Earlier this week, The Times-Gazette posted on Facebook an article providing information on a program the Highland County Quick Response Team (QRT) took over. The program provides free naloxone, commonly known as Narcan, and offers training on how to administer the drug to someone who has overdosed.
Multiple people responded, asking why the QRT was choosing to provide addicts with naloxone instead of providing other life-saving medications like insulin and chemo to members of the public for free.
“The reason there is naloxone being distributed without charge is because so many citizens cried out to their elected representatives, ‘Do something about this problem,’” QRT Health Specialist Creed Culbreath, who was the source for the original story, said. ”Elected representatives allocated tax money for this. Now, we can say, ‘We in Highland County don’t want to take this product that our tax dollars have already been used for,’ or we can take this drug, which has been proven in county after county in Ohio and in counties all over the U.S. to be effective in harm reduction.”
Culbreath said another Highland County organization ran a similar naloxone public distribution program, though it only offered one location in the county where people could get both naloxone and training to administer it. When QRT heard that program was ending, it stepped up.
“We wanted to make it possible for people who couldn’t drive to get naloxone in the communities where they live and at hours that were convenient for them,” Culbreath said. “We were simply challenged by a team in another county to do this because we are meeting family members of overdose survivors weekly. This enables family members to have a fighting chance to keep their loved one alive until professional help can arrive.”
As for the comments that mentioned the lofty prices of medications like insulin, Culbreath said there are programs that can help people get their medications for reduced rates or even for free. He suggested that people struggling to afford their medication should talk to their doctors and pharmacists. Culbreath said that not only might doctors typically have samples of medications at hand, but pharmaceutical manufacturers sometimes have programs that reduce the cost of medications, and there are alliances of pharmacy owners that work with pharmaceutical manufacturers to provide medications for people who struggle to afford them.
“In my mind, the best way to reduce or lower the price of other life-saving medication would be to lobby for it,” Culbreath said. “That’s what brought [the QRT’s] program into being.”
However, Culbreath said commenters who — intentionally or not — compared addiction to chronic conditions like diabetes were accurate.
“We’re not dealing with choices. We’re dealing with a chronic disease,” Culbreath said. “I’ve never met a person who chose to be an addict. Just like a person who starts smoking socially or drinking socially doesn’t want to be dependent on tobacco or alcohol, which by the way are still our largest addictions in America, far exceeding other drug addictions. The overwhelmingly typical person the QRT meets is a person who has suffered a great deal of childhood, adolescent or young adult trauma, for which they’ve never been treated. This drives the addiction.”
Culbreath said the QRT also meets people who suffer from chronic physical illness or workplace injuries that their pain management can’t eliminate. Culbreath said their drug abuse stems from a desire to escape from life, if only for a few hours, because it’s too painful for them. He added that there are people with congenital behavior illnesses like ADHD, who self-medicate with meth so they can calm down and focus.
As a member of the QRT, Culbreath, who also serves as the president of the Highland County Drug Abuse Prevention Coalition and collaboration coordinator for REACH for Tomorrow, frequently works with people addicted to substances like methamphetamine, heroin and fentanyl in the Highland County area to help them find resources and treatment.
At the Highland County Drug Abuse Prevention Coalition meeting on Oct. 24, Culbreath shared a story about a man who was using meth to focus on work, so he could provide for his family. Culbreath said it took time to figure out a treatment plan for the man, whom a doctor wouldn’t prescribe more than a month of Adderall for due to his history of substance abuse. Culbreath said that, eventually, he met care providers from the VA Hospital in Chillicothe, who told Culbreath illnesses like ADHD and PTSD could be managed without medication through mindfulness therapy, which Culbreath pointed out is more extensive than mindfulness meditation and takes a lot of work.
“Addiction is treatable,” Culbreath said, “but it takes a lifelong commitment, just like any other chronic disease.”
Several people who commented on The Times-Gazette’s Facebook post accused the QRT of enabling addicts to continue abusing substances like opioids by providing free naloxone, which they argued minimized the consequences of drug abuse.
Culbreath said that, though QRT has only been running the program for three weeks, QRT members have seen four categories of people come in for training and free naloxone: family members and neighbors of people struggling with addiction, treatment providers, civic groups and churches, and people afflicted with the disease of addiction who are now actively clean and working in treatment programs in the county to help others overcome their addictions. Culbreath said naloxone can be used not only on people who have overdosed on illicit drugs but also people who have been prescribed — and aren’t abusing — strong opioids, who may inadvertently go into an overdose. Culbreath compared having naloxone on hand to having a first aid kit for emergencies.
“We’re trying to help parents keep their loved ones alive until we can meet with them and give them treatment options,” Culbreath said. “We mistakenly received an offense report from a law enforcement agency about the overdose of a man in his 30s. We went to his residence to offer him treatment options. His mother was in the house and could not come to the door. His father was driving around on a garden tractor, but really, as he told us, it was something to take his mind off of his grief. His first words to us when we introduced ourselves were, ‘Well, you’re too late. He died.’ I later found out this young man was a classmate of one of my children. He was a good student. He was a kind young man. He was not a career criminal. I just don’t want to hear that we arrived too late again.”
While several people commented on the Facebook post, describing people struggling with addiction as “worthless,” Culbreath said that, in his experience, once a person commit to lifelong sobriety and begins working through the underlying behavioral and mental health factors that drove their addiction, what often emerges is someone who is able to contribute and do valuable things. He said that many people who were once addicted go into professions like addiction and mental health counseling after they recover.
“It’s a very brave thing because they are confronted daily with memories of their past that are most unpleasant and, in some cases, are potential triggers for relapse,” Culbreath said. “This disease cuts across all ethnic and sociological boundaries, but a number of persons have tremendous potential in sobriety. In fact, many of them were very high-performing persons before they were overtaken by the disease of addiction.”
Culbreath added that assigning a monetary value to a human being is a new concept in western society.
“[The idea of the monetary value of a person] was put into full use after the National Socialist German Workers’ Party came to power. We know them by their nickname: the Nazis,” Culbreath said. “In the 1930s, one of the things they did was to kill veterans of the First World War who were unable to work. This was a party whose leaders included highly decorated veterans of the First World War. One was Adolf Hitler himself. Another was Hermann Goering, one of the greatest air aces Germany had. They thought they were doing the right thing, so they were very public about these programs. They didn’t hide them. The German public that had elected these people to office was so horrified of what they were doing to infirmed veterans — sick people who were not at that time able to work — in order to save the German economy money. There were huge protests, and those programs that killed disabled veterans stopped. Those may be extreme examples, but that’s where you go when you put a financial value on human life. Because when you are able to mark someone as worthless and someone society would be better without, then you have actually devalued humanity. You’ve also unknowingly devalued your own worth. Any one of us can and will someday be unable to work, be unable at some point to care for ourselves.”
However, Culbreath said that, because there are people who believe addicts shouldn’t be saved when they overdose, he decided to research the cost of treating someone after an overdose compared to the cost of letting them die. Culbreath found that the last time such a cost analysis had been completed was in 1999, so using sources like the USDA and Cincinnati Enquirer in 2018, he compiled an itemized list. He found that, on average, treating one addict until they commit to sobriety costs taxpayers around $56,634 — a number which allows for two emergency room visits, eight doses of naloxone spread out over four overdoses, four ambulance rides, four offense reports, stabilization treatment and transitional treatment.
On the other hand, allowing a person struggling with addiction to die after one overdose, Culbreath found, costs the American economy around $2.8 million, which takes into account one squad run, a coroner’s investigation, lab work, an autopsy, one offense report, cremation and burial, as well as mental health care for the person’s survivor, care for the person’s children, education costs for the person’s children, the loss of that person’s workforce productivity, the loss of that person’s economy spending and the loss of that person’s tax revenue.
“So many people think, ‘OK, they die, and that’s one less expense,’” Culbreath said. “Who takes care of the body? That person probably died without a burial insurance plan. Often the families are pauperized already, so the public has to bury that person. That’s just a tiny expense. It’s not infrequent that I meet people who are afflicted with addiction who are trying to hold down a job and raise family. Who replaces them in the workplace, and who, more importantly, raises those children until they’re 18? That’s a tremendous burden on our system.”
Culbreath then took this list to law enforcement and health care providers in Highland County to check its accuracy. He said they told him that, not only was it accurate, but they also pointed out some factors he’d missed.
“This cost of $2.8 million is actually on the low side,” Culbreath said. “There are other costs there. I’ve noticed that now some other people at universities are doing the same kind of research, and they’re coming out with roughly the same dichotomy. In every case, they find it’s far, far cheaper to treat — even with relapse. We’re actually saving America and our community money by treating people rather than letting them die.”
Culbreath shared with The Times-Gazette that someone close to him went into a downward spiral after his parents’ divorce. This man tried a variety of drugs but cocaine was the one that stuck. When cocaine became too expensive, Culbreath said the man turned to meth.
“He was on methamphetamine for so many years that the recovery rate — the number of people who are able to leave the meth and stay sober — was essentially zero. He was at the point of suicide because he felt like he was worthless. He’d burned all his bridges with family. He friends were people like him. He felt like he was a pain to the people he loved. Ready to jump off a bridge, and he suddenly said, ‘Maybe God can help me.’”
The man’s family got him into the Salvation Army’s treatment program, which didn’t cost the man or his family anything, and the man got sober.
“If you’ve been convicted of drug offenses, you’re probably not going to get accepted into a law school. You’re probably not going to get admitted to a bar [a licensing institution for attorneys]. You’re probably never going to get a job working in the banking industry,” Culbreath said. “Against all those odds — not hiding his past, simply telling his story — he was admitted on an exception to one of the most prestigious law schools in the country, University of California Davis’s Martin Luther King School of Law. When he graduated, he applied to the State Bar of California, was admitted on an exception because they’re not supposed to admit people with his past. He practiced law. He was an executive for one of the largest banks in the world. When he’s not at his job and he’s not with his family, he’s giving to other people. He speaks without charge to people in treatment programs, and he’s done that all over the country. These are the kinds of people I hope your readers will not write off. If they live, their story isn’t over.”
Those interested in participating in the QRT’s program can go, during businesses hours, to the Reach For Tomorrow office at 132 S. Washington St. in Greenfield; Downtown Drug at 119 S. High St. in Hillsboro; or the Highland County North Joint Fire and Ambulance District at 200 Monroe St. in Leesburg. If a person isn’t near any of the current locations, Culbreath said they can call the QRT at 937-752-6002 or 937-752-8030 to schedule an appointment. There is no cost for the kits, but those requesting them must register then watch a video that lasts about 16 minutes explaining how to administer naloxone. Culbreath told The Times-Gazette earlier this week that there should also be locations in Lynchburg and the Rocky Fork Lake area within the next couple months. The QRT is trying to establish a few locations where naloxone will be available to the public 24 hours a day, 365 days a year.
Reach McKenzie Caldwell at 937-402-2570.