Looking for the Fix

A blue, green and white illustration of a male figure caught in a blizzard

J

aclyn Lucibello, a former opioid user, jumped right into the deep end of the darkness.

“I am a convicted felon, and the choices of my past continue to live with me,” said Lucibello, who served three years at the York Correctional Institution in Niantic, Connecticut, and gave birth to a son while shackled to a hospital bed.

Lucibello shared her story at Quinnipiac as part of a seven-month, sharply focused summit, “Building Bridges and Finding Answers: The Opioid Crisis in Connecticut.” In her remarks, Lucibello described the spiral from a graduate student working as a social worker to someone she barely recognized, a woman haunted — and hunted — by addiction.

In response to this opioid epidemic sweeping the state and the nation, Quinnipiac partnered with the Connecticut Bar Association and the Connecticut Bar Foundation from November 2018 to June 2019 to come up with bold, innovative ways to help people with opioid use disorder. The Schools of Education, Health Sciences, Law, Medicine and Nursing all were involved in the forum.

After filling several prescriptions for Percocet to relieve post-surgical pain, Lucibello found herself hooked. But when the scripts stopped, the arrests began on larceny charges and other crimes in New Haven, North Branford and Guilford in 2009 to pay for her drug habit.

“Eventually, I could no longer get the prescription drugs, so what did I do? I turned to heroin,” Lucibello said, referencing the street-available substitute for the likes of OxyContin, Vicodin, morphine and codeine.

Although her story is raw with remorse, Lucibello is one of the lucky ones. In 2017, there were 1,038 accidental drug deaths in Connecticut, mostly from opioids, according to the Office of the Chief Medical Examiner.

“Twenty-first century problems are too complicated to be solved by a single discipline,” School of Law Dean Jennifer Gerarda Brown said to hundreds gathered in the Ceremonial Courtroom.

The Quinnipiac summit brought together statewide experts representing law, medicine, public policy, social services, politics, education, nursing, law enforcement, EMS, treatment options and other fields. They all came to create connections, exchange resources and collaborate on solutions.

After that day-long kickoff in November, the attendees broke into 10 groups to study the opioid epidemic. Each group met several times before reporting their ideas, findings and strategies at a follow-up forum at Quinnipiac on June 7.

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New Bills Discussed

Jennifer Herbst, a professor of law and medical sciences in the School of Law and the Frank H. Netter MD School of Medicine, led a work group of 24 people who studied law enforcement and legal matters.

The group included physicians, attorneys, law enforcement representatives, a mother whose daughter died of an opioid overdose, and public health professionals — a diverse room of perspectives and life experiences.

Among the topics discussed by the group was the introduction of two opioid-related bills in February by state legislators in the Connecticut General Assembly.

One of the bills, HB 6131, would require “transportation to a treatment facility that provides medical triage to a hospital after administration of an opioid antagonist.” In other words, anyone who is revived by naloxone spray delivered by a first responder — EMS personnel, a firefighter or a police officer — must be transported to a hospital emergency department or other comparable facility.

“The advantage of emergency departments is that they’re open 24 hours, of course,” Herbst said. “The downside is, not all emergency departments are staffed to handle someone with addiction particularly well.”

Herbst explained that emergency departments are designed to treat acute conditions, but not longer-term chronic conditions such as addiction.

Colorful illustration of two doctors cutting the strings around a trapped man holding a hypodermic needle

“To the extent that effective treatment of opioid use disorder may have both components,” said Herbst, “emergency departments are staffed to effectively handle acute crisis, but may not be able to provide an effective transition to outpatient (or residential) long-term management.”

The second bill, HB 5900, would “allow police officers to take a person with a substance use disorder, and who is a danger to himself or herself or others or gravely disabled, into custody for treatment.” This decision would be at the discretion of the police officer at the scene.

“So, we have police officers who want to do this for a lot of really good reasons. And we have families who would like law enforcement to do this for a lot of really good reasons,” Herbst said.

 “At the same time, we have certain histories of police wrongdoing, and some really important constitutional rights that are smack in the middle of all this.”

Unlike an arrest and court-ordered treatment for substance abuse, a police officer taking someone into custody would not carry the legal consequences of an arrest. But this bill could conceivably raise issues with the 5th Amendment, which guarantees that “no person shall be … deprived of life, liberty, or property without due process of law.”

Herbst said these are inherently complicated discussions: “There isn’t any one string we can pull on and fix things. Trying to move public health, law enforcement, the medical community, the prosecutors, the public defenders and the judges all along the same path, no one person or group can do that. It has to be done with consensus and collaboration.”

It’s the same thing in the law enforcement and legal work group, Herbst said. After more than a half dozen meetings, members developed a deeper understanding of the opioid epidemic and a deeper appreciation for other perspectives.

Despite often polarizing positions, Herbst said, everyone shared the same objective — helping those who are struggling with opioid abuse disorder. The rub, of course, is in the legal, social, civil and financial implications of how to best address the epidemic.

“This work is letting me bring in my bioethics lens,” Herbst said. “It’s letting me bring in my legal lens and my public health lens. There are so many different ways to look at these issues.”

An Opportunity to Share

Lindsay Boyle, an adjunct professor in the School of Communications who has written about the opioid epidemic extensively for The Day of New London, Connecticut, served on the work group that studied opioid awareness through communication.

Boyle pointed to the important work being done in New London and nearby Norwich to reduce overdose deaths and limit exposure to opioids in southeastern Connecticut. Both communities have engaged, purposeful task forces, she said.

In Norwich, law enforcement, medical professionals, the city’s director of human services and other invested parties meet monthly to discuss progress as well as problems. The city’s human services department also started an initiative, “Norwich Unhooked,” in 2017.

In New London, the task force includes the mayor, police chief, fire chief and Jeanne Milstein, the city’s director of human services. Milstein has an extensive professional network in both Connecticut and New York compiled from years of advocating for families and children.

“New London has gotten some state and national recognition for its response, but Norwich has seen better numbers lately,” Boyle said. “Whatever Norwich has done in the last year and a half, they saw a drop from 32 fatal overdoses in 2017 to about 13 or 14 in 2018. That’s a big drop, a really big drop.”

“There isn’t any one string we can pull on and fix things ... no one person or group can do that. It has to be done with consensus and collaboration.”
Professor Jennifer Herbst

But just imagine if Norwich and New London pooled their talent and their resources? The two communities are only separated by 14 miles. And yet, they each have separate task forces and separate budgets for fighting the opioid epidemic.

“Part of the problem is that they’re chasing the same grants. The money isn’t shared. It’s pretty much all or nothing,” Boyle said. “It’s almost like the grant process inadvertently discourages collaboration in some ways.”

Another problem is the longstanding culture of autonomy among Connecticut’s cities and towns.

“This model of sharing ideas and services seems to be missing in my experience,” Boyle said. “Everyone in southeastern Connecticut wants to do it their own way. I think you see that with Connecticut, period.

“You have 169 towns and no one wants to regionalize anything, so that’s still very much a problem,” she said. “It doesn’t mean that some of these cities haven’t come up with really good [opioid] responses on their own. It’s just that others could benefit from them, too. Everything is just so self-contained.”

‘No More Shame’

For Millie Hepburn, an adjunct professor in the School of Nursing, this assignment was all about access to services, if not hope. She and the family support work group wanted to develop a compelling website that was both intuitive and informative. No one wanted a digital thicket of searching and scrolling.

“As a diverse group of stakeholders, we determined that families of persons with addiction need comprehensive information that is easily accessible in three main areas of need: crisis, recovery and bereavement,” Hepburn said.

But after researching existing websites, the family support group learned there wasn’t a central repository — a go-to website — for people in Connecticut to get the help and information they need about opioid use disorder.

After reaching out to the state Department of Mental Health and Addiction Services for insight, the family support group learned DMHAS was already working on a similar website project with the Odonnell Company of New Haven.

‘Dopesick’ Author Says Opioids Hook without Discrimination

Best-selling author Beth Macy looked out at the Quinnipiac crowd and pointed her finger like a soul-stealing dementor from “Harry Potter.”

“I want you. I want you. I want you,” said Macy, mimicking the arbitrary nature of opioid addiction. Her latest work, “Dopesick,” chronicles the deadly path of the opioid epidemic across all ages, races, genders and socio-economic groups.

Macy came to Quinnipiac in March to give an unvarnished talk about addiction and the 72,000 people in the United States who died of drug overdoses in 2017 — 60,000 of them from opioids, according to the Centers for Disease Control and Prevention.

Headshot of best-selling author Beth Macy

Her two lectures, one on each campus, were part of the university’s Campus Cross Talk series that, like the Building Bridges summit, sought to shed light on the opioid crisis and explore solutions.

“I know from experience there are people in this room who have lost people to drug overdose,” Macy said, offering her sympathies. “There’s nowhere this epidemic hasn’t reached.” One of those places, Macy said, is a coveted neighborhood in Roanoke, Virginia, a city of about 100,000 in the Blue Ridge Mountains. This is where Tess Henry lived.

Henry, 28, was the daughter of a surgeon and a hospital nurse. She shined in her youth until an opioid addiction made her world desperate, even dangerous. Henry’s demons emanated from a toxic cocktail of cough syrup with codeine and hydrocodone pills, a prescription to beat bronchitis and ignite a death spiral that ended in Las Vegas in December 2017.

“Her [burned and beaten] body was found by another heroin-addicted person who was foraging for cans in a dumpster on Christmas Eve — and her murder remains unsolved,” Macy said. “So we’ve got to do better.” 

Good families, bad families, heroin doesn’t care, Macy told the crowd as she described opioids and heroin as “molecular cousins.” The award-winning journalist was deliberate with her words. 

The exact diagnosis for Henry and others is opioid use disorder. Henry wasn’t a worthless junkie or some dope fiend. She was a human being with a son, a love of poetry and a heart big enough to dream about beating this disease, Macy said.

And yet, access to potentially lifesaving treatment — and the unconditional love of friends and family — is often painfully elusive. Stopping cold turkey isn’t an option for many struggling with opioid addiction.

Medication-assisted treatment is the best approach, a protocol endorsed by the U.S. Food and Drug Administration, Macy noted. MAT includes counseling, psychosocial therapy and medication approved by the FDA for the treatment of opioid dependence — methadone, buprenorphine and naltrexone. “These medications also increase the likelihood that a person will remain in treatment, which itself is associated with lower risk of overdose mentality,” she said.

Only now, Macy said — after all the deaths and all the grief — is America finally taking notice of opioid addiction. In 1999, three years after Connecticut-based Purdue Pharma began selling the highly addictive painkiller OxyContin, Macy said Dr. Art Van Zee wrote a letter to Purdue Pharma from rural St. Charles, Virginia, a “politically unimportant place” with a population of just over 100. 

Macy recounted Van Zee’s follow-up phone call with the drug manufacturing giant. “So Art called them up and said, ‘Look, I know it says on the insert your drug isn’t addictive, but I’ve got kids I immunized as babies who are now overdosing in the high school library. I think it is addictive.’ He was the first doctor in the country to push back,” Macy said.

Today, Purdue Pharma is currently the defendant in thousands of lawsuits, but the damage has already been done, Macy said.

Just ask Tess Henry’s family.

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Hepburn and her group partnered with DMHAS to make sure all necessary information and resources were available on the new website — liveloud.org — including some public service announcement (PSA) videos to make the experience even more interactive.

Suddenly, help was just a few clicks away.

“NO MORE SHAME” — note the capital letters — shouts out from the home page of the liveloud.org website. With bold, colorful tabs and images, people can easily find the answers to questions about opioid use disorder, including family support groups, treatment options, risk factors and the disease’s impact on Connecticut’s communities.

Linked by a Legacy

Last August, police and EMTs responded to more than 100 overdoses in three days on the New Haven Green. Although the synthetic cannabinoid commonly known as K2 was first thought to be laced with the powerful synthetic opioid fentanyl, officials later learned the K2 was tainted with Fubinaca, a highly potent synthetic cannabinoid developed by Pfizer as a painkiller.

While the New Haven incident was not directly related to Connecticut’s opioid epidemic — the frenetic response, the non-stop sprays of lifesaving naloxone, people suddenly and startlingly collapsing — everything echoed the grip of addiction.

Judge Anne C. Dranginis, a retired associate judge of the Connecticut Appellate Court, spoke candidly about a mother’s grief last fall. She addressed the summit with a recorded message about her daughter’s fight with opioid addiction.

“My Charlotte died on June 29, [2018] of an overdose. She was in Florida,” Dranginis said. “It happened after 12 years of a struggle with addiction. It happened in a way that broke my heart like it breaks all parents’ hearts.

“No one is immune, and that is why I have chosen to be very public about my loss,” Dranginis added. “So many young people feel the shame of addiction when we should just be enveloping them with love, treatment, prevention and education.”

Colorful illustration of a doctors hand rising up through a sea of pills, holding a family in the palm of its hand

However, even when prescribed and taken appropriately, opioids still can be highly addictive.

Joel Cartner, JD ’19, takes opioids to help relieve the pain and symptoms of cerebral palsy spastic diplegia, a condition where his muscles, especially those in his legs, are in a near-constant state of contraction.

“My first experience with opioids, I was 9 years old,” Cartner said. “I was having what’s called a muscle release surgery. They take the muscles — they cut them away from the bone — and they stretch them the length they’re supposed to be, and then they reattach them. The baseline of pain is indescribably awful.”

In 2011, Cartner had another surgery to address scar tissue buildup that had increased his chronic pain. This meant a longer, more closely monitored opioid regimen to help protect him against the threat of abuse.

For Cartner, voices like his are essential to better understanding the opioid crisis in Connecticut.

“The current state response has been really focused on how to prevent deaths,” Cartner said with conviction, calling it admirable, great and absolutely necessary.

“But for those of us who have these deep, personal connections to this crisis, it means a lot not just to tell the story to people who can actually effect change, which is great all by itself, but to be able to be part of the change,” Cartner said. “That’s so important.”