Tobacco, Opioids Killed More Than 14,000 Hoosiers Last Year

IU Health is on the front lines in the fight against

A pair of
reports released last week by the Richard M. Fairbanks Foundation paint a
dismal picture of the opioid and tobacco epidemics that are killing Hoosiers,
but IU Health Simon Cancer Center employees who are on the front lines
of treatment are not surprised.

Tobacco and
opioids claimed 14,200 Hoosier lives in 2017 and cost the state $12.6 billion
annually in healthcare costs, lost productivity and other economic damages,
according to the reports.

There were
1,700 deaths linked to drug overdoses last year, a 75 percent increase since
2011, the report said. The vast majority were attributed to opioid misuse.
Despite that sobering statistic, tobacco claims seven times as many lives each
year. Smoking and second-hand smoke cause a combined 12,500 Hoosier deaths

When Debi
Hudson reviewed the reports, she said, “I wanted to stand up and cheer.” Not
because it was good news, but because she’s on a mission to reduce
tobacco-related deaths. Tobacco doesn’t get the attention that many other
addictions do, said Hudson, director of the IU Health Simon Cancer Center Tobacco
Treatment Program, “even though more people are dying from tobacco every day
and every year.”

Hudson, a
tobacco treatment specialist for 21 years, said during that time, Indiana has
always been in the top 10 for “highest adult smoking prevalence.”

The two
addiction crises are the root causes of Indiana’s poor health outcomes and
burdensome healthcare costs, said Claire Fiddian-Green, president and CEO of
the Fairbanks Foundation. “All Hoosiers must realize the urgency and work
together to address them.”

While there has
been a steep decline since 2011 in the number of fatal overdoses that involve
prescription opioids, Indiana has seen a rapid rise in the synthetic narcotic
fentanyl. The presence of fentanyl in Marion County overdoses increased from 6
percent in 2013 to 46 percent in 2017.

Linda Bond,
lead therapist in IU Health’s Chemical Dependency Program, said the OD numbers
listed in the report actually seem low to her. “Everybody who comes in here
pretty much knows someone who OD’d.”

The intensive
outpatient program housed at IU Methodist is five hours a day, five days a week
for four to six weeks. Within that window are activities including group
counseling, art therapy, yoga, physical therapy and meditation. Currently, 22
are enrolled in the program. A similar program is offered in the evenings.

About half of
the participants are being treated for alcohol abuse, the remainder for
methamphetamine and opioid addictions, she said. But it’s not like a lot of
drug treatment programs.

“We’re not a pill
mill,” Bond said. “We don’t give out suboxone or methadone,” two medications
often used to treat pain and addiction.

The program
uses opiate blockers such as vivitrol and naltrexone to reduce the craving for
drugs and alcohol. It has a 79 percent completion rate, Bond said, though
overall success rates are difficult to measure.

“Intense work
gets done in a very caring, comfortable environment,” she said.

Andrew Gaddie
is a peer recovery coach in the same program. Since January, he has been on the
front lines in the addiction fight, meeting people in the emergency department
at Methodist when they have overdosed and presenting them with treatment

Gaddie knows what
they’re going through. For 20 years, he battled addictions to alcohol, cocaine
and heroin. He’s been clean for 12 years, though he admits to still being a
smoker. “That’s one of my vices I have not been able to put down and it’s
probably the most deadly one.”

As a recovering
drug addict, though, he delivers a dose of reality to the patients he sees in
the ED.

“We have found
that peer recovery coaches can reach the addict better than a doctor or nurse
or technician because we’re people with lived and learned experiences. We’ve
been in their shoes.”

But not
everyone is receptive. Some are hostile when he tries to talk to them, Gaddie
said. He has been there when people have been saved with Narcan, which helps
reverse an opioid overdose. “I’ve heard people say, ‘Why’d you bring me back?’ A
lot of people just want to go back out and use. They’re not looking at the fact
that they have another chance to live life.”

Gaddie knows what
it’s like to get another chance at life. He might be on his ninth life already
– having survived multiple heart attacks, a gunshot wound to the head and other
health crises. Now if he could just kick the cigarette habit.

Like drugs,
tobacco has a devastating effect on Hoosier health, the Fairbanks study said.
More than one in five Hoosiers smoke, a decline from 25.6 percent in 2011, yet
Indiana consistently places among the 10 states with the highest smoking rates

IU Health has been at the
forefront in treating tobacco-related lung disease and cancers, said Dr. Khalil
Diab, IU Health pulmonologist. A large number of patients with smoking-related
diseases, including COPD, asthma and lung cancer, are treated at IU Health
facilities across the state, he said.

Research by pulmonologists
and lung cancer specialists at the IU School of Medicine aims to understand the
mechanisms of DNA damage and repair in cancer cells. “We have multiple clinical
trials with cutting-edge therapies for lung cancer patients in Indiana,” he

A lung cancer screening
program also has been developed to improve the survival rate of Hoosiers who
are current or former smokers, said Dr. DuyKhanh P. Ceppa, associate professor
of thoracic surgery for the IU School of Medicine. The multi-disciplinary
treatment program, funded by a two-year grant from the National Cancer
Institute, launched Nov. 1 at the IU Health Simon Cancer Center, and the goal is to
eventually expand it to include all IU hospitals.

Still, Ceppa
said, “The data are very clear that more strict smoking laws have a direct
effect on decreased lung cancer rates in our states.”

The key is
prevention and early diagnosis, Diab agreed. “And state laws are urgently
needed to address that.”

Tobacco use is
the leading preventable cause of premature death and disease in the United
States, causing more deaths annually than alcohol, HIV, car accidents, illegal
drugs and firearm-related incidents combined, according to the Tobacco
Prevention and Cessation Commission.

Each year,
3,700 children under 18 become new daily smokers, the Fairbanks study cited.
Nearly 14 percent of women in Indiana smoke while pregnant, ranking the state
11th worst in the U.S.

Action steps
suggested by the Fairbanks study include: increasing the cigarette tax by $2
and the legal smoking age to 21; expanding access to medication-assisted
treatment; increasing syringe exchange programs and safe disposal sites for
opioids; and boosting prevention programs in schools.

— By Associate Senior Journalist Maureen Gilmer