I have a relative and two friends who became addicted to opioids initially prescribed to them by their doctors to treat physical pain. It makes me mad to think about the suffering they endured.

It is common knowledge that large pharmacy companies, particularly the Sackler family’s Purdue Pharma, manipulated U.S. health regulators and thousands of doctors into believing that painkilling pills such as OxyContin are not addictive.

“It is one of the biggest con jobs in the medical history of the United States,” says Edward Mersereau.

Mersereau is the director of the Hawaii Department of Health’s Behavioral Health Services Administration and the first person I called to find out why opioid addictions, overdoses and deaths are not as prevalent here as they are in some mainland states.

PaijBritt Emmanuel in the Hawaii Health and Harm Reduction Center outreach van. A recovering opioid addict herself, she now works to steer other addicts toward treatment. Courtesy of PaijBritt Emmanuel

Certainly opioid misuse has brought anguish to the islands. Just listen to anyone who has become a pill addict or mixed opioid pills with other drugs and you are likely to hear a story of sorrow and regret.

“Opioids are an equal-opportunity catalyst for misery,” says PaijBritt Emmanuel, a recovering heroin and prescription painkiller addict. “It doesn’t matter who you are. If you become addicted, you will end up in the same place: the gutter. It is horrible, just horrible.”

Opioids include illegal drugs like heroin and the synthetic opioids such as fentanyl and pain relievers that can be obtained legally by prescription, including OxyContin, Vicodin, codeine and morphine.

Emmanuel, who grew up playing at Kaimana Beach at Diamond Head, started experimenting with heroin soon after she graduated from high school. As the years went on, she says she added prescription opioids to her mix of drugs because of a concern the heroin she was buying at various locations on Oahu might have been altered.

“At least with a prescription morphine pill, you know what you are getting,” she says.

Emmanuel says her downtown Honolulu dealer sold her morphine pills that he got with a legal prescription, which he then turned around to sell to get cash to buy his illegal drug of choice: crystal meth.

Pills-for-cash exchanges like this are going on every day here but even so, prescription opioid abuse is not as prevalent here.

Mersereau says that although deaths by opioid overdoses are relatively low in Hawaii, the amount of opioids pills prescribed is still a concern. Last year there were 640,000 prescriptions for opioids in Hawaii.

“In a state of 1.4 million, that is a huge amount of opioid prescriptions,” he says. “It is good that deaths by opioid overdoses are decreasing in Hawaii, but it is hard to pin down exactly why.”

There were 640,000 prescriptions for opioids in Hawaii last year, says Edward Mersereau, director of the Department of Health’s Behavioral Health Services Administration. Denby Fawcett/Civil Beat

In 2017, the latest year data is available from the National Institute on Drug Abuse, Hawaii had 3.4 opioid-related deaths per 100,000 people compared with places like West Virginia with 49.6 deaths per 100,000 people, and New Hampshire with 34 deaths per 100,000 persons.

“We are not sure why Hawaii hasn’t gotten slammed like West Virginia and other states,” says Dr. William F. Haning III. “We can only speculate. All we can do is to continue doing what we think is right to try to prevent it. We don’t know what will happen in the future.”

Haning is the program director of addiction psychiatry and addiction medicine at the John A. Burns School of Medicine at the University of Hawaii, where he is also a professor emeritus of psychiatry.

He speculates that one of the reasons the death rate is lower in Hawaii is because crystal methamphetamine is still a top drug here, as well as cannabis, but not heroin or prescription opioids.

Hawaii Department of Health data for July 2017 to December 2018 show that 9% of individuals (750 people) enrolled in state substance abuse treatment programs were opioid users compared with 40% or 3,444 people who had crystal meth or other amphetamine diagnoses.

Haning speculates that opioid use also may not be as prevalent here because Hawaii does not have factories or wholesalers directly diverting pills to drug dealers, as has happened elsewhere.

“I was homeless downtown for many, many years. Now I am the one who gets back into the van to continue traveling to help others.” — PaijBritt Emmanuel

He says opioid deaths are higher in places where heroin or homemade, illegally imported fentanyl are more readily available.

Opioid deaths may also be lower here because of the rapid response by ambulances in Hawaii.

“Transport times in Hawaii are excellent just like they are in California and other areas where the majority of inhabitants live in urban centers,” Haning says.

Jared Redulla, the administrator of the state’s Narcotics Enforcement Division, Department of Public Safety, says because some drug abuse trends take longer to reach Hawaii, the opioid crisis creeping across the mainland has given Hawaii time to create proactive defenses.

“This time with opioids the community realized the importance of confronting the problem before it got bigger. Everyone has had a strong buy-in and that has made a whole lot of difference,” says Redulla.

Gov. David Ige’s plan on opioids, unveiled by the health Department on Dec. 1, 2017, brings together health care providers and government agencies, law enforcement, first responders and community groups to address opioid and other substance abuse problems in a coordinated way.

Mersereau says it is the first time he has seen the involvement of so many medical practitioners and agencies.

These opioid drugs were confiscated by authorities on Kauai. Courtesy of Kauai County

Also helping are new laws from the Legislature, including a measure approved last year to require doctors to record in a central data base system known as the Prescription Drug Monitoring Program every prescription they write for a controlled substance to prevent illicit drug users from “doctor shopping.”

Before, registering in the system was only voluntary.

And there is better success in weaning opioid addicts off heroin and painkiller pills as more and more doctors and treatment facilities each year offer prescriptions for the drug Suboxone.

Emmanuel says Suboxone has transformed her life. She has been clean and sober for more than seven years.

Suboxone is a combination of two drugs, buprenorphine and naloxone. The pills reduce the pain of withdrawal and tamp down cravings for opioids.

”Suboxone has kept me normal, not exciting, kind of boring,” Emmanuel says. “But that’s okay. I am freed up. I am able to have a job. I am a contributing member of society.”

She is employed as an outreach worker with the Hawaii Health and Harm Reduction Center, going out in a van every day to help guide addicts to treatment, counseling and medical care as well as exchanging syringes one-for-one with drug users.

Emmanuel says she feels no cravings in “the combat zone” — downtown Honolulu — when she interacts with her old friends she used to do drugs with.

“I am the one healing them. I was homeless downtown for many, many years. Now I am the one who gets back into the van to continue traveling to help others. I call myself an agent of change.”

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