Category: Opioid Crisis

  • Privilege Lurks at the Heart of Recovery Movements

    Privilege Lurks at the Heart of Recovery Movements

    Making blanket statements that “anyone can recover” whitewashes and overlooks the gross inequities that people of color and marginalized communities face.

    Recovery is possible for anyone, but it isn’t the reality for everyone. We may see an increasing number of people on social media proudly displaying their recovery as badges of honor — which in turn reduces stigma about addiction and a life in recovery — but it doesn’t accurately depict the true picture that recovery isn’t accessible to everyone, it heavily depends on your privilege.

    Recovering “out loud” has gained so much momentum that it’s now a social justice movement: we are now questioning advertisers who normalize the excessive use of alcohol, challenging the use of biased language, highlighting the inequity in authorities tackling opioids but overlooking alcohol as the leading cause of drug-related deaths, and advocating for policy changes that affect people with substance use disorders.

    While this recovery activism should be celebrated, we are still overlooking the inconvenient truth lurking beneath the surface: recovery is, unfortunately, still a privilege. Can we really be part of a social justice movement if we overlook the role privilege plays in the accessibility of recovery? 

    The Role of Privilege in Substance Use Disorders and Recovery

    Many people within the recovery movement believe that recovery is possible in spite of race, ethnicity, economic circumstances, nationality, sex, gender, access to health insurance, and a strong support system — in other words, privilege. This simply isn’t the reality. There are great disparities both in how addiction affects people and how much recovery capital is available to us based on privilege.

    Rates of addiction are higher in oppressed populations, especially among LGBTQ people and people of color. Black women over 45 are the fastest growing population with alcohol use disorder, and the risk of developing a substance use disorders is 20-30 percent higher for individuals who identify as LGBTQ+.

    We don’t hear about those statistics, though; we see an opioid epidemic that is largely affecting white people. When drugs have a detrimental impact on communities of color, the media is less interested in covering it. Advocate Shari Hampton explains “Nobody gave a damn when black lives were being ravaged by crack cocaine in the 80’s. Families were ripped apart; communities were literally destroyed. People were thrown in jail and some of them are still there.”

    She continues, “I’ve witnessed grandparents raise grandchildren right up to their grave while their grown children suffered from a crack addiction or a jail sentence that is so ridiculously long, it might as well be life. But now we have an opioid epidemic. It’s affecting a different demographic. And now, now it’s a treatment issue. This is disparaging and discouraging, especially to the black and brown folks that have never been treated with even a remote sense of compassion compared to what we see today.”

    This disparity continues in access to recovery. Recovery is vastly different for those who lack recovery capital — the resources that can be used to sustain recovery: financial security, education, health insurance, and a support system — which is heavily linked, again, to our privilege.

    Not all people who speak openly about their addiction and recovery are blind to the reality of the effects of privilege. In her recent book Strung Out, author Erin Khar unpacks the role of privilege in her own recovery: “Escaping addiction, and it truly does feel like an escape, requires protective layers of aftercare. I have been incredibly fortunate to have access to the support I’ve needed.”

    She continues, “We don’t have a system in place that makes it simple or easy for people to get help or support. There are financial, social, and racial barriers to getting help. If we are going to see a real downshift in the opiate crisis, support is what is needed — not just from peers and family members, but also the medical community and government.”

    Studies show that African American and Latinx individuals are far less likely than white people to complete outpatient and residential substance use disorder treatment.

    The inequity is also in access to medication. NPR highlighted a recent study by Dr. Pooja Lagisetty, an assistant professor of medicine at the University of Michigan, who stated that “this epidemic over the last few years has been framed by many as a largely white epidemic, but we know now that’s not true.”

    Lagisetty found that as overdose deaths rose between 2012 and 2015, so did though the number of medical visits where buprenorphine was prescribed. However, researchers found no increase in prescriptions for African Americans and other minorities. In fact, the study found that white populations are almost 35 times more likely to have a buprenorphine visit than African Americans even though death rates among people of color were rising faster than white people. Researchers also observed that these visits were paid for by cash (40 percent), or private insurance (35 percent) rather than with Medicaid (25 percent), suggesting inequalities in healthcare. 

    “We shouldn’t see differences this large, given that people of color have similar rates of opioid use disorder,” says Lagisetty. “As the number of Americans with opioid use disorder grows, we need to increase access to treatment for black and low-income populations, and be thoughtful about how we reach all those who could benefit from this treatment.” 

    People of color have less access to treatment not only due to socio-economic circumstances. There is also a disparity in how drug use is viewed in communities of color. Despite similar rates of drug use and sales, people of color are more likely than white people to be arrested and receive harsher punishments for drug-related offenses. 

    Khar reflects on the criminalization based on race: “Some might say it’s a miracle that I never got pulled over, never got caught with that briefcase of drugs. But I see it less as a miracle and more because I was a young woman with passing-white privilege in a Jetta.”

    She continues, “I’ve thought about this often, that had my skin been darker, had I come from less privilege, I have no doubt that I would have been arrested early on. I’ve thought about how that would have changed the trajectory of my life, how early arrests may have kept me forever trapped in a cycle of incarceration. Our drug laws are undeniably skewed to keep people of color and people of less privilege imprisoned and enslaved. And I’ve always been aware of that.”

    The true picture of addiction and recovery inequity are often ignored on social media because our privilege blinds us to these realities. But if we really want to create a social justice movement, we have to change how we relay what substance use disorders and recovery looks like for all.

    Creating a More Impactful Social Justice Movement

    Let me be clear: this article is not intended to shame anyone for their privilege; instead, I’m suggesting that we can’t ignore the true picture in favor of a prettier, more palatable version. Making blanket statements that “anyone can recover” whitewashes and overlooks the gross inequities that people of color and marginalized communities face. 

    Advocate Shari Hampton explains this discomfort that underlies many recovery advocacy conferences. “I went to a conference earlier in the year and the white fragility in the room was nauseating. I literally didn’t understand why even talking about inequality caused so much discomfort. Simply discussing the topic had white folk with pursed lips and clenched fists. White folks can’t bear to examine a system that has entitled them to more, as being broken. It’s like admitting that Jesus was black. It’s not going to happen. To do so would disrupt all things.”

    When asked how we can make a difference, Hampton responds: “America’s history teaches that black people are inferior to white people — that we don’t deserve the same treatment or opportunities. The mindset must shift. Because until we are seen, truly seen as magnificent beings, equal and worthy of the same quality of life and opportunities afforded to whites, very little will change.”

    If we really want to create a more impactful social justice movement, we need to get uncomfortable. We need to be more mindful in our social media posts and consider if what we are portraying is an accurate representation of recovery, and question if our privilege played a role in our access to resources. We need to consider if we are amplifying the voices of those marginalized and oppressed. If not, why not? And in creating events to address addiction, or in going to Washington, DC seeking policy changes, we need to stop and ask ourselves if we have invited the people who are most affected by these policies. If not, we need to ask ourselves why we aren’t amplifying the voices of the people who most need to be heard?

    We cannot divorce recovery from true social justice. Writer and sobriety coach Holly Whitaker says: “For those people who don’t want to ‘dirty up’ or confuse recovery spaces with talk of racism, classism, transphobia, homophobia, ableism, classism, etc. — remember that recovery is about awareness, and that this path is about inclusion, love, and acknowledging wrongs and injustices. If we aren’t talking about the way the system works, and who gets crushed by the system, we aren’t actually talking about recovery. We’re still just talking about our comfort zones, and using our privilege to deny other experiences.”

    View the original article at thefix.com

  • DEA Was "Slow To Respond" To Opioid Crisis, Report Reveals

    DEA Was "Slow To Respond" To Opioid Crisis, Report Reveals

    According to a watchdog report, the DEA allowed the drug crisis to reach a level that could have been prevented.

    The DEA could have done more to blunt the impact of the national opioid crisis, which has claimed more than 300,000 lives in the U.S. since 2000, according to a new report.

    The “harsh” report—released by the Justice Department’s Office of the Inspector General, which is responsible for auditing the DEA—found that despite rising opioid abuse being reported early on before the full-blown epidemic emerged, the DEA failed to act in a timely manner, allowing the drug crisis to reach a level that could have been prevented.

    “DEA is responsible for regulating opioid production quotas and investigating its illegal diversion,” said inspector general Michael E. Horowitz in a video summarizing the report’s findings. “We found that DEA was slow to respond to this growing public health crisis and that its regulatory and enforcement efforts could have been more effective.”

    Opioid Manufacturing Skyrocketed From 1999 To 2016

    The report noted that from 1999-2016, despite increasing reports of opioid abuse, the amount of opioid manufacturing authorized by the agency “also increased dramatically during that same time.”

    It should be noted that during this time period, a number of high-profile events occurred that established opioid abuse as a national public health crisis. From 1997-2002, OxyContin prescriptions for non-cancer related pain increased from 670,000 in 1997 (a year after OxyContin went on the market) to about 6.2 million in 2002, according to a timeline provided in the report.

    In 2007, Purdue Pharma and three company executives pleaded guilty to charges of false branding of OxyContin and were fined $634 million. Meanwhile, the rate of drug overdoses, fueled by opioid abuse, surged.

    Too Little, Too Late

    The agency waited until recent years to scale back opioid production. “It wasn’t until 2017 that DEA significantly reduced the production quota for oxycodone by 25%,” the report noted.

    The report did acknowledge the agency’s recent efforts to tighten up enforcement of drug diversion (when prescription drugs end up being abused in a way it was not intended) but said that more work is needed overall.

    The inspector general offered a list of nine recommendations to improve the DEA’s opioid response. They include developing a comprehensive national strategy that involves better cooperation between federal and local authorities and timely monitoring of emerging drug abuse trends, among others.

    View the original article at thefix.com

  • Man Who Posed As Doctor Convicted Of Prescribing Thousands Of Opioids At Pill Mill

    Man Who Posed As Doctor Convicted Of Prescribing Thousands Of Opioids At Pill Mill

    The fake doctor wrote prescriptions which had been pre-signed by a registered physician for more than 200,000 doses of hydrocodone.

    A man who pretended to be a physician and issued prescriptions for hundreds of thousands of doses of opioids was found guilty after a five-day trial, the Department of Justice (DOJ) announced.

    Muhammad Arif, 61, is awaiting sentencing for one count of conspiracy to unlawfully distribute and dispense controlled substances and three counts of unlawfully distributing and dispensing controlled substances, which he carried out from late 2015 to early 2016 at an unregistered pain clinic in Rosenberg, Texas, which federal authorities described as a “pill mill.” 

    Though unlicensed to practice medicine, Arif saw patients and wrote prescriptions for hydrocodone and other drugs that were pre-signed by a registered physician. Both the doctor and the owner of the clinic were named as co-conspirators in the case.

    Patients Shell Out $250 Cash For Hydrocodone, Soma Prescriptions

    According to the DOJ release, evidence presented at the trial showed that up to 40 people a day could visit the Aster Medical Clinic, where they obtained prescriptions for over 200,000 dosage units of the opioid pain medication hydrocodone and over 145,000 dosage units of the muscle relaxant carisoprodol, a Schedule IV controlled substance which is also sold under the brand name Soma. 

    “The combination of hydrocodone and carisoprodol is a dangerous drug cocktail with no known medical benefit,” wrote the authors of the DOJ release.

    Testimony revealed that individuals were charged $250 in cash for each visit. “Crew leaders” would recruit individuals to pose as patients and paid for their visits in order to obtain the prescriptions, which were sold on the street.

    Real Doctor Pleads Guilty for His Role in Pain Med Scheme

    The co-conspirators—Baker Niazi, 48, and Waleed Khan, 47—both pled guilty for their roles in the prescription scheme at Aster Medical Clinic, and like Arif, are currently awaiting sentencing.

    The case was investigated by the Drug Enforcement Administration and was brought as part of the Medicare Fraud Strike Force, a joint initiative between the DOJ and the U.S. Department of Health and Human Services.

    Since 2007, the Strike Force, which operates in 23 districts, has charged nearly 4,000 defendants, who have billed Medicare for more than $14 billion.

    The news comes on the heels of the DOJ’s August 28th announcement regarding charges filed against 41 individuals for their alleged involvement in a pill mill network of clinics and pharmacies.

    According to the press release, the owner and pharmacist at one pharmacy allegedly dispensed the second highest amount of oxycodone 30 mg pills of all the pharmacies in Texas in 2019, and the ninth highest amount in the United States.

    View the original article at thefix.com

  • Doctors Prescribe More Opioids Late In The Day, When Running Late

    Doctors Prescribe More Opioids Late In The Day, When Running Late

    Time constraints and “chaotic practice environments” may be to blame for the troubling reliance on prescriptions.

    Doctors are significantly more likely to prescribe opioid pain pills later in the day or when their appointments are running behind schedule, according to a new study. 

    The study, published in JAMA Network Open, looked at records from nearly 700,000 primary care appointments. The study authors found that doctors were 33% more likely to prescribe opioids late in their day than they were during their earlier appointments. In addition, appointments running behind schedule increased the likelihood of an opioid being prescribed by 17%. 

    It’s often mentioned that time constraints on patient appointments cause doctors to turn to prescriptions, rather than engaging to find alternative treatments, a process that can take much longer. The researchers wanted to use measurements and data to see if that is truly the case. 

    A Long-Suspected Factor in Overprescription

    “Many observers have blamed chaotic practice environments (ie, increasing financial pressure, productivity expectations, and the cognitive effort of caring for complex patient populations) for high rates of opioid prescribing because opioids can be a quick fix for a visit where pain is a symptom,” study authors write. “The concept that time pressure can drive physician decision-making is long-standing, but little empirical literature has examined the existence of this phenomenon or its magnitude.”

    They found that the theory did hold up, across all providers. 

    “Physicians were significantly more likely to prescribe opioids as the workday progressed and as appointments started later than scheduled,” they wrote. 

    Awareness of Bias May Help Reduce Opioid Dependence

    The researchers said that there are vast difference in prescription rates between individual doctors and hospitals that can’t be explained just looking at the the time of day of appointments. However, they point out that the difference in prescribing at different times of the day can also help explain some of the difference in prescribing between different providers.

    “Full-time clinicians may have higher opioid prescribing rates simply because of the effort involved in long clinical days,” they wrote. “Sharing individual data on these patterns with physicians could raise awareness of this bias and help them develop approaches such as schedule modifications to lower the burden of taxing or time-consuming decisions late in the day.”

    On a national level, addressing this difference could help reduce opioid prescriptions and ultimately lead to fewer people becoming dependent on opioids. 

    “If similar patterns exist in other clinical scenarios, such as managing challenging chronic illness, this phenomenon could have relevance for public health and quality improvement efforts,” the study authors write. 

    View the original article at thefix.com