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Tina and Michael Hoehler lead an anonymous group of individuals dealing with the addiction of a loved one at Maricopa PAL. Photo by Mason Callejas

Addiction is a disease that does not often discriminate based on age or social strata.

Teachers have addicts for students. Students have addicts for teachers. Parents have addicts for children. Children have addicts for parents. Spouses have addicts as partners. And, sometimes, when you look in the mirror, an addict is staring right back.

For two Maricopa parents, the struggle to confront a loved one’s addiction left them feeling isolated. When Tina and Michael Hoehler finally realized their somewhat-guarded coping mechanisms weren’t working, they changed their approach.

The two had struggled with the harsh reality of loving an addict for several years, attending support groups like Al-Anon and Nar-Anon. But none of the tools they were taught or advice they were given provided them with that final piece to the puzzle they needed so desperately.

Then they found the program they said might have saved their loved one’s life – Parents of Addicted Loved Ones (PAL).

“It taught us how to set boundaries,” Tina said. “And how to stick by them.”

Soon after, they both saw how setting and enforcing those boundaries allowed their loved one to also make a change.

“When you begin to make changes, they see that and they change,” she said.

PAL not only helped them establish those boundaries, but it helped them open up and share their personal experience, they said.

It changed their mindset so much, they decided to bring PAL’s tenants of “education” and “support” to Maricopa.

“I wanted other parents to know that they’re not alone, and that’s exactly how you feel, alone.” Tina said. “Sometimes you choose it [to be alone], sometimes it just happens.”

Now, every Monday evening PAL meets “to receive support from, and give support to, others who are facing the same challenges.”

PAL is not unlike Al-Anon and Nar-Anon in that it provides a network and support. However, Michael said, PAL allows something the others do not – crosstalk.

“It allows people to have conversations, personal conversation,” Michael said.

One of the biggest differences, Tina said, is the education.

“I can spout off all statistics about drug abuse, but what good is that,” she said. “People need actual knowledge they can use.”

Each week, PAL offers lesson plans to provide attendees with tools to better understand themselves and, in turn, improve the lives of their loved-ones.

Lesson plans range from delayed emotional growth and transitional living to healthy helping and enabling.

“Understanding [these topics] is the difference,” Tina said.

For more information, visit PALgroup.org or stop by PAL’s weekly meeting on Mondays, 7-8:30 p.m., at 19395 N. John Wayne Parkway, Suite 16, on the second floor at the Maricopa Behavioral Health Services office.

PALgroup.org 


This story appears in the November issue of InMaricopa.

by -
Brandi Homan

By Brandi Homan

You always read the headlines about senseless deaths or drug overdoses, but if you’re like me you rarely read the articles. I never did, because it all seemed so abstract.

Until about two weeks ago when I woke up and saw a text from my friend Jennifer’s little brother. “Hey, Brandi I know it’s been a while but wanted to let you know that Jennifer passed away last night. She was in a long battle with an addiction to opioids. God bless her.”

I was shocked and sat in silence for a long time. I had no words. This was not an obscure name in the paper or a statistic I didn’t relate to. This was my friend. My friend had a name – Jennifer.

It took me awhile to respond because I had a million questions. When I did talk to her family, I learned what I had always feared but didn’t accept; Jennifer became addicted 10 years ago. The family tried everything possible to help Jennifer with rehab, therapy and unconditional love. Jennifer eventually made her way in and out jail, but she would rather have gotten her next fix than get better and get clean.

My kids asked why I was upset. I wasn’t sure what to say. I used words like “heroin,” “needles,” “addicted.” They weren’t sure how to respond. I ended with “she was very sick.” This opened my eyes to the fact that I have more explaining to do with my kids.

I want to be open and honest with my kids about everything. There will be a time that I will not be around, and I hope they make the right decisions. I’m on the board for the Be Awesome Youth Coalition. We are dedicated to developing confident, connected and successful youth. Our youth will be none of these things if they become addicted to opioids.

We as parents need to teach them how to be good consumers of our medications and we need to be well informed.

Here are some tips for talking with your kids:

  1. Remain calm and open-mined. (They are nervous, too.)
  2. Avoid lecturing; be positive.
  3. Remind your child that you value this conversation and care about their health.
  4. Be honest about your own experiences as you express your desires for their decisions concerning drugs. Do not glamorize past use.

For more tips visit DrugFree.org.

Brandi Homan is a board member for Be Awesome Youth Coalition.


This column appears in the September issue of InMaricopa.

This is the final story of a four-part series on the crisis, care and prevention of opioid abuse, which was recently named an epidemic by the governor's office.

 

Opioid addicts seeking rehabilitation have numerous options for treatment.

Twelve-step programs are the largest common denominator of long-term recovery programs.

The support network Advocates for Opioid Recovery strongly suggest medical detoxification which uses a combination of “behavioral interventions and medications” to treat opioid abuse. The organization claims 66 percent of addicts who use medication detoxification reach sobriety after six months, versus only 31 percent who use no medication.

Once detoxed, medications like short-term Subutex (buprenorphine) and long-term Vivitrol (naltrexone) are often effective treatments for opioid cessation. These drugs work by binding to the same neurological receptors as opioids negating the desire to use. Whereas “antagonist” drugs like naloxone, on the other hand, actually reverse the effects of opioids.

A drug known as Suboxone is a combination of buprenorphine and naloxone and is often used with addicts going through immediate detox.

Methadone can also significantly help with the detoxification process. However, in recent years many authorities including the CDC, have begun to urge against its prolong use as it has been reported that users have developed dependencies on the drug.

Cognitive therapy is also used to treat addiction of all types, focusing on addressing the underlying causes of substance abuse through counseling, group therapy and other cognitive exercises.

Twelve-step programs are the largest common denominator of long-term recovery programs. When used in conjunction with Medication Assisted Treatment (MAT) and counseling 12-step programs have proven to be quite successful.

Rehabilitation & Recovery Resources

Inpatient – Adult
Valley of Hope (Chandler)
Located in Chandler, Valley of Hope’s 55-bed addiction treatment facility “provides a variety of addiction treatment (drug rehab) options to adults ages 18+ including medically monitored detoxification, residential and partial/day levels of care. We also offer free professional consultations and would be happy to arrange a tour of our facility.”
www.valleyhope.org
480-899-3335
501 N. Washington St.
Chandler, AZ 85225

Inpatient – Youth
The Pathway Program (Tempe)
Offering support groups and both inpatient and residential treatment for young people ages 13-25, the Pathway Program provides “fun and positive social interactions,” so that young people have the ability to realize “that a sober lifestyle doesn’t mean giving up on having fun.”
www.thepathwayprogram.com
877-921-4050
4820 S Mill Ave., Suite 101
Tempe, AZ 85282

Outpatient, Support & Recovery – Adult & Youth
Maricopa Behavioral Health Services, LLC (Maricopa)
Maricopa Behavioral Health Services offer outpatient treatment for those with substance abuse and behavioral or mental health on an income-based “Sliding Fee Scale.” They offer evaluation and screening Services, referrals to inpatient treatment, outpatient recovery and relapse prevention, counseling and therapy in the city of Maricopa.
www.maricopahelpingeachother.com
480-524-2699
19395 N. John Wayne Parkway, Suite 16 (upstairs)
Maricopa, AZ 85139

Sun Life Family Health Center (Maricopa)
Accepting Medicare, Medicaid and private health insurance Sun Life Health Center offers outpatient behavioral and mental health services including counseling and therapy, assessment evaluation and screening services and inpatient referral for substance abuse and mental health treatment.
www.slfhc.org
520-568-2245
44765 W. Hathaway Road
Maricopa, AZ 85139

Community Bridges, Inc. (Casa Grande)
Offering substance abuse outpatients services, Community Bridges provides “a continuum of care that begins with prevention and continues for individuals and families through treatment and recovery.”
www.communitybridgesaz.org
520-426-0086
675 E. Cottonwood Lane, Suite 1
Casa Grande, AZ 85122

Arizona Treatment Institute, LLC (Casa Grande)
Arizona Treatment Institute Offers outpatient detoxification and substance abuse treatment programs including medication assisted treatment using naloxone for opioid dependency. They accept military insurance (TRICARE or CHAMPVA) as Well as Access to Recovery (ATR) vouchers.
www.arizonatreatmentinstitute.com
520-836-9788
1927 N. Trekell Road
Casa Grande, AZ 85222

Horizon Health and Wellness
Horizon Health and Wellness offers outpatient treatment for substance abuse, mental health and crisis intervention. They offer assessment, evaluation and screening services and inpatient referrals, as well as outpatient partial hospitalization services.
www.hhwaz.org
520-836-1688
120 W. Main St.
Casa Grande, AZ 85122

PSA Art Awakenings (Casa Grande)
Art Awakenings provides rehabilitation through “expressive arts programs using the healing power of creativity to explore feelings and process issues.” Adult programs are “primarily psychosocial rehabilitation with individual, peer support, group and family supportive counseling along with case management.” Whereas programs for children are focused on “therapeutic expressive arts.”
http://www.artawakenings.org/
520-423-0707
309 W. 2nd St.
Casa Grande, AZ 85122

 

Additional Information & Hotlines

Governor’s Office of Youth, Faith and Family
www.goyff.az.org

Arizona Treatment Locator
www.substanceabuse.az.gov

Crisis Response Network www.crisisnetwork.org
(602) 427-4600

Teen Lifeline
(602)248 -8336
Text “Listen” to 741-741


Part 1: How the addiction starts

Part 2: Stronger and deadlier than ever

Part 3: Naloxone often the last line of defense

This is the third story of a four-part series on the crisis, care and prevention of opioid abuse, which was recently named an epidemic by the governor's office.

Naloxone is sold over the counter to combat the effects of an opioid overdose.

One of the best options for saving an opioid overdose patient is to use an opiate antagonist like naloxone.  

Pharmacies in the Maricopa area are confirmed to carry one or more forms of naloxone.

Arizona Department of Health Services’ Real Time Opioid Data tracker estimates as of Aug. 24, there have been 1,961 suspected opioid overdoses, 1,339 doses of naloxone administered to those overdose patients, and an estimated 1,050 of those patients being successfully revived by the antagonist.

It’s important to note these are conservative estimates. Sometimes when users encounter the stronger forms of opiates such as heroin laced with fentanyl and carfentanil, multiple doses of naloxone are needed to revive the individual.

As of June 9, Arizona has joined more than 25 other states in creating a standing order” for naloxone, making it available without prescription over the counter at most pharmacies.

Anyone near someone who may heavily use opioids or opiates, prescription or otherwise, are recommended to obtain some form of naloxone to use in the event of an overdose.

Though in limited supply, pharmacies typically offer naloxone in two forms.

The most common form is a nasal spray called Narcan, which typically comes in a two-dose package and costs around $140 without insurance.

The next most common is a generic naloxone injection typically sold in 1-milileter, single-dose vials at around $25 a piece without insurance, or in a two-dose kit for around $50.

Another, less common, form of naloxone is being manufactured in the form if an auto-injector similar to an EpiPen, called Evizo. Costs of the auto-injector can be $500 or more.

 

Pharmacies in the Maricopa area are confirmed to carry one or more forms of naloxone. Most, including CVS, Walgreens, Walmart and Bashas’ pharmacies, carry at least the Narcan nasal spray. Though not regularly stocked with naloxone injections, most are willing to order them.

For those with insurance, naloxone can be significantly cheaper. For those without insurance coupons are available and organizations such as Sonoran Prevention Works will deliver free naloxone and offer instruction on how to administer it.


 

Part 1: How the addiction begins

Part 2: Stronger and deadlier than ever

Part 4: Recovery & Rehabilitation

This is the second story of a four-part series on the crisis, care and prevention of opioid abuse, which was recently named an epidemic by the governor's office.

Photo by Mason Callejas

Most people are familiar with the lesser forms of opioid pain killers such as Percocet (oxycodone) or Vicodin (hydrocodone), and the even stronger forms such as Oxycontin, morphine and its derivatives.  And most people are also familiar with the more common black tar heroin.”

 However, the recent spike in overdose numbers has been partly attributed to the sudden availability of lesser known though incredibly potent, synthetic opiates such as fentanyl and its exponentially stronger cousin carfentanil.

Carfentanil and its synthetic relatives are so powerful they have even been weaponized.

To put their strengths into perspective, the federal Drug Enforcement Agency warns that by weight heroin is about 5 times stronger than hydrocodone, fentanyl is about 50 times stronger than heroin, and carfentanil is about 100 times stronger than fentanyl.

As another measurement, think about it like this. One milligram of carfentanil packs the strength of nearly 5 kilograms of heroin.

According to the DEA 2 milligrams of Fentanyl can be lethal, which means a dose of carfentanil not much bigger than a few grains of salt can prove deadly. 

CBS News reported in August of 2017 that 18 members of a SWAT team in Pittsburgh Pennsylvania were hospitalized after conducting a drug raid during which they inhaled an unknown airborne chemical substance” the U.S. Attorney’s office now believes to have been fentanyl.

Fentanyl and carfentanil are rarely marketed on the streets as themselves.

According to the DEA, they are often mixed or cut” with heroin, typically in powder form, or other cutting agents to increase its potency or imitate heroin all together.

These drugs are also found in forms other than powders or pills. Lozenges, suckers and patches similar to a nicotine patch are also pharmaceutically manufactured. Though less common on the streets, these forms have been known to be illegally diverted” from the pharmaceutical industry.

Carfentanil and its synthetic relatives are so powerful they have even been weaponized. In October of 2002, Russian military used an aerosol chemical agent, now proven to have contained carfentanil, against 40 or so Chechen terrorist who had taken more than 800 theater-goers hostage at a Moscow theater.

In a 2012 article published in the Oxford Journal of Analytical Toxicology, researchers claim to have found traces of the drug and its derivatives on the clothes and in urine samples of the hostages.

The article alleges 125 of the 129 hostages who died in the standoff perished as a result of the chemical agent.


Part 1: How the addiction starts

Part 3: Naloxone often last line of defense

Part 4: Recovery & Rehabilitation

As much of the United States has begun to face down the staggering number of opioid-related deaths in recent years, Arizona too has begun to confront the harsh reality of what Gov. Doug Ducey declared in June to be a “statewide emergency.”

After as little as one week of consistent use, the body can develop a physical dependency on opioids.

The reality Ducey is confronting with his declaration is one where, according to the Center for Disease Control, 91 Americans are dying every day from an opioid-related overdose, two of which are Arizonans.

A recently completed study by the Arizona Department of Health Services shows the city of Maricopa and its surrounding area has managed to largely avoid this deadly affliction, seeing between 8-12 opioid-related deaths per 100,000 people in 2016.

For comparison, the report says, that same year the Salt River Pima-Maricopa Indian Community saw between 37-60 opioid-related deaths per 100,000 people.

We are fortunately behind the curve, and we want to stay behind the curve,” Maricopa Police Chief Steve Stahl said Aug. 10 at an MPD presentation on opioid abuse.

To remain in this lightly affected position, Stahl said it’s important for the community to understand the roots of this “epidemic” to better identify and prevent opioid abuse. 

According to the AZDHS report, the number of opioid-related deaths in Arizona have increased by almost 75 percent in the last five years. Two major factors have been identified by the AZDHS as the likely causes for the increased number of overdoses.

The first factor they consider is the dramatically disproportionate consumption of prescription painkillers (analgesics) seen in the United States compared to the rest of the world.

According to AZDHS, the United States makes up only 5 percent of the world’s population but consumes “80 percent of the global opioid supply.”

 

Prescription pills: The gateway

oxycodone, hydrocodone, alprazolam, diazepam, loarazepam, clonazepam

The Center for Disease Control estimates as much as 80 percent of heroin users start on prescription pain killers, which some think may be too loosely prescribed.

Often, people are given 30-day prescriptions of opioid painkillers like Percocet (oxycodone) or Vicodin (hydrocodone) for routine procedures such as having wisdom teeth removed, or for minor sports injuries. This excessive dosing can prove to be problematic.

After as little as one week of consistent use, the body can develop a physical dependency on opioids, according to CDC. Patients using opioids only a week are 14 percent more likely to be using the drug a year later. Patients using opioids for only a month are 30 percent more likely to be using opioids a year later.

Additionally, with prolonged use, the pain-killing effect of opioids is often lessened, causing the user to seek higher doses and/or stronger forms of the drug.

When users are no longer physically satisfied with their prescribed dose, or they suddenly find themselves unable to afford the sometimes-costly prescription drugs, they turn to the streets for the stronger and often cheaper heroin and its derivatives.

One of the easiest and most impactful solutions lawmakers are suggesting is to limit the amount of pain medication patients are initially prescribed.

Many states, including Arizona, have already begun limiting state employee insurance and Medicaid recipients to a seven-day initial supply of any narcotic pain killer, excluding patients with chronic pain or traumatic injury.”

In 2016 Gov. Ducey signed the order he hopes private insurance companies will also get behind. 

AZDHS further recommends patients take charge of their treatment when prescribed pain medications by discussing non-narcotic options and/or creating a path for exiting the pain management plan.

Unfortunately, it’s not solely access to prescription opioids that has caused the spike in opioid related deaths.

CDC also warns of combining opioids with benzodiazepines (BZDS) such as Xanax (alprazolam), Valium (diazepam), Ativan (loarazepam) and Klonopin (clonazepam). BZDS are estimated to play a role in 31 percent of opioid-related overdoes.

For those using stronger forms of opioids, the increased availability of extremely powerful synthetic opiates is the second factor the AZDHS has identified as a cause to the increased number of overdose deaths.

Part 2: Stronger and deadlier than ever

Part 3: Naloxone often last line of defense

Part 4: Recovery & Rehabilitation

Ted Huntington presents information on opioid abuse in Arizona. Photo by Mason Callejas

Eighty percent of heroin users start with addictions to prescription medication.

Photo by Mason Callejas

Maricopa Police Department, in cooperation with the Be Awesome Youth Coalition, hosted a presentation Thursday about the effects of the “opioid epidemic” in Arizona, and across the country.

Ted Huntington with the ICAN Arizona organization led the presentation, which focused on identifying opioid addiction and mitigating the role of prescription pain medication in perpetuating what Gov. Doug Ducey has labeled a “crisis.”

MPD Chief Stahl said so far, the epidemic has yet to impact Maricopa the way it has in other parts of the state. With the help of presentations like Thursday’s, he wants to keep it that way.

“We’re fortunately behind the curve,” Stahl said at the presentation. “And we want to stay behind the curve.”

In 2017, between June. 1 and Aug. 8, Arizona saw 206 suspected opioid related deaths, 1,417 suspected opioid related overdoses, 105 babies born exposed to opioids, 1,071 doses of the opioid antagonist Naloxone (Narcan) administered and 1,045 overdose victims were revived.

John Koch, a reformed addict turned advocate who spoke at the presentation, said the actual numbers are much higher.

Koch works with several organizations which help distribute Naloxone. The data they keep, he said, shows a need for greater access to the lifesaving drug.

Currently, he said, pharmacies have a “standing order” for Naloxone which can now be purchased over the counter. For those who don’t have insurance and cannot afford the $30-$65 cost, he said, an organization he works with called Sonoran Prevention Works will deliver Naloxone, and teach how to properly administer the drug, free of charge.