Shedding Light on the Opioid Epidemic

Tyler Podcast Episode 8, Transcript

Our Tyler Technologies podcast explores a wide range of complex, timely, and important issues facing communities and the public sector. Expect approachable tech talk mixed with insights from subject matter experts and a bit of fun. Host and Content Marketing Director Jeff Harrell – and other guest hosts – highlights the people, places, and technology making a difference. Give us listen today and subscribe.

Episode Summary

Dr. Kevin Gilliland is back to talk about the opioid epidemic and why the problem has skyrocketed in recent years.

Transcript

Kevin Gilliland: We tend to think treatment doesn't work when it comes to addiction. Like all behavior change it takes time, whether it's eating or being more physically active or navigating away from a really unhealthy choice in life that's become an addiction. What you did to solve the problem yourself, that didn't work. You're going to need some help,

Jeff Harrell: From Tyler Technologies, it's the Tyler Tech Podcast, where we explore issues facing communities today, and do so in a way that's both interesting and entertaining. I'm your host, Jeff Harrell, and my promise to you is to help break through the clutter and provide great information and a format that's super easy to consume, and maybe just, maybe we'll have a little bit of fun along the way.

A few weeks ago, we released a bonus episode with clinical psychologist, Dr. Kevin Gilliland, talking about the impact the coronavirus on our mental health. We had some incredible feedback, and so Dr. G is back again to discuss another really important problem facing communities today, and that's the opioid epidemic. Kevin is an expert on the topic and we get his insight on questions like what are opiates? Why are they such a big issue? What are some of the warning signs that we can look for to help others in our community? I think you'll find this episode very informative. Here's my interview with Dr. Kevin Gilliland.

Defining the Epidemic

Jeff Harrell: Well, Dr. Kevin Gilliland, we are super excited to have you back with us again today. We tackle an equally tough issue, the opioid epidemic, so I'm going to jump right in. We hear opioid epidemic thrown out all the time, but I think it'd be great to start by defining what that actually means.

Kevin Gilliland: We have seen a resurgence, and we've seen it at a couple of different times of people becoming addicted to opiates and people dying from opiates, and we saw that trend and a significant trend that started in the late '90s, when we started trying to do a better job of treating pain and chronic pain, and the prescriptions escalated quickly. What it meant was, we ended up with a lot of that was out in public hands, written by physicians, and we tend to think, oh, it's a script. It's safe. No. Opiates are very powerful medications used for a very specific medical condition, but they are abusable. So, we've seen a real rise in it, and that's what's been really overwhelming, and particularly tragic is the way people lose their life with opiates. A lot of times these are young individuals that are dying significantly before the prime years of their life.

If you think about heroin and opiates in the same category, because they do the exact same thing, we needed opiates in order to have an expected response from a medication. So, what happened was, heroin was used by a particular set of the community or a population, but when it started being written in prescription form, it just spread everywhere. For instance, like in the late '90s, I think there was something like 76 million scripts were written, prescriptions for opiates. Let's say 2000 and 15 years later, there were 250 million prescriptions written. So, in 15 years we went from 75 million to 250 million. Like if you've had surgery lately, or if you had a root canal or my guess is, you didn't take all those pills and they're sitting in your medicine cabinet or in your bathroom, there's enough today sitting in all of our bathrooms for every adult in the US to take one pill a day for a month. That's how much has flooded into our worlds, and if you become addicted to those they're readily available.

Jeff Harrell: How has the abuse of opioids changed over the years, and why is it such a problem today?

Kevin Gilliland: Well, there's a couple of things, to be honest. It was us having chronic pain, right? Baby boomers, and we get hurt, and instead of changing our lifestyle, we get surgery and we keep going. I've been guilty of that at times, or of overdoing it or not aging well. Then there was also the pharmaceutical world advertising and pushing those as non-addictive ways to manage pain. Now everybody likes to beat up big pharma, but before you do that, we also beat up big tobacco, and if you're going to beat up big pharma, get ready to beat up big marijuana as well, because we humans can do that. So, there was a push from there. Also, some different things hospitals who are doing post-surgery with questions that were about quality and pain management. So, it became a focus and unfortunately it took off on us. It really, but honestly, we're doing the same thing with marijuana. Now, marijuana's not nearly as lethal as opiates, but if you think about how fast it's being pushed out there, we just have done that before. Opiates are just horribly deadly. There's no margin for error.

Paths to Addiction

Jeff Harrell: What are the common paths that people unfortunately take that would lead them down the path to an opiate addiction?

Kevin Gilliland: Yeah, it's really interesting, right? You have the typical 18 to 20 something male. Those are the most at risk for abusing any substance, and it's true with opiates as well. Where it's different with pain meds is that people in their thirties and forties that have not had a history of addiction, will have a surgery for anything, whether it's a broken something or your teeth or gallbladder and opiates deaden pain. If you're in a difficult job, a stressful job, marriage, life, you also might realize that they deaden psychological pain as well. We've done actually a lot of studies that when we take it beyond seven or eight days, we have a high likelihood of being on it for months, and that's a group that is not typically addicted to substances.

Jeff Harrell: If you're struggling with opiates or you're afraid you're headed in that direction, what are some of the things that you can do?

Kevin Gilliland: There's a couple things, and actually the CDC has got some stuff out. So does Johns Hopkins, of other ways to manage pain. Some involve ibuprofen and acetaminophen. Talk about that with your physician. Then the other thing is, when we study it, if we take pain meds beyond three days, our risk goes up quite a bit each day. If we get that second script filled, there's a significant chance we may be taking it a year from now. So, I think one of the things is, there used to be this expectation that I had surgery, and I'm going to be on pain meds. Well, I think we have to start that mindset of, I got to get off these pain medications as quickly as I can. I'm not against pain medications. I've had to have some knee surgeries over the years, and I have taken some pain medications, but I have been far more thoughtful of late of, I don't want to be on these beyond three, four, five days, of having that mindset of, I got to get off these as quickly as possible.

Jeff Harrell: Melissa Etheridge's son died of an opioid overdose.

Kevin Gilliland: Yeah. I saw that.

How to Help

Jeff Harrell: What can you do if you suspect someone maybe is struggling with or on the verge of an addiction?

Kevin Gilliland: Talk to your doctor about alternatives for getting off. Talk to your doctor about tapering off, because one of the mistakes is our bodies physically get dependent on opiates pretty quick after three, four days, meaning we'll feel it when it leaves our system. That's not addiction. That's just a physiological response, and so we can feel really nasty, and oftentimes we'll keep taking them because we're trying to avoid that feeling. So, talk with your doctor about how to taper off. Talk with your doctor about alternatives to pain medications. Talk to your doctor about alternatives and therapies, whether it's stretching, hydrotherapy, warmth, cold, anything. It's really one of those things that we've got to get out of this mindset of, I have pain and I'm going to take a pill. Have that conversation, and also talk to family about it. Verbalize your concerns.

Jeff Harrell: Are there warning signs that we can look for?

Kevin Gilliland: Well, a couple of things. One, if you have a family member or a friend or somebody close to you that you know is struggling with it, I would have Narcan available in your car, in your home. Narcan immediately reverses the effects of an overdose. It's the only reason Demi Lavato is alive, and I love how she's talked about it. She's done a great job. Those close to her knew she struggled with it. They had it on hand when she became unresponsive. Narcan's almost like a mist up somebody's nose. It used to be in an injection. They've made it even easier. Most states you can get it without a prescription, but they gave her Narcan while they were waiting for 911 to get there. They had to administer it again, and there is a very good chance that saved her life. So, it immediately reverses the effects of an overdose, which your lungs and diaphragm just can't breathe, and so you end up dying.

So, I would have that. Then I would also be mindful of, there's very little margin for error with opiates, that even with prescription pain meds, when people start buying them through the internet or from other people, you don't know what you're getting. Sometimes when people aren't able to get prescriptions, you will see people that will start using heroin, because they're afraid of legal consequences. So, it's a pretty common path for people to switch to buying heroin, and people that you just are amazed they're doing heroin. Well, they don't want to do heroin, and never in a million years thought they would be there, but it's cheaper and it's more available. It's also significantly more deadly, and you really don't know what you're getting, and that's where it gets dangerous. So, if you have a loved one or family member, or if you're struggling with it, and it's gotten to the point that that's starting to occur, call somebody, talk to somebody. Treatment does work.

It is hard to stop on your own, because you physically feel so sick. So, reach out, get some help, and if you've got a friend or family member ... I've been doing this for almost 30 years, and have worked on the research side, and the treatment side, opiates are by far the most common substance that people have accidentally died from that I've worked with over the years, and either because they used something, and it was 10 times more potent than they thought, or because they were doing really good and had to relapse, and did what they used to do, and their body couldn't function. So, it is very dangerous from that standpoint.

Jeff Harrell: Kevin, what are some of the warning signs people should look for if they're suspecting that perhaps someone is struggling with opiates.

Kevin Gilliland: I always say, look for a significant change. You know your family member or your colleague or your friend, and you got to remember, opiates are very sedating. I mean, we all have times like even now where we're not getting the sleep we need to, and we're kind of dragging, but when somebody's dragging all the time, and their speech is slowed, and they look like they're falling asleep, and you've suspected it, I would have the discussion. If they've had a surgery of recent, ask them, and keep an eye on it. Look for things like pills. Look for things like they ask to use the bathroom, and instead of using the guest bathroom by the entrance, they go to your bedroom. I've had a lot of people that'll do that, and rummage through, because none of us remember if we took all our pills or not. Then look for things like syringes or a change in friends or money, starting to withdraw cash. So, those are some of the little things that you can kind of be mindful of and look for.

Impacts of Addiction

Jeff Harrell: I'll be back with my interview with Dr. Gilliland in just a moment. Did you know that this is the eighth episode of the Tyler Tech podcast? If you missed the first seven, I highly recommend you go back and listen. We did a four-part series on how the four major generations feel and interact with their local government. We also learned how Kansas City used technology to help make doing business with the city easier, and we learned how you can access city hall, right from your smartphone. I think you'll find the episodes really enlightening. Now back to my interview with Dr. Kevin Gilliland. Well, how has this addiction impacted people, families, businesses, even government?

Kevin Gilliland: Oh man, because it really does. It starts to spill out into those areas, and when it comes to addiction, unfortunately, sometimes people make bad choices, sometimes intentionally, sometimes accidentally. So, we have to balance consequences with treatment, and we seem to swing one way or the other. I think the most thoughtful things that I've seen from officials or treatment is that real balance of, we got to provide treatment, because it works, and we also have to have consequences, because that helps reign in our lives as well. Sometimes it's a minor legal issue that forces someone into treatment that course corrects their life. So, if we use those two things well, they can really have a significant impact in our little corner of the world, and that's what we have to focus on. There are so many things that we can get caught up in treatment-wise and parody and policy.

You go, "Look, in my little corner of the world that I can have some influence on, I'm going to try to have a really good balance between treatment and consequences, and when there are consequences, I'm going to force treatment." We tend to think treatment doesn't work when it comes to addiction. There's some truth in, yeah, what you did to solve the problem yourself, that didn't work. You're going to need some help, but that's the same is true for other health issues. Whether it's our hypertension or the way we eat, you're like, "Yeah, I'm going to need somebody else that's got a different view on this to help me change course." So, just be mindful. It absolutely does help, and stay with it. Stay the course. Like all behavior change, it takes time, whether it's eating or being more physically active or navigating away from a really unhealthy choice in life that's become an addiction. So, I'd say be mindful of that.

Jeff Harrell: Kevin, as always, fantastic information. How can people connect with you?

Kevin Gilliland: They can track me down here at innovation360, I360dallas.com. I think we also do some stuff on Facebook, Innovation360. I think it's Dallas. Then on Instagram, it's @Dr_KevinG. Dr_KevinG.

Jeff Harrell: Yeah. We really appreciate that.

Kevin Gilliland: Oh man. It's so great to be with you, Jeff, and I'm so thankful that you guys are an organization that's getting out ahead of, look, this is going to be a challenge for all of us to step back into life. Let's be mindful of a couple of things, and I think we'll be surprised at how much that actually helps us do that well.

Jeff Harrell: Kevin, thank you so much.

Kevin Gilliland: All right.

Jeff Harrell: Well, hey, thanks so much for listening. We are excited to bring you relevant topics impacting communities today, and we would welcome your feedback. You can actually email me directly at podcast@Tylertech.com. Also, please subscribe. Please leave us a review, and even spread the word. Tell a few friends about the podcast. We'll be back in a couple of weeks with a brand new episode. So, until then, this is Jeff Harrell. I'm the Director of Content Marketing for Tyler Technologies, saying, thanks again for listening, and we'll talk to you soon.