Reny Mathew (Baylor) and Anna Goike (Notre Dame) interned at the Cleveland Clinic Lerner School of Medicine.
Treating Drug Addiction to Limit Poverty
By Reny M. Mathew and Anna Goike
This summer, we had the opportunity to participate in an internship through the Shepherd Program Consortium under the supervision of the Cleveland Clinic Lerner School of Medicine. For eight weeks, we worked alongside different professionals to learn more about addiction. We each spent one day a week shadowing and working with Dr. Kristin Englund, an infectious disease doctor at the Cleveland Clinic; one day a week at an alcohol and drug rehabilitation center with Dr. Jason Jerry who is an addictionologist; and twice each week with Judge David Matia who heads the Cuyahoga County Drug Court. On the fifth day we rotated to different sites in Cleveland to learn more about other programs in the area that help others fight addiction. The overall goal was to learn about the causes behind addiction and what steps are available to people in Cleveland in order to combat this disease.
How we got here:
Currently there is an opiate epidemic in Cleveland. The number of deaths from opiate overdose has surpassed those from motor vehicles and in the past year numbered five a day. This did not become a problem overnight. Many people cite the start of pain becoming the fifth vital sign in 1998 to be the start of the rising opiate epidemic. While pain is important to monitor, when this vital sign was added to routine diagnoses, doctors started prescribing pain pills more frequently due to increased attention to pain levels. This practice led to “pill mills” cropping up around the country, allowing people a greater access to prescription opiates. “Pill mills” are locations where people can receive opiate drug prescriptions without being seen. People may have become addicted while on this pain medicine and then turned to cheaper street drugs like heroin. This problem still occurs and is increasing. The fastest growing group of heroin users in Cuyahoga County today is Caucasian females ages 16-25. This group of females comes from all demographics and socioeconomic classes. Addiction does not discriminate between ethnicity, social class, or background. Anyone can be affected. It is easy to lump drug addicts into a group of individuals who selfishly choose to use drugs; however, we should recognize that addiction is a disease, not a choice. Through the internship we were able to see this disease first hand. We met many people in rehab who started taking pain pills for pulled teeth or back pain, and ended up using heroin. They did not start by putting a needle into their arm, and they wanted to get clean.
Programs and places:
Infectious Disease Clinic and Rehabilitation Center
The Cleveland Clinic Infectious Disease Clinic and the Lutheran Hospital Alcohol and Drug Rehabilitation Center (ADRC) are two of the places where we spent a lot of time. People detoxed at the ADRC. The population could be divided into people who wanted to be there, people who were forced to be there, and people who were there but still felt like they had one more bender left in them. A stay in the ADRC often depended on how much and what type of insurance patients had. Most people stayed for two to three days before being discharged; however, those who could afford private insurance had the opportunity to stay longer. The social workers and doctors worked to make sure that patients had a plan before they left: options for sober housing, the meetings they would be attending, and how they were going to avoid triggers.
We encountered a wide array of patients at the infectious disease clinic. The patients ranged from people traveling abroad who needed vaccines to pre-operative transplant patients. Many were HIV and Hepatitis C patients, who contracted HIV through needle drug use. Some still used while others were clean, but both groups still had ailments due to their drug use. It really demonstrated how drug use not only affects the addiction center of brains but also permeates other areas of people’s lives.
Cuyahoga County Drug Court
The Cuyahoga County Drug Court program takes non-violent offenders with less than four felonies (non-sex offenders) and puts them in a program that mandates rehab, sober living, sponsors, meetings, and random drug testing. If they maintain this multifaceted program for a year, participants graduate, and the charge that brought them to the drug court is expunged from their record. We had the privilege of attending weekly drug court meetings and court proceedings where participants updated the judge on their progress, and we witnessed how their lives improved. We also made a database of sober living locations, rehab locations, and outpatient programs in the area that the drug court team could use to find placements for participants. Space was limited, and while there were many locations, very few had available beds. The program is not without controversy. Many believe the program sympathizes with criminals; however, it actually helps people fight their disease and stay clean, thereby saving taxpayers’ money. Most drug offenders have a high rate of recidivism, close to 70%. Participants who graduate from this drug court end up with a recidivism rate of less than 10%. Even those who do not graduate and are terminated from drug court have a recidivism rate of only 40%. This program does a fantastic job of removing the stigma from addiction and working hard to make sure that participants succeed. Many government programs could learn from the example of drug court. It is a hard sell to spend money to help addicts, but in the long run, programs like drug court help better society more than prison can. Drug court truly helps rehabilitate people away from drugs and back into society
Needle Exchange Van
Cleveland has one of the oldest needle exchange programs, which helps provide clean needles to users, and also provides HIV and Hepatitis testing. While this program remains controversial, it saves the taxpayers money in the long run. Contracting HIV can cost hundreds of thousands of dollars to treat, and the average cost for treating someone with Hepatitis C is at least $150,000. Needles cost a couple of cents and are often donated. At the van, people receiving needles are told about openings in rehab locations and given information about how they can obtain help. The people on the van are former addicts and do not judge those receiving needles. Some people who are now clean came back to visit.
Project DAWN, which we also had the privilege of observing, gives addicts and healthcare providers naloxone, a drug that reverses overdose. Naloxone, an intranasal spray, allows addicts and friends of addicts to avoid overdose and death. Many of the people in training had seen an overdose occur to someone they knew or had overdosed themselves and wanted to avoid it.
Addiction is a disease that can overtake every aspect of a person’s life. Unfortunately, as a society we are not providing good support or promoting a healthy environment for addicts. We fail to recognize it as a disease, and fail to remove the stigma preventing people from receiving help. Addiction affects everyone regardless of gender, race, and socioeconomic standing. Being impoverished only exacerbates this vicious cycle. For addicts, drug use is a top priority. Persons who have means are more likely to receive help. People in poverty have less access to the resources they need to receive help and often become even more deeply entrenched in poverty. This internship helped us understand the large problem of addiction and how it truly is a disease. We learned that there is more than one way to combat addiction, and that it will take multiple people from several agencies to help a person stay on the path of sobriety.