Revamped Vanderburgh County task force now looking at heroin problem

"It’s going to be tough problem (to fix)," said Dr. Kenneth Spear.” We need more treatment facilities. We need more addiction services.”

But Spear, who is the health officer of the county health department, said the idea that more treatment places would be ready sooner rather than later in the Evansville area is more of a wish than a possibility.

In the meantime, he urged people to have open conversations about the dangers of drugs – especially parents talking to their children – as well as talks on how everyone can help find ways to help addicts find help.

Though pain pill abuse has plagued Southwestern Indiana for years, the region has only recently seen an influx of heroin into the region. Often, prescription opioid users turn to heroin to get a fix because it is easier or cheaper to obtain than pills. There were six overdose deaths blamed on heroin in 2015 and that number has already about quadrupled this year, according to the Vanderburgh County Coroner’s Office.

Of those who have died in recent months from an overdose, many had heroin and Fentanyl in their system. Law enforcement officials across the country have warned that Fentanyl is often added to shipments of heroin to make the drug more powerful -- and lethal.

Spear recently joined a local task force aimed at addressing the opiate drug issue. That group is a re-branding of Evansville Mayor Lloyd Winnecke’s no-meth task force and is headed by Dr. William Wooten. Wooten, who is the founder of Youth First Inc., also worked many years in addiction services. He said the task force has members who work at area treatment facilities and both St. Mary’s and Deaconess hospitals. It also includes city fire department and local law enforcement officials. The group will likely be known as the Mayor's Task Force on Substance Abuse, Wooten said.

The group is still in the "game plan" phase for its new mission and goals, but he said it will try to engage the community to promote "awareness education, prevention and treatment."

"I think the best things that we can do is to help people understand what resources are available for help and (to) help families of those affected in influencing people who may be addicted to get some support and help," Wooten said.

He warned that there is no "quick-fix" when it comes to stemming the opioid and heroin issues.

"It's a multi-faceted problem, and it's (going to take) a multi-faceted solution," Wooten said.

The path to addiction

Spear asked the public to exercise extra caution when they are prescribed an opioid painkiller.

"If Tylenol works, take Tylenol. If Advil works, take Advil. If you have to have opioids take them as prescribed and get off of them as rapidly as possible,” Speer said about legitimate painkiller prescriptions. “I would use the least potent pain medication necessary to control the pain.”

Spear said he’s exploring the idea of making the health department a drop-off location for unwanted drugs. If that is done, his department would join the Vanderburgh County Sheriff’s Office command post on U.S. 41 and the Morton Street office of the county coroner as places people could drop off their unused drugs for proper disposal.

“There are a lot of drugs that are sitting all over this country and all over this town that are not being used,” he said. “You don’t need 100 opioid tablets sitting in your medicine cabinet.”

Katy Adams, the director of Stepping Stone, agreed that prevention measures such as drug take back programs are the best the thing the public can do to help curb the problem. She also encouraged physicians to look for patients who show signs of painkiller addictions.

Finding ways to provide more drug take back locations and encourage area medical providers are two objectives identified by the Community Health Needs Assessment group, which is made up of representatives of Deaconess, St. Mary’s, the county health department, ECHO Housing Corp., and the Welborn Baptist Foundation.

Stepping Stone is one of a handful of places that offers addiction services. Adams said the Evansville is actually lucky because it has several outpatient facilities in the area that can treat addiction.

For the last couple of years though, all such providers have been “overflowing, “ and that “everybody is really, really busy,” she acknowledged. Adams said that influx started around the same time as the implementation of the Healthy Indiana insurance plan so she hopes that the increased treatment numbers mean that more people are seeking help – not just more people suffering from addiction.

Adams also said the lack of residential options for addicts to try to kick their habit is an obstacle. Her facility has 26 beds and the other closest residential options in the state are in Jeffersonville or Indianapolis.

“When you’re looking at a residential level of care, which is what a lot of people do need to break the relapse cycle and get their feet under them before they do an outpatient (program), we are more limited,” she said. “Stepping Stone has 26 residential beds. We serve the entire state of Indiana, and there are really only three other places like us in the state.”

Costs are often prohibitive for residential programs. Fees can range from a few to several hundred dollars a day, and those expenses are not traditionally covered by insurance.

“There are people in the community who will say that we need more beds, we need more of this,” Adams said. “But the push from the insurance companies for treatment is to do everything in the community and not do residential based care,”

Medicaid and HIP have historically never paid for residential treatment so private insurances have followed suit and have said, ‘Well, if the government is not going to pay for it, then why should we?’  It’s expensive.”

Adams said her residential program does stay full, but she encourages anyone who is ready to seek treatment through that avenue to contact Stepping Stone. Wait times usually are one to two weeks but sometimes new patients can be admitted that day.

There’s no one segment of the population that can find a solution to the rise of opioid addiction alone, Spear said. Instead, he stressed the need to find a community solution and that the problem won’t be able to be fixed by a single “magic bullet” remedy.

Both Spear and Kristina Carter, who serves as the health department's clinical and outreach director, urged the public – as well as loved ones of users -- to view drug addiction as a medical issue, not a criminal one.

“People don’t wake up in the morning and hope and pray for a mental illness or an addiction. We can’t support individuals who are in that state – or their families – if we feel like we should be ashamed (for them) or that it’s not appropriate to talk about it,” Carter said. “You can’t help individuals if you feel like you can’t even bring it up with people who are close to you.”

The idea that drug addiction is primarily a medical issue isn’t just the compassionate stance to take though. According to Indiana’s health commissioner, Dr. Jerome Adams, it’s also backed by science.

“Addiction really changes your brain. We keep talking about the need to look at it as a chronic disease than as a moral failing,” he said. “That’s the truth, but I don’t think it resonates with people … (Addiction) literally changes how your brain works. I tend to think about it similar to a person who has bipolar disorder. We wouldn’t say to them ‘Look, you need to get better,’ and expect them to do it.”

Stepping Stone has a program called Community Reinforcement Approach and Family Training program. Known as CRAFT for short, it is designed specifically for people who want to learn the most effective ways to help someone seek treatment. Katy Adams said family or others close to users are usually the ones who are most influential in getting them to finally seek out help.

“We can’t make people access these (treatment) programs … but engaging the support system around that person can be very motivating in getting that person help,” she said.

The prospect of a needle exchange  

One thing Spear and the health department could do is to declare a public health emergency so the county could possibly qualify for a needle exchange program. However, because of how narrow the state legislation allowing such programs is, that measure requires the health department to declare such an emergency that is tied only to the county’s HIV or Hepatitis C rates.

Spear and Carter said they hope that the General Assembly modifies the law to make it easier to implement for needle exchanges, but told the Courier & Press they don't foresee Vanderburgh County creating one soon under the current rules. Spear also acknowledged that setting up an exchange would not be a “standalone solution” to the current drug problem.

“Unless Senate 461 changes or the legislation loosens up, we have to be really cautious when even pursuing a needle exchange,” Carter said.

However, Jerome Adams, the state health official, said the legislation has at least led to conversations in communities about needle exchanges and the opioid problem as a whole, and from his standpoint, is in part what the law was supposed to do. He noted that even if there was no law restricting exchange programs, they would only be successful if they had local support.

“I don’t think the law itself is what is limiting syringe exchanges. I think it is the stigma, the community beliefs and the community’s wiliness to engage. I actually think the law facilitates those conversations,” he said. “There is always an opportunity to improve upon things, but I think we’ve got to do a better job educating people about the opioid epidemic and what led to it … versus the law itself.”

While smoking and alcohol abuse still effects more Hoosiers than heroin and other opioids, the use of the drug is becoming one of state’s top health issue because of how deadly just one hit of heroin can be, Adams said.

"The opioid epidemic is really just wiping out a generation of our best and brightest and wiping out of them young, he said. "Alcohol and tobacco, they’re killing people, but they’re killing people when they kill 50, 60 or 70. Opioids are killing 16, 17 and 18 year-olds.”