As we are all no doubt aware, our country struggles with the impact of opioid addiction and as case managers we witness its human impact. The 2017 statistics were recently released and the news is not good. Drug overdose deaths totaled 70,237 human beings. That is an increase from 2016 by almost 10%. To give that statistic context, in 2016 opioid-related deaths were 19.8 per 100,000 lives. In 2017, deaths increased to 21.7 per 100,000 lives (Centers for Disease Control and Prevention, n.d.). It will be a few more years before statistics bear out any appreciable impact as a result of recommendations of the 2017 Opioid and Drug Abuse Commission (Office of National Drug Control Policy, n.d.), but the human toll has gained ground for yet another year.
There is a hole in my family, created by addiction to heroin. We speak of him at family gatherings. He was an active part of our family, a son, brother, nephew, and grandchild. He used to be at all our family events, his dry sense of humor kept us all entertained. At the holidays, he used to make beautiful artwork as gifts. One year, he crafted a wooden pen for me. He was especially talented in the Americana-style drawing and painting. Some of us still have those treasured pieces because we gave up hope of ever seeing more produced. Heroin continues to rule our family member's life. Like a phantom, it continues to steal experiences and memories from those of us left in its wake.
If you have walked down this road with a loved one, you know exactly what I mean; family members and friends are never quite the same. We struggle to reconcile our memories of happier times with the present-day toll suffered at the hands of a merciless tyrant. We witness someone change from a loving, caring person into a zombie willing do anything to score the next hit. Until that loved one is living on the streets, it is amazing how many keepsakes go missing. We realize that it became an artifact of just how far an addict will go to feed his/her addiction. Cherished items from previously passed loved ones that are tucked away in a jewelry box evaporate unnoticed for months. It is not until we have an occasion to wear it that we realize it is another casualty on the path of an addict's self-destruction.
This is just one story. While some details change, the tale of betrayal and loss due to addiction is a constant drag in the life of those who are left behind. Depending upon the degree of connectedness between the family and its addicted member, the cycle is not likely to change. For us, it has been over a decade. The hope for real change in the trajectory of our beloved "Tommy" slowly vanished. In his ongoing interactions with health care services, it appears (to us) as if nothing changes and no one cares. We hoped that Tommy would benefit from a diversion instead of another incarceration. That hope no longer exists. Things have not changed for Tom.
So how can we affect this vicious cycle? Those of us working in acute care and managed care settings understand some of the challenges this population presents because addiction affects hospital care and transition planning. Opioid-related admissions frequently result in longer lengths of stays, strained interpersonal relations, and shame. Family dynamics and support systems available to the addict following an acute care episode vary in degrees, but sadly these relationships are frayed and often not the best option.
We need to add drug-related diversion programs to our transition resource list if they are not already on it. An example of a diversion program is the Law Enforcement Assisted Diversion (LEAD). There are similar programs across the country and it takes just a few minutes of your time and effort to learn which one(s) is available in your location. These programs are considered diversion opportunities for addicted individuals who are willing to make a change in their lives. These community-based opportunities have sprung up across the country and should be a component of all transition plans for those people suffering with opioid misuse disorder. The goals of LEAD are to improve public safety and reduce unnecessary justice system involvement for those who participate in the program (LEAD National Support Bureau, n.d.). This organization's website features a map and list of jurisdictions that are exploring, developing, launching, or operating LEAD or LEAD-aligned programs. Many of these efforts are county-based though some are city-specific. Check the LEAD website (https://www.leadbureau.org) to determine whether there is an active resource near you.
Another resource worthy of investigating is Stop the Addiction Fatality Epidemic (SAFE). This group focuses on community awareness and education. It is a national nonprofit organization that collaborates across six lines of operations focused on campuses, community, and the veterans community (SAFE Project, n.d.). Its operations include law enforcement and criminal justice, prescriptions and medical response, family outreach and support, prevention, treatment and recovery, and public awareness. Contact information is available on the SAFE website (https://www.safeproject.us).
Our case management action plan is as simple as 1-2-3.
1. Take a few moments of your time to reach out and speak to a point person at one of these (or a similar) organization in your area.
2. Invite a representative to speak at your next local case management meeting or at your place of employment.
3. Learn about the specific resources available to you and begin developing strong relationships with these assets.
We are not powerless to constructively contribute to making new connections in order to help our substance misuse disorder clients. The only thing we need to do is reach out and begin a dialogue with these resources. Let's take a step to help stem the tide of individuals who repeatedly cycle through acute care to detoxification to the street and back to acute care. Case managers are an asset to this community-based effort because we are well-placed across the care continuum. Let's do what we supposedly do best. Let's get the dialogue started and assume our place at this table.
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