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Voices In Prevention

Voices in Prevention spotlights people on Maui, Moloka’i and Lana’i who are working in drug use prevention, treatment and recovery, or are affected by substance use. This month, we spoke with Dr. Jeffrey H. Chester, co-owner and medical director at Akamai Recovery in Wailuku.

Q: What substance are you most concerned about right now in the Maui community?

Chester: I am concerned about the recent fentanyl overdoses in Kihei. I’ve been practicing on Maui for 20 years this December, and what I’ve seen is an increase in overdoses from illegal drugs, especially fentanyl. So we may feel like we’re winning because we’re not prescribing as many opioids, but we’re seeing more illegal fentanyl.

Q: What does fentanyl look like?

Chester: Counterfeit pills that look like the pills from the pharmacy, but are not. The cartels have enough money to make pills that look real. Same color dye, same casing. They’re using the exact same machinery. So when people buy something like hydrocodone (off the street) — they may not actually be getting that. They may be getting fentanyl instead. They will be getting a dose of one of the most powerful drugs we have. If they’ve been taking a lot of opioids, maybe they can survive. But if this person is not — maybe they’re used to taking a benzo or cocaine or meth — they may get into a car crash or overdose. The drugs available to people right now are much more powerful and much more dangerous. That’s my primary concern. (Benzodiazepines, or “benzos,” are depressants — drugs which lower brain activity. They are prescribed to treat conditions such as anxiety, insomnia and seizures)

Q: What are we getting right with substance use treatment on Maui?

Chester: I’m happy to hear there’s more access to Narcan. The more that it’s in the community, the more likely it is that it’ll be there when needed. Police officers were hesitant to carry it at first, but now it’s better. The worry was that people would be more risky with their (drug) use, but that doesn’t seem to be the case. (Narcan Nasal Spray is used for the treatment of a known or suspected opioid overdose. It contains naloxone, a medicine that rapidly reverses an opioid overdose.)

Q: What is the biggest barrier to treatment you see people face on Maui?

Chester: There’s still a lot of stigma. The old-school view is that addiction is a moral failing or ethical problem, instead of being empathetic towards the person who has this disease. The definition of addiction is a compulsive behavior. It’s not a choice that someone has under control. That’s why we treat it. If someone had the control, they wouldn’t choose to do it.

Q: How has the pandemic affected treatment for substance use disorders on Maui?

Chester: Telemedicine gave access to people to people who would have otherwise struggled to get treatment. That’s been great. But we just discussed today when we might transition to a hybrid group, because there’s something missing when you’re not in person.

Q: What can we do differently to prevent substance use disorders on Maui?

Chester: Mindfulness, mediation and cognitive behavioral therapy. Everyone experiences stress, including children. When you’re a child, things are confusing and stressful, because there is a lot to learn, a lot of changes and it is hard to navigate. The world is not a safe place sometimes. If they are not taught healthy ways to deal with stress, they may find unhealthy ways, like drugs. They may find the feeling they get from nicotine or other drugs reduces stress. As a kid, you can learn how to concentrate on your breathing. You learn how to focus and relax. It’s not weird, voodoo, religious or political. It’s a skill. You practice it, you learn it, you reinforce it, it gets easier. And then when you’re feeling really stressed, you call upon it. The more that is normalized into a curriculum when you are young, people learn to cope better. Then as adolescents and adults they can do that, instead of having a beer, or 12.

* To learn more about Akamai Recovery visit akamai.healthcare/. For more information on the Maui Coalition for Drug-Free Youth, visit www.mcdfy.org or follow on Facebook and Instagram @mauicoalitionfordrugfreeyouth.

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