Answer Addiction

Tag: opioids

  • The Opioid Crisis Is Our Greatest Opportunity

    The Opioid Crisis Is Our Greatest Opportunity

    Overdose survivors need more than a second (or third) chance: they need a parachute. When you’re in free fall, a little more time isn’t much help.

    Perhaps everything that is terrible is,
    in the deepest sense, something
    that wants our love.

    Rilke

    The overdose epidemic in the U.S. has been called “the greatest public health crisis of our time.” It’s also our greatest opportunity.

    The opioid crisis is an identity crisis: it’s a challenge to how we see ourselves. Do we truly believe that we are all in this together? One answer leads us deeper into despair. The other, into a hopeful future.

    It’s been said that “doing more things faster is no substitute for doing the right things.” What are the “right things,” the measures that can resolve the crisis, not just postpone it? The right actions come from the right thoughts. Those thoughts come from feelings, and feelings are never right or wrong. But there are some feelings we are born with. They are our birthright. And one of them is love.

    The Kindness of Strangers

    Hatred never ceases by hatred, but by love alone is healed.

    The Buddha

    Behind the opioid epidemic is a prevailing lack of compassion, of caring about everyone equally. At the heart (or lack of it) of this societal disease is rampant inequality. The social determinants of health: stress, unemployment, lack of support, poor health care, etc. are major drivers of addiction. Many authors promote this view, including Gabor Mate, Bruce Alexander, Sam Quinones, Robert Putnam, and Harry Nelson.

    Our increasing fragmentation affects everyone, poor or rich.

    Drug overdose is the leading cause of death for Americans under the age of fifty…

    Our material lives may be outwardly prosperous, but our psychological and spiritual lives are in freefall. What is driving us to self-destruction? There are many factors, all with one unifying theme: we are no longer living in community with one another and, consequently, we are lonely.

    Francie Hart Broghammer

    We all hunger for the same thing. The question is this: do we love our neighbor as ourselves? That’s not just a commandment; it’s a requirement. How do we rebuild community? First, by taking full responsibility for the fallout of not being one.

    For Whom the Boom Tolls

    Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Compassion becomes real when we recognize our shared humanity.

    Pema Chodron

    I live in Asheville, a city that has recently, like the opioid crisis, exploded. Tourism is at an all-time high, and Asheville has appeared in dozens of destination top ten lists. It has also been ranked second in the country in gentrification.

    Asheville sits in the heart of Appalachia, where the opioid crisis is at its worst. In 2017, North Carolina had the second highest increase in opioid deaths in the country. The Blue Ridge Parkway runs through town and I spend a lot of time there, mostly foraging. That’s where last summer, for the first time, I found not mushrooms, but needles.

    Despite the crisis, the city just spent six months trying to shut down the local syringe exchange. The same thing is happening in other cities. In Asheville, the exchange had been operating without incident for over two years — until the houseless (a.k.a., homeless) in adjacent areas were kicked out to make way for new development.

    Addiction depends on denial. What if development is the real addiction? Will we face up to the dark side of gentrification or just try to make it “go away?”

    If a canary dies in a coal mine, you don’t blame the canary. Yet blaming the victim is exactly what we’ve been doing.


    Blue Ridge Parkway, 8/20/18 

    License to Ill

    A man came to the Rabbi and said, “Rebbe, my son has turned against me. What should I do?” The rabbi said, “love him even more.”

    Hasidic story

    Most people by now have heard that naloxone (Narcan) can prevent a deadly overdose. So many Americans are dying — often from a mix of drugs, but mainly due to opioids — that naloxone should be as ubiquitous as aspirin. Everyone using a drug that may contain opioids should carry it like an EPI pen. And with the increasing prevalence of fentanyl, a single dose may not be enough. Everyone should know how to tell how much naloxone to give someone in the midst of an overdose. This should be basic, universal knowledge.

    But keeping someone alive is just the beginning. In fact, while naloxone may be physically safe, it does have one significant side effect: precipitated withdrawal. And not helping someone through it is like catching them from falling only to drop them from higher up.

    A Devil’s Bargain

    Be kind, for everyone you meet is fighting a hard battle.

    Ian Maclaren

    As one response coordinator describes it, precipitated withdrawal is like “the worst flu you’ve had… times 100.” For some, the feeling is so bad that they find themselves dying, so to speak, to use again.

    To the uninformed, it is inconceivable that someone who nearly died from a drug would run out that very same day and buy more of it. Narcan works by binding to opioid receptors, blocking the effect of narcotics like heroin. In drug users with a physical dependency, it also has the effect of causing severe withdrawal symptoms. This all but guarantees that the first thing a user will think of after their overdose is reversed is getting another fix…

    Christopher Moraff

    Naloxone is not just a “bandaid on a bullet hole.” It can feel like ripping open a wound. For “withdrawal is the very situation that [users] are seeking to avoid in the first place.”

    “A dose of naloxone,” according to the Chief Medical Officer for a Connecticut health agency, “is a chance. But if it’s not coupled with immediate offers of treatment, it may be a slim chance that leaves the revived individual running back to the same dealer who sold them their last lethal dose.”

    Overdose survivors need more than a second (or third) chance: they need a parachute. When you’re in free fall, a little more time isn’t much help.

    Back on the Chain Gang

    Without forgiveness, our lives are chained, forced to carry the sufferings of the past and repeat them with no release.

    Jack Kornfield

    “They’re usually very angry when we bring them around,” says one responder. “One kid yelled at me, ‘You think this will make me stop doing drugs?’” Indeed, one substance abuse specialist in Ohio says that 67% of people revived with naloxone in her area use again within 24 hours. NPR reports that “about 30 percent of those revived with Narcan at Boston Medical Center have been revived there more than once… and about 10 percent of patients more than three times. Those statistics are in line with what’s seen in ERs elsewhere, public health officials say.”

    According to a former agent for the DEA, one woman in Ohio, within 24 hours of being revived for the the sixth time, was using again. In the first half of 2017, one man in North Carolina was revived fourteen times.

    To be clear, I am not saying naloxone provides a safety net that encourages people to take bigger chances. Studies have shown that naloxone does not increase drug use any more than free condoms increase sex. Nor am I saying we should place limits on the number of times we revive people.

    What I am saying is that naloxone is no miracle drug. When you “come to,” the problem remains. Overdose survivors are 24 times more likely than the general population to die in the following year. One study found that for those revived with naloxone, nearly one in ten are dead within a year, the majority within the first month. Follow up is critical. But even that is not enough.

    Not by Locks Alone

    Few things can help an individual more than to place responsibility on him, and to let him know that you trust him.

    Booker T. Washington

    In June of 2019, New Jersey became the first state to allow paramedics to administer buprenorphine along with naloxone to ease the pain of withdrawal. Buprenorphine is the drug that, like methadone, is used in opioid replacement therapy. But this measure will, according to one expert, “make a meaningful difference only if rescued individuals are linked immediately to ongoing treatment and agree to participate in that treatment.”

    “Immediate” is key. And at least one hospital in New Jersey has been making that link, through state-paid recovery coaches, since 2017. A coach might work with someone “for weeks or months.” And the cost to taxpayers of helping people in this way is surely far less than the cost of leaving them on their own.

    Unfortunately, however, getting people into treatment is not enough. Not all treatment is good treatment. In fact, much of it is worse than doing nothing at all.

    Under the Rug

    Beware of all enterprises that require new clothes, and not rather a new wearer of clothes.

    Thoreau

    People usually go to rehab for 28 days, maybe a month and a half. In most cases, the treatment fails, if you regard failure as return to use. A study reported in the Irish Medical Journal found that 91% of people who go through rehab are using again within a year; 80% in the first month.

    “Most honest program directors,” says veteran addiction expert Julia Ross, “will admit to 90% relapse rates, and I assume that if they admit to 90%, it’s probably worse.” Drug courts are no better. A national study of seventy-six drug courts found a reduction in the rate of rearrest of only 10 percent.

    Moreover, when people come out of abstinence-based rehab, their tolerance has gone way down, so they are more likely to overdose. This is a common reason why fentanyl is killing people: it’s much stronger than they are expecting, especially in an opioid-naïve state. Making fentanyl test strips available can help prevent overdose, but that still doesn’t deal with the basic issue of why they’re using in the first place. What pain are they killing?

    Zero Tolerance

    Winning isn’t everything; it’s the only thing.

    Henry “Red” Sanders

    I watched my grandmother die a very slow death. At 90 years old, after three cancers, open heart surgery, and several strokes, she still fought tooth and nail. Christopher Ryan, author of Civilized to Death, compares our approach to death to the final minutes of an NBA basketball game. We drag it out. We go for quantity instead of quality. Is that also our approach to addiction? As long as they don’t die, we’re OK. This is similar to abstinence-based approaches to addiction treatment: As long as you don’t use, you’re OK. This amounts to saying, “it’s more important to look good than to feel good.”

    To be clear: I’m not saying we should just let our neighbors die. I’m saying we need to do more than just keep people alive; not less. We need to treat the cause, not just the symptom.

    Spare the Prod

    If you want to be heard, whisper.

    Author Unknown

    The overdose crisis is part of a larger epidemic of despair. The facade of America as the “land of opportunity” is failing. Asheville today is “booming.” For whom? Are we saving lives or just saving face?

    Fortunately, Asheville has begun to address its weak spots, and we now have three needle exchanges. We all need to look in the mirror and face where we — as a community, as a country — are really at. Because not doing so is killing us. Whether we die quickly from overdose or slowly from alcoholism, cancer, or depression, we are ALL canaries in a coal mine. And you can’t just rake the canary over the coals.

    It’s one thing to save lives. But throwing someone into withdrawal without providing detox support or throwing them out of treatment because they’ve relapsed is like hitting a child to make them stop hitting other children. Such heavy-handed measures only perpetuate a cycle of abuse. Even a magic bullet leaves a wound.

    Sticks and Phones

    Can you love people and lead them
    without imposing your will?

    …leading and not trying to control:
    this is the supreme virtue.

    The Tao Te Ching

    There’s a reason our greatest leaders practice nonviolence. If all we do is arm people with naloxone, if we fight firearms with firearms, the conflict will only escalate. Stronger opioids are already requiring stronger antidotes.

    With this approach, we may win a few battles, but we will lose the war. You can’t win when you see this as a war to begin with. Because you can’t force someone out of addiction any more than you can force them to stay alive. Force is what causes addiction.

    In 2015, Victoria Siegel, 18, died of a methadone overdose precipitated by cyberbullying. We worry about bullying in schools. What about parental bullying — or governmental? Some of us are aware of the alarming incidence of domestic violence. How many of us recognize how our culture is inherently abusive, our very way of life?

    Sometimes we forget that we are treating people, not diseases. We are bio-psycho-social beings. We have feelings. If addiction comes from pain, and pain comes from hurt, then we need to reduce hurt, not just harm.

    A Dying Shame

    You cannot be lonely if you like the person you’re alone with.

    Wayne Dyer

    We will not end drug abuse until we end human abuse. We will not end human abuse until we end abusive thinking, because violence starts with what you think. A saying often attributed to Martin Luther King Jr. is that “you can have no influence over those for whom you have underlying contempt.” As long as I think, “you’re not good enough; this is all your fault,” or I say that to myself, addiction has a foothold.

    The blame game has no winners. “We’ve lost what it means to just be ourselves and for that to be ok and for that to be enough. So we find ways to self-medicate,” says Rev. Shannon Spencer. People will use painkillers as long as the pain is killing them, for there are few emotions more agonizing than shame.

    We Are Faminy

    I don’t remember now how many days we stayed—long enough to hear David sing often and tease us about white people’s music, which, according to him, is only about “love.” He observed that the Hopi have many songs about water, which they consider the rarest and most precious of resources, and then asked, with feigned innocence, if white people sang so often about love because it was equally rare in our world.

    Peter Coyote

    To many, opioids feel like the opposite of shame. One user describes the feeling as “like being hugged by Jesus.” Indeed, “the very essence of the opiate high,” according to Gabor Mate, is that it feels “like a warm soft hug.” This is the feeling of unconditional acceptance and support, or love.

    We live in a culture where love is the one thing we sorely lack. Millions of people are starving for just a few drops of it. If only for a few moments, we desperately need to feel like we’re OK, that someone wants us to be here, as we truly are. Like they say, it is rain that grows flowers, not thunder.

    Inside, we know we’re not just here to feed The System. We know it should be feeding us. We should not be starving. We should not have to be forced, or force ourselves, to do anything. People need to be supported to decide for themselves what healing looks like for them and to approach it in their own time.

    The Emperor in the Room

    Opioids are like guns handed out in a suicide ward; they have certainly made the total epidemic much worse, but they are not the cause of the underlying depression.

    Anne Case and Angus Deaton

    To solve the drug problem, we need to focus on more than drugs. Otherwise, we are shooting the messenger. Drugs are like the emperor’s clothes; it’s time to look at who’s wearing them.

    Like Dr. Jekyll and Mr. Hyde, opioids and their antagonists are two sides of the same coin. Focusing on either is like looking for your keys under the streetlamp when you know you dropped them further up the street. There is an “upstream” issue here. That issue is our domination-based, “have to” culture. If we stick to our guns, if we continue to be violent, inside and out, we will continue to die.

    Whether we kill another person, the planet, or ourselves, we are a culture committing suicide. We are overdosing on “progress.” We are addicted to things far more insidious than opioids; you’re looking at one.

    Progress isn’t progress when it’s in the wrong direction. The direction we’re going is apart. The direction we need to go is back together.

    Only the Lonely

    Humanity’s current crisis may not, at its root, be an economic crisis or an environmental crisis. It may well be a crisis of consciousness, a crisis in how see ourselves and the world around.

    Peter Russell

    If you’re in the right place at the right time, armed with enough naloxone, you can save a life. But what about an hour later, or the next day? You might get someone into treatment, but what about after that? A person that susceptible to overdose can scarcely be left alone. And that aloneness is the real problem. In fact, it’s how addiction starts.

    The connection between social isolation and addiction shows up on many levels, from treatment to prevention. The most obvious is that you can get naloxone into the hands of every drug user, but it will do them no good if they overdose alone.

    Human beings may be the most social animals on earth. Social isolation can drive us to despair, addiction, and even suicide. Loneliness is self-reinforcing and can lead to shame, for it can mean “I don’t deserve to be loved.” This can be the underlying emotional pain that comes back during withdrawal, whether from an opioid or from someone withholding their affection. And that lack of affection could be the primary cause of addiction.

    Fatal Attraction

    If one has a friend, what need has one of medicines?

    Bhartrihari

    There can be no healing without community. “This unique American moment asks not for a call to arms, but for a call to neighborliness.” (Francie Hart Broghammer)

    No amount of “care” can substitute for the watchful eye of loving family, friends, or neighbors. No amount of “treatment” can make up for how we treat each other. It truly takes a village.

    Ultimately, it’s not drugs that are killing us; they are just finishing us off. Whether or not we beat the horse, we’re already practically dead. Something has weakened us enough to succumb to drugs. It’s the same thing that allows dealers to intentionally make some of their merchandise deadly, or if it’s naloxone, to jack up their prices.

    What our culture is most addicted to is exploitation. It’s what the system is set up for. It compels us not to care. As Ken Eisold says, “The loss of community is not a problem that can be dealt with through psychotherapy,” for what needs rehabilitation is our society. There’s something wrong “with the village.”

    The greatest tool I know for rebuilding community is Nonviolent Communication (NVC). The best approach I’ve encountered for addressing the disconnection inherent in addiction is SeekHealing.

    We are the Medicine

    At the root of the opioid epidemic are deeper questions that we have to ask about society. What kind of society do we want to live in? Do we want to live in a society where we believe every life truly matters? Do we want to live in a society where we all chip in, recognizing that we are vulnerable in some way, whether it’s to addiction or loneliness or other conditions, and that we are stronger when we come together, when we recognize our interdependence, and when we help each other?

    As tragic as the opioid epidemic is, if it can move us in a direction of shared understanding about our interdependence, if it can help us address these deeper social roots of disease, then I believe that we will have used it ultimately to improve ourselves to become stronger as a country.

    Vivek Murthy

    To make it out of this crisis, we need to look at the big picture. As writer David Dobbs puts it, “trying to understand mental illness without accounting for the power of social connection is like studying planetary motion without accounting for gravity.” If we only look at addiction on an individual level, we are missing the forest for the trees. If you don’t heal the forest, it gets harder and harder to heal each tree.

    It’s especially hard to heal when you’re continually cut down. In this culture of mutual exploitation, we treat each other like truffula trees. We factory-farm humans and clear-cut them for fuel. We do it to each other and we do it to ourselves. All to feed the machine, the matrix. To race into space, we’re melting our wings.

    Saving lives, then, is only the beginning. It’s the tip of the iceberg. Because it is we, not “they,” who have an addiction. This isn’t about how we use drugs; it’s about how we use each other. Because ultimately, there are no others. We are not just a bunch of individuals. We are one, interdependent whole. Our greatest public health crisis is that we’ve forgotten who we are.

    The Opposite of Addiction

    Sometimes out of really horrible things come really beautiful things.

    Anthony Kiedis

    This crisis is an opportunity, a wake-up call. If we take responsibility for it, there’s no limit to what we can do. It’s said that anything is possible if it doesn’t matter who gets credit for it. The same is true of blame.

    We are all in this together. That’s the bottom line. There is but one answer to this crisis, and we each carry it at the bottom of our heart.

    View the original article at thefix.com

  • Overdose Deaths: Not an Epidemic or a Crisis, and Not by Accident

    Overdose Deaths: Not an Epidemic or a Crisis, and Not by Accident

    Overdoses are not mysterious, they result from predictable causes like criminalizing drug use, ineffective policies, poverty, lack of stable housing, and persistent racism.

    Opioid-related overdoses are not a crisis or an epidemic, and should not be described as either. Both words stigmatize the victims of a phenomenon that is not happening by accident. Such overdoses have been steadily increasing throughout the United States and are especially high in Appalachia (where we both work). Yet overdoses are not a natural or mysterious phenomenon. They result primarily not from individual, but from larger structural factors — criminalization of drug use, ineffective social policies, poverty, lack of stable housing, historical and persistent racism, and other forms of systemic oppression — which are all the result of deliberate policy decisions.

    We are told by the media, CDC, and state governments that the region where we live and work is ground zero for a drug “crisis.” Yet those same entities contribute to the problem through policies, funding allocations, and covering-up of underlying systemic causes. We must shift our language to reflect this. Substance use and overdose happen in predictable contexts and disproportionately affect marginalized communities.

    Terms Like “Epidemic” and “Crisis” Cause Alarm and Hysteria, Stigmatizing People Who Deserve Compassion

    More than 67,000 people in the United States died from opioid-related overdose in 2018. Alarmist headlines, even well-intended reports, do not justify an inaccurate framing. We advocate instead for the use of the term impact, or other language that indicates the underlying roots of suffering, instead of epidemic or crisis.

    Epidemic is most accurately used to describe infectious or viral spread of a disease within a population over a short period of time. Substance use, even for the relatively low 18% of people who use “chaotically,” does not meet this criteria. People who overdose or suffer negative consequences of substance use may be more socially or genetically vulnerable to a substance use disorder but in basic epidemiological principles, that does not an epidemic make. Calling structural violence that leads to specific overdose patterns an epidemic or a crisis feeds into a hysteria that marginalizes drug users and their loved ones. Both words take the focus away from the underlying causes of suffering; naturalizing it and leaving the conversation at a surface level without motivating real change. 

    We both work in and study harm reduction and overdose prevention in North Carolina: a microcosm of opioid-related deaths and specific patterns of suffering repeated elsewhere in Appalachia and throughout the country. Daily, we observe the dynamics of economic policies, limited healthcare access, and stigmatization that impact people already at greater risk for substance use and overdose. Later in this essay we discuss how it plays out in North Carolinians’ overdose risks — making it more likely they and their loved ones will be blamed if they do.

    How Misguided Drug Policies Blame the Victims While Ignoring the Causes

    Like the thousands of lives lost to fentanyl poisoning in the context of increased drug use criminalization today, there was nothing natural about the thousands of lives lost to alcohol poisoning during prohibition a century ago; or the increase in deaths and drug-related arrests that ravaged inner-cities during the government-manufactured “crack era” of the 80s and 90s. Consequences of drug use, like mass incarceration, have never been a natural disaster. Instead, policy responses to drug use tend to create systemic storms that rage in vulnerable communities. This is a classic example of blaming the victims of problems while ignoring the causes.

    If a “crisis” is happening to those around you, you may feel bad for them, you may vote for a politician who promises to address it — but you probably won’t ask how the same politicians or political system contributed to creating it, or how arresting and jailing poor and Black and Brown people will fail to fix it. Overdose deaths in the U.S. have always been both a symptom and outcome of discriminatory policies. 

    Suffering is further exacerbated by punitive policies such as drug-induced homicide laws that increase overdose deaths, weaken Good Samaritan legislation intended to reduce overdose, and criminalize drug users and their loved ones. For example, opioid de-prescribing mandates in 19 states appear to result in an increase in heroin overdose deaths. And, healthcare policy is an oft-overlooked aspect of overdose prevention — states that did not expand Medicaid (which increases coverage of treatment) are disproportionately states with higher overdose and substance use.

    Mainstream media portrays sympathetic stories of the middle-class sons and daughters of urban politicians dying of overdose, while the stigmatized partners and friends of poor Appalachians who disproportionately die of overdose from drugs often laced with fentanyl fear being arrested under ‘drug-induced homicide’ and ‘death by distribution’ laws if they call 911. The ways that drug users are talked about serve political agendas that further contribute to patterns of suffering.*

    We must acknowledge and address what is missing, obscured, and ignored when we promote an inaccurate framing of drug use as a “crisis” or “epidemic,” rather than something caused by policy decisions. Who is disproportionately blamed? Who is left out of the conversation? 

    When we fail to address how a combination of economic, political, biological, behavioral, genetic, and social factors intersect within the lives of drug users and their wider communities, we legitimize the use of simplistic and punitive approaches to complex issues. Where we live and work, North Carolina policy makers used the 2016-2017 increase in drug overdose deaths to justify an argument for harsher punishments despite a wealth of research that shows that such approaches increase the very health consequences they claim to reduce. Further, these approaches do nothing to address economic disparities in North Carolina where 13 of 100 counties have experienced rates of poverty at 20% or higher for the last three decades. They do nothing to address the lack of Medicaid expansion or limited employment and economic growth — all upstream drivers of overdose and suffering.

    Simply put, an increase in overdose deaths is not the result of society’s inability to get tough on crime, or even the need for more biomedical treatment. Rather, overdose deaths persist due to an unwillingness to acknowledge that treatment expansion and more or harsher punishment fail to address gaping social wounds. 

    Communication: Start Using Language That Reveals the Roots of Unequal Suffering

    As long as policymakers, politicians, and journalists continue to use inaccurate terms like “opioid crisis/epidemic,” opportunities are missed to discuss and address the causes and effects of substance use and overdose. We advocate for talking instead about “opioid impact” or “overdose impact.” A more neutral term like impact is less stigmatizing and hyperbolic, and thus less marginalizing for those directly affected. Impact is also more flexible — not all drug use is harmful, nor leads to substance use disorder, illness, or overdose. Impact is a more accurate and flexible term to allow for discussion of people’s lived experiences with substances.

    Even so, it may not go far enough. As a parallel example, public pressure and justice-oriented advocacy shifted public conversation and journalistic style from talking about human beings as “illegal” to “undocumented.” But referring to these same folks as “economic refugees” would be even more accurate and less stigmatizing. Similarly, impact is a more useful term than “crisis” or “epidemic” when referring to patterns of opioid-related overdose and substance use-related illness. And, terminology that clearly unmasks the deeper roots of unequal suffering would be even better.

    A person using drugs is not a disease vector nor the precipitator of a crisis. What we witness in communities like Philadelphia, Austin, and Asheville are not drug-related epidemics or naturally occurring crises. The harms impacting these communities are symptoms of destructive social policies that ensure the most vulnerable populations remain vulnerable, shamed, and disproportionately suffering from the very problems for which they are blamed. 

    So where do we go from here? We can start by answering this with another question: How might our conversations, and thus policy and response efforts change, if we use language that reveals the structural roots of suffering instead of further contributing to stigma and hysteria that shames the people who are most directly affected?

    View the original article at thefix.com

  • Drug Deaths in Black Communities and Our Collective Denial

    Drug Deaths in Black Communities and Our Collective Denial

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

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

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

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

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

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

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

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

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

    There’s Always Been a Cocaine Epidemic

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

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

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

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

    The cocaine epidemic in black communities is not new. 

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

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

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

    It’s Just a Cruel Delusion

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

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

    “It’s just a cruel delusion.”

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

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

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

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

    Every single photo was white.

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

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

    Just Say No

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • We Need Harm Reduction for All Drugs, Not Just Opioids

    We Need Harm Reduction for All Drugs, Not Just Opioids

    While we’ve made great strides with harm reduction for people who use opioids, we’re slow to provide non-abstinence-based treatment for people who use other drugs.

    A quick glance at the news reveals the catastrophic effects of opioids across the nation: around 120 people a day die from opioid-related overdoses. It’s so devastating that the nation is calling it an opioid epidemic. Yet even as we watch this tragedy unfold, we’re missing the point.

    By focusing exclusively on opioids, we’re overlooking the harm caused by other deadly drugs. How can we highlight harm reduction resources if we only focus our efforts on people who use one class of drug?

    The Problem with the Opioid “Epidemic”

    According to the Centers for Disease Control and Prevention, more than 700,000 people died from a drug overdose between 1999 and 2017. Sixty-eight percent of those deaths in 2017 involved an opioid — approximately 70,200. However, that’s not the 100 percent that the “epidemic” coverage would have us believe.

    While I’m not arguing that the opioid-related deaths shouldn’t be covered — they should! — I am saying the problem with zeroing in on the opioid epidemic is that we are focusing too narrowly on the harms caused by one drug and are blinding ourselves to the impact of other deadly drugs. We should be reporting on those, too.

    A more accurate picture of drug-related deaths in 2017, according to the CDC, looks like this:

    • Alcohol was responsible for the deaths of 88,000 people
    • Cocaine misuse killed 13,942 people
    • Benzodiazepine misuse was responsible for 11,537 deaths
    • Psychostimulant misuse, including methamphetamines, was responsible for 10,333 deaths.

    Those aren’t insignificant numbers, so why are they being overlooked? I asked recovery activist Brooke Feldman for her perspective.

    “The sensationalized and narrow focus on opioids fails to account for the fact that people who develop an opioid use disorder typically used other drugs before and alongside opioids,” Feldman said. “So, we really have a polysubstance use situation, not merely an opioid use situation.”

    She continues, “Focusing on opioids only had led to the erection of an opioid-only infrastructure that will be useless for the next great drug binge and is barely relevant to address the deadliest drug used, which is alcohol.”

    The Deadliest Drug: Alcohol

    Alcohol is responsible for more deaths than any other drug. But we overlook it for two reasons: because it’s legal, and because it’s a socially acceptable drug. Not only that, but advertising actively promotes its use — you only have to look on Instagram or Etsy to see how widely excessive use of alcohol is normalized — especially among mothers and millennials. These advertisers have been smart to market alcohol as a means of self-care — encouraging drinking to help unwind from the stresses of the week — and as a means of coping with motherhood. 

    Social media reinforces the message that alcohol is a tool to cope with stress and something that should be paired with our favorite stress-relieving activities, like yoga. Captions on Instagram read like “Vino and vinyasa,” “Mommy’s medicine,” “Mommy juice,” “It’s wine o’clock,” “Surviving motherhood one bottle at a time,” and “When being an adult starts to get you down, just remember that now you can buy wine whenever you want.”

    Perhaps what is most insidious about alcohol is that it heavily impacts marginalized and oppressed communities. For example, Black women over 45 are the fastest-growing population with alcohol use disorder. And the LGBTQ+ community is 18 percent more likely to have alcohol use disorder than the general population.

    Alcohol aside, looking at the harm done by other drugs, we can see that opioids are no longer the leading cause of drug-related death in some states. In Oregon, statistics show, deaths related to meth outnumber those that involve one of the most common opioids, heroin. In fact, there has been a threefold increase in meth-related deaths over the last ten years, despite the restriction on pseudoephedrine products, which now require a prescription. 

    Similarly, in Missouri, which was ground zero for home-based meth labs 20 years ago, the recent spotlight on opioids has overshadowed an influx of a stronger, purer kind of methamphetamine. Deaths related to the new and improved drug are on the rise.

    Oregon’s state medical examiner Karen Gunson speaks to this disparity of focusing on opioids over other deaths and the damage that those other drugs cause. “Opioids are pretty lethal and can cause death by themselves, but meth is insidious. It kills you in stages and it affects the fabric of society more than opioids. It just doesn’t kill people. It is chaos itself.”

    Abstinence Is Not Attainable for Everyone

    Our approach to recovery has been too one-dimensional, stating that complete abstinence is the goal. But this perspective is outdated. Abstinence isn’t attainable for everyone. If it were, then more people would be in recovery. However, harm reduction is attainable. It reduces deaths, treats medical conditions related to drug use, reduces the transmission of diseases, and provides options for treatment services. In fact, people who use safe injection sites are four times more likely to access treatment.

    “Whether it is with problematic use of alcohol, tobacco, cocaine, methamphetamine, etc. use, centering harm-reduction principles and practices would likely engage more people than an abysmal 1 out of 10 people who could use but do not receive SUD (Substance Use Disorder) treatment,” Feldman explains. “Requiring immediate and total abstinence rather than seeking to address overall well-being and quality of life concerns is a barrier to engagement — and sadly, it is placing the focus more on symptom reduction than it is on what is causing the symptom of chaotic drug use in the first place.”

    Harm Reduction for All Drugs Means Fewer Deaths

    Our focus on the opioid crisis has helped improve harm reduction resources — like the increased availability of naloxone to reverse overdoses, and the more accepted use of pharmacotherapy and medication-assisted treatment (which has now been endorsed as a primary treatment by the Substance Abuse and Mental Health Services Administration), and some safe injection sites — but it has also meant we aren’t concentrating as much on research, funding, and education devoted to harm reduction practices for other harmful drugs. The result is that we have fewer resources and less awareness when it comes to keeping people who use non-opioid drugs safe.

    We need to look at reducing harm across the spectrum of drug use to reduce all deaths. More safe usage sites, clean tools, safe disposal bins, medical assistance, education, referral to other support services, and access to pharmacotherapy (including drugs to treat or mitigate harms of alcohol use disorder and the development of new medications for help with other substances). Specialized treatment other than abstinence should be accessible for people who use all drugs — not just opioids. 

    View the original article at thefix.com

  • Purdue Reaches $10 Billion Settlement In Opioid Lawsuits

    Purdue Reaches $10 Billion Settlement In Opioid Lawsuits

    The deal does not include any admission of wrongdoing by Purdue Pharma or the Sackler family. 

    Purdue Pharma, the most infamous manufacturer of prescription opioid pills, has reached a multi-billion dollar settlement with thousands of state, city and county governments that are suing the maker of OxyContin for its alleged role in the opioid epidemic. 

    The deal was first reported Wednesday evening (Sept. 11). The details were not immediately made public, but The New York Times reported the basics of the settlement: Purdue will declare bankruptcy.

    What Happens To Purdue?

    A new company will be formed to sell OxyContin, and the profits from those sales will go to Purdue’s settlement payout. The Sackler family, which owns Purdue, will contribute $3 million to the settlement over seven years. In addition, Purdue will donate prescriptions, including those for addiction treatment. NBC News reported that the settlement is worth $10-12 billion overall. 

    The deal does not include any admission of wrongdoing by Purdue Pharma or the Sackler family. 

    According to NBC News, as of Thursday (Sept. 12), at least 20 states have rejected the deal while legal officials in 27 states are reportedly in favor of the deal, which still needs to be approved by a bankruptcy judge and the board of Purdue Pharma. 

    “We are proud to participate in the nation’s most significant step in addressing this deadly crisis,” Texas attorney general Ken Paxton said through a spokesperson. 

    Tennessee Attorney General Herbert Slatery, who earlier this week predicted that Purdue would likely file for bankruptcy, said the settlement “would secure billions of dollars nationwide to go toward addressing the devastating effects of the opioid epidemic and will result in the Sackler family divesting themselves of their business interests in the pharmaceutical industry forever.”

    Florida Attorney General Ashley Moody said that the settlement was historic and will help provide treatment. 

    “Sadly, this agreement cannot bring back those who have lost their lives to opioid abuse, but it will help Florida gain access to more life-saving resources and bolster our efforts to end this deadly epidemic,” Moody said. 

    The Opposition Calls The Settlement “An Insult”

    However, not everyone was satisfied with the settlement. At least 20 states have opted not to sign on to the deal. New York Attorney General Letitia James had one of the strongest reactions, calling the settlement “an insult, plain and simple.”

    Other states want to hold onto their right to sue the Sackler family personally. 

    “If Purdue cannot pay for the harm it inflicted, the Sacklers will,” said New Jersey Attorney General Gurbir S. Grewal. 

    Massachusetts Attorney General Maura Healey wanted to see Purdue Pharma and the Sackler family forced to admit wrongdoing. 

    “It’s critical that all the facts come out about what this company and its executives and directors did, that they apologize for the harm they caused, and that no one profits from breaking the law,” she said. 

    View the original article at thefix.com

  • In Australia, Frustrations Rise As Opioid Crisis Takes Hold

    In Australia, Frustrations Rise As Opioid Crisis Takes Hold

    “We’re living in a country that is oblivious to what’s going on.”

    Jasmin Raggan watched as her brother developed addiction and died of an opioid overdose, and her brother-in-law became addicted to OxyContin.

    Raggan, who lives in Australia, began researching opioids and the toll they were having in the United States, and realized that no one was talking about the real dangers headed Down Under. 

    “If only Australia could understand how quickly this can get out of hand. We’re not immune to it,” Raggan told The Associated Press. “I was screaming from the mountaintops after Jon died and I’d started doing my research. And it was like I’m screaming and nobody wants to hear me.”

    Lack of Awareness

    In Australia, both opioid prescription rates and overdose rates have risen steeply in recent years, but the increase has been largely overlooked. Even Sydney pain specialist Dr. Jennifer Stevens, didn’t realize how bad it was until she tallied up data from her hospital and saw that prescriptions for one specific opioid had risen 500% in eight years. More alarmingly, 1 in 10 patients was still on opioids three months after a procedure, increasing their risk for dependence and addiction. 

    “We were just pumping this stuff out into our local community, thinking that that had no consequences, and now, of course, we realize that it does have huge consequences,” Stevens said. 

    Pharmaceutical Companies’ Aggressive Marketing

    Drug companies are in part to blame for the rise, pushing the same aggressive sales tactics that now have them in trouble in America. It’s illegal for pharmaceutical companies to advertise directly to consumers in Australia, but companies like Mundipharma, the international affiliate of Purdue, have skirted around the laws with “awareness campaigns” that don’t mention specific drugs by name, but still direct consumers to websites with information on the drugs. 

    Stevens recalls Mundipharma marketing aggressively to doctors at her hospital. 

    “Marketing, on the whole, is very clever and very successful — otherwise it wouldn’t be done,” she said. 

    At the same time, the country lacks programs like prescription monitoring databases, which can help prevent overdoses and “doctor shopping.”

    In 2012, Australian Matthew Tonkin came home after serving in Afghanistan alongside American troops. He had been injured, and was also dealing with PTSD after witnessing the death of his best friend. He proudly showed his father David Tonkin the Americans’ solution: a strip of powerful opioid pills. 

    Davis Tonkin recalls his son saying to him “Look, Dad, the Yanks really know how to look after you.”

    At home, Matthew started doctor shopping for powerful opioids, until he died of an overdose in 2014. 

    Not Learning from America’s Mistakes

    Sue Fisher, whose son died of an overdose in 2010, said it’s frustrating to see the lack of policies, especially since Australia can look to the US to see what solutions have worked to help stem overdose deaths — like prescription monitoring and Narcan programs.

    “We’re living in a country that is oblivious to what’s going on,” Fisher said. “Why aren’t we learning from America’s mistakes? Why don’t we learn?”

    View the original article at thefix.com

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

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

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

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

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

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

    A Long-Suspected Factor in Overprescription

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

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

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

    Awareness of Bias May Help Reduce Opioid Dependence

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

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

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

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

    View the original article at thefix.com

  • In Recovery, on Suboxone, and in the Weed Business

    In Recovery, on Suboxone, and in the Weed Business

    In print and online, I preached cannabis. In life, I practiced therapy and Suboxone.

    I had a few days left on my Suboxone script when I interviewed Justin “Bong King.” He was a professional bong-racer and self-described champion of the competitive smoking circuit. An affable guy, nonetheless his was an image of American cannabis long past, pushed aside by marketing grads and stay-at-home moms who sold branded CBD and touted the benefits of micro-dosing. 

    But Justin drew a crowd, and an entourage to boot. And his natural talent for hitting the fastest gram of weed would corner me into compromising my recovery.

    Throughout my career as a cannabis journalist, I’ve kept silent about my sobriety. Finding freelance gigs is hard enough without the added burden of having to be that guy. Besides, if I learned anything from active addiction, it was how to lie at my job.

    Covering Cannabis Events and Lying About My Sobriety

    But as time passed, I felt withdrawn and disconnected. My recovery had no place in the cannabis industry. Moreover, medication-assisted treatment (MAT) seemed anathema to its goals, according to experts and the news. Rep. Matt Gaetz openly questioned whether buprenorphine and methadone are “a more effective offramp [to opioid use disorder] than medical cannabis.” CNN announced that CBD cures heroin addiction. And the editors of Leafly figured out how to combat the opioid crisis with medical cannabis two years prior.

    After 20 years, recovery had finally become routine. As a cannabis journalist; as an editor in chief — so had my lies.

    Some lies were easy. Weekly therapy appointments usually coincided with editorial meetings or deadlines. I worked from home, my boss was lax, and anyway, I kept hours around the clock. Monthly visits to my psych and 30-day Suboxone refills upped the number of undisclosed appointments I logged, but still, no one seemed to care.

    On assignment was a different story. I covered cannabis expos or dispensary openings — events where the drug laws were lax and the supply was liberal. At a hotel in Hell’s Kitchen, I spent three nights alone avoiding networking galas and after-parties hosted by music moguls turned industry entrepreneurs. In the world’s largest dispensary off the Las Vegas strip, I dodged more questions than I asked when leaving empty-handed. With hand waves and head shakes and less-than-assertive no’s, I passed over pot by lying about my sobriety.

    But face to face with Justin “Bong King,” there was nowhere to hide — no hotel room to run to, no door from which to make a quick exit. There was a crowd around us, boxing us in as he finished his gram smoking demonstration. I shook his hand and stumbled over my words as I signed off the segment on camera.

    It was either a contact high or placebo effect, or maybe just panic anticipating the piss test I would take in the next few days.

    Intensive Outpatient: 12 Steps and Scoring Drugs

    When I had about two months left in my treatment program, I walked out of group for good. It was an intensive outpatient program; a six-month IOP run by Philly’s NHS that championed the Big Book and 90 days. For a minute it worked, but it’s drug rehab mired in a puritan past. The 12 steps are great, but they shouldn’t be a front-line defense.

    Besides, all I did there was make friends and score drugs. Thirty addicts in a room is an excellent opportunity to network and learn.

    By Easter Sunday that year, I felt broken. I was in a dirty motel on Route 1, hopped up on Benzedrex cottons and a $60 baggie of hex-en I purchased online from China. After 20 years of addiction, I had no drug of choice, save for anything that made me high.

    My wife and kids back home slept together in one bed, a little less worried than the last time I disappeared. I was out of work and estranged from everyone. My best friend joined AA and realized I was one of his people, places, and things.

    All I had was my family, and I was losing them too.

    One lie allowed my addictions to grow without the worry of what would happen tomorrow. It’s the lie I told myself when I stole my ex-wife’s Dilaudid two days after her shoulder surgery. It’s the lie that made me laugh when I snorted enough Adderall to make my nose blue. And it’s the same lie that made me indignant when my ex-girlfriend’s brother became angry that I was a sloppy drunk in front of his small children.

    On the Monday after Easter, I drove home before sunrise. It was dark and muggy and difficult to see through my tears and dilated pupils. When I got home, I faced my wife and children and ended the lie that had followed me through two decades of addiction.

    “I can’t stop,” I whispered. That week, I discussed MAT options with my doctor. I’ve been in recovery since that day.

    Cannabis as the Magic Bullet for the Opioid Crisis?

    Tyler Sash won the Super Bowl in his rookie year with the New York Giants. At the time, he didn’t know he only had a few years left to live. A sixth-round draft pick out of Iowa, he overdosed on a combination of methadone and hydrocodone at the age of 27.

    “[He] asked if he could smoke marijuana for his pain like the other players,” recalled his one-time girlfriend, former Miss Iowa and reality-show contestant Jessica VerSteeg. I interviewed VerSteeg when she was promoting a new blockchain-bitcoin something-or-other product in the cannabis space. She recounted Sash’s tragic tale during our interview, explaining how it became the backbone of her business.

    “I wanted to change the way that other people saw cannabis,” she said.

    VerSteeg’s article drew in readers, as did most CEO and celebrity interviews. Her story reminded me of how lonely my secrecy about my recovery had become. I often wished I could reach out and say that I understood. There are millions of people with substance use disorders, and we’re all so alone.

    But like most of the executive class in the cannabis industry, her hot take on opioids ended up being bullshit. Conventional wisdom in the cannabis industry had run somewhat amok on this topic, and it forced me, I felt, into compromising everything.

    There was the DEA agent who was so disgusted with opioids that he became a cannabis executive. Without irony, he told me that more research would prove the plant’s medicinal value. The head of an “innovation accelerator” in my city held a conference on the role of medical cannabis in the opioid crisis. He quoted research showing that states with medical cannabis laws have lower rates of opioid overdose deaths. Cannabis, they were convinced, would solve the opioid epidemic.

    But Where’s the Evidence?

    “Morphine, when it was introduced, was promised to cure what they called alcoholism at the time,” Dr. Keith Humphreys told me. A professor of psychiatry and behavioral sciences at Stanford University, he’s also worked at the White House Office of National Drug Control Policy under Presidents Bush and Obama. “Then, people got addicted to morphine, and cocaine was introduced.”

    He continued: “In general, there’s been this enthusiasm of if we just add a different class of addictive drug on top then that will drive the other addictions out. Generally, what happens is we get more addiction to that drug, and we still have the original problem.”

    I spoke with Dr. Humphreys after reading his research on cannabis laws and opioid overdose mortality rates. Contrary to conventional wisdom, he found the correlation to be spurious at best. It’s alarming — though not unsurprising — to see the industry ignore his findings. Several states, including Pennsylvania, where I live, approved opioid use disorder as a qualifying condition for medical cannabis.

    “I couldn’t recommend something medically without clinical trials, well-controlled by credible groups [and] checked for safety,” Dr. Humphreys said. He explained that in the case of cannabis, there was little more than these state-level correlational studies. “None of that has been done.”

    “I’m amazed and disappointed that we don’t care more about people who are addicted to heroin [and other] opioids, that we would wave through something like [medical cannabis] without making sure that it will help people, not hurt them,” he continued, noting that cannabis has shown no efficacy as either a replacement for or an adjunct to any MAT therapy.

    Listening to Dr. Humphreys made me realize how little I stand up for what I believe. Sometimes, when you’re an addict and you lie so much, you lose any sense of truth.

    Tyler Sash’s family asked Jessica VerSteeg to stop using his name to promote her business. According to a report in the Des Moines Register, they didn’t want his name associated with drugs anymore, neither opioids nor marijuana. VerSteeg refused, repeating the story she told me to several news outlets.

    For two years, I wrote about and reported on the emerging cannabis industry while hiding my ongoing recovery. In print and online, I preached cannabis while practicing therapy and Suboxone.

    Even in recovery, you can still have regrets.

    View the original article at thefix.com

  • How "Wired" Betrayed John Belushi's Legacy and Misportrayed Addiction

    How "Wired" Betrayed John Belushi's Legacy and Misportrayed Addiction

    While Belushi’s family and friends would prefer that “Wired” be forgotten, the book provides a fascinating glimpse into how we didn’t understand addiction and harshly judged people who struggled with it.

    “Woodward – that cocksucker!”

    You can’t blame Jim Belushi for being upset. In fact, many of John Belushi’s friends and family members were infuriated with the book Wired, which was written by Bob Woodward, the legendary Watergate reporter.

    Published by Simon and Schuster two years after Belushi’s death from an overdose, Wired was a stark and frightening portrait of drug addiction, but those close to Belushi felt its focus was too narrow, that it didn’t contain any of Belushi’s humanity or good qualities. Woodward put together the cold hard facts of Belushi’s addiction and piled up a number of horror stories, without capturing the whole picture of who the man really was.

    “Exploitation, pulp trash” – Dan Akroyd Describing Wired

    A swift counter attack on the book came from Belushi’s widow, Judy Jacklin. Dan Aykroyd denounced the book as “exploitation, pulp trash,” and Al Franken told Variety, “I hated Woodward’s book because I don’t believe he made an honest attempt to understand John, who despite his sometimes gruff exterior was a gentle soul. My former partner Tom Davis put it this way: ‘It’s as if someone did your college yearbook and called it ‘Puked.’ And all it did was say who puked, when they puked and what they puked. But no one learned any history, read Dostoevsky for the first time, or fell in love.’”

    The controversy made Wired a major best-seller, and the people close to Belushi, who spent untold hours telling all to Woodward, felt burned and betrayed. Woodward was seemingly befuddled by the controversy, and many found his obtuseness infuriating. Woodward told People he was sorry that Jacklin was upset, but “what is important is that Judy is not alleging inaccuracy.”

    While Belushi’s family and friends would prefer that Wired be forgotten, the book provides a fascinating glimpse into how many of us, like Woodward, didn’t understand the nature of addiction and harshly judged people who struggled with it.

    Today, the rise and fall of John Belushi would be written differently, and much more sympathetically.

    Robin Williams once joked that if you remember the seventies, you weren’t there. Not only was it an exciting time for comedy, but many in the entertainment business were out of their minds on cocaine. No one thought the high times would ever end.

    Belushi: A Regular Guy Who Became a Star

    John Belushi was a regular guy who became a star, thanks to the success of Saturday Night Live and Animal House. He was relatable and appealing. The public loved him.

    But his private life was more complicated. Belushi could be brusque and awful, and like many people with addiction, there was a terrible Mr. Hyde that came out when he used. But just as frequently he was kind, decent, and generous.

    Despite his talent and confidence as a performer, offstage Belushi was vulnerable and unsure of himself. Bernie Brillstein, Belushi’s manager, once said that the comedian was “sometimes good, sometimes bad, sometimes in need of a swift kick in the ass, more often in need of a hug.”

    When Belushi died at age 33, it shocked the public. In the pre-internet, pre-TMZ eighties, Belushi’s addiction to cocaine and heroin was mostly hidden from the public. 

    Belushi’s death hit hard. He was a major counterculture hero and a whole generation felt the loss. It was also a big indicator that the seventies were finally over. As Paul Schrader, screenwriter of Taxi Driver and American Gigolo, told journalist Peter Biskind, “The game was up. Some people quit right away, but the feeling was, the rules have changed.”

    In the world of journalism, Bob Woodward was a major star in his own right. He came from the same hometown as Belushi, Wheaton, Illinois, and his reporting on Watergate turned him and his partner Carl Bernstein into household names. He was portrayed by Robert Redford in the big screen adaptation of All the President’s Men, further cementing his legendary status.

    Was His Death a Sting Operation Gone Bad?

    As a political writer, drugs and the Hollywood fast lane were not in Woodward’s usual wheelhouse, but when Judy Jacklin reached out shortly after her husband’s death, he was intrigued. Jacklin felt there was more to her husband’s death than a simple drug overdose, and she believed Woodward, who was already admired by the counterculture for bringing down Nixon, could get to the bottom of it.

    Michael Dare, a former dealer and film critic who knew Belushi well, started asking around to find out what happened. There was apparently a rumor going around that Belushi’s death was “a sting operation gone bad.” Cathy Smith was a groupie who sold heroin to Belushi and gave him the speedball injections that killed him; some believed she was an informer for the LAPD.

    Robin Williams and Robert DeNiro were with Belushi briefly at about 2 a.m. the morning he died, and some suspected the LAPD were hoping to set up a big bust where all three would get nailed. According to the rumor, the drugs that killed Belushi were given to Smith by the police. Dare even claimed he heard that a cop “prepared the scene the way he wanted it to be found, then went down the block and waited for the body to be discovered.”

    Woodward never found any evidence of this, “not even as a wacko theory,” Dare said, and in retrospect the theory does seem ludicrous. But this was the primary reason Jacklin reached out to Woodward in the first place, and Wired is the result: a hard rebuke to that “wacko theory.” (Where Deep Throat told Woodward to “follow the money,” Dare told the reporter to “follow the drugs,” which he probably now regrets.)

    As far as personalities, Woodward and Belushi couldn’t have been any less alike. Many who worked with Woodward found him cold, aloof, an uptight authoritarian workaholic without much of a sense of humor. In other words, he was the wrong person to write Belushi’s story from the get-go. But could be disarming, and many people confused the real Woodward with the version of him they knew from the big screen: Redford-as-Woodward.

    In fact, when one of Belushi’s friends, Anne Beatts, was contacted by Woodward, “my secretary thought it was Robert Redford on the phone. Woodward was so charming, such a good listener, and we were so impressed meeting him. It was like, would Robert Redford lie to you?”

    Woodward was so good at getting sensitive information out of people, most of Belushi’s friends didn’t catch on to him until it was too late. (“None of us knew what he was really up to,” Aykroyd recalled.) In hindsight, Belushi’s peers realized they were naïve. Considering Woodward helped topple the White House, what made them think he could be trusted not to reveal anything they didn’t want to see in print?

    Woodward Wasn’t the Best Person to Write About Belushi…or Addiction

    There were other reasons why Woodward wasn’t the best person to capture a complicated personality like Belushi, or the complexities of addiction. Jacklin said that he took a complicated story “and made it very simple,” and one of Woodward’s colleagues told Rolling Stone that he “isn’t all that introspective. He’s a wonderful machine for gathering facts. He’s not good at insight…He wanted to go beyond the facts, and the gray areas were too immense…the facts about Belushi became his only refuge.”

    What was especially infuriating to Belushi’s survivors was that Woodward blamed the Hollywood system and many close to him for enabling his death. But for Woodward, who was accustomed to tackling American corruption, condemning Hollywood came naturally: “There was no friendship and a safety net in that circle to save him,” Woodward told journalist Alicia Shepard. “I think it would have been morally offensive for me to try to please.”

    Bernie Brillstein was one of Belushi’s peers who objected to Woodward’s characterization of show business. In his memoir, he wrote, “Woodward blamed John’s death on what he thought was a morally corrupt business that indulges its stars with reckless disregard for their well-being because so much money is on the line. That really offends me. We’d have to be scum. Inhuman. No amount of money in my pocket would have made me ignore John’s health for my own gain.”

    When celebrities like Belushi needed help, it was a different world. In the early eighties, we didn’t have rehabs on every corner or TV shows like Intervention. The underlying causes of addiction were not well understood by most doctors, and treatment options were still in the dark ages. (There’s speculation in Wired that Belushi’s addiction and mood swings could have been from a chemical imbalance like “manic depression,” but he was apparently never diagnosed.)

    Belushi’s Death Signaled a Need for More Addiction Treatment

    “We’d talked about institutionalizing Belushi but never did,” Brillstein explained. “The choices at the time were limited to hospital psychiatric wards and white-bread joints for alcoholics. Belushi’s death, perhaps the first high-profile cocaine casualty of the ‘80s, certainly signaled a need for drug rehab centers.” (The Betty Ford Center opened the same year Belushi died.)

    Aykroyd added, “Intervention back then was not a tool that was used. Today if we had a problem like this, we’d get six to ten people together, we’d get the guy in the room, sit them down and say, ‘It’s gonna stop. You’re going into rehab and that’s it.’ Back then that was not a technique that was wide-spread.” For a while, Belushi had a sober companion hired from the Secret Service who did a good job keeping the drugs away, but it was a triple overtime job that wasn’t sustainable.

    Years after the Wired fall-out, Jacklin and Tanner Colby wrote an authorized Belushi biography, and it’s fascinating to read both books back to back because together they give you a good idea of the intense highs and lows of John’s life. Jacklin’s book gives you the good memories, the brilliance of Belushi’s comedy, and the good side of his personality. Then when you pick up Wired, you realize what terrible, terrifying lows Belushi sank to in his addiction.

    If Belushi had lived, he would be 70 today. His comedy still stands the test of time, but he had so much more to give. Not long after he died, a fan left a note on his grave: “He could have given us a lot more laughs, but NOOOOOOOOOO….”

    If any good came from Belushi’s passing, it was that it scared a lot of people straight. SNL producer Bob Tischler recalled in the book Live From New York, “When John died, it changed me. I gave up doing drugs. And I haven’t done any since.”

    He Made Us Laugh, and Now He Can Make Us Think

    And while many felt that Wired gave an incomplete picture of Belushi’s life and legacy, Woodward definitely got one thing right: “Nonetheless, his best and most definitive legacy is his work. He made us laugh, and now he can make us think.”

    Or as Brillstein summarized, “Four years of television, seven movies, and we’re still talking about him. Isn’t that amazing?”

    View the original article at thefix.com

  • Nothing Left to Prove: The Joy of Growing Older in Recovery

    Nothing Left to Prove: The Joy of Growing Older in Recovery

    I entered recovery in handcuffs. I had chipped teeth, abscesses, a fresh diagnosis of Hepatitis C. But there I was, sitting in my County orange-colored jumpsuit, breathing in the fragrance of fresh opportunities.

    I invested hundreds of thousands of dollars with the idea that I would be dead by the time I was 30 years old. I was killing myself on an installment plan, knowing the bill would one day be due. I’m not sure if it was genetics or environment, but unfortunately suicidal ideation was a frequent companion starting when I was in sixth grade. The soft-spoken psychologist in the glasses with the round frames said I was “depressed.” I wasn’t quite sure what that meant. I did know I was restless in my own skin. It would be five more years before the warm gloss of drugs lacquered over my feelings.

    If an early demise was the result of continuing on this path, young me speculated that I was willing to pay the price. I didn’t want to live long enough to be touched by the ugly reality the future had in store for me. Ugly was the world my parents lived in: Married for decades, they argued on a daily basis over his drinking and her compulsive shopping. I would sit in my footie pajamas, playing with my stuffed animals, pretending for a moment I was someone else. This was good training for my years of active addiction. I always wished I was someone different. 

    Addiction Was for Other People

    As I delved into the world of drugs, I saw the premature expiration date emerge in the people around me. People just looked older — pain trapped in their cloudy eyes. Young me said that could never happen. Addiction was for other people.

    I was both naive and nihilistic when I took those first few forays into “partying.” Day drinking led to cocaine-fueled nights. There were benzos and meth and whatever I could get my hands on. By the time I got to opioids, I was firmly entrenched in addiction. Heroin became the cornerstone of my self-defeating belief system: The only day worth living was today; that day was only worth living if I had enough drugs. As my habit increased, so did the sinking feeling in the pit of my upset stomach that any day might be my last.

    Maybe this wasn’t what I actually wanted for myself. 

    If Only…

    Wrapped in the covering of a slowly hardening young woman was still this quiet little being who wanted to know what it felt like to be loved. My body was a means for getting the attention I desired, the substances the keys to unlocking my inhibitions. I desperately sought the approval of others. If only I was thin enough, if only I was pretty enough, if only I changed these few things about myself maybe then you would love me. But heroin numbed my ability to care. 

    I had no value beyond what my body could obtain for me. While my addiction included many radically low points, the wear and tear on this unit forced me to gain perspective. Time was crawling along at the same snail’s pace of the dealers I paged from dirty payphones. This can’t be all that life has to offer. I spent nearly a decade dying — what would it be like to live?

    At 27-years-young, I entered recovery in handcuffs. The legacy of impermanence was marked on my physical self: chipped teeth, stretch marks from the weight I’d lost, gained, lost, and gained again. There were circles on my body from areas where I had picked my skin. Holes from abscesses. A fresh diagnosis of Hepatitis C. But there I was, sitting in my County orange-colored jumpsuit, breathing in the fragrance of fresh opportunities. 

    No Shortcuts to Healing

    Asking for rehab was, as the judge stated, the first “intelligent decision” I had made in a decade. I briskly completed a god-awful rehab with horrible success rates as I was eager to move to the next phase of life. I moved into a sober living facility with two garbage bags of belongings and the weight of all my regrets. It wasn’t the material possessions that concerned me, it was the fact that I was going to have to learn to adapt to the world using the vague internal strength I was told I possessed. I was now in charge of the well-being of this newly sober woman of substance. There would be no shortcuts to healing. 

    The process of unraveling the years of unhealthy living started with a whimper. There were 12-step meetings, shitty jobs, meditation, yoga, long walks, inventories, caffeine, terrible sex, and tears shed in front of a paid professional. I needed to cast off the attachment inherent to the vessel given to me by the universe before I could see my value. The adversity I have experienced has made me stronger; like coal pressed into a diamond, I learned I could shine. 

    The day before my 30th birthday, I started dating someone who I would later discover to be the love of my life. This was a less than perfect love, not like the ones in the books I read as a child. It was a realistic love, one that takes out the garbage. It was the kind of love I needed. I finished my degree at 35, and finished graduate school at 37. I found a career I actually enjoyed. I had my last child when I was almost 41. I began to not only see a future for myself but actually start to create one. 

    Hot Flashes and Freedom

    The passing of time has had many challenges: the death of my beloved mother, a few surgeries requiring opioids, my kids screaming they hate me. I have also outlived nearly everyone I knew. Yet, I am happier than I have ever been. There is a liberation of the spirit in knowing I have nothing left to prove. I enjoy the simple pleasures of a good face cream and a tight hug. I also dress in layers. 

    Perimenopause has been a horrible wake-up call. There are days when the anxiety makes me feel like I am slowly being ripped out of my skin. Caffeine, my last addiction, has become my enemy. In my 40’s, a bottomless cup of coffee has been replaced by herbal tea. Sleeping in a pool of sweat under two blankets and a sleeping bag was something I never expected to experience again after I kicked dope. It’s like my body is its own micro climate. My hair is thinning in spots. My nails are brittle. My tolerance for foolishness is at an all-time low. Yet, there is a freedom in being the raw and uncut version of myself. I have acceptance of my strengths and limitations. I want to enjoy every single day of my life. 

    I’m old now, or at least what I once considered old. I have three pairs of reading glasses strewn about my house. Hot flashes and night sweats are the current alarm bells that wake me up in the morning. My chest is starting to sag, followed by my neck. There’s the consistent search for garments that can adequately hide my midsection. I find myself asking for recommendations for shoes that have arch support. But I’ve also achieved a level of satisfaction knowing I have 21 years of mostly good decisions under my belt. At 49, I have the freedom I so desperately sought in my youth. 

    Tomorrow is not promised. And I don’t know how much longer I have left in this world. I spent hundreds of thousands of dollars trying to kill myself. But in the process of dying, I realized I wanted to live.

    View the original article at thefix.com