Utah prides itself on being among the nation’s most healthy states. Its low rates of smoking, cancer deaths and diabetes earned it seventh place in the United Health Foundation’s “America’s Health Rankings” for 2015.
But the Beehive State has one very big health weakness. It ranks even higher — No. 5 — in overdose deaths from opioids, including heroin.
How could that be in a state that’s 60% Mormon? While the Church of Jesus Christ of Latter-day Saints discourages any use of alcohol or drugs, prescription medications get a clean bill of health. And when those run out, the transition to heroin isn’t so difficult, despite Mormon teachings.
“Heroin is huge here,” said Victoria Delheimer, LMFT, LCMHC, executive director of Journey Healing Centers in Utah. “We see a lot of people from the LDS church and they’re shamed, they’re humiliated, they feel awful. When addiction kicks in, the things that you value and are important to you become secondary to feeding the addiction. While they can rationalize the behaviors around prescription drugs, once they have to engage in illegal behavior, it feels very different.”
Delheimer, who has more than two decades of experience in treating people with substance use and mental health disorders, said most of the patients she sees began with a prescription opioid to treat an injury or chronic pain. And an enormous number of those prescriptions have been written. In 2014, 32% of Utah adults had been prescribed opioid pain medications.
“Utah has a lot of outdoor activities, but they often lead to injuries,” Delheimer said. “So people are getting treated for a physical injury and end up, over time, addicted to pain medication. What happens, of course, is that you can no longer get a prescription and heroin becomes a much cheaper alternative. Another contributing factor is that you have drug corridors going right through Utah.”
What also sets Utah apart from other states is the progression in drug use.
“In other parts of the country, people drink, they try marijuana first,” Delheimer said. “People don’t start right off with heroin. It doesn’t happen that way. But in Utah, it does.”
Naloxone, Good Samaritan Laws Only Part of the Answer
So what’s being done to try to reverse the trend?
For its part, the Utah Department of Health has embarked on a media campaign to educate people about the use and abuse of prescription painkillers. In addition, state lawmakers have passed legislation to help reduce drug overdoses — a good Samaritan law that gives limited immunity to bystanders who summon help at the scene of an overdose, and a law allowing individuals to administer naloxone, a life-saving drug that can reverse an overdose, without legal liability. Utah also now allows people to get naloxone without a prescription at pharmacies across the state.
Delheimer says the public needs a better understanding about how opioids work in the body and also the serious psychological risk they present.
“If you have a headache and you take OxyContin, it helps deal with the pain in your arm but it also lowers your respiration and heart rate,” she said. “The effects of the pain reliever wear off sooner than the effects on your respiration and heart rate. So you take another pill. But you can’t do that when your heart rate and respiration haven’t returned to normal.”
As to the psychological risk, she says people who take that extra couple of pills are on a dangerous course.
“Taking four in a day when you should take two is risking going down the path to addiction,” Delheimer said. “Do you do it sometimes and it doesn’t bother you and you never become an addict? Of course. But it’s what we call a high-risk choice. Be careful. There are only so many of those you can make.”
When it comes to treating patients who have crossed over to addiction, Delheimer says a combination of evidence-based behavioral therapies and medications is the best course. Although some treatment centers believe abstinence is the only viable approach, “we like to keep an open mind,” she said.
Medications Can Help Prevent Relapse
Therapists are sometimes hesitant to provide medication, she said, because of the idea that a patient is simply trading one drug for another, “but that’s not how it’s proven to be,” she said. “I have high blood pressure. It’s hereditary. I have to take medication. I exercise, I eat right, I do all those other things, but I still have to take medication.”
Delheimer stressed, however, that with drug addiction, medication-assisted therapy (MAT) is not to be used in lieu of behavioral interventions, such as cognitive behavioral therapy.
“So much of recovery depends on other things,” Delheimer said. “It depends on how bad have you messed up the relationships in your life, do you still have people who support you, do you still have a home to go to, do you have a job? If your addiction hasn’t gotten too out of hand and you have all of these other supports, maybe you don’t need to be on the medication. On the other hand, if it works for you, if that’s what keeps you clean and sober, then do it.”
For those reluctant to enter treatment but find themselves in rehab as the result of an intervention or other urging by a loved one, Delheimer says an appeal to their values will often help them come to grips with their addiction.
“We don’t have to approach it with, ‘Yes, you are an addict,’ but something like, ‘Let’s just take a look at how your life is going. Let’s talk about your values. How does where you are now line up with those values?’
“We help them to see the correlation between the behavior they’re engaging in and what that does to what they want for their life. You can get them to come to their own conclusions pretty easily. Everybody values something. But no one will tell you they value sticking a needle in their arm and shooting themselves up with heroin.”
By Laura Nott