Opioid and heroin abuse have reached epidemic levels across the country, and no city is immune. Drug overdose is now the leading cause of accidental death in the United States, with more than 47,000 lethal drug overdoses in 2014, according to the National League of Cities.
In the 1990s, there was a push to better address pain management, and the concept of "pain as the fifth vital sign" was introduced. Physicians began prescribing high numbers of pain killers. According to the Centers for Disease Control and Prevention, 259 million prescriptions were written in 2012 for opioids. This is enough to equip every American adult with his own bottle of pills.
Opioids—the class of drugs that includes heroin and prescription drugs like morphine, codeine, oxycodone and hydrocodone—are highly addictive. They work by binding receptors in the nervous system and minimizing the body’s perception of pain. They also influence other functions, such as the regulation of breathing, blood pressure and mood. Experts say that people who develop an addiction to prescription opioids often move on to heroin due to its lower cost and higher potency.
It is not just a big-city problem; opioid and heroin addiction touches every community. There are 20-year-old, upper-middle class kids shooting heroin who became addicted after legitimately being prescribed opioids for sports injuries, said Richard Cole, owner of Insights Educational & Treatment Services, Inc., an outpatient treatment center that provides a variety of behavioral health services including Drug Free Workplace programs. Plus, 70 percent of all addicted people are gainfully employed.
"It’s in your workplace; it’s your co-workers," Cole said. "Municipalities need to be positioned to identify impaired professionals, test them and get them the help they need."
Local elected officials, as community leaders, can be among the strongest voices to increase awareness and prevention education of this problem, reduce the stigma associated with addiction, advocate for public health solutions in cooperation with surrounding cities and counties, and mobilize resources for increasing the number of treatment opportunities for those suffering from addiction, according to Jim Brooks, City Solutions director for the National League of Cities.
Brooks said that police chiefs and the U.S. Department of Justice officials agree that we cannot arrest our way out of the epidemic of opioid drug overdoses and deaths.
"This is a public health problem—fighting the disease of addiction. Putting people in jail will not cure the addiction. Police are seeking to ‘divert’ drug users away from the criminal justice system and into the public health system," Brooks said.
Brooks said cities should work with local pharmacies to support drug "take-back" programs for safe drug disposal. He also recommended that all emergency responders (police, fire/EMS) be issued and trained to use Naloxone, a lifesaving drug which can reverse the effects of an opioid overdose.
Efforts are underway to get all police officers in the Columbia area outfitted with Naloxone kits, according to Columbia Police Narcotics Agent Anthony Branham. That includes officers with the Columbia police department, Richland County Sheriff’s Department and public safety officers at the University of South Carolina.
Some officers already have received training and have been issued kits. The kit is user-friendly. Once the cap of the injection is removed, a recorded voice gives step-by-step instructions on how to administer the drug, Branham said.
The cost of the program is one drawback. While a private donor is funding the initial kits, Branham said, he would like to see money set aside in the city’s budget to sustain the program. He also hopes the city will receive federal grants to help combat the opioid and heroin epidemic.
Over the past three years, there has been a 2000 percent increase in the number of seizures and arrests for heroin in Columbia, Branham said.
The full extent of the problem across the state may not ever be clear, according to Sara Goldsby with the SC Department of Alcohol and Other Drug Abuse Services. In some cases, families don’t want a loved one’s death to be recorded as an overdose due to the stigma. Other times, coroners don’t have the money, staff, technology or equipment to run toxicology reports to determine cause of death, Goldsby said.
Municipalities need to pave the way for dialogue, including town hall meetings, to reduce the stigma of addiction, she said. This can be a step forward in helping people move toward treatment and recovery.
"Addiction is a medical disorder that affects the biology of the brain," Goldsby explained. "It shouldn’t be regarded as a moral failing or criminal activity."
In addition to affecting individuals and communities, opioid abuse and addiction is a human resources and risk management issue for cities, according to Venyke Harley, loss control manager for the Municipal Association.
Municipal employees on opioids are prone to injury, have slower reaction times, and have impaired judgment and depth perception. They can pose a risk to the public simply by the nature of their work—whether it is operating heavy equipment or providing clean water.
Supervisors need to be trained to identify signs and symptoms of opioid addiction, Cole said. Those can include changes or inconsistencies in work performance, frequent tardiness or attendance problems, making simple errors repeatedly or needing to be retrained multiple times on tasks because they can’t remember how to do them, impaired coordination or judgment or slurred speech, changes in mood or alertness, or change in appearance to a white or ashen color.
Municipal officials also need to update their drug testing panels to include opioids, Harley said. In the past, workplace drug testing primarily focused on identifying alcohol and marijuana use. Officials need to be prepared to identify opioid addiction in employees and have a plan to get them help, she said.
The Association will offer a breakout session at the Annual Meeting about the role of municipal leaders during a public health crisis. The session will cover both the Zika virus and opioid abuse.