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  • Prevent Opioid Overdose Deaths: A Call for Specific Prescribing Laws and Physician Oversight

    Prevent Opioid Overdose Deaths: A Call for Specific Prescribing Laws and Physician Oversight

    Make doctors precisely explain why they are prescribing opioids and why they decided on the pill count and refill allowance for each patient. 

    Recently, a friend’s teenage daughter underwent a procedure common for young adults: she had her wisdom teeth extracted. I had the same procedure performed in the late 1990s, at age 20. Back then, I was given a bottle of ibuprofen for the pain and, for the bleeding, told to apply tea bags. My friend’s daughter was given something just a tad stronger: 

    Vicodin.

    A teenager was given a strong opioid painkiller to numb the pain of a routine tooth extraction. It’s absurd that this is the accepted medication for this procedure when there are no complications, nothing that would indicate breakthrough pain on a level of requiring a narcotic that is given to cancer patients.

    However, the fight against opioid abuse is finally gaining promising victories by wielding an effective weapon: lawsuits. 

    Holding Big Pharma Accountable

    As the epidemic grew, many – myself included – called for state and local authorities to take drug companies to court for knowingly encouraging large-scale consumer usage of highly addictive prescription painkillers such as OxyContin, Vicodin and Percocet. Thousands of lawsuits have now been filed and in August, the $572 million decision won by Oklahoma against Johnson & Johnson became the first large-scale trial ruling concerning Big Pharma’s role in creating the opioid crisis. The state argued that J&J, which had supplied 60% of the opioids drug makers used for painkillers, aggressively marketed the drug to doctors and patients as safe. 

    Most recently the Sackler family – owners of Purdue Pharma, which makes OxyContin – reached a tentative settlement for$10-12 billion, a move that will result in the company’s bankruptcy. 

    They lied, we died, and now they have to pay up. Hopefully these are just the first few drips in an oncoming flood of restitution owed Americans by companies responsible for an unprecedented addiction crisis. They deserve whatever fates come their way – criminal, civil, or, as the 800-pound spoon left at Johnson & Johnson’s headquarters intended, shame-filled. 

    Now, as the overdose death rate shows signs of ebbing but has by no means abated – 68,000 Americans died in 2018 compared with 72,000 in 2017, hardly cause for celebration – it’s time to ask what’s next. 

    For years, drug companies pushed opioids as a panacea for all things pain-related. The result was an absolute avalanche of prescriptions: 191 million in 2017 alone, which averages to 58 opioid prescriptions for every 100 Americans. And despite guidelines intended to discourage opioid painkillers as a first-step approach to easing pain, primary care clinicians – most patients’ initial gateways to healthcare – wrote 45% of all opioid prescriptions. 

    Surgeons also have been implicated in widespread overprescribing. One study of nearly 20,000 surgeons, led by Johns Hopkins School of Public Health researchers, noted the common practice of prescribing dozens of opioid medications even for low-pain operations. Some prescribed over 100 opioid pills for the week following a surgery, along with usage instructions far exceeding guidelines from several academic medical centers. No wonder some six percent of all patients prescribed opioids post-surgery become dependent. 

    The diagnosis is simple: Doctors have proven incapable of, or unwilling to, exercise responsible discretion in determining which conditions and medical procedures necessitate painkillers notoriously linked to addiction, misuse, and overdose. 

    A Painful Backlash

    Complicating matters, the opioid crisis has become a two-way street. 

    In response to the backlash to the initial opioid free-for-all, many doctors have become so wary of prescribing opioids that those who truly need them are unjustly suffering. Much of this hesitancy is a reaction to guidelines issued by the Centers for Disease Control in 2016 that, according to Richard Lawhern, founder of the Alliance for the Treatment of Intractable Pain, has subjected patients with legitimate chronic pain to a “draconian reduction” in doctors willing to meet their needs with opioid-based medication.

    The problem with the CDC’s directive was vagueness of language. The guidelines state that opioids are appropriate for pain caused by cancer, end-of-life care, and “palliative care.” But “palliative” is a subjective term, and therefore confusing for doctors who, understandably, now have their guards up against malpractice suits in addition to opioid addiction and abuse. In a February 2019 reiteration of its guidelines, the CDC clarified that opioids are reasonable for chronic pain but, unfortunately, repeated its ambiguous wording concerning specific conditions. 

    However unintended, the result is patients who rely on opioids for legitimate medical reasons suffering for the sins of Big Pharma and, subsequently, the incompetence of government officials and the inadequacies – including cowardice – of doctors.

    The scale of the crisis and forcefulness of the backlash also has resulted in patients who, through no fault of their own, became dependent on opioids and, at the drop of a guideline, found themselves completely cut off from a highly addictive drug and dropped into a hellish withdrawal. The unsurprising consequence of this overreaction by doctors is patients turning to the streets for unregulated, often fentanyl-tainted heroin. Any laws written to specify opioid painkiller administration must include reasonable ways of relieving already-addicted patients through treatment centers and weaning agents like methadone and buprenorphine (suboxone). 

    However, the conviction permeating the chronic pain community – that doctors rather than laws should be the primary determinant of opioid prescriptions – simply doesn’t hold water. It’s become clear that doctors don’t necessarily know best. We need rules that hamstring the parasitic overprescribers while unhandcuffing the paranoid underprescribers.

    Guidelines Aren’t Enough

    It’s time for legislators to take the mystery out of this branch of medicine. If doctors can’t stop writing opioid prescriptions to those who don’t need them, or refusing to write prescriptions for those who do, then we must enact laws with clear prescribing instructions. 

    We’re all familiar with mandatory sentencing guidelines; we need mandatory dispensing guidelines – laws that bring harsh punishment for overprescribing pain medication when it’s not indicated, while reassuring doctors that they will not be unfairly punished for providing chronic pain patients with the relief they require.

    The time has come for customized ailment and procedure-related opioid painkiller dosing laws, complete with extensive medical rationale requirements. Make doctors precisely explain why they are prescribing opioids and why they decided on the pill count and refill allowance for each patient. 

    We also need to look at something else: ourselves. Especially in post-surgery settings, the opioid overprescribing epidemic was exacerbated by the naïve, altogether modern notion that patients should never feel discomfort or pain. 

    If alternatives to opioids don’t kill 100% of post-procedure pain, the new one-word answer should be “tough.” The idea that we can go through life without ever experiencing pain is not only delusional but, as we’re seeing, destructive. Things heal. Patients will need more, well, patience. 

    Numbing people literally to death is not the answer. It is irresponsible and dangerous to prescribe opioids for an ingrown toenail. Or for carpal tunnel syndrome. Or to a child following a tonsillectomy or, of course, a teenager after a tooth extraction. 

    On the flip side, it is cruel and flat-out stupid to deny patients with serious chronic pain access to a now-demonized family of medicines that for many has meant the difference between functioning and debilitation. 

    The time for general guidelines is behind us. We need strict, specific statutes that greatly diminish doctors’ discretion while placing transparency and responsibility squarely on their shoulders. 

    View the original article at thefix.com

  • "Dope World" Takes a Globe-Spanning Deep Dive into Our Relationship with Drugs

    "Dope World" Takes a Globe-Spanning Deep Dive into Our Relationship with Drugs

    Vorobyov investigated drug use and culture in 15 different countries on five continents, from the coca plantations of Colombia to the mean streets of Moscow.

    With the release of his new book, Dope World: Adventures in Drug Lands, Niko Vorobyov has become the Anthony Bourdain of drugs and the worlds they inhabit, a modern day Hunter S. Thompson. By interviewing cartel members, big-time drug dealers, street guys, gang members, and even government officials, Vorobyov seeks to understand humanity’s bond with drugs. 

    Before our interview, Vorobyov told me about one surreal night in the mountains of Sinaloa, Mexico, where he and his buddy had traveled for a meeting with one of El Chapo’s relatives. Deep in cartel territory, with posted guards everywhere brandishing AK’s and AR-15’s, where one wrong move could mean death, El Indio, the guy who owned the ranch, threw a sushi party. 

    Vorobyov remembers all these guys standing around with assault rifles slung over their shoulders eating sushi. One of the gun-toting sentries even came over to Vorobyov and started chatting to him about movies. He came away with the feeling that El Chapo’s family were pretty normal, if you forgot about the guns.


    Tributes to Malverde, the Sinaloa patron saint of narcotraficantes.

    The Fix: Why did you decide to examine every angle of the drug war and how has the drug war affected the whole world?

    Niko Vorobyov: There’s a lot of great books about this already — Chasing the Scream is one of my favorites — but they take a very Anglo-centric point of view. I wanted to explore other places that we don’t hear about so much like Russia, Japan, and the Philippines. Some people like to say it’s all America’s fault and that they started this whole mess with Richard Nixon, but it goes back way before that, all the way to China and the Opium Wars. Right now, America’s legalizing weed while Russia, China, and the Philippines are fighting the drug war the hardest.

    Why do you think you got involved with drugs in the first place?

    Growing up I was quite a weak person with low self-esteem, so I kinda thought if I acted in a certain way, that would help me accept myself; that drugs and criminal activity would get me friends and respect and all that. I started getting a lot into the underground rave scene and became a student drug dealer. And once you start moving in those circles it’s quite easy to make connections and meet a supplier. From then on, I worked my way through ups and downs till I had a small crew running weed, coke, and MDMA through the hallowed halls of East London universities. 

    But I got reckless and ended up doing a 2½ year prison stretch which really changed my outlook on life — it made me question who I was and what I was doing here. Sitting in a cell on 24-hour lockdown I read everything I could about the history of drugs and drug bans, how and why they were forbidden, and what the consequences of that may be. When I got out, that led me on a journey across 15 different countries on five continents, from the coca plantations of Colombia to the mean streets of Moscow.

    Looking back now, how did your early drug use and even prison prepare you to write Dope World?

    I’ve always had an anti-authoritarian streak; I’ve hated others telling me what to do, especially if it was “for your own good.” Of course I’ve taken drugs — if I haven’t, would that make me more [qualified] or less qualified to write about this topic? I keep reading articles where you can tell they’ve never dabbled in any psychedelic pleasures because none of them have a clue what they’re on about. Looking back, I wasn’t really very political before I went to prison because it’s easy to feel detached when it’s happening to someone else. 

    But when you’re locked in a cell for 23½ hours a day and there’s not enough staff because someone wanted to save a few pennies, you start to see all these abstract ideas are life-or-death shit. And when you see all these poor, working-class people or ethnic minorities while the government’s laughing all the way to the bank — the UK’s one of the biggest legal weed exporters in the world — it makes you ask what’s wrong with this picture. 

    You interviewed Freeway Rick Ross. What did that teach you about the crack era in L.A. and across the nation?

    The first thing you need to know is the real Rick Ross is not a rapper – that Rick Ross actually batted for the other team as a prison guard. Freeway Rick Ross was the biggest crack kingpin on the West Coast in the 80s and early 90s — this dude supplied the Bloods and the Crips. Ricky’s a tough man to get ahold of; he was actually on his own book tour as I was trying to reach him, so I’m glad he came through. Where his story gets really interesting is when he was involved in the Contra cocaine scandal. 

    The CIA was allowing the Contra rebels in Nicaragua to smuggle coke into the U.S. for buying more firepower and fighting communism back home. Freeway Ricky unknowingly took the Contra’s coke and cooked it up into crack before selling it in South Central, without realizing he was just a small pawn in a chess game of global politics. I’m not really a conspiracy nut, but it’s amazing that this whole scandal came to light—how the Agency knowingly used a foreign army pumping crack into the hood — and it makes you think about what else they might’ve done that we don’t even know about. 

    At the same time, the Feds were going down hard on the inner city to fight the so-called crack epidemic. Congress passed the Anti-Drug Abuse Act 1986 which meant that mostly black and brown people who were caught with five grams of crack got the same sentence as someone with half-a-kilo of regular blow. Freeway Ross ended up getting life, while none of the top players who approved the Contra plan wound up going to jail. That tells you everything you need to know about the hypocrisy, racism, and corruption in the war on drugs.

    In the book, you write about LSD in Tokyo. Can you talk about that?

    So the chapter on Tokyo is all about meth, LSD, and synthetics. I mostly fucked with the Yakuza (Japanese organized crime) and found out how they roll with being among the top meth dealers in Asia. But there was another group that was also quite interesting — a cult named Aum Shinrikyo or “The Supreme Truth,” which in 1995 carried out the deadliest terrorist attack in Japan, poisoning 13 people on the Tokyo subway with sarin gas. Like the CIA used to do in the 50s, the cult used LSD as part of their brainwashing. Maybe being on psychedelics made their wacky conspiracy theories believable. 

    Of the places you visited, which had the worst addiction problems? 

    When I was in Lisbon, the head of an NGO showed me a video of how this neighborhood used to look like. In the 1990s, Casal Ventoso was one of the biggest open-air drug markets in Europe and it really looked like a nightmare version of The Wire or a cheap movie set of the bad side of town. Dystopian scenes; crowds of ragged-looking addicts shuffling past crumbling buildings and filthy, trash-ridden streets. One guy was missing his arm. Portugal had a major heroin crisis — something like 1% of the population was addicted — but it’s precisely because their crisis was so bad that they managed to push through reforms and de-stigmatize addicts.

    Of the places I’ve been to now, it’s hard to say — everywhere has its problems — but probably the most widespread I’ve seen was in Kerman, an Iranian city near the Afghan border. It seemed like every household had at least one member smoking opium, or taryak, and you can see people lighting up pipes or spoons in the archways of the old market. Iran’s a very religious country and opium’s tolerated more than booze. But I’d say every other young person drinks, and there’s a rising alcohol problem because they’re too scared of getting help.


    Vafoor, or opium pipe, in Kerman, Iran.

    When do you think the world will stop criminalizing addiction?

    I think we’re slowly moving in that direction. The police in some parts of the UK have stopped targeting low-level user-dealers. A lot of the people I’ve talked to are cops, and as a former drug dealer that’s not a conversation I expected to have six or seven years ago! Then you’ve got someone like Boris Johnson inhaling a South American nose remedy, and he’s gone on to be leader of a country that used to own half the world. 

    I’m not saying they’re connected, but we’re starting to realize taking drugs doesn’t always lead to the worst-case scenario. A couple of months ago Malaysia, which was putting convicts to death, announced they’re following Portugal and decriminalizing drugs which means that you won’t end up in jail for having a gram in your pocket. And that’s a very conservative country; much more conservative than, say, Ohio. So I think there’s hope.

    What did you learn the most during your travels and writings?

    I think the most important thing is no matter how much you read, you’ll never truly know how the world works from your bedroom (or in my case, my cell). You’ve got to go to places and talk to people. Listen to them, even if they’re chatting complete bollocks, and try to understand why they think the way they do. We try to put everything in boxes — good or bad, left or right — but our world is too complicated for that. My agent called my book a fucked-up travel guide. I hope I’ve inspired someone to check out these places, if I haven’t scared the shit out of them already.

    There’s a sense that this is it, you’re fucked now. No one’s coming to get you. When you and I get stressed now we can take a walk; go outside; talk with our friends; but when you’re in prison, you’re stuck alone in a tiny cell till they let you out, and you start going crazy. When I was inside there were so many cutbacks they didn’t have enough staff to run the show properly, so sometimes we’d be locked up 23½ hours a day— suicides went sky-high that year.

    What takeaways do you want readers to have after reading your book?

    Look, you might not like the idea of your little cousin bouncing off the walls after a line of Bolivian marching powder. My mum read the book and she was fucking mortified. But dopeworld is everywhere, from scuzzy housing projects to the highest echelons of power, so we’ve got to find a way of living with it, otherwise families will keep getting torn apart and the bodies will keep piling up, whether it’s through prisons, gangs, or ODs. We’ve tried drug war, now let’s try drug peace.

    Search results from the dark web.

    View the original article at thefix.com

  • The Perils of Dating While Sober

    The Perils of Dating While Sober

    I am acutely aware of how careful I am to minimize my recovery journey when I first start dating someone.

    A few months ago, a male friend and I were talking about the frustrations and disappointments of dating. I mentioned how lonely it can be navigating this world on my own, without a traveling companion, a long-term lover, or a hiking partner, without someone with whom to Netflix and chill on a rainy Sunday.

    He said, “Dating is complicated for everyone, but for you, with your history? I can only imagine. Maybe guys are afraid of you, afraid of your intelligence and strength.” He hesitated and then continued, “Or maybe they’re just afraid to get close because of your bipolar diagnosis and…well, you’re an alcoholic. So a drink in a bar is out. Your history makes them wary. It’s going to take someone special, someone who’s willing to accept that risk and all your baggage.”

    All Your Baggage

    All your baggage. My old shame rose up, and his words fell on me like a one-hundred story building collapsing, cinder block by cinder block, The only words I could say in clipped retort? 

    “It’s called alcohol-use disorder now,” I said. “Update your vocabulary.”

    For days I replayed his assessment in a loop, an auto-play rumination and in self-defense, even wrote out a bulleted response:

    • Men afraid of me? Seriously? Maybe he’s afraid of my brain, but I’m afraid of his brawn. I’ve been sexually assaulted twice by two different men. Statistics show that women are more likely to be harassed and assaulted and raped—their lives endangered—by men than vice versa. 
    • I’m on a low dose of lithium now, and eight years stable and on an even keel since my divorce. My psychiatrist thinks I may not really be bipolar, or that maybe my bipolar instability was triggered by the conditions of my marriage.
    • And on dating apps, so many men post pictures swigging beer, wine, and booze and list beer, wine, and booze as hobbies. Almost always the first message they send is, “Do you want to get a drink?” And when I suggest a walk, a museum, non-boozy meetup? They disappear.
    • No drama, no crazies, no baggage: an oft-repeated list of No’s on dating profiles, but then these men (perhaps women do this, too?) indicate that they are married and looking for discretion, no strings attached; they also like to post photos of bloodsport: bare chested with AK-15’s and dead animals. But no drama!
    • And finally, too risky to love me? I’m a safe bet now! Look at the evidence: Sober, stable, all my s*** sorted!

    Doth the lady protest too much? Might my bulleted explanation be my armor against latent shame? Because what I am admitting to in my list is that I am lovable only now that I am well, and that when I was unwell? I was unlovable. 

    Love Is an Inherently Risky Proposition

    “I stopped loving you when you got sick,” my ex-husband told me when we decided to divorce, and it’s what I have secretly believed for so long. Hence, my adamant insistence that I am well, well, well and have been now for years, years, years. 

    But this narrative—I am such a scary person to love that it will take someone with extra-special love powers to love me—is one that no one with any diagnosis or at any stage of recovery should ever buy into. Love is an inherently risky proposition. We are at our most vulnerable when we love, trusting our hopes and fears to each other. And there is always the risk of love’s end, but, too, always the possibility of love’s beginnings, its growing and expanding.

    And yet, finding our way to a beginning of love with someone can be daunting and terrifying as we have to negotiate our commitment to honesty, open-mindedness, and willingness. We must reconcile that old shame that rises up, sometimes in ripples, sometimes in waves, when we summarize our histories or share how we still struggle with one day at a time with a new partner. I am acutely aware of how careful I am to minimize my recovery journey when I first start dating someone.

    “Oh,” I might say, “I stopped drinking because I wanted to live a healthier life, and for a few years I struggled with depression, but it’s all good now. Really, all good now.” Again that adamant insistence, again that background noise in my head: If he can fall in love with me now in all my lovableness, then none of my previous unlovableness will matter. Of course, even for those who have not struggled with mental illness or alcohol or substance use disorders, it is impossible for “all” to be forever good.

    “Really Crazy”

    I recently ended a relationship with someone after two months of mostly happy, breezy fun but I realized I’d been dodging my shame. When we first met, he mentioned early on that his ex-wife was bipolar. “Really crazy,” he said, and gave me a look that put me on notice.

    So I casually mentioned to him that I had bipolar as well, but “Stabilized!” I said, with a giant calm smile plastered across my face, and I even fluttered my eyelashes in flirty dismissal.

    He said he could see I was in a “good place” and not at all like his ex. And because I want the world to believe that I am in a good place (and most days I am), I nodded in enthusiastic agreement. 

    But then, a few weeks later, he mentioned that my town was known for the State Psychiatric Hospital, opened in the 1840’s and now shuttered. 

    “Have you ever been there?” I asked, because it is now a tourist stop—The Walking Dead once filmed a scene at the mostly abandoned grounds and there are historical markers describing the troubling treatment of the mentally ill across its almost 150 year history.

    “No,” he said, immediately and with a laugh. “I’m not one of the crazies.”

    Of course, during a period of my own instability, I was once one of those “crazies,” in and out of a psychiatric hospital. He knew this by now, though maybe because I “presented” as so very very well, he couldn’t believe that was part of my history.

    To be fair, he made these comments casually, without malice, the kind of talk that generally surrounds those of us who suffer from mental illnesses or who are on a recovery journey. They were the kind of comments I often hear because most people assume, by looking at me and my “got it all together life,” that I am one of them, i.e., “not crazy.”

    But even if his comment was thoughtless, I felt that old shame rise up and stayed silent because I didn’t want him to suddenly see me as sick, and hence unlovable, and consequently maybe leave this beginning of us. So I made a silly remark about ghosts who must surely haunt those grounds. 

    No bulleted list at the ready but here’s what I should have said:

    “It’s hurtful to hear you call someone with my diagnosis ‘really crazy,’ and to call those in treatment ‘crazies.’ We all have our baggage, don’t we? We live and stumble and get up and try to live better, always. All of us.”

    But his remarks and my silence unsettled me. How easy it is for me to talk the talk, but how hard it can be to walk the walk. A few weeks later, I ended this beginning because, yes, I have baggage, and it is not just a free carry-on roller bag, but one of those $20K vintage Louis Vuitton trunks that have drawers and a hanger rod, room enough for my pain and my joy, my mistakes and my amends, my shame and my wisdom. 

    That is, a trunk big enough to carry all my necessities for this continuing journey.

    View the original article at thefix.com

  • Drug Deaths in Black Communities and Our Collective Denial

    Drug Deaths in Black Communities and Our Collective Denial

    “While white addicts receive treatment, drug counseling, and a lenient criminal justice system, there are Black people still behind bars because of mandatory minimums, three-strikes laws, and disparate drug sentencing.”

    “Google ‘Children of the Opioid Epidemic,’” said professor Ekow N. Yankah. The search sent me to a year-old New York Times feature about children born to mothers struggling with opioid use disorder.

    “How tender a picture is that?” he asked.

    The image, a white infant coddled by her mother, was hard to ignore. They stood crouched down on the floor of what could be my childhood home. Mom’s dirty-blonde hair was strewn about, covering her face as she embraced her child. She was asking for forgiveness or redemption or both. I’ve been there.

    “That is a picture of a young woman who, whatever her drug addiction is, is fighting to be a decent mother,” Yankah continued. 

    Yankah, who teaches criminal law at Cardozo Law School and is a board member of the Innocence Project, made his point. “Compare that with what you know of welfare queens and crack mothers,” he said. “Was there any image like this in the collective mind of our society when we talked about crack mothers?”

    It’s a rhetorical question. Images and headlines from the crack-cocaine era remain burned into our psyche. But awareness is not acceptance. So, let’s be honest. It’s no accident that America’s newfound compassion comes during the opioid crisis. Eighty percent of overdose victims are white. 

    “We don’t get to move on by pretending that this is a coincidence,” Yankah said. 

    “People are saying: look, it’s not racism. It’s that we tried the other model and it just didn’t work,” he continued. “As if for 25 years, we tried to lock up a whole community, and when the color of the community switched, we suddenly grew enlightened.”

    There’s Always Been a Cocaine Epidemic

    According to the Centers for Disease Control and Prevention, cocaine-related overdose deaths rose about 216 percent between 2012 and 2017. That’s double the growth rate of opioid deaths for the same period.

    Most of those deaths happened in black communities. Black adults were twice as likely as whites to die from cocaine-related causes. In 2017 the numbers were 8.3 per 100,000 compared to 4.6. And even though overall deaths rose recently, the data shows that black people have always had double the rate of cocaine overdose as their white counterparts. 

    Further data shows that black folks are more likely to develop cocaine dependence or a past-year use disorder. For almost two decades now, we’ve had data that shows cocaine use disproportionately affects black communities.

    But today’s headlines make it appear as if it’s a recent phenomenon. “The Opioid Crisis Is Becoming A Meth And Cocaine Crisis,” wrote Buzzfeed last January. “As the Opioid Crisis Peaks, Meth and Cocaine Deaths Explode,” the Pew Trusts noted in May. The list goes on ad infinitum. 

    The cocaine epidemic in black communities is not new. 

    Around three-fourths of these fatalities involved fentanyl or other opioids, but we don’t know if the presence of the opioid was disclosed to the user. Officials speculate it could be a contaminated drug supply. More people could also be doing speedballs (a combination of cocaine and opioids).

    Whatever is behind the disproportionate rate of overdose, experts remain stumped — and until recently, no one really cared.

    Because despite the data, and the appreciation for treatment-based solutions, research remains lacking. A PubMed search shows little to no relevant information. Most news outlets have ignored the issue. 

    It’s Just a Cruel Delusion

    “Americans really have the sense that history starts anew with every generation,” Yankah said. 

    “I schematically undermined your family, and then my children look up and say to your children, ‘look, I don’t know why I’m so much better off. I must have worked harder,’” he continued. 

    “It’s just a cruel delusion.”

    At first, systemic racism spared black people from the opioid crisis. Doctors are more likely to label black patients as either addicts or drug dealers, so they are less likely to prescribe opioid painkillers. 

    But opioid use is rising in black communities. Minority-majority cities like Baltimore, Chicago, and Washington D.C. know this better than most. The opioid crisis isn’t white. Over 47,000 people died of an opioid overdose last year. More than 5,000 of those deaths, or 12 percent, occurred in black communities. 

    Black people have less access to life-saving medications like buprenorphine than white people. And due to limited resources, they’re less likely to complete addiction treatment. Even if they do find treatment, almost 90 percent of psychologists are white. As one Philadelphia reporter wrote, it’s difficult to connect in a clinical setting.

    Outside Philadelphia’s federal courthouse this summer, activists gathered in support of SafeHouse. It’s the city’s — and the nation’s — possible first planned safe injection site. Family members lined the building with photos of overdose victims. 

    Every single photo was white.

    “Doing the right thing for the wrong reasons is yet polarizing, divisive, and racist,” Bishop Talbert W. Swan, II told me. Swan, the pastor of Spring of Hope Church of God in Christ, is a civil rights activist and president of the Greater Springfield NAACP. 

    “The wrong reason, of course, is because the addicts are now considered ‘victims’ because they’re predominantly white,” he continued. “The softer, gentler approach is not because lessons were learned by how America dealt with the crack epidemic, but because of white supremacy and the consistent dehumanization of Black and brown people.”

    Just Say No

    During the crack-cocaine era, murder rates doubled for young black males of all ages. Fetal death rates increased, fathers went to prison, and children, to foster care. Many black urban neighborhoods, which have the highest concentrations of poverty in the country, still bear the scars of those years.

    “America needs to remember that the U.S. government allowed the influx of drugs into inner-city Black America and profited from the death, addiction, incarceration, and destruction of Black families and communities,” said Bishop Swan.

    He continued: “While Nancy Reagan went around the country telling Black people to ‘just say no,’ her husband Ronald Reagan and Oliver North were funneling proceeds from the sale of crack to the Contras in Nicaragua and funding terrorism.” 

    We held black people to a higher standard. Americans preached personal responsibility. But the opioid crisis created victims. We blame Johnson & Johnson, Purdue, Richard Sackler, and our doctors.

    “The government will now ensure that pharmaceutical companies pay [restitution] for the addiction of whites to opioids, but will never pay for being complicit in the devastation to Black families and communities,” said Swan.

    “While white addicts receive treatment on demand, drug counseling, and a lenient criminal justice system, there are Black people still behind bars because of mandatory minimums, three-strikes laws, and disparate drug sentencing,” said Swan.

    We have “collective self-denial” about this disparity, Professor Yankah once wrote. It’s left black people world-weary and bitter. Yankah and Swan agree that contemporary models of addiction treatment are the way forward. Each expressed the need to reflect on our past — not to be cliché — for fear of repeating it.

    “One of the things I got a chance to do once was have a thoughtful conversation with one of the first minority judges who is on the federal bench in Miami,” said Yankah. “He spoke about when heroin was ravaging Miami in the 70s.”

    “People wanted to wrestle with this problem that was hurting their communities until a bunch of politicians started making hay that the heroin problem was a problem with Hispanics,” he continued. “Suddenly all this money for rehabilitation disappeared.”

    Meanwhile, cocaine continues to ravage black communities. Since 2012, cocaine has killed as many, if not more, black Americans as opioids. They die unseen as politicians and policymakers do nothing. There is no New York Times spread, no pharmaceutical company settlement. No one asks about the black children of the cocaine epidemic.

    View the original article at thefix.com

  • Harpies, Bitches, Witches and Whores: Women Write About Anger in New Anthology

    Harpies, Bitches, Witches and Whores: Women Write About Anger in New Anthology

    “People can see an angry man [who is] fighting for a cause and see him as strong. It’s not the same for women—especially not for women of color and trans women.”

    Burn It Down: Women Writing About Anger is a fiery collection of 22 essays. Editor Lilly Dancyger (Catapult, Narratively, Barrel House Books), an accomplished essayist (Longreads, The Rumpus) and journalist (Rolling Stone, Washington Post), brought together a diverse group of writers. Currently Dancyger is working on a memoir about her artist father and his heroin addiction.

    With empathy in short supply these days, Burn It Down is an invigorating read. The collection is filled with compelling creative nonfiction in the form of first-person narratives from women of different races, ethnic groups, and religions. No matter how you identify—cis female, cis male, trans, or nonbinary—there is a lot to learn here. Dark humor and gorgeous prose take you through the lessons learned in other people’s lives.

    The first sentence in Dancyger’s introduction demanded my attention: “Throughout history, angry women have been called harpies, bitches, witches and whores.” With a shorter-than-ever attention span, I was surprised to devour this book in one sitting. Dancyger guided the writers to go deep and spill raw feelings. 

    Dancyger told The Fix about her troubled teen years. She said, “I had good reason to be angry.” Not only was she raised by two people with drug addictions, but her father died at age 43 when she was a preteen. Her beloved cousin Sabina was only 20 when she was randomly murdered.

    “Anger overwhelmed me,” Dancyger said. “It came out in excessive drinking and doing a lot of drugs.” Her life was thrown out of whack, which sent her on a rocky journey where she learned that you need to “make space for anger in your life or it pushes you into self-destruction.”

    “Those were wild, reckless years. Then I dropped out of ninth grade,” she said. She made it to college, still drinking heavily. “There’s a big difference between drinking with your friends and being determined to get drunk every day. Finally, I ran out of steam and decided I was just done.”

    Writing has been healing, Dancyger told me.

    Burn It Down is meant for readers to give themselves permission to access their own anger. “To feel it, recognize it and accept it. There are so many things to be angry about,” Dancyger said. “It can be fortifying to enforce boundaries, pursue passions, and let anger out.” The book acknowledges that men are angry too, but this is a book about women. “People can see an angry man [who is] fighting for a cause and see him as strong. It’s not the same for women—especially not for women of color and trans women.”

    The first piece, “Lungs Full of Burning,” is by Leslie Jamison, who never thought of herself as ill-tempered. She spent years telling people, “I don’t get angry. I get sad.” Jamison writes about her long-held belief that sadness was more refined than rage. Out of a fear of burdening others, she squelched her feelings in order to spare people the “blunt force trauma” of her wrath. She writes, “I started to suspect I was a lot angrier than I thought.” Her essay talks about women in literature and film, pointing to the Jean Rhys novel, Good Morning, Midnight, in which the heroine resolves to drink herself to death, and describing Miss Havisham as “Dickens’s ranting spinster—spurned and embittered in her crumbling wedding dress.”

    I Started to Suspect I Was Angrier Than I Thought

    Jamison writes, “I’d missed the rage that fueled Plath’s poetry like a ferocious gasoline.” She talks about I, Tonya and how it handled what became known as the “whack heard around the world,” where one woman’s anger leaves another woman traumatized. Harding was portrayed as a “raging bitch,” said Jamison. Kerrigan was a pitiable victim. Yet, things are usually not as black and white in real life. Jamison points out how little coverage there was of Harding’s abusive mother and husband.

    “Women’s anger is a necessary conversation to be having,” said Dancyger. On Hillary Clinton, she explained, “Here was a woman who bent over backwards to avoid coming off as shrill. Look at the words used to describe angry women—hysterical, crazy, hormonal, irrational. And women of color experience an extra dimension of misogyny.”

    Alexandria Ocasio-Cortez is “under tremendous pressure. We hear the racism in words like ‘fiery Latina.’ Kamala Harris is an ‘angry black woman.’”

    Erin Khar, editor-essayist-columnist and author of the much-anticipated memoir, Strung Out: One Last Hit and Other Lies That Nearly Killed Me (Park Row Books, Feb. 25, 2020) writes in her essay “Guilty” about panic attacks and anxiety she felt as a child, who then began keeping secrets. She grew into a troubled 13-year-old who turned to heroin. Later she was a chronic relapser: “As a junkie I was a walking apology.” Finally, thanks to a wise therapist, she learned that it wasn’t the guilt that was killing her; it was unexpressed anger. It’s a powerful story that illustrates the madness of addiction.

    There are tough scenes of self-loathing in Khar’s piece: digging fingernails into her arms till she bled, using a box cutter to carve into her leg. Recovering memories of being raped at age four. But the ending is satisfying, with a description of what her life is like today and the steps she took and tools she used to get there.

    Khar was generous with her time and very open in our interview. We covered a wide range of topics and segued into how many women experienced PTSD from watching the Brett Kavanaugh hearings. 

    “Lilly [Dancyger] was editing the essays during the Kavanaugh hearings and I was writing my essay for the book at that same time,” Khar said. We talked about Kavanaugh’s weeping, and blubbering about beer during his job interview for SCOTUS. We teared up as we shared our similar experience of shaking while listening to Christine Blasey Ford. 

    An Angry Black Woman, No Matter the Reason, Is Thought to Have an Attitude

    Burn It Down isn’t about what makes you angry, it’s about anger itself. In the essay, “The One Emotion Black Women Are Free to Explore,” Monet Patrice Thomas writes, “[A]nger spread through me like red wine across a marble floor, but I did not show it.” She describes her conditioning: “An angry Black woman, no matter the reason, is thought to have an attitude.” Her rage was inside her “like a shaken can of soda.”

    In “Rebel Girl,” Melissa Febos writes, “I knew that I was queer and that it wasn’t safe to admit that at school.” She burned with self-hatred that was “slowly blackening my insides.” Then she met Nadia, who was “six feet tall in combat boots … with a shaved head and arms emblazoned with tattoos. She stomped rather than walked.” 

    Lisa Marie Basile describes living with chronic pain and all of the stupid, condescending advice that dismissed her very real symptoms in “My Body Is a Sickness Called Anger.” One doc tells her she probably stuck her finger in her eye too hard. She writes, “I gently remind the doctor…that feeling like absolute shit with two enlarged assholes for eyes just cannot be normal.” Friends say she looks fine, then offer useless unsolicited advice like yoga, green juices, and giving up gluten. Basile’s snarky inner dialogue is hilarious. 

    There is an energizing quality to women’s rage and it builds a united front. Dancyger has succeeded with her goal to “create a place where anger could live” and her vision to display rage on pages that “sizzle and smoke.” As the last sentence of her intro reads, “Our collective silence-breaking will make us larger, expansive, like fire, ready to burn it all down.” 

    Burn It Down is now available on Amazon and elsewhere.

    View the original article at thefix.com

  • Ibogaine: Promising Addiction Treatment or Snake Oil?

    Ibogaine: Promising Addiction Treatment or Snake Oil?

    The induced vivid hallucinations and memories of childhood and formative experiences seem to be the key to ibogaine’s effectiveness in treating addiction, but experts don’t fully understand its mechanisms.

    With the rise in interest of various psychedelic drugs for a range of conditions (MDMA for PTSD, and ketamine and psilocybin mushrooms for treatment-resistant depression, to name a few), it seems only fair that we should pay serious attention to other substances in this family that might treat other conditions.

    Introducing ibogaine. Well, not quite introducing. The fairly-obscure African plant, used traditionally in Gabon, was first patented in the United States for use in treating opioid addiction in 1985. Unlike common street drugs such as MDMA (“ecstasy,” “molly”), ibogaine does not have the reputation of being known as a club drug.

    Like Years of Therapy in One Day

    But Ibogaine is still relatively unknown, despite a guest appearance in an early episode of Homeland. When I have advocated for its use in combating our nation’s opioid crisis, most of the responses range from a confused “What?” to an inquisitive “Oh, yeah. I’ve heard of that.” It isn’t a cheap thrill, something folks are clamoring to ingest. People who have found relief with the African root-bark have compared it to receiving years of therapy in the course of one day. The induced vivid hallucinations and memories of childhood and formative experiences seem to facilitate the process of overcoming addictions, even if it isn’t an automatic or guaranteed cure.

    However, that doesn’t mean it’s free of stigma. The federal government classifies it as schedule one – right up there with heroin, the addiction it is most well-known for treating, despite having “no medical use” according to the law. Statistics vary, with some rates as low as 20 percent. Other data shows  61% abstinence, eight months after treatment.

    So, what’s the issue? If this plant boasts a higher success rate than Suboxone (8.6%, once Suboxone use is discontinued), why is it only available outside the U.S.? Why are we not allowing a treatment method that people with opioid use disorder have touted as the thing that saved their lives?

    Why Is Ibogaine Illegal in the U.S.?

    Some of the fault lies with the media. Much like with LSD, clinical studies are slow and evolution of public consciousness is slower. Most of what we see in the news is negative and exaggerated. As with anything, there are risks. Up to 30 deaths have been documented. When people with other health problems related to addiction are treated by those without medical training, death rates can be as high as three percent. In healthy folks, that same rate is around .3%. 

    But when much of what you see in the news and on television is people panicking, convulsing, or dying, it’s tough to form a well-rounded opinion. We are emotional creatures, and even with positive perspectives from people who swear by their experiences, we can’t get the negative images out of our minds for long enough to consider the benefits of ibogaine treatment. 

    Many of the risks involve heart issues. Most psychedelics function as stimulants, raising the heart rate, but ibogaine can be especially cardiotoxic. Ibogaine affects electricity in the heart and could potentially result in dangerous arrhythmias or bradycardia (low heart rate). Because of this and any other possible risks, legitimate clinics pre-screen patients and offer a small test dose to evaluate the effects. Based on the results, they decide if a full dose will be safely tolerated. 

    Like Other Hallucinogenics, Proven Benefits but Not a Panacea

    The substance seems to work due to the uniqueness of the experience. I’ve read multiple accounts of people having vivid visions of the choices they made, and how they’ve arrived at this particular point in their life. This type of experience seems to be the key to its effectiveness in treating severe opioid and alcohol addictions, but experts don’t fully understand its mechanisms.

    And yet, even with its proven benefits, it’s not a panacea. The person with the addiction cannot just visit a clinic, have an ibogaine experience, and expect to return home without changing anything. There is still a rate of relapse, because they haven’t worked on the external triggers. They must still tackle their disease in a proactive way, which may include altering their life and addressing what led to using in the first place.

    Unlike commonly-used routes of getting off opioids – substitution medications such as methadone and Suboxone – ibogaine doesn’t require a patient to remain on another drug, taking it day in and day out to avoid experiencing cravings or going into withdrawal. Ibogaine seems to work by disrupting the receptors associated with addictive behaviors, as was witnessed in one 2015 study on its efficacy in opioid addiction.

    Scientists found that the substance (which, I learned, doesn’t always produce the talked-about hallucinogenic effects that led to its illegal status) acts on receptors such as dopamine and serotonin, which are linked to addiction and the brain’s reward system. Other psychedelics that are currently being studied for their effects on mental illness and addiction – such as MDMA and psilocybin mushrooms – make use of these same receptors. What makes ibogaine unique is that, rather than attaching to receptors on the outside of a cell membrane, it attaches to the inside. This mechanism seems to be unique to ibogaine; it has not been observed in any other naturally occurring molecule.

    Legal Status of Treatment Creates Financial Barrier and Increased Risk

    A major barrier to receiving an ibogaine treatment is the prohibitive cost. A single week of treatment in Mexico costs $5,000, and that’s after the price of a plane ticket. In Canada, the price for a ten-day round is $8,000. As a result, it’s not an option that’s available to most people in need of addiction treatment.

    We must legalize it here. International travel, necessary funds, time off from your job to recover – all these restrictions make it virtually impossible for the average person with treatment-resistant addiction to crack the barriers of that final, desperate chance at a life beyond drugs or alcohol.

    There is a strong, tight-knit movement of psychedelic therapists, but due to the criminalized status of what should be viewed as medicine, those involved with administering these substances remain underground, increasing risks. Even though many of these practitioners are medical doctors, they work without the support of a hospital or facility. While their willingness to practice this medicine outside of the law is a testament to their belief in its efficacy, it also means they are less able to quickly and safely address problems that may come up.

    Who knows what the genuine death toll of ibogaine is in the U.S.? It’s not likely that underground doctors are reporting these deaths to nurses and other hospital staff. If so, they’d be discovered, in turn ruining their careers and possibly derailing the entire growing movement. At least, that’s what instinct tells me. If nothing else, with the substance legalized, fewer deaths and injuries would occur due to more rigorous testing and administering – and consequently fewer accidents would happen as well.

    Ibogaine has shown lasting benefits in treating addiction, as many people attest. One patient was quoted as saying: “It’s not just [that] it gets you off the heroin, it’s like, it hits the reset button — that’s the only way to really explain it. It’s like a new brain.” Shouldn’t we be listening to the voices of people who have actually been there, rather than tossing their words to the wind and sticking with what hasn’t worked?

    View the original article at thefix.com

  • "The American Dream Is Built on Crime": An Interview with "Godfather of Harlem" Creator Chris Brancato

    "The American Dream Is Built on Crime": An Interview with "Godfather of Harlem" Creator Chris Brancato

    Even though he wants to help his community, Bumpy Johnson is an anti-hero. He is a criminal capable of extreme violence who is visiting horror on Harlem through the sale of drugs.

    Executive produced and written by Chris Brancato, EPIX’s Godfather of Harlem chronicles the complicated criminal life of Ellsworth “Bumpy” Johnson, one of the most notorious African-American mobsters. In 1963, Bumpy is released from an 11-year sentence in Alcatraz on a drug conspiracy charge. Upon his return to Harlem, he realizes that his drug turf has been taken over by the mafia. Bumpy, played by Forest Whitaker, butts heads with Vincent “The Chin” Gigante (Vincent D’Onofrio), the newly-minted head of the Genovese crime family. Heroin is the money drug, and Bumpy knows he has to control the distribution and the supply. The period crime drama also depicts Bumpy going head-to-head with Malcolm X (Nigél Thatch) and Adam Clayton Powell Jr. (Giancarlo Esposito). In supporting roles, Paul Sorvino plays mob fixer Frank Costello, and Chazz Palminteri plays mob boss Joe Bonanno.

    Brancato also wrote the 1997 feature film Hoodlum, about a younger Bumpy Johnson (played by Laurence Fishburne back in the day) and his battles with infamous gangster Dutch Schultz (Tim Roth). In Godfather of Harlem, Brancato revisits Bumpy as an older man fighting to regain his form.

    The Fix: When I interviewed you about your experience making Narcos, you described Pablo Escobar as a psychopath. Would you describe Bumpy Johnson in the same manner? 

    Chris Brancato: John, that’s a great question. Unlike Pablo, Bumpy was not a psychopath nor a sociopath. He was a multifaceted character and a complex human being. Yes, he could be violent, and he could deliver beat downs and such when they were needed, but he did not thrive off of the violence as Pablo did. Any violence that Bumpy committed was predicated on business or maintaining his turn. 

    In contrast, Escobar was fine with blowing planes out of the sky. He did not mind bombing bookstores and causing widespread havoc. He repeatedly caused the death of innocent people, and that’s something Bumpy Johnson would never do. 

    Like Pablo, Bumpy reached out to his community, helping people so they would help and protect him. Today, how would you describe his community outreach efforts? Was it pure self-interest, or did he truly care about the people of Harlem?

    In Narcos, we made a fascinating comment about the nature of drug money. When you have made so much money that you have bought everything you could think of buying, then it’s easy to give it to the people. You don’t need it. Escobar certainly had leftist tendencies, and he did build barrios for the poor. Some of those feelings were likely genuine, but a lot of what he did was self-aggrandizement. Escobar wanted to raise his stature in the eyes of the people of Colombia in general. He wanted to be viewed as a public figure. 

    In contrast, from the beginning of his life, Bumpy believed that education was the step ladder to success. He spent a fair portion of his life in prison, and he was extremely well-read. He promoted the values of education throughout his life. My college friend Paul Eckstein first told me about Bumpy Johnson. Paul is the co-writer on the pilot and the co-creator of Godfather of Harlem. His grandmother was helped by Bumpy Johnson; this African-American mobster paid for her to go to secretarial school. Bumpy also paid the college tuition of the father of the playwright Lynn Nottage, who has won the Pulitzer Prize for two of her plays, Ruined (2009) and Sweat (2015).

    Bumpy was all about education. Although he was well-known for his public gestures like handing out turkeys on Thanksgiving, his desire to improve his community extended well beyond such gestures. Bumpy wanted people to have the advantages he had lacked. He truly believed that education was vital to success. 

    Heroin is a bigger drug today nationwide than it was in Bumpy Johnson’s time. What do you think Bumpy would have said about such a development? 

    I have an interesting statistic to toss at you in regards to that question. In the 1960s and 70s, during the heroin crisis in Harlem, 90% of the heroin addicts were black, and 10% were white. Also, 90% were men, and only 10% were women. In today’s opioid epidemic, it’s actually reversed. 90% of the opioid addicts are white, 10% are black, and the male-female ratio is cut right in half, fifty-fifty. It’s a development that is hugely due to the prescription painkiller origins of the current crisis and the easy availability of OxyContin and morphine-based pain medication. Of course, it’s the same active ingredient. When people get tired of paying $60 for black market OxyContin, they might as well get a $20 bag of street heroin, which will last just as long, if not longer. 

    The show tries to suggest that Bumpy’s criminality was due to lack of opportunity. He wanted to go to city college as a young man, but they wouldn’t accept him. He tried to be a lawyer, but he was told it wasn’t going to happen. He was left between a rock and a hard place. Feeling there was no other choice, he turned to crime. 

    Thus, one of the themes of the show is how second-class, impoverished communities use crime as a step ladder. Crime provides money that leads to political, social, and cultural power. Such criminality continues until that second-class community is woven into the tapestry of the American dream. Crime does not require a college degree, and there is no barrier to starting a career as a criminal. You just have to be willing to take the risk. The fundamental precept that the American dream is built on crime beats at the very heart of the series. 


    Back Row: Chris Brancato, Forest Whitaker, Paul Eckstein; Front Row: Vincent D’Onofrio, Paul Sorvino, Chazz Palminteri (Courtesy of David Lee_Epix)

    When the five families of the American Cosa Nostra were first formed, dealing drugs—particularly heroin—was forbidden. Drug dealing could get a contract taken out on a made man’s life. In Godfather of Harlem, the mafia is neck-deep in the heroin trade. How and why did that happen?

    The fundamental word to use when talking about any criminal organization, including the Italian mafia, is greed. Movies like The Godfather emphasize that dealing in drugs goes against the rules of honor and so forth, but this is a mythic portrayal of the Italian mob. Goodfellas is much closer to the reality of what was happening. It’s more realistic in its depiction of the venality and violence of these men. The lack of honor of these men is much closer to the truth.

    Yes, throughout history, mafia dons have given lip service to not wanting to deal with drugs. However, it’s believed that Lucky Luciano established the heroin pipeline from Turkey to Lebanon to Marseille to New York City when he was exiled and living in Sicily. 

    I have a book of every mug shot the FBI ever took of someone that was reputed to be in the mafia. If you look through it, 70% of the charges behind those mugshots were for narcotics in one form or another. It’s specious to suggest that the mob wasn’t interested in the heroin trade because of some kind of honorable notion that we don’t distribute drugs. It was all about money, and the most money was in the drug trade.

    The prime fear to face in regards to drugs was not dishonor, but long prison sentences. When a mafia soldier is faced with a three-year prison sentence, they’ll keep their mouth shut. When they’re faced with a thirty-year prison sentence, however, they’ll rat out on their superiors to save themselves. Henry Hill from Goodfellas is the perfect archetype of that reality.

    One of my early Facebook friends was Henry Hill. He mainly was using Facebook to sell his paintings, which overflowed with mafia themes like guns firing and bottles of liquor and fast cars. 

    I’ll tell you a funny Henry Hill story. I had the great pleasure of having breakfast with Nicholas Pileggi, the writer of Wiseguy, the book that was the source for Goodfellas. Nick told me that when the book came out, he got a message from Henry Hill that said, “I need more copies of the book. I need like a hundred copies.” At this time, Henry Hill was in the witness protection program. Nick told him that he could get him copies, but he didn’t know where to send them. 

    It turns out that Henry Hill was staying at the Mandarin Oriental in Hawaii, a well-known fancy hotel. It was like the exact opposite of the Witness Protection Program. Henry Hill wanted to give out signed copies of the book to women at the bar so he could get laid. Of course, Henry was telling these women that the book was about him and that he wrote it. He told Nick that the book was working like magic, so he needed a bunch more sent to him. 

    Okay, next question: Drugs, crime, and family play a significant role in the series. I don’t mean crime families, but actual family life. Even in the families of the criminals, drugs lead to trauma. Can you talk about the trauma of drug abuse in families as a theme of the show?

    Since Harlem was wrenched with huge heroin addiction problems, families were torn asunder. Crime was out of control with family members stealing from their own homes. During that time, one guy told me you had to have three locks on your door. Addiction was a horrific blight on the community. 

    At the same time, Bumpy saw it as a commodity that was going to be there whether he was involved with it or not. He’d rather be the one organizing the trade than the Italians. He wanted to keep the money in the community, meaning in his pocket as well. At the same time, he has an addicted daughter. We bring home the storyline that the guy who sells dope has a drug addict in his own family, and sometimes under his own roof. In the course of the series, we plan to move into that territory where the dichotomy gets exposed, and Bumpy’s role gets challenged. 

    You have to remember that back in 1963, there wasn’t the lexicon of recovery that we have today. Dope addicts were looked at as fiends. In other words, you were stupid if you touched that drug because it gets you hooked. In that regard, Bumpy had a great deal of discipline on a personal level. He was never a drug user, and his favored drink when he went out was ginger ale.

    At the same time, Malcolm X, who is a major character in the series, knew firsthand about the seriousness of the drug problem. Part of the recruitment process of the Nation of Islam was taking junkies off the street and helping them to recover. He then was able to bring them into the fold. Saving people from themselves is a great recruitment tool. 

    In terms of family, when you’re doing a gangster show, you have characters who are morally compromised and who are anti-heroes. What you need to do to make them relatable is give them family lives. You need to know the people who are affected by the gangster and his choices who aren’t fellow criminals.

    In Godfather of Harlem, we spend a lot of time focusing on Bumpy’s family. We make a real effort to create three-dimensional African American women characters. They often get short shrift in these kinds of shows, particularly period pieces. We couldn’t let that happen because, at the time of our story, the backbone of the community in Harlem were the women. From the very first time we sat down, Paul Eckstein and I made it a priority to represent complex, fascinating, and diverse women from the African American community of that period. Family life, particularly their relationship with the women in their life, help us to tap into the gangster as a real human being.

    In Parade, co-creator Paul Eckstein said, “A lot of what we were dealing with in the ‘60s is exactly what we’re dealing with today.” What can we learn from the history portrayed in Godfather of Harlem?

    I believe the contemporary parallels of the two drug crises will make the series relevant for our time. Also, without giving any spoilers, we have a story of recovery in the first season that is very powerful. It will take many twists and turns over the course of the series. Paul and I often talk about the show as the ongoing education of Bumpy Johnson. Despite the fact that Forest Whitaker is playing him as true intellect, even though this gangster wants to help his community, Bumpy is an anti-hero. He’s a criminal capable of extreme violence who is visiting horror on Harlem through the sale of drugs. 

    Over time, incrementally, Bumpy is going to become more conscious of his own actions and their effect on the community at large. He also will start to breathe the fresh air of the Civil Rights Movement that is happening all around him. For me, Bumpy’s journey to a deeper realization and even redemption over time will be the home run of the show. I want to show how a criminal figure changes as he becomes more aware of the consequences of his actions and how they negatively affect his community.

    View the original article at thefix.com

  • Nicotine and Self-Recrimination: Kicking My Last Addiction

    Nicotine and Self-Recrimination: Kicking My Last Addiction

    I had four months smoke free under my still loosely fitting belt and had been patchless for over 30 days. Hours passed without any thought of a cigarette. I felt confident. And then one day, I stepped on the scale.

    According to the QuitNow! app glowing from the glossy face of my phone, I’ve been smoke-free for 294 days. I have saved almost $3,000 and “won” back three weeks that otherwise would have been squandered away standing in the rain sucking on a Basic Menthol Light. 

    This almost unthinkable achievement, this formerly unattainable goal, is a boast I have bellowed to and fro for the last eight months to anyone who does or doesn’t give a shit. In support groups with quitters swimming in self-pity and weakness, I have proclaimed myself the victor over nicotine and tobacco; an easy battle because I am committed. Though 42 years of smoking may have damaged my body in ways yet to be revealed, I have managed to silence the relentless chatter of the irrational addict and return logic to the part of my brain that runs every other program of my life.

    That is, until a month ago.

    During my four tours in rehab, counselors and addicts alike proposed the theory that the last substance an addict quits will be the most difficult. I have 16 years clean and sober from drugs and alcohol but it was not without many slips along the way. 

    Whatever made me think I could quit smoking and get it right on the first try? The hubris of the addict.

    Using the NicoDerm patch system, the first few months of my quit were reminiscent of my first stay in rehab at age 26. The pink cloud, as it’s called, evidently happens no matter what drug you kick and it buoyed me through those initial weeks of cigarette cravings. I lived and breathed the Facebook quit smoking groups (there are dozens!) where I could experience all the regret, heartache, and depression of relapsing by reading of others’ failures while still remaining smoke-free.

    I weathered internet and cable outages and the subsequent maddening phone calls to Comcast that I thought I couldn’t endure, and I considered lighting up and smoking my Williams Sonoma Wintergreen candles to deal with the stress. I survived a devastating family fight that left me bent in half on the couch for a week, my tears spilling onto the floor until they crested over the cushions. I couldn’t write because I didn’t smoke and those two activities were knit together like a friendship bracelet. 

    But I persevered. I went on walks, something I hadn’t done for, well, ever. With my grandchildren, the nucleus of my motivation, I trotted along as they biked or scootered; again, unprecedented. 

    “Gwammy, you’re going to walk us to school?!” they would squeal, their incredulity expressing a maturity unheard of for a seven- and five-year-old.

    “Why yes, my darlings,” I would declare with the wisdom and assurance of Yoda. “Gwammy can walk now!”

    I had spent so many years anticipating the sudden fatal heart attack that would befall me should I exert myself even a wee bit, and now I felt a freedom I had not known since my teenage years, when I first started smoking but thought myself immortal. 

    And I gloated. I admit it. I went to the groups and while they whined and cried about gaining weight, I lectured about exercise and eating right and how it’s all about choices. Eat fruit and popcorn, like me! Drink lots of water, like me! Walk to the store, like me!

    I had not had a problem with my weight for, well, ever. At five feet and 105 pounds, I felt very positive about how I looked – in clothes. I was hypervigilant about maintaining my weight because at my height, even a few extra pounds could mean an unwelcome eight-hour shopping excursion to Nordstrom Rack for a wardrobe in the next size up. That’s not happy shopping. 

    I had four months smoke free under my still loosely fitting belt and had been patchless for over 30 days. Hours passed without any thought of a cigarette and most of the habitual smoking associations like driving, talking on the phone, writing, eating, cooking, breathing, living, had been broken effectively enough for me to feel like an actual non-smoker. I steered clear of the last few friendly smoking circles I’d once been a part of (people, places, and things) and reveled in my success. I felt confident. I didn’t need support.

    And then one morning, I stepped on the scale. And it was different. VERY different. 

    I had read accounts of ex-smokers who claimed to gain ten pounds overnight. I thought them daft. I accused them of looking for excuses to smoke. I showed them no mercy.

    And the scale continued to climb. 

    Suddenly everything that seemed manageable fell into chaos. Work became untenable. I seethed with HATRED for my boss, who had the unmitigated gall to ask me to do things. I purple-screamed in traffic at other drivers. I muttered in the grocery store like a sociopath when the deli clerk sliced honey ham instead of Black Forest. I stopped eating plain, dry, Styrofoam-like popcorn at night because clearly that was the culprit behind the weight gain. I cried on the kitchen floor because I could no longer have popcorn. I cried because I grew a muffin top overnight. I cried because I hate fruit and now it was my only treat. I cried because my thighs were about to…touch.

    The chatter returned. Quiet, reluctant, and shy at first, it built up steam quickly, as I fought with all the strength I could muster to shut it down.

    “Fatty. Fatso. FAT GIRL. You’re going to get so fat, it won’t matter if you live longer because you’re going to hate yourself.”

    “Shut it.”

    “Look how depressed you are! Is that how you want to feel the rest of your life? Don’t you know you could feel BETTER, happier, skinnier, right now?”

    “Feel better momentarily and then feel horrible because I failed? No thanks.”

    “Who says you’ll feel bad? All those other fat people? Who cares! You’re the one alone, depressed and getting larger with every clean, deep breath you take. And there’s nothing you can do about it. Walk, cut back on popcorn – it’s inevitable. Your metabolism is in a coma.”

    “That’s rubbish. Leave me alone. I don’t want to die.”

    “Drama queen.”

    I’d quiet myself down, still the noise with an audiobook or some raucous comedy on Spotify. But always waiting in the silence: the nicotine Night King, ready to strike…and I felt ill-equipped for the battle.

    “Hey, you know it took you four tries to kick drugs and alcohol.”

    “That’s true.”

    “Theoretically, you’ve got a few more years of smoking to go before you really quit.”

    “As illogical as that is, I’m listening.”

    And so it goes.

    I bought a pack of fake, herbal smokes made of marshmallows, rose petals, and the flatulence of unicorns. And I told EVERYONE. I brought the unopened pack to my therapist’s office and slammed them down on the couch. 

    “Let’s talk about these fake cigarettes,” I stated.

    And we did, but I still wanted to smoke them. I told my older sisters, my greatest champions in this quit, and they both implored me to refrain from lighting them. I told my son, who shrugged and mumbled “slippery slope.”

    I’ve smoked a few a day for about a week. The menthol flavor is not terrible, as the reviews on Amazon claimed. They help when a strong craving steers my car into the 7-11 with only one objective that has nothing to do with Slurpees. Already, my lungs feel uncomfortably full and I’m concerned about the long term effects of marshmallow leaf and unicorn farts.

    But for now, I’m still nicotine and tobacco free. I can’t say smoke-free anymore because that’s dishonest. I hope I don’t go back. It would be miserable AF to have to start a quit again. I hope I don’t gain any more weight. I’ve already dropped a grand at Nordstrom’s for a wardrobe to fit my new bountiful 115 pound frame. But mostly, I hope that whatever happens, I can cut out the self-recrimination as successfully as I cut out the popcorn. That, I suspect, is the deadliest extra weight I now carry.

    View the original article at thefix.com

  • Social Media Algorithms as Triggers: Wish-ing for a Meth Pipe

    Social Media Algorithms as Triggers: Wish-ing for a Meth Pipe

    Imagine if Spencer’s Gifts from the mall in the 80’s smoked crack, got skyrocketed into the future, and became a Black Mirror episode. 

    Working in the digital world, publishing online, and playing the whole social media gig, there are certain things you have to make peace with as a sober person like myself. For instance:

    Every day, Facebook will ask if I want to stroll down a memory lane of old updates, many of which feature me with a red bloated face and a pinched hammered look in every picture. Hard pass, FB! But thanks for asking! Ditto I have learned to live with my Instagram feed being filled with people I follow but might not really know (or like, for that matter) as they endlessly post about White Claw or rosé all day. 

    Is It Possible for Targeted Advertising to Go Too Far?

    Then there are the ads and accounts for weed enthusiasts, microbrews, and wine tours that follow you on Twitter based on a few tweets that happen to have the words booze or weed in them, regardless of context. Oh social media, you’re so delightful. But is it possible for the algorithms and targeted advertising to get out of control and maybe cross a line? Can a company be so far off base with their social media ads that people in recovery can even feel triggered? In the case of the disaster that is Wish.com’s Facebook marketing strategy, I would emphatically say yes.

    Listen, with a decade plus of sobriety, I try to accept the things I cannot change and the many problematic aspects of Facebook fall squarely in that category. Name something about the social media platform that is awful and troublesome and I will totally agree with you. Yet I still use the damn thing, mainly because as a writer it’s super useful. Also, I’m an addict and maybe mildly hooked on the instant approval I receive every time I post something funny. Regardless, I’ve leaned into its ridiculousness so it takes a lot to make me notice how insane it can be.

    That is, until a few months ago. I was scrolling endlessly, as one does, and stumbled upon a Wish.com ad for bullets. Not bullets for guns, but bullets as in the little plastic canisters that hold your cocaine. For people who didn’t share my affinity for that substance or other sniffable powders, bullets were a handy, very 90’s way to keep your blow on you and do it without going to the bathroom to cut lines on the back of gay bar toilets, as glamourous as that all sounds. 

    Bullets, Meth Pipes, Sex Toys, and Poppers

    The ad featured the bullets in a variety of colors and they were only a dollar! What a bargain! I naturally took a screenshot of the ad and turned it into one of those aforementioned hilarious posts. Mainly, it was just so jaw-droppingly blunt that I felt like it needed to be laughed at and shared. Like, really? This is where we are, Facebook? Ads for the new Mindy Kaling movie and Dove Bars alongside cocaine bullets? I mean, talk about spot-on algorithms, but good lord. Obviously, I’m an open book (to a fault sometimes) and I have shared bluntly on Facebook about my drug use. Therefore, I get the ads appropriate to what I talk about. Still, this one felt a little too on the nose, as it were. 

    Thankfully, I have been sober for a long time, so it didn’t trigger me. But the sheer wildness of the ad was hard to get out of my head.

    A couple of weeks later, a friend posted a Wish ad for meth pipes, poppers, and sex toys. A former meth addict and gay man himself, his post expressed amazement at the brazenness of the items and basically called out Wish.com for providing all the tools for a relapse on his timeline. The comments from other sober folks echoed his shock, expressing disgust and anger over such garbage thrown carelessly in someone’s ad feed. 

    Yes, of course, you can block Wish. Yes, you can report them and take them out of your timeline. However, you don’t get a choice in the beginning. These ads just show up on your page uninvited, regardless of what’s happening in your life and in your recovery. 

    Days after that post, another gay male friend in recovery shared a similar status about Wish and their ads. Obviously, I was far from alone in my reaction to the inappropriateness of the ads. In fact, there are entire Facebook groups devoted to how insane Wish.com is. Oh, it’s not just drug paraphernalia. It’s everything from magnetic weight loss bracelets to weird teeth-whitening lasers. Oh and don’t even fall down the rabbit hole of all their wacky apparel and sexy underwear like this writer did if you at all value your time. It’s like if Spencer’s Gifts from the mall in the 80’s smoked crack, got skyrocketed into the future, and became a Black Mirror episode. 

    How Well Do You Really Know Me, Facebook?

    Of course, for Wish, none of these ads are personal. They have a whole bunch of crap and they want to sell it to you. Wish doesn’t know I had an epic drug problem nor does it care. Again, I get it. While vast and certainly random af, Wish’s inventory is not the problem. What seems more problematic is that a platform like Facebook has zero regulation or even a thought process about what’s being advertised to the people who use their service. You’d think in a country with an exploding meth epidemic, ads for glass pipes would be off limits, algorithms be damned. Their refusal to address this seems odd, since Facebook takes great pride in how accurately it can read our minds, suggesting who we should be friends with, what pages we should like, and what we should buy. So the fact that someone like me, who very much lives and breathes sobriety out loud on social media, can still get these kinds of ads proves maybe they don’t know us all that well at all. 

    Besides, shouldn’t we draw a line somewhere prohibiting certain things from being advertised? Meth accessories might be a good place to start that line.

    Also not fantastic is what seems to be the blatant targeting of these kind of products to gay men. In a community with a higher rate of addiction, death, and mental illness, it blows my mind that alcohol companies still sponsor pride festivals, travel companies shill drug-soaked vacation packages, and social media platforms suggest products used in practices that are literally killing the population they’re targeting. 

    This is an advertising hat trick as old as the game itself: market to the folks who use it the most. But like cigarettes or alcohol billboards plastered all over economically depressed neighborhoods, it feels like a cheap shot to push this stuff to gay men who innocently log on to Facebook. 

    Yet at the end of the day, it’s a drinking and using man’s world so I’m sure very little can be done. If I am in a good spot emotionally in my sobriety, I can go to bars, walk down grocery store wine aisles, and even look at meth pipe ads. But what about people new to recovery, fresh off their last run? Or someone in a vulnerable place and craving their drug? There’s a reason they tell us to stay away from bars or other using-associated cues in early sobriety. 

    Maybe if enough of us block, report, and unfollow, something will happen. Or is that too much to Wish for? 

    View the original article at thefix.com

  • 5 Ways to Process the Death of a Friend in 12-Step Recovery

    5 Ways to Process the Death of a Friend in 12-Step Recovery

    Dealing with the death of a close friend in sobriety can be tough. But if you follow some simple guidelines and take it slow, you can transform a painful trial into a caring tribute that honors their memory.

    When a friend in a 12-step fellowship dies, processing the loss can be challenging, even if the person was sick with a chronic disease or naturally nearing the end of life. The idea that someone might die is very different from the reality of that person dying and being forever gone. 

    Because of the way we share in 12-step groups, we quickly become intimately acquainted with our fellow meeting-goers. We also see our peers regularly—weekly or more frequently—often over years, sometimes decades, in the same rooms and homes and restaurants. The resulting relationship is uniquely strong and meaningful. So when a loss occurs, whether you are working a program or just on the outskirts of meetings, it can be tough to get through. However, if you follow some simple guidelines and take it slow, you can transform a painful trial into a caring tribute that honors their memory. 

    Recently, I lost a sober friend in a 12-step fellowship. Although we rarely saw each other outside of the meetings, there was a close connection between us. His smile helped me overcome a feeling of alienation after I’d moved to a new neighborhood and started to attend new meetings. He made me feel welcome. As a person with the disease of alcoholism or addiction or whatever you want to call that sense of being “other” and “less than” that bubbles up from within, I resisted, especially then, acceptance and comfort when it was offered to me. My new sober friend, a senior citizen in his 70s, helped me overcome this insecurity and feel “part of” a meeting that eventually became my beloved home group. 

    Not that long ago, he was diagnosed with a brain tumor. At least, it seems not that long ago. When it happened, I immediately knew something was wrong. Although his smile remained bright, his health and strength were taken from him. He fought a courageous battle for well over a year. 

    My friend was loved by many, and after he passed, we had to figure out a way to process his death. The guidelines below, which focus on maintaining decency and decorum and avoiding added hurt and unnecessary damage, helped us grieve. (Although these suggestions may be helpful in general, they are specifically meant to be considered within a 12-step context.)

    1) Respect the Spiritual Principle of Anonymity

    The 12th Tradition of Alcoholics Anonymous states: “Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities.” The majority of 12-step fellowships have adopted this tradition. In the digital age of mobile technologies and the internet, anonymity needs to be respected beyond the original boundaries of “press, radio, and films.” 

    Although many people, including myself, are quite open about sobriety on social media, others are strict about maintaining anonymity. When a sober friend dies, you may be tempted to post a tribute on their Facebook page, letting the world know that they died sober. Resist the temptation. By taking such an action, you could be violating their anonymity, and revealing something to family or co-workers that they would prefer to have kept anonymous. Also, don’t automatically assume you know all the details, which brings us to number 2.

    2) Never Presuppose a Relapse or Speculate on Causality

    Sadly, people in recovery sometimes return to drug and alcohol use, and sometimes it results in death. Although this was not the case with my friend, I have seen too many people overdose and die or develop fatal diseases because of excessive drinking. However, when a sober friend dies, until you know for sure from a medical report or similar legitimate source, you shouldn’t speculate on whether or not they relapsed. Such speculation is nothing more than gossip, even if you don’t intend it to be. As Aesop wrote in a fable and Thumper later adopted as his motto, “If you can’t say anything nice, then don’t say anything at all.” 

    Even if someone did die as a result of a relapse, do not act like the “wise” sage. It’s not your job to use that knowledge to warn others. Such an attitude raises you above the emotional reality and places your sobriety on a pedestal. And imagine if you are wrong. Then, not only have you damaged a sober friend’s legacy, you have hurt yourself by telling such a story. In these cases, better safe and kind than sorry and foolish. As a member of a 12-step fellowship, I don’t want to point fingers or take other people’s inventories. I don’t want judgment to consume my capacity for love and empathy. 

    Instead, focus on the good: What was special about your friend?

    3) Be Cautious and Respectful When Speaking to the Family

    If you meet a sober friend’s family at a memorial service or funeral organized by them, make sure ahead of time that it’s okay to discuss your friend’s sobriety. Many people remain anonymous even within their own families. They also have friends and co-workers who know nothing about what happened in the past. 

    It’s not your job to enlighten everyone about what a great speaker or sponsor your friend was. You will likely end up creating confusion and uncertainty. And if your friend did not disclose his or her participation in a 12-step program, you could be adding to the family’s already-heavy emotional burden. 

    If you believe the family may not be aware of a sober friend’s 12-step participation, then come up with a story about how you knew each other. Maybe a book club, a favorite activity, or a past introduction through mutual friends. 

    It’s easy to take the focus off of you by talking positively about your friend. You can tell people what a good person he or she was and how much you enjoyed their sense of humor. With my friend who died recently, his family knew about his sobriety and celebrated it. At the same time, people who knew him from 12-step fellowships talked about his business acumen, his lovely smile, and his joking personality. It was not hard to find topics to discuss that were outside of the 12-step context. 

    4) Set Up a Separate Memorial for the 12-Step Fellowship to Mourn and Celebrate a Sober Friend

    Although it makes sense to attend the family’s funeral or memorial service to show your support by being present, it’s a good idea to set up a separate memorial service as well. This second service can focus on your sober friend’s 12-step community. Often there will be a meeting before this kind of memorial service. Then, in the service, people will openly talk about the person’s role in the fellowship, and what gifts he or she brought to the program. The meeting and the service should both be open so that anyone can attend. When you publicize this event, be careful not to use social media in such a way that violates anonymity. In most cases, word-of-mouth at meetings and personal one-on-one communications should be enough to raise awareness. 

    5) Celebrate the Positive and Maintain a Loving Legacy

    Once a sober friend is gone, the best way to process that loss is to celebrate the positive. Rather than focusing on the loss, talk about what that person gave to others and their memorable qualities. My sober friend always made a point to offer a seat next to him to newcomers. He made everyone feel welcome. Today, I do my best to maintain that loving legacy by doing what he did. I keep his smile and his love alive by going outside of my comfort zone, following his example, and acting as he did. 

    As alcoholics and addicts in 12-step fellowships, we are vulnerable to our character defects, and sometimes end up relapsing as a result of them. The process of getting sober is about progress and not perfection, and we make mistakes and fall back into deeply entrenched negative patterns of behavior. The death of a sober friend reminds us of the real, lasting value of our sobriety. We can celebrate the positive while we grieve the loss. We recommit not only to our recovery, but also to practicing the principles that reflect the best qualities of our departed friend. 

    In Memory of Lenny Levy

    View the original article at thefix.com