Headlines News

The opioid crisis

Atmore, Escambia County not immune to addiction epidemic

Dr. Sheldon Harigel and nurse Judy King

News Staff Writer

Note: This article is the first in a two-part series on the opioid crisis and its effect locally. Part two, which will be published in the November 7 edition of Atmore News, will deal with the options available for those addicted to opium-based pain medications.

A medical problem that began cropping up in the 1990s has now spread across the U.S. and has reached the epidemic stage.
The problem, addiction to and misuse and abuse of opium-based prescription medicines (including Oxycontin, Percoset and hydrocodone medicines) has reached into virtually every community in the country, including Atmore and the remainder of Escambia County.
Denise Carlee, director of Escambia County Drug Court, said the problem has existed for years but has just recently begun to draw the attention of the government and the medical community.
“Generally speaking, it has been bad for years, and I don’t see it any worse this year than in the last three,” Carlee said. “But the government is finally recognizing that it is a real problem. Now that it has gotten the attention that it has, it is called a crisis. I agree with that, but it has been that way for several years now. It is really bad.”
Statistics maintained by the Centers for Disease Control and Prevention show that more than 630,000 people died from a drug overdose between 1999 and 2016. About two-thirds of those deaths involved an opioid, including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl.
Dr. Sheldon Harigel of Atmore said the problem has grown to epidemic proportions, but noted that new detoxification programs and awareness campaigns have slowed the growth rate to some degree.
“Yes, it’s a crisis,” Harigel said. “The state of Alabama is actually ranked number one in America in opioid prescriptions. There’s probably some decline now, with the new programs and the increase in awareness. From what I’ve seen in the physician community, there has been a modest decrease in the prescribing of opioids, especially in our practice.”
Court officials, doctors and law enforcement officials noted that the decline in opioid prescriptions has led many addicts in another direction in their search for pain relief.
According to the National Institute on Drug Abuse, “nearly 80 percent of Americans using heroin (including those in treatment) reported misusing prescription opioids first.”
“The doctors have really cracked down on prescriptions, and (opium-based) pills have become harder and harder to get,” Atmore Police Chief Chuck Brooks said. “There has certainly been a reduction, but you still have people who are hooked, and they are going to get them on the street or go to something like heroin.”
Harigel said he has seen evidence that the decrease in opioid prescriptions has triggered an increase in the availability and use of illicit drugs, which he said are the primary agents of drug overdoses.
“People sell their pills on the street,” the family physician said. “But the biggest overdoses come from heroin or fentanyl. Heroin is on the rise again, and pills are much more difficult to get. A recovering addict from Pensacola told me that you can hardly find pills, but you can find heroin all day long.”
Carlee has also seen proof.
“Heroin is a lot cheaper than it was years ago, thus making it very attractive for addicts,” Carlee said. “Heroin has made a real comeback in our county. Five years ago heroin was not mentioned much around this area. Although it is an opioid, pills were much bigger up until the past couple of years.”
She said Lortab and Oxycontin are the two prescription drugs most involved in cases that come before the county’s drug court.
“All of the opiates are something that addicts abuse, but those are the two I hear most about with drug court clients,” she said, adding that there is also another, most unlikely, source of opioid abuse. “Then we have Imodium [an anti-diarrheal medicine] that people are taking to get an opioid high. Of course it can be bought in most any store, in as large a quantity as one would want to buy and then take at one time and get high. They may not be able to use the bathroom for months, but they don’t seem to care.”
Fentanyl is another opioid that has become a drug of choice for opioid addicts who can’t get prescriptions, although most realize the potential hazard of the medication, a version of which is imported illegally from China. The question of potency has limited the indulgence in the drug, which is a pain killer usually used with others in anesthesia.
“The biggest epidemic on the streets right now is fentanyl,” Harigel said. “It’s mostly a different kind than that prescribed by doctors. It comes from China and is 20 times more toxic. That’s what a lot of people overdose on because they don’t realize how potent it is.”
Brooks and Carlee concurred that the increase in the use of fentanyl has not reached very deeply into the local drug culture.
“Fentanyl is a scary thing among addicts so they tend to not play with it much,” Carlee said. “Most people find that it is laced in something they purchase, and until they take it they don’t realize what they have ingested. I would say that while it is here, it certainly has not risen to the top or even the middle and is still lower on the scale of most-sought-after drugs.”
Addiction to pain-killing medications, especially opioids, is not just a problem for those who are part of the drug culture.
“It goes all the way up the socio-economic scale,” said the police chief. “This crisis affects everybody. Drugs don’t care if you’re male or female, rich or poor, black or white. If you’ve had a knee replacement, hip replacement or back problems – all of them very painful procedures – it’s so easy to become dependent on pain medications.”
Still, those who are hooked on pain medications are going to find some type of substance that will mitigate their need for another fix. The cost of those substances is often not a factor.
“I had a patient who was taking 30 pills a day, bought on the streets for $8 each,” said Harigel, who operates a clinic designed to help addicted individuals kick their habits. “Addicts are going to get whatever they can to get the high they need, whether it’s sniffing a gas can or popping pills. People are people, and you can’t take out the human factor.”