海角乱伦社区

Melanie Densmore was on her way to a residency showcase in Murfreesboro, Tennessee, to network with pharmacists in the state. She was just beginning her final year in Union University's pharmacy program and was thinking about her 海角乱伦社区 after graduation.

Melanie pulled off at a gas station on the long stretch of highway and began pumping gas. Two pumps over, she saw two men arguing in a car, their muffled raised voices making her uncomfortable. Then one of the men got out of the car and ran directly to her.

"Do you know CPR?" he asked.

She did. Realizing it was an emergency, Melanie ran to the car, where she saw a motionless woman in the back seat. She got in the back of the car and flipped the woman over to perform CPR. The woman was foaming at the mouth. In the front seat, Melanie saw a used syringe.

That's when she knew what she was dealing with — an overdose. The two men confirmed it.

"I got tunnel vision," Melanie says.

She immediately called out to another man at a nearby pump, "Will you call 911?"

"What happened?" he responded.

"She's overdosed," Melanie said.

"I have some Flonase that will help her," the man said.

Melanie hoped it wasn't just allergy medication but something more useful like Narcan, a nasal spray that can reverse an overdose. It was.

Melanie hurried back to the car and turned the woman over to administer the medication. The woman was bleeding profusely from her arm where she had injected the drugs. Melanie took off her suit coat and tied it around the arm of the overdosing woman to stop the bleeding.

As she did so, one of the woman's companions began to protest.

"Don't try to save her life," he said. "She obviously overdosed for a reason. She did this on purpose. It's her fault. Just let her die."

Melanie felt chills as she heard the other man respond.

"No. Save her. She's pregnant."

Melanie administered the first dose of the medication and waited an agonizing two minutes. She administered a second dose. Thirty seconds later, the woman woke up, crying. She said she was pregnant, that she would be fine and that she didn't want to bother anybody.

Melanie comforted her, "An ambulance is on its way. I'm staying with you until it gets here."

Melanie waited with her until EMS showed up and took her to the hospital. Having most likely saved the woman's life, she got back in her car and drove to the showcase.

---

Melanie Densmore speaks to Kim Jones, associate professor of pharmacy practice, in the OTC lab in Providence Hall.

ON THE FRONT LINES

Melanie had recently finished a pharmacy rotation in pain management when she crossed paths with the overdosing woman. She had dealt with Narcan regularly, so she knew about its uses. She may have been uniquely prepared, but she says anyone can be — Narcan is available without a prescription in most pharmacies.

Kim Jones, associate professor of pharmacy practice, teaches a Drugs of Abuse class that focuses on opioid addiction — a national crisis that has escalated dramatically in the last 10 years. Union is working to train students across its campus in how to respond to this crisis.

According to the U.S. Department of Justice, at least 78 people die each day from an opioid-related overdose. Opioids include the illegal drug heroin and prescription pain relievers such as oxycodone, hydrocodone and morphine, among others. These are drugs that pharmacists encounter every day, and those pharmacists often serve as the last barrier between addicted people and the addictive drugs.

Jones says the high risk for addiction from prescription pain medication was not even considered by many until recently.

"There's the perception that because I'm getting this from a pharmacist and because my physician or nurse practitioner wrote this for me, that it's safe," she says.

Jones says while the drugs are safe and efficacious when used as prescribed, they become very dangerous when used incorrectly or for too long. Once a user becomes addicted to the euphoric effects of pain relievers, they often move on to more and more powerful and dangerous opioids, usually obtained illegally.

She said the opioid crisis is a complex problem — one that cannot be fixed by regulation or legislation. People with addiction come from many backgrounds and can become addicted in many ways. Some addicts deal with chronic pain and still need pain medication while dealing with their addiction. More mild opioids like methadone and bupomorphine that can be used to help prevent overdoses are still met with skepticism by many and are thus underprescribed.

"Even though more is being done and our federal and state governments are making changes, people are still dying," Jones says. "And they're dying from drugs that are dispensed from a person in a white coat."

That's why Jones says pharmacists and other healthcare professionals must be knowledgeable and do everything they can to care for people with addiction and prevent more people from becoming addicted. They are on the front lines.

Jennifer Delk, assistant professor of nursing at Union, says one way nurses are being trained to combat addiction is through open communication with their patients. While the value of the nurse-patient relationship has always been a cornerstone of nursing education at Union, the College of Nursing is incorporating specific training in asking direct questions about addiction.

"We teach these students that we have to be vigilant in asking questions," Delk says.

She says in the past, most nurses would give out pain medication based on the pain scale. The nurse would ask the patient to rate his or her pain on a scale of one to 10, with 10 being the most painful. If the number was high, the nurse would administer a strong pain reliever. Now, that model is changing.

"We're looking at a number of things to determine what medication to give them, like movement, appetite and how far they are from surgery," Delk says. "You want to administer pain medication to keep them at a level that's appropriate for their stage."

Patients who are one day post-surgery might need to be able to get out of the bed and maneuver. They don't need to be able to walk several miles, Delk says. Their medication should be adjusted to their functional level.

"In the past, a patient could be sitting up, talking on the telephone and eating a cheeseburger and rate their pain a 10, and we would give them morphine," Delk says. "In reality they were probably better without it."

Delk has been a nurse for 20 years. For 19 of those, nurses did things the same way. As conversations about opioid addiction progress, things are changing, and the students in Union's nursing programs are learning a different approach.

This is just one small piece of addressing opioid addiction from the healthcare side. Delk agrees with Jones — it's a complex issue.

"It's not something that's going to go away," she says. "But we can make progress."

Jennifer Delk, assistant professor of nursing, talks about pain management with her students.

---

"JUST LET HER DIE"

Looking back on her experience at the gas station, Melanie Densmore is still troubled by the words of the pregnant woman's companion: "It's her fault. Just let her die."

It was not the first time she heard something like that, but her training in Union's College of Pharmacy has taught her to think about it differently.

"Despite what he said, I knew that I couldn't give up on saving her," Melanie says. "Because addiction is a brain disease. She has her issues, yes, and we need to help her through those, but it's not all about her choices."

Jones says this is one of the driving factors in the opioid crisis — a deleterious perception that people with substance use issues deserve their suffering, that their own choices are to blame.

"God designed us all differently," Jones says. "Some of us in our neurobiological wiring are more predisposed to succumb to addiction. That, coupled with the social stigma that addiction is a moral failing and a personal problem, is why it's really important to me to train our students."

Jones says addiction is a disease, just like hypertension or diabetes, and a wealth of scientific studies back that up. In her Drugs of Abuse class, she engages students in a thought experiment:

"If you had a patient with diabetes, and you saw them eat a donut, would you withhold their medication, their insulin?" Jones asks her students.

Most of the students confidently answer. No. Of course not.

"If you have a patient with an opioid problem, and they're abstinent for a while, and then they relapse, they take their opioid again, what's the difference?" Jones asks.

The students' answers vary, but they trend along the same line: Because that was their choice — a bad decision. This is the perception Jones is trying to change for them.

"We should treat patients with substance use disorders the same way that we would treat others with chronic disease," she says. "We cannot judge them and give up on them."

This is why Melanie knew that the woman's companion was wrong. The woman had made destructive choices, but she was dealing with a serious medical issue, and Melanie could not give up on her.

Nita Mehr, associate dean for Union's School of Social Work, says perceptions and stigmas are a major contributing factor in the increase in opioid overdoses. These drugs carry massive negative stigmas that connect drug addiction to personal character and even human value. The stigmas not only affect how other people view those with addictions, they affect how people with addictions view themselves.

"Stigma isolates us. It keeps us from going to treatment, and it may impact how professionals perceive us or want to work with us," Mehr says. "The personal perception of stigma can lead to shame, which can have a crippling emotional effect. The fear says, 'If I go to treatment, you're going to label me even more.'"

She says this shame and fear keep people from revealing their issues or seeking treatment until something dramatic, like an overdose, pushes them to it. She says close friends and family are most affected by a person's use of drugs, and they can often be the ones to extend the negative perceptions.

"Even when it's someone we love dearly, we may still put a label on them," she says. "We might say, 'They're our loved one, but they're an addict.' That just serves to reinforce the stigma."

Mehr says stigma is societal as well as personal. Addressing the opioid crisis requires changes not only in how individuals think, but in how society treats people with addiction. The criminal justice system is one area that is having to seriously consider the way it deals with people with addiction.

Nita Mehr, associate dean for the School of Social Work, speaks with social work graduate Haley Coble.

---

BREAKING THE CYCLE

Haley Coble, a graduate of Union's social work programs, is the director for the City of Jackson Recovery Court. The court works with individuals in the criminal justice system who have substance abuse problems by placing them in a year-long, intensive treatment program.

"They'll deal with the actual problem that has caused them to be in the criminal justice system in the first place," Coble says.

About half of her clients are dealing with opioid addiction. Most have been in jail for multiple drug-related crimes — punishing them, but not fixing the problem, Coble says.

"It's a continual cycle, a revolving door of people in and out of jail," she says. "We're working to break it."

In addition to drug treatment, recovery court helps people in recovery find housing and jobs and get their GEDs. It also provides accountability and personal counseling.

"It's a holistic approach to not just get off drugs but also deal with problems and things that led to drugs in the first place so that when you leave here, you can cope in a better way," Coble says.

She says substance use disorders are often coupled with co-occurring trauma and mental health issues — issues that come with their own set of stigmas and negative perceptions. She says there are countless factors that can lead to addiction, and the demographics for the recovery program are all over the place.

"It's people from every background — different ages, races," she says. "You could look in our treatment group and see people from every walk of life. They all start from a different place."

For Mason McBride, one of Coble's clients, it began at age 13. He and a friend stole some pain relievers from his friend's dad, who was recovering from a surgery. At 16, he started lying and stealing to get more pills and experimenting with other drugs. By 18, he was using intravenous heroin.

"I never thought that I would be shooting heroin when I started taking pills," Mason says. "But it progresses really fast, and that's what it led to."

After a year of nothing but drugs and several overdoses, Mason tried to pull his life together on his own. He enrolled at Union and even earned a possible position on the baseball team.

"I was doing good, and then one day I just walked out of class and never went back," Mason says. "I had started using again."

Mason spent the next five years in and out of jail for stealing, using drugs and selling drugs. He says it's hard for him to explain what addiction is like to people who have not experienced it. When he was on drugs, he couldn't manage anything in his life. He couldn't think about anything but getting high.

"When I was using, I didn't have a choice at all," he says. "I had to have it. If I didn't, I would be really sick. I was going to do what I had to do to get it."

Coble says this is one reason heroin and other opioid addictions can be so powerful. High risk of overdose also comes with extreme withdrawal symptoms for those who stop using. In addition to the physical symptoms, recovering addicts often are forced to confront things in their lives the drug use may have been covering, as well as guilt and shame from their time on drugs.

"Once they come off of drugs, it's really overwhelming," Coble says.

She says this is why those other services, support and counseling are so important in the drug treatment process. She says recovery is an incredibly difficult process, but seeing these people change over the course of a year can be extremely rewarding.

"You start with them from day one when they're behind bars, and then you get to see them a year from that when they have jobs, they have their kids back, they have their families back," she says. "They've actually had some clean time and are gaining positive things in their life."

Coble says the process is filled with small daily successes for each person in the program — when they have a full month clean or get their GED — and when they leave the program, whether they remain clean or not, they have the resources, support and services to get them back on track.

"Just because people have a relapse or a setback, that doesn't mean all the progress they made isn't valid," she says.

Mason graduated from the recovery court program in April. In May, he celebrated one year clean, and he plans to stay that way. He has been able to keep a job, start new relationships and rebuild relationships with his parents and friends.

"When I was using, the first thing that was on my mind every morning was to get high," he says. "Now that I'm clean, I have time to think about stuff that actually matters and stuff that can better my life."

Coble meets with a city court judge to discuss an impending case.

---

CALLED TO COMPASSION

As Jones, Delk, Mehr and Coble assert, the opioid crisis is a complex issue that will not go away anytime soon. According to the Department of Justice, the number of overdose deaths is expected to rise even higher in the next two years. While Union's faculty and staff are consistently training students to deal with addiction and offering workshops and resources for the broader community, the university has more to offer.

C. Ben Mitchell, Graves Professor of Moral Philosophy at Union, said because Union is a Christian university committed to core values like being people-focused, it should be on the front line of helping people with their struggles, including opioid addiction.

"Jesus had a lot to say about being Good Samaritans, didn't he?" Mitchell says.

Because Union affirms a biblical view both of humanity and the fallenness of world, Mitchell says its students and employees know and accept that all humans are frail and fallen, susceptible to temptation and sin.

"So addiction is real," Mitchell says. "We know it wrecks lives and families. Knowing this provides an opportunity for us to work redemptively to help people as they struggle and to support them as they try to overcome the addiction by the grace of God through a relationship with Jesus Christ."

Mehr says churches and Christian communities like Union have an opportunity to minister to people who are recovering by welcoming them into their congregations, homes and lives.

"God calls us to reach out to everybody and to love our neighbors as ourselves," she says. "People see through our actions what we believe."

Delk says these redemptive, charitable actions and attitudes are crucial in health care. They are modeled by Christ and required of every Christian.

"We want to handle everything with an attitude like Christ," Delk says. "He was right there in the middle of everybody, of the sinners and the outcasts. As followers of Christ, we are called to that kind of compassion."

That is what drives Union's faculty to invest in training students every day. It's what motivates alumni like Coble to assist people through the long recovery process, and it's what prompted Melanie Densmore to help a stranger at a gas station.