When U.S. Rep. Hal Rogers (KY-5) created Operation UNITE in 2003, he hoped it would help stem the tide of drug addiction that was sweeping his Congressional district in southeastern Kentucky.
Since then, the organization has worked with families, medical professionals, and law enforcement in those 32 counties, and has become a vital facilitator in a national dialogue about addiction, treatment, and recovery.
Operation UNITE hosted its fifth annual summit on prescription drug and heroin abuse in Atlanta last week. The three-day event featured President Barack Obama, U.S. Surgeon General Dr. Vivek Murthy, and other key figures in the fight against addiction. KET was there to document the conversations and produced a program of highlights from the summit.
The Roots of the Opioid Epidemic
In 2014, some 28,000 Americans died from opioid-related overdoses. Unfortunately, the roots of this epidemic can’t be blamed on the illegal activities of addicts, dealers, or foreign drug cartels.
“We arrived here on a path that was paved with good intentions,” Surgeon General Murthy says. “Nearly two decades ago, health care professionals were urged to be more aggressive about treating pain… It also coincided with more options for opioid medications and an increase in direct-to-consumer advertising, which urged patients to go to their doctors and to seek opioids. The results have been devastating.”
Murthy says nearly 250 million prescriptions for opioid drugs are written every year in the U.S. – enough for every adult in the nation to have a bottle of pills. That’s contributed to a tripling of opioid-related overdose deaths since 1999, according to Murthy. He says the problem is also driving an increase in heroin use and a rise in HIV and Hepatitis C among addicts who share used needles to inject drugs directly into their veins.
“Opioids are devastating communities and they are costing lives, and we cannot afford that any longer,” Murthy says.
In the rural, impoverished counties of southeastern Kentucky, the problem became especially profound. At so-called pill mills, doctors and pharmacists would dispense narcotics like Oxycontin for even minor complaints of pain. Soon, Congressman Hal Rogers says, the region was known as the painkiller capital of the nation.
“Our communities… were under quiet siege and we were simply not prepared for the influx of these powerful drugs in our homes and our schools,” Rogers says.
In response to the scourge, the Congressman launched Operation UNITE, which stands for Unlawful Narcotics Investigations, Treatment, and Education. The group employs a holistic approach to fight drug use and abuse by shutting down pill mills and arresting dealers, increasing treatment options, and educating adults and youth about the dangers of opioid addiction.
Nancy Hale, then an educator in Rockcastle County, attended the first town hall meeting for Operation UNITE. Her son had recently entered a recovery program, and Hale and her husband were struggling to cope with the realities of his drug use.
“We felt like we were all alone,” says Hale. “But then we find out that there are families in Laurel County and Pike County and Letcher County and Leslie County, and we can all come together and do something as parents.”
Hale has gone on to become the president and CEO of Operation UNITE, and she says her son is doing well now.
Drug abuse continues to plague eastern Kentucky. Rogers says he attended an event at the Harlan County Boys and Girls Club several years ago, where 13 children present had lost a parent to an addiction related-death within the last few weeks. At a nearby school district, Rogers says half of the students only have one parent at home because of a drug-related problem.
And in the years since he started Operation UNITE, Rogers has seen opioid addiction spread from his native Appalachia to impact the entire nation.
“Lives have been lost [and] ruined, families devastated, the future of entire communities put at risk,” Rogers says. “We need to address the crisis and we need to do it now.”
Bringing Parity to Addiction Treatment
Justin Luke Riley grew up along the front range of the Rocky Mountains in Colorado in a family that he says raised him well. But by third or fourth grade, he began using prescription Benadryl to “fill a hole in the soul.” As he grew older, he used other drugs and alcohol to cope with his insecurities.
“I never felt good enough or liked who I was,” says Riley. “Being in my own skin was something very, very uncomfortable for me.”
In north-central Ohio, Crystal Oertle started using Vicodin recreationally when she was 20 years old. Once she became hooked, she says she soon needed something stronger to help get her through her day. She advanced to Oxycontin, Dilaudid, and finally heroin. Oertle says she shoplifted to afford her habit, and she shot up while her children were in the next room.
“It’s crazy to think about now the things that I did, but it was necessary or I wouldn’t have been able to function,” Oertle says. “It was so much a part of my life.”
Both Riley and Oertle are in recovery now: Oertle for a year and Riley since 2007. They shared their stories at the Rx Drug Abuse and Heroin Summit during a panel discussion that also featured President Barack Obama and Baltimore City Health Commissioner Dr. Leana Wen.
“When I was a kid, I was, how would I put it, not always as responsible as I am today,” Obama joked with the audience at the panel discussion. “In many ways I was lucky, because for whatever reason addiction didn’t get its claws in me with the exception of cigarettes.”
Obama says more people are killed because of an opioid overdose than in traffic accidents. He contends that America has become a society that medicates and self-medicates many of its problems, and that the pharmaceutical industry has grown to fill that demand.
The president says one of his goals with the Affordable Care Act was to require insurance companies to cover mental health problems and drug addiction the same way they would any other illness or medical condition. Since 85 percent of Americans still get health insurance through their jobs, Obama says it behooves employers to hold their insurance carriers to this standard of parity.
“For business owners, for companies to recognize that they are much better off pressing their insurer to see that in fact mental health and substance abuse parity does exist, they will save money, their workers will be more productive, and they’ll be getting more bang for their insurance buck,” Obama says. “That’s all part of the approach that I think we can take and we’ve got to carry through over the next several years.”
Treatment Versus Incarceration
Health care providers have been slow to embrace the treatment of addiction and addicts. Oertle says she encountered doctors who would help her only if she paid in cash. As a young emergency room doctor in Baltimore, Leana Wen says she saw how the health care system fails those with substance abuse issues.
Wen had a 20-year old patient who was a competitive swimmer. After sustaining a back injury, the woman became addicted to pain pills. She lost her job, her home, and her family, and eventually made repeated visits to Wen’s ER to get help with her addiction. Wen says the best she could do for the woman was to schedule a treatment appointment two weeks later. The patient died of an overdose later that day.
“It’s one of the most humbling things and worst feelings as a doctor to know that you can’t help them,” Wen says. “What so many of our patients need is addiction treatment at the time that they’re requesting it.”
But it’s not just the health care system that’s failing those with substance abuse issues. Wen says that the criminal justice system is also at fault.
“We need to recognize that addiction is a disease,” Wen says. “If we treat addiction like a crime, then we’re doing something that’s not scientific, that’s inhuman, and it’s frankly ineffective.”
Obama says he wants the federal government to model best-practice policies on drug treatment and related criminal justice issues that state and local authorities can follow. That includes devoting more resources for treatment and training for incarcerated addicts.
“If somebody has gone to jail for a non-violent drug offense, and they are not getting treated and provided with some baseline of skills and some hand-holding when they’re released, they are going to get back into trouble,” Obama says. “That’s just human nature.”
Wen agrees with Obama that putting addicts in jail without providing them with treatment and resources to get their lives on track is foolish. To illustrate her point, she says 40 percent of inmates in Baltimore jails have a mental illness, and 80 percent of prisoners have a substance abuse problem.
Improving Access to Treatment
To help stem the tide of overdose deaths, Wen has instituted a policy in Baltimore where anyone can be trained to administer Naloxone and then receive a prescription to obtain the overdose reversal drug.
Obama says he wants to see greater implementation of needle exchange programs and wider availability of Naloxone and other anti-addiction and overdose medications. While some critics claim those efforts can lead to more drug abuse, Obama says there’s no scientific evidence to support those beliefs.
Access is another issue. The president says there are still too many gaps in the health care system that leave individuals in rural communities without easy access to drug treatment options.
Living in her small midwestern town, Crystal Oertle says she attempted to quit on her own but couldn’t stand the withdrawal symptoms. She’s found success with an Ohio initiative called the Urban Minority Alcoholism and Drug Abuse Outreach Program. That involves intensive group and individual counseling coupled with a medication called Suboxone, which Oertle says blocks receptors in her brain so she can’t get high.
Oertle says she still feels a stigma about her addiction, and she still encounters stories of doctors and law enforcement officials who discount addiction as a disease. But she says being open about her journey has been a critical part of regaining her health.
“Getting out there, telling my story, and helping other people helps me and it makes me want to stay in recovery and keep doing what I’m doing,” says Oertle.
View complete coverage of the panel discussion, including full comments from President Obama, Congressman Rogers, U.S. Surgeon General Murthy, and other attendees.
This video is a KET production, funded in part by the Foundation for a Healthy Kentucky.