Opioids are killing one person a week in Washtenaw County.
From the February, 2018 issue
Ashton Marr, an elfin woman with a slicked-back Mohawk, is a former opioid addict. "I was a normal and well-adjusted kid," she says. Born and raised in Ann Arbor, she went to Eberwhite, Slauson, and Pioneer. But "when I got to high school, I was really unsure of my place in the world," she explains. "Anxiety and insecurity lead to addiction, and, when substances were presented to me, that was the decision I made."
Those street drugs were bad enough. But opioids were worse, and she got them from doctors. "I had an emergency appendectomy in 2004, and, when I was exposed to opioid-based painkillers, I was off and running."
During the next nine years, she went from prescription opioids to heroin. "My life was lonely and painful and terrifying," she recalls. "I resigned myself to die."
Instead--"and I couldn't explain it even today"--she called for help. The Brighton Center for Recovery had a bed available, "but I was already experiencing withdrawal symptoms, and I didn't know how I was going to get to Brighton.
"So I called my dad," Marr says, brushing aside a tear. "The shame was tremendous, so I couldn't even get the words out to tell him where we were going. I just asked him for a ride ...
"I was in a bad way. I weighed thirty pounds less than I do now. But food didn't matter. Nothing mattered if it came between me and my substance. I'm surprised it didn't kill me."
Today, Marr works at Home of New Vision, doing advocacy for substance use disorders and prevention education.
She knows how lucky she is: she lost her first friend to drug addiction at age sixteen. "It breaks my heart to admit this," she says, "but there have been so many lost throughout my lifetime that I probably couldn't guess as to a total number of people I've known who lost their battle with this devastating disease." One friend, Brittney Krogh, was twenty-two
and "seven months pregnant when she relapsed. She and the baby both died. She was a good person, very smart and very kind, and her boyfriend is still in jail on related charges."
Krogh was one of forty-nine county residents killed by opioids--both legal and illegal--in 2015. Fifty-nine died in 2016, and sixty-five through last October.
"We now have a Washtenaw County resident overdose every day, and an overdose death every week," says county epidemiologist Adreanne Waller. She tracks the cumulative toll on a map that shows overdoses and deaths since 2011 (at left). More than 1,000 blue dots mark overdoses that were not fatal but required treatment in a hospital emergency department. Another 276 red dots mark the place where someone died. Krogh's is across from Home Depot on Green Meadows Dr.
Krogh was tragically typical of the casualties of the opioid epidemic. Waller says that in Ann Arbor in 2016, 52 percent were under thirty, and 20 percent were female. And "fentanyl is involved in almost all of the deaths as an immediate cause of death."
Fentanyl is a powerful synthetic opioid used to spike black-market heroin. But while it's the proximate cause of death, she adds, "that should not distract us from what caused the initial misuse." Many opioid addicts got started the way Marr did, by taking legal painkillers prescribed by doctors.
"These are medicines that were previously only available if you were inpatient at a hospital, and you weren't discharged until you didn't need narcotics anymore," Waller says. "Now we do many of our surgeries outpatient, and we now have very, very powerful drugs out in the community."
Sheriff's commander Marlene Radzik saw the results firsthand. Twenty years ago, she was an undercover narcotics detective buying drugs on the street. "It was crack cocaine mostly, marijuana, and powdered cocaine. Heroin was rare," and there were only a few overdose deaths a year, typically older men.
But "around 2010 I started seeing a lot of overdose deaths, and they were twenty years old, sixteen years old." When deputies investigated, Radzik says, "pretty much every story was the same. It was a football injury, a car accident, some kind of medical procedure where they were given Vicodin or OxyContin or Percocet. Two weeks' worth of that, and you can become addicted--and when you're not getting any more, then you start buying pills off the street."
They were easy to get. According to the CDC, between 1999 and 2016, prescriptions for opioid painkillers quadrupled--and deaths from overdoses more than tripled.
Herb Malinoff, a physician who specializes in addiction treatment and pain management, blames "bad science, wishful thinking, and money ... There were a couple of people who proposed the theory that pain was being undertreated and it was safe to treat people with opioids, because they're very unlikely to produce addiction.
"The wishful thinking is when doctors think 'all I have to do is put people on high dosages of opioids, and they won't complain of pain' ... and physical dependency happens to everybody. If I put my grandmother on opioids and ramped her up, she would become dependent.
"The third factor is money." Purdue Pharma, "a sleepy little company in Connecticut, came up with OxyContin." It was just an extended-release version of oxycodone, a heroin relative long known to be addictive. But as the New Yorker explained in an October 2017 article, the company "funded research and paid doctors to make the case that concerns about opioid addiction were overblown and that OxyContin could safely treat an ever-wider range of maladies."
Even after accounts of abuse multiplied, Purdue tried to discredit and intimidate OxyContin's critics. It was not until 2007, a dozen years after it was introduced, that Purdue's parent company admitted to deceptive marketing and paid a $600 million fine.
When newly addicted patients used up their legitimate prescriptions, they could turn to "pill mills," ask-few-questions clinics that tapped into the new abundance of legal narcotics. Last year, two doctors were convicted, and a third pleaded guilty, to charges related to the Meghnot Comprehensive Center for Hope. Located in a Tudor-style mansion on Golfside, the clinic, according to prosecutors, dispensed 1.5 million doses of oxycodone alone before it was raided in 2015.
As awareness of the crisis grew, the number of prescriptions written for narcotic painkillers peaked in 2012. Yet nationally as well as locally, the number of deaths has continued to rise: the CDC counted more than 42,000 in 2016. More Americans were killed that year by opioids than by firearms (33,000) or motor vehicles (37,000).
Waller thinks the falling number of prescriptions may be offset by more rapid progression of addiction. "The window between the introduction of opiate use and severe addiction is shrinking," she says. And, paradoxically, "as you reduce the number of prescriptions available, when people are trying to access their opiates, they have to turn to street drugs ... Prescription drugs are very expensive on the street, and heroin--or what you think is heroin--is much cheaper and, frankly, easier to get."
Shockingly, the death toll could have been far higher. Since 2011, Huron Valley Ambulance crews have carried naloxone, an "opioid antagonist" that can quickly reverse the effects of an overdose. As of mid-December, they had administered more than 3,300 doses to more than 2,300 individuals. The sheriff, the AAPD, and other local police departments also carry it. So does the Delonis Center homeless shelter, where last year nine people staying at the warming center overdosed. The staff was able to save eight; despite their efforts, one died.
The sheriff's department started carrying it in 2014, and counts seventy-seven saves. In the past, "I had overdoses where the parents had to kick in the bathroom door because their son or daughter didn't respond when they knocked," Radzik recalls with a shudder, "and the twenty-year-old is laying there with a needle in his or her arm, and you do CPR, and they die. Now we have that extra tool to save lives." And when they do, a deputy and a social worker from the county's Community Mental Health follow up and try to get the person into a treatment program.
"Abstinence-based recovery is the treatment of choice," says Malinoff. "But there's also medically assisted treatment." His Ypsilanti clinic, Pain Recovery Solutions, prescribes buprenorphine for patients who have opioid addiction. "It immediately stops the craving of withdrawal."
One patient in his late thirties "was taking forty Vicodin a day," Malinoff says. "He was holding down three jobs, working sixty to eighty hours a week. His wife [and] four little kids are at home. Most of his money is going to pay for his Vicodin. He goes on buprenorphine. His craving stops. He stops buying Vicodin ... It's not recovery, but he's not dying of an overdose either.
"Addiction is an illness," he says. "These people are not bad, dumb, stupid, and crazy. They're killing themselves unintentionally."
That was Ashton Marr four years ago. The Brighton Center for Recovery "was my first exposure to the recovery community. The staff showed me this world that I could become a part of. It's incredible on this side. I've had opportunities I never would have had otherwise."
Like working for the sheriff's department. Responding to a Facebook post about a meeting to enhance police and community trust, she emailed the department's director of community engagement, Derrick Jackson. "So what does a girl with the red Mohawk tell this guy? That I'm a person in recovery? I don't think the statute of limitations is up on some things I've done ... but I took the leap, and much to my surprise he offered me a job.
"Among other things, I helped with the naloxone training for deputies. It's important for them to see somebody in recovery, because they certainly see us at our worst, and it would be hard to always see that and maintain hope. And there is hope. As long as we're breathing, there's still hope."
After two years with the department, she went to Home of New Vision, first working in their recovery residences then heading their new Washtenaw Recovery Advocacy Project.
"We advocate for people with substance use disorders on local, state, and federal levels," Marr says. "We do a lot of community education at schools and events. My favorite is a softball game between people in recovery and deputies from the sheriff's office. It's a hoot!
"I was very fortunate to find recovery, the help that I needed and still need," she continues. "I believe for me to maintain my own recovery, it's important to help others. I know what goes bump in the night, and I want to be part of the solution.
"We're not bad people trying to be good. We're sick people trying to become well."
[Originally published in February, 2018.]
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