Tag: opioids

  • An Addicts Mind

    I lay on this bed encased by these walls. sober now.

    I can feel the pain of all my flaws.

    Peaceful and lost in the illusion I slept thru all my loved ones’ cries.

    Even her kind eyes couldn’t keep me from wanting to end my life.

    Caged outside my mind also brings confinement inside.

    My willpower shatters faced with all the brain cells I’ve fried.

    I was captivated by her pinprick of charm.

    Why didn’t God save me from sticking her into my arm?

    How could a bag bring such pleasure and pain?

    I still sit N stare, insanely at my veins.

    The bruises of this Lust affair dance up n down my body.

    Track marks tell the world far too much about me.

    Only time I felt Joy was with the pull of the plunger.

    Within the next few seconds, a nodded out slumber.

    Blue in the Lips N White in the Face.

    But with a shot or 2 of Narcan, it becomes just another day.

    Awakening startled I just overdosed, Yet still cursing at the E.M.T…

    “Next time just let me Go!”

    This tragedy to U has become my Life, U see?

    Inside I feel I’m No One.

    Just a junkie In long sleeves.

    I’ve become the monster U all made me out to be.

    And with a needle and a spoon, I’d nod my way to peace.

    Sleep away the day and steady search thru the nite.

    The daily fucking routine of a stupid dope heads Life.

    I snatch the mirror that I see myself in off the wall.

    As I looked inside I loathed the person that I saw.

    Sometimes in my Heart creeps a tiny bit of hope.

    I wish upon a star for the power to just stop shooting dope.

    But then Bam reality hits.

    So I’ve stopped throwing pennies and seeking shooting stars.

    Because I’ve learned prayers don’t get answered for those who are the likes of ours…

    “THIS IS A HEROIN ADDICT’S MIND”
    “Or at least this addicts mind”

    HOWEVER, IF YOU FIRST LISTEN TO YOUR HEART AND EMBRACE CHANGE, YOU CAN CHANGE YOUR THINKING AND USE IT AS YOUR COCOON. AND I PROMISE IF YOU DO THIS CONFIDENTLY AND PATIENTLY THEN U2 WILL EMERGE AND FLY LIKE A BUTTERFLY.LEAViNG OLD REGRETS BEHIND AND NEW MEMORIES AHEAD.

    mwah

    Luv y’all

    Michael Henry Roberts

  • Chapter 6: The Thrush’s Song

    Shauna Shepard, who works as a receptionist in the local health clinic, visited with me on my back porch. She shared why she drifted into substance abuse, and how she struggled to get — and remain — sober.

    After a man in my small Vermont town who had a heroin addiction committed suicide, I began asking questions about addiction. Numerous people shared their experiences with me — from medical workers to the local police to people in recovery. Shauna Shepard, who works as a receptionist in the local health clinic, visited with me on my back porch. She shared why she drifted into substance abuse, and how she struggled to get — and remain — sober.

    “Drugs,” Shauna finally said after a long silence, tapping her cigarette on the ashtray. “Drugs are really good. That’s the problem. When you’re using, it’s hard to imagine a life without them. For a long time, I didn’t know how to deal with my feelings any other way. It’s still hard for me to understand that getting high isn’t an option anymore.”

    I nodded; I knew all too well how using could be a carapace, a place to tuck in and hide, where you could pretend your life wasn’t unraveling.

    “You can go weeks, months, even years without using, and then you smell something or hear a certain song on the radio, or you see somebody, and — bam! — the cravings come right back. If you don’t keep your eye on that shit, it’ll get you.”

    “It? You mean cravings for drugs? Or your past?”

    “Both,” she said emphatically. “I mean, fuck. Emotions don’t go away. If you bury them, everything comes crashing out when someone asks you for a fucking pen, and they get the last six months of shit because they walked in at the wrong time.”

    I laughed. “So much shit can happen in six months.”

    She nodded, but she wasn’t smiling.

    I rubbed a fingertip around the edge of the saucer, staring at the ashes sprinkled over its center. “What’s it like for you to be sober?”

    “It’s harder. But it’s better. My job is good, and I want to keep it. I have money the day after I get paid. I’ve got my therapist and my doctor on speed dial. I have Vivitrol. But I still crave drugs. I don’t talk to anyone who uses. It’s easy for that shit to happen. You gotta be on your game.”

    “At least to me, you seem impressively aware of your game.”

    With one hand, she waved away my words. “I have terrible days, too. Just awful days. But if my mom can bury two kids and not have a drug issue, I should be able to do it. When my brother shot himself, his girlfriend was right there. She’s now married and has two kids. That’s just freaking amazing. If she can stay clean, then I should be able to stay sober, too.”

    “Can I reiterate my admiration again? So many people are just talk.”

    Shauna laughed. “Sometimes I downplay my trauma, but it made me who I am. I change my own oil, take out the garbage. I run the Weedwacker and stack firewood. I’ve repaired both mufflers on my car, just because I could.” Her jaw tightened. “But I don’t want to be taken advantage of.” She told me how one night, she left her house key in the outside lock. “When I woke up next morning and realized what I had done, I was so relieved to have survived. I told myself, See, you’re not going to fucking die.”

    “You’re afraid here? In small town Vermont?”

    “I always lock up at night. Always have, always will.” Cupping her hands around the lighter to shield the flame from the wind, she bent her head sideways and lit another cigarette.

    “I lock up, too. I have a restraining order against my ex.”

    She tapped her lighter on the table. “So you know.”

    “I do. I get it.”

    *

    As the dusk drifted in and the warm afternoon gave way to a crisp fall evening, our conversation wound down.

    Shauna continued, “I still feel like I have a long way to go. But I feel lucky. I mean, in my addiction I never had sex for money or drugs. I never had to pick out of the dumpster. My rock bottom wasn’t as low as others. I’m thankful for that.”

    I thought of my own gratitude for how well things had worked out for me, despite my drinking problem; I had my daughters and house, my work and my health.

    Our tabby cat Acer pushed his small pink nose against the window screen and meowed for his dinner. My daughter Gabriela usually fed him and his brother around this time.

    “It’s getting cold,” Shauna said, zipping up her jacket.

    “Just one more question. What advice would you give someone struggling with addiction?”

    Shauna stared up at the porch ceiling painted the pale blue of forget-me-not blossoms, a New England tradition. She paused for so long that I was about to thank her and cut off our talk when she looked back at me.

    “Recovery,” she offered, “is possible. That’s all.”

    “Oh . . .” I shivered. “It’s warm in the house. Come in, please. I’ll make tea.”

    She shook her head. “Thanks, but I should go. I’ve got to feed the dogs.” She glanced at Acer sitting on the windowsill. “Looks like your cat is hungry, too.”

    “Thank you again.”

    We walked to the edge of the driveway. Then, after an awkward pause, we stepped forward and embraced. She was so much taller than me that I barely reached her shoulders.

    When Shauna left, I gathered my two balls of yarn and my half-knit sweater and went inside the kitchen. I fed the cats who rubbed against my ankles, mewling with hunger. From the refrigerator, I pulled out the red enamel pan of leftover lentil and carrot soup I’d made earlier that week and set it on the stove to warm.

    Then I stepped out on the front steps to watch for my daughters to return home. Last summer, I had painted these steps dandelion yellow, a hardware store deal for a can of paint mistakenly mixed. Standing there, my bare feet pressed together, I wrapped my cardigan around my torso. Shauna and I had much more in common than locking doors at night. Why had I revealed nothing about my own struggle with addiction?

    *

    I wandered into the garden and snapped a few cucumbers from the prickly vines. Finally, I saw my daughters running on the other side of the cemetery, racing each other home, ponytails bobbing. As they rushed up the path, I unlatched the garden gate and held up the cucumbers.

    “Cukes. Yum. Did you put the soup on?” Molly asked, panting.

    “Ten minutes ago.” Together we walked up the steps. The girls untied their shoes on the back porch.

    “We saw the bald eagles by the reservoir again,” Gabriela said.

    “What luck. I wonder if they’re nesting there.”

    Molly opened the kitchen door, and the girls walked into our house. Before I headed in, too, I lined up my family’s shoes beneath the overhang. Through the glass door, I saw Molly cradling Acer against her chest, his hind paws in Gabriela’s hands as the two of them cooed over their beloved cat.

    Hidden in the thicket behind our house, the hermit thrush — a plain brown bird, small enough to fit in the palm of my hand — trilled its rippling melody, those unseen pearls of sound.

    In the center of the table where Shauna and I had sat that afternoon, the saucer was empty, save for crumbles of common garden dirt and a scattering of ashes. When I wasn’t looking, Shauna must have gathered her crushed cigarette butts. I grasped the saucer to dump the ashes and dirt over the railing then abruptly paused, wondering: If I had lived Shauna’s life, would I have had the strength to get sober? And if I had, would I have risked that sobriety for a stranger?

    In the kitchen, my daughters joked with each other, setting the table, the bowls and spoons clattering. The refrigerator opened and closed; the faucet ran. I stood in the dusk, my breath stirring that dusty ash.

    Excerpted from Unstitched: My Journey to Understand Opioid Addiction and How People and Communities Can Heal, available at Amazon and elsewhere.

    View the original article at thefix.com

  • Dear William: A Father's Memoir of Addiction, Recovery, Love, and Loss

    The last time David Magee saw his son alive, William told him to write their family’s story in the hopes of helping others. Days later, David found William dead from an accidental drug overdose.

    The officer standing in the doorway raised his arm when I stepped forward, blocking my entrance to my son’s apartment. I tried to peer over his blue-uniformed shoulder to gaze around the corner to where the body of my son sat on the couch. My precious William—I saw him take his first breaths at birth, and I’d cried as I looked down at him and pledged to keep him safe forever. Now, within a day of his final breath, I wanted to see him again.

    “Please,” I said to the officer.

    “Listen,” he said, and I dragged my eyes from straining to see William to the officer’s face. His brown eyes were stern but not unkind. “You don’t want to see this.”

    “I do,” I said. “It’s my son.”

    He glanced over his shoulder, then back at me. “Death isn’t pretty,” he said. “He’s bloated. His bowels turned loose. That’s what happens when people die and are left alone for a day or more.”

    I didn’t say anything. I couldn’t.

    “And there’s something else,” he said.

    “What?”

    “He’s still got a $20 bill rolled up in his hand used for whatever he was snorting.”

    I felt the pavement beneath my feet seem to tilt. I reached to steady myself on the splintered doorjamb one of the officers had forced open with a crowbar just minutes before.

    At his hip, the officer’s radio squawked. I knew the ambulance would be here soon. “Your son—we found him with his iPad in his lap. It looks like he was checking his email to see what time he was due at work in the morning.”

    Yes, William was proud of holding down that job at the Apple Store. He was trying to turn things around.

    “It’s typical, really,” the officer continued. “That’s how addicts are. Snorting a fix while hoping to do right and get to work the next day. It’s always about the moment.”

    This past year, William had been the chief trainer at the Apple Store, and he’d been talking again about heading to law school, the old dream seeming possible once more now that he was sober. He seemed to have put the troubles of the previous year, with his fits and starts in treatment, behind him. They’d kicked William out of one center in Colorado because he drank a bottle of cough syrup. Another center tossed him out because he and a fellow rehabber successfully schemed over two weeks to purchase one fentanyl pill each from someone in the community with a dental appointment. They swallowed their pills in secret, but glassy eyes ratted them out to other patients, who alerted counselors. When asked, William confessed, hoping the admission might move the counselors to give him a second chance. But they sent him packing back to Nashville, where his rehab treatment had begun. One counselor advised us to let William go homeless. “We’ll drop him off at the Salvation Army with his clothing and $10,” he said. “Often, that’s what it takes.”

    We knew that kind of tough-love, hit-rock-bottom stance might be right, but our parental training couldn’t stomach abandoning our son to sleep at the Salvation Army. Instead, my wife and I drove five hours from our home in Mississippi to Nashville to pick him up. He was fidgety but he hugged us firmly, looking into our eyes. We took him to dinner at Ruth’s Chris Steak House, and, Lord, it felt good to see his broad smile, our twenty-two-year-old son adoring us with warm, brown eyes. We told stories and laughed and smiled and swore the bites of rib eye drenched in hot butter were the best we’d ever had.

    The next morning, after deep sleep at a Hampton Inn under a thick white comforter with the air conditioner turned down so low William chuckled that he could see his breath, we found a substance treatment program willing to give him another chance.

    “This dance from one treatment center to another isn’t unusual,” a counselor explained at intake. “Parents drop their child off for a thirty-day treatment and assume it’s going to be thirty days. But that’s just the tip of the iceberg.” My wife and I exchanged a look; that’s exactly what we’d thought the first time we got William treatment. Thirty days and we’d have our boy home, safe and healthy.

    The counselor continued, “If opiates and benzos are involved, it often takes eight or nine thirty-day stays before they find the rhythm of sobriety and self-assuredness. The hard part for them is staying alive that long.”

    When we left William in Nashville for that first thirty-day treatment, weeks before Thanksgiving, we imagined we’d have him home for Christmas. In early December, we bought presents that we expected to share, sitting around the tree with our family of five blissfully together. But William needed more treatment. Thanksgiving turned into Christmas, and Christmas turned into the new year, and the new year turned into spring. We missed William so much, but finally, the treatment was beginning to stick. We saw progress in William’s eyes during rare visits, the hollowness carved by substances slowly refilling with remnants of his soul.

    Now, when parents ask me how they can tell if their kid is on drugs, I say, “Look into their eyes.” Eyes reveal the truth, and eyes cannot hide lies and pain. In William’s eyes, we saw hopeful glimmers that matched improved posture and demeanor. Progress, however, can become the addict’s worst enemy since renewed strength signals opportunity. Addicts go to rehab because substances knocked them down, yet once they are out of treatment and are feeling more confident, they forget just how quickly they can be knocked down again.

    Yet we, too, were feeling confident about William’s prospects. He’d always been scrappy, a hard worker. In college, he ran the four-hundred-meter hurdles in the Southeastern Conference Outdoor Track and Field Championships, despite the fact that he had short legs for a college hurdler. He overcame that by being determined, confident, and quick. And all the time he was competing at the Division 1 level, he was an A student in the Honors College. He’d set his mind on law school and people had told us that with his resumé he could get into most any law school in America.

    During that year after his graduation, in 2012, when William was in and out of treatment, I decided to quit my job as a newspaper editor to spend more time with him. I wanted to keep an eye on his progress and be there if he started to slide, so I visited him in Nashville every other week. He worried I was throwing my career away, but I would throw away anything to help him. Also, I had a plan. Instead of the daily grind of editing a newspaper, I thought quitting might provide the opportunity to return to a book project I’d abandoned. The Greatest Fight Ever was my take on the John L. Sullivan versus Jake Kilrain bare-knuckle boxing match of the late 1800s. The Sullivan-Kilrain fight was an epic heavyweight championship held in South Mississippi, lasting seventy-five rounds in sultry July heat, part showmanship theater and part brute brawl. I had researched the story for years and was once excited about explaining its role in the playing—and hyping—of sports today. I enjoyed sharing anecdotes over the years, like how the mayor of New Orleans served as a referee. Or that the notorious Midwestern gunslinger Bat Masterson took bets ringside on the fight, which set the standard for sports’ bigger-than-life culture that continues today.

    I had written other books by then, including some that found commercial success, but looking back at them from a distance, I judged none to be as excellent and useful as they could have been. I wanted the Sullivan-Kilrain fight story to change that. But William noticed as we visited that my enthusiasm for the story had evaporated. I wasn’t spending time crafting the manuscript.

    “You need to finish your book,” William said that April when I visited him in Nashville. We were eating breakfast at a café known for pancakes, but I was devouring bacon and eggs as William wrestled with a waffle doused with jelly.

    “I’m trying,” I said between sips of coffee. “It’s easy to tell a story, but it’s more difficult to tell a good story. That’s what I’m working at.”

    “You are a good writer. You can do it if you get focused.”

    “It’s hard to immerse yourself in a championship boxing match from the 1800s when you and your family are in the fight of a lifetime,” I said.

    William looked at me over his jelly-slathered waffle. He knew I wasn’t just referring to his struggles. I was referring to my own as well. Two years earlier, I’d almost destroyed our family completely through a string of spectacularly bad decisions, and we, individually and collectively, were fragile.

    “William,” I said. “I’m worried about you. I’m worried about me. I’m worried about all of us.”

    We hadn’t talked so much about my own self-immolation. But now William turned to me. “I’m sorry if the mistakes I’ve made were what made it worse for you. I mean—” he looked off and took a breath. “For so long, I thought drugs were for fun, and I didn’t realize how deep I was in. And then it was too late. I needed them. I’m sorry for making it harder on you and Mom.”

    “No, William, don’t put that on yourself. I caused my own problems. And I want to apologize to you too. I’m sorry for when you struggled in college and I was so caught up in my own life or career that I wasn’t there when you needed me. I failed you.”

    We went on that way for a while, saying the things that had burdened us, the things we’d needed to say for a long time. That weekend was our best, most direct connection in years. I was glad to sit beside my son over coffee and a breakfast we could live without for conversation we’d been dying for, glad I’d quit a decent editing job, glad even to stop pretending I was writing a book that no longer held my interest.

    “Maybe there’s another book you should be writing, Dad,” he said.

    “About sports?”

    “About us.”

    I looked at his plate, the waffle barely eaten. I looked at his eyes, shining with encouragement.

    “Do you ever think maybe other people could learn something from hearing about our story? I mean, when we were growing up, no one would have looked at our family, this all-American family that pretty much lacked for nothing, and predict how bad we’d crash. But maybe hearing what happened to us could help people. Maybe that’s the story you should tell.”

    “Maybe we should tell it together,” I said after a bite.

    “I’m not ready yet,” he said. “But one day, we’ll do it.”

    “Yes,” I said, clutching his hand in mine. “One day, we’ll do it.”

    We said goodbye then and told each other we loved each other, and I walked to my car.

    “Dad,” William called out.

    “Yeah?” I turned over my shoulder.

    “Make sure you finish that book,” he said.

    I stopped. “What book? The Greatest Fight Ever?”

    He smiled and waved goodbye.

    I wiped tears away, then drove home.

    That was the last time I ever saw my firstborn child.

    Five sleeps later, William died. He didn’t plan on dying. But the early days of sobriety can be the loneliest days. And it’s never hard for an addict to find an excuse.
     

    Excerpted from Dear William: A Father’s Memoir of Addiction, Recovery, Love, and Loss by David Magee, available November 2, 2021 at Amazon and elsewhere.

    View the original article at thefix.com

  • Doctors More Likely to Prescribe Opioids to Covid ‘Long Haulers,’ Raising Addiction Fears

    The study of VA patients makes it “abundantly clear that we are not prepared to meet the needs of 3 million Americans with long covid.”

    Covid survivors are at risk from a separate epidemic of opioid addiction, given the high rate of painkillers being prescribed to these patients, health experts say.

    A new study in Nature found alarmingly high rates of opioid use among covid survivors with lingering symptoms at Veterans Health Administration facilities. About 10% of covid survivors develop “long covid,” struggling with often disabling health problems even six months or longer after a diagnosis.

    For every 1,000 long-covid patients, known as “long haulers,” who were treated at a Veterans Affairs facility, doctors wrote nine more prescriptions for opioids than they otherwise would have, along with 22 additional prescriptions for benzodiazepines, which include Xanax and other addictive pills used to treat anxiety.

    Although previous studies have found many covid survivors experience persistent health problems, the new article is the first to show they’re using more addictive medications, said Dr. Ziyad Al-Aly, the paper’s lead author.

    He’s concerned that even an apparently small increase in the inappropriate use of addictive pain pills will lead to a resurgence of the prescription opioid crisis, given the large number of covid survivors. More than 3 million of the 31 million Americans infected with covid develop long-term symptoms, which can include fatigue, shortness of breath, depression, anxiety and memory problems known as “brain fog.”

    The new study also found many patients have significant muscle and bone pain.

    The frequent use of opioids was surprising, given concerns about their potential for addiction, said Al-Aly, chief of research and education service at the VA St. Louis Health Care System.

    “Physicians now are supposed to shy away from prescribing opioids,” said Al-Aly, who studied more than 73,000 patients in the VA system. When Al-Aly saw the number of opioids prescriptions, he said, he thought to himself, “Is this really happening all over again?”

    Doctors need to act now, before “it’s too late to do something,” Al-Aly said. “We must act now and ensure that people are getting the care they need. We do not want this to balloon into a suicide crisis or another opioid epidemic.”

    As more doctors became aware of their addictive potential, new opioid prescriptions fell, by more than half since 2012. But U.S. doctors still prescribe far more of the drugs — which include OxyContin, Vicodin and codeine — than physicians in other countries, said Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University.

    Some patients who became addicted to prescription painkillers switched to heroin, either because it was cheaper or because they could no longer obtain opioids from their doctors. Overdose deaths surged in recent years as drug dealers began spiking heroin with a powerful synthetic opioid called fentanyl.

    More than 88,000 Americans died from overdoses during the 12 months ending in August 2020, according to the Centers for Disease Control and Prevention. Health experts now advise doctors to avoid prescribing opioids for long periods.

    The new study “suggests to me that many clinicians still don’t get it,” Kolodny said. “Many clinicians are under the false impression that opioids are appropriate for chronic pain patients.”

    Hospitalized covid patients often receive a lot of medication to control pain and anxiety, especially in intensive care units, said Dr. Greg Martin, president of the Society of Critical Care Medicine. Patients placed on ventilators, for example, are often sedated to make them more comfortable.

    Martin said he’s concerned by the study’s findings, which suggest patients are unnecessarily continuing medications after leaving the hospital.

    “I worry that covid-19 patients, especially those who are severely and critically ill, receive a lot of medications during the hospitalization, and because they have persistent symptoms, the medications are continued after hospital discharge,” Martin said.

    While some covid patients are experiencing muscle and bone pain for the first time, others say the illness has intensified their preexisting pain.

    Rachael Sunshine Burnett has suffered from chronic pain in her back and feet for 20 years, ever since an accident at a warehouse where she once worked. But Burnett, who first was diagnosed with covid in April 2020, said the pain soon became 10 times worse and spread to the area between her shoulders and spine. Although she was already taking long-acting OxyContin twice a day, her doctor prescribed an additional opioid called oxycodone, which relieves pain immediately. She was reinfected with covid in December.

    “It’s been a horrible, horrible year,” said Burnett, 43, of Coxsackie, New York.

    Doctors should recognize that pain can be a part of long covid, Martin said. “We need to find the proper non-narcotic treatment for it, just like we do with other forms of chronic pain,” he said.

    The CDC recommends a number of alternatives to opioids — from physical therapy to biofeedback, over-the-counter anti-inflammatories, antidepressants and anti-seizure drugs that also relieve nerve pain.

    The country also needs an overall strategy to cope with the wave of post-covid complications, Al-Aly said

    “It’s better to be prepared than to be caught off guard years from now, when doctors realize … ‘Oh, we have a resurgence in opioids,’” Al-Aly said.

    Al-Aly noted that his study may not capture the full complexity of post-covid patient needs. Although women make up the majority of long-covid patients in most studies, most patients in the VA system are men.

    The study of VA patients makes it “abundantly clear that we are not prepared to meet the needs of 3 million Americans with long covid,” said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “We desperately need an intervention that will effectively treat these individuals.”

    Al-Aly said covid survivors may need care for years.

    “That’s going to be a huge, significant burden on the health care system,” Al-Aly said. “Long covid will reverberate in the health system for years or even decades to come.”
     

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    View the original article at thefix.com

  • The Current Status of Addiction Recovery in Pennsylvania

    The pandemic continues to affect virtually every aspect of American life, and that, sadly, also includes those suffering with an addiction – including opioids.

    It’s holiday season, 2020. Undoubtedly, a different kind of festive season than normal for many Americans, but… it’s still the holidays, nonetheless.

    However, for many families, there’ll be empty places at the dinner table this year – loved ones missing not because of the dreaded and awful coronavirus pandemic that continues to tragically affect the U.S., but from fatal opioid drug overdoses, part of a national epidemic that was here long before COVID-19 ever became part of our vocabulary.

    Take a few moments out of this day to look back at the statistical data for the U.S. opioid epidemic, and you’ll see the highest peak in opioid-related fatal overdoses was during the first half of 2017 – in virtually every state across the nation. Only 3 short years ago, U.S. citizens were dying at a rate of around 130 every single day.

    It’s difficult to fully comprehend, but it happened – surely, we’d never see such death rates again (we’ll get to the dreaded “corona” shortly, which is now, more tragically, taking many more lives per day).

    Back to the opioid epidemic.

    A range of pain-killing medications, arguably misbranded by Big Pharma, were being prescribed freely across the U.S. in a practice that went on for over 20 years, leaving thousands upon thousands unknowingly dependent on powerful narcotics, and with a chronic medical condition – opioid use disorder (OUD).

    Like the layered tragedy of a Shakespeare play, just when you thought things were actually looking up (as the national rate of opioid-related deaths began to noticeably fall), along came a global accident-waiting-to-happen – the COVID-19 pandemic.

    Take a further few moments to access everyone’s favorite search engine, type in “US Covid Latest 2020,” and you’ll see the latest statistics about how badly the nation has been hit by the pandemic. Over 335,000 deaths, and still rising.

    However, the pandemic continues to affect virtually every aspect of American life, and that, sadly, also includes those suffering with an addiction – including opioids.

    In Beaver County, Pennsylvania, District Attorney David Lozier recently spoke about how his region is being affected by the virus in terms of the detrimental impact on people’s mental wellbeing, including rates of opioid use and addiction:

    COVID has sucked the wind out of every other issue. Now this year, the [drug overdose] numbers are going up like 2016 and the first half of 2017. We’re seeing an increase in domestic violence, Childline and child abuse calls, a worsening mental health picture, and worsening drug and alcohol pictures. The people who need support services or who are in treatment… It’s all been by phone. They haven’t had the in-person contact they need.”

    So it begs the question – what exactly is the current status of addiction recovery in Pennsylvania?

    To answer this, we first need to look at how Pennsylvania stood last year (2019 seems a remarkably long time ago now, doesn’t it?) with respect to substance addiction rates and addiction treatment levels, and how the state stands now, after around half a year of severe socio-economic disruption, including mandatory lockdowns and long periods of social isolation for its residents.

    How COVID-19 Has Radically Altered Addiction Recovery

    2019:

    According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2019, Pennsylvania rehab centers saw more than 19,000 admissions. There’s little doubt, the fight against the opioid epidemic was still being fought (a situation destined to last many years). However, many thousands of Pennsylvania residents were still becoming addicted to the prescriptions written out by their family doctor.

    According to a research study by the Perelman School of Medicine at the University of Pennsylvania, in Philadelphia, it was found that excessive, high-dose opioid prescriptions were still being routinely prescribed following common, minor day-patient surgeries – at a strength strictly advised against by the Centers for Disease Control & Prevention (CDC), for the purpose of reducing the number of opioid-related fatal overdoses.

    So how was the level of access to opioid addiction treatment at this time?

    In short – increasing. For example, under the Blue Guardian program in Lehigh County, PA, police and other first responders would notify the program when they had responded to an opioid overdose. Later, an officer and a certified recovery specialist would visit the person to follow up and discuss their treatment options.

    This hands-on approach was highly successful, as confirmed by Layne Turner, Lehigh County’s drug and alcohol administrator. She stated that, “Of the 52 individual face-to-face meetings, 34 individuals entered treatment. The lesson learned is when the face-to-face contacts are made, 65% of the time individuals enter treatment.”

    Clearly, the state of Pennsylvania was moving in the right direction when it came to accessing and providing opioid addiction treatment for opioid abusers and addicts. In fact, a rate of 65% is far, far higher than the national average for the numbers of drug addicts who make it into such treatment. In 2019, that national rate stood at a lowly 10-13%.

    When you consider that recent estimates say one-fifth of U.S. citizens who have clinical depression or an anxiety disorder will also have a substance use disorder (SUD), like OUD, you quickly understand that the very last thing the nation needed in fighting addiction was the soon-to-arrive COVID-19 pandemic, with its resulting lockdowns and isolation.

    The concerns we have are related to the big challenges people are facing right now with COVID: isolation and uncertainty resulting in very high levels of stress.”  
    Nora Volkow, Director of the National Institute for Drug Abuse

    2020:

    The (first) year of the COVID-19 pandemic arrived, leading to the “isolation and uncertainty” and “very high levels of stress” quoted above. Fatal drug overdoses – not just from opioids, but now including cocaine and methamphetamine – are spiking alarmingly across the nation.

    Just like any other U.S. industry, the addiction treatment field has been hit hard, with many rehab centers, including those in Pennsylvania, facing financial collapse if things don’t improve soon. Many treatment centers report clients not making their scheduled treatment appointments – either the simple fear of coronavirus infection, or, worryingly, because more and more of those in recovery are experiencing overdoses and relapses.

    In an effort to meet the changing conditions, addiction treatment centers have also had to invest in new “telemedicine” technology to be able to provide services, where clients receive counseling and other treatment via their computer screens.

    Nonprofits have struggled to treat their clients. In a recent survey, 44% of members from the National Council for Behavioral Health say they will easily run out of money in the next 6 months.

    Interestingly, if you look at the 2019-related paragraphs above, you’ll see words like “admissions,” “individual face-to-face meetings,” “right direction, “access” and “contact.” All of these are being heard less and less, if at all, for many recovering addicts in 2020.

    The sad proof of this lies in the national rise in fatal drug overdoses, as described by the American Medical Association in its updated Issue Brief (October, 2020), which reports that more than 40 states have “reported increases [around 18% – nearly a fifth] in opioid-related mortality, as well as ongoing concerns for those with a mental illness or substance use disorder.”

    And, lo and behold, guess what? Yes, sadly, Pennsylvania is again one of those 40.

    Addiction Recovery = Hope

    However gloomy-sounding this article may appear at first glance, there is a distinctly positive and hopeful side.

    The sphere of addiction treatment, providing long-term, sustainable recovery for OUD sufferers and those with other SUDs, is recovering itself, and this is happening in a number of essential ways:

    • More and more of Pennsylvania’s facilities and clinics are becoming accustomed to the necessary COVID-19 protocols and regulations required in running their treatment options, from residential care, to Partial-Hospitalization Programs (PHPs), Outpatient Programs, and their own counseling sessions and group support meetings.
    • Telemedicine technology, with the addiction experts looking on, is growing, expanding and even researching its own effectiveness as a method of healthcare provision for those with SUDs and mental health issues.
    • As for the telemedicine “patient,” they are becoming more accustomed to accessing their treatment, care and support online, just like the vast numbers of those in AA and NA when virtually “attending” their own 12-Step meetings.
    • If you’re looking for Pennsylvania’s online 12-Step meetings, the links for these are provided here:
    • Finally, the use of Medically Assisted Treatment (MAT), such as the provision of methadone and other MAT drugs for opioid replacement, has had its own regulations relaxed, thus increasing its range of access to those who need it.

    Dr. Mark Fuller, the Medical Director of Addiction Medicine at the Center of Inclusion Health, part of the Allegheny Health Network in Pittsburg, PA, recently stated, “Some folks say that the opposite of addiction is connection – connecting with a therapist, or other friends in recovery, or your 12-step meeting. Those connections are a really powerful part of recovery and really a key step in helping people stay clean and sober.

    How many of Pennsylvania’s reported 800 licensed drug abuse and addiction treatment centers, both nonprofit and for-profit, will survive 2021 remains to be seen. Without the vital professional connections these treatment centers provide, and without the social “recovery community” connections referred to by Dr. Mark Fuller in the quote above, there will clearly be fewer inspiring stories of real addiction recovery happening across the state during this year of coronavirus.

    However, for now, with the excellent strategies listed above, the vast field of addiction treatment – just like the rest of us – is starting to get to grips with the strong and undeniable challenges that lie ahead.

    View the original article at thefix.com

  • Understanding Dependence Versus Addiction

    Opioid dependence and opioid addiction are closely related, but two distinct conditions.

    Opioids are powerful substances, whether they’re being used in a medically-sanctioned way or abused. Any opioid is likely to have an impact on your health and wellness, but how that plays out will vary greatly. Most people who use opioids regularly will experience some level of physical dependence, and others will develop opioid addiction.

    Understanding the difference between physical dependence and opioid addiction can help you find the treatment that you need.

    What is opioid dependence?

    To understand physical dependence, you need to understand a bit about how opioids work in the body. Opioids attach to opioid receptors. Normally, these receptors can be used to send pain signals; having opioids bound to them prevents pain signals from being sent. That’s why opioids are commonly prescribed for pain.

    However, over time your brain adjusts to the opioids that you’re taking — even if you’re following doctor’s orders. You might need more opioids to experience the same pain relief.

    The brain changes that happen as a result of taking opioids can lead to opioid dependence. The Centers for Disease Control and Prevention defines dependence as experiencing withdrawal symptoms when you stop taking an opioid medication or using illicit opioids. Symptoms of opioid withdrawal can include anxiety, nausea, diarrhea and sweating.

    Over time, if you continue to take opioids — whether prescribed or illicit — you’ll likely need more and more opioids to feel normal and avoid the symptoms of withdrawal. This is because your opioid tolerance has increased. That can lead to addictive behaviors.

    What is opioid addiction?

    Opioid dependence is a physical condition brought about by brain changes, whereas opioid addiction is a condition that can happen as your physical dependence becomes more acute, according to Waismann Method® Opioid Treatment Specialists.

    Addiction to opioids is a pattern of physical and emotional responses that stem from your physical dependence on opioids. As you try to avoid withdrawal symptoms, your behaviors can change. This can have a devastating impact on your life and impact your career, friendships and family relationships.

    People who are experiencing opioid addiction can display uncharacteristic behaviors, like:

    • Ignoring responsibilities to family or work because you are focused on obtaining opioids.
    • Having trouble controlling your emotions or behaviors.
    • Fixating on how and when you will next be able to obtain opioids.

    With time, these symptoms of addiction can erode the bedrock of your life.

    Treatment for opioid dependence and addiction

    Whether you are struggling with opioid dependence or full-blown opioid addiction, the first step toward treatment is detoxing from opioids. Detox is the process of removing opioids from your body, so that you no longer need opioids to function at a normal level.

    Detox can be painful, because it brings about the symptoms of withdrawal. However, there is a medical detox option that provides the highest level of comfort available. Rapid detox allows your body to be flushed of opioids while you are under anesthesia in a fully-accredited hospital. Because you’re sedated, you don’t feel the acute symptoms of withdrawal. Using a combination of medications, detox can happen much more quickly than it would under normal circumstances if you tried to detox on your own.

    Addressing physical dependence is only one step toward recovering from opioid addiction. After you have detoxed from opioids, you can address the pain — whether physical or emotional — that drove you to use opioids in the first place.

    At Waismann Method®, people who undergo detox receive continued care at Domus Retreat, where they can make a plan for an individualized approach to life in recovery. There are no set schedules or required meetings, but there is space to rejuvenate and recover, and guidance toward the next steps that are right for you.

    A dignified approach to treating opioid dependence and addiction

    Waismann Method® understands that opioid addiction is rooted in the physical brain changes that take place when opioids enter your body. Furthermore, addiction often results from using drugs to cope with underlying physical, emotional or mental health issues. There is no shame or blame in treating opioid addiction — just an understanding that no matter your past, you can have a new opioid-free beginning.

    View the original article at thefix.com

  • For Pregnant Women, Stigma Complicates Opioid Misuse Treatment

    In Pennsylvania, one community health center is working with new and expectant moms to tackle opioid dependency.

    New and expectant mothers face unique challenges when seeking treatment for an opioid use disorder. On top of preparing for motherhood, expectant mothers often face barriers to accessing treatment, which typically involves taking safer opioids to reduce dependency over time. The approach is called medication assisted therapy, or MAT, and is a key component in most opioid treatment programs.

    But with pregnant women, providers can be hesitant to administer opiate-based drugs.

    According to a study out of Vanderbilt University, pregnant women are 20% more likely to be denied medication assisted therapy than non-pregnant women.

    “In the beginning, I was so scared as a new provider to write my first prescription for medication assisted therapy to pregnant women,” said Dr. Linda Thomas-Hemak of the Wright Center for Community Health in Scranton, Pennsylvania.

    The health center serves low-income individuals who are underinsured or lack insurance altogether, many of whom struggle with opioid misuse.

    “Pennsylvania was hit particularly hard by the opiate epidemic that really has plagued, terrified and challenged America,” said Hemak, who is a board certified addiction medication specialist.

    On this episode of the podcast, we speak with Dr. Hemak about whether medication assisted therapy is safe for new and expectant mothers and how the Wright Center is helping women overcome opioid dependency during pregnancy.

    Direct Relief · For Pregnant Women, Stigma Complicates Opioid Treatment
    Listen and subscribe to Direct Relief’s podcast from your mobile device:
    Apple Podcasts | Google Podcasts | Spotify


    Direct Relief granted $50,000 to The Wright Center for its extraordinary work to address the opioid crisis. The grant from Direct Relief is part of a larger initiative, funded by the AmerisourceBergen Foundation, to advance innovative approaches that address prevention, education, and treatment of opioid addiction in rural communities across the U.S. 

    In addition to grant funding, Direct Relief is providing naloxone and related supplies. Since 2017, Direct Relief has distributed more than 1 million doses of Pfizer-donated naloxone and BD-donated needles and syringes to health centers, free and charitable clinics, and other treatment organizations.


    Transcript:

    When it comes to getting treatment for an opioid use disorder, pregnant women have an uphill battle.

    Most patients undergoing opioid treatment are prescribed safer opioids that reduce dependency while limiting the risk of overdose and withdrawal.

    This kind of treatment is called medication assisted therapy, or MAT.

    But with pregnant women, providers can be hesitant to administer opioids.

    According to a study out of Vanderbilt University, pregnant women are 20% less likely than non-pregnant women to be accepted for medication assisted therapy.

    “In the beginning, I was so scared as a new provider to write my first prescription for medication assisted therapy to pregnant women,” said Dr. Linda Thomas-Hemak.

    Hemak is a board-certified addiction medication specialist and CEO of the Wright Center in Scranton, Pennsylvania.

    “Pennsylvania was hit particularly hard by the opiate epidemic that really has plagued, terrified and challenged America,” said Hemak who has been practicing in the state for several years.

    In 2016, the health center launched a comprehensive opioid treatment program to address the growing crisis in their community. They quickly realized a number of patients were pregnant—and had specific needs, from prenatal care to job support. And so, a new program was born.

    “The Healthy MOMS program is based on assisting mothers who are expecting babies or have recently had a child, up until the age of two,” explained Maria Kolcharno — the Wright Center’s director of addiction services and founder of the Healthy MOMS program.

    “We have 144 moms, through the end of August, that we have served in the Healthy MOMS program and actively, we have enrolled 72.”

    The program provides new and expectant moms with behavioral health services, housing assistance, educational support; providers have even been delivering groceries to moms’ homes during the pandemic.

    But the crux of the program is medication assisted therapy.

    Moms in the program are prescribed an opioid called buprenorphine—unlike heroin or oxycodone, the drug has a ceiling effect. If someone takes too much, it won’t suppress their breathing and cause an overdose.

    Nonetheless, it’s chemically similar to heroin, which may raise eyebrows. But while some substances, like alcohol have been shown to harm a developing fetus, buprenorphine isn’t one of them.

    “Clearly there are medications, like alcohol, that are teratogenic. And there’s medications like benzodiazepines that have strong evidence that they are probably teratogenic. When you look at the opioids that are used and even heroin, there is no teratogenic impacts of opiates on the developing fetus,” Dr. Hemak explained.

    So, opioids like buprenorphine can be safe for pregnant women. What’s not safe is withdrawal.

    If someone is abusing heroin, overdose is likely. In order to revive them, a reversal drug called Naloxone is used, which immediately sends the person into withdrawal.

    But when a woman is pregnant and goes into withdrawal, it can cause distress to her baby, lead to premature birth, and even cause a miscarriage.

    Which is also why these women can’t just stop taking opioids.

    “Stopping cold a longstanding use of an opiate because you’re pregnant is a very bad idea and it is much safer for the baby and the moms to be transitioned from active opiate use to buprenorphine when pregnant,” explained Hemak.

    Because buprenorphine has a ceiling effect and is released over a longer period of time, women are less likely to overdose on the drug.

    Regardless, there’s still a risk their baby goes through withdrawal once they’re born. For newborns, withdrawal is called neonatal abstinence syndrome or NAS.

    Babies may experience seizures, tremors, and trouble breastfeeding. Symptoms usually subside within a few weeks after birth.

    Fortunately, the syndrome has been shown to be less severe in babies born from moms taking buprenorphine versus those using heroin or oxycodone.

    That’s according to Kolcharno who has been comparing outcomes between her patients and those dependent on opioids, but not using medication assisted therapy.

    “Babies born in the Healthy MOMS program, we’re finding, that are released from the hospital, have a better Apgar and Finnegan score, which is the measurement tool for NAS and correlates all the withdrawal symptoms to identify where this baby’s at,” said Kolcharno.

    But NAS is not the only concern women have post-partum.

    During and after delivery, doctors often prescribe women pain killers. For those with an opioid dependency, these drugs can trigger a relapse.

    Dr. Thomas-Hemak says preventing this kind of scenario requires communication.

    The Wright Center works with their local hospital to ensure OBGYNs are aware of patient’s substance use history.

    “We want the doctor to know that this may be somebody that you’re really sensitive to when you’re offering postpartum pain management,” said Hemak.

    That way, doctors know to tailor patients’ post-partum medication regimens. Instead of prescribing an opiate-based pain killer they can offer alternatives, like Ibuprofen or Advil.

    Maintaining an open line of communication between addiction services and hospital providers also helps to reduce stigma.

    Women with substance use disorders have long been subject to discriminatory practices by both providers and policy makers.

    From denying them treatment to encouraging sterilization post-delivery, women struggling with opioid dependency can be hard-pressed to find patient-centered health care.

    But Dr. Thomas-Hemak says, she’s learned to set her opinions aside.

    “I think one of the magical transformations that happens when you do addiction medicine really well is, it’s never about telling patients what to do.”

    It’s about allowing them to make informed choices, she says, and understanding it’s not always the choice you think is best.

    This transcript has been edited for clarity and concision.

    View the original article at thefix.com

  • Opinion: The Opioid Crisis + COVID-19 = The Perfect Storm

    How can the addiction treatment community continue to assist people who are now being left even more isolated and desperate?

    Addiction – a chronic relapsing brain disorder, and a disease that gets deeply personal. It gets low-down and dirty, too.

    If you’re not an addict yourself, you surely know someone who is.

    You know someone abusing their opioid prescriptions, not because it’s a barrier to their pain, but because it’s a potent way to make them feel happier. You know someone whose alcohol consumption is dangerously high and verging on alcoholic – if they’re not already there, of course. Your kids will certainly know someone who abuses recreational drugs like they were going out of fashion. They’ll also know other students who swallow ADHD prescription tablets (as a study aid) because it makes them get their grades, and keeps their parents, people like you, happy.

    Among the people who are in your extended family, among your circle of friends, or someone within your workplace – at the very least, one, probably several more, will be a secret drug addict or an alcoholic. At the very least.

    It doesn’t discriminate. It certainly doesn’t care where you live either, just like most other diseases, and now this new coronavirusCOVID-19.

    Arizona & The Opioid Crisis

    Over the last 3 years, in Arizona alone, there have been more than 5,000 opioid-related deaths. Add to that the 40,000-plus opioid overdoses that have taken place during the same period, and you realize that COVID-19 has never been the only serious health issue the state continues to face, or the rest of the U.S., for that matter.

    In our “new reality” of social distancing and masks, more than 2 people every single day die from an opioid overdose in Arizona. Nearly half of those are aged 25-44 years old – in their prime, you might say.

    Opioids are not the only addictive group of substances that is costing young Arizonan lives right now either.

    From the abuse of “study aid” drugs, like Adderall and other ADHD medications, to the “party drugs,” like cocaine and ecstacy, and so to opioid prescription meds, and, if circumstances allow, a slow and deadly progression to heroin – addiction is damaging lives, if not ending them way too soon.

    These drugs did so before anyone had ever heard of COVID-19, and they’ll continue to do so after, or even if the world ultimately finds another drug – the elusive coronavirus vaccine – it is hoping for.

    Opioids + COVID-19 = The Perfect Storm

    We now live in this time of coronavirus. With the ongoing opioid epidemic, the question arises:

    How can the addiction treatment community continue to assist people who are now being left even more isolated and desperate, still with their chronic desire to get as high as they can, or drunker than yesterday?

    Furthermore, coronavirus has raised questions itself about the ongoing mental health needs of our population as a whole, and drug addicts and alcoholics continue to feature heavily in any statistics you offer up about those in the U.S. living with a mental health disorder.

    In fact, around half of those with a substance use disorder (SUD) or an alcohol use disorder (AUD) – the medical terminology for addiction – are simultaneously living with their own mental health disorder, such as major depression, severe anxiety or even a trauma-related disorder like PTSD.

    How are these predominantly socially-disadvantaged people able to receive the treatment they really need when they have been directed to isolate and socially distance themselves even further?

    This is why I believe the conditions for a “perfect storm” of widespread deteriorating mental health and self-medication through continued substance abuse are here now, with overdoses and fatalities rising across the addiction spectrum.

    There will be many drug or alcohol abusers living in Arizona who will be lost to us, and the majority will be young people in the age group of 25-44 mentioned previously, left isolated and unnoticed by an over-occupied medical community.

    The U.S. opioid epidemic plus the global coronavirus pandemic.

    A deceitfully isolating disorder in a time of generalized social isolation. For some, there will be no safe harbor from this, and it will wash them away from the lives of their families and friends without any chance of rescue whatsoever. The perfect storm – our perfect storm.

    Today, the truth is that successful addiction recovery has become exponentially more difficult. Apart from ongoing isolation to contend with, there exists an unfounded but very real distrust of medical facilities per se, and a real personal problem in maintaining good physical and mental health practices, eg. through nutrition and physical activity.

    Innovation: The Ideal Recovery Answer for Isolated Substance Addicts?

    Digital technology has advanced far further than its creators and financial promoters ever envisaged – or has it? We have become a society where it doesn’t matter where you are in the world, you’re always close by to loved ones you wish to talk to, friends you want to have a laugh with, and colleagues you need to share information with.

    Communication anywhere with anyone is as simple as the proverbial ABC.

    However, if you think that innovation and digital technology – sitting in front of your laptop or tablet, in other words – can provide the answers to the questions raised earlier about the timely provision of professional addiction or mental health treatment to those that need it, then you’re wrong. If only it were all that simple and straightforward.

    Online meetings of 12-Step organizations, like Alcoholics Anonymous, Narcotics Anonymous, and others, have been available for many years. However, all of these support organizations realize that an online or virtual 12-Step meeting is not the real thing. They are a temporary substitute and no more.

    In fact, they are a poor substitute when compared to the face-to-face and hands-on meetings that continue to be held successfully all over the nation and all year round.

    The various “sober aware” and “sober curious” communities that are present online do not provide a realistic treatment option to any substance addicts whatsoever, whether their SUD or AUD has been clinically diagnosed or not. Furthermore, the current crop of online addiction treatment and recovery programs available are currently statistically unproven in terms of successful outcomes, and with no official accreditation.

    That said, there is limited evidence that “telemental health care” does have several benefits in terms of more timely interventions in those with mental illness generally, particularly when these people are located in isolated communities.

    I honestly wouldn’t know, as there is no official patient outcome data for these services. In fact, by the time that data is able to be impartially and officially collected, these groups and so-called programs may have already lost their internet presence.

    Online “help” (you honestly couldn’t call it an actual treatment) with addiction is severely limited and nowhere near approaching the answer. Here’s exactly why…

    Substance addiction is an utterly isolating disorder. It can obliterate close family bonds, destroy what keeps us close together as friends, and will happily rampage unabated through any social life you may still hold onto, accepting no prisoners. Bleak isolation like you’ve never known before.

    Corona has little on addiction.

    Addiction is the catalyst behind premature death, the end of families and their marriages, long-term unemployment, and endless legal issues. It costs financially too – countless billions of dollars every year are lost to this disorder, over double that of any other neurological disease.

    Let me be absolutely clear and concise – there exists no replacement whatsoever for your hand held by another when lying in an intensive care bed, scared you’ll become just another coronavirus statistic, and there exists no replacement for the smiles, warmth, and openness of fellow recovering drug addicts meeting in a daily support group, especially on those days when you came so close, so very close, to using or drinking again.

    There’s little difference between the two either.

    The online addiction treatment industry is still in its childhood. It truly is an industry too, as you’ll only buy the brand and the product; you’ll never actually meet those telling you how to best change your life.

    At present, it falls woefully short.

    Really, what would you prefer? A mask-wearing addiction professional, clinically qualified to assist with your detox, your medication if needed, and your psychological needs, located in an accredited treatment facility (formally certified as being coronavirus-free), among peers, fellow addicts, and trained medical staff?

    Or a video image on a computer screen of someone you will never meet, who is telling you to do things you’ve never done before? At least, successfully?

    As society moves towards a more home-orientated existence, with WFH (working from home) the new norm, consider this:

    Would a specialized medical professional treating your disease ask you to consider “getting better from home,” as an alternative to the hospital?

    All we can hope for – the best that we can hope for – is that coronavirus soon leaves the state lines of Arizona, and that can continue all of our recoveries as successfully as before. Until then, the advice is simple – take the best help you can from wherever you can get it. Sadly, you are yet to find it on a computer screen.

    One last thought before I sign off…

    Protective masks may well become standard attire in our unknown future. So why, oh why, can they not make these transparent? Just take a moment… We’d be able to see each other – our friends, our colleagues, even complete strangers in the street – smile again.

    View the original article at thefix.com

  • One Hit Away: A Memoir of Recovery

    Even though I know a lot of junkies who walk these streets with no life left in them, this is the first dead body I’ve ever seen.

    Sprawled across the side entryway to Beth Israel Congregation, I roll onto my side and wipe a palmful of dew off my clammy face. Everything about this morning is brittle, cold and still. Suspended in limbo, I’m drained from squirming all night on the slick ground like a caterpillar in a cocoon. As first light swirls around me and creeps into the shadows, I’m in no rush to greet it—there’s no point jump-starting the engines until the street dealers kick off their rounds. Having suffered through too many of Portland’s sunrises in recent years, the art on the horizon has either lost its beauty or I’m too jaded to see in color anymore. 

    Peeling my head away from an uncomfortable makeshift pillow made of rolled-up sweatpants, I see that both Simon and the surrounding streets are sleeping in. We’re nestled in darkness, lit only by the headlights of an occasional car that turns down Flanders Street. My sleeping bag is bunched under my hip to help relieve the pressure from the cold stone beneath me, but it’s not the only reason I had a hard time sleeping last night. 

    A few hours ago, I woke up to the alarm of Simon snoring and rattling away in his sleep—it was an eerie and guttural sound like an empty spray-paint can being shaken. I was still fighting to fall back asleep, long after his sputtering faded and drifted away with the breeze. So, while he put another day behind him, I was reminded that long nights take a toll and this life never pays.

    We both went to sleep with full bellies and a shot, so we’re fortunate that neither one of us will be dope sick. It’s nice to catch a break now and then and wake up without wishing I would die already. But it’s never enough—I’m still skeptical about how hard Simon crashed out and wonder if he’s holding out on me. Though if I were in his shoes, there’s no doubt I’d do the same. Riding high comes naturally in a free-for-all where everyone looks out for themselves. We all have it—a grizzly survival instinct to take what we can, when we can and figure tomorrow out if it comes. 

    This isn’t our land, but we periodically come here to stake a claim in the covered alcove guarding the ornate entryway. If unoccupied, I prefer this location because it’s a reasonably safe place to hang my boots. Not only is there protection overhead from the frequent rain that tends to ruin a good night’s sleep, but it’s also set back from the street enough that being noticed, roused and moved by the police is a rarity. 

    The groundskeeper here is a man of quiet compassion. It isn’t in him to run us off outside of business hours, and he refuses to call the police on us. For the most part, we are often gone before he would have to step over our bodies to open the temple doors. Scattering like roaches, we are sent packing by an internal alarm that forces us to get up at first light and attend to our bad habits.

    Simon is still asleep. He’s had it easy after spending all day yesterday collecting free doses from every street dealer he could pin down. This is common for any junkie recently released from a stint in jail. Any time after I’ve been arrested, all I have to do is show one of my dealers my booking paperwork and they’ll set me right. A freebie from them is a cheap investment in their own job security, reigniting the habit that was broken by an unpleasant jailhouse detox. Our dealers also need us back up and running again, racking up goods and on our best game. It’s no secret that a dope sick junkie is unprofitable.

    I pull myself together and pack with purpose, grabbing the dope kit I stashed in a tree nearby and then my shredded shoes that I left out to dry. I often struggle to tell whether my insoles are wet or merely cold, but when water oozes out of my shoelaces as I double-knot them, I take note that at some point today I need to steal fresh socks. 

    “Time to go,” I call out. 

    Simon, in one of the few ways that he is needy, often depends on me rousing him. He’s never been a morning person and is still sound asleep, his face buried in his sleeping bag. 

    “Come on, get up.” I spin in place and scan the ground to make sure I’m not forgetting anything. Eager to start the day, I nudge him with my toe a bit harder than I intended to. 

    When that doesn’t wake him, I reach down to shake his shoulder and feel an unnatural resistance. Something, everything, is wrong. His whole body feels stiff, and as I pull harder, Simon keels over, his rigid limbs creaking out loud like a weathered deck. There is lividity in his face—his nose is dark purple and filled with puddled blood. A pair of lifeless, open eyes stare through me and into nothingness. Instinctively, my hand snaps back and Simon sinks away.

    I stumble back and try to make sense of my surroundings. Nobody is around yet, but soon, the world will rise.

    “No, no, no.” I lose control of the volume of my voice and squeeze my throat. “Don’t be dead, please, don’t do this to me,” I chant as I drop to my knees, pleading over his corpse. 

    My hands hover over him as if trying to draw warmth from a smothered fire. I desperately grasp for a way to fix this. My heart is racing as though I just sent a speedball its way, but the surge doesn’t stop. A decision needs to be made, and fast, but before I can make sense of anything, a wisp of breath rolls down my collar and an invisible hand clutches my cheeks, forcing me to stare down death. 

    I snap the clearest picture in my mind and my eyes sting. Even though I know a lot of junkies who walk these streets with no life left in them, this is the first dead body I’ve ever seen. Looking down at Simon, I finally understand how pathetic this existence is and how lonely this life will always be. I see nothing beyond this moment for Simon, other than being hauled away like trash on the curb. We are forever trapped here, alone and useless, likely remembered only for our crimes, selfishness and former selves. Heaven is out of the picture, and because of that, I am okay with what I have to do next. I know the act is irreversible and unforgivable, but then again, if God has abandoned us, he’s not around to judge me.

    Dropping my sleeping bag onto the ground, I slide my backpack off my shoulders and let it fall like a hammer. I kneel over Simon’s body, steal one last look around and wince as I rummage through the front pocket of his jeans. I know he always keeps a wake-up hit on him. His pocket is tight and fights my hand as I dip into them. My fingers scratch around but keep coming up empty-handed. Time is running out and traffic is increasing. 

    I reach into his back pocket and soon realize the dope isn’t in his wallet either. The longer I search, the more determined I am, but I can’t bring myself to roll him over and disturb him further. By the time I give up, I sit back on my heels. I can’t believe what I’ve become. 

    “I’m so sorry, Simon.”

    Please stop looking at me. I can’t take it. Pulling my sweater cuff over my palm, I reach out with a shaky hand to close his eyes. My hand gets close, then backs off as I turn my head away to exhale. When my hand reaches forward once again, my palm lands on his face but fails to brush his frozen eyelids closed.Backing away, I grab my belongings and shrink into the distance.

    Excerpted from One Hit Away: A Memoir of Recovery by Jordan Barnes. Available at Amazon.

    View the original article at thefix.com

  • The Hidden Deaths Of The COVID Pandemic

    A recent analysis predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse, triggered by the uncertainty and unemployment caused by the pandemic.

    BROOMFIELD, Colo. — Sara Wittner had seemingly gotten her life back under control. After a December relapse in her battle with drug addiction, the 32-year-old completed a 30-day detox program and started taking a monthly injection to block her cravings for opioids. She was engaged to be married, working for a local health association and counseling others about drug addiction.

    Then the COVID-19 pandemic hit.

    The virus knocked down all the supports she had carefully built around her: no more in-person Narcotics Anonymous meetings, no talks over coffee with a trusted friend or her addiction recovery sponsor. As the virus stressed hospitals and clinics, her appointment to get the next monthly shot of medication was moved back from 30 days to 45 days.

    As best her family could reconstruct from the messages on her phone, Wittner started using again on April 12, Easter Sunday, more than a week after her originally scheduled appointment, when she should have gotten her next injection. She couldn’t stave off the cravings any longer as she waited for her appointment that coming Friday. She used again that Tuesday and Wednesday.

    “We kind of know her thought process was that ‘I can make it. I’ll go get my shot tomorrow,’” said her father, Leon Wittner. “‘I’ve just got to get through this one more day and then I’ll be OK.’”

    But on Thursday morning, the day before her appointment, her sister Grace Sekera found her curled up in bed at her parents’ home in this Denver suburb, blood pooling on the right side of her body, foam on her lips, still clutching a syringe. Her father suspects she died of a fentanyl overdose.

    However, he said, what really killed her was the coronavirus.

    “Anybody that is struggling with a substance abuse disorder, anybody that has an alcohol issue and anybody with mental health issues, all of a sudden, whatever safety nets they had for the most part are gone,” he said. “And those are people that are living right on the edge of that razor.”

    Sara Wittner’s death is just one example of how complicated it is to track the full impact of the coronavirus pandemic — and even what should be counted. Some people who get COVID-19 die of COVID-19. Some people who have COVID die of something else. And then there are people who die because of disruptions created by the pandemic.

    While public health officials are trying to gather data on how many people test positive for the coronavirus and how many people die from the infection, the pandemic has left an untold number dying in the shadows, not directly because of the virus but still because of it. They are unaccounted for in the official tally, which, as of June 21, has topped 119,000 in the U.S.

    But the lack of immediate clarity on the numbers of people actually dying from COVID-19 has some onlookers, ranging from conspiracy theorists on Twitter all the way to President Donald Trump, claiming the tallies are exaggerated — even before they include deaths like Wittner’s. That has undermined confidence in the accuracy of the death toll and made it harder for public health officials to implement infection prevention measures.

    Yet experts are certain that a lack of widespread testing, variations in how the cause of death is recorded, and the economic and social disruption the virus has caused are hiding the full extent of its death toll.

    How To Count

    In the U.S., COVID-19 is a “notifiable disease” — doctors, coroners, hospitals and nursing homes must report when encountering someone who tests positive for the infection, and when a person who is known to have the virus dies. That provides a nearly real-time surveillance system for health officials to gauge where and to what extent outbreaks are happening. But it’s a system designed for speed over accuracy; it will invariably include deaths not caused by the virus as well as miss deaths that were.

    For example, a person diagnosed with COVID-19 who dies in a car accident could be included in the data. But someone who dies of COVID-19 at home might be missed if they were never tested. Nonetheless, the numbers are close enough to serve as an early-warning system.

    “They’re really meant to be simple,” Colorado state epidemiologist Dr. Rachel Herlihy said. “They apply these black-and-white criteria to often gray situations. But they are a way for us to systematically collect this data in a simple and rapid fashion.”

    For that reason, she said, the numbers don’t always align with death certificate data, which takes much more time to review and classify. And even those can be subjective. Death certificates are usually completed by a doctor who was treating that person at the time of death or by medical examiners or coroners when patients die outside of a health care facility. Centers for Disease Control and Prevention guidelines allow for doctors to attribute a death to a “presumed” or “probable” COVID infection in the absence of a positive test if the patient’s symptoms or circumstances warrant it. Those completing the forms apply their individual medical judgment, though, which can lead to variations from state to state or even county to county in whether a death is attributed to COVID-19.

    Furthermore, it can take weeks, if not months, for the death certificate data to move up the ladder from county to state to federal agencies, with reviews for accuracy at each level, creating a lag in those more official numbers. And they may still miss many COVID-19 deaths of people who were never tested.

    That’s why the two methods of counting deaths can yield different tallies, leading some to conclude that officials are fouling up the numbers. And neither approach would capture the number of people who died because they didn’t seek care — and certainly will miss indirect deaths like Wittner’s where care was disrupted by the pandemic.

    “All those things, unfortunately, are not going to be determined by the death record,” says Oscar Alleyne, chief of programs and services for the National Association of City and County Health Officials.

    Using Historical Data To Understand Today’s Toll

    That’s why researchers track what are known as “excess” deaths. The public health system has been cataloging all deaths on a county-by-county basis for more than a century, providing a good sense of how many deaths can be expected every year. The number of deaths above that baseline in 2020 could tell the extent of the pandemic.

    For example, from March 11 to May 2, New York City recorded 32,107 deaths. Laboratories confirmed 13,831 of those were COVID-19 deaths and doctors categorized another 5,048 of them as probable COVID-19 cases. That’s far more deaths than what historically occurred in the city. From 2014 through 2019, the city averaged just 7,935 deaths during that time of year. Yet when taking into account the historical deaths to assume what might occur normally, plus the COVID cases, that still leaves 5,293 deaths not explained in this year’s death toll. Experts believe that most of those deaths could be either directly or indirectly caused by the pandemic.

    City health officials reported about 200 at-home deaths per day during the height of the pandemic, compared with a daily average 35 between 2013 and 2017. Again, experts believe that excess is presumably caused either directly or indirectly by the pandemic.

    And nationally, a recent analysis of obituaries by the Health Care Cost Institute found that, for April, the number of deaths in the U.S. was running about 12% higher than the average from 2014 through 2019.

    “The excess mortality tells the story,” said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston. “We can see that COVID is having a historic effect on the number of deaths in our community.”

    These multiple approaches, however, have many skeptics crying foul, accusing health officials of cooking the books to make the pandemic seem worse than it is. In Montana, for example, a Flathead County health board member cast doubt over official COVID-19 death tolls, and Fox News pundit Tucker Carlson questioned the death rate during an April broadcast. That has sowed seeds of doubt. Some social media posts claim that a family member or friend died at home of a heart attack but that the cause of death was inaccurately listed as COVID-19, leading some to question the need for lockdowns or other precautions.

    “For every one of those cases that might be as that person said, there must be dozens of cases where the death was caused by coronavirus and the person wouldn’t have died of that heart attack — or wouldn’t have died until years later,” Faust said. “At the moment, those anecdotes are the exceptions, not the rule.”

    At the same time, the excess deaths tally would also capture cases like Wittner’s, where the usual access to health care was disrupted.

    A recent analysis from Well Being Trust, a national public health foundation, predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse, triggered by the uncertainty and unemployment caused by the pandemic.

    “People lose their jobs and they lose their sense of purpose and become despondent, and you sometimes see them lose their lives,” said Benjamin Miller, Well Being’s chief strategy officer, citing a 2017 study that found that for every percentage point increase in unemployment, opioid overdose deaths increased 3.6%.

    Meanwhile, hospitals across the nation have seen a drop-off in non-COVID patients, including those with symptoms of heart attacks or strokes, suggesting many people aren’t seeking care for life-threatening conditions and may be dying at home. Denver cardiologist Dr. Payal Kohli calls that phenomenon “coronaphobia.”

    Kohli expects a new wave of deaths over the next year from all the chronic illnesses that aren’t being treated during the pandemic.

    “You’re not necessarily going to see the direct effect of poor diabetes management now, but when you start having kidney dysfunction and other problems in 12 to 18 months, that’s the direct result of the pandemic,” Kohli said. “As we’re flattening the curve of the pandemic, we’re actually steepening all these other curves.”

    Lessons From Hurricane Maria’s Shifting Death Toll

    That’s what happened when Hurricane Maria pummeled Puerto Rico in 2017, disrupting normal life and undermining the island’s health system. Initially, the death toll from the storm was set at 64 people. But more than a year later, the official toll was updated to 2,975, based on an analysis from George Washington University that factored in the indirect deaths caused by the storm’s disruptions. Even so, a Harvard study calculated the excess deaths caused by the hurricane were likely far higher, topping 4,600.

    The numbers became a political hot potato, as critics blasted the Trump administration over its response to the hurricane. That prompted the Federal Emergency Management Agency to ask the National Academy of Sciences to study how best to calculate the full death toll from a natural disaster. That report is due in July, and those who wrote it are now considering how their recommendations apply to the current pandemic — and how to avoid the same politicization that befell the Hurricane Maria death toll.

    “You have some stakeholders who want to downplay things and make it sound like we’ve had a wonderful response, it all worked beautifully,” said Dr. Matthew Wynia, director of the University of Colorado Center for Bioethics and Humanities and a member of the study committee. “And you’ve got others who say, ‘No, no, no. Look at all the people who were harmed.’”

    Calculations for the ongoing pandemic will be even more complicated than for a point-in-time event like a hurricane or wildfire. The indirect impact of COVID-19 might last for months, if not years, after the virus stops spreading and the economy improves.

    But Wittner’s family knows they already want her death to be counted.

    Throughout her high school years, Sekera dreaded entering the house before her parents came home for fear of finding her sister dead. When the pandemic forced them all indoors together, that fear turned to reality.

    “No little sister should have to go through that. No parent should have to go through that,” she said. “There should be ample resources, especially at a time like this when they’re cut off from the world.”

    View the original article at thefix.com