Major components need to be added, attitudes shifted, as the fight against opioid misuse marches on

KAILUA-KONA — These days, Christian K. doesn’t let his past define him.

“I’m a lot more than just a person in recovery,” he said. “I don’t really consider myself ‘recovered’ or ‘recovery,’ just I had my issues in life that I worked out.”

Christian used opioids and other drugs for about three years after a plastic surgeon prescribed him oxycodone following a severe hand injury at the beginning of 2014. In the middle of 2015, months after he had gone to rehab, Christian broke both bones in his arm in a car wreck in Colorado, after which an orthopedic surgeon prescribed him oxycodone again, along with morphine, which is an opiate, and Valium, known generically as diazepam, which is a benzodiazepine.

From there, Christian went to several pain doctors and pain clinics to get his prescriptions for pain relievers filled. He was also in and out of rehab, including a couple weeks in California in 2015 that culminated with him overdosing on Xanax, Ativan and heroin at the Los Angeles International Airport before being revived in an ambulance with naloxone.

In early 2016, Christian was in and out of Hawaii Island Recovery three times during a term of about six months before returning again to Colorado, where, he said, “things didn’t change.”

Not long after, he said, his parents, while still paying his bills, stopped talking to him.

“Eventually I was like, ‘I can’t do this anymore,’” he said. “‘I have no money, no income. I don’t have very many friends anymore because I didn’t really go out and do anything and I’m just high all day at home.’”

After detoxing in California to get off the benzodiazepines, he returned to Hawaii and went through Pacific Quest, a wilderness therapy program in Hilo. After 30 days there, he went to Hawaii Island Sober Living for three months before returning to Colorado, living in a community house in Boulder where he met his girlfriend.

At the end of October 2017, only a week after the surgery that removed a plate that was put in his arm in 2016, his arm broke again and another plate was put in.

Doctors put him on hydromorphone, an opioid made from morphine. But when he ran out, he said, he had no desire to get anymore.

“I didn’t want to go back completely to how I was living,” he said. “Because things had gotten pretty good.”

Where care is lacking

While Christian made use of Hawaii Island resources, experts say the system is far from perfect.

Ask any of those on the front lines what the community needs to successfully help those with addictions and one answer is nearly unanimous.

“Absolutely quicker access to treatment,” said Alysa Lavoie, a case manager at the West Hawaii Community Health Center.

“People are ready to go and then it’s a three-month wait list,” she said. “And by the time they come up on the wait list, they’re not ready to go anymore to residential.”

Waiting lists can be a major hurdle for people who seek recovery.

“It implies the condition can wait,” said Jimmy Kayihura, admission director at Hawaii Island Recovery, “and people are dying.”

Time and time again, health care workers who spoke to West Hawaii Today pointed to accessible residential treatment facilities as a huge need here.

“It’s just probably the most glaring piece of the entire fabric that has got a big hole in it,” said Teri Hollowell, director of programs at the Hawaii Island HIV/AIDS Foundation. “There is no treatment facility.”

Even with places like Hawaii Island Recovery in the area, Eliza Wille, program director and therapist there, said the resources in the community aren’t enough to meet the need.

“It’s affecting wealthy people and middle class people and homeless people and everyone in between,” she said. “And there just aren’t adequate resources available to people on a community-wide basis.”

The “gold standard” for treatment, she said, is residential care, but those are lacking in the state, particularly for people on assistance programs like QUEST.

A list maintained by the state Department of Health of treatment agencies funded by its Alcohol and Drug Abuse Division, showed there are no Hawaii Island agencies identified as offering residential services, with the closest one being Aloha House in Maui.

Changing perceptions

One hurdle continues to be public attitudes toward drug use and addiction, and experts point to a need to change the stigma attached.

Bud Luth, community health outreach worker at HIHAF and the Hawaii Health and Harm Reduction Center said from a social worker aspect looking at the issue islandwide, he does believe addiction issues are more accepted than in previous years, particularly with services that work directly with people.

“From a community point, I think that there’s just a blind eye turned towards it,” he said. “People for the most part want to ignore addiction, not treat it as the illness that it is.”

Comparing West Hawaii to places that are establishing safe injection sites and taking similar harm reduction approaches, Hollowell said the community here is “a long way from that,” citing the stigma that still exists.

“They want to just think that it won’t happen to them and the people that are doing it are the ones that live in the bushes and the ones that are homeless,” she said. “And that’s something that needs to change in terms of attitude for us to move forward. Realize that it could be your auntie, it could be your neighbor.”

That’s a point confirmed by Hawaii Fire Department Emergency Medical Services Bureau Capt. Chris Honda, who said just from the calls to which they’re responding, it’s evident addiction is a health issue that crosses socioeconomic bounds.

“We see a wide range of individuals, from the younger generation to the older generation,” he said. “It affects everybody, from people that have no money to people who have a lot of money. To be honest, we see a lot of middle upper class people in our community with the opioid issues and addiction.”

A state publication covering the opioid issue notes that of 56 people in Honolulu who died of opioid-related overdoses in 2016, just one was homeless at the time of their death with just one other who had been homeless in the past. Forty-eight were found inside a house or apartment.

At West Hawaii Community Health Center, the addiction medicine program is one that involves a paradigm shift for the whole staff, “from front desk to physicians,” said Dr. Laura Ankrum, a family practice doctor at the clinic, “really training people to view addiction as a medical condition, rather than seeing it as a choice or a character flaw.”

Sickness, but recovery a matter of choice

While recovery is definitely possible, those working with clients to recover from opioid use disorder, note that, at the end of the day, it’s up to the client.

“People call and say ‘I’m gonna come in; fix me,’” Kayihura said. “Well, we can provide the vehicle but you’ve got to get in and inevitably you’re taking the wheel.”

Recovery, Wille said, is “not something that happens to a person.”

“It is something people come in hungry for and they really have to want it more than anything else,” she said. “They have to sink their teeth into it, and part of that is taking responsibility, taking ownership for the fact that this is where they are.”

That’s why approaching opioid use in a way that isn’t stigmatizing or judgmental and offering a path to recovery is crucial.

“Somebody smart told me we change when we either see the light or we feel the heat,” said Dr. Michael McGrath at the Recovery Enhanced Medicine Institute. “So part of what I try to do is a little bit of both.”

Christian moved to Hawaii at the beginning of this year, saying the fact everyone he knew here was sober appealed to him.

“I wanted to be around people that are sober and to be able to do things with people,” he said.

Christian said he believes the stigma around addiction is slowly dying, “because it’s being so shoved in everyone’s faces through media.”

When Christian spoke to West Hawaii Today at the beginning of this month, he said his relationship with his parents had been a big motivating factor for him.

“Because I didn’t want to lose them in my life,” he said. “Family’s pretty important to me, and the trade-off of being high versus my family is just too big.”

He’s getting ready to start working with a video game company and, with a dog, cat and his best friends, things are looking up.

“I talk to my parents probably every other day,” he said. “It’s good. It’s really good.”

Coming out the other side

Proving recovery is possible is a key component of the process, and a large part of recovery is connecting with people who went through addiction and came out the other side.

“When you see those people, they don’t look at you judgmentally. They don’t look at you from above, criticizing, judging,” McGrath said. “They look at you like ‘Come on, brother, I was there. You can do it. I can give you suggestions on how it worked for me and you can try it.’”

“That’s powerful!” he added. “There’s nothing in the medical model we have that works quite as well as that.”

Kayihura, a person in recovery himself, said his position offers him the chance to connect with people in exactly that way.

“At the onset of this, all I wanted to do was to stop drinking. That was my motivation. I saw that drinking was destroying my life,” he said. “But by doing the deal, what I’ve gotten is so much more.”

“And it’s a stage where — in hindsight — having gone through all that darkness that addiction causes, that isolated place, in hindsight, I can say truthfully that if that’s what it took for me to have the life that I have today, I wouldn’t change a thing.”