Mind and Body

Nothing changes if nothing changes

An interview with Jonathan Goyer, recovery community expert, talking about how we missed an opportunity to align an OD epidemic response with a COVID-19 pandemic response

Photo by Richard Asinof [file photo]

Jonathan Goyer in front of a portrait of Jim Gillen

By Richard Asinof
Posted 7/19/21
One of the most outspoken voices of the recovery community, Jonathan Goyer, talks about how the recovery community was “disenfranchised” by the coronavirus pandemic.
When will state government officials convene a gathering with recovery community advocates to talk about how to frame the recovery from COVID-19 as a long-term effort? What changes are needed in metrics around recovery to focus not just on OD deaths but on more sustainable measurements that include housing, daycare, and jobs? Is Rhode Island willing to build and maintain a database that analyzes the diseases of despair – alcohol, suicide, drugs, and gun violence related to domestic violence, tied to economic conditions? If the cost of prescription drugs is the major driver of escalating health care costs in Rhode Island, what kinds of new regulation is needed to protect consumers? How does the latest expansion of health equity zones in Rhode Island change the dynamics of health care delivery?
Much ado has been made about developing plans for how we envision future health, education, and community in Rhode Island, with a tendency to defer to the knowledge base of corporate consulting firms to provide the expertise and guidance about decision-making. What is missing, perhaps, is the recognition that Rhode Island already has a sophisticated knowledge base of experts when it comes to drug policies – what Jimmy Gillen and Tom Coderre often referred to as a “constituency of consequence.”
We tend to sell ourselves short if we continue to denigrate what I call the sources of innovation from the bottom up – those folks who can rebuild communities and neighborhoods as a sense of place.

PROVIDENCE – No one, really, should have been surprised by data released on Wednesday, July 14, by the Centers for Disease Control and Prevention that showed a record number of overdose deaths occurred in the U.S. in 2020, with some 93,000 dead, a 29 percent increase from the previous year, another perverse metric from the consequences in the convergence of the coronavirus pandemic and the opioid epidemic.

“This is a staggering loss of human life,” said Brandon Marshall, a Brown University researcher, as quoted in an Associated Press story written by reporter Mike Stobbe.

The news hit the headlines just as an expert witness testifying on behalf of three major drug distributors – AmerisourceBergen, Cardinal Health and McKesson – now on trial in West Virginia said: “I’m not aware of current research that indicates we’re still experiencing an [opioid] epidemic.” To quote WPRO’s Steve Klamkin, “Really?”

Meanwhile, in federal bankruptcy court in White Plains, N.Y., the Sackler family, owners of Purdue Pharma, are engaged in an effort to evade personal liability under bankruptcy protection. As Nan Goldin tweeted: “The Sacklers and 1,000+ of their friends, family members and businesses will be given immunity from all opioid-related lawsuits in the future. This ultra-rich family is being given broad legal protections despite NEVER going bankrupt themselves. This is justice for sale.” [See link below to ConvergenceRI story, “Marking 50 years of the failed war on drugs.”]

R.I. Attorney General Peter Neronha is one of the state attorneys general that are still attempting to hold Purdue Pharma and the Sacklers to a higher standard of accountability. In February, for instance, McKinsey and Company settled a lawsuit involving their efforts to “turbo-charge” the opioid epidemic by providing strategies to Purdue Pharma to increase their sales of OxtContin. [See link below to ConvergenceRI story, “The high cost of consulting firms making policy.”]

Some states, including Massachusetts and New York, recently decided to reach a settlement with the Sacklers, but Neronha’s office has decided to persist in seeking accountability.

“For the past several years, we have been working diligently and aggressively to ensure meaningful accountability on the part of those companies and individuals responsible for the opioid epidemic, and to ensure the maximum recovery for Rhode Island,” said Kristy dosReis, spokeswoman for the Attorney General. “We have repeatedly taken the position that before we could responsibly reach any agreement, we would need much more information about the financial holdings of Purdue Pharma and the Sacklers to be confident that the resolution adequately compensates Rhode Island and, equally as important, holds the company and its owners accountable.”

In a statement emailed to ConvergenceRI, dosReis continued: “Measured against these principles, the plan on the table is deeply unfair and unacceptable. This plan allows the Sacklers to walk away as billionaires, without paying what we know they can afford to remedy the enormous destruction they have caused in Rhode Island and across the country. At the same time, the plan would afford them all the benefits and protections of the bankruptcy process – a legal shield for life, including against the claims we have brought on behalf of the state of Rhode Island.”

Further, dosReis said: “We are evaluating all options to continue to fight for Rhode Islanders and hold the Sacklers accountable.”

Editor's note: On Thursday, July 15, attorneys for the Sacklers filed a motion asking for sanctions against five states, including Rhode Island, that have opposed the Purude bankruptcy plan. On Friday, the attorneys hastily withrew their motion. Conn. Attorney General William Tong responded by calling the sanctions threat a "a huge mistake" by the Sacklers.

"If these entitled thugs think they can ride off on their yachts clinging to their art and jewelry, they have another thing coming," Tomg said. " If there was any doubt, let me be incredibly clear — Connecticut will file our objection to the Purdue bankruptcy on Monday [July 19]  and we will fight until every viable option is exhausted. The Sacklers have now demonstrated they are incapable of acting in good faith and have zero respect for the rule of law and the courts."

Metamorphosis
In 2020, Rhode Island also saw a dramatic increase in opioid overdose deaths, with totals in the perverse metric reaching their highest totals ever. Further, the statistics published by the R.I. Department of Health for the first two months of 2021 showed that the increased number of overdose deaths are not decreasing.

Part of the problem has been the way that the opioid epidemic has morphed, originally driven by addictive prescription painkillers pushed by manufacturers and distribution firms, and now transformed by the increased poisonous presence of fentanyl in the illicit drug stream.

“What’s really driving the surge in overdoses is this increasingly poisoned drug supply,” said Shannon Monnat, an associate professor of sociology at Syracuse University who researches geographic of overdoses, told AP reporter Mike Stobbe. “Nearly all of this increase is fentanyl contamination in some way. Heroin is contaminated. Cocaine is contaminated. Methamphetamine is contaminated,” Monnat said. [Monnat’s research has been featured in numerous ConvergenceRI stories; see link below to “Painting by numbers: coloring in the landscapes of despair.”]s

At the same time, promising new legislative initiatives are underway to create a pilot program for a harm reduction center/safe injection site in Rhode Island, under a bill signed into law by Gov. Dan McKee. How the new pilot program will work, and how it will be funded, are still issues to resolved. However, the program represents a major sea change in emphasis on how to address the rampant ongoing opioid epidemic in Rhode Island.

Similarly, the R.I. General Assembly also passed new legislation to change the definition of felony drug crimes, advocated by R.I. Attorney General Peter Neronha, in an effort to move away from the misguided philosophy that the state can arrest its way out of the drug crisis. [See link below to ConvergenceRI story, “Where state drug policy and gun violence policy converge.”]

A conversation with Jonathan Goyer
Jonathan Goyer was recently featured in a story in The Providence Journal, “Drug bills signal sea change in RI’s approach to opioid crisis.” Goyer, who serves as an expert advisor to the Governor’s Overdose Prevention and Intervention Task Force, has been a strong voice in promoting community recovery efforts and, in particular, recovery housing and workplace recovery initiatives in Rhode Island.

Goyer has never been shy about voicing his opinion or in asking questions. Here is the ConvergenceRI interview with Goyer, in which he agues persuasively that Rhode Island and the nation missed the opportunity to align an OD epidemic response with a COVID-19 pandemic response, in effect disenfranchising the recovery community.

ConvergenceRI: Where are we at with the number of overdose deaths in Rhode Island?
GOYER: Pre-pandemic, our highest year was 336 deaths in 2016. We saw a notable decline in years proceeding, landing at 308 deaths in 2019. Unfortunately, through COVID-19, we saw an increase to 384 deaths in 2020. We are now seeing an estimated 13 percent increase in the first part of 2021 [which currently projects about 433 deaths this year].

ConvergenceRI: How has COVID-19 impacted the recovery community?
GOYER: COVID-19 has seemingly exacerbated issues surrounding substance and alcohol misuse, as well as mental health conditions. There are an abundance of answers to this question. However, some basic observations regarding the impact on four key components needed to find and sustain long-term recovery:

• Health: Many people's physical health were significantly compromised due to the virus itself. I am a believer that addiction is a disease of body, mind and spirit. We need all three parts to be well in order to optimize recovery.

• Homes: Many people's housing became compromised throughout the pandemic. There were times of mandated quarantine that impacted their living situations. Domestic violence was also at an all-time high.

• Community: People in recovery often rely heavily on face-to-face contact with their support networks. Contact and connection was essentially eliminated as an unintended byproduct of the executive orders.

• Purpose: Many individuals lost their jobs and had to pivot their daily routines. Jobs and routine resemble structure.

These four factors cannot account for all of the increase, as fatality deaths began increasing drastically in the very beginning of 2020, before the pandemic hit.

ConvergenceRI: Is the Governor's Overdose Prevention and Intervention task force still effective?
GOYER: It can be. The task force is the largest gathering of recovery and treatment community and covers the most in-depth and timely data we have available. It meets monthly on Zoom [more info is available at preventoverdoseRI.org] and it is open to the public.

With that said, it is up to the community at-large to show up, participate and voice their concerns. Some of the best resources we have available in the state for addiction and recovery today were born from ideas and/or rants that occurred during the public comment portion of this meeting.

ConvergenceRI: Many of our efforts focus on addressing opioid impacts. What is being done to address other substances and alcohol?
GOYER: That’s the million-dollar question. Most toxicology reports in Rhode Island show poly-substance use being a factor in fatal overdose deaths [there has been a huge rise in methamphetamine and cocaine overdoses in the past four years].

Nationally, more than 93,000 died from an overdose in 2020 and the CDC reports that, additionally, there are more than 95,000 people that die each year from excessive alcohol use.

What is being done, you ask? Not enough. Historically, there has always been a significant shortage of detox and residential beds in the state of Rhode Island.

Although there is a spectrum of care, that care is provided by numerous organizations with little to no state oversight or accountability for collaboration [and warm “hand-offs”/referrals] among these providers.

This presents gaps that people quickly fall through, only to have to start over again if they’re so lucky to have a chance to.

ConvergenceRI: How do we compare the COVID-19 epidemic with the overdose epidemic?
GOYER: Rough numbers: COVID-19 claimed the lives of 365,000 people in this country last year. Drugs and alcohol claimed the lives of 200,000 people in this country last year. Both are very real pandemics, yet only one has had a real response.

As I watched the state and federal government respond to COVID-19, it made me proud. It was incredible to watch regulations drafted and evolved, relief and resources be provided and communities come together with clear direction of what their role was. Shortly thereafter, I became disheartened at discovering the reality: we are capable of responding the same way to the addiction pandemic, but we don’t.

Advocates have been shouting about a shortage of treatment beds for many years. We were told it could not happen. Then, overnight, the R.I. Convention Center became a field hospital with more than 600 beds providing life-saving care for COVID-19 patients.

Advocates have been shouting that we need to expand and mobilize medication-assisted treatment clinics for many years. In response, we were faced with barriers and told that these things take time. Then, overnight, it seemed, there were COVID-19 vaccination clinics in every neighborhood across the state.

Advocates have been shouting for years that we needed more transparency around overdose numbers, in real time [including suspected overdose deaths]. We were told these things take time and numbers can take up to six months to finalize.

Then, overnight, we have a state dashboard laying out COVID-19 death counts on a daily basis, accompanied by weekly press conferences that discuss specific and detailed metrics.

We fundamentally understand the financial impacts of COVID-19 – and provide relief accordingly. Yet we do not fundamentally understand the financial impacts that addiction has on the community. Nor do we recognize the correlation of funding treatment and recovery to be an investment rather than an expense.

Rhode Island and the country missed an incredible opportunity to align an overdose epidemic response with the COVID-19 pandemic response.

For example, a lot of times people do not know where to turn if they are struggling with substance or alcohol misuse. Those people are often hard for us to find, hard to track or hard to identify.

Yet, we have managed to swab the noses of Rhode Islanders an average of 4.5 times per resident. If there were any other pandemic going on, COVID-19 testing sites could have served as a platform to educate individuals on the risks and resources for that pandemic.

But not addiction. God forbid we handed out a flyer of addiction resources at a COVID-19 testing site as part of a public health announcement.

Is this all because of the stigma or negative public attitudes of addiction?

Perhaps. People still think "addiction is a choice.” That sounds as ridiculous as me making the argument that COVID-19 is a choice: you decided to touch that gas pump without gloves on, you chose to get COVID-19. Or, you decided to go to work and have close contact with people, you chose to get COVID-19.

The parallel applies to every scenario. Addiction is as much of a choice as contracting COVID-19 is. The difference is: we didn’t criminalize anyone for getting COVID-19. We didn’t blame anyone for getting COVID-19. We recognized it with empathy and we addressed it with compassion. And it worked. Maybe we should start doing the same for addiction.

ConvergenceRI: Where is the recovery community going?
GOYER: The recovery community has become disenfranchised through the pandemic, in my opinion. But now is a time to rebuild. People who are in recovery and allies who have been impacted by substance misuse are some of the strongest, smartest, caring and most resilient people in the world.

The recovery community is going wherever we want it to go, but it’s up to us to take it there. I want to remind everyone in and around the recovery community that we are the experts in this field. Some 24 million of us in this country have found a way to put addiction behind us and live a life in recovery.

This is our time to shine, and we have an obligation to stand strong in our communities and let people know that recovery is here, it’s obtainable by anyone, and it’s happening every day. I hope to see this years “Rally4Recovery” have the strongest attendance yet

ConvergenceRI: So much of the response by the recovery community has been one of trying innovative approaches, such as the development of peer recovery coaches and their presence at hospital emergency rooms, an initiative developed in large part by the late Jim Gillen. How do you think he might view the current landscape?
GOYER: During this unprecedented time, I often think to myself: What would Jim Gillen do?

Jim was like the godfather of the recovery movement here in Rhode Island. He fought for a spot at the table and used his seat as a voice for the recovery community.

He would tell state leaders and nonbelievers exactly how things needed to be, but he always did so in the most eloquent and constructive way.

He was a heck of a wordsmith and he didn’t take no for an answer. He did the right things for the right reasons to better serve his community, even if it displeased his superiors.

He mastered the art of asking for forgiveness rather than asking for permission. Jim always said: “Nothing changes if nothing changes.” We all need to be a little more like Jim Gillen, and be the change we need.

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