Answer Addiction

Tag: opioids

  • Nurse Prescribed Patient 51 Pills Per Day, Kept License

    Nurse Prescribed Patient 51 Pills Per Day, Kept License

    The nurse practitioner was the ninth most heavy-handed opioid prescriber in Tennessee.

    Forty opioid pills, four muscle relaxers, six Xanax and an Ambien in a day would likely do more harm than good for even the sickest of patients, but that’s the amount that a Tennessee nurse prescribed a patient eight years ago, exceeding today’s opioid recommendations by more than 31 times.

    And yet, the nurse is still licensed to prescribe today. 

    Christina Collins, a nurse practitioner near Knoxville, was the ninth most heavy-handed opioid prescriber in Tennessee, and officials now say that she must have known that her patients were not taking the pills as she prescribed them. 

    “In short, Mrs. Collins was a machine that dispensed prescriptions without regard for any professional responsibility,” Mary Katherine Bratton, a Tennessee Health Department attorney, wrote in state documents analyzed by The Tennessean. “Her own lawyers argued that Mrs. Collins engaged in patient-led prescribing, simply giving patients whatever dangerous drugs they requested.”

    Last year, officials attempted to have Collins’ license revoked, but the state nursing board opted to instead put her on professional probation, which means she can still write prescriptions. She still works as a nurse in the Knoxville area.

    However, the state’s health department and attorney general are now appealing that decision in a move that a spokesperson called “rare but not unprecedented.” 

    Collins and her lawyer claim that despite doing things like telling one patient to wear three fentanyl patches at once in addition to taking other medications, Collins thought she was giving good medical advice at the time the prescriptions were written. 

    “She became a victim of her environment and the medical community and the ideas that were floating around out there at that time period,” said Eric Vinsant, her lawyer. “This case stretches from 2011 and 2012, which was a time before Tennessee really began looking at the prescribing of opioids and other controlled substances for pain, and there was really a very limited amount of guidance for practitioners on what was expected and what were best practices.”

    Vinsant added that there was “no real evidence” that Collins’ pills were resold on the black market. 

    During a hearing with the nursing board last year, Collins said that she left the clinic she was with at the time when she became suspicious that Dr. Frank McNiel, who ran the clinic, was overprescribing. McNiel surrendered his medical license. 

    “When I initially started there … obviously I did not think that there was anything below the standard of care or anything wrong with the patients or the prescriptions they were taking,” Collins said, according to a transcript of the hearing. “If I were looking at doses like that in today’s time after the guidelines and everything that I’ve learned, yeah, I would think that was very high amounts.”

    View the original article at thefix.com

  • Angels of Addiction Exhibit Tells Story Of Lives Lost To Opioid Crisis

    Angels of Addiction Exhibit Tells Story Of Lives Lost To Opioid Crisis

    “When you see these faces you will cry because we’ve lost all of these people,” says artist Anne Marie Zanfagna.

    Last week, about 130 faces of lives lost to drugs graced the rotunda of of the Russell Senate Office Building in Washington, D.C. The brightly-colored paintings are part of a series called Angels of Addiction by Anne Marie Zanfagna, a New Hampshire mother who lost her daughter Jacqueline to heroin in 2014.

    After finding comfort in painting Jacqueline, Zanfagna has since made it her calling to create portraits for others grieving like her. Her paintings are free of charge, funded through her nonprofit Angels of Addiction that collects donations for art supplies.

    “It is a work of love. I know how people feel when they receive these, and that warms my heart,” said Zanfagna, according to the Concord Monitor. “If I can do something to help someone else, I’ll do it. It’s my way of giving back.”

    In 2017, there were 483 confirmed drug overdose deaths in New Hampshire, according to the state Medical Examiner’s Office. Fentanyl was involved in more than 350 of these deaths.

    “You hear the numbers and you know it is a lot, but when you try to translate that into lives, it’s different,” said Zanfagna. “When you see these faces you will cry because we’ve lost all of these people.”

    Zanfagna first showed her paintings in the New Hampshire State Library in August 2017. “When I saw all 90 together it was very powerful,” she said at the time. “It struck me that every one of those beautiful people are dead.”

    Since then, she’s painted more than 150 portraits, and her exhibit has graced the walls of town halls, libraries and recovery centers.

    Last week, her paintings went up in the Russell Senate Office Building in Washington, D.C., after the artist was invited to show her work there by Sen. Jeanne Shaheen of New Hampshire.

    “To see them, it reminds you that the opioid epidemic that we’re facing isn’t about numbers and statistics. It’s about real people. This is something that can happen to anybody,” said Shaheen.

    “Each of these portraits tells a story, and the Angels of Addictions exhibit reminds us who we are fighting for as Congress takes steps to address this crisis.”

    Ultimately the series is about putting faces to lives lost, and capturing the joy that each individual brought to their loved ones. “I think the people in my exhibit need this recognition because they were all good people,” said Zanfagna.

    View the original article at thefix.com

  • Exploring The New Opioids Package: What Does The Legislation Cover?

    Exploring The New Opioids Package: What Does The Legislation Cover?

    The wide-ranging bipartisan legislation addresses overprescribing, overdose prevention, medication-assisted treatment and more.

    New legislation intended to aid in the fight against the opioid epidemic was approved by both the House and Senate in early October, and is currently headed for signature by President Donald Trump.

    The bill, known as the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (or SUPPORT), is a rare bipartisan effort, authored primarily by Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), and offers $8 billion in wide-ranging programs that intend to boost access to substance treatment, as well as methods of intervention to reduce the influx and availability of opioids.

    Policymakers have expressed their support for the bill, though treatment advocates have voiced reservation about the scope and effectiveness of the legislation. Here’s what is proposed by the SUPPORT Act:

    – Expansion of provisions for Medicaid programs, including expanded access to opioid addiction treatment, including secured flexibility for alternative services not permitted under a state Medicaid plan, improved data sharing between state databases, and increased screening for opioid dependency during doctor’s visits;

    – Increased Medicaid coverage for opioid treatment programs that prescribe medication-assisted treatment (MAT), which is currently not recognized by Medicaid, and an increase in the number of health care specialists that are allowed to prescribe and dispense such treatment;

    – A provision to expand a grant program that allows first responders to administer naloxone for opioid overdoses;

    – Creation of a grant program from the Substance and Mental Health Services Administration to establish comprehensive opioid recovery centers, which will provide dependency and recovery programs for communities;

    – A provision to allow the National Institutes of Health (NIH) to establish “high impact, cutting-edge research” for combating the opioid epidemic and development of non-addictive pain management medication, which will be funded through reauthorization of the Common Fund from the 21st Century Cures Act;

    – Authorization for the Drug Enforcement Agency to reduce manufacturing quotas for controlled substances, including prescription opioids, when the agency suspects diversion; 

    – Authorization for the Department of Health and Human Services to allow doctors to remotely prescribe medication-assistant treatments to assist needy individuals in remote or rural areas;

    – The “STOP Act,” which will assist the U.S. Postal System in preventing the import of fentanyl through international mail by improved digital tracking; 

    – Improved coordination between the Food and Drug Administration and the U.S. Customs and Border Patrol to allow greater means of detecting and halting the import of drugs at borders;

    – Increased penalties for manufacturers and distributors in regard to overprescription of opioid medication.

    Response from health care and dependency officials to the bill was mixed. Some, like Kelly J. Clark, the president of the American Society of Addiction Medicine, called it “an important step in ensuring that individuals with substance use disorder are able to get the help they need.”

    But Keith Humphreys, a drug policy expert at Stanford University who worked with White House staff on the bill, viewed the scope of the bill as limited.

    “This reflects a fundamental disagreement between the parties over whether the government should appropriate the large sums a massive response would require. Lacking that, Congress did the next best thing – which is to find agreement on all the second-tier issues as they could.”

    View the original article at thefix.com

  • Alleged Drug Dealer Indicted For Fentanyl Overdose Death

    Alleged Drug Dealer Indicted For Fentanyl Overdose Death

    Calvin Warren Jr. is the first person to be arrested and charged under a new Florida law.

    A new Florida law regarding the prosecution of drug dealers, signed by Gov. Rick Scott in 2017, has gone into effect. The law expanded the state’s first-degree murder code to include adults who sell a lethal dose of fentanyl.

    The Palm Beach Post reported that Calvin Warren Jr., 35, was arrested on first-degree murder charges in the overdose death of 36-year-old Thomas Matuseski. Warren is the first person to be arrested and charged under the new law.

    Thomas Matuseski died on January 28 after ingesting fentanyl; Warren is accused of providing the deadly drug. Warren remains in the Palm Beach County Jail without the possibility of parole. The indictment against him states that he caused Matuseski’s death “unlawfully from a premeditated design.”

    The Palm Beach County State Attorney’s Office announced that Warren distributed heroin, cocaine, and fentanyl. On January 28, Matuseski’s roommate found him collapsed on his bedroom floor in Boynton Beach, according to city police records. Matuseski’s friend called 911 but the Boynton rescue crews were unable to resuscitate him.

    Police reported no sign of drugs or paraphernalia in Matuseski’s home on Citrus Park Lane, and it was not announced how Warren was suspected to be linked to Matuseski’s death. Police records do show that Warren was arrested in February on a case that remains open and includes multiple drug-related charges.

    Greg Newburn, Florida’s state policy director for Families Against Mandatory Minimums, told The Daily Beast, “Most deaths we’ve seen since the rise of fentanyl in Florida have been a mixture of heroin and fentanyl.”

    Florida’s new law does not account for the mixture of drugs or if the dealer claims to have known they were using fentanyl. If a drug mixture containing any amount of fentanyl is involved in the drug user’s death, the dealer can be charged with first-degree murder, a charge for which “the only two sentences available are life without parole and the death penalty,” Newburn said.

    “We will aggressively charge drug dealers who spread fentanyl-laced heroin into our community,” Palm Beach County State Attorney Dave Aronberg said in a statement, as reported in The Palm Beach Post. “We will use all tools provided us by the Florida Legislature to hold drug dealers accountable for causing the deaths of others.” 

    Thomas Matuseski was a New York native, and according to his obituary was remembered as a loving father and son who loved sports.

    View the original article at thefix.com

  • Maryland Funeral Directors: We're The "Last Responders" To Opioid Crisis

    Maryland Funeral Directors: We're The "Last Responders" To Opioid Crisis

    Funeral directors in the state claim that safety has become an issue when dealing with opioid overdose victims. 

    Proactive funeral directors in Maryland are stocking up on naloxone, the opioid overdose antidote, as they’ve seen a dramatic increase in the number of opioid-related deaths.

    They’re calling themselves the “last responders” to Maryland’s opioid crisis, the Baltimore Sun reports.

    In 2017, the Tri-County Funeral Directors Association launched an awareness campaign in local newspapers to notify communities that “We Don’t Want Your Business” when it comes to opioid abuse.

    “We see a side of this tragic epidemic that many don’t see,” said association president James Schwartz. “The devastation families are facing is heartbreaking.”

    Schwartz tells the Baltimore Sun that other funeral home directors have known not only family members, but funeral home guests “who have come and had either an opioid reaction in the parking lot or other areas during the service time.” 

    “This has caused the folks stress because not only are they grieving this person and now somebody else is having the same tragic result,” Schwartz said.

    The National Funeral Directors Association urges members to protect themselves while handling deceased victims of opioid overdose.

    “Coming into contact with a minuscule dose of fentanyl or carfentanil can be fatal,” the association warns. (This point is oft-repeated, but harm reduction and addiction/recovery advocates say it’s merely a harmful myth.)

    “The opioid crisis presents unique challenges for funeral directors, from working with families whose loved one has died from an overdose to protecting themselves from harm when handling the body of an overdose victim during removal or embalming,” says the funeral directors association.

    In 2017, opioid overdose deaths continued to climb in Maryland, accounting for the majority of drug/alcohol-related deaths—2,009 of 2,282 overdoses were opioid-related, according to the state’s Department of Health.

    “This is an escalating epidemic,” said Baltimore Health Commissioner Dr. Leana Wen, whose city saw the worst of the opioid crisis. “But still we don’t even see the peak of this epidemic yet.”

    In response, Maryland schools and libraries are also stocking up on naloxone. “The rule of thumb is: when in doubt, use it,” said funeral director Jeffrey L. Gair.

    The antidote is there “if there’s ever the need while we’re on duty at the funeral home,” Gair said.

    View the original article at thefix.com

  • Narcan Creator Working On Fentanyl "Antidote"

    Narcan Creator Working On Fentanyl "Antidote"

    The new formulation is reportedly five times stronger than Narcan and will last longer. 

    A stronger formulation of Narcan (naloxone) nasal spray, the opioid overdose antidote, is in the works, FOX Business reports. There’s a need for a stronger antidote, its developers say, to counter the rising use of fentanyl.

    Fentanyl is a synthetic opioid pain reliever said to be 50-100 times more potent than morphine. Though it is a pharmaceutical drug, illicitly-made fentanyl is said to have fueled rising rates of drug overdose deaths in the United States.

    Narcan nasal spray, which reverses opioid overdose, hit the market in early 2016 after receiving fast-track designation by the Food and Drug Administration. Now first responders, health workers, and laypeople across the U.S. are equipped with Narcan—but in some cases, the otherwise life-saving drug is not enough.

    “Narcan is not the 100% fail safe that people may think it is, it does not always work,” warned police officials in West Fargo, North Dakota, responding to the emergence of acryl fentanyl, a newer, stronger fentanyl analog, last year. These illicitly-made opioids may require multiple doses of Narcan.

    Roger Crystal, the creator of Narcan and CEO of Opiant Pharmaceuticals, is now working with the government to create a new opioid overdose antidote that will match the strength of increasingly potent fentanyl analogs.

    The new formulation, Nasal Nalmefene, will not only be stronger but will last longer. “The reason we think it could have advantages is because nalmefene is a drug itself [and] is stronger than naloxone. It’s five time stronger and it lasts longer,” Crystal told FOX Business.

    According to data released by the Centers for Disease Control and Prevention (CDC), fentanyl accounts for a significant portion of drug overdose deaths in the U.S. In 2016, opioids (prescription and illicit) accounted for 42,249 deaths out of total 63,632 drug overdose deaths in the U.S.

    The CDC also reported that “over half of people in 10 states who died of opioid overdoses during the second half of 2016 tested positive for fentanyl.”

    Crystal, who is working with the U.S. Health and Human Services Department, said they are aiming for FDA approval of Nasal Nalmefene by 2020.

    “Compounds like fentanyl, carfentanil and other synthetic opioids act for longer periods of time. The concern is that naloxone’s half-life doesn’t provide sufficient cover to prevailing amounts of fentanyl in the blood,” said Crystal in a past interview.

    Learn how to administer naloxone: How to Reverse an Opioid Overdose with Naloxone.

    View the original article at thefix.com

  • There Was Light A Mile Deep: Interview with Poet William Brewer

    There Was Light A Mile Deep: Interview with Poet William Brewer

    Someone contacted me when the book came out, who had very recently lost a parent to heroin. She said to me, and I’ve held on to this, “The poems gave me a feeling that I had a place to go.”

    The West Virginian landscape exists as one of the great splendors of North America, but beneath the canopies of spruce and maple and folded inside the canyons smolders a public health crisis whose effect has verged on apocalyptic for some communities, both spiritually and literally. Peddled by big pharma, opioids found special traction, furthering the hardships inherited from a history of economic injustice. Like new gears spinning a rusted machine.

    These conditions have sown a very human consequence, which looks out from the porch of William Brewer’s debut book of poems, I Know Your Kind, with lines like: “[I] have placed my lips against the shadow / of his mouth, screamed air into his chest, / watched it rise like an empire then fall.”

    Born and raised in West Virginia, the poet left Appalachia to pursue higher education, but his craft was drawn back towards the hills of his youth, rendering the anguish and ghosts that multiplied rapidly there in the mid-aughts when the state ranked as having the highest overdose rate in the country (it still does).

    With delirious imagery, Brewer uses natural subjects such as flies and logging to express deep emotions, at the same time accessing the past in order to help explain the unbelievable present. His poems have been published in The New Yorker, The Nation, American Poetry Review, and his chapbook Oxyana was selected by the Poetry Society of America for their 30 and Under chapbook fellowship.

    Then, last year Ada Limon selected I Know Your Kind as a winner of the National Poetry Series. A practice in empathy, the book illustrates not only the spirit of a place struggling to stand, but a cross-section of the epidemic timeline on a local level when the national media was just starting to grasp what was happening. Before the big policy responses. Despite all the graves already in the ground.

    Interviewed by The Fix, Brewer hikes into these “terrible truths” and cracks open the question of what drives someone to give themself to an artificial comfort, underlining that rural living can marginalize culturally and politically.

    Estimates place the number of people recovering in the United States around 25 million, and close to the same amount experiencing active substance use disorder. More than ever, there is a need for a strong literature to reflect this population, how we lived and how we want to live. I Know Your Kind stimulates our thinking about the prismatic possibilities of a modern addiction poetry.

    Note: This is sometimes a sad conversation, about suffering caused by substance use disorder. Seek out another interview if you’re unbraced.

    The Fix: Your book opens with the poem “Oxyana, West Virginia,” which establishes the setting of I Know Your Kind as a place where both splendor and suffering co-occur. Can you talk more about the relationship between the people and the land?

    William Brewer: Oceana is a small town in southern West Virginia, a blast site of the opioid epidemic. The nickname Oxyana refers to Oxycontin, the drug that took over. This poem takes the notion of a single place and applies it to multiple regions of the state to create a condensed fictional stage, to build out a landscape. Throughout the book, when I talk about one place, I’m talking about the whole state, because the problem is everywhere. The whole state is a kind of Oxyana.

    Now, with the idea of splendor and suffering, I think the word you used was co-occur—that’s absolutely right in West Virginia. It’s an immensely beautiful state, but it’s a state of contrasts. The ancient hills are beautiful, but that ancientness meant coal, which meant prosperity, but only for a very few until the mid-20th century. Coal, for much of its history, has meant a very hard way of living that has benefited very few. So the thing that gave West Virginia its prosperity is also the thing that has caused most of its destruction environmentally, economically, and to the physical well-being of its citizens.

    Now that the coal industry has died away, people are left in drained away communities, isolated from the outside world by the mountains and rivers, which also prevent jobs like manufacturing from coming in. The landscape becomes a beautiful prison.

    You often manipulate the symbol of light, twisting away from classic associations, or at least complicating them. For example, in “Overdose Psalm,” a tree is cut down and the line goes “Snow committing its slow occupancy, / filling the column like words, the light / saying in so few of them, like all terrible / truths, something here did not survive.” Besides being very very sad, it’s so resonant. How does light function in your book?

    In IKYK, I’m interested in exploring the power opiates have to mimic a kind of divine energy. They aren’t like psychedelics, which connect you to the feeling of a greater universe. Or amphetamines, which accelerate our reality. This is something simple: an optimism, a brightness, a luminosity, therefore light will function in the mind of the speaker as positivity, but for the reader the function is more sinister. Here, our feelings about beauty (which light is often in service of) become less straightforward than they seem.

    Writing has to look carefully at the way certain chemicals make people feel.

    We must recognize the ways substances make you feel fulfilled.

    Yes. And in the case of West Virginia, you have a largely poor, often isolated populace that is, in many respects, ignored by the rest of the country. When the outside world does engage with WV, it’s often through joke and insult. “Trash,” “Hillbilly,” “Did you marry your cousin?” “I’m surprised you wear shoes.” In her essay “The Fog Zone,” Leslie Jamison gets it right: “West Virginia is like a developing nation in the middle of America. It has so many resources and it has been screwed over again and again: locals used for labor; land used for riches; other people taking the profits.” With all that in mind, it’s suddenly a lot easier to understand how big unfulfillment can be as an idea, and how deep unfulfillment can function like a kind of pain. Through that pain comes the chemicals.

    What about the power dynamic between other parts of the U.S. and West Virginia? In your poem “Oxyana, West Virginia” you have those lines about river beds being wine glasses for the Roosevelts. It seems to me this dynamic could compound with the marginalization of the state, worsening the epidemic, distancing external aid.

    You’re absolutely right. That Jamison quote again. This is a place that gave everything to America during its rapid rise through the last century, and then when it was finished America turned its back on them. This was and continues to be a form of erasure. When people are told they don’t matter or feel like they don’t exist—that’s going to worsen a problem like the epidemic. The drug problem has been going on for over 10 years, but it’s only just now garnered attention. That’s in part because a lot of people—a lot—still don’t know WV is its own state. A few months back I was seated at a dinner beside an Ivy League graduate who kept referring to my home as Virginia, even after I corrected them multiple times.

    Yeah, that’s a completely different state.

    And when your country doesn’t know you exist, it’s like your suffering doesn’t exist. Then it’s like, who are they to tell you how you handle your suffering?

    All of this leads to the larger point, the key point about the book. IKYK is not about the opioid epidemic, and it’s not about WV, it’s about how these two subjects are bound together through a continuation of history. The history of WV is the history of massive industry making gargantuan profits off the lives of WV citizens. Timber, minerals, oil, coal, gas, and now: pharmaceuticals. They pumped 780 million pills into a state of 1.8 million people. By doing that, those companies, that industry, made a conscious choice: The lives of West Virginians aren’t as important to us as money; this is a population we can afford to kill.

    Leads me to think of “Daedalus in Oxyana.” There’s a line… “I gave my body to the mountain whole. For my body, the clinic gave out petals inked with curses.”

    I want to hear more of how you funneled real life places and people into this book. What was your research process like?

    The research was living and seeing the issue grow. The research arrived. But I don’t necessarily like that word, “research,” because it suggests I went looking for it. It’s more that the problem appeared. Things snowballed very quickly. Sometimes I didn’t realize it, other times I did. In conjunction, at one point someone came to my fiancée and me and told us they were a heroin addict and they were terrified. I got angry, thinking they got themselves into the mess and didn’t care about anyone else. Ten minutes later I realized this reaction was repulsive. I wrote the person off at their most vulnerable. A flip switched, and I realized this was something deeper I wanted to sit with and look at. That meeting between personal interrogation and social observation is how the book came to be.

    I like how the initial motivation for this book was a reaction to the stigma you had fallen into initially. You were like, “Wow, this is the way I think, so I’m going to do some work and examine it.”

    The disease of addiction has taken a toll on my family throughout my life and my parents’ lives, so I’ve seen how people come to reckon with it. I thought I had developed sophisticated responses, but in that moment those responses failed when presented with this new problem. I’d seen what alcoholism can do, and how as a culture we accept it as a problem. But we were turning away from opiate abuse and denying its reality, and I felt I needed to resist that turning away.

    I think it’s stunning for someone who hasn’t experienced addiction himself, how you put words to those unique feelings and moments. There’s a line from “Resolution,” “…I stood in the yard // and decided that sometimes / you have to tell yourself / you’re the first person // to look out over / the silent highway / at the abandoned billboard // lit up by the moon / and think it’s selling a new / and honest life.”

    There are details about the way of life that can accompany opioid use disorder, which echo the conversations I’ve had with people. “Leaving the Pain Clinic,” you write “…and though the door’s the same, / somehow the exit, like the worst wounds, is greater / than the entrance was. I throw it open for all to see / how daylight, so tall, has imagination. It has heart. It loves.” Like, how did these lines come to be in such striking detail?

    For me, the writing of a poem is an impulsive act. But there’s a lot of gestation and thinking that goes on behind the scenes, before I write—a lot of thinking. And there’s living that goes into them, too. When I was in college I had an accident that required some heavy surgery and a long rehab period. Opioids were a big part of that period, I was on them for a long time. The power of those drugs, what they could do, has remained vivid in my mind, and always will. That passage about daylight comes from that.

    In regard to the former passage: I’ve dealt with serious depression my whole life. Depression and substance abuse are often bedfellows. What depression can unleash in someone—hopelessness, dependency, fear, recklessness towards how we feel about our lives, suicidal impulses—can certainly be unleashed by substance use disorders, too, with the volume turned up to 11. To be clear, I do not mean in any way to suggest that depression and substance abuse are the same thing. Rather, what I mean to articulate is that I brought every bit of myself to every poem. This is not just a matter of aesthetics. It’s me doing my best to extend myself out, to say, “Dear Person X, the possibility that your pain may feel even remotely similar to my pain is why I’m trying to do my absolute best to recognize you in hopes that you may feel less alone, but even more importantly, so that you may feel loved. Loved.”

    I come from a spoken word community that preaches sticking to your own story. Personally, I think your book is an important addition to literature, both generally and in the addiction/recovery sub-genre. But throughout it you often speak through the persona of someone with substance disorder. I worry other poets will take this as license to do the same, without possessing the knowledge or respect you have for the subject. What are some potential hazards here?

    First, thank you for saying that. I appreciate it greatly and don’t take it lightly.

    While you come from a spoken word community, my literary life is rooted in fiction. The literary texts we had in my house were Herman Melville, Mary Shelley, Jane Austen, Nathaniel Hawthorne. They sat on a single shelf at the top of the stairs. I can still see them. Likewise, at school, literature = fiction. I read maybe two poems in high school, so my life in books began, and in many ways persists, through fiction, and so because of that, the root of my literary practice has always been—to use Roth’s (for better or worse) definition of fiction writing—“the crafting of consciousness,” with the understanding that this requires immense care, thought, patience, and humility. Do as much work as you can to get it right, and then do more. IKYK is very much a book that attempts to synthesize this quality of fiction, in addition to its immense capacity for world building and social examination, with poetry’s sense of deeply distilled emotional and psychological textures, its power to challenge language, and its unique ability to find unexpected connections. 

    As for other poets taking my work as license, I’m not sure what to say about that. It would seem to me that the potential for bad poetry, and bad poems about this subject, was there long before any of my poems came into the world. At the same time, for as long as that potential for faulty work has existed, there’s been a concurrent tradition of very valuable work being done in persona, poems by Bidart and Ai being just two gleaming examples (not to mention what has been done in fiction). So, maybe we could reframe the thinking in more positive terms, i.e. maybe this book can stand as an example of what persona can do? What the poem can do?

    What eats at me is how there aren’t a lot of poets writing about their personal experiences with substance recovery, at the level where they’re prominent within the poetry industry or community. Are these poets dead from overdoses? Did their time go towards using instead of writing? Or maybe they’re not writing openly because of stigma? Can you speak on the importance of us all lifting up and listening closer to people who have personal experience with these issues?

    I’m not sure about this, though it’s a wise question, one of huge importance. I don’t know of a clear answer. But it seems like the work you do in your day to day is connected to this and is very valuable. That’s something to be optimistic about. People have reached out and told me how they have brought my poems or the book into spaces like meetings, support groups, halfway houses, and that has been very humbling to hear. Just getting poems into spaces where maybe they’ve never been before—maybe that’s part of how we turn it around? As for the importance of lifting people up and listening closely—it is the most important thing. At the same time, the responsibility to write about this problem, which is now a national problem, shouldn’t rest solely on those suffering, should it?

    What do you hope your book accomplishes?

    Someone contacted me when the book came out, who had very recently lost a parent to heroin. She said to me, and I’ve held on to this, “The poems gave me a feeling that I had a place to go.” This was the greatest response I could have received. I hope that on a larger level, the book can extend the realities of the epidemic in WV to people who maybe had no idea what was going on, or didn’t believe it, or didn’t think it mattered—i.e. didn’t think the lives of West Virginians mattered.

    To graft onto that statement, I think the book is educational for people who don’t understand West Virginia, and how the opioid epidemic has taken root so deeply in this specific place.

    I surely hope so. That’s one of the book’s largest aims.

    I also want to add, while it’s a needed pursuit to write a place for pain to feel seen, it’s also necessary to create sites for recovering peoples to draw strength, hope, and triumph. What are some lines in your book that are doing this work?

    I think strength is an impulse that runs through much of the book—books about WV are inherently about strength. I think “Resolution” is a poem that leans toward a sense of hope or even triumph, even if it may be the first of a few failed attempts toward a larger triumph. Overall, though, I don’t think hope or triumph are large elements in the book, again this is because it’s a book about a specific situation in a specific place, and when I was writing it and editing it, things didn’t seem very hopeful or triumphant. I turned my book in to my editor in the fall of 2016. At that time, it felt like a situation that no one much cared about. The New Yorker hadn’t yet run its large profile about the state, the Charleston Gazette-Mail hadn’t yet run its now Pulitzer Prize-winning expose that gained national attention, Netflix’s Heroin(e) hadn’t yet been released, etc. etc. That said, I agree wholeheartedly that these sites and books are necessary, and I’m confident that they are coming, especially as our relationship to this epidemic, and our ability to help those afflicted by it, changes. So, while some of those elements may not be as present in my book, I don’t believe every book can or should do everything. Moreover, this subject, and its impact on our country, is vast. Perhaps, when it’s all said and done—if it’s ever all said and done—this book will be seen as one part of the larger record and discussion.

    Last question. What’s next for you? Anything that involves substance use disorder?

    I’m working on a novel that looks at the larger social, political, and economic networks that can be at play in making something like the opioid epidemic thrive in a place like West Virginia. I’m also working on a second book of poems about paranoia, suicide, and the idea of inherited death. And let me say thank you for taking the time to talk to me, your generosity toward the work, and for everything you do.

    More poems by William Brewer:

    “In the New World,” Southern Indiana Poetry Review

    “Oxyana, WV: Exit Song,” Diode Poetry

    Other interviews in this series about poetry and addiction:

    Lineages of Addiction: Interview with torrin a. greathouse, a Trans Poet in Recovery

    Addiction and Queerness in Poet Sam Sax’s ‘madness’

    Kaveh Akbar Maps Unprecedented Experience in “Portrait of the Alcoholic”

    View the original article at thefix.com

  • Surgeon General Mentions Brother’s Opioid Addiction In New Report

    Surgeon General Mentions Brother’s Opioid Addiction In New Report

    “I tell my family’s story because far too many are facing the same worries for their loved ones,” the Surgeon General wrote in the report.

    The U.S. Surgeon General has released an updated report on the opioid crisis—to call for Americans to talk about opioid abuse, understand addiction as a disease and be prepared to use naloxone if needed. 

    Facing Addiction in America: The Surgeon General’s Spotlight on Opioids was released on September 20 and updates the previous Surgeon General’s report on addiction. 

    In the report, Surgeon General Jerome M. Adams opened up about his own family’s experience with opioid addiction. 

    “My family and I are among the millions of Americans affected by substance use disorder,” Adams wrote in the report. “My younger brother has struggled with this disease, which started with untreated depression leading to opioid pain reliever misuse. Like many with co-occurring mental health and substance use disorder conditions, my brother has cycled in and out of incarceration. I tell my family’s story because far too many are facing the same worries for their loved ones. We all ask the same question: How can I contribute to ending the opioid crisis and helping those suffering with addiction?” 

    The updated report highlights the fact that available addiction treatment often lags behind what science says are best practices. 

    “The existing healthcare workforce is understaffed, often lacks the necessary training, and has been slow to implement Medicated-Assisted Treatment, as well as prevention, early identification, and other evidenced-based recommendations,” the U.S. Department of Health and Human Services said in a news release. 

    Partially because of this, only 1 in 4 people with opioid use disorder receive specialized treatment. In order to help more people get sober, law enforcement, faith communities and healthcare providers need to come together to streamline access to treatment. 

    “Now is the time to work together and apply what we know to end the opioid crisis,” said Dr. Elinore McCance-Katz, assistant secretary for Mental Health and Substance Use (under the Substance Abuse and Mental Health Services Administration). “Medication-assisted treatment combined with psychosocial therapies and community-based recovery supports is the gold standard for treating opioid addiction.”

    The report concludes with actionable steps that various people can take to reduce the harm from opioid addiction. Family members should be non-judgmental and trained in using naloxone, the report says.

    Healthcare providers should treat addiction with the same care that they dedicate to other chronic diseases. Communities should raise awareness by talking about substance abuse as a public health concern. 

    “Through partnerships, we can address the overall health inequities and determinants of health that exist where we live, learn, work, and play,” Adams wrote. “Together we can reduce the risks of opioid misuse, opioid use disorder, and related health consequences such as overdose and infectious disease transmission.”

    View the original article at thefix.com

  • Doctor Who Made 6K A Day For Prescribing Oxy: "I Was A Scapegoat"

    Doctor Who Made 6K A Day For Prescribing Oxy: "I Was A Scapegoat"

    “When I started treating people with chronic non-cancer pain. I felt it was unethical and discriminatory to limit the dose of medication.”

    Florida physician Barry Schultz was convicted to 157 years in prison for illegally prescribing enormous amounts of opioids to his patients.

    Now he calls himself a “scapegoat” for the pharmaceutical companies who produce, distribute and advocate for the prescription of opioids.

    Mallinckrodt pharmaceutical company was the provider of opioids in Schultz’s practice. The company eventually paid a fine for its part. Mallinckrodt provided 500 million oxycodone pills to the state of Florida, which has a population of 20 million people.

    Even after Mallinckrodt’s own internal investigation concluded that Dr. Schultz’s prescriptions had “a suspicious pattern indicating diversion” the company continued to supply him with opioids.

    Barry Schultz interviewed from prison with 60 Minutes to announce that he was a “scapegoat” for those really to blame—the opioid manufacturers.

    State Attorney Dave Aronberg’s office prosecuted Barry Schultz. Aronberg blamed Florida’s lax laws at the time for fueling the opioid overdose crisis. Pain clinics in Florida allowed patients to visit, pick up pills, and pay in cash. As a result, people from other states began coming to Florida to obtain opioids, creating a frenzy where waiting rooms would be overflowing.

    This was the kind of pain clinic that Schultz operated in Delray Beach, Florida. DEA records show in 2010 that Dr. Schultz was prescribing some patients as many as 100 pills a day, and making more than $6,000 a day from prescribing opioids.

    Despite this, Dr. Schultz refuses to take responsibility for his actions. “When I started treating people with chronic non-cancer pain,” he told 60 Minutes, “I felt it was unethical and discriminatory to limit the dose of medication. And if I had known that the overdose incidents had increased dramatically the way it had, I would have moderated my approach.”

    Carol Tain’s son David died in 2010 of an opioid overdose from pills prescribed by Dr. Schultz for pain management after a car accident. Tain’s mother considers Dr. Schultz responsible for her son’s death.

    “He didn’t even examine him. He hadn’t seen him in four-and-a-half years,” Tain said to 60 Minutes of the doctor’s prescriptions for her son. “He just—just wrote—wrote out these scripts… As far as I’m concerned, he’s a murderer and—and not a doctor. He murdered my son. He – he didn’t need a gun. He used his pen to murder my son.”

    View the original article at thefix.com

  • Kicking Heroin Cold Turkey Changed My Life

    Kicking Heroin Cold Turkey Changed My Life

    Nobody ever tells you how it feels, especially for the first time.

    This was the most pain and anguish I had ever experienced in my life, and I had given it my best shot, but there was really no point in going on.

    There were three of us.

    Eric was dashing and handsome, with eyes that cut through you, even as a child. He’d walk into a room and own it, immediately, and he knew it. He had leading man features that greatly resemble Chris Pratt, after he got sexy.

    James was the athlete, gifted with a physique that a teenager shouldn’t have been allowed to have. He was also kind to a fault, and loved God in the way that a puppy loves anything. If being a charismatic, fun-loving priest didn’t work out, he would have settled for being the NFL’s hottest running back.

    And then me: two years younger, two heads shorter, with eyes twice as wide when I’d look at my cousins, whom I worshipped. I thought of myself as their sidekick, but to be honest, if they were both Superman then I was a bundle of kryptonite around their necks, weighing them down. They didn’t mind, though. It kept them human.

    Musketeers. That’s what our family called us, and we were inseparable. We came from a prototypical Irish-American Catholic family (which means lots of kids). If you’re at all familiar with that demographic, you know that such families are tightly knit. Since the three of us were so close in age, our parents made sure that we spent time together, every single day. “Protect each other!” They’d always say.

    Even though Eric and James were two years older than me, they always encouraged me to hang out with them and their friends after school, but only after all my work was done. Ironically, it was my cousins more than my parents who forced me to get my homework done, but that could have been because they needed me to help them with theirs. I could never have hoped to be as cool as my cousins, but book smarts came easily to me. Together, we were a perfect team.

    And then we lost Eric.

    Not immediately. Acute myeloid leukemia works quickly, but it still gives you plenty of time to wait for the inevitable. After chemo failed, the doctors gave him two months. Eric gave them four. He frequently joked that he was going to live forever, despite having leukemia, just out of spite. In fact, he probably put up the most convincing happy face during the whole ordeal. In a way, this helped a lot of us. If Eric wasn’t scared, then why should we be? But underneath, he had to be frightened to death.

    Eric died in his senior year of high school, a few weeks before Christmas. I can’t believe that we found enough tissues for his funeral. My family doesn’t pick favorites, but deep down, I think everybody knew that Eric was the most beloved of any of us. He was the all-American boy we loved to boast about. Despite the tears, though, something felt dignified about his funeral. I think my whole family was proud that he put up a fight, that he went down swinging. That’s the kind of people they are.

    James and I took it harder, though. Family mattered to us more than anything, but what we had with Eric was something else. It was like a family within a family. And Eric was always our fearless leader. I thought he was invincible. As for James, I think he felt like a knight with no prince to follow.

    “Always protect each other,” our family would say.

    How?

    ***

    A few months earlier, James hurt himself playing football; torn ACL, his senior season cut short. To be honest, I wasn’t surprised when he did. As I watched him play, I thought he seemed angry. This was during the waiting game with Eric. It was while treating this injury that James received his first prescription of painkillers.

    Even after Eric died, James and I were still inseparable. I think I was the first one to notice that he was particularly fond of his medication. Besides numbing the pain from his injury, I think it helped him feel numb to the situation, and made him seem stronger than he was. Despite this, he got even more active than he already was in the church. If his plan B of being an NFL superstar was out the window, he’d have to work extra hard to make sure that the priesthood worked out. We sang songs together at church. Even though I was angry that Eric had been taken from us, I loved God more than I ever had. I had to. Eric was somewhere better, and that’s all there was to it.

    Two years went by, and James was still taking his pills. He mainly avoided taking them around family, but we were together too much for him not to do it around me. I wasn’t stupid, I knew his prescription ran out a long time ago. Without a prescription, opioids can get expensive, and it was only a matter of time before James found a cheaper, stronger substitute.

    And that’s how we both started doing heroin.

    At this point, I was a fairly upstanding high school citizen. I attended school full-time and worked an after-school job. Schoolwork came easy to me, and grades and test scores followed. On top of that, I still sang in church with James and volunteered with the Catholic Services food bank. I was responsible to a T, and I hated it.

    There’s not a lot of glamor in being the responsible one in a family that tells stories of war and fights, and values adventure above all else. Sure, the whole family would throw a barbeque every time an acceptance letter came in the mail, and they never showed anything but pride and support. But I wanted experience. I was young and stupid and had a thirst for everything that I couldn’t have. So when James switched from the pills to the heroin, I took some and tried it on my own (you can learn anything on the internet).

    Nobody ever tells you how it feels, especially for the first time. To this day, I can promise you that the most euphoric moments in your life cannot compare to the rush that heroin will give you; not love, not sex, not pride, nothing! Literally, it’s chemically impossible. Heroin forces your receptors to overload, giving you an overwhelming feeling of pure pleasure.

    One time, and I was hooked.

    At first, James was furious with me, although I suspect he was more furious with himself. At that point, though, we both already knew what it felt like, and neither of us was going to stay away.

    For the next six months, we both used regularly whenever we could. James had a full-time job, and I had a part-time one with no expenses. On top of that, people always expected us to be around each other. There were no obstacles in the way of our continued drug-fueled lethargic shenanigans. During this time, I maintained my grades, my job, my church activities, and my relationship with my girlfriend, who was in the dark about my darkest habit. Somehow, I had convinced myself that I could maintain everything I had while still being a heroin addict. Anyone who couldn’t figure it out was just too foolish.

    There is a cost to such pleasure, though. Due to the amount of dopamine that is released in your brain when you do heroin, your brain starts to get complacent, and won’t produce any new dopamine without the stimulation of heroin. Over time, this meant that I couldn’t feel pleasure, or giddiness, or satisfaction, unless I had recently used heroin. Towards the end of school days, I would get irritable, getting restless for my next fix.

    James realized this before I did. He never excelled in school, but he always had much more emotional wisdom than me. It’s because of this that he told his parents about his addiction. I first found out from my parents that he had told them, and I selfishly was terrified that he had ratted me out. But James would never do that without my consent.

    “Always protect each other,” they’d say.

    James, with the help of family, started getting treatment. In the meantime, I continued to shoot up in his bedroom while he tried to convince me to do the same. Near the end, I was strongly considering it. Even at the point when heroin had the strongest hold over my life, I still loved and trusted James more than pretty much anything in this world. And truthfully, he was doing well. He hadn’t used for nearly a month.

    But then I made a mistake.

    One night, I took the bus home from James’ home and went to bed. Early in the morning, though, I shot awake with the realization that I had left my bag in his room, and in that bag was the thing that James most needed to stay away from. As I hurried to get back to his home, my stomach was already filling up with a sickness of certainty.

    James was already long dead when I walked into his room.

    I thought my heart was going to pound out of its chest. I’m ashamed to admit that my first thought was that I needed a fix, and then my second was how long it would take to bleed out if I cut my wrists. At that moment, I probably could have found the courage to cut my own throat. Somehow, I did neither of these things, and managed to call 911.

    And then there was one.

    If he had never have gotten help and stopped using, the dosage wouldn’t have killed him, but he didn’t lower it to compensate his reduced tolerance. This irony never escaped me, even when I first found him.

    This funeral was harder than Eric’s. It was harder to find the dignity, to justify the purpose of this loss. Eric’s death brought sadness to my family. James’ death ripped the rug out from under them.

    Everybody blamed themselves. His parents thought they didn’t try hard enough. His older siblings thought they weren’t good enough influences. My grandparents felt they didn’t talk to him enough after Eric died.

    But it was me. If there was a metaphorical trigger to pull, then I was the one who did it. Not only was it heroin that I bought that killed him, a fact my family was woefully ignorant of, but I was the one who continued to use in the environment that he needed to be a safe space. I was too proud to think that I needed help, and it cost the life of a far kinder person and gentler spirit than me.

    As I looked at his open casket, all I could think was that I was the worst fucking scum on the planet, and that I should follow him into the ground.

    But as everyone I love wept around me, I could practically hear their hearts cracking. And then I had a realization would define every molecule of my existence for the coming days: I would not be the next one to hurt my family. I couldn’t bring myself to tell them that I was also an addict, so I decided there was really only one option, something I had never done before, but had heard about from TV shows and online articles. I had to go cold turkey.

    Because of how close James and I were, it was easy to get a few days to myself that I would need to completely detox. My family would simply think I was grieving. They were right, but only half so. That thought at the funeral put me into a mode of complete obsession, and I was determined to follow through with my plot.

    ***

    I bought a couple cases of water, a few bags of salted jerky, and a rotisserie chicken, and then locked myself in a spare room at my grandparents’ home. There was a lot of family in town, so they would be busy for the next couple days. I felt ready for anything.

    But, just like nothing could prepare me for the pleasurable feeling that heroin washed over me, neither could reading about the cold turkey process ready me for how horrific it really was. Below is my attempt to be as straightforward about the process as I can be, and to tell it as factually as I can…

    Once I was 14 hours in from my last fix, I consider the withdrawals to have truly begun. First, it starts with intense cravings. You want heroin more than you’ve wanted anything in your entire life, or at least you think you do. I constantly reminded myself that this was a trick, but I’m not sure I believed it at the time. Remember, after you’ve become dependent on heroin, your brain is practically incapable of producing positive thoughts. I tried to remember happy memories of James, but they were fuzzy in my mind. Beyond this, my concept of time began to blur for the next several days.

    After I had neglected my strong desire to use, I began to get uncontrollably irritated. Every time I clattered my teeth or made a sound, I would frustrate myself to the point that I wanted to punch a wall. I started to scream into pillows to let off steam. However, this got harder once the nausea set in. I was prepared for this. I had read all about the physical effects that would happen to me. However, reading did little to mitigate the sickness and dizziness. Pretty soon, standing became a difficult task.

    I stayed in bed and attempted to control my breathing. For a little while, I was even almost able to relax. This was short lived, though. Again, I knew that the skin crawling sensations were coming, but I didn’t realize how sporadic it would be. Everywhere on my body felt like it was on fire. I tried to hold my breath and keep still, but pretty soon I was scratching everywhere I could reach. After a matter of minutes, my arms were bleeding. I wrapped my fingers in duct tape to prevent myself from doing further harm.

    I knew that I would eventually start vomiting and purging everything in my body. I had readied myself for all of the physical effects. However, the true hell of heroin withdrawals isn’t in the physical aspects, it’s the mental side effects that really get you. At this point, my irritability had climbed to a full-scale anger. I kept clenching my jaw so bad that my gums started to bleed. All I could do to let out the energy was to continue screaming into a pillow, but I was starting to get tired. Then, out of nowhere, the vomiting started.

    I vomited and dry gagged in a throbbing cycle that lasted about an hour, but would continuously rear up throughout the whole process. While the initial vomiting was quite painful, it actually provided me some relief from the thoughts in my head. Afterwards, I was so overcome with exhaustion, that I was actually able to sleep for several hours. To my memory, this was the only continuous sleep I would have for about two days.

    Although I very much needed these few hours of sleep, it almost wasn’t worth it because of the nightmares that started at the end and woke me up. Up to this point in my life, I wasn’t very prone to nightmares at all, and could probably have counted the number of nightmares I had had (or at least remembered) on one hand. However, the dopamine from my last hit was finally hitting the dregs, and my brain couldn’t produce anything to balance itself out, chemically.

    I woke up in a cold sweat and felt paralyzed with fear. For the next several days, every time I would start to fall asleep, nightmares and partial hallucinations (waking nightmares) would jolt me awake in terror. After a few times of trying to doze off, I began to question my own sanity. We tend to hear a lot about the physical aspects of heroin withdrawals, but one of the most dangerous threats to people going cold turkey is suicide.

    Somewhere at this point, although time was a bit of a blur, my mind hit rock bottom. My dopamine receptors were doing nothing at this point, and my brain began to fall apart, unable to produce a single happy thought. The world was a bleak pit, and I was just washing around at the bottom of it. I had felt small bouts of depression before, but this was soul-crushingly different. Out of instinct, I began to pray. I begged God to make the pain end. I begged for a light at the end of the tunnel. I begged for some sort of sign or to be saved from my own thoughts.

    Then, it occurred to me how easy it would be to simply end it all right there. It wasn’t hard to reason myself into it. I could be with Eric and James. We could be the three musketeers again! This was the most pain and anguish I had ever experienced in my life, and I had given it my best shot, but there was really no point in going on. I’m sure that God would understand. I knew that he would have mercy.

    It was then that I remembered the thought that saved my life. I didn’t need a happy memory. I needed the memory of feeling the worst I had ever felt. I needed to remember the self-loathing that washed over me at James’ funeral, as I heard the people I cared most about bawling uncontrollably in pain, because of me.

    And then it hit me as if the sky fell down: God wasn’t there.

    I don’t expect everyone to have this same revelation. It was an incredibly personal moment to me. Addiction recovery programs frequently talk about needing to surrender to a higher power, and this was my own special ‘higher power’ moment.

    It wasn’t that God didn’t care, or that he was cruel, or that I couldn’t understand his grand plan. He wasn’t there. There was nothing above me or below me that wasn’t a meaningless abyss. A void of space that stretched beyond what my brain could conceive for absolutely no reason. There was no cavalry coming to save me, and there was nothing waiting for me if I were to die now; just more pain for my family.

    I had gotten myself in this situation, and only I could get myself out. I was going to have to do this Eric’s way: survive, out of spite. I abandoned every notion of meaning I had ever put on the world, and replaced it with this one simple purpose. For the rest of this battle, that would be my single function. I may have wanted to die, but I had too much hate to give in. If you can’t find happiness, hate can be a powerful motivator.

    The only thing I knew was that I would not be the next reason my family grieved and hurt. I would survive. No cancer, or heroin, not even God himself would stop me. If I died and woke up in heaven, I would have killed every last angel to get back to Earth; to get back to my family.

    Dramatic? Yes. But the mind of an addict suffering from heroin withdrawals is hardly a place for subtlety.

    From this point on, I sat against the wall, and remained there for about a day, just staring and drinking water. I wouldn’t let myself fall asleep and be the victim of yet another night terror. Every craving and thought of suicide filled me with more and more spite, and I sat there, stewing in it, until finally, I could feel the physical effects wearing off.

    I had survived.

    The cravings continued to last for months. Even years later, I sometimes have a sharp, discernable memory of how good the pleasure of heroin felt. But I can say with certainty that I don’t have the temptation to use. If I sat in an empty room with an ounce of heroin, I wouldn’t even have the slightest desire.

    In that room, I burned down who I was as a person, and built something else with the pieces that I had. Truth be told, going cold turkey is a horrible idea, and isn’t safe to try under even the best of circumstances. Please, if you or a loved one find yourself struggling with heroin dependency, get professional help and stick with it. This is by no means a road map to fighting addiction. It doesn’t really feel like a feel-good story, either. Hell, I’m not even sure if this is a happy ending.

    But it’s my story.

    *Names have been changed for the sake of anonymity.

    View the original article at thefix.com