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Cesar Rodriguez

Seminar sheds light on stigma

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The old adage, “sticks and stones may break my bones but words will never hurt me,” may not be exactly true — at least for those who are working to overcome alcohol and substance addiction, mental illness and cultural competency issues.

In other words, hurtful words do matter.

That was the consensus of a group of panelists affiliated with the Pasco County Alliance for Substance Addiction Prevention (Pasco ASAP), a nonprofit organization working to mobilize the community to prevent substance use by implementing evidence-based strategies that produce environmental-level change.

The panelists spoke at a June 1 webinar, titled “Change The Language ASAP.”

The webinar sought to bring awareness to the role stigma plays in addiction, and how everyday words and phrases may have an influence regarding whether someone seeks needed help.

The hourlong discussion was moderated by Pasco Sheriff’s Office Cpt. Toni Roach, who oversees the agency’s Behavioral Health Intervention Team (BHIT) unit.

Cesar Rodriguez (Courtesy of Pasco County Alliance for Substance Addiction Prevention)

Stigma experienced everywhere
Cesar Rodriguez understands the problem better than many, as someone who has been in recovery for seven years, after battling a heroin addiction.

He has seen dark days, including an overdose that nearly killed him.

Now, he’s general manager at Sun Coast Roofing and Solar and is proudly married, with two children.

He’s also been a Pasco ASAP volunteer since 2015. He helps with fundraisers, town halls, and other outreach events.

Although he’s in a good place today, it didn’t come without constant struggles due to stigma, he said.

Before ultimately finding his path to treatment and recovery, Rodriguez told those listening in that derogatory terms, such as “junkie” and “alcoholic,” thrown at those with addictions can morph into a self-fulfilling prophecy — creating barriers that can discourage people from seeking help.

“You begin to believe the labels, and you think you’re not worthy, because you feel like you’re not worth the help,”  Rodriguez explained. “You start believing what everyone’s called you, you apply the label to yourself, ‘Well, I’m just a junkie, I’m not worth it, this is what a junkie does.’”

Stigma shows up in the real world, too, when individuals in ongoing recovery are looking for work.

With multiple felony convictions and a spotty work history, Rodriguez struggled for months, trying to find a job or even land an interview.

“I got door after door shut in my face,” Rodriguez said. “It was really disheartening.”

The increasing use of online applications also prevented face-to-face meetings with hiring managers, where life circumstances could be illuminated in more detail.

“We live in a time where almost every application is digital, so, if you look at me on a digital application with no opportunity for me to present myself and put no personality or anything to it, I just get shifted out of the pile,” he said.

Finally, he was hired for an entry-level labor position with Sun Coast Roofing.

Shame and bias toward former addicts is pervasive on social media, too.

Rodriguez has witnessed online users condemning and humiliating professionals and local businesses owners who are anonymously seeking help via 12-step recovery programs. People use social media to post old mugshots and share past criminal histories.

Said Rodriguez: “I have friends that are business owners that are also in recovery, and I see it used against them in social media, ‘Hey, did you know the guy that owns this business, here’s his mugshot,’ and people post it on social media.

“To have their mugshots paraded around Facebook, saying, ‘Don’t let this person in your house, he’s a drug addict with a record.’

Country Oaks Animal Hospital Medical Director Dr. Philip Richmond (Courtesy of Country Oaks Animal Hospital)

“Well,” Rodriguez continued, “if you’re not a strong person, that might send you running, that might send you back out again.”

Recovery is hard, he said.

It’s particularly tough when someone has been successful in recovery — built a business or a brand, and rebuilt trust — and someone comes along to tear it down — “just out of petty jealousy or ignorance,” he said.

Stigma even exists within the recovery community, said panelist Toni Reynolds, a certified peer recovery specialist who’s also in long-term recovery.

In particular, there can be judgmental attitudes toward people on medication-assisted treatment used to treat opioid addiction, like Suboxone, Subutex, Sublocade or Vivitrol.

Panelists said these medications are used by many as critical first steps in the recovery process.

“There’s still a lot of tension when people announce they’re on that (medication), and a lot of times they’re not welcomed into traditional 12-step meetings. I think it really hinders their ability to feel like they’re part of a community,” Reynolds said.

She said she personally experienced pressures among coworkers at a former workplace, while she was in a recovery program.

“It was kind of frowned upon that I was in recovery,” Reynolds said.

“Some people that I worked with weren’t supportive, and they almost encouraged me to party with them, and it just wasn’t something that I wanted to do with my life,” she said, noting she was not willing to go backwards.

Stephanie McCann has been in recovery for four years now.

Overcoming addiction and a jail stint, the 32-year-old panelist assists others as a recovery support specialist for BayCare Health System.

McCann was an IV drug user for 12 years, abusing opiates and methamphetamine among other substances, before undergoing residential treatment.

She agreed with the assertion about negative perceptions toward medicated-assisted treatment — including medical marijuana — within recovery communities, such as Narcotics Anonymous and Alcoholics Anonymous.

While considerable stigma remains in those rooms, McCann said, she’s also recently observed increased understanding of the methods others are using to get clean.

“I think it’s a work in progress and it’s getting better,” McCann said. “I think people are getting a little bit more open to the fact that not everyone’s path to recovery is the same, and that’s OK, because ultimately, if they stride to recovery, what path they took is not necessarily as important.”

The speaker also noted that people often are reluctant to be open about issues surrounding substance abuse and mental health because of stigma.

As an example, McCann said her mother once displayed embarrassment in a doctor’s office when the daughter revealed to nurses and physicians she was attending Narcotics Anonymous groups.

“It really showed me that like older mindset with mental health and substance abuse, that it just wasn’t something you talked about in front of other people,” said McCann.

McCann, however, refuses to stay silent regarding her own assorted life experiences.

“I’ve totally embraced it,” she said.

She added: “Recovery is so much of who I am now, and the path that I’ve taken through addiction has made me the person that I am now, and I’m just not able to be quiet about it.”

Stigma surrounding substance abuse and mental illness also seeps into medical profession, said Dr. Philip Richmond, who serves as medical director at Country Oaks Animal Hospital in New Port Richey.

Richmond freely offered up his past challenges with alcohol since high school, and having suicide ideations back in 2008 upon entering the field as a “newly minted” veterinarian amid stress and other factors.

The panelist referenced a study that claims around 12% to 15% of physicians will encounter an alcohol or substance use disorder. He also referenced a Centers for Disease Control and Prevention (CDC) study that reveals veterinarians are about 3.5 times more likely to die by suicide than the general population.

Yet, these problems remain “very stigmatized” throughout the medical community, Richmond said, as health professionals feel they must resolve issues themselves, without outside help.

“We (as medical professionals) somehow think that we should be able to outthink things, that we should be able to tough it out,” said Richmond.

“That’s what almost led me to not being here, was thinking, ‘It shouldn’t happen to me, look at all these things I’ve done in my life, I should be able to overcome this by myself,’ and I 100% could not.”

In his case, colleagues intervened. They recognized what was happening and got him into an inpatient treatment facility, which saved his life.

He emphasized the need for compassion and understanding for those battling addiction and mental illness.

He cited a 2015 CDC study illustrating how people with four or more traumatic childhood experiences are seven times more likely to have an alcohol use disorder, seven-to-10 times more likely to have a substance use disorder, and 12 times more likely to take their own life.

“Things that happened to probably all of us on this panel, before we had any say in it, increased our chances exponentially of having a use disorder,” Richmond said.

That, he said, has been one of the most powerful things he has learned.

Published June 23, 2021

Town hall sheds light on opioid overdose prevention

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Cesar Rodriguez spent 17 years of his life as a heroin addict.

He overdosed on five separate occasions, only to be saved by first responders who administered him naloxone, or Narcan, an emergency treatment that counteracts the life-threatening effects of opioid overdose.

“If I didn’t have Narcan,” he said, “I wouldn’t be able to sit here and share my experience. I would’ve never had a shot to recover.”

Pasco County Sheriff’s Cpl. Sherry Johnson Tandy demonstrates how to use the Narcan nasal spray to counteract the life-threatening effects of opioid overdose. She said her agency has deployed the medication 60 times, each of which has been successful in preventing an overdose-related death. (Kevin Weiss)

Parent Lisa Conca also has observed the Narcan’s life-saving effects when her son overdosed on heroin.

“I had never even heard of Narcan until that day he overdosed and was taken to the hospital,” Conca said. “Narcan saves lives and gives our kids another chance to help them on the road to recovery.”

These comments came up during a community discussion on opioid overdose prevention on March 8 at North Tampa Behavioral Health, which is located in Wesley Chapel. The event was organized by the Alliance for Substance Abuse Prevention.

The panel discussion was part of a community-wide effort to provide education about opioid overdose and what individuals can do to save the lives of those suffering with the chronic illness of addiction.

Much of the panel addressed how to access and administer Narcan.

Narcan is the first and only FDA-approved nasal form of naloxone for the emergency treatment of a known or suspected opioid overdose. The medication helps blocks the effects of opioids on the brain and restores breathing.

Opioids include heroin and prescription pain pills like morphine, codeine, oxycodone, methadone and Vicodin.

“Often the reason (over-dosers) end up passing is because the brain does not have oxygen. This medication helps alleviate that,” said Szilvia Boos Salmon, a pharmacist with Tampa Poison Control.

Along with the nasal spray, naloxone is available in an injectable form.

The Pasco County Sheriff’s Office is one of a number of growing law enforcement agencies to carry naloxone for possible overdose calls.

Pasco Sheriff Cpl. Sherry Johnson-Tandy said the agency has had over 60 deployments of Narcan. Each deployment was successful in preventing an overdose-related death, she said.

In addition to reversing overdoses, the medication is also for deputies and first responders who may become exposed or have incidental contact to illicit fentanyl or heroin at a particular crime scene.

Johnson-Tandy demonstrated how to safely and effectively administer both the nasal spray and injectable forms of naloxone. Free samples of Narcan were later distributed to the audience.

Johnson-Tandy said it’s onset time is anywhere between 1 minute to 3 minutes.

“It works almost just like an EpiPen,” she said.

Narcan is the first and only FDA-approved nasal form of naloxone for the emergency treatment of a known or suspected opioid overdose. The medication helps blocks the effects of opioids on the brain and restores breathing. Opioids include heroin and prescription pain pills like morphine, codeine, oxycodone, methadone and Vicodin. (Courtesy of Amphastar Pharmaceuticals)

“The best thing about this is, if you give it to someone and they don’t need it, it can’t hurt them,” she said, adding if someone overdosed on cocaine or stopped breathing for another reason, it won’t have adverse effects.

The Narcan medication might be needed more than ever.

Opioid overdoses increased by roughly 30 percent across the U.S., in just 14 months between 2016 and 2017, according to a new report by the U.S. Centers for Disease Control and Prevention (CDC).

The CDC called the data a “wake up call to the fast-moving opioid overdose epidemic.” It recorded 142,000 overdoses in hospital emergency departments across the nation, between July 2016 and September 2017.

Although not all overdoses in the study were fatal, they are part of the unsettling toll of opioids. Nationwide in 2016, illicit and prescription drug overdoses killed 64,000 people.

The problem is growing locally, too, experts say.

Pasco County had the highest rate of hospitalization in the Suncoast Region for opioid overdoses, according to 2016 data from the Agency for Healthcare Administration.

Additionally, Pasco has tied for fifth highest out of the state’s 67 counties for drug overdose mortality rates over the last few years, according to county health rankings.

There were 165 overdoses in Pasco in 2017— matching numbers from the 2010 and 2011 prescription pill crisis, said Capt. Mike Jenkins, who oversees the narcotics unit for the special investigations division at the Pasco Sheriff’s Office.

There’s also been a gradual rise in fentanyl and heroin use in the county over the past year, he said.

Other topics covered during the session included how to prevent opioid addiction and avenues for long-term treatment of people who are dependent on opioids.

Speakers agreed it starts with education and advocacy.

“We can’t arrest our way out of this issue,” Jenkins said. “It takes comprehensive, strategic partnerships to really move forward.”

“Start in the schools early, and educate kids as to how dangerous mom and dad’s pill bottles are,” said New Port Richey-based attorney James Magazine.

Communities must find ways to effectively integrate recovering addicts back into society after they receive treatment, Magazine said.

Rochelle Zwicharowski, a support specialist with the St. Petersburg-based Recovery Epicenter Foundation, said those who have been rehabilitated need to share their experiences.

“There’s 23 million people in recovery, and how many people do you know? We’re too quiet about it. If you’re in recovery, don’t be afraid to speak out about it because we do have to smash that stigma,” she said.

Revised April 3, 2018

New mindset needed in substance abuse battle, speakers say

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A shift in attitudes could go a long way toward reducing impacts from substance abuse, speakers said at the sixth annual Substance Abuse Prevention Conference held in Wesley Chapel.

Stigma is a huge issue, they said.

Those attending the sixth annual Substance Abuse Prevention Conference could visit a number of booths, including this one, which featured a poster on the topic of shattering the stigma associated with substance abuse. (B.C. Manion)

Until that changes, fewer people will seek treatment, and employment and housing challenges will remain for those in recovery from substance addictions, they explained.

A new mindset is also needed toward people who are in recovery, several speakers said.

Even when people have stopped misusing drugs or alcohol and are trying to reform their lives they often encounter roadblocks because of previous run-ins with the law, speakers said.

Those were among myriad issues discussed during the Sept. 21 conference at the Saddlebrook Resort in Wesley Chapel.

The conference, which had the theme “Strengthening Our Communities: Opportunities for Action,” was presented by the Pasco Alliance for Substance Abuse Prevention (ASAP) and BayCare Behavioral Health.

About 400 people were registered, including youths involved in prevention efforts, people at various stages of recovery, mental health and medical providers, elected officials, judges and members of law enforcement. Besides the speeches, the event included a panel discussion and breakout sessions.

The keynote speaker was Andy Duran, executive director of Linking Efforts Against Drugs (LEAD) and the SpeakUP! Prevention Coalition, based near Chicago.

About 400 people registered to attend the sixth annual Substance Abuse Prevention Conference at Saddlebrook Resort in Wesley Chapel. The conference was presented by the Pasco Alliance for Substance Abuse Prevention (ASAP) and BayCare Behavioral Health. (B.C. Manion)

He talked about the need to change the conversation, as it relates to the topic of the misuse of drugs and alcohol.

He suggests dropping labels commonly used to describe people with drug or alcohol issues.

“We use pejorative words, even in prevention we do this. We use words like ‘addict’ or ‘junkie’ or ‘dirty’ … We’ve got to get those words out of the language.

“Someone has an addiction, they’re not an addict. Someone has an alcohol problem or struggles with alcoholism, they’re not an alcoholic.

“When we start to talk differently, we start to think differently. And, when we start to think differently, society then follows us and starts to think differently,” Duran said.

Society generally views substance abuse as a crime, a moral failing or a simple choice, Duran said. In reality, it’s a complex medical behavioral problem, he said.

The stigma attached to the problem reduces the likelihood that someone will ask for help, which increases the risk for overdose, Duran added.

Worst crisis in decades

Another speaker, Mark Fontaine, executive director of the Florida Alcohol & Drug Abuse Association, offered an assessment of the current situation. He also addressed ongoing efforts to bring about change and the challenges ahead.

“I’ve been doing this work for 40 years. I have never seen a crisis as we’re facing in this state right now,” Fontaine said.

Opioid overuse is affecting every community in Florida, with opioids being the direct cause of 2,538 deaths across the state in 2015, he said. Statistics are not available for 2016 yet, but the number is expected to double, he said.

It’s not an isolated problem.

Mark Fontaine, executive director of the Florida Alcohol & Drug Abuse Association, gave an assessment on the state’s current situation relating to substance abuse issues.

“This epidemic is affecting us all. It’s the most important thing that’s on the table in the state right now,” Fontaine said.

While efforts are underway to increase funding in the battle — and Gov. Rick Scott has declared it an emergency — the state lacks a comprehensive plan for tackling the problem, Fontaine said.

He pointed to gaps in service.

“In Florida, there are many people who come knocking on the door for treatment and treatment is not available to them,” Fontaine said.

And, while there’s a focus on the opioid crisis, that’s just one part of the substance abuse picture, speakers said.

“I can tell you that in the Pasco County Drug Court, we are seeing more methamphetamine than opioid cases,” said Judge Shawn Crane, who oversees that court. “That is a growing number. We see it all of the time. It’s cheap. It’s easy. It’s something for those practitioners and providers — just keep that on your radar. That is an important part of what we are facing in our court.”

And, while the opioid crisis is the focus of today, other problems persist, Duran said. “Alcohol still kills more people a year. Tobacco use still kills more people a year.”

In addition to the conference speakers, there was a panel discussion, moderated by Carley Boyette of Tampa Bay’s Morning Blend. It

A detail shot of a slide, used as a backdrop for conference speakers. (B.C. Manion)

took a look at the issues from the perspective of recovering addicts, social service providers, elected officials and law enforcement.

Cesar Rodriguez, who has had his share of battles with substance abuse, talked about the struggles that he encountered in finding work and housing, after he got sober.

“I stayed the course and I was able to find a job after a while, but by no means was that easy.

“When I made enough money and I was on my feet, the next obstacle was — you have to fill out these background checks to rent anywhere, and people don’t want convicted felons in their neighborhoods or in their HOAs (homeowners associations).

“Everything is, ‘Put your application online.’ You don’t get a chance to present yourself.

This artwork was on display at the sixth annual Substance Abuse Prevention Conference in Wesley Chapel. (B.C. Manion)

“It can break people. When you get told ‘No’ enough — ‘No you can’t have safe housing,’ ‘You can’t have an hourly wage job to keep your life moving forward,’ — it can send somebody back out,” he said.

Pasco County Commission Chairman Mike Moore noted “substance abuse doesn’t discriminate …Every one of us has friends and neighbors that are going through this. Every one of us probably has a family member that has gone through this,” Moore said.

“As a community, we need to give people a chance,” Moore added.

Erica Smith, a licensed mental health counselor from BayCare Behavioral Health, said the road to recovery begins with meeting people where they’re at.

“It’s really about helping them to achieve behavior change,” she said.

“You get asked the question a lot of times: ‘How many times are you going to let this person come and use this service, or go to detox?’

The answer, she said, is “As many times as it takes.”

“We never shut the door,” Smith said.

Published Oct. 4, 2017

Medication can reverse effects of opioid overdoses

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As communities across the nation struggle with an opioid epidemic, there’s a medication — that’s not widely known — that can reverse the effects of an overdose and save lives. Its generic name is naloxone.

About 75 people attended a June 15 seminar on opioid addiction and the benefits of naloxone moderated by Judge Shawn Crane, who presides in the sixth circuit.

Law enforcement officers, health care providers and a local pharmacist shared their expertise during a panel discussion. People recovering from addiction or helping family members to recover also shared their insights.

More than 75 people attended a seminar on opioid addiction and the medication, known as naloxone, which can save lives during overdoses. Pasco County Alliance for Substance Abuse Preventions sponsored the event. (Kathy Steele)

Pasco County Alliance for Substance Abuse Prevention (ASAP) sponsored the seminar at St. George Greek Orthodox Church in New Port Richey.

The opioid epidemic is widely known.

Data from the United States Department of Health and Human Services estimates more than 650,000 prescriptions of opioid pain pills are dispensed daily. While the United States accounts for about 5 percent of the world’s population, Americans consume more than 80 percent of the world’s opioid supply.

China is a major manufacturer of illicit opioids, such as fentanyl and its derivatives.

Since 1999, the rate of deaths from opioid overdoses has quadrupled, including deaths from illegal use of heroin and other opioid synthetics, according to health and human services statistics.

On average 78 people in the country die every day from an opioid-related overdose, the department reports.

Health care providers and law enforcement officers are trying to spread the word that naloxone can reverse the effects of an overdose.

While the medication doesn’t eliminate the need for emergency medical care and treatment, it can save lives.

Naloxone is available to anyone at area pharmacies, and can be administered as an injection or through a nasal spray.

Crane and law enforcement officers agreed that the most prevalent drug of choice among addicts is methamphetamine.

“It’s cheap,” Crane said.

But, there is an increase in opioid pain medications from prescriptions or their synthetics. The use of heroin also is on the increase.

“It’s important that people know law enforcement understands that we can’t arrest our way out of the problem,” said Sherryl Johnson-Tandy, a corporal with the Pasco County Sheriff’s Office. “Drug addiction is a public health issue.”

Every Pasco deputy, as of April, carries naloxone as a nasal spray – sold under the name Narcan. The deputies can use the spray as first responders on the scene, without waiting for emergency medical personnel to arrive.

“We have a unique opportunity to make contact with people who are in their greatest need,” said Pasco Sheriff’s Capt. Michael Jenkins. “In an overdose, every second counts. It was a no-brainer for us.”

Johnson-Tandy said Narcan also is a protection for first responders.

During investigations, officers, or their K-9 partners, can inadvertently ingest or inhale opioids. Especially dangerous are the opioid synthetics, fentanyl or carfentanil. They could have an overdose and need Narcan immediately. Emergency medics also are at risk.

Cesar Rodriguez is a recovering addict, and serves on the ASAP Recovery Committee. He used heroin for about seven years, and nearly died from an overdose. Naloxone saved him, he said.

There is a stigma attached to addiction, but Rodriguez said, “We do recover and become productive members of society. We can turn around and help the next recovering addict.”

Naloxone also saved Lisa Conca’s son, who has been in and out of rehabilitation programs for about eight years. In years of seeking help, Conca said no one ever told her about naloxone. “I just want to pay it forward and help our community,” she said. “It’s a disease of the brain, not a moral failing. Every life deserves a chance.”

Kent Runyon likened naloxone to the automated emergency defibrillators. The portable devices save people who are having heart attacks, and can be found in public places, such as offices, gymnasiums or shopping malls, he said.

People can keep naloxone doses at work, at home, or in a purse.

“We need to do everything we can to put every tool in the box to help people live,” said Runyon, who is vice president of community relations for Novus Medical.

Asking for naloxone at any pharmacy is easy, said Ashley Huff, a Walgreen’s pharmacist.

Some health insurance plans pay for it; others don’t. But pharmacies treat naloxone requests in the same way as flu shot requests, she said.

“We don’t ask any questions,” Huff said. “Anyone can get it, and get as many prescriptions as you want, as long as you are willing to pay for them.”

A nasal spray kit, with two nasal sprays, can cost about $135. But, doses for injection can be about $20 each, although two doses are recommended, Huff said.

In some cases, one dose won’t be enough and a second would be administered soon after.

The most expensive medication is sold as Evzio at a cost of more than $4,500. It is an auto-injector, similar to the Epi-pen that is sold to people with asthma.

People with addictions aren’t the only ones who should get naloxone, Huff added. Anyone who gets an opioid prescription should consider naloxone — as a precaution against an accidental overdose, she said.

Published June 28, 2017