If there was ever any doubt that the United States is grappling with a far-reaching opioid crisis, it was answered Jan. 24 at an Emory town hall discussion with one simple question.

“Forty-four percent of Americans say yes, they have known someone who has been addicted to prescription painkillers. How many here know a close friend or relative?” asked Peter D. Hart, the NBC and Wall Street Journal pollster leading a series of discussions launched by Emory to foster a deeper understanding of America’s views on critical issues.

Throughout the crowded presentation room in Emory’s Oxford Road building, hands from roughly half the audience shot up.

“If you look around, this is no longer just somebody that’s down the road. It’s right in your own family, your acquaintance, your best friend,” Hart said. “It’s no longer relegated to a small group of people — everyone is there.”

The town hall meeting on the opioid crisis was part of Emory’s “Conversations with America,” a series conducted in collaboration with Hart that is convening focus groups across the country to help advance civil discourse on difficult issues. The series kicked off Aug. 29 in Pittsburgh with a focus on immigration issues.

Throughout the Emory event, Hart showed video clips from the second focus group in the series, which was conducted in Wilmington, North Carolina. Held Nov. 15, that conversation featured a diverse cross-section of local residents discussing their opinions about the opioid epidemic. 

Using recent survey data, Hart showed the packed Emory audience a series of slides illustrating how the rate of opioid use has spiked dramatically in the U.S. over the last five years, cutting across all demographics.

“Who is responsible? How do we look at it?” Hart asked. “Do we look at it, indeed, as an illness or a weakness? How do we handle it? Where do we go? Prosecute? Provide treatment?”

Addiction: Everyone’s problem

For Emory President Claire E. Sterk, who opened last week’s town hall, the issue of addiction is especially relevant. As a social scientist and public health expert, Sterk has spent decades working on major public health issues that have included HIV/AIDS and addiction. 

“I come from a culture that strongly believes in the philosophy that if somebody has a problem with opioids, the last thing we should do is blame them and turn him or her into a criminal,” said Sterk, who is also Charles Howard Candler Professor of Public Health.

“Because at the end of the day, addiction is a societal problem — it’s a problem for all of us. It’s a sign that something is wrong in the world in which we live.” 

That means “we collectively are responsible for not stigmatizing people, for thinking about solutions and for having the kind of conversations we are going to have today,” Sterk added, thanking those present for their “commitment to be part of the conversation, to learn from each other.”

The dialogue opened with remarks by three panelists who shared expertise on facets of the opioid crisis. Here are some of the highlights:

John “Jack” Killorin, director of the Atlanta-Carolinas High Intensity Drug Trafficking program 

• A Navy veteran who served in Vietnam, Killorin noted that some 58,000 American lives were lost in the conflict. “Last year, we lost 63,000 Americans to opioid overdose,” he said. “We live in a country that has 6 percent of the world’s population; we consume 96 percent of the opioid medications produced in the world.”
• Opioid addiction feeds ancillary criminal issues. But there is a role for law enforcement in the crisis beyond arresting substance abusers. “We do not want to lock you up. What we want to do is administer Naloxone and save your life on the scene. We want to build systems with our partners in the community … if you are suffering from abuse disorder, we want to get you into a treatment program. And we believe in you and your chances to make it back and have a rich life.”
• The crisis does have a criminal component. Transnational gangsters now make about $26 billion a year feeding our national hunger for painkillers. That’s where law enforcement does and should have a role, he said.

Debra Houry, director of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control and a former associate professor in Emory’s Department of Emergency Medicine

• As an emergency room doctor at Grady Hospital for 15 years, Houry’s views on the opioid epidemic have evolved. “Some say ‘We never saw it coming.’ I will say, ‘I kind of saw it coming,’” she said. Over the years, Houry saw a rise in patients arriving for opioid abuse, addiction issues, substance abuse disorders and referrals for pain management.
• There are now about 230 million prescriptions for opioids administered in the U.S. on an annual basis. “That’s enough for every single adult to have a bottle of pills around the clock for three weeks,” Houry said. “That’s too much.”
• About three years ago, Houry took on a CDC project to outline “Opioid Prescribing Guidelines for Chronic Pain,” which has helped decrease opioid prescriptions over the last two years. While the guidelines advocate prescribing non-opioid medications for chronic pain first, “we’re still at three times (opioid prescriptions) what we were at in 1999,” she said. “My concern is we primed the pump, so a lot of people became addicted to prescription pills and have then gone on to misuse heroin and now fentanyl, which we know is just killing people due to its potency.”
• The CDC is now funding prevention programs across the country that work with health systems to employ syndromic surveillance to help identify non-fatal overdoses in emergency departments. The data are then used to issue health advisories and activate agencies to a quest to prevent fatalities. “My goal is to prevent people from getting addicted in the first place,” she said. 

David Laws, founding member of Georgia Overdose Prevention, a grassroots organization of parents, health care professionals, advocates and friends formed to advocate for the passage of the Georgia 911 Medical Amnesty Law

• In 2013, Laws lost his daughter, Laura Hope, to an accidental overdose. A high school senior and varsity goalie, she had been prescribed a powerful opiate painkiller for injuries sustained from being kicked in the face during a soccer match.
• “There are statistics that say if you are exposed to an opioid by 21, you have an 80 percent chance of developing a substance abuse disorder,” he said. “I didn’t know the repercussions of an opiate being prescribed to a young person of 15, what it does to the brain, how they like it so fast.”
• Laws helped lobby for passage of the Georgia 911 Medical Amnesty Law, which provides protection for those seeking assistance for someone experiencing a drug overdose. Under the bill, signed in 2014 by Gov. Nathan Deal, neither a caller nor a victim can be arrested, charged or prosecuted for small amounts of drugs, alcohol or drug paraphernalia as a result of seeking medical assistance.
• The law also increases access to the opioid overdose “antidote” Naloxone, also called Narcan, which physicians may prescribe to assist those at risk of opioid overdose and to first responders, pain management clinics and harm reduction organizations.
• Since then, “there have been 1,100 overdose reversals that we know of and 174 law enforcement agencies throughout the state that now have access to Naloxone because of the law we passed and helped facilitate,” Laws said.

The Emory presentation concluded with about 45 minutes of audience discussion, touching on topics that included the impact of drug dependency on families, the role that stigma plays in addressing addiction, what drives Americans to seek comfort in prescription pills, what college campuses can do to help, and how physicians can moderate prescription practices.

“If the question is who has the magic wand, you are the magic wand,” Killorin said. “The answers will be slow for a long time. (The opioid crisis) was 10 years coming and it will be 10 years out. We can already see the next wave.”

To view past “Conversations with America” events, visit here.