"This has been very eye opening," Robin Sides with Pyramid Tri-County Hospice said while attending the Missouri Opioid Summit at Mt. Calvary Powerhouse Church in Poplar Bluff. "I knew the issue with fentanyl patches, but I didn't know some of the uses and how pure some of the forms could be."
Sides was one of the many representatives from the community, including prevention and treatment workers, social services agencies, school and medical professionals, law enforcement officers and faith-based groups, who came together to address the opioid epidemic in the area and statewide.
The summit was hosted by the Missouri Department of Health and Senior Services in partnership with the Butler County Health Department.
According to Whitney Preslar of the Butler County Health Center Emergency Response Center, about 250 people from all over the region attended the summit.
Fentanyl, an opioid medication used to help relieve severe ongoing pain, prescribed to many cancer patients, has become a growing problem in the area, especially when being mixed with heroin.
According to Butler County Sheriff Mark Dobbs, the issue hit close to home recently.
Dobbs recounted an incident where a young woman died from a drug overdose in her home and during the investigation drug paraphernalia was found.
Once processed, it was discovered the young woman died from an overdose of heroin mixed with fentanyl.
"It (fentanyl) is so dangerous to come in contact with and can remain airborn," Dobbs said.
The officer, who packaged the substance from the scene to be tested, began to show symptoms of coming in contact with fentanyl and was taken to the hospital.
"He probably would not be with us if we had not gotten it addressed as soon as symptoms began to show," Dobbs said.
Vice Chairman for Research from the Department of Psychiatry at Washington University Theodore Cicero told the crowd the situation is probably worse than they have heard.
Many patients Cicero has come in contact with said their mind set for taking opioids was they were legal, "at least it was not heroin," and they know the dosage amounts they are taking.
"The drug they avoided before, heroin, they are now switching to because it is purer," Cicero said. "They feel they have no choice because it has been made harder to get the pill they took before."
Cicero said he has heard many other reasons as to why opioid abusers are turning to heroin, including a way of "escaping," to chase a high feeling or self-esteem and other underlying issues.
Heroin, Cicero said, has an uncertain, purity and things added to it make the approximate dose amount very hard to determine and in return, overdose deaths have increased.
Once tolerance levels build, Cicero said, many begin to snort or inject the drug to get it to the brain quicker.
"The bottom line is the opioid problem is not going away until it is addressed," he said. "Treatment or better yet, prevention is the first step," Cicero said.
Assistant Special Agent in Charge with the Drug Enforcement Administration Larry J. Reavis said he wanted the crowd to take away a message of hope from the summit.
"There is power in prevention," Reavis said. "We can't arrest our way out of this problem."
National Council on Alcoholism and Drug Abuse Executive Director Howard Weissman said when it comes to the disease of addiction, prevention methods have not been applied as with other diseases.
"When we are talking about prevention, we are not talking about wagging a finger at someone saying don't do drugs," Weissman said. "We are talking about ways to deal with self-esteem and depression issues."
Funding issues came up during discussion of school based prevention curriculum being incorporated into schools.
"I'm asked 'how can we afford it?' And, that is not the right question," Weissman said. "How can we afford not to?"
Missouri House Speaker Todd Richardson said during the summit he was glad to see so many people working together on a significant problem for the state of Missouri and the country.
A statewide drug monitoring program has been a focus of Richardson since the first day he took office, he said.
Gov. Eric Greitens recently signed an executive order establishing a prescription drug monitoring program statewide, no longer leaving Missouri as the only state in the country without such a program.
Richardson said he is hopeful Missouri will become a leader on how to combat the opioid epidemic.
The Opioid Summit concluded with a panel of local experts giving their take on the problem and needs they see in the community.
Poplar Bluff Chief of Police Danny Whiteley was among one of the ten panel members.
"Somewhere around 2003 to 2005, we initiated a 'prescription pill case' locally," Whiteley said. "We identified a huge problem then with opioids, and we still have that problem today."
It was during this investigation, Whiteley said, Poplar Bluff was discovered to lead Troop E by a large margin in prescriptions written for hydrocodone, oxycodone, oxycontin, fentanyl, xanax and soma.
"With the opioid prescription abuse, it has opened the door for heroin to become a major problem for all of Southeast Missouri," he said.
The area also was one of the leading in meth manufacturing, but the requirement of a prescription for sudafed has reduced the number of meth labs drastically, Whiteley said.
"Legislation in these areas absolutely works," Whiteley said. "It is tried and proven."
With the assistance of the sudafed prescription requirement and drug monitoring program, Whiteley said, law enforcement can concentrate on other criminal activity.
Butler County EMS manager David Ross said they are seeing a slight decrease in opioid calls.
When a call comes in of an unresponsive person, Ross said, the first order of business is to assist with breathing.
Ross described a person believed to have overdosed on opioids as sweaty, have shallow breathing and are blue in color due to lack of oxygen.
Once arriving at an overdose situation, Ross said, Narcan is administered and is very effective, but has to be given immediately.
Narcan is used to counteract the life-threatening effects of opioid overdose.
Many times, Ross said, there is a hesitance to call for help in an overdose situation. "They might have waited too long, and there is nothing we can do," he said.
In an effort to combat the growing number of fatal drug overdoses in the state, Missouri lawmakers passed the "Good Samaritan Law," which allows someone present during an overdose to call for help without fearing they would go to jail, even if they have drugs on them or in their system.
Emergency doctor at Black River Medical Center Christopher Pinderski said 140 overdose patients came through emergency services last year.
So far in 2017, 125 overdose cases have been treated, and Pinderski said, if the trend continues, the year will top out with 160 cases.
"This is a 10-15 percent increase," he said.
Between Black River Medical Center and Poplar Bluff Regional Hospital, Pinderski reported about 47,000 emergency room visits each year.
Emergency service doctors are trying to decrease the number of opioid prescriptions written, Pinderski said.
To help reduce the number of unused, unwanted or expired prescription medications in the community, police departments across the U.S. are participating in Prescription Take Back Day Saturday, Oct. 28.
The police departments in Poplar Bluff, Dexter and Puxico are all drop off locations for prescriptions.
Last year, more than 1,000 pounds of medication were collected during Prescription Take Back Day and kept off the streets.
If citizens are not able to make it to Prescription Take Back Day, the Poplar Bluff Police Department has a box located in the lobby to drop off prescriptions at any time.
Preslar said everyone at the Butler County Health Department believed the summit went great and was very successful.
"We were able to get out information that people didn't know," Preslar said. "Many knew opioids were a growing concern, but realizing it was an epidemic was eye opening."