Interview: Danish Hasan on Addiction Awareness & the Opioid Epidemic

This interview also appears on MVSLIM.

Danish Hasan is a community organiser, social entrepreneur, public health advocate, and Founder of Tampa’s Opioid Research Network. In 2017, TORN was launched when the Crescent Community Clinic of Spring Hill, Florida received an AmeriCorps Vista grant. The founding members developed a targeted plan to address and understand the outbreak of opioid addiction and abuse in the area while partnering with local health organisations and law enforcement.

The opioid epidemic is a unique crisis that cuts across communities. In 2015, it cost the public 78.5 billion dollars. Last year, Florida Governor Rick Scott declared it a state health emergency. Hernando County, TORN’s base of operations, is a microcosm of the challenges posed by opioid abuse throughout the United States: rates of addiction, death, and health outbreaks have all risen in recent years. In response, TORN’s ongoing initiatives have been dynamic and multifaceted: a sharps program for collecting needles, Naloxone distribution to prevent overdoses, prescription tracking, youth education programs, and physician awareness campaigns form the core of their advocacy.

How can communities organise to solve systemic problems that seem overwhelming or impossible? In discussion, Hasan explores the challenges of the opioid epidemic, strategic thinking for nonprofits, and the global need for empathy when considering the lives of others.

“…until people start realising that every single policy affects individuals, they’re not going to change their perspective. Whether it’s healthcare or economic policies, it does affect individuals, and every individual has a story.”

Since its founding, TORN has both grown and successfully launched initiatives with communal support. Early on, what made your team effective?

We were effective because there was very little that was happening in Central Florida when it came to the opioid crisis; however, it is one of those things that has been going on for many years. Right when we were beginning, it was declared a national emergency by President Trump. A few weeks before we officially started, it was declared a state-wide emergency by Governor Rick Scott. Those two things really propelled a lot of attention towards the crisis, and it was on a lot of people’s radars, especially within the medical community.

When we started our project and were reaching out to individuals in the educational, medical, and research fields, first responders — a lot of them were updated about the opioid crisis. They were seeing it in their news feeds and on social media. The platform had been set for us. Anything that we talked about was perceived very well by the community.

One thing that I think makes us unique is that most of the people involved are doing it from the medical point — they’re health professionals who are treating addiction, or a therapist helping individuals recovering from addiction. But very few people in Central Florida are doing the grassroots stuff: holding events and candle light vigils; making this network where we’re connecting community leaders from all across the spectrum; uniting students within the college campuses and having the discussion there; and hosting panels with medical professionals.

Narcan distribution is one of our current projects: it’s a prescription nasal spray. When someone overdoses on opioids, the opioid latches onto the receptors in their brain, mainly pain receptors, and they go brain dead. When Narcan is administered, it attacks the opioids on the receptors and brings back the person. Its distribution and training is something that’s funded by the state of Florida — it doesn’t require a tax increase, fundraising, or a financial burden on the community, and now our goal is to host these trainings for physicians and pharmacists throughout Tampa Bay.

Another of our current initiatives is a prescription monitoring program. It addresses one common theme with individuals addicted to opioids, which is doctor-shopping: Person A goes to Doctor B, gets a prescription, and then they go to another doctor in a different city, and so on. E-FORCSE, the monitoring software, is free and created by the State of Florida. Doctors who are using it can then immediately know when that patient has had prescriptions filled and followed up in order to prevent possible abuse and inquire about their specific needs. Unfortunately, with the transition to electronic medical records, there’s some resistance from medical professionals — -they don’t want an additional chore.

At times, there’s an issue with compliance at hospitals. But think about the private practice setting: it’s not the doctor doing triage, it’s assistants. And so with our program, the idea is that the assistants can use the program and take notes. It can be difficult for someone to adopt technology, so we’re planning out training sessions and informational workshops to physicians, and in a way that can help maximize their efficiency as a medical practitioner.

Not many people are working within those realms of the project. I think that’s what made us effective: the foundation was already set for our work and the projects we’re working on are quite unique.

“…with mental health, someone is diagnosed and then all of a sudden society shuns them. We are getting better, but that stigma is definitely still there. To treat it like a medical crisis requires acceptance that it is a medical condition.”

Funding is a common barrier for nonprofit initiatives. What sort of strategy have you used to implement multiple projects while overcoming costs?

That’s what’s exciting for TORN: we’re finding a way to make the impact without those restrictions. A lot of people see that we’re getting the impact without the costs. These are lessons I’ve learned by being in the nonprofit sector for some time, and why I wish there was more of an emphasis on social entrepreneurship within the nonprofit community.

You need to find a way for nonprofit organisations to be self-sustaining. Every year, we see a rise in nonprofit organisations — so many individuals are so passionate about things and want to have their own project to solve a problem in the way they envision — but what ends up happening is that there’s a greater pool of nonprofit organisations, but unfortunately the number of wealthy donors and financial sources remain consistent, so they struggle to accomplish their mission.

If you can find a way to somehow return that investment of your donors, it motivates them to give even more. We don’t have that model in place currently, but it’s something we’re thinking about for the future: how can we take the funds that we’re getting and use them in a way that returns value to donors, has a community impact, and is self-sustaining?

TORN’s research finds that the resources exist but aren’t properly distributed or effectively used. What leads to this blind spot towards the opioid epidemic for government, the private sector, and others?

The opioid crisis is not dissimilar to any other medical crisis, whether it’s cancer, diabetes, smoking, or whatever it may be. What makes these crises possible is that the medical community is not being proactive — we’re not really working on prevention; it’s more of the approach that we’re just going to help resolve the symptoms of the illness. So, a patient comes in, describes symptoms, and the doctor prescribes them medicine. But who’s asking the question of how can we prevent it from happening in the first place?

A lot of what we were taught in our Public Health courses was prevention: there’s different levels of it. If you’re doing screening early on, it can prevent a lot of cancers. If you’re making lifestyle modifications, you can generally prolong the onset of diabetes or hypertension. I think the medical community in general — and no fault to their own, it’s just how things have happened — is not really proactive in going after any crisis.

The opioid crisis is nothing different and, unfortunately, I think we’re in this climate where lobbying has a lot of affect on the policies and procedures that are implemented. Last year, the pro-pharmaceutical companies were the largest lobbying group on Capitol Hill. That gives you a good idea of why some of these problems might exist. People say follow the money, and if you follow the money, the answers are pretty clear.

What’s the importance of understanding addiction and the opioid crisis in a medical sense?

I do want to emphasize that it’s not just a medical crisis. A lot of these individuals who fall into the trap of addiction often become homeless or unemployed, so it becomes an economical crisis. It’s a larger public health crisis, a social crisis, because it’s breaking up families and there’s a lot of stigma. It’s a spiritual crisis, because a lot of religious institutions are not accepting towards addiction and the support isn’t necessarily there. It becomes an economical, social, medical, and spiritual crisis, which is what makes it so dissimilar from a lot of other similar crises we’ve faced in the past, because it covers the whole spectrum.

The real issue is addiction — not opioids — and that’s a very important distinction to make. Tampa Bay Opioid Network is not against opioids. The issue isn’t the use of opioid; it’s the abuse, mismanagement, and over-prescription of opioids that leads to addiction. I think with addiction, as with much of mental health, we’re still not giving it the importance or funding from the federal government that it needs, or the safe spaces for individuals to talk about addiction, or anxiety, depression, alcoholism — whatever it may be.

That’s the society that we live in currently — those are the self-imposed restraints that we have. It makes people less willing to talk about it, less willing to accept individuals who are struggling with it, because they think it’s their fault, which is not really the case. Addiction can be genetic; there are so many other factors that might cause a person to become addicted. So the real issue is talking about addiction, treating these individuals like we treat any other patients.

I wrote a letter to the editor [of Suncoast News, a local publication] recently. I talk about how when a smoker gets lung cancer, we don’t sit there and criticize this individual for smoking for the last 30 years, right? We sit down, the social workers comes in, the oncologist is there, the family members are there, and we talk about the next five or ten years: how are we going to help fight the cancer? What are the steps we can take to stop smoking? These are the things I learned while working in research as the Moffit Cancer Center. I was in the Tobacco Relapse Intervention program.

Unfortunately with mental health, someone is diagnosed and then all of a sudden society shuns them. We are getting better, but that stigma is definitely still there. To treat it like a medical crisis requires acceptance that it is a medical condition. Once we overcome that, I think the path clears itself.

“As humans, we’re shaped by our experiences and the people we interactive with. We have to be open to change and constantly challenging ourselves. When we are susceptible, vulnerable, and put ourselves into those situations and experiences, we not only grow intellectually, but as a person…”

Have you experienced any political resistance while pursuing certain programs or policies?

Personally, no. Indirectly, yes. There are still individuals in the medical community who are unwilling to accept at least partial blame for the current crisis that we’re in. When we generally think of the opioid crisis or these sorts of hard drugs, a lot of people just imagine that it’s heroin or Fentanyl, but over 80% of individuals who are passing away as a result of drug overdose or who are falling in this addiction with opioids, it’s coming through prescribed pills.

We have certain individuals in every field and education who feel we should not be talking to students about it because it might encourage them to experiment with them. Unfortunately, those were the same individuals who don’t want us talking to about smoking or safe sex practices or pregnancy, things of that nature. Some individuals in the medical pharmaceutical business don’t really like what we’re doing. But what I will say that for every maybe one or two who are against what we’re doing, there are so many more — hospitals, CEOs, physicians — in support of our initiatives.

I think that the people who are disagreeing or becoming obstacles in the greater mission are definitely in the minority; however, even those people who do like what we’re doing and see the vision, maybe aren’t being as proactive — so there’s no real change being done. Progress is slow because everyone is still a little new to the opioid crisis and they’re not necessarily being as proactive as possible.

National Institute for Drug Awareness

In changing minds and advocacy, is there a strategy that’s proven particularly effective?

I think statistics and graphs are perhaps the best way to convince somebody. Because it’s not my opinion, your opinion, it is data that has been collected for a year or two years or three years, that has been compiled and scientifically edited and now displayed to the public. So when I share some of the statistics as a result of the opioid crisis, it really opens up people’s minds and that’s when I get most of the questions.

I do a lot of presentations in front of the county commission, school board, smaller groups in the community, and it’s always the graphs and statistics that raise the most questions and really get people’s interest. All of a sudden, everyone wakes up in the room. They’re like, “wait, can you repeat that for a second?”

Some of those statistics: in 2016, more than 64,000 Americans died from drug overdose. If you divide that by 365 days, it comes out to over 170 individuals every single day. I hate to use this example, but for a lot of mass shootings and accidental plane crashes, it makes headlines for weeks across the world, and there’s the concept that something tragic happened and innocent lives were lost.

That’s the concept that I want to emphasize — it doesn’t matter if it’s one or 50; the fact that it happened is very tragic. But can you imagine waking up every single day, turning on the news, and you see this headline, “170 Americans died yesterday as a result of opioid overdose.” In 2015, over two million people suffered from prescription opioid use disorders. That just puts into perspective some of the statistics related to the opioid crisis.

“…we’re not here to change the world, the state of Florida, or even our city. We’re here to help support individuals and families. If 10 individuals all help support one individual…those individuals become neighborhoods that then become communities.”

How can empathy shape someone’s views of addiction? Has being more directly involved with the opioid epidemic changed your perspective?

That’s a common theme in so many different policy issues, whether it’s immigration, education, general healthcare. A lot of individuals and policymakers don’t have a personal connection with the issue at hand, so they’re looking at economic factors or what voters in their district would want them to do.

A personal example: the lottery system with immigration. President Trump recently decided that he wants to do away with the lottery system. For the majority of people in this country, that didn’t really mean much — it was just another immigration act that was dismantle. But I personally came to the United States via the lottery system. As soon as I heard it, I thought, “if this hadn’t been around, I might not have been here or had the opportunity to live, reside, be educated in America.”

And that really hammered home this for me as well. A lot of people in the public are not really aware of the many issues that are prevalent in society, because they don’t necessarily have somebody or someone or a personal experience that relates to the cause.

I will say, however, that the opioid crisis is changing that. It’s unique in the sense that it has seeped into every community: religious, ethnic, and those of different socioeconomic status. Almost everybody nowadays has a family member, neighbor, close friend, an in-law, someone in the neighborhood, that has been suffering with addiction. So more and more people are showing that they do care about the issue at hand, but until people start realising that every single policy affects individuals, they’re not going to change their perspective.

Whether it’s healthcare or economic policies, it does affect individuals, and every individual has a story. Every individual has experiences. They have certain inalienable rights, so to marginalize them from society, to dismiss their issues, to not give them that open space, the welcoming atmosphere — it really is very shameful and painful in many different levels.

The reason that we call ourselves a network — and not an organisation or society or association — is because we truly want to bridge that gap between our community leaders and have that open communication and safe environment where individuals who are suffering with addiction or recovering can come to us, share their experiences, and informally talk with the physicians or educators in our network, without having to worry about the stigma.

More people need to start thinking, have a session of personal reflection: why are they not really thinking about these issues? I’m personally researching the opioid crisis, but the same mindset is definitely there for many other issues as well.

Center for Disease Control

How do you see TORN’s initiatives evolving in the future?

The more research that’s being done about the opioid crisis, the more that the community finds out, and a lot more opportunity opens up. We get new insight on some of the obstacles that are there and the resources available. Our process and initiatives are always evolving. We’ve scratched the surface in terms of our research and we’ve developed our initiatives as a result, but even then we’ve had to change a few of them up.

For example, one of our initial initiatives was a needle exchange program. One of our co-founders of TORN (Adam Albadawi) quickly found out that implementing a fully functioning needle exchange program was actually illegal in the state of Florida. These laws were implemented back during the war on drugs and the legislation has never changed since then. So here we are in 2018, trying to implement certain policy changes to help alleviate an epidemic, and there’s all these legal obstacles standing in our way. But what we could do is implement a sharps program to offer needle drop-off locations that are open to the public to help prevent the reuse of needles.

Unfortunately, our political system moves so slow, so to make any real progress might take months, at the quickest, if not years. It’s not that people don’t want to help or that our political leaders or hospital administrators are bad people — it’s just not on their radar.

What perspective can motivate someone to take initiative and contribute to a cause?

This is a view I’d have for many years: even if you change the life of one person, it matters. Truly, you go around, one by one — even if somehow we wake up and the opioid crisis is gone, there’s so many people who have suffered from addiction, so many families who have suffered, and that still needs to be taken care of. To really help them overcome that kind of experience requires a lot of one-on-one attention, emotional energy, someone sitting there and listening, caring, and being genuine, passionate, and determined to help.

This is what I tell my group all the time: we’re not here to change the world, the state of Florida, or even our city. We’re here to help support individuals and families. If 10 individuals all help support one individual, then all of a sudden you have 10 individuals that are healed. If that’s our mentality, the those individuals become neighborhoods that then become communities.

It’s a huge epidemic. It’s not possible to miraculously fix it. But what we do need more of is individuals just going around, one by one, and being a listening ear and showing genuine care to those individuals who are suffering with addiction.

As a leader and someone pursuing social change, are there principles that particularly motivate or inspire your efforts?

It’s the individuals I’ve been surrounded by. In terms of leadership, when you keep taking initiative and surround yourself by leaders and like-minded individuals and others who are taking initiative to combat community crises, you automatically develop those qualities of compassion and becoming a visionary.

Of course, I was able to hone these skills while in college and even in college I was surrounded by a lot of individuals who shared the same desire to help: we worked with refugees, feeding the hungry, making meals for people, continuing working at the Crescent Clinic as a volunteer — even after deciding not to pursue a career in medicine. I continually surrounded myself with individuals who were giving, compassionate, and dedicated by nature — leaders in their own way.

What’s your perspective on learning, change, and growth?

With every experience I have, a little part of me changes. You just become more aware of your surroundings, more compassionate. I think everyone should constantly be striving to challenge themselves and put themselves in these positions where they’re forced to think and act differently. There’s no such thing as not changing. That’s something that doesn’t really work.

People fall in this trap where they believe their mind, priorities, and perspective are set. As humans, we’re shaped by our experiences and the people we interactive with. We have to be open to change and constantly challenging ourselves. When we are susceptible, vulnerable, and put ourselves into those situations and experiences, we not only grow intellectually, but as a person and humanitarian — a global citizen. The journey of life is sharing experiences. We can only do that if we’re willing to engage with other individuals.