“On the Opioid Crisis”
A Sermon by Dr. Melissa Lai-Becker
Delivered on April 8, 2018
At The First Parish in Bedford
A Thought to Ponder at the Beginning:
The purpose of people on earth is to counteract the tide of entropy described in the Second Law of Thermodynamics. Physical things are falling apart at a terrific rate; people, on the other hand, put things together. People build bridges and cities and roads; they write music and novels and constitutions; they have ideas. That is why people are here; the universe, as it were, needs somebody or something to keep it from falling apart.
—Annie Dillard, Here to Fight Entropy
Opening Words from the writings of Rev. John Corrado
In a culture that worships winners,
Some people say the church is a
a place for losers –
And they are right!
This is a place for losers!
This is a place for people who have
Lost their hair,
Lost their teeth,
Lost their memories,
Lost their savings,
Lost their jobs.
It is a place for people who have
Lost their parents,
Lost the love of their life
And even lost their children.
This is a place for people who have
Lost their way,
Lost their faith,
And, worst of all, lost all hope.
This is a place for losers – us!
Let’s see who we are
And how we are
And how much we need and can
help on another.
We are the losers.
God bless us, everyone!
Brief Reflection on Health, Healing and Religion by Rev. John Gibbons:
I spoke with one of you a few days ago and you recently happened to visit the Unitarian Church in Milwaukee. That Sunday happened to be a speaker on the subject of quantum mechanics. And you loved it! And here a few weeks ago, we had a speaker who told us a lot about dirt and “Microorganisms: Unseen and Undervalued Workers of the World.” Last week I wondered aloud about the afterlife and the quality of pomegranates in heaven. And now today it’s opioids. What’s going on here? We say, you know, “It’s not like this…every Sunday!”
I simply want to affirm that one of our foremost values as Unitarian Universalists is “a free and responsible search for truth and meaning.” That means that matters of quantum mechanics, and soil microorganisms, and the meanings of life and death, and community health and the common good are all matters of our religious concern. Everything is connected! “One cannot pluck a flower without disturbing a star,” once said Francis Bacon. One of our theologians also observed, “A purely spiritual religion is a purely spurious religion.
Unto prehistoric times, matters of health and wholeness have especially been a concern of religion. And now, as Melissa is here to confirm, we live in a time of crisis and epidemic. I’m going to ask you now to raise your hand if, in some way, your life has been touched in some way by issues of substance abuse or addiction. My hand is raised and it looks unanimous.
To be human, Albert Schweitzer once said, is to be “in the fellowship of those who bear the mark of pain.” That’s all of us.
Introduction of Melisa Lai-Becker by Nan Jefferys:
It is my great pleasure this morning to welcome Dr. Melissa Lai-Becker to the pulpit to discuss the impact of the nation’s opioid crisis.
Dr. Lai-Becker is uniquely positioned to discuss this topic. She is Chief of Emergency Medicine at Everett-Whidden Hospital in Everett, part of the Cambridge Health Alliance, which sees over 50,000 ER admissions each year. She is the Founder and Director of its Division of Medical Toxicology.
A graduate of Brown University’s School of Medicine, and an instructor at Harvard University Medical School, she is a Fellow of the American College of Emergency Physicians and American Association of Emergency Medicine. Dr. Lai-Becker also serves on numerous committees and task forces established to address opioid overdose throughout the Commonwealth.
I would say more, but after the first 24 pages of her CV, I started to get a little over-whelmed, and just included a very few of the highlights of that report.
Of course, while always somewhat in awe of her professional accomplishments, I know Melissa as a personal friend. We met many years ago at First Parish in Lexington. The Rev. Bill Clark performed her marriage to Sean Becker there in 2007. I remember being at church for one reason or another and seeing a stunning couple waft through the hall en route to a wedding rehearsal, both beaming with that inimitable “we’re getting married” bliss.
Later I learned that Melissa and Sean, both busy career professionals, had met on-line and were impressed to learn that each of them was a rabid Rex Sox fan. In fact, Melissa’s CV states that she is both a citizen of the United States and, perhaps more significantly, one of Red Sox Nation. Unable to secure tickets to an actual game at Fenway, they agreed to meet at a bar nearby that would broadcast it. Each felt that there was little to lose in this transaction, and that if the date was bust, at least they wouldn’t miss seeing the game.
The date wasn’t a bust, and in fact, it was a sufficient success that two years later, Melissa and Sean married, and held their wedding reception at Fenway Park. Over the ensuing decade, they have also taken impressive responsibility in creating future Red Sox fans by producing sons Aiden, age 9, Ronan, age 7, and daughter Erin, age 5. What a delight it has been for me to see this wonderful young family grow and thrive.
This is the second time I’ve managed to lasso Melissa into doing a service. The first time, her subject was, “What It Feels Like to Be a UU in the ER.”- drawing connections between our religious liberal faith and decision making in running an emergency room and treating patients. I am sure her remarks today will be equally compelling.
Please join me in welcoming Dr. Melissa Lai-Becker.
On the Opioid Crisis.
And it is, in fact, a crisis. Because it’s come to this: this Emergency physician is speaking
about it. At church. At not the one I irregularly attend. About the Opioid. Crisis.
So what can I tell you about the Opioid Crisis? What do you already know? What do you
want to know? What do I want you to know? What do you need to know?
You may already know these facts:
– That last year more than 59,000 people died last from a a drug overdose of an
opioid; at least 41,000 from opioids. 115 people a day.
– That we’ve hit an inflection point where deaths from opioid overdoses
outnumbered deaths from car crashes.
– That throughout our country, particularly in the midwest, deaths from opioid
overdoses increased by 30% last year.
– … while here in New England, our numbers declined. By 10%.
– That opioids can kill because they are narcotic analgesics. A narcotic — a
sleep-inducing agent. An analgesic — a drug that tempers and relieves pain. A
narcotic — a sleep-inducing agent. A sleep-inducing agent that tells your brain to
sleep and tells the part of your brain that tells you to keep breathing while you’re
sleeping to go to sleep, too.
– That an opioid is an opiate. And quick aside tox trivia: opiates with a T are
“natural” opioid narcotic analgesics, derived directly from the opium poppy.
OpiaTes come from the opium poppy — heroin, codeine, morphine. Opiates. With
a T. Heroin. Morphine. Codeine. OpiaTes. With a T.
– And Opioids — with a D — are the bigger bucket of opiaTes and opiaTe-derived
synthetics. Like oxycodone (the active ingredient in PERCOCET), hydrocodone
(VICODIN), fentanyl, carfentanil…
– Opioids with a D are the bigger bucket encompassing opiaTes with a T.
– Tox tangent: it takes only a 1” slice of poppy seed bread to turn your urine drug
screen positive for opiaTes. With a T.
What else? You may already know, without my telling you, that opioids… narcotic
analgesics… analgesics that take away the pain… that for many people are their form of
self-medication to help them through the tremendous often soul-sucking overlap of
substance use disorders with mental health crises. That some people, they don’t know
what neurotransmitter they’re lacking, they just know that they don’t feel right; that
they have psychic pain; and that opioids — they take that pain away.
And that for some reason, pre-1999, people could survive most physical pain with
ibuprofen alternating with acetaminophen (TYLENOL).
And that combined, OPIOIDS killed more than 41,000 people. Last year. More than the
number of people killed in car crashes. 115 people a day.
You may already know those facts.
So why would you come to church to hear them again? From an Emergency physician.
Because am I going to tell you how many times in the just the last year someone has
come into my Emergency Department following an overdose? How many times we’ve
administered naloxone (NARCAN(™))? In the parking lot? How many times a limp body
has been pushed out a car door in the ambulance bay and we’ve run outside, naloxone
in hand? How many resuscitations we’ve attempted? How many resuscitations have
made it to the ICU? … How many have not?
How many times we’ve called the New England Organ Bank and told them we have a
patient whose will be donating; that organs have been harvested for transplant… at my
Because I’m NOT going to perpetuate the myth of blaming the ER for the opioid crisis.
That I and my colleagues were told that it’s our fault — that we brought it upon ourselves
— that we’ve been prescribing too many opioids. When in fact prescribed fewer than <
4% of the opioid prescriptions and fewer than 1% of all tablets/pills have been
prescribed from Emergency Departments. Which is not to say that physicians and the
healthcare system and patient satisfaction scores and BIG PHARMA don’t share in the
cause of this crisis. And patient satisfaction scores; and pressure from administrators…
and patient satisfaction scores…and patient satisfaction scores and pressure from
Because we do share in responsibility. Particularly surgical colleagues and dentists, and
all physicians and prescribers who wanted to believe that there was such a thing as a
magic pill that can take away the pain. All the pain. That there is a non-addictive opioid
narcotic analgesic. Something that would not just relieve but remove THE PAIN. And we
forgot to teach people to listen to their bodies. To know that recognizing pain is
important — that it’s a signal. That the only way a pain score ever truly reaches zero is
when we’re dulled, numb to the world; dead. And that to feel some pain, is to at least be
alive. That reducing pain and not smashing it away is ok. That masking pain could hide
something… something insidious in our bodies, where pain is a signal to ask for help.
Because I’m not going to tell you how many times a patient who has overdosed is
brought in kicking and screaming — but at least alive! — kicking and screaming and
spittng; and the only thing they want to do is to leave.
I’m not going to tell you how many times patients have assaulted my staff, called us… all
sorts of not very nice names… and told us to f— off because they were dead, but now
they’re not, and they have a right to leave. They do. Have a right to leave.
I’m not going to tell you how many times mothers, fathers, siblings, girlfriends,
boyfriends, grandparents…have begged me to wave my magic wand and force their
someone — who has just punched my nurse — to go to rehab.
How many times we’ve petioned the court to force a patient into treatment.
The number of times I’ve held a moment of silence after declaring a person dead
following an overdose.
The number of times I’ve told a mother, a father, a brother, a sister, a husband, a wife, a
partner… a mother, that their child has died of an overdose.
The number of times I’ve heard teenagers more mature than you’ll ever know tell me
how they found their parent slumped on the bathroom floor; how they shielded their
younger siblings from what was happening; how they called 911 and started CPR.
And then, here’s the Kafka-esque twist: I’m not going to tell you the number of times a
patient comes to the ED and asks for help. And asks to go into detox. To start recovery.
To enter the chain of recovery. The chain of life. And together – the patient, my nurse,
myself ,our social worker, our case manager – we call and we call and we call; and it’s the
weekend. And there is no answer. And it’s after 5p. And it’s a holiday. And there is no
And then someone answers the phone! Hallelujah!… ?… and there is no room at the inn.
And worse, I can’t tell you the number of times my patient — our fellow
friend/neighbor/relative — is told by their insurance company – when they answer the
phone – that their authorization is denied you’ve used up too many days that’s not a
covered benefit that’s not essential. I’m not going to tell you the number of times these
scenarios have played out in my ED. Because the answer is TOO MANY TIMES.
TOO MANY TIMES.
You already know: we are in the midst of the Opioid Crisis. Capital O. Capital C. Every
year now more people die from opioid overdoses than in car crashes. Last year more
people died from opioids than Americans died in the Vietnam war.
And I can’t tell you how many times… how many times these sad, devastating, crazy
Kafka-esque soul-sucking scenarios play out. Sometimes it’s like a parody. A PARODY.
Instead, I’m going to let you all in on something. The secret to how we slowly; steadily;
and certainly, turn the tide. One word. Actually, one letter. Not a PARODY with a D.
PARITY. With a T.
It goes like this: opioid use disorder is a disease. It’s a disease. And we need to treat it
like a disease. Like HTN. Like asthma. Like diabetes.
Because that is the key. It is a real disease requiring lifelong treatment and maintenance
Substance use disorder is a illness. Recovery is longterm management of that illness.
Exacerbations are relapses. Relapses are part of recovery.
And that like any medical illness – like hypertension, like asthma, like diabetes. That like
any surgical disease – like appendicitis, like trauma… that opioid use disorder and in fact
substance use disorders need to be treated with parity.
The Mental Health Parity and Addiction Equity Act of – wait for it – 2008 — is ten years
old! Federal law. Federal law that prevents group health plans and health insurance
issuers that provide mental health or substance use disorder (MH/SUD) benefits from
imposing less favorable benefit limitations on those benefits than on medical/surgical
benefits. I’ll say it again. There is a federal LAW. The Mental Health Parity and Addiction
Equity Act of 2008 prevents group health plans and health insurance issuers that provide
mental health or substance use disorder benefits from imposing less favorable benefits
on those than on medical/surgical benefits.
It means: when you’re having a heart a????ack, I call the cath lab, not the insurance
company. No one cares what your insurance plan is.
But if you are suffering from substance use disorder and you are ready to enter and add
that first link in the chain of recovery, that carabiner to that lifeline, that missing link is
whether your insurance plan is willing to provide you coverage for your condition.
Yes, there are many other irons in the fire. Public Health officers of all shapes and stripes
have made recommendations and we know that there are so many things already being
– Nasal naloxone is free and available with standing orders
– Physicians of all specialties (surgery, orthopedics) and dentists are writing fewer
prescriptions, for fewer pills
– E-prescribing so that physicians can prescribe fewer pills
– Medical students and allied health professionals are receiving education on the
magnitude of the issue, of the best means to prevent is by prevention
– School children are being given education
– Prescription monitoring programs in all 50 states
– Law and law enforcement are decriminalizing the act of using
– Peer recovery coaches
– Medication-assisted treatment
And there is more to do.
And so I am deputizing all of you now, for we are all part of the problem so certainly we
are the solution.
Please stand and repeat after me:
“I pledge to treat substance use disorder with the parity – with a T –
that it deserves, as I would any other illness. That we will change the paradigm. To give
people parity. With a T.”
Because substance use disorder is a disease. We need to treat it as one.
Because this crisis is not about politics. It is about people. It is a personal pain. It is
about changing the paradigm.
Capital O. Capital C.
The solution is pariTy. With a T.