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

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

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

Q: What does fentanyl look like?

Chester: Counterfeit pills that look like drugstore pills, but aren’t. The cartels have enough money to make pills that look real. Same color dye, same envelope. They use exactly the same machines. So when people buy something like hydrocodone (on the street), they may not get it. They can take fentanyl instead. They will be given a dose of one of the strongest drugs we have. If they have taken a lot of opioids, they may be able to survive. But if that person isn’t – maybe they’re used to taking benzo, cocaine, or methamphetamine – they could have a car accident or overdosed. The drugs available to people now are much more powerful and much more dangerous. This is my main concern. (Benzodiazepines, or “Benzos”, are depressants – drugs that decrease brain activity. They are prescribed to treat conditions such as anxiety, insomnia, and seizures)

Q: What do we get right with addiction treatment on Maui?

Chester: Glad to hear that there is more access to Narcan. The more he is in the community, the more likely he will be there when needed. The police were reluctant to wear it at first, but now it’s getting better. The concern was that people would be at risk with their (drug) use, but that doesn’t appear 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 quickly reverses an opioid overdose.)

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

Chester: There’s still a lot of stigma. The old school point of view is that addiction is a moral failure or an ethical problem, instead of being empathetic towards the person with the disease. The definition of addiction is compulsive behavior. It is not a choice that anyone has control over. That’s why we treat it. If someone was in control, they wouldn’t choose to do it.

Q: How has the pandemic affected the treatment of substance use disorders in Maui?

Chester: Telemedicine has given access to people who otherwise would have had difficulty accessing treatment. It’s awesome. But we just discussed today when we might switch to a hybrid group, because something is missing when you’re not in person.

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

Chester: Mindfulness, Mediation, and Cognitive Behavioral Therapy. Everyone is stressed, including the children. As a child, things are confusing and stressful because there is a lot to learn, a lot of changes and it’s hard to navigate. The world is sometimes not a safe place. If they are not taught healthy ways to deal with stress, they can find unhealthy ways, like drugs. They may find that the feeling that they are getting nicotine or other drugs reduces stress. As a child, you can learn to focus on your breathing. You learn to focus and relax. It’s not weird, voodoo, religious or political. It is a skill. You practice it, you learn it, you strengthen it, it gets easier. And then when you feel really stressed, you call on him. The more this is standardized in a school curriculum when you are young, people learn to adapt better. Then, as teenagers and adults, they can do it, 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 us on Facebook and Instagram @mauicoalitionfordrugfreeyouth.

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