JoCo on the Go, episode #122, the opioid epidemic is a reality here in Johnson County. Learn about disturbing trends related to overdoses and who is being most heavily impacted. Find out what resources are available now and potentially in the future to address substance use. Also, learn more about the opioid settlement that could have funds coming to the county very soon.

Time	Subject
00:24	Introduction
01:11	What are opioids and how does addiction start?
04:08	Overdoses and opioid addiction
08:04	Spotting and treating an overdose
10:52	Resources available to treat addiction
13:31	Money from the opioid settlement coming to Johnson County
16:52	Where to find help

Theresa Freed 00:00

The opioid epidemic is a reality here in Johnson County. On this episode, we'll discuss disturbing trends related to overdoses. We'll also talk about resources available now and potentially in the future to address this substance use.

Announcer 00:14

Whether you live in or just love Johnson County Kansas, JoCo on the Go has everything Johnson County. Here's what's happening and what's coming up in the community you call home.

Theresa Freed 00:29

Thanks for joining us for JoCo on the Go. I'm your host Theresa Freed, a Johnson County resident and employee of Johnson County government. Opioid addiction is a serious issue that can have devastating consequences. Johnson County government is addressing some of these impacts and helping residents overcome this form of substance use. Here to talk more about that we have with us Deputy County Manager Maury Thompson, Johnson County Chief Medical Examiner Dr. Diane Peterson and from Johnson County Mental Health Center, we have Deb Stidham, she is the Division Director of Clinical Services. Thank you all for being here. What are opioids? So it feels like it's a substance we hear a lot about. But a lot of people may not be familiar with what exactly it is. And so Deb, you want to start us off with that,

Deb Stidham 01:11

I'd be happy to. Thank you for inviting me. So opioids are a class of drugs that it like you said, everyone's heard about that act on opioid receptors on the brains and signals send these receptors to block pain. And if it blocks enough pain, you can actually feel euphoric. So that's pretty much I think, why people tend to abuse sometimes these drugs. And, you know, I think it's important to understand how many different types of opiates there are. And they come in powder form, tar, pill, liquid, and that just with the potency and how long acting they are, there's just a strong potential for addiction. And of course, these are these medications are regulated. But what we're seeing that's coming into the county, and of course, across the country is these man-made synthetic drugs, it's opiates with the fentanyl. And that fentanyl is a class of opiates all by itself. That's extremely powerful. And very, very addictive. So between the fact that the opiates are already such a powerful drug, and then you add fentanyl, it's really just not a great combination. Plus, we're seeing this synthetic fentanyl being intertwined with other drugs, it can be an anything that these kids and adults are taking, and sometimes they don't know. So I think that's contributing to the overdose problem as well.

Theresa Freed 02:40

So does it typically start out as, you know, you have like, say, a car crash, and then you're prescribed something for legitimate purpose, and then it becomes addictive or how does somebody? How does this evolve, I guess?

Deb Stidham 02:56

Well, I think there's many routes to what we call addiction. And I think in the first wave of the opioid problem, that is kind of what you saw, there was the Oxycontin, it was just way over-prescribed. Physicians were encouraged by the companies. And now you're seeing the settlements, right? Because of that over prescribing and really downplaying of the addictive nature of those drugs. So I think that the one of the waves was certainly that in the very beginning. As education started of the physicians, and the real dangers of those drugs became known, then that trend started to go down. But then unfortunately, what you saw was an increased use of heroin. And so then you're going to the street, right, probably to get that. And then really, as that started to dissipate, or the demand, you know, the supply didn't meet the demand, then you see where the fentanyl and the synthetic opiates, you know, the man made came into play to create that third wave and unfortunately, it's probably one of the most, you know, deadly and destructive waves we've had to date. So it's just a real concern, you know, that I think people need to be aware of

Theresa Freed 04:08

Alright. And speaking of that, that deadly trend. Dr. Peterson, do you want to talk to us a little bit about what you're seeing from the medical examiner's office in terms of overdoses?

Dr. Diane Peterson 04:17

Yes, so, in Johnson County in 2021, our number of overdose deaths or deaths due to intoxication from an opiate certainly increased. And I do have some graphs to share to highlight this situation. And so this first one is just showing you just the large increase in the number of times an opiate was involved in a death and this is the times when an opiate so not an individual. So, as you can see, it's really increasing and even the number of individuals that are dying of opiate related deaths is increasing dramatically, as well. Most of the people who pass due to an opiate related death are have more than one opiate in their system. It's not just fentanyl. It's not just oxycodone, they're combining it with other drugs. Some of those other drugs are opiates. Some of those other drugs are benzodiazepines like alprazolam, or Xanax. And then as you can see, she was discussing the increase in fentanyl-related deaths. And definitely, that is what we noticed most in 2021 is just this very sharp increase in fentanyl related deaths. And the emergence of acetyl fentanyl, which is again one of those manmade designer fentanyl drugs that has zero prescription use. It is entirely illicit. And we hadn't been seeing that in this area until late 2020. And then it continued in 2021. I will say most of these fentanyl deaths and acetyl fentanyl. The history that we get is somebody that thought that they were buying oxycodone on the street. And in reality it was fentanyl or acetyl fentanyl. And when they pass which some of them pass very quickly. We had an individual who passed within an hour of obtaining the medication off the street, there is none of what they thought they were buying in their system. So they thought they were buying oxycodone. There is no oxycodone in that pill. It is fentanyl and fentanyl does not take very much to kill you and acetyl fentanyl takes even less. The population that this is primarily affecting depends varies depending upon the drug that's involved. As you can see, the fentanyl and heroin deaths are typically younger. And the asterisk indicates that there are statistically significant age differences. When compared to fentanyl. So our oxycodone or hydrocodone deaths and our methadone deaths, those kind of classic opiate deaths, they're typically older individuals. These are not necessarily kids. But when you talk about the illicit the fentanyl, the heroin, all of that they are younger individuals, but they're still in their 30s. Most of these are men, the grand majority are men and the grand majority are white men with mirroring the population, but some of them going above the population expectations with regard to race.

Theresa Freed 08:04

And so if somebody has taken one of these substances, you know, what signs or symptoms are you looking for that you need to get help right away.

Dr. Diane Peterson 08:13

So an opiate death is typically preceded by somebody who is very tired, very lethargic, they might fall asleep. Basically, what's going on in our bodies, is we have a decreased drive to breathe, and decreased functioning of our brain. And that drive to breathe has caused respiratory depression. And basically what we do is we slowly go to sleep. And we slowly stop breathing as many times a minute as we should, and as deeply as we should. So a lot of the history that I get of a person that took a drug, and then was found dead in that interim, they are heard to be snoring. And so if I have a history of somebody who was snoring then dead, I'm immediately thinking of an opiate. So if you have a loved one that might be taking drugs, and they are asleep and have been asleep for a long time and you hear snoring. Be very concerned. That is a very common history. And that snoring is that respiratory depression, it's more of a agonal respiration, which is basically the breathing immediately preceding death. And it sounds like snoring, but it's not snoring, and it is very concerning.

Theresa Freed 09:43

Okay, and I'm trying to remember with my time with the Kansas Department of Health and Environment when we were addressing this issue, it seems like paramedics maybe armed with some substance or something to help help people in those immediate situations. Is that right?

Dr. Diane Peterson 09:57

Yes, paramedics and law enforcement in the county do carry what's called Narcan or Naloxone, which is kind of an antidote to opiate deaths. There is there are suggestions and around the country, where if you are an opiate user, if you're a heroin user or whatnot, you or your loved ones around, you should have Narcan so that it can be administered. The quicker it's administered, the more effective it is. The thing about the acetyl fentanyl and the fentanyl is sometimes it takes more than one administration to have an effect. And so if you or your loved one has Narcan, and can give that to you while they're calling 911, and then law enforcement or paramedics can issue some more, you have a higher chance of survival than if no Narcan is administered at all.

Theresa Freed 10:52

That's very good to know. And we certainly hope nobody gets to the point where they need that. And so now we kind of want to pivot and talk about the resources that are available to help people who may be new to the this addiction or you know, it may be going on for many years, but they're they need help stopping. So Deb, can you talk about what resources are available through Johnson County Mental Health Center?

Deb Stidham 11:15

Sure, I'd be happy to. So here at Johnson County Mental Health, of course, we provide mental health and co-occurring substance use disorder treatment for kids and adults. So if you think you are suffering from you know, those particular issues, feel free to come to our open access, walk in and be assessed by someone. Of course, we do also have the adult detox unit, which admits folks 24 hours a day, seven days a week who are in acute withdrawal. And that can be from any substance, it is non-medical. And so you know, we would work with you if you're coming in in opiate withdrawal, we would work with a local methadone clinic here to see about getting you the resources that you need around that medication. We do have medications available also in our outpatient, primarily on the naltrexone, and injectable naltrexone, Vivitrol. Is really pretty much the only medication that we offer here, which is good for alcohol use disorders, by the way, as well as opioid use disorders. Oh, and I should say we have adolescent center for treatment as well, for youth 12 to 18, who are suffering from a substance use disorder.

Theresa Freed 12:36

Okay. And of course, this is an issue that can affect not just the person who's taking the substance, but also their loved ones can have pretty devastating impacts for them as well. Can you talk about resources available to help them as well.

Deb Stidham 12:47

So you're totally right. I mean, this, this is definitely a family and community illness. And we do offer family therapy, as well as part of that individualized treatment. And of course, there are great resources here in Johnson County. You know, the the Church of the Resurrection has lots and lots of recovery resources for people suffering as well as their loved ones, I would highly recommend Al-Anon as another resource for families. And then you know, there are quite a few. We're fortunate here in Johnson County, we have quite a few treatment centers that will offer, you know, family therapy, individual family therapy for couples and families who need that.

Theresa Freed 13:31

We're also looking at maybe some future resources that may be available here in Johnson County through the opioid settlement. So Maury, can you talk a little bit about what that settlement is and how Johnson County is involved? And then also, you know, what potential we have there?

Maury Thompson 13:44

Absolutely. So I would go back to some of the graphs that Dr. Peterson showed as a starting point for that part of the conversation. A number of years ago, we began monitoring this issue. And even though we weren't seeing terribly high numbers in Johnson County, monitoring what was going on across the country, we're concerned that it was probably a matter of time, and now that the statistics are beginning to bear that out. So we began conversations with the Board of County Commissioners about the possibilities of holding those accountable for this action and the increased costs that we as local county government, were beginning to see and likely would be seeing into the future. So the board agreed to enter into litigation, again, in an attempt to hold those responsible for this growing crisis in the country accountable and to provide those resources. So we did that. At about that time, or shortly thereafter, this became a very topical issue around the country. And many state’s attorney generals entered into conversations, trying to bring together those claims from municipalities, counties, such as Johnson County, so that that eventually occurred here in Kansas, with a passage of that Kansas Fights Addiction act and of bringing that together. So those settlements, if you've been following the local headlines, are starting to come to fruition. So resources are starting to flow. I anticipate we'll begin to see some of those here in Johnson County, likely by springtime. So when you talk about resources, they're really two different pools, there will be some direct reimbursement to counties who were engaged in litigation to address their costs. But there will also be, under the state litigation, the Kansas Fights Addiction Act, a statewide grant program established that Johnson County will have full access to make application to that for those resources as well. So I'm confident we'll be working with Deb and with Dr. Peterson and others, MED-ACT comes to mind as one, law enforcement obviously impacted by growing costs due to the opioid crisis. So making application for those funds as well.

Theresa Freed 15:53

Okay, and any timeline that we know about yet? I know that things are happening fairly quickly. Now we're getting some momentum behind that. But how quickly can we see some of those dollars flowing in here?

Maury Thompson 16:04

Again, I'm anticipating some of the direct funds to Johnson County, we should see by probably June at the latest some of those dollars, the grant program, we're still waiting for some of the specifics about structure and how to make application so probably a little later in the year before we have access to those funds.

Theresa Freed 16:21

All right. Sounds good. And anything else you would add about the settlement that people might want to know about in terms of resources that that might be invested in?

Maury Thompson 16:30

Well, I would say, stay tuned, if you're interested in following that there are still settlements pending and work to be done. So I anticipate more resources becoming available in the in the short term.

Theresa Freed 16:40

All right, that sounds good. And as we wrap up our conversation about this Deb, we want to make sure that everybody knows where to go to, to access the resources that are available through the Johnson County Mental Health Center to get help. So can you talk about that?

Deb Stidham 16:52

So we have two main locations, 1125 West Spruce in Olathe, Kansas, or 6440 North Nieman in Shawnee, Kansas, you can just like I said, do a walk-in basically from eight to five. And someone will assist you and determine what your needs may be even if it's not here, then we'll be sure to connect you to those resources.

Theresa Freed 17:15

All right, great information. Well, thank you all for being here today. We appreciate the conversation and hopefully that helps some of our listenersif they're directly impacted or indirectly impacted by this issue.

Announcer 17:25

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