace on a 10-point scale, you're not paying attention. In 1950, there was no breast cancer, lung cancer, prostate cancer, etc., there was cancer, that was it. It’s the same way that we treat all pain as being more or less the same; is it dull, sharp, sustained?

Restricting the flow of painkillers barely scratches the surface when it comes to addressing this moment in the opiate epidemic. In its wake, throngs of Vermonters with real legitimate pain issues are left without access to a meaningful remedy. At the same time, these same patients then must address their physical pain concerns and their reliance on opiates, often due to misuse, misapplication (or both) of their past prescribed narcotic painkiller. That legal prescription in many cases was the opening chapter that which kicked off deeper and more sustained opiate use for thousands of Vermont patients.

This is a public health emergency. For this generation of Vermonters this is the equivalent of the AIDS epidemic in the early 1980s. This is our 1918 flu epidemic. So where is the urgency? We have watched people in officialdom debate siting a safe injection site like it’s a matter of complying with some kind of arcane zoning problem. These are not ordinary times. People continue to be dying. The stakes demand a different brand of leadership.

Officialdom would lead you to believe that we can simply restrict the flow of painkillers and we will have solved the opioid epidemic because this is simply an opiate problem where too many painkillers have seen the light of day. That narrow view does a disservice to all Vermonters ensnarled in this crisis. Right now, today, legislators are discussing the need for more prison beds. There is a critical and unfortunate intersection between prison and addiction. Lost in the larger conversation about corrections and prison beds is the fact that precious little has been said about the desperate need for treatment spaces and detox beds across Vermont. Or for that matter, virtually nothing has been said about the fact that not every Vermonter leaving detox, treatment or prison has a safe place to return to and as such might need transitional housing prior to establishing a residence for themselves. Precious few transitional housing beds exist around the state.

We need to act, and we need to act deliberately and with grand intention for these are no ordinary times. The people of our state caught in the middle of this opiate epidemic deserve and require a kind of intensity of forethought and urgency in deed; for these truly are the most extraordinary of times.


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