The opi­oid epi­demic is more com­pli­cated than the wide­spread abuse of heroin and pre­scrip­tion painkillers.

Milwaukee Magazine - - Content - BY ARCHER PARQUETTE

Heroin is far dead­lier when it works with an ac­com­plice.

TWO HUN­DRED and fifty nine peo­ple died in Mil­wau­kee County from ac­ci­den­tal drug over­doses in 2016. In­side the chilly lab­o­ra­tory of the Mil­wau­kee County Med­i­cal Ex­am­iner’s Of­fice in Down­town Mil­wau­kee, Sara Schreiber, the of­fice’s tech­ni­cal lab­o­ra­tory di­rec­tor, an­a­lyzed each case and found that a ma­jor­ity were caused by “mixed drug” tox­i­c­ity – of­ten a com­bi­na­tion of in­tox­i­cants, such as heroin, al­co­hol and Xanax, that slow the heart and lungs. Yet lo­cal and na­tional preven­tion pro­grams fre­quently tar­get heroin and opi­oid abuse in iso­la­tion, miss­ing the big­ger pic­ture, which is more com­plex. Heroin is a killer, but it typ­i­cally works with an ac­com­plice.

Opi­ate-re­lated deaths con­tinue to rise. In 2012, the Med­i­cal Ex­am­iner’s Of­fice recorded 147, a fig­ure that seemed el­e­vated at the time. By 2016, it had grown by 61 per­cent, and while the vast ma­jor­ity of 2016’s drug deaths in Mil­wau­kee County, 88 per­cent, in­volved an opi­ate, only 30 per­cent of those were caused by opi­ates alone. The other 70 per­cent came from mix­ing the drug with an­other sub­stance, with fa­tal re­sults. Out of those cases, 41 per­cent in­volved ben­zo­di­azepine seda­tives, and a quar­ter in­volved al­co­hol.

There are many rea­sons for the wide­spread preva­lence of drug mix­ing. Heroin users some­times take anti-anx­i­ety ben­zo­di­azepine drugs to in­ten­sify a high, com­bat in­creas­ing drug tol­er­ance, and ease the later come-down, but the com­bi­na­tion can be deadly. Users may try to get a pre­scrip­tion for the “benzo” or, as is of­ten the case, buy it il­le­gally, which leaves them in the dark about proper dos­ing. Com­bine the above sub­stances in high doses, and “breath­ing has a high like­li­hood of be­ing stopped,” says Schreiber.

Education is needed, she says, “to make in­di­vid­u­als aware of th­ese things up­front be­fore they start us­ing.”

Un­til re­cently, pub­lic education cam­paigns in Wis­con­sin have tended to focus on anti-ad­dic­tion mes­sag­ing and stop­ping us­age be­fore it starts. The state De­part­ment of Jus­tice has rolled out two ma­jor anti-heroin ef­forts, “The Fly Ef­fect” from 2013 and “Dose of Re­al­ity,” ex­panded in 2016. Aimed at teenagers, The Fly Ef­fect pri­mar­ily ad­dressed heroin abuse, whereas Dose of Re­al­ity con­cerns the haz­ards of pre­scrip­tion painkillers.

In an ef­fort to pre­vent fa­tal­i­ties, a new sci­ence-based ef­fort is fo­cus­ing on what’s com­monly re­ferred to as “harm re­duc­tion” – strate­gies to min­i­mize harm for users who are al­ready ad­dicted. The Mil­wau­kee Com­mu­nity Opi­oid Preven­tion Ef­fort (COPE) be­gan in 2016 as a joint ef­fort be­tween the city of Mil­wau­kee, the Med­i­cal Col­lege of Wis­con­sin’s De­part­ment of Emer­gency Medicine and the Zil­ber Fam­ily Foun­da­tion, and the group gath­ers lo­cal data to use in pro­grams that lessen the risks faced by users.

Ac­cord­ing to Brooke Lerner, deputy di­rec­tor of the In­jury Re­source Cen­ter at MCW, the task force’s ad­vice to known users is as fol­lows: Don’t use alone, try the drug in a small dose first to test its ef­fects and have plenty of Nar­can on hand, a drug that treats nar­cotic over­doses.

COPE doesn’t over­look the dan­ger in­her­ent in mix­ing drugs, and in­cludes this fac­tor in its hand­outs for users, list­ing it as one of the ma­jor causes of over­doses.

“It’s go­ing to take the ef­forts of the gov­ern­ment,” Lerner says, “the non-gov­ern­men­tal agen­cies, aca­demics and law en­force­ment, re­ally com­ing to­gether to think about how to ad­dress this.”

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