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Opioids: Collateral Damage

Growing Opioid Crisis Spawns Unintended Victims: Teens

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With just under 2 million residents, West Virginia is relatively small in comparison to other states, ranking 38th in population size. And yet, the mountainous region is ranked among the top states most affected by the opioid crisis.

A national crisis, the opioid epidemic has prompted public outcry for action, and elected officials have spoken about pushing legislation to help. Many first responders in areas critically affected now carry a drug called naloxone, which can stop the effects of an opioid-induced overdose. In 2016, the Centers for Disease Control reported that West Virginia was one of five states “with the highest rates of death due to drug overdose,” and the main driver of those deaths was opioids.

Families, and more specifically, children, are often caught up in the complex and disheartening web of drug addiction. West Virginia’s children suffer grave consequences when their parents are addicted to opioids.

“The drug epidemic is the driving force in (the) child welfare crisis with approximately 80 percent of children removed coming from homes with substance abuse,” Jessica N. Holstein, Assistant Director of Communications at the Department of Health and Human Resources of West Virginia said via email. In 2016, 2,171 children were removed from homes due to drug abuse, over double that of 10 years prior.

With this overwhelming influx of children entering the foster system, teenagers in the state’s care are at a particular disadvantage. As of March 5, the DHHR of West Virginia reports more than 6,000 children in foster care. More than 1,600 of those children are between the ages of 13-17.

Why Teenagers in Foster Care are at Risk

As a general rule, the outcome for teenagers in foster care is grave. Most families interested in adoption want younger kids, leaving teenagers overlooked, says Rachel Kinder, Director of the FrameWorks program at Mission West Virginia. In some cases, families are afraid of taking in teenagers, Kinder explains, because adoptive families don’t necessarily think they’re ready for the teenage years, and older kids in foster care are stigmatized.

“People think they’re in foster care because they’re juvenile delinquents,” says Kinder. “The truth is that teenagers are removed from their families for the same reasons as younger children.”

FrameWorks is a program that finds and recruits families to foster or adopt children who are wards of the state. Kinder, who has been with the organization for the last 11 years, watched as the opioid crisis forced a shift in priority at the organization.

“At one time we were focused on working with child-specific recruiters to find adoptive families,” Kinder explains, “but with the opioid crisis hitting our state so hard, we’ve had to shift a lot of our focus to recruiting foster families for the sheer number of children in the system.”

Kinder states that the number of children entering into the foster care system as a result of the opioid crisis has far surpassed the number of families available to take them in.

Kinder reports that a mere 1,200 foster families are currently available to accommodate the over 6,000 children in state care. As a result, time and resources are stripped from finding children —and teenagers specifically — adoptive families as the focus shifts to bringing on foster families.

Some Common Misconceptions Surrounding Teenage Adoption

Even as part of a nuclear family, teenagers are often described as unruly, troublesome and typically challenging to parent. Add the label of “foster kid” in the mix, and the stigma is difficult to overcome.

“A lot of people think that if they adopt a younger child, it will be easier to mold them,” says Kinder. “It’s difficult just to get families to consider adopting an older child.” Kinder goes on to talk about the normal difficulties in raising teenagers, noting that much of teenage behavior might be overwhelming to new parents. Still, she attests, “Many teenagers in foster care are great kids that just need some guidance.”

Another reason families shy away from adopting teenagers, especially those within the 15-17 age range is because they believe these kids are close enough to adulthood to not need a family.

The opposite, in Zachary Cochran’s case, proved to be true. Cochran, now 17 years old, was adopted by the Cochrans when he was 10. He hopes to follow in his parents’ footsteps and become a science teacher. His father is a biologist, and his mother, Kim, is a primary school teacher in Charleston, West Virginia.

When asked if pursuing his dreams of college and a career in education would be possible without the guidance of his family, Zachary replies, “Not at all.” While in the foster care system, Cochran’s focus was getting through the day-to-day. He had trouble even thinking about how to plan for the future.

“You know, I’m almost 42 years old and I still need my family,” says Bradley Borsuk. Bradley and his husband, Johnny Ballard, adopted their son, Keith, when he was 14 years old. “I don’t think age has anything to do with whether or not someone needs a family,” he continues. “These kids have learned to survive and bury their emotions very deep, and the system has hardened them, but none of that means they don’t want, deserve or need a family.”

The Truth About Aging Out of Foster Care

Having an anchor to provide guidance in the teenage and young adult years is crucial for healthy development, especially for foster care kids. For the children who “age out” of the system — those who turn 18 or graduate high school before finding a family — the absence of family steering is palpable.

According to Children’s Rights, in 2015 about 20,000 children aged out, and, the National Foster Youth Institute reports that 1 in 2 children who don’t find families will develop a substance dependency problem and 20 percent of the children who age out will instantly become homeless.

“I’d say about 80 percent of youth who are over 18 and out of foster care have no idea who to call if they need to get to a hospital or doctor,” says Tanya Quaife, who was an Event Planner and Volunteer Coordinator for 12 years at Covenant House, a national organization that provides resources and support for homeless youth. Quaife was also in foster care from ages 15-18.

Aging out means a child enters into the world with no guidance, support or love from a family, hindering his or her ability to thrive as an adult.

From left to right:On a family trip to Tennessee, Bradley Borsuk and Johnny Ballard surprise their son, Keith Dennison, with matching T-shirts. Photo provided by Bradley Borsuk. Photo provided by Bradley Borsuk.

Teenagers in foster care experience trauma in many forms. Being removed from their home, even though their parents might be addicted, abusive or ill-equipped to care for them, is trauma in itself. On top of being victims of physical or sexual abuse or neglect, children face feelings of loneliness and abandonment when placed in foster care. Once placed in the system, teenagers have no idea how long they will reside in one location.

Dennison, who was in the system for three years, lived at six placements, which include Borsuk and Ballard’s home. Placements included group homes and an adoptive placement that did not pan out.

“I hated going back to the group homes,” he says, “I’d say a group home is probably a small step up from being in jail. You don’t know who is going to be there and someone is always stealing your stuff.”

For Cochran who was moved around 10 times in his four years in foster care, learning to trust adults didn’t come easily. “I was placed with several families who said they wanted to adopt me,” he explains, “but none of them did and I was always sent back into foster care. It took about six months for me to call my parents mom and dad, and even then it was hard.”

As the opioid crisis continues to rage on throughout the Appalachian region and the country at large, more teenagers could find themselves in the care of the state rather than the comfort of their homes. Right now, West Virginia’s need for foster families is most dire. Providing a permanent home to a teenager in the system has the power to change the trajectory of that child’s life.

“It’s hard to think about some of the things Keith has had to go through in his past,” says his father, Johnny Ballard, “but he’s permanent in our house. He’s not going anywhere, and he deserves to be here.”

Nicole Slaughter Graham is a freelance journalist based in St. Petersburg, Florida. She covers a variety of topics including social issues, real estate, health and parenting. 

Opioids: Collateral Damage

In West Virginia, Doctors Assumed My Chronic Pain Was Really a Drug Problem

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When anyone in my city, specifically someone young and healthy-looking, is lethargic and incoherent, an EMT’s first guess is an heroin overdose.

I considered hanging a printout of my upcoming pain management appointments on my kitchen wall, but didn’t out of fear. What would someone think if they saw it? What would they assume? I live 40 minutes from Huntington, West Virginia—and I haven’t always been able to get the care I need. Because my home in Appalachia? It’s ground zero for the opioid crisis.

For years, I lived with endometriosis and myofascial pain syndrome. My endometriosis-related pain has almost entirely disappeared after two surgeries and treatment with the chemotherapy drug, Lupron. The myofascial pain syndrome remains under control with physical therapy, massage, and exercise. But my pain-management will be lifelong.

So many in my state struggle with addiction; I’ve been accused of it regularly, even though I don’t take opioids for my pain. As a chronic pain patient in West Virginia, I had to constantly defend myself to those who were supposed to help me.

More than 42,000 overdose deaths involved opioids in 2016, according to the U.S. Centers for Disease Control and Prevention. For years, drugmakers pumped extraordinary amounts of opioid medications into the state of West Virginia, and manufacturers and doctors running “pill mill” clinics made a fortune exploiting coal miners with disabilities and others suffering from chronic pain. According to a congressional committee investigating the opioid crisis, as reported by the Charleston Gazette-Mail: “Over the past decade, out-of-state drug companies shipped 20.8 million prescription painkillers to two pharmacies four blocks apart in [Williamson,] a Southern West Virginia town with 2,900 people.”

I began complaining about pain in 2012. That year, my endometriosis pain began as hip and lower back pain, eventually spreading to my abdomen and sciatic nerve. At the same time, after a car accident, I developed retrolisthesis in my cervical spine: the backwards slippage of a vertebra, leading to neck pain and arm numbness.

Both my endometriosis and neck pain went undiagnosed for years. Ignored, minimized, and left untreated, the pain became constant, resulting in myofascial pain syndrome, which requires lifelong management. I didn’t get the surgery that solved nearly all my endometriosis pain until 2016, and didn’t receive help for myofascial pain syndrome until 2017.

Local doctors found it hard to believe I could be suffering so much. I’m 39 and slim. I look healthy. But I had many emergency room trips and many years of searching for help and not finding it. Physicians went to a default explanation: It must be drugs.

Each time a doctor decided I was a drug-seeker, refused to run diagnostic tests, and sent me to another doctor who did the same, I was shoved closer and closer to the edge of giving up. I’ve cried more than once in an emergency room or doctor’s office. Bursting into tears doesn’t help a woman’s credibility.

The pain was costing me my life. I didn’t date for years. I couldn’t keep plans with friends; I was always too exhausted and depressed from being in constant pain. I couldn’t work. I wasn’t living but existing: a shell of my former self, pacing around the house at night when the pain and hopelessness was too much to let me sleep.

One ER doctor asked me point blank if I was an addict. I had many who didn’t ask, but their nonchalance when I said, “I can’t live like this much longer” told me that’s what they believed.

I got another hint of what these doctors might be thinking in April of 2017. I was scheduled to do a reading in Parkersburg, West Virginia, with other West Virginia authors, all contributors to a book from West Virginia University Press. As my niece and I were about to begin our drive, I became strangely ill. After half an hour of sudden nausea and weakness, I felt confused and incoherent. It was then I recalled the advice of my mother, a registered nurse: “If you ever feel like you might pass out, lay down right where you’re standing so you don’t fall and hurt yourself.”

I knew I was about to lose consciousness, and so I lay down at the top of the stairs—the most inconvenient place in the house for the EMTs—and quietly instructed my niece to call 911. She was cool and calm as could be.

When anyone in this city, specifically someone young and healthy-looking, is lethargic and incoherent, an EMT’s first guess is a heroin overdose. I knew it would be.

I could hear everyone around me talking as I drifted in and out of consciousness. I kept trying to say, “I’m not a drug user.” I knew they were considering it, and I’ve never been so scared in my life. I had terrifying thoughts—what if they gave me Narcan?—then abdominal and pelvic pain made me come to. I screamed for nurses.

Eventually, I was catheterized and had nearly 1,500 milliliters of urine drained from my bladder. I had acute urinary retention, a serious and dangerous emergency, which can have multiple causes, including side effects from medications. The tissue from endometriosis I’ve had removed from my bladder and my interstitial cystitis could also be causes. But one doctor insisted the condition arose from long-term opioid use.

I didn’t even have the strength to argue that time.

In May of this year, Walmart announced an initiative they claim will help “curb opioid abuse and misuse.” According to their website, Walmart and Sam’s Club will “restrict opioid fill limit up to seven days nationwide [and] require e-prescriptions for opioids by 2020.” In February 2018, Purdue Pharma said their sales representatives would no longer visit doctor’s offices to pitch their pain drugs, and that they were cutting their sales force.

Purdue, OxyContin’s manufacturer, is being sued for allegedly misrepresenting their drugs as safe and less addictive than other narcotics.

Numerous other lawsuits have named multiple drug companies. But the focus seems to be on suing companies long after the damage has been done. Restricting pill access hasn’t stopped the rise in heroin use and, some argue, may even contribute to addiction.

For years, I looked for an accurate diagnosis for my pain, not drugs. Time and time again, yet another doctor failed to listen, failed to spend more than five minutes with me, or refused to run diagnostic tests.

Surgery eventually resolved most of the pain I endured. My remaining issues are being dealt with without narcotics. Now I see a pain management physician once a month. I receive anti-inflammatory drug injections in the muscles around my cervical spine and upper back. I am not prescribed opioids. I go to physical therapy regularly, exercise, and get massage therapy.

I didn’t hang up my pain management appointment sheet, because I feared what EMTs might think if I need them again and I am unable to speak. I know what they’d suspect if they saw a list of appointments at a “pain management clinic” hanging on the wall. What if it happens again, but next time, I’m alone and can’t tell them not to inject me with Narcan?

What if they kill me by accident?

Although unlikely, what happened that day could happen to me again and any time I’m alone. There are so many people suffering in a variety of ways as a result of opioids. While my own pain has been controlled, the opioid crisis still rages: No one is safe.

I write my pain management appointments down in my calendar because certainly, in West Virginia, it’s too dangerous to hang them on the wall.

This article was originally published by Rewire

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