Webinar presenter Denise Beagley answered a number of your questions after her presentation, "Heroin & Opioids: A to Z." Here are a few of her responses.
Audience Question: Regarding the statistics, you shared regarding state data for deaths. The person is wondering if whether or not the CDC or anyone else shares that information based on the percentage of the population. So how many people died from heroin overdose based on the percent of the population and whether or not the ranking will change because of that?
Denise Beagley: Yeah, per 100,000. It's really heavy, Yes that's the basic. and then also the I want to look at 84%, I think it was Ohio, were from heroin – opioid overdose. So, you want to drive it down. Yes, it looks per 100,000. In fact, I'll put that link to those– so you can look for your state specifically. Because it is really eye-opening when they draw it down. Now, I will say as a caveat I don't always trust the numbers per se. It's just like with suicide. They don't always count. So, some become an accidental death, not necessarily an overdose or is it a suicide? How do they decide where or what thought does that one goes into? That's why it's always approximately or an estimated number. It's still pretty staggering. When you look at those numbers from 2000-2016. I get that we're two years behind. I would say we're elevated, even yet still continuing to rise.
Audience Question: This one is from someone who is a Vivitrol agent. They provided the first 12 shots over a 1-year period. She'd like to know a couple of things. Number one, do you have any thoughts or suggestions about the amount whether it's just right, or if it’s too much or not enough? And also, whether or not do you have experience with they found they might no longer be using opiates but have now decided to use meth?
Denise Beagley: Oh yeah, That's a tough question. I mean we look at harm reduction but it's mass harm reduction. We would want the person you know. I'd rather have the person turn to marijuana than turn to methamphetamine. Is meth less of an issue of the two? Heroin, probably? That doesn't mean I'm recommending, “Stop using heroin and use methamphetamine”. A lot of my friends in the field would say I'd rather have someone using real meth versus the (indiscernible) using a real weed. I would still uncomfortable. I'm not making the recommendation of that at all. I don't know a whole lot. I just put the slide back up so people can see the Vivitrol extended release there. I don't know enough. I'm not a doctor so I wouldn’t have an opinion to speak on what is the appropriate dosage or not. I think ultimately, we look at medication as just a treatment. There are people who truly need another drug, but under supervision, to get off another drug. I'm just a big believer that it's not just a pill for every ill. We need to talk through things. There's got to be talk therapy. For me, motivational interviewing. I know I say it a lot but it's about having that rapport and relationship with somebody. Talking to them, listening to them. That's where people start to change. if you can get a person talking about their desire to have a different life, that's key, Dr. Miller will talk about that. Having a person talk about their goal, they're more likely to achieve it. They've got to hear it from themselves too. During worksheets, whatever it takes, talking to a peer, someone who is a positive influence in their life is going to have a better chance of survival rate from this disease.
Audience Question: Denise, what do you suggest first responders and even other justice personnel such as probationary officers say to console family members that have suffered a loss due to, a drug-related loss?
Denise Beagley: That's the one that really gets – Whether we have to do a death notification. Sometimes our police or sheriff has to go and notify them and we get called out as crisis because it went wrong. Great intention but a person is literally in crisis because they found out about their loved ones. A lot of times I try to comfort them, I say, "You did all you could, we know you loved them, this is a very difficult thing". When I say, "You saw more of the drug personality than the person", things tend to resonate with people that your person was not a bad person. They were really suffering from this disease. To acquaint it with dementia. A person will be upset, yelling at you. But the person's not a bad person. Their brain is literally dying. I try to just have empathy and understanding of what this person is going through, be there for the family and listen and use reflective listening. Be as supportive as possible. Connect them with grief counseling, other people. As first responders, we think we got to wrap it all up ourselves. It's okay for us to do a warm handoff and connect people with services because we can't do everything. We need to get back out there and help the next person that needs our immediate support and help.
Audience Question: You mentioned compassion fatigue earlier. How can a first responder be genuine and generally concerned for an addict without becoming a victim of compassion fatigue? How do they build that barrier?
Denise Beagley: Yeah, I've recently been training. We have a grant here with Arizona State University and Chandler Fire, my two jobs kind of together. We created the Crisis Support Training. I have some videos depending on what position you are as a first responder. There’re some really good videos out there to help you. I think it's about looking at these individuals as human beings, as somebody’s one-one. Whether it's two o'clock in the afternoon or 2 o'clock in the morning, how can you be supportive? How can you connect that person with a resource, putting that number in their phone or getting them connected? After that call is done, you've got to take care of yourself. You have to refill your tank. If you are suffering from compassion fatigue, you are not going to approach that person the same as you would depending on that time of day, and it should be consistent, right? But it becomes difficult when our tank is empty. You have to have a life outside your job. I know it sounds silly but it's true. You have to, like, I get in the truck and thank goodness I don't wear a mike or anything and I drive away. If I have a partner or wait to get back to the station. I got to talk about this call, I got to talk about what I just experienced and if I don't, it just upsets me and I just compress it down. It then becomes unhealthy and it comes out in other ways. Maybe I'm short with my poor kids. I come home from a shift, a 36-hour shift, and I'm short because I've been compacting all of this stuff and not letting it out. So, we have to have an arena in which we can talk to each other. We're really primed to encourage peer to peer connections in our fire department, using that kitchen table to about what we just experienced. I think it helps to know being a clinician I can go over there and talk it through but when I'm not there how can they help each other? Sometimes it’s happening right on the scene as everybody's gone. Myself and PD, my folks at fire who wind up having a quick conversation to kind of look at that. I got my Mr. Rogers theory, what Mr. Rogers do when he came into the neighborhood. He took off his jacket, he put on a sweater, he changed his shoes. He did that same thing when he went back out into the street. We need to have some sort of a threshold to protect our core and not forget the meaning of why we got into this work. It's really to help people, right? So, we got to also help ourselves and know when we need that help. First responders are dying more by their own hands than they are in the line of duty. That's something we don't talk about because usually, we don't ask for help. That's another one I'd be willing to talk to you all about, compassion fatigue and self-care because it's something that is so important.
Audience Question: Some cities like Philadelphia are experimenting with safe injection sites or consumption rooms to limit overdoses. Just would love to hear your thought on this, whether or not there will be benefits to this kind of approach?
Denise Beagley: I know certain cities have a needle program, they're using clean needles. I think there are some other things there that are going on. Is there counseling? You're not just allowing this environment to happen but are you also addressing other things with them? I do think there could be benefits to that as long as there is some sort of connection to how do we get this person to recognize that this behavior is dangerous for them. As long as there is that responsibility of somehow leading it to treatment, it could be beneficial. I'm all about harm reduction and reducing harm. I know it's controversial but how do we do that. I kind of see the program that way but I think what’s irresponsible is not addressing it and trying to connect to people. Does that make any sense?
Audience Question: Are you familiar with any programs that really help provide accessible and affordable treatment and what if the areas you're in only provide limited and expensive treatment options? Do you have some suggestions on the best way to help someone?
Denise Beagley: Yes, on the second question, grassroots — you know how AA started was lifting up the garage door and having a meeting with peers. I think it's simple connecting within the community and giving back. I think it's huge. You're right. Treatment is very expensive. I can remember a joke about promises and Malibu. I think it promises to take your $150,000. I'm sure that program can work for some people but not everybody can afford $150,000 to get treatment. So how do we make these things affordable, particularly in a rural setting? I know here in Arizona, we have the Hopi nation, a large native population. They have a trailer out in the middle of nowhere. Rural setting, that's their jail, that's their detox unit, that's their AA meeting. They make it work and they connect to people. Even in a rural setting, it takes just one person to start it, getting people together, calling in favors. A lot of times that's what I do, I call I call in favors. How can I get people connected? We're even saying there is a wait for services. How do we use spiritual or religious groups to help? We got to find some sort of connection for this individual, for them to connect if they are in kind of in limbo waiting for those services to start. AA is wonderful for some, some people don't like it. We got to find something that works for them, connecting them with any support network. People need a web of support when dealing with this addiction. I kind of have forgotten the first one, I'm sorry.
Audience Question: Are you familiar with any Arizona law enforcement agencies that are looking into programs like the Law Enforcement Assisted Diversion Program to treat the individual for their disease before they are treated as a criminal?
Denise Beagley: I don't know necessarily the LEAD program or not but we do have drug courts here, maybe that's what the person's meaning? We do try to get the person help particularly for SMI — seriously mentally ill individuals. We have a jail diversion program. Adults over the age of 18 have that diagnosis of serious mental illness. Drug addiction can be determined that way. They can get treatment in lieu of going to jail or prison. The caveat is they have to complete whatever it is given in that courtroom or treatment. If that makes any sense. I had a guy who graved(?) an officer. He was high on meth and also experience hallucinations and not in his medications, his prescribe psychotropics. He thought the officer was not real. He swatted the officer on the face and got a battery and assault on the officer. I advocated for him to have this jail diversion program. He had six months of anger management program which he thought was kind of funny once he had been in recovery for a little bit. But he actually said I like how it helps him with boundaries and it provided like an insulation of services for him that he did not have before. He got into housing and it really opened up and it got him back working and living independently again. It was pretty amazing.
Moderator: My guess and I'm going to follow up to this person who asked this question to find out if, I don't think they trying to mean the drug court programs. It sounds something different that even before they refer for prosecution or even before it gets to court, law enforcement is taking it under their own initiative to divert the person but that's just based on the title. We'll do some research and maybe we can work a webinar about it if it's something different than a drug court program.
Denise Beagley: Yeah, we had, in Maricopa County alone, which is our largest county here in Arizona we had 22,000 people diverted from treatment. From going to jail and receiving treatment. Last year, that's pretty substantial. I think the P.D. is not arresting people for having drugs on them but getting treatment instead. Obviously, looking at the severity and what else is going on but they are able to make that judgment. I don't know the LEAD, that name, but I can also do a little bit of research myself.
Moderator: Got it. She just confirmed that it is at the discretion of Police officer to refer before they appear in court. I think it's she misjudged it from a drug court and I'll see what I can do about finding more information about that.
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