Our country’s ongoing opioid epidemic has its roots in prescribed “pain killers.” Some pharmaceutical companies convinced the medical community, and the general public, that their pills would take away our pain. In the wake of the surge in addiction to opioids, matters are further complicated and increasingly deadly due to the rise in fentanyl and xylazine being added to illicit opioids.
On April 27, 2023, we heard from health care professionals who helped us to change the way we manage and treat pain, and explored options for treatment of Opioid Use Disorder (OUD). We also heard a personal story about opioid use and subsequent recovery.
Fentanyl
Fentanyl is a potent opioid synthetically produced in laboratories that activates the reward centers of the brain to produce sensations of euphoria and provide pain relief. Side effects have included alterations in consciousness, sensations of heaviness, decreases in mental function, constipation, anxiety, changes in mood and appetite, nausea, dry mouth, intense itching, constricted pupils, and increased body temperature. Fentanyl is 50 to 100 times more potent than morphine, and is available in legal prescription form, and increasingly, in illegal illicit forms.
Long-term health consequences (most often through injection use) include: insomnia, infection of the heart lining and valves, collapsed veins, loss of sense of smell, abscesses, constipation, liver or kidney disease, pneumonia, sexual dysfunction (men), irregular menstrual cycles (women), increased risk of HIV and Hepatitis, coma or death.
Fentanyl can be in prescription form: injected, worn as a transdermal patch, or ingested through lozenges; in non-prescription illicit form: ingested (eaten), snorted, or injected.
Xylazine
Xylazine, a non-opioid veterinary tranquilizer not approved for human use, has been linked to an increasing number of overdose deaths nationwide in the evolving drug addiction and overdose crisis. Studies show people exposed to xylazine often knowingly or unknowingly used it in combination with other drugs, particularly illicit fentanyl.
While the full national scope of overdose deaths involving xylazine is unknown, research shows overdose deaths linked to xylazine have spread westward across the United States, with the largest impact in the Northeast. From 2015 to 2020, the percentage of all drug overdose deaths involving xylazine increased from 2% to 26% in Pennsylvania.
Research has shown xylazine is often added to illicit opioids, including fentanyl, and people report using xylazine-containing fentanyl to lengthen its euphoric effects. Most overdose deaths linked to both xylazine and fentanyl also involved additional substances, including cocaine, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids.
Watch a recording of the April 27, 2023 Program
Meet Our Presenters
Below are some of the presenters and panelists who have shared their expertise and experience at various programs related to opioids. Their contact information may be found by clicking on the “Learn More…” buttons.
Be a Part of the Conversation programs do not provide behavioral health advice and are for informational purposes only. Our programs are not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of a qualified health care provider with any questions you may have regarding substance use disorders or related family needs. Never disregard professional advice or delay in seeking it because of something you have read or seen in any Be a Part of the Conversation program or video.
Kate Appleman, MA, LPC, CAADC, CSAT, CCS
Senior Director, Clinical Practice and Professional Development
Caron Treatment Center
Kate Appleman, MA, LPC, CAADC, CSAT, CCS
Kate Appleman is the Senior Director, Clinical Practice and Professional Development at Caron Treatment Center. Kate’s work places a major focus on improving programs that support Caron’s clinical teams. Since 2013, Kate has been active in program development, supporting the development of evidence-based clinical programming for executives, healthcare professionals, attorneys, and those with an opioid addiction. Her areas of expertise include motivational interviewing, working with family systems impacted by addiction, relapse treatment and prevention, and men’s addiction treatment and recovery.
Steve Moriconi, DMD, FACD, FICD
Oral & Maxillofacial Surgeon
Steve Moriconi, DMD, FACD, FICD
Passionate about educating the public, as well as fellow prescribers throughout Pennsylvania, Dr. Moriconi’s message delivers a clear understanding of safe prescribing practices and the treatment of pain. He has become interested in substance use disorder, particularly opioid use, and feels that education about our current epidemic is very important, particularly as dentists have prescribed large numbers of narcotics over the years. Dr. Moriconi is Pennsylvania Dental Association’s official lecturer on Safe Prescribing Practices. Dr. Moriconi’s two-hour course is required for dentists to be licensed in the State of Pennsylvania.
email: ESMDMD@GMAIL.COM
J. Gregory Hobelmann, M.D., M.P.H.
Joint CEO
Ashley Addiction Treatment
J. Gregory Hobelmann, M.D., M.P.H.
Dr. Greg Hobelmann serves as the joint CEO of Ashley Addiction Treatment together with Alex Denstman. He previously worked as a staff psychiatrist and until recently as the senior vice president and chief clinical and medical officer here at Ashley. As joint CEOs, Greg and Alex share responsibilities, with Greg overseeing Medical Services and Nursing, all of Ashley’s inpatient and outpatient programs, extended care programs, Stabilization Unit, Spiritual and Weekend Counseling, Family Services, as well as Dietary, Quality Improvement, Health Information Management, and Patient Support and Transportation. Greg holds a Master of Public Health from the Johns Hopkins Bloomberg School of Public Health and completed a psychiatry and anesthesiology residency as well as a pain medicine fellowship at Johns Hopkins.
Prior to his arrival at Ashley, Greg worked as an interventional pain specialist. His special treatment interests include substance use disorders and chronic pain. Greg is committed to assuring that all our patients and their families receive the most innovative and excellent holistic care on their recovery journey.
Learn more about Ashley Addiction Treatment: https://www.ashleytreatment.org/
Dana DePaul Ellis, MSTOM, L.Ac
Licensed Acupuncturist
Dana DePaul Ellis, MSTOM, L.Ac
Dana Depaul Ellis is a graduate of the renowned Pacific College of Oriental Medicine, San Diego where she obtained a Masters of Science in Traditional Chinese Medicine after completing a rigorous 4-year program consisting of nearly 4000 hours of classroom and clinical training in Chinese Herbology, Acupuncture, and Western Medicine. During her training, Dana gravitated toward a specific type of Japanese Meridian Acupuncture Therapy, which promotes the body’s ability to heal itself, focusing on the “root” of the problem rather than just the symptoms. Dana has used this style of treatment to effectively treat many health conditions, with a particular focus on women’s health, chronic pain management, autoimmune issues, as well as preventative care and maintaining overall wellness.
email: depaulellisacu@icloud.com
Sean Rodgers
Person in Recovery
Director of Family Services and an interventionist and family coach with Synergy Houses
Sean Rodgers
Sean Rodgers is a person in recovery from Opioid Use Disorder. He is the Director of Family Services and an interventionist and family coach with Synergy Houses in West Chester. He strives to act as a mentor, provides direction for families in crisis and be an active positive presence in the lives of Synergy’s residents.
email: seanrodgers34@gmail.com
David Clements, IV, MD
Addiction Psychiatrist
Founder, Southeastern Executive Health
David Clements, IV, MD
Dr. Clements is a compassionate, engaging, personable psychiatrist and the founder of Southeastern Executive Health. He grew up in the Philadelphia area, and has recently moved to Wilmington. He enjoys fishing on the Chesapeake bay, golfing with his wife, and gardening.
His practice philosophy is that the connection between physician and patient is the most important component to success. He understands that stigma can be a barrier to care, and practices in discrete locations without significant signage to respect patient privacy
email: Md@myexecutivehealth.com
Accreditations
– ABPN Board Certified General Psychiatrist – 2017
– ABPN Board Certified Addiction Psychiatrist – 2018
Professional Recognitions & Honors
– Best Doctors Under 40 – PA Medical Society – 2019
– The Gold Humanism Honor Society Teaching Award Winner
– Clinical Instructor – Rowan School of Medicine
– Chief Resident
– House Staff Council – Cooper University Hospital
Education
– Addiction Psychiatry Fellowship – University of Pennsylvania
– Psychiatry Residency – Cooper University Hospital
– M.D. Temple University School of Medicine
– M.B.S. Drexel University
– B.S. Lafayette College – Mechanical Engineering
Press
Philly may get more federal money to address opioid crisis as alarm grows over xylazine*, a dangerous and increasingly common drug additive
Philadelphia Inquirer, 4/19/2023
*While xylazine is not an opioid, but a tranquilizer, it is being added to opioids such as heroin and fentanyl.
Biden administration declares fentanyl laced with xylazine ‘an emerging threat’ in the US
CNN Health, 4/12/2023
FDA Approves First Over-the-Counter Naloxone Nasal Spray
US Food & Drug Administration, 3/29/2023
The feds just removed restrictions around prescribing a popular addiction medication (buprenorphine). What does it mean for patients?
Philadelphia Inquirer, 1/30/2023
Racial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems
Academic Emergency Medicine, 1/19/2023
Pharmacists Can Be Key to Helping Folks Kick Opioid Addiction
US News & World Report, 1/13/2023
Pennsylvania Harm Reduction Network
Deep Brain Stimulation for Severe Opioid Addiction
National Institutes of Health, 11/21/2022
Useful Resources on Opioid Overdose Prevention
SAMHSA (Substance Abuse & Mental Health Services Administration), 7/19/2022
Naloxone Overdose Prevention Laws
Prescription Drug Abuse Policy System, 1/21/2022
2021 Overdose Epidemic Report: Physicians’ actions to help end the nation’s drug-related overdose and death epidemic —and what still needs to be done.
American Medical Association, 9/2021
Philadelphia drug deaths soared again in 2020, hitting Black residents hardest: ‘It’s a racial justice issue’
Philadelphia Inquirer, 6/3/2021
Opioid Crisis Fast Facts
CNN
PAStop.org
The Commonwealth Prevention Alliance Campaign to Stop Opiate Abuse
“Good Samaritan” Drug Overdose Immunity Laws
Pennsylvania Department of Health
Find a Drug Take-Back Location
Pennsylvania Department of Drug & Alcohol Programs (DDAP)
Prescription Drug Abuse Epidemic; Painkillers Driving Addiction, Overdose
National Safety Council
Opioid/Heroin Reversal (Naloxone)
Pennsylvania Department of Drug & Alcohol Programs (DDAP)
Pennsylvania’s Prescription Drug Monitoring Program
Pennsylvania Department of Health
Heroin & the Opioid Epidemic: From Understanding to Action
Partnership for Drug-Free Kids
Treatment Approaches for Drug Addiction
National Institute on Drug Abuse (NIDA)
Behavioral Health Treatment Services Locator
SAMHSA (Substance Abuse and Mental Health Services Administration)
Find a Parent Support Group near you:
Meeting finder.
Principles of Drug Addiction Treatment: A Research-Based Guide
National Institute on Drug Abuse (NIDA)
Chronic Pain Anonymous
Mutual Aid Groups
Guidelines for Prescribing Opioids for Chronic Pain
Centers for Disease Control & Prevention (CDC)
American Society for Addiction Medicine (ASAM)
Prescribing gabapentin with opioids may increase risk for OUD, overdose
Healio
Dental Schools Add An Urgent Lesson: Think Twice About Prescribing Opioids
NPR
Pennsylvania’s Prescription Drug Monitoring Program
Pennsylvania Department of Health
Medical and Health Professional Resources
National Institute on Drug Abuse (NIDA)
📖 Books
There are hundreds. Here are just a few:
Nonfiction:
Empire of Pain: The Secret History of the Sackler Dynasty
by Patrick Radden Keefe (interview with the author)
Dream Land
by Sam Quinones
Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
by Beth Macy
A Day Without Pain
by Mel Pohl, MD, FASAM
Staying Sober: A Guide for Relapse Prevention
by Terrence Gorski
In the Realm of Hungry Ghosts: Close Encounters with Addiction
by Gabor Maté, MD
Addict in the Family: Support Through Loss, Hope, and Recovery
by Beverly Conyers
The Joey Song: A Mother’s Story of Her Son’s Addiction
by Sandra Swenson
Fiction:
Demon Copperhead
by Barbara Kingsolver
Long Bright River
by Liz Moore
Before I Let You Go. A Novel
by Kelly Rimmer
🎞️ Films
Dopesick
on Hulu
Crime of the Century
on HBO
The Pharmacist
on Netflix
Warning: This Drug May Kill You
on HBO
The Recovery Boys
on Netflix
Heroin(e)
on Netflix
Do No Harm
on PBS
Handouts
