WASILLA — Dr. Michael Alter, who practices emergency medicine at Mat-Su Regional Medical Center, said he’s “never seen anything quite like” the opiate epidemic that is currently facing the state of Alaska.
And he’s taking it personally.
“I’ve never seen an epidemic ravage young people who used to be my kids’ friends … (and) turn them into heroin addicts,” Alter said in an interview at the Frontiersman office on Friday.
As a Valley ER doctor for the past 16 years, Alter has seen patients for just about every reason, from heart attacks and appendicitis to car wrecks and work-related injuries.
“A typical day in the ER? It could be anything,” he said.
But recently, a pattern has emerged. More and more frequently now he’s seeing people for drug-related problems, he said.
One of those people was a 24-year-old man with a steady job.
“Clean-cut, nice kid, polite, pleasant … and 100 holes in each arm from shootin’ heroin. Came in with a big abscess that I had to drain,” Alter said.
And the problem is not limited by the age of the patient, he said. A couple weeks ago, Alter said he treated a 52-year-old, married man who had been working on the North Slope and was found injecting himself with heroin in a gas station bathroom.
“His friend dragged him in and he was breathing like two times a minute and purple,” Alter said.
According to 2016 figures presented by the American Society of Addiction Medicine, 47,055 people died from drug overdoses in the United States in 2014 — that’s 129 people per day. Of those 47,055 deaths, 18,893 were related to use of prescription pain relievers, and 10,574 were related specifically to heroin.
Such numbers have left a lot of people wondering why and how the Valley, Alaska and the country as a whole are being consumed by opiates — but not enough, according to Alter.
“You have something horrific like (the) San Bernardino (shooting) happening and the whole country is up in arms and 14 people died. Not to minimize that … but everybody’s eyes are closed to the fact that 50,000 people a year are dying from this opiate overdose (epidemic).”
The problem with pain
Though neither opiate use nor overdoses are new to the world, Alter said there have been changes in pain management tactics that are feeding the problem.
According to a 2015 book called, “Dreamland: The True Tale of America’s Opiate Epidemic,” by Sam Quinones, pain became an important topic for medical professionals in the late 1990s. In 1998, for example, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Veterans Administration declared pain to be “the fifth vital sign,” in addition to temperature, pulse, respiratory rate and blood pressure. This development led to the idea that no one should have pain, and that doctors should do everything in their power to eliminate a patient’s pain.
“It sounds great, but the unintended consequences aren’t,” Alter said.
Practitioners were soon required to ask patients about their level of pain on a scale of 1 to 10. If someone came in with a sore throat and claimed a pain level of 9, for example, doctors like Alter would be expected to address that number with the appropriate pain medication.
“Back in the old days I’d give you some ibuprofen, tell you … to gargle some salt water, and your throat will be better in a few days and life will move on,” he said. “Life is not meant to be pain free.”
But since over-the-counter drugs like ibuprofen were not deemed appropriate for high pain levels, and the level of pain on a numeric scale can only be determined by the patient, doctors began to feel pressure to cater to the patients’ personally perceived needs.
And it wasn’t an insignificant pressure, Alter said.
“If the numbers weren’t addressed, people’s jobs got threatened,” he said.
About 10 years earlier, Dr. Hershel Jick at Boston University began researching the effects of narcotic painkillers on hospital patients, wondering how many had developed addictions to narcotics as a result of the use of painkillers. After the study was complete, Jick’s secretary sent the paragraph-long abstract to the New England Journal of Medicine. It printed on Jan. 10, 1980 with the headline, “Addiction Rare in Patients Treated With Narcotics,” and revealed that, of 11,882 patients treated with narcotics at the Boston University hospital, only four became addicted.
But there had been no data collected on the dosage, frequency or timeline of drug administration to the patients, nor for what ailment the patients were being treated.
Assuming they were prescribed appropriately, Alter said the strongest painkillers would be reserved for terminal cancer patients and post-surgical patients, which likely made up the majority of the roughly 12,000-patient sample.
Four years after the study came out, Purdue Pharma released MS Contin, a type of morphine painkiller, for such patients, but it was marketed for much more than that, Alter said, and quickly. When it was prescribed to patients without relatively minor pain levels, addiction seemed almost certain.
For many of those patients, the prescription or money would inevitable run out, and they’d turn to something more accessible.
“Heroin took over because it was far more available, and cheaper,” Alter said.
Whatever the cause of heroin addiction, Alter said he’s willing to be part of the solution.
On Tuesday, March 2, Alter was one of 25 people representing 18 different entities called together by MY House founder Michelle Overstreet at the nonprofit’s Wasilla office. Overstreet said she arranged the meeting in order to “identify solutions and set goals for increasing access to treatment and filling in the gaps on the continuum of care” in regard to drug addiction, specifically addiction to heroin. She said such issues are directly affecting MY House clients, who are homeless youth.
The primary topic of the Tuesday discussion was a new drug called Vivitrol, which is billed on its website as “The first and only once-monthly, non-addictive treatment for opioid or alcohol dependence.”
Though he didn’t claim to be an expert on the drug, Alter said it seemed to be a step in the right direction.
“For years the drug therapy for narcotic abusers was more narcotics, something like methadone, which … keeps people out of withdrawal but they’re still hooked,” he said.
Not only that, but if more than the prescribed amount is taken, a person can actually get high from the proposed solution, Alter said.
Not so with Vivitrol. Some people have even said that the drug reduces cravings, though few formal studies have been done.
“I don’t know that Vivitrol is the be-all-end-all solution,” Alter said. “But it makes sense, biologically and physiologically, that it should work.”
Alter said Mat-Su Regional is “probably better than most” hospitals as far as “giving us autonomy to try and do the right thing.” But there’s more to be done for the recovering community.
“This area needs a detox, and it needs it pretty bad. When somebody asks for help, they need to get it, right then and there, and maybe that’ll be a saved person. But right now there’s nothing.
“If you’re having chest pain I can send you to the cardiologist,” he said. “If you’re diagnosed with cancer, I can get you into an oncologist. But if you’re an opiate addict I can do nothing for you.”
Not yet, that is.
Overstreet said she is planning to host another meeting of unofficial opioid task force members on Tuesday, March 22 to discuss detox options, the problem of needle exchange, and “harm reduction strategies.”
Contact reporter Caitlin Skvorc at 352-2266 or email@example.com.