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The Opiate Epidemic: Keeping a finger on the pulse

August 7, 2017

The opiate epidemic continues to be a national, state and local concern. Angela Colistra, PhD at the Capitol building in Washington D.C.There are many contributing factors including the rise of prescription practices of opioid medications, which began in the 1980s and continue. Also, the war on drugs, which was popularized by Harry J. Anslinger, a government official who criminalized drugs and supported prohibition and created a culture that prioritized the criminalization of individuals with substance use disorders as opposed to rehabilitation. This has ultimately sent a message that drug use is a moral failing as opposed to a disease of the brain where many individuals are more vulnerable to its grips when compared to others. More recently, the spread of heroin, and heroin laced with fentanyl and carfentanil continues to contribute to the surge in deaths. Fentanyl is 50 times stronger than heroin (synthesized from morphine) while carfentanil is 10,000 times that of morphine and 100 times that of fentanyl (NIDA, 2016). To put this in perspective, one grain of carfentanil can kill a human being (the size of one grain of salt). Lastly, social stress and availability of these drugs create an environment for use disorders to grow.  Understanding these causes are essential to understanding and developing of the solutions. 
Behavioral health workers, first responders, law enforcement, emergency departments, politicians, journalists, family members and loved ones from across Pennsylvania are talking about the graveness of this epidemic, and for good reason. According to the Centers for Disease Control (2016) 91 people die daily from an opioid overdose and from 2000-2015 more than a half million people died from drug overdoses, with the majority of those deaths involving an opioid (more than six out of ten). The headlines have been both saddening and hard to believe. “Last month, right down the street in Manayunk, first responders saved the youngest overdose survivor,” lamented Angela Colistra, PhD, a clinical assistant professor in Drexel’s College of Nursing and Health Professions. “A nine-month-old baby was found with a hypodermic needle in her leg and first responders were able to administer a version of Naloxone (Narcan) to reverse the opioid overdose,” she added. It has been reported nationally that some states are using refrigerated trucks to store the masses of dead bodies resulting from this epidemic (Freytas-Tamura, 2017). Solutions to this epidemic are in everyone's interest, especially for nursing and health professionals. 
Colistra and her team—community partners Beth Mingey and Aerielle Waters from Holcomb Behavioral Health and behavioral health counseling student Judy Liberotoscioli—are looking at two trends that continue to drive the 15-year rise in opioid overdoses: prescription opioid overdoses, and a recent surge in illicit overdoses driven by heroin and illegally made fentanyl. Pennsylvania was identified as a state that showed a statistically significant drug overdose death rate increase from 2014 to 2015. With the surge of opiate overdoses across the United States, Pennsylvania experienced 26.3 overdose deaths per 100,000 people (CDC, 2016), which was the sixth-highest rate in the nation with a 20.5 increase of opioid overdose deaths from 2014 to 2015. Therefore, identifying intervention and prevention training protocols for the different stakeholder groups is essential to our progress. This is what Colistra’s current research study is aiming to do—provide solutions for community response in Delaware County, PA. 
Her passion for this topic is not new. She has spent seven years working directly with individuals managing and overcoming opioid use disorders and advocating for medicated assisted treatment and other forms of harm reduction approaches as a certified advanced alcohol and drug abuse counselor (CAADC), licensed professional counselor (LPC), certified clinical supervisor (CCS) and trainer. Another focus of hers has been training the addiction workforce. Her expertise has been sought to train individuals internationally under the direction of the International Center for Health Concerns in Kathmandu, Nepal and Beijing, China. “Closer to home, I’ve educated city council members, behavioral health agencies, and law enforcement personnel in Clarksburg, West Virginia, my hometown, because it’s been ravaged by this epidemic and I will return there this fall,” Colistra commented. Within the Drexel University community, she recently worked with an interdisciplinary team, including Dana Murphy-Parker, MS, Carol Okupniak, DrNP, Kathleen Ryan, MD and Vincent Zarro, MD, to create and present opioid poisoning emergency response, screening, brief intervention, and referral to treatment (SBIRT) training using simulation videos. The goal of these interprofessional educational sessions is to improve health care professionals’ abilities to move clients into a continuum of treatment post the emergency room visit. “I’ve lost dear friends and clients to this epidemic. I want to contribute to a deeper understanding of the problem and develop solutions to this growing crisis while empowering students and community members to be ambassadors for change.”   
Each year the opiate epidemic brings together interdisciplinary professionals at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. This conference brings together influential stakeholders—government officials like Patrick Kennedy and Newt Gingrich, the National Institute of Drug Abuse's Nora Volkow, MD—and those on the ground doing the clinical work. “My research team and I represented the College of Nursing and Health Professions and Holcomb Behavioral Health in April. We presented the preliminary results from our research study titled, Developing an Opioid Intervention and Prevention Training (Colistra & Mingey, 2017), Colistra explained.  The purpose of that qualitative study is to inform community-training protocols in Delaware County, PA. Interviews are being conducted in five groups within that County and one national group. National naloxone trainers, behavioral health specialists, family members and loved ones who know someone with OUDs, first responders and recent opioid overdose/poisoning victims are among the 67 interviewed to date. Colistra’s research was also presented at the Substance Abuse and Mental Health Services Administration (SAMSHA) 13th Annual Prevention Day/Community Anti-Drug Coalitions of America (CADCA) conference last February. “I want my work to improve opioid intervention and prevention trainings and increase moving clients along a continuum of care not just in Delaware County but across the United States,” she disclosed. To do that, she conducted focus groups with recent overdose victims. “Just last month I interviewed a group of women overcoming the grips of opiate addiction. I’m interested in their ideas about intervention and prevention protocols. I think this focus group has the potential to have a strong influence on how work is done moving forward with those struggling. We have to talk to those who are struggling with this disease and those on the ground doing the work and allow them to illuminate the solutions for intervention and prevention and we hope to do just that through this research study.”  In the coming year, Colistra is looking forward to publishing her data and presenting her research findings while collaborating on interdisciplinary addiction education initiatives both at home and nationally. 

By Angela Colistra, PhD and Roberta S. Perry