Answer Addiction

Tag: opioids

  • "Little Woods" Explores Family Bonds, Poverty, and Opioids in Small-Town America

    "Little Woods" Explores Family Bonds, Poverty, and Opioids in Small-Town America

    “I hadn’t set out to make a political film but my personal point of view about what’s happening right now is horrifying. I mean whatever way we’re dealing with the opiate crisis, it isn’t working.”

    Writer-director Nia DaCosta’s first feature Little Woods is fresh off the film festival circuit and now playing in theaters nationwide. The movie earned multiple awards including Tribeca’s prestigious 2018 Nora Ephron Prize. It’s the kind of thriller that makes you lean forward—a nail-biter. Tessa Thompson and Lily James keep the audience transfixed.

    This is a tale of two sisters living in Little Woods, North Dakota, a fracking town in rapid decline. Ollie (Thompson) is the stronger, tougher sib. She’s the one who gets things done. Unfortunately she got too careless as a drug runner and was caught transporting opioids across the border from Canada. When Parole Officer Carter (Lance Reddick) reminds Ollie that they have only one more meeting before she’s free to start a legit job in Spokane, his concerned look foreshadows looming problems. He says, “Please stay out of trouble,” but the audience understands: Uh oh. Something bad is gonna happen.

    Deb (James) had been the most popular girl in high school so it’s not a surprise that she paired up with the most popular guy, Ian (James Badge Dale). But now Ian is an alcoholic and deadbeat dad to their son Johnny (Charlie Ray Reid). Frail Deb is a broken and broke substance abuser with a knack for screwing up her life.

    The estranged sisters are together again in the house they grew up in, each feeling exhausted and alone despite their close physical proximity. They are separately grieving the recent loss of their mother after a prolonged illness, in which Ollie stayed to provide care while Deb did her own thing. Their family history is fraught with resentments.

    Easing their mother’s pain was the impetus for Ollie’s initial border-crossing opioid-gathering mission. Canadian prescription painkillers were cheaper. That was how the trafficking started; we get the bigger picture when Deb asks Ollie why she got caught.

    “I forgot to be scared,” Ollie said. “I liked it too much.”

    There is no money left after their mom’s death. Mortgage payments are overdue and Ollie finds a foreclosure notice on the front door. She is ready to just walk away, to blow this depressing town and let the bank take the house. With a new job to look forward to, she feels hopeful for the first time in longer than she can remember.

    Then everything comes to a screeching halt.

    Deb reveals that she is accidentally pregnant by Johnny’s no-good father.

    Deb tried to handle things herself: She went to see a doctor but was told that without insurance, the cost of prenatal care combined with the fees for the birth would run between $8,000 and $9,000. Disillusioned, she opts for an abortion only to discover that North Dakota abortion centers were shuttered. Finally, desperate, Deb researches where she can get a legal abortion in Canada.

    When Deb breaks down and tells Ollie the news, including that she’ll have to travel hundreds of miles in order to get an affordable abortion, the stronger sister kicks into high gear like the super-duper codependent she is. With only one week to pay the bank at least half of the $6,000 they owe on the mortgage, Ollie decides she can’t leave destitute Deb and Johnny homeless.

    That’s when I wanted to scream, “No! Go to Al-Anon!”

    But Ollie risks her freedom, her new job, and her safety to make one last drug run. The heart-pumping action begins. Luke Kirby plays the frightening drug dealer.

    Nia DaCosta talked to journalist Dorri Olds for The Fix.

    “They told me in film school, ‘Write what you know,’” said DaCosta. “At first, I took that literally. But I didn’t want to write about my life, I wanted to explore other worlds.”

    DaCosta figured out that she could use the same principle to write about topics she didn’t know but could learn if she was able to relate emotionally.

    “We look at poverty and addiction as personal failures, moral failures,” said the Brooklyn-born, Harlem-raised 29-year-old. “I had a great family. I mean we weren’t well off but growing up in New York City, I could walk to a hospital. I can get to a Planned Parenthood. Lives of deprivation, like Deb and Ollie’s, [were] completely unfamiliar to me.”

    Determined and hardworking, DaCosta spent time in Williston, North Dakota to write the fictional town of Little Woods. She was stunned by how little she knew about how dark life is for so many people in America, especially women.

    “I wanted to present what was happening. This is reality. This is where we are. Medications are overprescribed to a startling degree. I remember getting 20 Vicodin pills when I got my wisdom teeth taken out. I didn’t need any of the pills.”

    Alarmed, she threw them out.

    “I hadn’t set out to make a political film but my personal point of view about what’s happening right now is horrifying. I mean whatever way we’re dealing with the opiate crisis, it isn’t working. That is heartbreaking.”

    DaCosta confirmed that trafficking opioids was never about getting high for Ollie. But after smuggling affordable painkillers to help her mom, Ollie found out how much locals would pay for the ill-gotten opioids. The town of Little Woods attracted men who came for the oil drilling jobs, hard manual labor that resulted in body aches and chronic pain. The more Ollie became known as the go-to for “meds,” the more it went to her head. She liked being a badass drug dealer. In a town where there were few options, especially for women, she liked her tough persona and getting to hang with the boys.

    “It gave her a purpose,” said DaCosta. “It gave her a place where she mattered; a way to stand out.”

    The filmmaker decided to add substance misuse to Deb’s problems after she spent time in North Dakota researching for the movie.

    “I remember talking to people, and it was just a part of the ecosystem. Everyone I spoke to either knew someone, or they themselves had substance abuse issues and had been involved with it in some way.”

    Even though she didn’t set out to make a political film, DaCosta’s movie explores interrelated social, economic, and health problems that the U.S. is grappling with. In the red states, clinics that perform abortions and other health services for women are being shut down. Many fear that Roe vs. Wade may be overturned. The opioid epidemic has reached astonishing numbers. Click here for more information.

    Nia DaCosta and Tessa Thompson discuss Planned Parenthood:

    View the original article at thefix.com

  • "Miles Davis: Birth of the Cool" Connects Jim Crow Oppression to Davis' Heroin Addiction

    "Miles Davis: Birth of the Cool" Connects Jim Crow Oppression to Davis' Heroin Addiction

    Miles Davis’ heroin addiction and alcoholism are all well known and well documented. However, Nelson frames this period as resulting from Davis’ return to a reality in which he was not wanted but his music was.

    The documentary Miles Davis: Birth of the Cool opened up the world of one of the most innovative musicians in American history. In the film, Director Stanley Nelson laid bare all the details of the music man’s life, including the darkness and despair of Davis’s struggle with alcoholism and heroin addiction. It is during this piece of the film, which should have been the low and slow point, that the pieces Nelson offered began to connect. Davis’s heroin addiction was a direct result of the treatment he received as a black man living under Jim Crow laws in 1949.

    In the documentary, Nelson offers audiences the French tour where Miles Davis discovered love and existence without the restriction and oppression of Jim Crow America post-WWII. Davis went to France in 1949, touring with the Tadd Dameron group for quite some time. By all accounts—even those outside of Nelson’s documentary—the man became enamored with the country that embraced him for his talent without placing restrictions on him due to his skin color. Here he experienced life without the heavy hand of racism weighing him down.

    The freedom of living abroad was buoyed by a romance with a French singer named Juliette Gréco. The couple, despite their racial differences, was able to maintain a public relationship just like other couples in France and much of Europe. The oppressive, dangerously restrictive Jim Crow laws in the U.S. would have made their relationship illegal. American laws and policies in 1949 were enacted to maintain the belief that black people were inferior to their white countrymen.

    In Birth of the Cool, the narrator discusses how Davis became “disillusioned” by American racism after spending quite some time away in France. The weight of Jim Crow was enough to send the musician into a depression that he could not recover from. This was compounded by the lull in his musical career because of the waning popularity of bebop and the lack of a fresh new sound from Davis. He was also mulling the loss of the relationship that he would remember well into his later years. Davis told an interviewer that he never married Gréco because he loved her and wanted her to be happy. Their marriage could not exist in the U.S.

    The next part of the documentary was a slow plunge into the darkest parts of the musician’s life. Davis’s heroin addiction and alcohol abuse are all well known and well documented. However, Nelson frames this period as resulting from Davis’s return to a reality in which he was not wanted but his music was. Although Nelson never explicitly says so, the racism Davis experienced led to his depression, which sent him into the heroin addiction and alcoholism rabbit hole. Even in the documentary, Davis describes his depression as something that sprouted the moment he returned to the racist United States and followed him through the period of his life where he struggled with addiction.

    Studies like “Exploring the Link between Racial Discrimination and Substance Use: What Mediates? What Buffers?” from the Journal of Personality and Social Psychology show that not only is there a relationship between racism and mental health issues as a whole, but the link also exists specifically between racism and addiction. The authors write, “Psychologists have known for some time about the pernicious effects that perceived racial discrimination can have on mental health.” The study goes on to dig into the research gathered from this link. They found that “[n]umerous correlational studies have documented relations between self-reports of discriminatory experiences and reports of distress, including anxiety and depression, as well as anger.” All of these elements were likely in place as Davis returned to the U.S. The weight of segregation, sundown laws, lynchings, and other trappings of Jim Crow laws was more than enough to anger and depress any black person at the time.

    Substance use promises an escape from pain and Davis needed a way to cope with all these feelings. According to the aforementioned study, “[T]he increased substance use we found was evidence of a coping style that includes use as a means of handling the stress of discrimination.” Davis probably became more angered and frustrated with the racist behavior (especially after returning home to the predominantly white St. Louis suburb his parents lived in). The documentary also described how his musical popularity waned and his personal life was disrupted from the breakup with Gréco. At the time, the musician’s life had all the elements in place to breed the raging heroin addiction that followed.

    Fortunately, Davis recovered from his addiction to opioids and alcohol, but it was a lifelong struggle. Nelson depicts as much in the documentary. In fact, racism and substance abuse become a very strong subplot to the documentary that works to educate viewers as much as entertain them. Between the scenes depicting the origins of the famous everchanging Miles Davis sound, Nelson buried important nuggets that should force us to redefine how we view and treat racism and addiction.

    Birth of the Cool essentially describes the environment from which Miles Davis’s addiction was created. There are other factors that also affected his addiction, but racism and depression were the primary and most powerful drivers that pushed him toward problematic substance use. Nelson thus lends one more voice to the chorus of stories that illustrate how racism and the oppression of white supremacy is an impetus to substance misuse and addiction. Acknowledging this can help with not only treating addiction in the black community, but also with understanding why racism should be considered a public health concern worthy of more serious attention.

    More info on Miles Davis: Birth of the Cool here.

    View the original article at thefix.com

  • What Causes False Positives on Drug Tests?

    What Causes False Positives on Drug Tests?

    Most instant drug tests are notorious for picking up false positives from common medications like antihistamines, antidepressants, antipsychotics, antibiotics, and analgesics. Poppy seeds can give a “true” positive.

    I had a routine during my pregnancy with my elder daughter. Each morning I woke up as late as possible—which never felt late enough—took a quick shower, and waddled over to my bus stop. There, while waiting for the bus, my senses sharpened in the thin, crisp mountain air and the yellow morning sunlight stretching its way across Boulder, Colorado. Sometimes I snoozed a little more on the bus—I’ve always been a sucker for vehicular motion. On less sleepy days, I watched out the window for prairie dogs bopping across the acres and acres of lush green land.

    I was riding into town for Naropa University, where I was attending grad school in the footsteps of Allen Ginsberg, Anne Waldman, and William Burroughs. But every day I turned into downtown several hours early for my classes. It wasn’t by choice, but because I was taking methadone to treat my addiction to heroin.

    Being new to the program meant I hadn’t yet earned take-home doses, so I had to ride in every day before the clinic closed and drink down my syrupy pink dose in front of a nurse. It was annoying, but I discovered a small comfort: my bus dropped me off next to a small, vegan-friendly grocery store called Sprouts. So before I dosed, I would stop in and treat myself to piece of sticky-sweet, lemon poppy seed cake. It would not take long for me to discover the weird, unexpected consequence of my treat.

    How to Get a False Positive for Opioids

    “Your UA was positive,” the nurse said, lips pursed, about two months into the program. I wasn’t showing yet but all the staff knew about my pregnancy.

    “For what?” I asked.

    “Opiates.”

    I laughed. “Well I’m on methadone.” At the time, I didn’t know clinics could differentiate between synthetic and non-synthetic opioids.

    “No, not the methadone.”

    Now I was pissed. I hadn’t used—not since enrolling in the program. Earning a take-home would depend on my compliance with the program, which meant testing negative every time they demanded I pee for them. Worse, a positive drug test during pregnancy could mean a child services investigation down the line.

    “I didn’t relapse,” I insisted. The nurse just stared at me. Then I remembered that urban myth I’d heard—that eating poppy seeds could trigger an opiate positive on a drug test. “I’ve been eating poppy seed cake,” I told the nurse.

    “You’d have to eat a whole lot of poppy seeds for that to happen,” she said.

    But I insisted that the positive was wrong. Finally, she relented and agreed to send my sample for confirmatory testing. A few days later, she reported that the levels of morphine in my urine sample suggested it had, in fact, come from a food source. Turns out, poppy seed positives are not an urban legend at all—in fact, they are even recognized by the U.S. government, which actually raised the opioid detection cutoffs to avoid these types of false positives for military personnel and other government employees.

    The Problem with Poppy Seeds

    Poppy seeds trigger a positive for morphine. Opium and its derivatives—which means any naturally occurring opioid—come from papaver somniferum, a type of poppy plant. It is grown commercially for the development of pharmaceutical drugs and for the harvesting of food-grade poppy seeds. But because of their origin, these seeds can contain tiny amounts of opioid alkaloids, which metabolize similarly to morphine or codeine. It’s not enough to produce a euphoric effect—but it can be enough, depending on how much is consumed, to trigger a positive on a drug test. And that positive is, in fact, a “true positive,” at least in the sense that your body produced that metabolite.

    Poppy seeds will trigger a positive for opioids on a general panel, or for morphine and sometimes codeine on a more detailed test. The problem here is that other opiates—including heroin—will also trigger a morphine positive. Heroin has its own unique metabolite, 6-monoacetylmorphine, but that will only show up for about 24 hours, whereas morphine from heroin use can show for up to a week.

    When my nurse said the test confirmed my positive was the result of poppy seeds, she probably meant the levels were too low to show up in the confirmatory test. The truth is that there is no way to definitively link a morphine positive to poppy seeds, leaving the decision ultimately up to clinical judgment.

    “They do try to correct for this by establishing cutoff limits,” says Ryan Marino, an emergency medicine physician and toxicologist with the University of Pittsburgh Department of Medicine. “So the person who is running the test might see the positive but it’s below the threshold, so it gets reported as negative.”

    In the late ‘90s, the Substance Abuse and Mental Health Services Administration (SAMHSA) changed the detection cutoff for morphine from 300 ng/mL to 2000 ng/mL in an attempt to prevent federal employees from losing their jobs over a bagel topping. While a bagel probably won’t trigger detection at that cutoff, something with a higher concentration of poppy seeds still might, like a poppy seed paste. And the SAMHSA cutoff is a recommendation; if you’re a government employee, your tests should follow that guideline. But other drug test administrators are under no obligation to adhere to the SAMHSA regulations. Treatment facilities or doctors’ offices might use lower cutoffs, making their tests more likely to detect the consumption of poppy seeds.

    False Positives on Instant Urinalysis Kits

    Poppy seeds aren’t the only substance that might trigger an unmerited positive on some drug tests. Immunoassay tests, the kind used in most instant urinalysis kits and as a preliminary screening tool in the lab, are notorious for picking up false positives from common medications. These include antihistamines, antidepressants, antipsychotics, antibiotics, analgesics, and other over-the-counter medicines. Specifically included on the list are ibuprofen, dextromethorphan (an ingredient commonly found in cold medicine that has its own intoxicating properties), diphenhydramine, pseudoephedrine, and ranitidine (an antacid/antihistamine). These drugs can cause positives for different substances, including THC, opioids, or benzodiazepines, but the most common false results are amphetamines.

    Positives that result from poppy seeds are tricky because they are, in a sense, genuine positives. Your body has, in fact, metabolized an opioid alkaloid; it’s just that it didn’t come from an illicit source and it wasn’t in quantities that could produce an intoxicating or euphoric effect. But when a positive for methamphetamine is triggered because you took some cold medicine, that’s a false positive—and that can be determined conclusively by further lab testing.

    Marino says that many of these substances are structurally very similar, “so it makes sense that enzyme tests can’t tell the difference… but if you send it out [to a lab] for gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry testing, that would be able to pick up most of these compounds.”

    The only issue here is whether whoever is testing you is willing to send the sample for another test. If you’re being tested on-site for a job, it’s entirely possible that your employer does not have a system in place for sending your sample to be examined in a lab. So you should definitely tell your employer in advance of the test if you have taken any medications. Hopefully, if it’s one that could trigger a false positive, your employer will give you the benefit of the doubt.

    What About CBD?

    Another substance that trips people up is cannabidiol (CBD). CBD is the non-intoxicating chemical compound found in the cannabis plant, which is generally credited for many of the plant’s medicinal properties. CBD was recently approved by the FDA to treat seizures and is marketed as a medicine called Epidiolex.

    But you don’t have to be prescribed Epidiolex to get your hands on CBD. It’s sold in a variety of stores and can often be found in smoke shops, vape stores, and recreational marijuana shops. People often wonder, however, if CBD can trigger a marijuana positive on a drug test. The simple answer is no: Drug tests look for THC, the intoxicating ingredient in marijuana. They don’t test for CBD, so CBD won’t make you pop positive for THC.

    The reality is a little more complicated. Because CBD is derived from the same plant species as THC, trace amounts of THC can end up in your CBD product. In order for CBD to be (mostly) legal, it has to come from a hemp plant (and there’s some weird politics around even that). That means the plant can’t contain more than a trace amount of THC. So if your CBD is coming from a hemp source—and if you’re buying it from a non-medicinal source in a state that has not legalized recreational marijuana, it probably is—then it’s unlikely to contain more than a trace amount of THC. And that should not show up on a drug test.

    But you do need to be careful to check your sources, especially if you’re buying from a rec store. Some companies intentionally add small amounts of THC because they believe it potentiates the therapeutic effects of the CBD. Those small amounts can range from 1 percent to 15 percent—and that amount can be detected in a urine test. It’s not a false positive, either. Even if you didn’t “feel” the THC, you still consumed it. So you won’t have much ground for disputing those results. Basically, if you’re going to use CBD, check your sources and make sure the THC levels fall below 0.3 percent, which is the legal limit for a hemp product.

    Drug testing is a politically complicated practice. Many people find it degrading, or feel that it adds an unnecessary element of surveillance into their lives. Nonetheless, if you find yourself in a position in which you have to take a drug test, it’s important to understand how and why a positive could show up even when you haven’t consumed illegal drugs. Bottom line: If you know you’re going to be tested, skip the poppy seed muffin.

     

    Have you ever gotten a false positive? Give us the details in the comments.

    View the original article at thefix.com

  • Americans Are Unhappy And The Opioid Epidemic May Be A Factor

    Americans Are Unhappy And The Opioid Epidemic May Be A Factor

    For the third straight year, the U.S. has dropped in the rankings of the World Happiness Report.

    The United States is now the 19th happiest country on Earth, its ranking falling for the third consecutive year. 

    This is according to the most recent World Happiness Report, released on Wednesday (March 20) or the United Nations’ International Day of Happiness.

    The Washington Post reports that the seventh annual report surveyed 156 different countries and took into account six factors: GDP per capita, healthy life expectancy, the freedom to make life choices, social support, generosity and perceptions of corruption.

    The top 10 countries in the report were Finland, Denmark, Norway, Iceland, Netherlands, Switzerland, Sweden, New Zealand, Canada and Austria.

    “We finished 19th on the list behind Belgium,” Jimmy Kimmel said on his late night show. “The people who feel the need to put mayonnaise on their french fries are happier than we are. Cheer up, everybody.”

    While the report doesn’t specify why each country ranked where it did, the authors of the report have speculated in a news release that substance use disorder and the opioid epidemic contributed to America’s ranking.

    “This year’s report provides sobering evidence of how addictions are causing considerable unhappiness and depression in the U.S.,” said Jeffrey Sachs, a Columbia University professor and the author of the “Addiction and Unhappiness in America” section of the report. 

    “The compulsive pursuit of substance abuse and addictive behaviors is causing severe unhappiness. Government, business, and communities should use these indicators to set new policies aimed at overcoming these sources of unhappiness,” Sachs added.

    Sachs also noted that the results of the report serve as building blocks for countries moving forward. 

    “The World Happiness Report, together with the Global Happiness and Policy Report offer the world’s governments and individuals the opportunity to rethink public policies as well as individual life choices, to raise happiness and wellbeing,” Sachs said. “We are in an era of rising tensions and negative emotions (as shown in Chapter 2) and these findings point to underlying challenges that need to be addressed.”

    According to the news release, this year’s report specifically honed in on happiness and the community, taking into account how technology, social norms, conflict and government policies have played a role in shaping each country. 

    “The world is a rapidly changing place,” Professor John Helliwell, co-editor of the report, said in the news release. “How communities interact with each other whether in schools, workplaces, neighborhoods or on social media has profound effects on world happiness.”

    View the original article at thefix.com

  • How Suboxone Helped Me Until I Could Help Myself

    How Suboxone Helped Me Until I Could Help Myself

    I felt confident that I had no desire to use opioids again, not because the Suboxone had eliminated my cravings, but because I had changed my life. The pain I worked so hard to anesthetize with heroin had been addressed.

    Suboxone, while often controversial among addiction treatment professionals and people in recovery, has moved to the forefront in discussions about opioid treatment. The recovery community has no shortage of naysayers insisting that medication-assisted treatment (with drugs such as Suboxone, buprenorphine, and methadone) is simply trading one addiction for another, characterizing it as heroin in legal form and just another way for the big pharma companies – who are already blamed for the initiation of the opioid epidemic – to pull in profits. But Suboxone is not an illicit street narcotic with fatal overdose rates surpassing even automobile accidents, it’s a life-saving tool that many experts insist is our best hope for the current public health emergency.

    Medication-Assisted Treatment Is Effective, But Stigmatized

    According to Dr. Gavin Bart, Director of the Division of Addiction Medicine at Hennepin County Medical Center and Associate Professor of Medicine at the University of Minnesota, opioid addiction requires long-term management; behavioral interventions alone have extremely poor outcomes with more than 80% of patients returning to drug use.

    “Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function,” Bart writes. “Extensive research shows that each of the three available medications used to treat opiate addiction have superior treatment outcomes to non medication based therapies. Increased retention reduces mortality, improves social function, and is associated with decreased drug use and improved quality of life.”

    Abstinence proponents may be skeptical about Bart’s research, but for me, it rings true. Reduction in illicit opiate use? Check. Decreased craving? Check. Improved social function and improved quality of life? Check, check. Abstinence-based treatment did not save my life. Medication-assisted treatment paired with specialized addiction therapy helped me save my own life.

    As an active member of the recovery community, I am mostly outspoken and typically very candid, even when it comes to mortifying revelations. And even for me, Suboxone is a touchy subject. I am more comfortable discussing random substances I’ve injected than I am discussing how Suboxone was a key player in my opioid addiction treatment. I think my discomfort is a result of the negative rhetoric that surrounds the medication, and ironically enough its harshest critics are often other people in recovery. The prejudice against medication-assisted treatment is harmful, and even deadly when the negative discussion derails someone from seeking the help that, according to the evidence base, may give them the best chance of staying alive.

    Is medication-based treatment the perfect fix to a horrific and increasingly deadly addiction? No. Suboxone has its burdens. I grappled with those too. When I first started taking Suboxone, I’d take it for a week and then relapse on heroin. I did that a handful of times before I was finally serious about getting clean.

    My Suboxone Journey: From Relief to Frustration

    My initial Suboxone dose was 8 mg buprenorphine with 2 mg naloxone. It was an orange strip with a tangy taste that I’d place under my tongue and wait while it dissolved into my bloodstream. Because I essentially switched directly from heroin to Suboxone (taking the first dose when I began experiencing opioid withdrawal symptoms), I didn’t have to suffer the weeks-long detox that frequently triggered my repeated relapses.

    Taking my daily dose of Suboxone was like a sigh of relief at the beginning: one more day that I didn’t have to suffer through withdrawal. But after a few years, the sighs of relief eventually turned into sighs of disdain. My once-considered reprieve from the consequences of my addiction was starting to feel like a rusty pair of shackles. I was sick of going to the doctor and refilling my prescription, I was sick of keeping this secret from everyone in my life, I was sick of being terrified to travel. This thing that had once made me feel normal now had me feeling like I was still, after so much time, tied to my painful past of addiction.

    Nothing else in my life reminded me of my past. There were no remnants of my previous addict self. I didn’t associate with any of my old using friends, I hadn’t seen or spoken with any dealers in ages, I never even got pulled over for traffic stops. I didn’t look like a junkie anymore and I didn’t act like one either. I had nurtured and repaired the ties with my family, I had a loving, healthy relationship, and I was well on my way to getting a college degree. I had successfully restored myself to sanity, as good ol’ Bill would say.

    Fear kept me stagnant, which didn’t feel fair. I had come so far and was nothing like the junkie I once was, but I still had this inevitable withdrawal from Suboxone hanging over my head. My one final detox. The big whopper. How would I go through with it? I was in school so I couldn’t miss two to four weeks of classes, and anytime a summer or winter break neared, I’d chicken out, despite telling myself it was time and trying to prepare for it. In the meantime, I’d slowly been cutting down. I went from the initial dose of 8 mg buprenorphine/2 mg naloxone strips to 4 mg/1 mg, and then even further to 2 mg/.5 mg.

    Suboxone Withdrawal

    I had no idea what to expect. Like many of us, I have some form of post-traumatic stress disorder from my time in active addiction, and a major part of that was the horrendous withdrawals. I was completely fixated on these impending withdrawal symptoms, and there was nothing I could do — I had to pay the debt.

    I finally made the decision to go through with it. I made the appropriate arrangements and was prepared to suffer for a couple weeks minimum, several weeks or maybe even months maximum. I watched YouTube to try to ease my frazzled nerves, but the videos pacified my anxiety like a game of Russian Roulette. Do not watch YouTube. Some videos had people detoxing, drenched in sweat and sobbing into the camera and others had people after just a week saying, “Not so bad guys!”

    The night before I took my final dose, which was a teeny tiny square cut from a buprenorphine 2 mg/naloxone .5 mg strip, I curled up into the fetal position, buried myself under my duvet and cried myself to sleep. I couldn’t believe I was about to enter junkie limbo after living as a functioning member of society for so long.

    The first few days weren’t pleasant, but it was nothing like I’d experienced in the past. I couldn’t sleep, I tossed and turned, I had tingling chills and clammy sweats, general anxiety and a sense of unease. I once detoxed from a $100 a day heroin habit and it was like I was the star of an exorcism horror film; compared to withdrawals like that, this one wasn’t nearly as bad as I’d anticipated. I think spending so much time tapering down to as small a dose of suboxone as I could handle really paid off when it came time to detox.

    Another big fear I had, mostly thanks to Google and YouTube, was post-acute withdrawal syndrome (PAWS). After the initial detox, the last time I felt any symptoms I knew were directly related to my withdrawal was about a month and a half after day one. I had a mini-panic attack when Target was too crowded. I started pouring sweat, rushed to my car, and burst into tears. And after that, I’ve simply felt normal. That thing we all desperately want to feel: “normal.”

    What If?

    The detox was tough, it was emotionally taxing and physically draining. But I realized that it was the fear of the withdrawal that had me suffering the way I was. It was a fear of the symptoms and a fear of the unknown. I felt confident that I had no desire to use opioids again, not because the Suboxone had eliminated my cravings, but because I had changed my life. The pain I worked so hard to anesthetize with heroin had been addressed. I did deeply introspective work in therapy and I changed my social environment, all while using Suboxone. I built up my self-worth by investing in myself and investing in healthier relationships, things I never could have done while still using heroin. I fixed my broken coping mechanism, I knew how to handle stress and sadness. Yet, there was still this tiny sliver of me that wondered, “what if?”

    What if it was all some magical mask that Suboxone created and none of this was reality and as soon as I stopped taking it I would revert to my old tormented life?

    That is what prompted me to finally write this piece — realizing that regardless of the discomfort I feel discussing Suboxone, there are other people in recovery using medication-assisted treatment right now, scared to talk about it and scared to get off, experiencing the exact same fears that plagued me. Once I made the leap and decided to go ahead with my final detox, and then when it was complete, I felt free. Finally free. Not because Suboxone had me stuck, but because Suboxone helped me move past the hardest time of my life. This withdrawal was the final chapter to that saga and it was finally over — and I survived.

    I closed the book, I’d won the war.

    View the original article at thefix.com

  • Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    There is overwhelming evidence that harm reduction keeps people alive and can bring them into recovery, yet it’s still met with opposition. We ask four harm reduction workers what inspires them and what we can do to help.

    Harm reduction has been a contentious topic for a while: staunch 12-step proponents who insist that abstinence is the only way to achieve recovery are met with resistance from a growing number of harm reduction activists who consider the reality of drug use more holistically while advocating for individual choice and safety. Many of us have deep-seated beliefs and strong feelings about recovery, but now more than ever we need to analyze and hopefully remove our biases, accept the overwhelming data in favor of harm reduction, and face the failed policies that have led to a national crisis. Every day 130 people die from opioid overdose in the U.S., and misuse of prescription opioids costs us an estimated 78.5 billion dollars each year.

    Abstinence alone isn’t working. If it were, we wouldn’t have an epidemic on our hands. Perhaps this realization is why we are seeing an increase in harm reduction measures—increased naloxone access, fentanyl testing strips, Good Samaritan laws, and needle exchange programs. And they work: many individuals enter recovery through various harm reduction programs. But regardless of whether people get treatment or not, harm reduction measures prevent disease and save lives.

    What Is Harm Reduction?

    Harm reduction is frequently misunderstood. Often people think it means the use of medication-assisted treatments (pharmacology), or moderating drug use instead of eliminating it entirely. But these are narrow definitions. Harm reduction is not a particular pathway of recovery; it is a means of reducing the harm associated with drug use.

    According to the Harm Reduction Coalition, “Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

    The philosophy of harm reduction accepts that drug use is complex and multifaceted, and that it involves a range of behaviors from frequent use to total abstinence. It acknowledges that some ways of using drugs are clearly safer than others. Harm reduction includes strategies such as safer use, managed use, needle exchanges, supervised injection sites, treatment instead of jail, and abstinence. It advocates for meeting the individual where they are and addressing their reasons for using and the conditions surrounding their drug use. Successful implementation of harm reduction should lead to well-being for individuals and communities, but not necessarily cessation of all drug use.

    Tracey Helton Mitchell, Devin Reaves, Brooke Feldman, and Chad Sabora advocate for the acceptance and practice of harm reduction. We asked what motivated them to pursue their activism and how we can all be more mindful of harm reduction principles.

    Tracey Helton Mitchell

    Tracey Helton Mitchell came into the public eye when she was featured in HBO’s documentary Black Tar Heroin, which documented her life on the streets on San Francisco. After she found recovery, she rebuilt her life and went back to school for a bachelor’s degree in business administration and a master’s in public administration. She has dedicated her life to advocating for the individual needs of people with addiction. She documents her journey in her book The Big Fix: Hope After Heroin.

    In 2016 Tracey told NPR that “We need to have a variety of different kinds of treatment interventions that address people’s needs.” In response to the argument that harm reduction measures such as needle exchange enable drug use, she said: “We’re not encouraging people to do anything, we’re taking a look at their public health behaviors and then addressing what the particular needs are, so look at the cost of one syringe versus the cost of someone getting hepatitis C and having to take care of them for a lifetime.”

    What motivated you to work in harm reduction?

    I started in harm reduction in response to the overdose crisis that was happening in San Francisco and the Pacific Northwest in the late 90s. I knew many people who had died, including Jennifer H., a person I loved very much. 

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Harm reduction is seen by many in the recovery community as a crutch when it should be seen as a lifeline. Harm reduction should be included as part of a continuum of care with a wide variety of options based around what is best for the person. Too much focus has been made on “abstinence only” as the standard for recovery. We need to broaden our scope. 

    See also: Naloxone and the High Price of Doing Nothing

    Devin Reaves

    Devin Reaves, MSW, is a community organizer and grassroots advocacy leader who is in long-term recovery. He is also the co-founder and executive director of the Pennsylvania Harm Reduction Coalition (PAHRC), serves on the Camden County Addiction Awareness Task Force, and sits on the board of directors for the Association of Recovery High Schools. He has worked on the expansion of access to naloxone, the implementation of Good Samaritan policies, and the development of youth-oriented systems, and he is leading conversations to bring about public health policy changes in the area of substance use disorders.

    PAHRC’s mission is to promote the health, dignity, and human rights of individuals who use drugs and the communities affected by drug use.

    What motivated you to work in harm reduction?

    As someone in recovery who lost a lot of friends to substance use disorder, when I learned about Narcan, I wanted it to be more available because I was sick of my friends dying. Seeing that harm reduction wasn’t utilized made me want to fight to see more of it: syringe services programs or more innovative programs.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    We can provide Fentanyl testing strips, Narcan, and sterile needles to use. For those seeking recovery, we should also provide Narcan because they are still at risk. What people don’t know about harm reduction is that individuals in programs of harm reduction are five times more likely to enter treatment—it is a pathway of recovery. 

    Brooke Feldman

    Brooke Feldman, MSW, is a social justice activist who identifies as a member of the LGBTQ+ community and a person in long-term recovery from substance use disorder. She has spent the past decade advocating for wellness and long-term recovery being accessible to all.

    What motivated you to work in harm reduction?

    Well, I think I was pretty primed to embrace harm reduction principles over 10 years ago when I was taught what are called “recovery-oriented” care principles. Back in 2008, and only a few years into my own recovery journey, I was working for an organization called PRO-ACT at Philly’s first Recovery Community Center. We had a sign on the wall that greeted people with, “How can I help you with YOUR recovery?” and we were educated and trained in practices such as meeting people where they’re at, supporting people in working toward their own goals rather than our goals for them, recognizing that abstinence is not the goal for everybody, and embracing diversity in recovery experiences and mosaics of pathways. My experience with what we call recovery-oriented practice over the past decade set the stage for harm reduction principles and practices to fit perfectly. Unfortunately, while I have found my own professional experience, education, and training in recovery-oriented care to fit neatly with harm reduction, I still see many gaps between the harm reduction and recovery movements. A large motivator for me currently is the strong desire to bridge those gaps, to highlight shared goals and values, and to be part of unifying the two movements wherever possible. I believe people die in the cracks of the divide, and I hope to serve as part of the glue that seals the cracks.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    I think that if we center the human rights of choice, self-determination and autonomy when it comes to directing the course of one’s own life, we become more inclusive of harm reduction principles across the board. One concrete area for centering these principles is that of the use—or declined use—of medications to treat opioid use disorders. People have a right to utilize evidence-based medications to aid in their recovery, and people also have a right to decline the use of medication as part of their recovery. Nobody should face discrimination or refusal of resources, supports, and services based on this choice of what to put in their bodies. Also, one of the things I love about the harm reduction movement is the social justice focus. In my experience, the harm reduction movement centers the roles that oppression and marginalization play when it comes to how our systems, and society at large, respond differently to drug use depending on the skin color or socioeconomic status of the drug user. I think that centering social justice would put us all in the right position when it comes to both people currently using drugs and people in recovery, however that recovery is self-defined.

    Chad Sabora

    Chad Sabora is the co-founder and executive director of the Missouri Network for Opiate Reform and Recovery (Mo Network), an organization that offers services to those struggling with substance use disorder and their loved ones. He has been the focus of several episodes of the show Drug Wars on Fusion and was part of an Emmy award-winning episode of NBC News with Brian Williams. Sabora has been an expert correspondent on CNN and MSNBC. He is also president and co-founder of the nonprofit Rebel Recovery Florida, and he is on the board of directors of the Discovery Institute for Addictive Disorders in Marlboro, New Jersey. Sabora is also known for filming himself while touching fentanyl, thus debunking the myth that you can overdose through skin contact with the illicit substance.

    Uniquely experienced as a former prosecutor and a person in long-term recovery, Sabora left legal practice in favor of pursuing drug policy reform and advocacy. He founded Mo Network in 2013, where he heads their work on legislative policy reform. Sabora and Mo Network focus on expanding services based on evidence-based solutions, and they lobby for more effective drug policy locally in Missouri and also at the federal level.

    He has helped write, advocate for, and pass several pieces of legislation in Missouri, namely first responder access to Narcan, third-party and over-the-counter access to Narcan, 911 Good Samaritan immunity, and access to medication-assisted treatment in various environments such as addiction treatment, mental health facilities, family court, and for certain frequently-overlooked populations such as veterans.

    What motivated you to work in harm reduction?

    The overwhelming data, basic common sense, failed policies of the past, and unconditional love was the motivation.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Inclusion will come in time, as long as we stay vigilant. Changing moral compasses and inherent biases could take a generation before we see the full impact.

    Read Chad’s rules for staying alive while using drugs (including how to use naloxone to reverse an opioid overdose)

     

    A Call to Action: We Need Harm Reduction Now

    The evidence is clear: If we provide the education and resources for people to use drugs safely, we reduce disease and save lives. Frequently we open the door to recovery. Isn’t it time for us all to start advocating for (or at least accepting) harm reduction wherever and whenever we can?

    View the original article at thefix.com

  • UFC Launches Opioid Awareness Campaign

    UFC Launches Opioid Awareness Campaign

    In the video, UFC president Dana White highlights statistics about the toll taken by the opioid crisis and offers resources for those in need of help. 

    The mixed martial arts organization Ultimate Fighting Championship (UFC) has joined in the fight against the national opioid crisis by launching its own public service campaign to heighten awareness about the impact of opioid dependency.

    The campaign, which kicked off in Las Vegas on March 2, 2019, featured UFC President Dana White, as well as the Substance Abuse and Mental Health Services’ (SAMHSA) National Helpline.

    The campaign fulfills the UFC’s 2018 commitment to create a public service campaign as part of its relationship with the Trump Administration’s Initiative to Stop Opioid Abuse.

    In a press release, UFC stated that future announcements will feature UFC athletes and take advantage of the company’s sizable social media audience of 75 million followers and widely viewed live events to “spread the message of prevention, treatment, and recovery related to opioid addiction.”

    The video featuring White premiered before the UFC 235: Jones vs. Smith event on March 2.

    In October 2018, the UFC was among a group of lawmakers and representatives from more than 20 major stateside companies, including Amazon, Facebook and Blue Cross Blue Shield, to appear at a White House ceremony where President Trump signed into law the SUPPORT for Patients and Communities Act, which was intended to provide help for opioid treatment and recovery initiatives.

    White, who spoke at the Republican National Convention in support of Trump’s bid for the White House, pledged his company’s assistance in helping to combat the epidemic. 

    “Opioid addiction does not discriminate,” said White at the 2018 ceremony. Millions of Americans are impacted by this tragic crisis. UFC is committed to helping President Trump in the fight to end opioid abuse.” At the time of the ceremony, UFC announced that it would roll out its public service campaign before the end of 2018.

    In the video, White highlights statistics about the toll taken by the opioid crisis – drug overdoses are currently the leading cause of death among Americans under the age of 50, and two-thirds of drug overdose deaths are caused by opioids – which is followed by the National Helpline number and SAMHSA’s web address.

    View the original article at thefix.com

  • Opioid Addiction Isn't Just A Rural Problem

    Opioid Addiction Isn't Just A Rural Problem

    While the epidemic has been framed as one that mostly affects rural America, new research shows that overdose rates are actually higher in urban areas.

    The common narrative of the national opioid crisis has been that this “disease of despair” has affected rural areas the most.

    However, a new working paper argues that economic depression and access to opioids are the biggest determinants of overdose rates in both rural and urban areas. 

    “I really do want to push back against this cliche that addiction does not discriminate,” Shannon Monnat, the paper’s author and a sociologist at Syracuse University, told Pacific Standard. “The physiological processes that underlie addiction themselves may not discriminate, but the factors that put people in communities at higher risk are are not spatially random.”

    Looking at non-Hispanic whites and controlling for demographics, Monnat found that overdose rates were highest in urban areas. The rate decreased the further one moved from cities, a trend that held true for all racial groups. Overall, urban counties had an average of 6.2 more deaths per 100,000 people than rural counties. 

    Interestingly, supply and demand interacted differently in rural and urban settings. In the city, supply of drugs seemed to have the biggest effect on overdose rates. In rural areas, economic distress was the stronger predictor of overdose rates.

    “A lot of what’s going on here are regional effects,” she said. “You get regional levels of despair and distress that seemed to reinforce and exacerbate the problem.”

    Monnat did find that some of the things associated with rural living were connected with an increased risk for overdose. For example, areas with an economy heavily dependent on mining or the service industries had higher rates of overdose. Controlling for how many drugs were supplied to an area, places with higher economic distress had higher overdose rates. 

    “What that means is that drug mortality rates aren’t higher in economically distressed places simply because they’ve had a greater supply of opioid prescribing there,” she said. “There’s something about economic distress in and of itself that helps to explain the variation that we’re seeing across the country and the magnitude of the drug crisis.”

    Places hardest hit by the crisis, like West Virginia, had both economic vulnerabilities and an excessive supply of opioids, Monnat said.

    “It’s no coincidence that widespread opioid prescribing first started in the most economically vulnerable places of the country—there was vulnerability there. These places had been primed to be vulnerable to opioids, which are drugs that numb both physical and mental pain, through decades of economic and social decline.”

    View the original article at thefix.com

  • Pregnant and Scared to Get Treatment: When Conception Meets Addiction

    Pregnant and Scared to Get Treatment: When Conception Meets Addiction

    If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop.

    With one in three individuals with opioid use disorder passing through the criminal justice system annually, court dockets across the country are overflowing with cases of illegal behavior fueled by addiction. Though such cases wrangle with the complexities of punishing individuals afflicted with what is increasingly seen as a disease that erodes free will, they are the bread and butter of the legal system. However, the recent Pennsylvania Supreme Court case known as In the Interest of L.J.B. adds another level of intricacy to the court’s decision-making process. The question asked in the case—Does drug use during pregnancy constitute child abuse? —is unpleasant to contemplate, but it is one of absolute importance.

    The defendant in the case, a woman referred to as A.A.R., tested positive for illicit opioids, benzodiazepines, and marijuana when she gave birth to her infant, L.J.B., in January 2017. L.J.B. then required 19 days of inpatient treatment for drug withdrawal and was placed in the custody of Children and Youth Services, which alleged that her mother’s drug use during pregnancy was child abuse. On December 28, in a 5-2 decision, Pennsylvania’s Supreme Court ruled in favor of L.J.B.’s mother, stating that Pennsylvania’s child abuse law clearly excludes fetuses in its definition of a child. While the issue may be settled in Pennsylvania, there is little doubt that similar cases will be heard across the country amidst the opioid epidemic.

    Pregnant Women with Opioid Addiction — Overlooked and Undertreated

    The case of L.J.B. and her mother has drawn national attention to women who simultaneously carry a child and the burden of an addiction—a group that has often been overlooked or ignored in the national discussions about the opioid epidemic. Few individuals in our society bear such a stigma as these women. As an addiction psychiatrist, I’ve heard harsher judgment passed on these patients—even from fellow healthcare workers—than on any others. This stigma permeates our medical and legal systems, creating dire consequences not only for these women, but also for their unborn children.

    Pregnancy is unparalleled in its ability to motivate women towards healthier behavior, but approximately four percent of pregnant women still use addictive drugs. When I’m asked to evaluate a woman who is pregnant, I know her disease is severe before I’ve even laid eyes on her. If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop. There is no better example of the ability of a chemical to overpower the deepest-rooted human instincts.

    A recent report released by the CDC revealed that opioid addiction among women in labor quadrupled from 1999 to 2014, signifying the need for immediate action. Opioid addiction during pregnancy can create many problems for mother and child, including preterm labor, neonatal abstinence syndrome, and even fetal death. Tragically, pregnant women with addictions are less likely to receive prenatal care. Aware of society’s disdain, many don’t want to be stigmatized at the doctor’s office. Some mothers-to-be can’t even find a physician willing to treat them, and others are afraid of being reported to authorities due to laws that have arisen out of prejudice and misinformation.

    Harsh Laws Harm Mother and Child

    Twenty-three states already consider drug use during pregnancy child abuse. In three states, it’s grounds for involuntary civil commitment. Though some people think such laws deter women from using drugs during pregnancy, they don’t. If a woman’s addiction is so severe that it is active during pregnancy, laws that threaten arrest or loss of custody will not bring about remission. They also rarely bring about legal punishment, since the charges are dismissed or the convictions are overturned 85 percent of the time.

    All that these laws do is cause pregnant women with addictions to avoid prenatal care visits or forego them all together. Tennessee discovered this the hard way, when it passed a law in 2014 making drug use during pregnancy punishable by up to a year in prison. The number of pregnant women seeking treatment for addictions fell drastically because they were too afraid of the legal ramifications. Thankfully, the law expired in 2016, but Tennessee’s legislature is now considering passage of a similar bill.

    How to Help Pregnant Women with Addictions and Their Children

    If our actual desire is to help pregnant women with addictions and their children, there are effective actions we can take. We can start with repealing counterproductive laws, and, as funding is being allocated to counter the opioid epidemic, we can earmark portions of it for these patients and create more treatment options for them. Only 19 states have programs specifically targeting the unique needs of pregnant women, and only 17 provide them with priority access to state-funded addiction treatment programs.

    Healthcare providers can help by addressing their own stigma and stepping up to provide treatment to this vulnerable group. These women already face significant barriers to care, so finding a willing and caring healthcare provider shouldn’t be another challenge to overcome. There are also ways to avoid tragic situations like this in the first place. Out of all pregnancies in women with opioid addictions, eighty-six percent are unintended, so ensuring access to affordable and effective family planning services is essential.

    For addicted women with unborn children, an invitation into care is far more effective than any legal threat we can muster. Let’s dispense with negative attitudes and legal barriers that keep these patients from seeking treatment. Ensuring that help is available when needed is the way forward, because the only way to aid an unborn child is to help its mother, regardless of how her actions might make us feel. 

    View the original article at thefix.com

  • How Fentanyl Hysteria Leads to Harmful and Ineffective Drug Laws

    How Fentanyl Hysteria Leads to Harmful and Ineffective Drug Laws

    We might as well accept reality and direct our efforts towards making drugs less deadly, in the same way that we accept the risks of driving a car, but also try to prevent accidents.

    My only experience with fentanyl was when I was pregnant. I was on a hospital bed writhing in agony when a nurse injected me with the synthetic opioid commonly used for pain management in laboring women. The drug calmed me and I soon gave birth to a healthy baby girl.

    That was before fentanyl moved from the hospitals to the streets, tainting the illicit drug supply and ratcheting up an already alarming death toll from overdose.

    Since then, deaths from synthetic opioids (mostly fentanyl) have begun a steep climb, jumping 540% in the past three years alone. More than half of the opioids in the U.S. are now laced with fentanyl and the fear surrounding the drug is palpable. Some people claim you can overdose on the drug just from touching it. As a result of this hysteria, many first responders are afraid to respond to overdoses for fear of coming into contact with fentanyl. Meanwhile, states are scrambling to pass laws responding to the ever-changing landscape of fentanyl and its many derivatives.

    Alice Bell, who works to reduce overdose deaths through Prevention Point Pittsburgh, a syringe exchange program, says that there are reasons to be concerned about fentanyl. In Allegheny County, Pennsylvania, where her program operates, the opioid was involved in 20% of deaths in 2014. In 2016 the number tripled to 63% and today fentanyl is present in 74% of drug-related overdose deaths.

    “Fentanyl is much stronger than heroin and other opiates,” Bell explains. “It is easy to get a high dose without realizing it… Because it is fast acting there is a smaller window before people [overdose].”

    What Is Fentanyl and How Is It Dangerous?

    Fentanyl, a synthetic opioid created to mimic the effects of natural opioids (which are derived from opium poppy plants), was first introduced in 1959 as an anesthetic and pain reliever for surgery and cancer patients. It wasn’t until 2014 that unregulated forms of fentanyl began arriving in the U.S. from China. Because these analogues are cheap to buy and highly potent, they’re often mixed into supplies of other illicit drugs, such as heroin, cocaine, or pills. People buying or selling drugs on the streets may have no idea whether the product contains fentanyl, or how strong it is. This lack of knowledge has contributed to skyrocketing rates of overdose deaths across the country.

    As Bell explains, because illicit fentanyl is mixed into other drugs in unregulated environments, it is hard to mix it uniformly. Thus, one person might get a very strong dose while another might get a weaker dose, even though both samples came from the same supply. Bell likens it to “mixing pancake batter and getting chunks.”

    But although Bell acknowledges the dangers of a fentanyl-laced drug supply, she also emphasizes that much of the panic surrounding fentanyl and its effects is misleading—including false rumors about Narcan-resistant fentanyl or people overdosing just from touching the substance.

    Dan Ciccarone, a professor at the University of California, San Francisco who has spent the last four years studying fentanyl, agrees that while there are reasons to be concerned, responding to the challenge with policies rooted in fear and misinformation only makes matters worse. He points out that the problem is not so much fentanyl itself, but the fact that it’s being added to other drugs in unknown amounts.

    “We have to take some of the hysteria and the irrationally out of it,” he says. “If we say the problem is heroin and heroin contaminants, [we] treat the problem differently than if [we] say it’s a new drug and it’s killing our teenagers.”

    How to address the fentanyl-related overdoses is a question vexing many policymakers. In the past few years, state legislatures have spun off in wildly different directions. Some have attempted to curb overdoses through the introduction of 911 Good Samaritan laws and expanding availability of naloxone, syringe exchange programs, and treatment options for people who use drugs problematically. Some have implemented diversion programs and sentencing reforms designed to keep people who struggle with addiction out of jail and to connect them to programs that address the root cause of addiction. Others are enacting ever-harsher penalties for crimes involving fentanyl. In fact, many states are doing all of these things at once, oblivious, it seems, to the fact that some of these new policies contradict or even cancel each other out.

    Opioid Confusion and Contradictory Drug Policies

    In 2017, Louisiana passed a bill that reduced prison sentences for drug possession convictions. But the same law created a new mandatory minimum sentence for illegally possessing opioid painkillers (such as fentanyl). Maryland likewise enacted legislation in 2016 to reduce penalties for drug users and sellers, but the very next year created a new penalty for drugs containing fentanyl that extends prison sentences up to 10 years. In 2017, North Carolina cracked down on synthetic fentanyl and created a task force to reform opioid sentencing laws in literally the same bill. On the federal level, the passage of The First Step Act, which reduces mandatory minimum and three-strike laws, came on the heels of the former Attorney General’s declaration to relentlessly prosecute every case involving any amount of fentanyl.

    In essence, many governments are passing laws that lessen penalties for opioid-related crimes, while simultaneously enacting laws that further criminalize fentanyl (an opioid).

    For Michael Collins, Director of the Office of National Affairs at the Drug Policy Alliance, the confusion stems from a desire to respond and a lack of knowledge about the most effective way to do so.

    “Policymakers feel pressure to do something,” he explains. “In the absence of public health measures that they are familiar with, legislators will dust off their Drug War playbook and go towards punitive measures…certainly there is no evidence that those penalties will decrease overdose deaths.”

    Collins’ explanation echoes my own experience as a lobbyist advocating against drug-induced homicide laws in North Carolina. Like many states, North Carolina is responding to increases in fentanyl-related deaths by introducing legislation that would allow prosecutors to charge people with murder if they distribute a drug that leads to an overdose. It’s a typical punish-first response that not only is proven ineffective at reducing overdose deaths, but could potentially increase overdose deaths by negating the state’s 911 Good Samaritan law, which was enacted in 2013 to encourage people to call 911 to report an overdose. If lawmakers agree that fear of being charged with possession of drugs is enough to deter someone from calling 911, surely they see that fear of being charged with murder would even further discourage life-saving medical calls.

    But, as I discovered, it is hard to reason with a politician, a prosecutor, or a law enforcement official who is under intense pressure from their community to “do something.” Of course to address the problem of people selling drugs that lead to overdose, we need to tackle the underlying factors that lead people to sell drugs in the first place, such as the need to support a personal drug habit or lack of economic alternatives. But proposing solutions such as more drug treatment centers, jobs programs for low-income neighborhoods, greater investment in vocational education…all these are high-cost, long-term solutions. And officials are being pressured to find answers now.

    Increasing penalties against drug dealers is quick, relatively simple, and the cost is picked up by local court systems, not by the politicians who passed the law. Better yet, harsher penalties sound like a solution that satisfies the public’s need for accountability.

    Incarceration and Stricter Laws Cause More Crime and Deaths

    The problem with using the criminal justice system to address complex issues like drug use is that we imagine the system to be far more effective than it actually is. We probably wouldn’t celebrate laws that incarcerate more people if we realized that locking up one drug dealer merely causes another to take his place. We probably wouldn’t be so anxious to pour billions of dollars into law enforcement efforts to disrupt drug supplies if we realized that U.S. illicit drug market is estimated at $100 billion annually, while law enforcement only seize between $440 and $770 million in drug money per year—around 0.5% of the total value. We might not swallow the $1 trillion price tag of the War on Drugs if we realized that after all this money spent and all the families disrupted from incarceration due to nonviolent crimes, drugs are now cheaper, more plentiful, and more deadly than ever before.

    To effectively lower the demand for drugs or decrease overdose deaths, we need to think outside the box.

    Alice Bell explains, “If you want to encourage people to avoid more dangerous drugs, you have to allow people access to less dangerous drugs.”

    That is certainly not a solution that politicians want to hear. It doesn’t “sound good.” But it would do far more to reduce overdose deaths than all our efforts to slap people with longer prison sentences. We need to help politicians confront their fear of drugs and to understand that drugs always have been and always will be a part of our communities. We might as well accept reality and direct our efforts towards making drugs less deadly, in the same way that we accept the risks of driving a car, but also try to prevent accidents. Most people age out of addiction—if they live long enough to do so. There is no reason that taking a hit of a mood-altering substance should be akin to Russian Roulette.

    Conservative economist Milton Friedman once said, “Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes the politically inevitable.”

    Fentanyl may be that catalytic crisis needed to produce change. In that case, we should work to turn tragedy into opportunity.

    View the original article at thefix.com