By Karli Ratliff
Speakers shared their experiences with opioids at Addressing Addiction, a conference hosted by Patrick Henry Community College at their site in Stuart. The conference also included overdose and naloxone education and breakout sessions.
Alex Elswick is the extension specialist for Substance Use Prevention and Recovery at the University of Kentucky, where he is finishing his PhD. He does research focusing on long-term recovery from addiction. Elswick is also in long-term recovery from substance abuse.
Born and raised in Lexington, Ky. by an accountant and a doctor, Elswick said he had a good upbringing. His parents never divorced, never used drugs, rarely drank alcohol, and that he was not abused.
“Despite the fact that I had this great upbringing, it couldn’t change two really important facts about who I was from the day that I was born,” Elswick said, and explained that he had a genetic predisposition to addiction and that he struggled with anxiety from an early age.
“Different people experience drugs and alcohol in different ways,” Elswick said, adding that his experience with drugs and alcohol can be explained by his issues with anxiety.
Elswick said he started drinking alcohol at an early age, probably around 13, and always drank in excess. He specifically remembers smoking marijuana for the first time at 15 years old and feeling calm and normal for the first time. He quickly learned that he could use these substances to change how he felt.
“For someone who’s having a negative internal experience there’s a lot of power in that, to be able to control your internal experience with substance,” Elswick said about his early relationship with drugs and alcohol.
He attended Centre College where he played baseball. When he got to college, he said he started smoking an egregious amount of weed. His problem became apparent when he started to run out of money and started selling drugs to support his own habit. He was arrested in 2010 and charged with a number of drug trafficking charges.
Elswick spent some time in jail. When he was released, he found that he was not only kicked off the baseball team but out of college completely.
He was put on probation with drug testing. If he violated his probation, he would serve a year in jail. This, he said, marked the first time he swore off drugs and alcohol.
About two months later, he was prescribed oxycodone after having his wisdom teeth removed. He didn’t have a problem with it until he was given a second prescription and ended up with about a 30-day supply. He spent the next two years using more and more oxycodone.
Elswick said that his habit eventually began to cost $150 a day, noting that he didn’t have a job. “Suffice it to say that I’ve done some awful things in my addiction.”
He said that the guilt of the terrible things he was doing drove him to seek treatment for the first time. He went to a seven-day detox in Nashville, Tenn., and relapsed after only 12 hours of being home.
He then went to a 30-day treatment center and where he was invested in the process. Within a day of being out he relapsed.
“I wanted desperately to make it stop and I couldn’t make it stop,” said Elswick. He went into treatment two more times before he moved to Cincinnati, Ohio with his girlfriend.
Within about two weeks, he was introduced to heroin. “What cost $150 in pain pills cost $20 in heroin,” Elswick said, adding that heroin became all he could afford.
He got kicked out by his girlfriend and because his family wanted nothing to do with him, spent time homeless in several states and cities, including in Nashville, Tenn., Lexington, Ky., Cincinnati and Dayton Ohio.
Elswick spent the last days of his addiction under a bridge in Dayton, Ohio begging for money. He checked himself into the Adult Rehabilitation Center at a Salvation Army.
“The first 30 days there are the worst 30 days of my entire life,” he said, adding that he was grateful that he had nowhere else to go. After six months at the Salvation Army, Elswick stayed in a church parsonage for free in exchange for doing labor around the church.
He got a job working in a tobacco field, and was able to finish his bachelors and get a masters in family therapy. He has since started a nonprofit called Voices of Hope that supports people in long-term recovery.
“Mere exposure to a drug is not sufficient for someone to get addicted,” said Elswick about the complexity of addiction.
He emphasized the importance of the fact that choice alone is not enough to create an addiction. “It’s necessary, if you’re never exposed to a drug you can never become addicted, that’s true, but it’s not sufficient.
“Statistically, the single biggest contributing factor to whether or not a person becomes addicted is genetics,” Elswick said of the fact that has been proven in twin studies. “About half of what determines whether or not a person will experience an addiction is genetic.”
Mental illness, abuse, environment and childhood trauma are all risk factors for substance abuse according to Elswick.
Opioid addictions are caused by an unnatural release of dopamine, a chemical normally released to reward behavior that promotes survival, said Elswick. As the addiction intensifies, the brain produces less and less dopamine to compensate for the release triggered by the opioid.
According to Elswick, withdrawal happens when the body panics because of a low level of dopamine caused by a lack of the opioid. Addiction to an opioid causes the brain to stop releasing dopamine for normal triggers, he said, adding this lack of dopamine is what often causes relapse.
Over time, the brain will heal and begin to release dopamine normally again. The average number of relapse cycles for a person with an opioid use disorder is seven. It takes about three to five years for the risk of relapse to plateau at about 15 percent or less, said Elswick.
“We have to find ways to match the chronic nature of addiction with ongoing disease management,” Elswick said, noting that addiction is a chronic disease.
His work at the University of Kentucky, and with his nonprofit Voices of Hope, involves a concept called ‘Recovery Capital,’ which is part of ongoing disease management. It revolves around social, personal and collective resources to support a person throughout their long-term recovery.
Sheriff’s Lt. Eric O’Connell discussed the narcotics problem during his tenure in Patrick County. When he began in 2008, O’Connell said methamphetamine was the leading problem locally. He said that authorities started working on an informant-based system.
According to the American Society of Addiction Medicine, the sale of prescription pain relievers in America in 2010 was four times what it was in 1999. As the government began to drive down the number of prescription pain reliever users, the number of heroin users went up, he said, adding pills for pain relief became a problem in Patrick County in 2010; opioids hit their peak in Patrick County in 2012.
Between June 2017 and January 2019, the Patrick County Sheriff’s Department made 150 heroin or fentanyl buys. Before that, authorities succeeded in making an estimated three buys in nearly 10 years, O’Connell said.
According to the Patrick County Emergency Services Coordinator Steve Allen, there were 371 nonfatal and 32 fatal overdoses in Surry County, N.C. in 2018, and 10 nonfatal and three fatal overdoses in Patrick County during the same time period.
“We’re still small enough here and we still work good enough with the prosecution and the courts to make a difference because we don’t think there’s something small,” O’Connell said, adding that is because “small can turn into an avalanche.”
O’Connell said that the problem in Patrick County is mostly coming in from surrounding areas and not starting from within.
Now, authorities are facing an influx of methamphetamine entering the region.
Dr. Kerry Gateley, director of the West Piedmont and Central Virginia health districts, discussed the importance of recognizing and reacting to an overdose. He explained how naloxone works to counteract an overdose.
Basically, he said the naloxone has a stronger affinity for opioid receptors in the brain than opioids do. It can attach to the receptors to block the opioids and has no effect on the person.
Participants had the option of learning to administer NarcanTM, a naloxone nasal spray. They also were given a prescription for it.
The conference included breakout sessions during the afternoon.