HAWLEY - If high on opioids, Eric Bunnell believes a person could place their hand on a hot stove without feeling pain immediately. At least, that’s what Bunnell said the “numbness” would allow a person to do.


Bunnell who is 25 and has been in recovery over a year, said it wasn’t until his addiction was at its worse, when he was 24, that he finally sought help for his dependence on opioids. His struggle with addiction didn’t start with opioids. Instead, when he was 16 he got in with the wrong crowd and he started drinking. Soon, he went on to try other narcotics.

But, it wasn’t until he tore a ligament, that he became addicted to opioids prescribed by a doctor and that eventually led to heroin. The opioids were like something Bunnell had never experienced, he said, because it was an “overall body experience,” whereas marijuana caused a daze. The feeling is “hard to explain.”


Dominic Vangarelli, the vice president of Geisinger Marworth who has been in the field for 24 years, said today, heroin addiction often results from peoples’ use of pain medications. The reason, the opioid “hits the center of the pleasure center of the brain” that, in turn is the “primitive reinforcement and reward center.”

Not like nicotine

Opioid addiction is different than that of nicotine or other drugs Vangarelli explained, because the connection to the brain isn’t as direct and everyone’s progression is different. With drugs like nicotine, people build a tolerance, which affects the speed of the consequences and the effect of the physiological systems. But with opioids, the response is “very quick and intense,” which is why there’s an epidemic he said. Since the connection is immediate, consequences and fatalities might happen soon after, whereas effects of alcohol may take years.


Since the progression of the drugs are so different, people are dying because they are unable to seek the help they need from the “fatal chemical” said Vangarelli. With tolerance building quickly, people are then using more, not always aware of what the heroin is cut with, so they overdose and die.


Currently the issue lies with both opioids and opiates, but Vangarelli explained that opioids are synthetic, whereas opiates are more connected to opium in the “very basic form.” Heroin however, is “interesting,” because it is an opiate. It’s just that usually, heroin isn’t pure, so its cut with other things, like fentanyl, which is an opioid. The reality is that, no one ever knows what he or she are going to “get when using heroin.”


Based on stories from patients, Vangarelli said he has been told people are becoming addicted to opioids because they’re available, its inexpensive and they have a “desire to feel no pain, no stress.” The reason, they want to escape the stresses of life, since they are very present because of technology. The heroin is their answer, because it offers a fast way to “cope with life.” These people tend to be 30 and younger said Vangarelli.


 

Although pain medications have been around for years, the difference today is that they’re more available and “accessible to everyone” said Vangarelli. Once unable to attain the doctor prescribed opioids, they turn to street drugs. One pharmaceutical pill like a Vicodin might cost $25 said Vangarelli. But a bag of heroin might be $5.00. The difference is the purity, the intensity and availability. The heroin is cheaper, simply because of supply and demand.

Individual journey

Today, recovery doesn’t mean an addict must spend 28 days in a rehab. Instead, Vangarelli said rehabilitation is a “very individualized personalized journey for everyone.” Approaching therapy with a mindset of just being 28 days, that he feels is unethical and “not evidence based.” Instead, it’s become tailored as each person’s history is learned, their personality is considered and what might be the most effective treatment for them. That might mean residential treatment, or it could be outpatient or partial hospitalization, a vivitrol injection or an oral naltrexone.


At Geisinger Marworth, Vangarelli said patients are educated on the forms of treatment, since injections are “adjunct complimentary therapy.” Or, there could be recovery support groups, outpatient treatment, residential treatment, cognitive behavioral therapy or other evidence-based approaches to treatment. 


The staff from Geisinger Marworth, Vangarelli believes have created an “integrated approach” to treatment that is effective, because of feedback received from patients who have explored other centers. The difference is the amount of options and the “individualized treatment approach.” The system at Geisinger Marworth is “evidence based” and the reality is that, everyone’s path isn’t the same, he said.


As a person is going through therapy, Vangarelli said there are residential medications that people may take to assist their therapy. This is a “maintenance program” that helps the patient as they’re struggling and aids them as they try to stay engaged in their treatment. The treatment ultimately decreases “cravings.” But, its more than a pill, because the treatment also includes a recovery support group, since the more options provided, the better a person’s chances are. 


In addition to the guidance provided by professionals, an essential component in the recovery process is strong support systems. The reason, Vangarelli explained that through an individual’s disease, they have ruined relationships, creating isolation and feelings of hopelessness. And so, having relationships with others, in addition to following a treatment program, allows for a person to learn new “problem solving skills” so they are able to “deal with life on life’s terms.” Having been in the field for 24 years, all at Geisinger Marworth, Vangarelli said every story started with the individual becoming isolated and lonely, ultimately feeling life wasn’t worth living.

 

Support of others

For Bunnell, connecting with others has been important in his recovery process. Bunnell said the support of others he has met through the groups have been helpful. He was at a point where he didn’t want to live anymore, but by talking and learning the 12 steps it made a difference. After a year sober, he attends meetings multiple times each week. At the second treatment center he attended, Bunnell received a sponsor and committed to attending meetings. Meeting others in recovery, he said is great because they too, want to recover and they can relate. This was also important, because it required him to make new friends, since he still sees people around town, that he used to use with.


Bunnell’s sponsor has been especially helpful, because its been meaningful he said, since the person didn’t know who he was. Initially the sponsor asked Bunnell if he would go to a meeting, but he didn’t feel a need. But, Bunnell later learned, the meetings are necessary. Having a sponsor, means there’s someone to talk to, because Bunnell cannot overcome his troubles alone. 


The support groups, Vangarelli said are not treatment, but instead act as a “compliment” to the treatment by giving people in recovery a chance to engage with others, which is necessary because they may be feeling “vulnerable” or need “motivation to stay clean and sober.” The groups are “another tool” and the interaction is necessary for “one day at a time” because there is “no cure for this disease” that will require “lifelong maintenance.”

Hiding his habit

Despite his use and drinking, Bunnell said his addiction went undetected because he was good at hiding his habit, by making sure his bills were paid. Hiding one’s addiction, Vangarelli said is very possible, because the body is “resilient” and it will acclimate to the drug. Eventually though, more will be needed and a tolerance will be built. So, people are able to live their lives with different thresholds. Vangarelli has known of patients who entered the center and were using 15 to 25 bags of heroin a day and they were able to function for a time. During treatment, Bunnell learned how much he spent on his addiction and the total he said, is “terrifying.” 


When he first started doing drugs, Bunnell said he told himself he would never use heroin. But eventually, he felt like there was no other option. All total, he used opioids for seven years and heroin for one, with it starting as a “weekend thing” and then every few days, then every other day and eventually the heroin. While using heroin, he didn’t eat and instead, despite losing a lot of weight, he felt he looked great, even though he was the lowest weight he had ever been.

 

Cyclical

While Vangarelli was unsure of when the present epidemic started, he did say through his career he has seen various drugs “cycle” and as a result, people must be aware that addiction will pick and choose depending on availability, cost and other factors. Presently, opioids are the epidemic “killing a generation of people.” People, however, must stay aware of other drugs since they may emerge again. 
 Addiction, which is a chemical dependency, is a disease said Vangarelli because there is a progression with symptoms and if left untreated, like any chronic illness, it will lead to death. Since some say addiction is a choice, the fact is, the individual chose to use, but once progression starts, the “ability for the individual to make healthy choices has been taken off the table” said Vangarelli.

New hope

Getting clean, Bunnell said wasn’t easy since he is from the area, but after nine months he realized things were improving and thereafter, he has continued to do well. Thinking about his addiction and how it affected others in his life, Bunnell said he is not proud of it. Today, he has set goals for himself, continues to maintain the same job that he is “blessed” to have and knows that, “not every day is going to be fantastic” because its just “dealing with life.”

Bunnell wants people to know that if they are struggling with addiction, “there is a solution out there” but the person must be willing to work for it. For more information about Geisinger Marworth visit www.marworth.org.