Are We Losing a Generation to Opioids?
Experts talk about the opioid crisis' potential for disaster and what we can do to prevent it
About a month ago, I had the opportunity to sit down with Calvin McGinn, a Substance Use Disorder (SUD) specialist, and Joyce Ann McGinn, a pain management specialist. We sat down to discuss McRISC©, their newly developed screening method for determining the level of vulnerability individuals have to addictive substances.
With years of experience in the medical feild, they proved to be extremely perceptive in recognizing the flaws in the ways society currently treats people with SUD. The United State’s failure to truly care about the growing problem has led the nation to the danger it currently faces. With the opioid crisis growing more severe by the day, the possible long-term repercussions are grim.
How Bad is the Opioid Crisis?
Today we see overdose being listed as the leading cause of death for people under the age of 50 in the US (1). In 2017 there were a total of 70,237 deaths caused by overdose in America, 47,600 of them were from opioids (2). To compare, the Vietnam war had a total casualty number of 58,220 soldiers (3).
At this point, it seems as though the potential for disaster is high. With such high rates of SUD, you have to wonder how many members of our youngest generations will actually live to the age of 50?
Meet the McGinns
Joyce and Calvin McGinn are the type of people who make an impression. Their numerous credentials and years working as medical professionals make their passionate speech about SUD all the more magnetic.
Joyce Ann McGinn
Joyce Ann McGinn is formally trained in Occupational Therapy and has worked everywhere from psychiatric institutes to early intervention programs. Additionally, she’s trained in the Feldenkrais Method® and the Masgutova Neurosensorimotor Reflex Integration (MNRI) Method®. Both of which are integral to her current practice as a pain management specialist. She is also the co-founder and Director of Operations for McRISC©.
The other founder, Calvin McGinn, happens to be her husband and the principal researcher for the assessment. Calvin began his medical career as a pediatric nurse in a cancer unit where he often found himself comforting families as well as providing treatment.
He continued his work as both a family counselor and ER nurse, and later found himself as Chair of the National Forum for the Behavioral Sciences in Family Medicine. At the explosion of the opioid crisis, Calvin was an addiction counselor and program director of a Chicago SUD treatment program. In 2016 he joined Lake County Opioid Initiative.
“When you’re in the real-world meeting people who are in trouble every day, you have to do something. You either learn to ignore it and deny what’s real, or you step up and show up. In a way, experiences like this fine tune your humanity. People don’t want to have a theoretical conversation when they’re in the ER, they want help.”Calvin McGinn
Both McGinns are no stranger to helping people dealing with addiction. Each has years of experience that comes from their time combatting a crisis many people forget or don’t care enough about.
Substance Use Disorder gets talked about in connection to the Opioid Crisis frequently, but not many citizens understand what its root causes are. SUD has existed for generations, but as a society, we’ve never really given addicts’ struggles much thought. People view individuals dealing with addiction differently than those dealing with other chronic illnesses, and this perception effects everything from funding to treatment.
“People need to understand that it’s really an illness. The most important thing is to realize that this is not a choice. It isn’t an inability to have strong willpower. It isn’t an inability to make better friends. It’s about people having certain built-in tendencies that are part of someone that makes them more at risk.”Calvin McGinn
The DSM 5 corroborates this with its entry on Substance Use Disorder. Typically, the patient only needs to fulfill 2-3 out of a list of 11 potential symptoms to be formally diagnosed. (4)
Professional vs. Public Opinion
Substance Use Disorder may be official in the medical and psychiatric community, but the general public’s view of people dealing with addiction tends to be different.
“I remember I was talking to somebody who had lost a daughter to SUD, and we were discussing how a friend of his down the street also lost a child to cancer. The family down the street got all this support, they got cards, they got meals, everything you’d expect. But the family that lost a child to addiction got no support. They were looked at differently. So this is a perception we need to change. It’s not just about how you bring up a child, it’s about so many other things in addition to that. “Joyce Ann McGinn
What Do We Have To Gain?
Understanding that people with SUD are dealing with a legitimate chronic illness can go a long way in advancing the national conversation about it. If people stop looking down on those who have problems with addiction it would be much easier to combat the growing Opioid Crisis.
More lawmakers could approve funding for treatment and assessment. more doctors would be willing to dedicate their time and research. More citizens could prevent their own potential addictions preemptively.
What is McRISC©?
Ultimately McRISC© is an assessment tool created by the McGinns with the goal of providing a profile that people can use to create targeted treatment plans or prevent future SUD.
“I decided that prevention had a better chance of solving this problem. There’s a lot of money being thrown at creating more access to treatment without that treatment being informed by known risk factors.”Calvin McGinn
Learning from History
Having an assessment system that doesn’t take key facts into its diagnosis plan is ultimately unhelpful to the people who use it. We need only look at America’s own history to see evidence of that.
“When people came back from the Vietnam war with PTSD a lot of them were so hypersensitive to daily life that they ended up with addiction problems . . . Even today we see how people who have depression or bipolar disorders have proven to be more susceptible to the risk of addiction.Calvin McGinn
These things all made sense. We’ve known that SUD is tied to specific risk factors for some time now. What we never did was follow this up by designing our assessment tools to capture that. As a result, we’ve gone for years with treatment based on assessments that do not include some of the most important information needed to facilitate a permanent and stable recovery.”
Acute vs. Chronic Illness
Permanent and stable are the keywords here. The term “revolving door” has been thrown around a lot in reference to American addiction treatment programs but not many people understand exactly why.
“This isn’t just an acute illness, this is a chronic illness. Like every other chronic illness, it lasts for a long time. People with SUD need to be assessed as if they’re dealing with a chronic illness, but all the assessment tools look for acute symptoms. That’s not going to solve the problem.”Calvin McGinn
How Does McRISC© Work?
The idea of an assessment based on all the factors that influence SUD is a good one. But how does it work for the person taking it?
Taking the Test
The assessment itself takes about 10 minutes to fill out. Upon completion, the assessment will provide you with a clinical profile that you can access with your treatment provider.
“The intention to offer provider profiles initially, then, once we have enough participation to confirm McRISC’s external validation, we will offer limited Personal feedback as well to engage the public in self-discovery as a first step before reaching out to providers.
We don’t want feedback to be occurring apart from provider engagement to help interpret what it means until the tool is validated enough to warrant some personal feedback as well.”Joyce Ann McGinn
It’s Your Business
Interestingly, there are advantages to taking an assessment like this outside a doctor’s office. The pressures that come with facing a doctor or nurse asking sensitive questions can be uncomfortable and may discourage honesty in responses.
“The nice part about this is that someone can do this anywhere they want. So if somebody doesn’t want others to know they might have a problem they can do it on their own. Nobody has to see them or stand over them asking all these questions. You can be more honest when you’re doing it on your own instead of answering someone who might have judgments.”Joyce Ann McGinn
Is It Free?
The patient pays nothing. Providers can bill insurance for the assessment but McRISC© will be licensing the use of the tool to the providers. This means the financial burden does not fall on the shoulders of the patient.
What Do You Get Out of It?
According to the McRISC© website, the plan provides the client with the following:
- Your addiction risk
- Prevention guidance
- Likelihood of sustained recovery if misusing
- Your readiness for treatment
- Evidence-based risk factors
- Treatment recommendations
- Level of care placement
- Medication guidance
- Treatment duration
- Next steps towards health
Preventive Action Saves Lives
The great thing about the McRISC© tool is that it can estimate levels of susceptibility to SUD in people who have not yet been diagnosed. If average people proceeded through life with the knowledge of their own personal triggers or dangers, they would be able to make more informed choices.
“This is about prevention. Just because your circumstances have not given you exposure to what could put you at risk, doesn’t mean they won’t change in the future. If you get assessed early, you can recognize when certain situations are dangerous for you and make safer choices. Once a chronic illness expresses itself, it’s going to be something that’s hard to deal with. So you want to avoid it as much as possible, which is why risk-informed tools are so important.”Calvin McGinn
Making it Normal
Think about it – it’s routine for people to get tested for allergies or review their family’s medical history with certain diseases. This kind of preventive medical action is already common. The McRISC© tool gives people a more informed view of themselves and provides them with the knowledge they need to make healthy life choices in the future.
Perhaps someday testing like McRISC© could be considered normal and suggested by people’s primary care physicians. Patients could have a better chance at a healthier lifestyle and doctors could have a better idea of how to help individuals with more customized treatment. The future McRISC© offers looks promising if it can play a role in preventing SUD.
What is the B.U.I.L.D. Model?
The McRISC© assessment tool itself operates on what Calvin McGinn calls the BUILD Model. BUILD is an acronym for the five key areas needed to asses a person’s risk factor.
B is for Blueprint
To start, this first area is all about genetics and epigenetics. Genetics can be studied in a person’s DNA which is inherited from your mother and father. Mostly they control how your body works and looks. Epigenetics are essentially tags on a person’s DNA that represent the effects of your parent’s lifestyles before you were born. Both can influence how prone you are to SUD.
U is for User Traits
User Traits has a lot to do with you own personality. This section questions you to determine whether your own natural inclinations affect your behavior in a way that makes you susceptible to SUD.
I is for Injured Developing Brian
To continue, this section is targeted at determining if a patient’s brain has sustained any damage while it was still growing. Early drug use can hamper a brain’s development and make them more prone to SUD.
“We know that people’s brains are still developing up to age 30 at least and that development causes much greater sensitivity to any input that the brain gets during that time. So if someone starts feeding their brain early on with substitute dopamine substances, then they’re more likely to have a brain that needs that for the rest of their life.”Calvin McGinn
L is for Life Trauma
It’s been proven that people who have experienced more trauma in their lives are more likely to be seeking a larger escape. Traumatic events or lifestyles with high amounts of stress can both contribute to higher chances of SUD.
“High stress leads people to look for ways to dampen that stress and addictive substances come into play.”Calvin McGinn
D is for Damage
Finally, this is dedicated to the costs SUD may have had on someone’s life. This includes social costs like lost relationships, legal costs like DUIs, and medical costs like liver problems. All of these can be used to assess how severe a person’s SUD might be.
Put it All Together
These five letters represent the five key factors the McGinns have identified in the research and creation of their assessment.
“I use these 5 factors in the creation of McRISC© so someone can self identify where they are in each area. After they do that, the assessment tool pulls all that data together to do a better job of seeing that person as a whole and helping them see themselves.”Calvin McGinn
After my conversation with both Calvin and Joyce Ann McGinn I remember having the distinct impression of their seriousness and passion for helping others. The two of them are prime examples of people who have worked inside of a broken system for a long time, seen its flaws, and come up with feasible solutions. It’s clear that their years of experience have led to the creation of a tool that has the potential to help a great deal of people.