Ripple Effect: The Opioid Epidemic Challenges Even the Most Resilient Communities

Small towns have faced everything and overcome all manner of struggles—until the opioid epidemic came to town.

I grew up in a wonderful town called St Marys in Pennsylvania. St Marys was founded in 1842 as a German Catholic colony by sturdy people who left Germany to escape religious persecution. They came to a new homeland in search of a better life for their families, using whatever they had available to eke out a living. My grandfather—one of those sturdy Germans—raised 8 children in a 3-bedroom house he bought from Sears, Roebuck and Company. The blacksmith shop where he sharpened chisels was made of wood from a nun’s chicken coop. He couldn’t afford to buy new nails, so he straightened out the nails on his anvil.

Between the late 1800s and mid-1970s, St Marys experienced an amazing economic boom. The carbon industry soared with all the new cars sitting in American driveways. Many components in these automobiles were made by my family members in carbon factories. Then, the late 1970s brought along automobile imports that devastated the economy. Factories closed and the town was hurting—but not for long.

The entrepreneurial spirit of these hard workers kicked in, and the townsfolk started making powdered metal components for everything from automobiles to NASA rockets. At a recent wedding I attended, I found myself discussing retirement. One of my childhood playmates told me he had retired 20 years ago, when he sold his company and retired as a millionaire—at the ripe old age of 40. 

What amazes me is that all this economic development occurs in the middle of a very sparsely populated county. The nearest 4-lane highway is interstate 80, which is 30 miles away. But residents don’t need the government to build a highway to spur economic development; they can overcome anything. Or, well, almost anything. The stubbornness and tenacity of this population has met its match with the scourge that has decimated so many communities: heroin.

I just finished reading a riveting book called Ripples: Effects of Addiction. This heart-wrenching book was written (unedited) by 19 different individuals who have had their loved ones taken from them due to overdoses, primarily from heroin. The book is a collection of stories from real people who will never recover from the devastating effects of opioids on their families. Their children are dead due to this scourge, leaving broken promises, voids in hearts, and the stigma of losing a family member to overdose.

I have been dispensing naloxone, using the standing orders from former Pennsylvania Secretary of Health Rachel Levine, MD, who wrote those orders in 2015. All my patients on medication-assisted treatment (MAT) are given naloxone nasal spray (Narcan) when I’m on the bench. I also offer naloxone nasal spray to anyone who is prescribed more than 50 morphine milligram equivalents, as recommended by the CDC.

A few weeks ago, one of my patients who receives buprenorphine came in and told me that he used the naloxone I had dispensed to him earlier in the week to save a 25-year-old heroin addict. Of course, I offered him another dose. Many of my fellow pharmacists are recalcitrant to dispensing naloxone for opioid overdose or buprenorphine for MAT. My prayer is that they never have to bury a friend or relative who died due to the scourge of opioid overdoses. 

I had the privilege of speaking with a mother who lost a son due to overdose and had shared her story in Ripples: Effects of Addiction. Like so many of the deaths described in the book, the common thread tying patients together was the need for mental health services. Families of patients struggle alongside their loved ones who are living with substance use disorder, in desperate need of mental health intervention from our health care system.

My hometown, like so many of yours, has conquered so many economic obstacles. The heroin epidemic seems to be the one that is most insurmountable.