by Sally Colby
A discussion of the opioid crisis isn’t necessarily a topic that draws farmers, but Dr. Glenn Sterner, assistant professor of criminal justice at Penn State, said it’s a critical topic.
When Sterner was conducting rural sociology research at Penn State, he talked with many people in small communities. While residents expressed favorable views about life in their small towns, Sterner learned that many areas are struggling with substance abuse. Sterner is adamant about sharing information and stories about substance abuse, striving to educate and begin conversations that lead to solutions.
“We have had a lot of drug overdoses in our country,” said Sterner. “In 2017, more than 72,000 Americans died of a drug overdose. This is not happening only in urban areas – it’s happening in all communities across the country.”
Sterner said there are three distinct forms of the drugs that can lead to addiction: opioids, heroin and synthetics. “Prescription opioids are legal medications you get from your doctor,” he said. “Sometimes those medications are shared or stolen, and that’s when we have issues.”
More men are dying from drug overdoses than women, and overdoses aren’t limited to young people. “The age group that’s dying is between 25 and 54,” said Sterner. “The number of overdoses in that age group is actually reducing the lifespan of white men. That’s how serious this issue is across the entire United States.”
Heroin is a white powdery substance that comes in several forms. “The purest form is white heroin; tar heroin is the least pure and really dangerous,” he said. “The powder forms can be cut with a synthetic known as fentanyl, which is another powder. Sometimes you know what you’re getting, sometimes you don’t.” Sterner pointed out that a minute amount of fentanyl is used to tranquilize large animals, and that one granule is lethal to humans.
At first, prescription opioids were the main problem, but that issue has leveled out. “Then heroin took over and seated itself in our communities,” said Sterner, adding that heroin use started to rise in 2010. “Now it’s fentanyl, and in two or three years use has gone up exponentially.”
The use of cocaine and methamphetamines (meth) is also rising.
Not all rural areas have the same problems. Sterner said while heroin is often the main challenge, for rural areas in general, prescription opioid pain killers continue to be one of the leading causes of overdose death. “The more we understand how people are dying, the better we can develop solutions,” he said.
While drug abuse is traditionally a problem in urban areas with predominately white collar workers and in rural areas with blue collar workers, rural areas have been hit harder over time. “This is not what we expected,” said Sterner. “We never expected people to be dying at this rate. But we saw that over time, we had the largest growth in drug use and overdoses in rural areas.”
Why is this happening? One reason is that people were taking legitimately prescribed opioid painkillers, became dependent on them and found it hard to stop using opioids. “It causes physical pain to stop using them,” said Sterner. “When you’re feeling physical pain and the only thing that makes you feel ‘right’ is to take another pill, you take that pill.” Sterner added that the brain becomes different after taking opioids. “Your brain is different from someone who has never taken these substances,” he said. “It can heal, but it takes roughly a year to heal the brain. But it’s important to realize you aren’t thinking right – you don’t have the same rational thought process and it’s because of the physiological changes.”
Sterner said one discovery made through research is that while we typically think of people initially getting access to drugs from their doctors, most are getting it from friends or family members. “Not because they’re trying to do it illicitly, but because they’re self-medicating,” he said, “either to address issues associated with mental health or their physical health, like chronic back pain. In some cases, people experiment with prescription drugs because ‘how bad could they be?’”
The transition from using prescription opioid painkillers to heroin is the primary concern. “When you stop using the painkiller, you feel a physiological difference,” said Sterner. He said while one person can take a prescribed opioid painkiller for a designated length of time following surgery or an injury and not feel the need to ever take another dose, another person might have a different reaction after the same dose and same amount of time. “Genetics can cause you to be more vulnerable to becoming addicted,” he said. “Most people are fine under the care of their physician, but some people become addicted.”
Emerging drug issues are different now than just two years ago. Sterner believes the more we understand and the more we work with law enforcement and public health colleagues, the better we can address these issues. “Many people are using multiple drugs – not just heroin, not just prescription opioids. We have to address many substances,” Sterner said. “We also have to address the issue of crystal meth coming into our communities again. The more we understand it, the better we’ll be able to fix it.” Sterner added that addiction treatment varies widely, and that it takes a lot longer to address crystal meth addiction.
Sterner said it’s important for neighbors and communities to discuss the issue and work on solutions together.
One option for families dealing with active addiction is to keep naloxone (Narcan) nasal spray on hand. “If a family member is actively using drugs, we can reverse an overdose with a nasal spray,” said Sterner. “It may take two or three doses, especially with fentanyl, because it takes more to reverse a higher dose. But in two to five minutes, people can be revived.”
It’s important to understand that while naloxone can reverse an overdose, it’s only effective for 30 to 90 minutes, and once administered, 911 should be notified immediately because the person can return to a state of overdose. Sterner said health departments and pharmacies often give away free doses of naloxone, which provides some assurance to families that their family member will be okay until emergency care can be given.
The substance abuse problem has many faces, and nearly everyone knows someone who has struggled with addiction. “The thing you can do today is reach out to someone you think might have some sort of substance abuse issue,” said Sterner. “Talk with them about it, let them know you care and let them know you will help them get into treatment.”
The “Someone You Know” series features stories and podcasts of addicts telling their recovery stories, and is available at www.ibxfoundation.org/htdocs/custom/someone-you-know/index.html.