GRAND Magazine - September/October 2019 - 32

health

What I wish I had known
BY ELISE SCHILLER

n January 3, 2014, my 33-year-old daughter, Giana, died from a heroin overdose. I
was 62. Giana had no children, although
I did inherit her very frisky rescued pit bull, who
is now ten. I know there are many parents and
grandparents worried about a family member who may
be using deadly substances. I wish I knew then what I
know now. Unfortunately, much of what I thought and
felt when Giana was living was the stigmatized misinformation that has prevented our country from
mounting an effective response to the national
opioid crisis and prevented families from providing the
most effective support for a loved one.

Opioid use disorder (OUD) is a chronic
relapsing disease, and she relapsed overand-over again.

Giana had been struggling with dependency on opioids
for several years and had checked herself into numerous
rehab facilities. She had very good insurance due to her
job as a veterinary nurse in an acute care hospital. Most of
the time she was a willing residential patient, attending all
required sessions and following treatment recommendations. However, when discharged, her behavior validated
the definition of substance use addiction: unable to stop
the use in spite of experiencing increasingly negative consequences. Opioid use disorder (OUD) is a chronic relapsing
32 GRAND

SEPT-OCT 2019

disease, and she relapsed over and over again.
It wasn't until after her death that I began to
understand why. As the co-executor of her estate, I
was able to access her treatment records and I began
to read them against the backdrop of proliferating
research as the opioid epidemic grew. What I realized was
that she had received outdated and ineffective treatment. In
each facility she followed a routine of group meetings and
workshops based on 12 step principles, often led by
someone who was not clinically trained, where abstinence without medication was prescribed. Yet at the
time of her death, there were three medications FDA approved
to treat opioid addiction. No treatment facility that she attended
used these medications except in detox and one actually wouldn't
allow her to remain in the program if she took medication when
it had been prescribed by her psychiatrist. Medication assisted
treatment is considered the gold standard for opioid addiction,
resulting in a remission rate of about 60% compared to a 10%
rate for abstinence based treatment. Yet there are many very
expensive private facilities that didn't use it then and still don't.

What I realized was that she had received
outdated and ineffective treatment.

Much of Giana's treatment emphasized her lack of will power,
her "character defects" and her inability to connect with a Higher
Power that would "do for her what she was unable to do for
herself" as reasons for her addiction. In family groups, I was told
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GRAND Magazine - September/October 2019

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