__Treatment__

Treating an opioid overdose often means acting quickly to save a life. In some states, the person who witnesses the overdose is able to administer the opioid antagonist, naloxone, which blocks the opioids from reaching opioid receptors. This must be administered rapidly for life-saving measures and comes in a nasal spray form for friends of family members to use, if needed. In other states, the administrator of the potentially life-saving drug must be an emergency responder.

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No matter who issues the naloxone, the victimized person should seek professional medical attention following the episode.

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Physician and specialist in emergency medicine at Saint Francis Healthcare System Ronald “Joe” Leckie said medical first-responders bring the overdose patient into the emergency room after administering the naloxone. The patient, he said, is typically conscious upon arrival.

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Leckie said those who overdose on opioids for the first time or are not repeat users will not usually experience a withdrawal period following an overdose.

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Someone who has abused opioids consistently, Leckie said, may typically experience a withdrawal period of a few days.

“The good news of opioid [withdrawals is that] they will not kill you,” Leckie said. “You’ll wish you were dead, though.”

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Leckie said the withdrawal period can include symptoms such as nausea, vomiting, body shakes and an overall sick feeling.

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A challenge Leckie said emergency doctors often see in an overdose situation is a mix of several drugs, not just opioids. The patients, he added, may not know or be willing to disclose all the drugs they consumed, which can make treatment more challenging.

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“You have to be like Sherlock Holmes,” Leckie said. “You have to really hunt and find what they’re taking to treat the right medication.”

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Of 20,000 physicians in Missouri, director of Missouri Department of Health and Senior Services Randal Williams said only 500 are certified to treat opioid abuse – him being one of them — and that a special course is necessary to receive that certification.

Because the opioid epidemic reaches to areas where access to medical care may be limited, Williams also said telemedicine is becoming a key to treating rural communities. The ninth state to implement a telemedicine program, he said Missouri is becoming efficient in the usage of medically assisted treatments, and that attention must also be given to those already addicted.

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Following the treatment period, Leckie said opioid overdose, misuse or abuse patients are typically recommended to the Gibson Recovery Center for long-term care. Those without a support system, Leckie added, often wind up back in the emergency room as “frequent fliers.”

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While most patients are recommended to Gibson Recovery Center, Leckie said the Cape Girardeau area needs more treatment center options. He added that the emergency department of Saint Francis does not typically prescribe methadone, a medication-assisted treatment option offered at the Cape Girardeau Metro Treatment Center.

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Methadone (suboxone) activates the opioid receptors just enough to prevent people with substance use disorder from feeling withdrawals or cravings, but not enough for them to get high. Methadone is used by some treatment facilities as a way to help slowly wean a person with substance use disorder off their opioid of choice.

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Leckie said he thinks methadone is a positive step forward for those with substance use disorder, despite it being a substance on which people can still become dependent.

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“It’s not as bad as the drugs that they were addicted to, but unfortunately they’re dependent on it,” Leckie said.

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Outside of overdoses, Leckie said at least 25 to 30 percent of the emergency room visits at St. Francis are “pain issues.” He said many primary care physicians have stopped writing refilling and writing narcotic prescriptions, so the emergency department gets an influx of patients looking for that, as well.

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The Missouri Department of Social Services began sending letters to physicians twelve years ago with names of patients who had been prescribed opioids. Leckie got his first letter in March and said the department sends out 8,000 letters every two months to physicians who then have just 21 days to return them each time with reasons for prescribing opioids to those patients.

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Leckie said the emergency department as a result is trying to get away from prescribing opioids for pain and instead offering non-addictive pain medications.

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“We have a policy that we’re not going to refill narcotics,” Leckie said. “So many patients come in every day wanting it, we kinda have to be all or none [when it comes to refilling individual prescriptions].”

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Despite the challenges still facing treatment in the opioid epidemic, Williams said the Missouri Executive Cabinet is collaborating on the issue for the first time. He expects a better outcome than in past years.

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There are many options available to those seeking treatment for substance use disorder, including chemical dependency treatment programs, detoxification, opioid overdose, behavior therapy and mutual-aid groups.

__Recovery__

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 419,000 Missourians struggle with a substance use disorder. Of those, 17,000 are between the ages of 12 and 17.

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Recovery is the long-term care and rehabilitation of an individual so that he or she may eventually be able to move on from the power of the drug which once held them. It’s defined by SAMHSA as, “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

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Long-term recovery options for those struggling with substance use disorder in Cape Girardeau are limited to Gibson Recovery Center and Adult and Teen Challenge, both of which have services primarily for men. Funded by the Missouri Department of Mental Health, Gibson Recovery Center does have some services available for women in recovery, according to Dana Branson, professor in the Department of Social Work at Southeast.

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Kristi Booth, a peer ambassador for Missouri Recovery Network, said there are simply not enough services available to many people in recovery in the Cape Girardeau area.

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Other southeast Missouri area recovery centers include Mission Missouri in Sikeston, Southeast Behavioral Health - New Era Center in Poplar Bluff and Southeast Behavioral Health in Salem.

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While it is possible to break an addiction, most people with substance use disorder classify themselves as lifelong “persons in recovery.” There is no known cure for substance use disorder, but recovery allows an individual to go from initial treatment to sustainable health.

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According to the Missouri Department of Mental Health, recovery supports are funded through the a federal grant, called Access to Recovery (ATR). The $7 million ATR 4 grant that was awarded to Missouri in 2015 by the U.S. Department of Health and Senior Services was to be spread out over a three year period.

In April, it ran out.

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On Feb. 7, the Missouri Recovery Network held a Recovery Advocacy Day at the Missouri Capitol to lobby for more funding that would replace the ATR 4. Advocates attended in order to speak with their representatives about passing legislation that would treat recovery as a special line item in the Missouri budget. That line item would provide the state with extra funding, $4 million to be exact, to specifically create more recovery programs to help rehabilitate those with substance use disorder.

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According to the Missouri Recovery Network, “funding recovery makes sense.” Funding for the line item of recovery would go toward community safety, reuniting families, reducing the impact to the foster system, increasing safe housing and decreasing homelessness.

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The total Missouri economic cost of the opioid crisis in 2016 was $12.6 billion, and Missouri sees up to a $12 return for every one dollar spent on prevention, treatment and recovery supports, according to the Missouri Recovery Network.

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The ways in which a life of recovery can be achieved and supported, according to SAMHSA, are broken down into four basic categories: health, home, purpose and community.

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It goes without saying an individual in recovery is someone seeking better health practices. But in this case, health is more than just feeling good and regular exercise. It’s also about checking in with oneself mentally, physically and emotionally, while also maintaining the ability to abstain from all the things which encouraged the disease (alcohol, illicit drugs, non-prescribed medications, etc.).

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Recovery is impossible without a safe and stable home. Recovery centers are designed to take an individual with substance use disorder out of the environment in which they became addicted. Only when isolated from that environment can an individual begin taking steps to get well.

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When an individual has substance use disorder, he or she can lose their sense of purpose. Meaningful daily activities such as a job, school or volunteer work can engage an individual and revive a sense of purpose that can make all the difference in the recovery process. In some recovery centers, this can take the form of a spiritual or faith-based program.

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Finally, community is a part of recovery which cannot be understated. In almost every kind of recovery center, there are people on a similar journey who become community. The ability of individuals with substance use disorder to find a community that understands what they’ve been through is an integral part of the recovery process.

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