Dr. Mary Ann Sens has a quick description of the web of issues beneath the national opioid crisis.
"It's the perfect storm right now with the factors that led to this," Sens said. "Now, we need to look to those factors for the way out."
Sens is a UND professor and chair of the department of pathology in the university's School of Medicine and Health Sciences along with serving as coroner for several surrounding counties. On Wednesday afternoon, she sat on an expert panel before a public forum in UND's Memorial Union to field questions about opioids.
Sens was joined by Steve Gilpin, a special agent with the North Dakota Bureau of Criminal Investigations and Sue Thompson, the wellness coordinator at Polk County Public Health.
The forum was introduced with a brief introduction by UND department of psychology Chair Jeff Holm and a screening of locally produced documentary "Faded," which follows the stories of Grand Forks community members who have struggled with opioids and other substances.
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Nationwide, more than 33,000 people died from opioid overdoses in 2015, according to the U.S. Department of Health and Human Services. About 2 million people had a prescription opioid use disorder.
The "perfect storm" metaphor used by Sens cut to an underlying theme of the forum: that widespread use of drugs such as opioids is rooted in a number of causes. The panelists drew from their respective areas of expertise to outline the extent of the problem.
The audience questioned the panel on a host of issues, raising subjects including the impact of drug abuse on local families and foster care systems, the use of medicinal marijuana in opioid recovery treatment and the viability of safe injection spaces, a concept intended to reduce the hazards associated with shooting narcotics.
For Gilpin, who told the audience he'd worked many of the high-profile cases discussed in the documentary, the local piece of the crisis is fueled in part by synthetic opioids brought to the region through cross-country smuggling or importation via the "dark web," a heavily encrypted section of the internet used by illicit traders seeking an unwatched marketplace.
Gilpin said these synthetic opioids, such as fentanyl, have caused "a lot of suffering" and loss of life in the region.
"The dark net itself has been a big pain in our area," he said. "It's almost like 'drug dealers anonymous.' We've traveled nationally, internationally chasing some of these folks who are on the dark net."
The internet expanded the reach of suppliers. Though the domestic drug trade has long had international connections, much of the fentanyl and other synthetic opioid compounds now found in the U.S. are sourced from China, Gilpin said.
Synthetic opioid molecules have built a name on their sheer strength, but heroin-an organic, or not man-made opioid source-still has its place in the ecosystem of American narcotics. According to the panelists, heroin has not only gotten stronger over the years, but it's also gotten cheaper. Both features have helped build a wider base of consumers.
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Beyond the divide between synthetics and organics, dark net and traditional smuggling, the supply side of the opioid crisis is further complicated by the fact that many of the drugs in this category are still readily, legally prescribed by physicians for pain management.
"We became a society that never had to deal with pain," Sens said.
Oftentimes users may begin an addiction to opioids through legal drugs prescribed after surgery and injury. As dependence grows and the prescribed medication runs out, they may turn to illicit drugs sold on the street.
Sens said doctors in the U.S. are increasingly aware of the wider hurt caused by loose prescriptions. Guidelines for prescriptions have changed over time to reflect the potency and addictive capacity of opioid-based medications.
Thompson likened the role of pharmaceutical companies that produce legal opioids to tobacco companies that made addictive products while clouding their actual danger to consumers.
"I think we're very culpable in what we're experiencing today," she said.
Dr. Andrew McLean, medical director for the North Dakota Department of Human Services, attended the forum and spoke briefly in response to an audience member. After the discussion, he said forums can "reduce the stigma" of drug abuse while sharing good information with the public. One of the major takeaways for McLean was the complexity of the opioid situation and the need for more treatment options for individuals.
"There's not going to be a simple solution," he said. "There are a lot of moving parts and responsibilities that people have to take."
