June 2, 2016
The opioid epidemic soars in the United States. Many professionals are affected from the disease. Churches play an ambivalent role
By Katja Ridderbusch
ATLANTA, Ga. – In the beginning, there was appendicitis. Or a sore wisdom tooth. Or a knee replacement. This is usually how the stories go, stories that Father Jim Duffy, Catholic priest at Our Lady of the Assumption in Atlanta, hears from parishioners and strangers. From people who are ashamed, ashamed of being addicted.
This is also how Janice Jaspersen’s story goes. After minor surgery, her former husband was prescribed 10 pills of hydrocodone, an opioid to help with post-operative pain. He didn’t take one single pill. She took one for her chronic back pain. The medication eased the pain. It also lifted the iron grip of stress and anxiety she had felt in her daily life. And it brought her the most pleasant lightness of being. She took all 10 pills. That was in 2011.
Since then she has taken many more. Hundreds, probably. Hydrocodone, oxycodone, hydromorphone -- all prescriptions opioids. Jaspersen, 45, is divorced, and has no children. She has autumn colored curls, a robust laugh and a firm handshake. She works as an attorney in Atlanta, enjoys competing in triathlons and volunteering in her church, where she helps organize the soup kitchen as well as the annual charity golf tournament.
Only a few close friends know about her addiction. Not her parents, not her siblings, not her coworkers. “This is how I want it to be,” she says. And that’s why she doesn’t want her real name published.
The use of opioids in the United States has soared in the past 15 years. More than 2.1 million Americans are addicted to opioid painkillers; and more than 28,000 people died from an opioid overdose in 2014, four times as many as in 1999. The latest prominent victim is pop icon Prince who, according to a report by medical examiners, accidentally overdosed on fentanyl, an opioid much more potent than heroin.
The U.S. has passed all other industrial countries when it comes to opioid consumption. While Americans make up about 5 percent of the world’s population, they use 80 percent of all prescription opioid painkillers.
“When you look at the staggering statistics in terms of lives lost, productivity impacted, costs to communities, but most importantly, cost to families from this epidemic of opioids abuse, it has to be something that is right up there at the top of our radar screen,” said President Barack Obama at a recent summit in Atlanta.
America’s opioid epidemic has many causes. One goes back to an initiative taken by the Department of Veterans’ Affairs which, in 1999, required pain to be measured as a fifth vital parameter in clinical settings – along with body temperature, blood pressure, pulse and respiratory rate.
The result was not only a medical but also a socio-cultural paradigm shift. Even moderate pain became something that one should not and need not accept nor endure, but something that could be treated with medications. Hence, physicians started prescribing opioid painkillers more liberally, and patients asked for them more aggressively. Until then, opioids had been largely reserved for severe post-operative pain, pain associated with cancer, or palliative care.
The boom in opioid painkillers has also spurred a new wave of heroin addiction in the U.S. Opioid painkillers are expensive, and access can be difficult. Heroin, in contrast, is cheap -- most of it flooding into the country from Mexico. One “shot” can be as cheap as $10. The drug works on the brain’s receptors almost identically to opioid painkillers.
Janice Jaspersen never has a problem getting her opioid prescriptions. She frequently travels for her work and knows a doctor in nearly every city. And if those doctors are reluctant about prescribing opioids, there is always ER, she says. Addiction experts call this type of behavior, “Doctor Shopping.”
In recent months, the U.S. government has launched numerous initiatives to combat the country’s opioid epidemic. The Obama administration is seeking an additional $1.1 billion in the fiscal year 2017 budget to pay for drug treatment and education. Also, the administration has called for stricter guidelines discouraging doctors from prescribing opioid painkillers.
The public battle against the opioid addiction calls upon all players of society, including the churches, which in the United States have a much stronger public voice of influence, particularly in the South.
Since 2012, Father Jim Duffy has held an addiction mass in his church. On the average, 25 to 30 people attend the mass, he says, “not very many for a parish of several thousand members.”
Duffy chooses his words carefully, while running his hands through his thick head of grey hair. He has observed how addiction has changed in his own parish over the past decade and a half. “First, there was alcohol. Now, there’s alcohol plus opioid pain medications.”
Once in a while someone seeks a confidential conversation with the priest. Father Duffy considers his role to be a modest one. “I’m a pastor, not a physician,” he says. “I don’t give advice. Sometimes, I recommend an addiction clinic, a therapist or a self-help group. But most of the time I just listen.”
Most self-help organizations for people suffering from addiction are based on the 12-step-program, which was started in the 1930s by Alcoholics Anonymous (AA) and which has become globally known. With its strong focus on faith and spirituality, the program resembles a religious conversion. It’s therefore no coincidence that, especially in the United States, AA groups are closely connected with churches and often hold their meetings on church premises.
More than previous waves of substance abuse, the opioid epidemic “shows that addiction affects everyone,” says Duffy. Black and white; rich and poor; young and old. People in the countryside; people in the cities; and people in the suburbs. The devout, the atheists and the agnostics.
And more and more career people - “well educated, well off, hard charging,” according to Duffy. People in jobs with tight schedules, high responsibilities, a high social status, and high expectations thrown upon them--business executives, pilots, physicians and lawyers. People like Janice Jaspersen.
Or Michael Fishman. His story has two parts and, for now, a happy ending. Fishman, 56, tall, with a calming presence and a soft, slightly brittle voice – is a doctor, a specialist in addiction medicine. He’s the director of the young adult program at Talbott Recovery Campus in Atlanta. Talbott was one of the first treatment facilities to offer a specific track for addicted physicians. It’s the place where 27 years ago, Michael Fishman sought treatment.
Back then he joined a 12-step-recovery program. “I’m not a real religious guy,” he says adding that however, the way out of addiction is “a spiritual journey of sorts. And if you don’t have faith in something you are going to drive yourself crazy.”
Fishman says doctors tend to have certain character traits which make them susceptible to addiction – and also, extremely difficult to treat. “Some doctors can be very arrogant and narcissistic,” he says. “They often have a ‘heal thyself’ type of attitude, and they don’t want to be told what to do.“
As for himself, he began taking drugs long before he knew he wanted to become a doctor. He started smoking marijuana when he was 13, and occasionally experimented with cocaine and alcohol. When he was 16, he had shoulder surgery. His doctor prescribed opioid painkillers. “Opioids created a sense of euphoria, a sense of peace, a sense of no anxiety," he recalls. “So I drifted towards the opioids. They became what you'd call my drug of choice."
When he started medical school he was already heavily addicted. But he functioned, and functioned well. He decided to do his residency in anesthesia. Later, one of his therapists suggested that he subconsciously felt drawn to anesthesia because he had access to all the narcotics. “Well, maybe,” he says, shrugging his shoulders. “However, back in the day, anesthesiologists made a very good living, so I guess that was one of the main reasons, really. “
He took advantage of his access to the narcotics, so much so that he developed a tolerance to traditional opioid painkillers. He started using stronger drugs, intravenously. “It got to a point where I couldn’t eat, I couldn’t sleep, I couldn’t think.”
The drugs hijacked his brain and took his body hostage. “I was 24/7 in withdrawal unless I had a drug, which only took me out of withdrawal for an hour, at the most.” He talks about this as matter-of-factually as if giving a report about a patient who had been long discharged. “I wasn’t suicidal,” he says, “I just didn’t know how to live.” At that time he was 29, and he knew that he needed help.
The medical board launched an investigation. “When I met with the investigators, I told them everything,” he says. “Things they already knew and things they wanted to know, things they didn’t know and things they didn’t even ask about.” It was humiliating but also a first step into a vague, naked, new freedom.
On the second to last day of this treatment he learned he could not to go back to his specialty, anesthesia. “That was crushing, because it was the last of my identity,” Fishman recalls. “In retrospect though, it was a good thing.“ He decided to retrain in the still young field of addiction medicine.
People who come from a fulfilling professional and stable personal environment usually have a good prognosis, says the physician. However, the way back comes with a price. ”You have to face all kinds of consequences,” he says. “You have to be willing to work though layers of shame, stigma and guilt, a lot of it. And you have to be willing to totally reset your life.”
Many lose their jobs, their families and their networks of friends. Fishman was lucky. His wife, with whom he has two, now adult, children, stayed by his side.
Guilt, shame, stigma and secrecy go hand-in-hand when it comes to addiction. As epicenters of social life, churches in the United States can help break and help pave ways out of this toxic circle of addiction. Sometimes, however, churches can also be part of the problem, says Lois Purrington, who has worked as an addiction counselor for 25 years. “Sometimes, they can even foster the stigma.”
For her own church, Purrington used to organize educational addiction seminars. Not any more. The church leadership didn’t promote those efforts, she says, and rather wanted to keep the issue under the carpet. At times, she even felt stiff-armed. “When I addressed my pastor, he replied, ‘We really don’t have an addiction problem here.’” Purrington laughs and throws her hands in the air. “Excuse me? Really?”
Jim Duffy doesn’t want to judge his colleagues. He does say, “But they fool themselves if they think this issue is not in their parish. Addiction is everywhere.” Sometimes he meets with people who come from other parts of town, sometimes from farther away. People who don’t feel comfortable opening up to someone from their own parish, even if the conversation is confidential.
Janice Jaspersen has, once or twice, approached a pastor at a different church in a different town. She has even participated in a few meetings run by the Narcotics Anonymous, which also uses the traditional 12-step-model. She says her own church is not an option. She meets her pastor for cocktails; she sits on various charity committees; and she knows and is known.
At times, she toys with the idea of taking a few weeks of vacation and checking herself into a recovery clinic, ”maybe somewhere out west, in Arizona or California, far away from Atlanta, in any case.” Then she quickly dismisses the thought, pushes it off to tomorrow, or just some day when there may be a window in her schedule.
This is the translation of an article originally published in German in the German weekly national DIE ZEIT / Christ & Welt
© Katja Ridderbusch