Note: This is the second in a series of articles outlining the problem of opioid use in the region, a personal perspective and potential solutions. The first story ran Jan. 25.

NEW ULM — Although statistical data shows a relatively small impact of opioids, the data cannot really convey what an individual’s experience may be.

Take Luke Bresnan, for example. The Fairmont resident now commutes to the New Ulm Medical Center (NUMC) once a month for treatment but spent roughly seven years addicted to prescription painkillers.

“Anybody can get addicted to these medications, anybody, and it can happen in no time,” Bresnan said. “I think people are afraid to come forward about it because of the addiction stigma, because they do not want to be known as an addict.”

It was a work injury that led Bresnan to start on painkillers. He was a server at a bar and grill. One night, during closing, a drunk man stepped on Bresnan’s foot and fell into him.

“I had broken my leg and my ankle and I tore all the ligaments in my ankle,” Bresnan said. “My toes were facing my back, is essentially what happened. I was hospitalized for a while, multiple surgeries and that was kind of back when the painkillers were being prescribed, and I was in a lot of pain. That is how it all started.”

He spent about a year in a cast as his leg healed and he soon realized he was hooked on his painkillers.

It made it hard to hold down a job. Bresnan was often too high or too sick from withdrawal to work any one place longer than a few months, he said.

Getting to his next fix became a constant preoccupation. Bresnan said he would fake cold symptoms or go to cash-only doctors in the Twin Cities to get the drugs he craved and avoid withdrawal.

“It feels like you are dying,” Bresnan said. “You sweat, you are hot, you are cold, you puke — you absolutely feel miserable. I would almost rather have been dead at some points than to go through all of that. It was the worst feeling I have been in, in my entire life.”

The addiction also ate at his mental health, degrading Bresnan’s self-confidence, leaving him feeling like a mess despite the functioning facade he put on.

“Everyone thought I was doing great, but I was a mess inside,” Bresnan said.

That is not too unusual, according to Treatment Director Jolene Hanson with Nova House, part of the Thrive Behavioral Network.

“When they start using, sometimes they — especially with opioid addiction — they do not have any mental health (problems) prior to that addiction,” said Hanson, who is also a mental health expert. “Then once that addiction happens, things spiral out of control for them, and it is difficult for them to maintain and function in their life.”

Addicts can develop low self-esteem and depression. That makes it harder for them to cope, Hanson said.

Where Bresnan’s story becomes more uncommon is how he got clean. He came to the conclusion himself.

“I knew I could keep going on the way I was, but I was not happy, and it was either going to take my life and I was going to lose everything or end up in prison, or just be clean and live a normal life like everybody else,” Bresnan said.

Most of the addicts in treatment that Hanson sees at Nova house, which takes care of people with mental health and substance abuse issues, got picked up by the system.

“Typically what we have seen is that there has been some sort of involvement from the system,” Hanson said, “whether that is police or whether that is county case managers that have stepped in, or they (people with problems) are hospitalized frequently because of overdose or having a hard time with mental health symptoms that have gotten worse from their abuse.”

Bresnan first attempted a 12-step in-patient program. He was sober for six months, four or five of which were in-patient.

Once someone is addicted, cravings become almost a pavlovian response to stimuli linked to use.

“When you have been an addict, especially for years, everything you see is linked to that drug,” Dr. Jeff Rayl with New Ulm Medical Center (NUMC) said. “If you used in a certain area — a lot of people go into the bathroom — every time you see a bathroom you get cravings for that drug.”

That was true for Bresnan. His cravings would kick in from walking past a pharmacy or seeing a pill bottle.

Suboxone treatment

Bresnan then turned to Suboxone treatment with Dr. Rayl. Suboxone is a partial opioid agonist antagonist.

An agonist partially stimulates the opioid receptors in the brain while an antagonist blocks other opioids by binding to those receptors.

“Once the person gets to their dose, that means that their receptors are saturated with the Suboxone and that adding more does not do anything,” Rayl said.

A patient reaches their dose through an induction period. They start with a small dose that they take a couple of times a day.

The next day they take the total amount of that dose at once and continue scaling until they have no more cravings. It usually takes two to five days.

“Interestingly enough, and this is hard to get through an addict’s head, taking more does absolutely nothing,” Rayl said. “You could double your dose and you would feel no different.”

Another benefit is that because Suboxone binds so tightly to the receptors, a patient could relapse, take a painkiller and feel nothing.

They would have to stop taking their Suboxone for days before they could even get high again.

Someone who has not been addicted to opioids, though, could get high off of Suboxone, Rayl said at an opioid panel late last year.

There is also the potential for abuse in opioid addicts buying it on the black market to avoid withdrawal while they try to get their next dose.

But so far the program is working for the 75 to 80 patients Rayl sees. Long-term, some may try to wean themselves off the drug, but that is case by case.

Connor Cummiskey can be emailed at ccummiskey@nujournal.com.