The plague of heroin and opiate abuse that’s descended on Greater Cincinnati and Northern Kentucky — not to mention much of the rest of America — is enough to make many people throw up our hands in dismay. But not Ann Barnum, vice president of community strategies at Interact for Health
She’s been dealing with this complex issue for years, her efforts focused on fostering collaboration with agencies and individuals concerned about what havoc addiction is wreaking on area residents, especially young people, the most likely and vulnerable users.
Barnum knows the horrifying truth behind drug abuse, since she’s worked for more than three decades with organizations in the region dealing with substance use disorders. She’s been with Interact for 16 years. The organization — a nonprofit serving 20 counties in Ohio, Kentucky and Indiana — is a catalyst for health and wellness
. Barnum has been a passionate advocate for eliminating opioid abuse in the region.
Asked how this epidemic came about, she offers a clear explanation.
“It started with an opiate prescription epidemic,” Barnum says. “Too many opiate pain killers were being prescribed.”
When that problem was identified and restricted by strong monitoring systems, she says, “Drug dealers saw an opportunity to get heroin onto the streets. It’s much cheaper and easier to get. All you have to drive through some neighborhoods and you’ll see people selling all the time.”
She calls this epidemic the “unintended consequences of good laws.”
Barnum says there are ways the disease can be contained.
“One is you make sure people don’t start using,” she says. “You make sure they are informed. Scare tactics don’t seem to work, but information helps. … Supply reduction is important, keeping illicit drugs like heroin and diverted prescription drugs off the streets. So sensitive law enforcement is important, too.”
The heroin problem is so complex that even reducing the drug’s supply has unintended consequences, as a recent Cincinnati Enquirer
front-page story pointed out. Some of the recent spike in gun violence in Cincinnati
is blamed on drug dealers battling over a shortage in heroin and cocaine supply, the story says.
Still, Barnum explains, once people are in the chain of addiction, “We need to reduce the harm. One way to do this when you’re talking about opiates is to make sure that when people overdose, they are brought back with naloxone
The drug can temporarily stall an opiate overdose, and Barnum understood its importance early.
In 2011 when the opiate problem was just beginning to be detected, she began to advocate for naloxone. She convinced Cincinnati’s Center for Chemical Addictions Treatment
(CCAT) to prescribe it for people leaving their programs. She helped devise a protocol for institutions, and Interact funded several ways of getting naloxone into the community — through emergency rooms, through treatment programs and through community education.
But it’s been an uphill, often political battle. Many public officials have been in denial about a problem in their own communities; some believe this drug will only encourage more abuse since it’s a kind of safety net.
Barnum is convinced that more and are starting to understand. The governor of Pennsylvania
last week encouraged local school districts and universities to stock and administer naloxone.
“They’re realizing that it could be my neighbor or my child,” Barnum says. “Some still say, ‘Why don’t you just let them die? It would cost us less money.’”
Forging networks to address the epidemic
The economic impact is horrendous, to be sure. Heroin use in the U.S. increased 79 percent from 2007 to 2012. Many estimates by federal agencies suggest the annual impact on the U.S. economy has exceeded $200 billion. The impact has four distinct factors: health, social welfare, crime and productivity.
Because overdose is a frequent problem, emergency rooms are experiencing rapidly increasing heroin-related visits. Social services have had to respond to address the needs of addicts and families, ranging from bankruptcy and prostitution to foster care and homelessness. The expansion of criminal distribution and heroin abuse requires more law enforcement, and the cost of incarcerating individuals found guilty has expanded.
But in a region such as Greater Cincinnati where workforce development is key to economic growth, perhaps the biggest impact is on lost productivity. Most addicts can’t hold a job, and even those who do function erratically. The National Council on Alcoholism and Drug Dependence estimates that drug abuse costs employers $81 billion annually.
And consider the loss of specific individuals to heroin: Actor Philip Seymour Hoffman died at age 46 from an overdose earlier this year.
“It’s certainly not a savings,” Barnum observes, “in terms of what a person could have contributed to our society.”
With the resources of Interact, Barnum has spearheaded numerous efforts to be a catalyst and move people forward.
“We need the community to understand what this epidemic looks like and how it needs to be addressed,” she says. “Our job is to help make networks happen.”
One path is to introduce people involved in responding to this crisis to one another.
“So we bring together the police chief and the head of a hospital,” Barnum says, “or someone in Colerain who wants to do something on a community level to address overdoses with the Addiction Services Council who can provide some staff.”
Her efforts constantly seek a broader scale, fostering planning efforts to make plans for a communities and regions rather than single neighborhoods.
“We helped fund the planning effort for the Hamilton County plan,” she says. “It was picked up by Commissioner Greg Hartmann and is being used as the county plan for both public dollars and private dollars that would come to them.”
The Hamilton County Heroin Coalition — a collaborative partnership of public health, treatment providers, law enforcement and other community stakeholders — presented its strategic action plan to Hamilton County Commissioners Sept. 28 and unveiled a one-stop website
for local families to learn more about heroin and opiate abuse, find treatment and assistance and get involved in combating the epidemic.
Interact has also sought to better inform funders about the epidemic.
“We’ve done a ‘Funders Response to the Heroin Epidemic,’” Barnum says, “and we’re working on getting them to pool their money so we can appropriately respond to this epidemic.”
Interact is aiding in the pursuit of funds from various sources, including the federal government.
“There are several grants that only a foundation can apply so we’ve coordinated an application that would award matching dollars to community dollars,” she says.
In everyone's backyard
While Interact for Health nurtures these broader community initiatives, there are ways that everyday citizens can be engaged in addressing the heroin epidemic. The most important thing, she asserts, is to never say "not in my backyard." There are no longer any barriers, Barnum points out.
“The kids are
in your backyard,” she says. “It’s predominantly young people who are dying. It’s affecting families in the suburbs, urban families, rural families, people who are black, white and Hispanic. It doesn’t cover just one population. If you have the problem there, you need to have the solution there — in your backyard.
“You need to say yes for a facility for recovering addicts. You need to say yes to an outpatient program. You need to say yes to public health initiatives coming to my neighborhood — like needle exchange. Say yes to police carrying naloxone.”
Barnum believes that the message is getting across. In fact, she fears people might be growing tired of talking about it.
“That’s concerning to me,” she says. “Just because you’ve heard it doesn’t mean we’re done. We don’t have a solution yet in place.”
A second thing concerned citizens can do is volunteer. Barnum suggests helping with needle exchange or going to a community cleanup: “People could to spend some funds to puncture-resistant gloves that will protect police and others.” (They’re $80 a pair but will stop people from getting stuck with dirty syringes.)
She urges concerned citizens to become better informed.
“We need to acknowledge that this is a problem affecting people who are just like you and me,” she says.
In Northern Kentucky, one in three people know someone who is addicted.
Physicians can help by reducing opiate prescriptions in volume or number of days, Barnum says.
“There’s no rule you have to give a 30-day supply,” she says. “Prescribing less means there won’t be all this extra supply sitting around.”
Additionally, she hopes people needing pain reduction will turn down a 30-day supply when a few days might be enough. “Tell the ER doctor, ‘No, I don’t need that.’ Tell them, ‘I just sprained my ankle really bad. What can you give me that’s not opiates?”
In particular, Barnum urges everyone to talk with youth in your network. “Tell them, ‘Don’t start smoking, don’t start drinking, don’t start smoking marijuana. Don’t start taking opiate prescription drugs.' Their brains are not fully formed.”
She points out that once the brain gets used to a chemical filling a particular niche, it stops being discerning as much about other drugs, particularly at a young age. “The disease of addiction is truly an adolescent process. People who end up addicted are much more likely to have started when they were under the age of 18.”
Take these actions and you’ll be playing a role in creating a healthier population for our region.
Community members and public health professionals are joining forces Sept. 30 to battle substance abuse at the 2015 Coalition Academy
, hosted by PreventionFIRST! at the Great Wolf Lodge in Mason. Ann Barnum is the keynote speaker and will discuss opioid prevention and its impact on coalitions and local communities in Ohio, Kentucky and Indiana. The program is designed to encourage coalition development and what coalitions can do within their communities, such as changing policies and norms.