PAWTUCKET – There’s something disturbing about it, really. All six of the 2014 gubernatorial candidates showed up at an Aug. 13 forum sponsored by Eat Drink Rhode Island at the Sons of Liberty Spirits distillery in South Kingstown, which crafts single malt whiskey with the branding of revolutionary language, “Take a stand.”

Yet, when the grassroots Rhode Island Communities for Addiction Recovery Efforts, or RICares, hosts its candidates’ forum on Friday, Aug. 22, at the Anchor Recovery Community Center at 249 Main St. in Pawtucket, beginning at 5:30 p.m., discussing the issues of substance abuse, addiction and recovery in Rhode Island, initially, only four of the candidates promised to show up: Providence Mayor Angel Tavares, Clay Pell, Ken Block, and Todd Giroux.

At first, R.I. Treasurer Gina Raimondo planned to send her husband, Andy Moffit, in her stead, to read a two-minute statement at the forum. Now she plans to attend but leave early. Cranston Mayor Allan Fung still has not committed to attending the forum.

There are few lives that the addiction crisis in Rhode Island have not touched, as its tsunami  of death and personal destruction has washed over the state, in what has become a major public health crisis.

Choosing to show up at a distillery to talk about food policy, but choosing not to show up at a recovery center to talk about the state's addiction epidemic, exposes a candidate's true policy priorities. The question is: can the recovery community translate its growing voice into a political constituency, one that bites back on primary day and in November?

Beyond the body count
The body count in Rhode Island from the epidemic of accidental overdoses is still front-page news. Since the beginning of 2014, there have been 127 apparent accidental drug overdoses in Rhode Island, with 17 recorded in July and the first week in August, according to R.I. Health Department officials.

Since the first of the year, the R.I. Emergency Medical Services has administered 932 doses of Narcan, to help revive patients who have apparently overdosed. Without Narcan being accessible, and the effort led by Dr. Michael Fine at the R.I. Department of Health and his team, the death toll could be more than 1,000.

Since April, when the R.I. Department of Health issued emergency regulations, requiring hospital emergency rooms to report the incidences of drug overdoses, there have been “three to four a day,” according to agency officials.

Efforts have been made by the R.I. Department of Health in conjunction with the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals to have recovery coaches available at emergency rooms at hospitals to assist patients who seek treatment.

But getting access to a bed in a treatment facility from a hospital emergency room is still often too high a hurdle for those seeking to enter recovery.

And, there is still “too much product” on the street, according to health officials.

Less than a quarter of all Rhode Island physicians are participating in the state’s Prescription Monitoring Program, pushing back against the idea that they may be over-prescribing opiates to patients who are doctor-shopping.

New data expected to be released this week will show that there are about 1,600 patients in Rhode Island who are receiving such prescriptions from five or more doctors or purchasing the drugs at five or more pharmacies.

High hurdles
In early August, Betsy [not her real name], who overdosed on heroin, then was revived by Narcan in an ambulance, and who told the physician’s assistant at Rhode Island Hospital that she wanted to go into treatment, couldn’t overcome those hurdles, despite having an advocate there to help her.

[The hospital had yet to establish the new protocols for recovery coaches to be available at its emergency room; for the caregivers on duty that night, it seemed that no training had yet taken place, although the new policy was said to be planned to be implemented on Aug. 13. That implementation still has not yet happened.]

[Care New England hospitals, according to recovery advocates, has implemented a program of recovery coaches at its emergency rooms.]

Betsy was struggling with her addiction; it was the seventh time she had been admitted to an ER as the result an overdose. 

There were no treatment beds available; a national drug help hotline went to an answering service, transferring the call, but after 20 minutes with no one picking up, the line went dead, according to the advocate.

SStar Addiction Treatment of Rhode Island told the advocate that no beds were available.

The Crisis Stabilization Unit, or CSU, at The Providence Center offered a glimmer of hope; there were some beds available, but first they had to make sure Betsy was appropriate for the program.

The advocate faxed Betsy’s insurance card to the CSU. Because the Crisis Stabilization Unit could not access her medical records from the Department of Corrections, the advocate was told that Betsy would need to have a full psych evaluation and blood work done before CSU could guarantee a bed.

To get the necessary medical tests and evaluation required to get her admitted for medicated assisted treatment, Betsy was moved downstairsat the hospital and then confined under guard in a locked ward, no longer a willing participant in her health choices.

Several hours later, with the transfer to CSU still in doubt, and the prospect of having to remain in a locked ward and wait for days until a bed became available, the result was predictable. Betsy said that she would rather go to prison than remain in a locked ward for days, and asked to be discharged.

Her discharge papers stated opioid dependence; the referral given was to get Narcan training, but nothing was said about referrals to medicated assisted recovery, addition treatment facilities, or any other recovery resources.

The blood work and x-rays done on Betsy were never discussed with her. The cost to the system: thousands of dollars.

“The doctors and hospital administrators need to be educated in addiction medicine and recovery supports so they can provide care with dignity and respect for those suffering the disease of addiction or mental health conditions,” said Holly Cekala, the executive director of RICares. “I am happy to educate anyone in the health care industry about recovery supports in the future.”

Does the doctor know best?
At the heart of the addiction epidemic in Rhode Island – and throughout the nation – is the relative ease through which patients can be prescribed addictive pain medication, for everything from back pain to a tooth ache to a sprained ankle, often with very, very low co-pays. Within a month to six weeks of use, a patient can often become hooked. 

The health insurance co-pay for Narcan, for instance, between $14 and $17 dollars, is about three times higher than the average health insurance co-pay for opiates such as Oxycodone.

The numbers help to tell the story: in 2013, some 385,000 Rhode Islanders – about 40 percent of the state’s population – purchased a controlled substance, according to Dr. James McDonald, chief administrative office of the Board of Medical Licensure and Discipline at the R.I. Department of Health. Previously, McDonald served as director of Health Services for the Naval Health Clinic New England in Newport.

“This is everyone’s problem,” McDonald told ConvergenceRI in a recent interview.

In the first six months of 2014, there has been no decrease in the number of controlled painkiller being prescribed in Rhode Island, according to McDonald.

Since 1990, the amount of opioids sold as prescription painkillers has tripled – despite the lack of scientific evidence about the efficacy of such painkillers in treating chronic pain, according to McDonald.

In McDonald’s opinion, these addictive drugs often create withdrawal symptoms much more profound than the original pain, requiring more and more frequent use and higher dosage.

Doctor-shopping by patients is a major problem, according to McDonald. “The way we define doctor-shopping is a patient going to five or more doctors [to get prescriptions filled], or five or more pharmacies, to get a controlled substance within a year.”

McDonald continued, saying that it is sometimes difficult for a doctor to recognize the drug-seeker. “I don’t want to make a moral judgment about the drug seeker. People who are addicted will do anything to get that drug,” he said.

Still, there has been resistance from physicians and physicians’ groups to join the voluntary Prescription Monitoring Program – with three-quarters of the state’s physicians not yet participating.

For those doctors that are participating, there has been a steady increase in the number of reports generated through the Prescription Monitoring Program. In July 2014, there were 12,373 reports on all prescriptions, up from the previous months. The good news, McDonald said, is that more doctors are registered and there is increasing utilization.