Staying the Course

Mike: Welcome everyone to Avoiding the Addiction Affliction, a series brought to you by the Kenosha County Substance Abuse Coalition. I'm Mike McGowan, your host. We wanted to spend a little bit at time again on the ongoing epidemic of opiod abuse in our state and country. Today. I'm pleased to have as our guest Paul Krupski.

Mike: Paul is the Director of Opioid Initiatives with Wisconsin Department of Health Services, welcome Paul.

Paul: Good afternoon Mike, thanks for having me,

Mike: You know, I didn't even ask you. Did I get your last name, right?

Paul: You did Krupski. That's correct.

Mike: That helps growing up in Wisconsin. Doesn't it. Hey, Paul, you know, I wanted to start, we're still coping with this ongoing COVID pandemic, but it seems like some people's coping mechanisms, uh, include pain medication and opioids.

Mike: We're still dealing with this ongoing epidemic right?

Paul: Uh, absolutely 100%, Mike, uh, I think one of the real important things to stress is that, you know, rightfully so, we've been caught up in the COVID pandemic for the past two years, but we can't lose sight that the, this opiod epidemic has continued within the pandemic.

Paul: And unfortunately, The, uh, you know, initial data that we're now starting to see since, since, uh, you know, a lot of data has some lag time to it. Uh, it's really, um, uh, showing what we unfortunately were seeing all along, which was, uh, more overdoses, more deaths, more people struggling, uh, with a substance use and specifically with opioids.

Paul: And, you know, in your question, you talked about, um coping. And, and, and one of the things that we've really tried to stress and educate during this pandemic period is that individuals self care and self coping mechanisms are really, really important, uh, coping with trauma and toxic stress, um, that.

Paul: Specifically with the pandemic, you know, that the isolation, the anxiety, all of that, that, that we know has come along with it. And, um, so one of the things that we've launched during the pandemic time period was the Resilient Wisconsin Campaign. And I really hope that over these past two years, people have found that, uh, but if not, uh, you know, better late than never to, to still promote that and direct people to Resilient Wisconsin, and what Resilient Wisconsin really does.

Paul: Exactly what we talked about. It provides those, those, um, um, self coping, um, self-care techniques that individuals can look into, but also connects them to different helplines hotlines and those virtual support, uh, meetings, videos, and webcast that can really, you know, help somebody get through, uh, whatever they might be dealing with.

Paul: Uh, you know, those different types of issues that we talked about that have come along with the pandemic. So we've definitely have recognized coping mechanisms are needed and resiliency as needed. And that's really one of the areas that we've tried to promote through Resilient Wisconsin.

Mike: And we'll put a, we'll put a link to those resources at the bottom of the podcast, you know, upon when I go around and talk, I have people all the time say, oh, "There's nothing you can do. It's always bad". But it, you know, I do this all the time. We were making some real progress. Uh, with painkilling medication with some of the initiatives, as far as pharmacies, uh, not renewing stuff, hospitals, not giving prescriptions on the weekends.

Mike: Pre-pandemic for COVID. We were making some progress weren't we?

Paul: We were, and I think that's where we have to draw our positivity from, to know that we were moving in the right direction and we can get back there. So as you, as you noted pre-pandemic, uh, for the year 2018, actually we saw, uh, just over a 10% decrease in opioid related deaths in Wisconsin.

Paul: And that was the first significant decrease in over 20 years. Uh, we also saw two years in a row of, um, Uh, re uh, decreasing, um, hospitalizations related to opioids for 2017 and 2018. So the work that had been put in the investment in systems and throughout the continuum of care prevention, harm reduction, treatment, and recovery.

Paul: We, we take that as we know that we're beginning to see change positive outcomes and change. And what we were doing was definitely moving us in the right direction. So the pandemic, obviously, as we've already talked about, threw a curve ball to just about everybody and anybody, and unfortunately, That kind of moved us back in the wrong direction and not specific to Wisconsin, right?

Paul: I mean, this is, this is an issue nationally, every single state across the country, you saw, uh, you know, movement in the wrong direction, this area. But we believe that, um, you know, the numbers, we are starting to see show we were moving in the right direction. If we just stay on that path, continue to expand on all the great work we're doing in this state.

Paul: We can get back moving in the right direction again.

Mike: Well, you know, it you're right. And part of the reason for my reaching out to you to be on this podcast was the, um, sad benchmark that in 2020, we went over a hundred thousand people who overdosed on drugs. And now with the law enforcement is telling us is that, uh, fentanyl is in almost everything that they, they confiscate on the street.

Mike: And we're talking about another ballgame entirely when we're talking about fentanyl right?

Paul: Correct Mike, yes. So, um, really the, the issue with fentanyl is it's potency. Um, it is so potent is 50 to a hundred percent more potent than morphine. Uh, and to your point, uh, it's now throughout basically, um, at any illicit drug substance that you can find, um, I know law enforcement have, you know, nationally reported found, not just heroin, um, not just the.

Paul: Counterfeit illicit prescription pills, but in marijuana and methamphetamine and cocaine. And that is what is, uh, really fentanyl is what is really driving our increase in overdoses as well as deaths here in Wisconsin, as well as nationally. And when we look at the data, it's pretty clear, uh, that ever since fentanyl has really been introduced, um, more largely in the, in the drug supply.

Paul: That's what's really causing this. So it's the next wave of the opioid epidemic. That's for sure.

Mike: You know, Paul I don't even know if you have an answer for this question, but when I talk about this, uh, people will say to me, who don't work in this field will say, well, that's crazy. Why would the people who are dealing this stuff, put a drug into their supply that is going to kill their customers?

Mike: That seems nuts. Um, I don't know. You must get that too. Do you have an answer?

Paul: So I think, you know, in my understanding, uh, you know, obviously not being in law enforcement, but my understanding working with different partners, our department of justice obviously is that it's kind of twofold. Uh, one is that fentanyl is very, very, very cheap.

Paul: So, um, so on the supplier side, uh, dealers or individuals in that side, they can, they make a higher profit margin when they cut fentanyl into whatever the other substance is. So cocaine, heroin, like we talked about before. And then the other part is that, uh, we talked about the potency of fentanyl. So when fentanyl is introduced, uh, you know, cut into the different substances and introduced to the individual, whether they know it or not, which is also a huge problem.

Paul: Cause a lot of people, a lot of users don't know that fentanyl is mixed into it, right there, their, their, their dealers or however they're accessing their drugs. Aren't telling them this. Uh, so that's why they're overdosing. But, um, when fentanyl is mixed into it, the user then is experiencing, uh, a different type of high, uh, different type of euphoria when they do it.

Paul: So a better high, if you want to say it that way. Uh, and so, um, yes, there is the risk obviously of a higher risk of the person overdosing, but that, that, that different type of high, a different type of euphoria that is obviously adding to the addiction. Right. And, and why people wind to come back to that, to experience that high again.

Mike: You know, and, and these things, uh, you know, when we do these, this is not meant to throw a scare into anybody, but one of our future guests is a mom who literally lost her son, her college age, son to fentanyl thought he was taking an oxycodone and the pill he took. Was all fentanyl and he, uh, is no longer with us.

Mike: You know, that's the danger that people have when they buy a street drug.

Paul: Yeah. Unfortunately we hear too many stories, just like the one you shared, uh, just individuals, not knowing that fentanyl is present in whatever substance they're using and that leading to the overdose. And unfortunately, in some cases death.

Mike: You know what we hear, what I hear and I'm sure you do too, is, uh, emergency room visits are up. Uh, treatment centers are full, uh, clinic visits are opted demand for therapy is sky high. Where are we at as a state in developing resources for people to get help?

Paul: Sure. Well, I think the number one thing that's important, Mike, is that we want people to know that help is available.

Paul: Um, now are there, are there issues sometimes with immediate access with waitlist? Yes. And we're aware of those and we are. Um, constantly, uh, working with different providers, um, obviously all of our counties, our county systems, um, to try and address that as, as best as possible and increase availability and access to immediate treatment.

Paul: But if an individual can't get in. To, to, uh, the treatment or care they're looking for immediately, there are other types of supports. So, um, you know, we want to make sure that individuals have Naloxone or Narcan on hand. Uh, if, you know, if they continue to use, we want to make sure that they have the life-saving reversal drug, um, uh, available to them.

Paul: Uh, we want make sure that people know that they can access peer supports, uh, our other type of support groups. That in the meantime, could, could, um, hopefully assist them and, um, and help them, uh, um, um, you know, wanting to stay clean or moving towards, uh, continuing to wind, to move towards treatment for when it becomes available and then treatment, you know, I, I know that this isn't what people want to hear and, and because we want it to be accessible and in their communities, but.

Paul: Treatment might not be available in the community they live, but that doesn't mean it's not available. And so if somebody is, you know, willing to look outside of their community, uh, if they have, um, obviously the, um, you know, ability to possibly travel to a different, uh, you know, uh, area to get treatment, uh, it might be available just unfortunately not where they are located.

Paul: So, um, I think, you know, one again to plug another, uh, another project of ours here. I really want people to know that the addiction, the Wisconsin Addiction Recovery Helpline is available to them. And when you call this, well, there's a number of way to access it. The easiest way is calling 2, 1, 1, but you can also connect to services via the website.

Paul: There's also a chat option and a texting option as well too. And when you call this, uh, when you called the, the addiction recovery helpline, uh, you'll, you'll connect with somebody who can talk with you, basically what I will share with you, basically what I was just, just explaining all the different types of services that are available to you.

Paul: Not just treatment services, if, if, uh, if you're looking for other types of support and, and, um, if, if you maybe need those types of support while you're waiting to get into treatment.

Mike: Well, I think that's a really good point because if there's anything we've learned during this pandemic is that we can utilize resources without being face to face. Right?

Paul: For sure. Yes. Uh, I mean, virtual supports, uh, in all different, you know, what, actually in medicine or in other just types of ways, you know, are definitely expanding the reach, uh, uh, to people and, and finding. And we've definitely, um, um, benefited from that and finding ways to support individuals.

Mike: Yeah. You know, and you made an excellent point, too.

Mike: It depends on where you live. Well, some of our urban areas in our country and certainly in our state do have resources. Boy, there's a lot of places in our state where there isn't a really a treatment. You do have to go somewhere to be seen by someone there isn't treatment resources in many of the rural parts of our country.

Paul: Again, Mike you're correct. And that's something that we are, uh, is constantly a priority of ours at the Department of Health Services. We want to make sure that individuals no matter where they live in Wisconsin have adequate access to not just treatment and care, but the appropriate level of treatment and care that they need.

Paul: So whether that be, you know, an intensive outpatient program or residential care, uh, You know, or just access to medication assisted treatment. We want to make sure that people have access to that. And you're right. There is a, in some cases in urban rural divide, but I will also say that, um, I think a lot of times there's an assumption that just because you're in an urban area, you have a lot of resources while you may have a lot of resources, but that doesn't mean that the higher level of resources is still meeting the need.

Paul: Because the need is greater in, in an urban area with just more people present. So it's still about building capacity in urban areas, as well as, uh, rural areas that we know are lacking services.

Mike: You know, I wanted to ask your opinion as you work with this all the time. And one of the other questions I get asked by people who are perhaps in recovery or struggling with a pain killing medication is, okay I need to have knee surgery. All right. I need to have some kind of medical procedure. How do I handle pain medication coming out of that surgery? If I'm already either recovering or struggling with it?

Paul: Yeah there, you know, there's a lot of work, uh, that has been done on the federal and also on the state level to better, uh, to bring better awareness and also better educate our prescribers.

Paul: And I think that that has really gone a long way and we are doing a much better job when it comes to actually that frontline prescribing, um, and, and. When an individual has. So let me take a step back just really quick. We have to remember that there is a legitimate use for opioids. And what we're trying to do is not eliminate opioids completely. Right. Um, and, but, but we want, well, we want to make sure is that they're, they're prescribed appropriately and that people understand, uh, um, the, the risks, people know how to manage it. People know what supports are available to them. Should they, uh, you know, unfortunately become dependent on them.

Paul: And I think that's what is happening with doctors and nurses, uh, those frontline medical professionals when having surgeries. There's better education and awareness going on when an individual receives a prescription, a written prescription for opioids, and they also talk about what are some other pain management alternatives, uh, you know, depending on the type of surgery can over the counter medication, be just.

Paul: Uh, um, uh, do just as well, right? Like your, your Advil or Tylenol, or should you at least try that first? And then if that's not working then consider, you know, um, using the opioid if you need more support, but I think just, um, that better education and understanding. Um, of the patient. Uh, and I think we're seeing more of that being done at the frontline by our medical professional.

Mike: Yeah, I think you're right. We've had, we've had physicians on here say, you know, take a Tylenol and Advil at the same time. You know, it has the same pain killing effects as a Vicodin does so well. And that's something that we didn't hear 10 years ago. Um,

Paul: Right. I mean, there's definitely, you know, um, going back to the early 2000's, a lot of, uh, um, miseducation, uh, around opioids, uh, how addictive the belief that they aren't even addictive, which we now know to not be true. Uh, you know, so I think there's just better, uh, understanding around, uh, how they should be used, you know, specifically for that acute care short term, uh, pain management, uh, and, and really, uh, when it's appropriate to prescribe.

Mike: Well, let me ask you one, one last question. What's on the horizon for us in Wisconsin to deal with this ongoing problem. I'm sure you have things in the mix.

Paul: Yeah. So I think, you know, going back to one of the, you know, earlier on in our conversation, um, pre-pandemic, we, we were seeing signs that what we're doing is working and what we're doing is having a positive impact with positive outcomes.

Paul: So the first thing is we're going to stay the course. Uh, we're going to keep investing in, um, all the different strategies again, across the entire continuum of care. Prevention, harm reduction, treatment and recovery, and we're going to keep, you know, we're going to keep, um, steadfast to that. What we're going to look to do is how can we continue to expand? Or enhance that, uh, you know, you brought up the issue of urban, rural before. Um, a lot of the services that we, that we've been able to support and expand. We're still not at statewide, so we want to continue to do that. And, um, we're going to have some opportunities, I think, available to us in the future.

Paul: There's I'm sure most people that'll listen to this are familiar with the all the different opioid, litigations and settlements that are happening, uh, across this country, as we move forward in the next, you know, year, year and a half, two years, uh, we'll see more funding coming into the state. Uh, and obviously that's going to allow us to invest in more areas.

Paul: Um, We are, the state of Wisconsin was also just one of seven states that was selected by Bloomberg Philanthropies to address, uh, opioid overdoses. And so we have just, we just began that partnership with them in December of last year. So, uh, we're still in the obviously infancy of that, but we have more support coming from outside partners to assist us with, uh, strategies and projects that can address specifically, uh, overdoses.

Paul: And then, you know, our legislature over the last, uh, you know, six, seven years has been very proactive in this area. So we'll continue to partner with them when that's, you know, when it's available to us, uh, you know, to, to look at what type of state support we can get for specific types of projects and initiatives.

Paul: Um, so I, I know that might not be, you know, really, uh, I might not be talking about specific areas there Mike, but, you know, I want to make sure that people understand that we are remaining committed and we know what we're doing is working. Uh, what we have experienced over the last two years was just right, like hopefully knock on wood a once in a lifetime thing for all of us.

Paul: And, and, and we know that we can get back to moving, you know, in the right direction. All of that being said, I will just say quickly, You know, there are some areas that we've definitely identified, like when we talked about medication assisted treatment, um, there's the opportunity right now to do a form of mobile medication assisted treatment, which will help in specifically those rural areas and whatnot.

Paul: That's something we're not doing right now, but that we're gonna work with, uh, partners and with some of this additional funding that comes in to really try and implement here in Wisconsin, that'll increase access.

Mike: Excellent. You know, I agree with you. It's not, uh, there's no magic program, but we know what works.

Mike: We've always known what works education, prevention, and then on the back end treatment, if you get into trouble.

Paul: I was just going to add there to your point, Mike. And we know we can't, we know we, we can invest in just one of those areas, right? We have to invest across the continuum. Uh, we can't silo ourself into one of those areas that we're not going to have the impact that we want to see.

Mike: Well, I want to tell you how much I appreciate you spending time with us today, and I'm sure this won't be the last time we'll address this on the podcast, or I'll give you a call.

Mike: Um, for all of you listening. We hope you've enjoyed this. We put, we'll put resources to resiliency, Wisconsin, uh, 2, 1, 1, and bunch of different things at the end of this podcast. So please join us again. Next time. When we discuss more issues around substance use, and until then, please stay safe.