Treating substance-use disorder on Martha’s Vineyard

Marina Lent has made it her mission to find trends in substance-use disorder on Martha's Vineyard. — Stacey Rupolo

Marina Lent is no stranger to substance-use disorder. She became an emergency medical technician when she first moved to Martha’s Vineyard in 1999, and two years later became a certified paramedic. Now the administrator and inspector for the Chilmark board of health, Ms. Lent has become all too familiar with substance-use disorder (SUD) and the havoc it’s wreaked on the Island community.

In an interview with The Times on Monday, Nov. 14, Ms. Lent said her focus now is on data collection and finding trends in SUD on the Island, in hopes of creating a dialogue among the different providers on the Island and connecting the various services available, so a person can more easily navigate a path to treating SUD.

She has gathered data from law enforcement, corrections, the Martha’s Vineyard Hospital (MVH) and emergency room (ER), and various health care providers. She has hand-pulled death certificates, and looked at prescription data, Narcan administrations, and court reports, trying to find trends over time that are better indicators of the problem at large.

Because the Vineyard is a small community, it may be possible to collect some concrete figures. However, Ms. Lent cautioned, that data will never provide what she called “the perfect picture” — definitive answers as to exactly how many people are suffering from SUD.

The real benefit of the data collection is the cross-connections among the different providers that it establishes. If all the various players continue to communicate with one another, the value goes beyond showing numbers. It starts a conversation about SUD among the many people involved — the person suffering from the disorder, law enforcement, EMTs, physicians, families, et al. — and it helps educate the community and break down the stigma of SUD.

‘Slow-motion train wreck’

The willingness to get clean doesn’t happen overnight, and sobriety can be a lifelong challenge. With an opioid addiction especially, time is not on a person’s side, and the risk of overdose is so great that it’s often a guarantee.

At times, Ms. Lent became visibly distraught when she spoke about SUD, something she described as “horrendous,” “truly horrific,” and “relentless.”

While collecting mortality statistics and listening to parents of young people who were addicted to opioids, Ms. Lent found that the prospect of dying from an overdose was so real that she equated it to watching a “slow-motion train wreck.”

Ms. Lent said that in most cases of overdoses that led to deaths, “a lot of the people themselves knew they were going to die. They were scared already. The parents knew they were going to die. The friends knew they were going to die. And then comes the call that everybody’s been dreading.”

This speaks to the nature of the disease and the difficulty of treating it, where the risk of death is so enormous, so obvious, and yet no one can stop it from happening.

Alcohol may operate on a different timeframe from opioids — a longer, somewhat drawn-out process — but it takes just as many lives.

Ms. Lent found that on the Vineyard, people in their 30s made up the majority of opioid-related deaths, while alcohol-related deaths occurred among people in their late 50s and early 60s.

“We can make improvements in how we address substance-use disorder, but we should never be under the illusion that it’s easy, effective, or that the reason it’s happening is because we haven’t found the right treatment,” Ms. Lent said. “It’s in the nature of the disease, and it is brutal.”

Synergetic services

One of the major hindrances to dealing with SUD on the Island is the disconnect in services. Though it’s a community with many resources, the services run independently of one another. Each has its own ways of dealing with SUD, and often doesn’t know what other services are available outside its own.

“We have very many good initiatives, but they’re more or less unaware of each other,” Ms. Lent said.

An awareness of the different kinds of work people are doing would create a sort of “synergy,” she said, that would increase the effectiveness of various forms of treatment by factoring in what else is available.

Medical students from the University of Massachusetts (UMass) who came to the Island in October for a 10-day study on SUD drew the same conclusion: There was a need for a centralized way of accessing the many services available to a person with SUD.

The students were with the group Rural Scholars, an educational program that is part of a UMass population health study for medical students and students from the Graduate School of Nursing. While on the Vineyard, the scholars served as a bridge between the various people involved — interviewing people and families dealing with SUD, meeting with police and healthcare providers, and working with Martha’s Vineyard Community Services (MVCS) and the Martha’s Vineyard Youth Task Force — sparking cooperation between people who usually don’t work together in the treatment of SUD.

Heather Reiley, a second-year medical student at UMass Medical School in Worcester, was one of the students who came to the Island last month to study SUD. In an interview with The Times last week, she said the challenge a person with SUD faces is navigating among all the services on-Island.

After about two weeks, Ms. Reiley said she still wasn’t able to tell someone suffering from SUD where to go. Rural Scholars suggested in their study that the community take existing services and make them work in better conjunction with one another.

“Martha’s Vineyard in so many ways is a model community for substance-use disorder,” Ms. Reiley said. “There’s so many people committed to it, and there are so many resources. But the points of entry and the communication between all of them is such a mess. For anyone, it’s overwhelming.”

Early intervention

Both Ms. Lent and the Rural Scholars said that early intervention is essential in preventing SUD. At a physiological level, alcohol and drug use at a young age largely dictates how a person’s brain develops and whether he or she could have issues with substance abuse later on.

“Early use of substances — even if it’s parent-supervised — early use affects neurological development in a way that makes later problems with substance use much more likely,” Ms. Lent said.

Rural Scholars found there’s “a culture of complacency” on the Island, one that at times condones early use of drugs and alcohol, making the need for early education vital. They considered the Island schools as a way to speak to a captive audience and prevent high-risk behaviors and habits from forming.

Education, at all levels, is essential in understanding and treating SUD. It’s also critical in addressing the stigma of addiction. Ms. Reiley said even the language has shifted; once called substance abuse, now it’s referred to by the medical community as substance-use disorder.

“It’s the medical community coming around to acknowledging that this is a disease. It’s a chronic illness,” Ms. Reiley said. “It breaks down the stigma. Substance abuse makes it sound more like a personal decision.”

Ms. Lent told The Times something similar. SUD is not a moral choice, it’s a genuine disease that leaves a person unable to stop the damage. It affects the many facets of a person’s life — mentally, psychologically, physically, socially, and even spiritually.

“Substance-use disorder is excruciatingly difficult to treat without the person being willing to be treated,” Ms. Lent said. “And it’s a characteristic of the disease that the willingness doesn’t come easily.”