Answer Addiction

Tag: stigma

  • The Stigma of Addiction

    Repeated addiction treatment is prevalent because rehabs do not adequately address each patient’s medical and emotional needs.

    Stigma creates harmful misconceptions surrounding people suffering with substance use disorder. A term that in the dictionary is defined as “a mark of disgrace or infamy,” one that has detrimental consequences to those struggling with harmful substance use or mental health issues. Although substance misuse often causes erratic behavior and impaired judgment, research shows that most of these adverse effects stem from chemical changes to the brain. Yet, those suffering from addiction continue to be stigmatized by society.

    Understandably, stigma causes embarrassment and shame among those suffering from addiction. The combination of personal shame and public stigma is considered one of the primary barriers to effective prevention and addiction treatment. This fear and shame prevent too many individuals from getting the help they need.

    Studies show that only one in ten Americans suffering from substance use disorder receives professional care for addiction. Furthermore, society’s stigma, negative attitude, and perceptions towards addiction keep people under-diagnosed and under-treated. Also, research and treatment programs are under-funded, especially compared to other primary health conditions currently affecting our nation. While substance abuse continues to be one of our nation’s most prominent public health issues, there is a lack of effective treatment and mental health resources.

    Substance Use Disorder is a Treatable Condition

    Sadly enough, most people see addiction as a moral or criminal issue rather than a health one, despite scientific findings establishing the condition as physiological. Understanding the physical effects of addiction remains mostly misunderstood and widely marginalized by mainstream medical professionals. Consequently, our country continues to suffer from the devastating effects of the deadly opioid crisis. We continue to pay the high price for years of neglecting the effective and adequate healthcare resources required to confront highly stigmatized addiction issues.

    Time for Change

    It is time we stop seeing and treating those suffering from addiction as immoral or dangerous. No one wants to feel lesser than, especially those struggling emotionally. Drug and alcohol abuse have only increased over the last decade, and overdose rates have skyrocketed. Individuals often lose their family, friends, and careers. They continue to use drugs despite the physical and emotional consequences. Sadly, many end up losing their life to an overdose. However, this condition is not only preventable in many cases, but also treatable.

    Stigma in Healthcare

    The addiction and mental health crisis continues to worsen without much change in the healthcare system. It takes a great deal of courage to ask for help and admit there’s a problem. It is our job as healthcare providers to respond with compassion and understanding. It is all too common for a patient admitting their substance use problem to be met with criticism and even let go by the provider due to being considered a risk. This type of medical rejection often leaves patients feeling hopeless and without the courage to seek further resources or support.

    Emergency Rooms and Drug Addiction

    Hospital emergency rooms receive an influx of patients suffering from opioid withdrawal. ER staff are often busy, overworked, and have to operate with limited resources, especially now during COVID-19. These facts, along with a lack of education about drug addiction, often leads to them dismissing patients –who desperately need immediate medical help–as ‘drug-seeking.’ Rather than turning their backs on patients, ER should have specialized staff to direct these patients into medically assisted detoxification, followed by providing mental healthcare resources. Instead, addicted people go back to the streets and continue using drugs. 

    Sadly, this fault in our healthcare system perpetuates the cycle of addiction. Each time a healthcare worker misses the chance to provide the appropriate level of care, a life may be lost.

    The Need for Change in Addiction Treatment

    Rehab centers across the nation are overcrowded because there is not enough access to addiction treatment, let alone adequate care. Repeated treatment is also prevalent because rehabs do not adequately address each patient’s medical and emotional needs. Consequently, the real issues that led to addiction go untreated, and immediate relapse is inevitable. 

    To ensure those suffering from addiction or mental health conditions receive the help they need, we must fix the broken system. We need to educate the public about how different substances can affect the sympathetic nervous system and how most people affected by substance use do not have enough control over their actions and behavior.

    All levels of healthcare professionals must receive training on the intersection of drug abuse and mental health, as well as how to provide adequate care for those patients. Then they can begin the healing process by treating patients compassionately and with the right level of care.

    The Benefits of Medically Assisted Detox

    There are many types of drug treatment centers, but medically assisted detox should be available as the standard of care. Medically assisted detox is the most effective way to help a person withdraw from opioids safely and comfortably. The chance of completing detox is almost certain, yet the healthcare system does not recognize this treatment.

    As it is now, only those who have the resources to seek private treatment can receive this level of care. There is no reason why everyone in need should not receive the best form of treatment for opioid withdrawal.

    Knowledge and understanding breeds empathy, an excellent tool against stigma. The sooner we educate the public, the more lives will be saved. We must change public views on substance abuse and treatment so that this crisis ends.

    View the original article at thefix.com

  • For Pregnant Women, Stigma Complicates Opioid Misuse Treatment

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

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

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

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

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

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

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

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

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

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

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

    Transcript:

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

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

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

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

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

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

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

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

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

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

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

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

    But the crux of the program is medication assisted therapy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    This transcript has been edited for clarity and concision.

    View the original article at thefix.com

  • Redefining Recovery: The Evolution of the Addiction Memoir

    Redefining Recovery: The Evolution of the Addiction Memoir

    From “Drugstore Cowboy” to “My Fair Junkie,” the focus of addiction literature has shifted to recovery.

    In July, the Centers for Disease Control and Prevention announced that last year, overdose deaths dropped slightly—from 70,000 to 68,000—the first dip since 1990.

    “Lives are being saved, and we’re beginning to win the fight against this crisis,” tweeted Alex Azar, the U.S. secretary of health and human services.

    But who’s “we,” exactly?

    Though I doubt Azar had contemporary literature in mind in the fight against addiction, it was the first thing I thought of when I read the statistic. For years, drugs and alcohol were so romanticized in literary culture, the words “writer” and “addict” seemed inseparable. Here it’s worth noting that, while you and perhaps many of the authors listed here might disagree, for this article—and, truthfully, because I do in general—I’m merging alcoholism and drug addiction into one thing, even if the individual recovery looks different.

    Back in 1990—when overdose deaths began to climb—novels like Drugstore Cowboy (1990), Leaving Las Vegas (1990), and Jesus’ Son (1992) presented a glamorized view of addiction. While these depictions weren’t sanitized, and it could be argued that they were less celebratory of boozy culture than the party chic depicted by F. Scott Fitzgerald and Ernest Hemingway, or even the work of beat generation authors like Jack Kerouac and William S. Burroughs, or later Hunter S. Thompson, these portrayals left their mark.

    Sarah Hepola, author of 2014’s best-selling memoir, Blackout (a redemptive portrait of addiction), agrees that she, too, “link[ed] writing with drinking and a kind of artful indulgence and libertinism… something close to a job description.” 

    But the culture has changed dramatically, and books today—like Hepola’s—offer more views of recovery than debauchery.

    The groundwork was perhaps first laid with Caroline Knapp’s Drinking, A Love Story (1996). Knapp took on not only addiction, but cutting, anorexia, and compulsive spending. Harrowing as her account was, the narrative throughout was informed by the lens of inevitable sobriety.

    Hepola remembers reading that book, “Chardonnay in hand.” But even if her “stomach sank” when Knapp sobered up, Hepola sensed that the author “was also thriving.” For Hepola, reading that book was part of an awakening that sobriety “might not be the death [she] feared.”

    Yet it wasn’t until Mary Karr’s Lit came out in 2009 that readers really got the chance to see addiction from the vantage point of long-term sobriety. This isn’t to say Karr made recovery look easy. As Karr wrote, “I haven’t so much gone insane as awakened to the depth and breadth of my preexisting insanity, a bone-deep sadness or a sense of having been a mistake.” That she would recover, however, was a foregone conclusion. That she would flourish—more so as a sober person than a drunk one—was obvious from her career.

    Since then, books more focused on recovery than addiction began to trickle in. There was Bill Cleggs’ 90 Days (2012), Hepola’s Blackout (2014), Lisa F. Smith’s Girl Walks Out of a Bar (2016), Amy Dresner’s My Fair Junkie (2017), and Catherine Gray’s The Unexpected Joys of Being Sober (2017).

    Then last year brought an avalanche. Leslie Jamison’s The Recovering, Kristi Coulter’s Nothing Good Can Come from This, Janelle Hanchett’s I’m Just Happy to Be Here, Porochista Khakpour’s Sick, Stephanie Wittels Wachs’ Everything is Horrible and Wonderful, and Tom Macher’s Halfway all came out in 2018.

    And it was this plethora of titles that made me wonder, could this uptick in rehabilitative tales have contributed to the decrease in overdose deaths? 

    It may not be possible to establish a cause-effect relationship, but there are clear correlations between art and life. The Netflix show 13 Reasons Why (based on a novel of the same name), has faced tremendous backlash over alleged copycat suicides, and research has shown these concerns to be valid. And despite the number of holes that could be poked in this idea—starting with how incomplete this list of titles is and including the fact that this study was provoked by the broadcast and not the book—it’s undeniable that recovery from addiction has a new kind of cachet thanks to these books. 

    And this trend doesn’t show signs of slowing, with more recovery titles on the way, including Dan Peres’ As Needed for Pain (February 2020), Eileen Zimmerman’s Smacked: A Story of White Collar Ambition, Addiction, and Tragedy (February 2020), Erin Khar’s Strung Out: One Last Hit and Other Lies That Nearly Killed Me (February 2020), and Rose Andersen’s The Heart and Other Monsters: a Memoir (July 2020).

    What may be even more interesting—and, dare I say, hopeful—about these titles, is that each offers its own individual path in recovery. There’s no one right way to do it, which not only reflects reality, but might make the prospect more palatable to more people.

    Khar, for instance, recalls looking for relatable stories. “There were very few books about drug addiction written by women, and I didn’t find any of them.” So she set out to write one.

    “I want my book to give people hope and to reduce the stigma around speaking about drug addiction,” says Khar. “I wrote Strung Out because it was the book I needed when I was younger.” 

    Andersen, whose forthcoming book addresses both her and her deceased sister’s addiction, puts it bluntly—”For so long, [the] addiction [narrative] has been centered on the white, male experience,” she says. “Even basic AA literature was written by and for men, so to expand the voices that can be read and heard in this genre is vital.”

    Another important facet of this trend is that getting sober isn’t the end of the story. Hepola puts it this way: “Addiction and alcoholism has been a helpful lens through which to understand my relationship with alcohol (and food and men), but it’s not the only lens.”

    These books reassure us that there is life beyond addiction, more to recovery than the sad dirge of replaying past exploits.

    “Sobriety is really about cracking open possibilities,” says Hepola. “A life that is so much bigger than the bar stool.”

    View the original article at thefix.com

  • 6 Movies That Portray Mental Health and Depression Realistically

    6 Movies That Portray Mental Health and Depression Realistically

    Movies have the power to shape how we perceive the world. Here are several films that treat mental illness respectfully and honestly, instead of contributing to stigma.

    Hollywood holds a lot of influence when it comes to current cultural beliefs surrounding mental illness, which is why fighting stigma should be a central tenet for filmmakers who tackle psychology and mental health in their projects. Films like Split demonize mental illness by twisting real disorders into monstrous villains. The real horror of mental illness is the pain it inflicts on the person with the disorder. Mental illness can affect those closest to us, but not in the horrifying ways portrayed in Split. The movies in this list are all successful in accurately depicting one or more aspects of mental health conditions.

    What films are we missing? Add your own recommendations in the comments.
     

    Melancholia

    Kirstin Dunst plays the leading role of Justine in Melancholia, a fantastical science-fiction film giving a terribly real reflection on depression. When I first saw this movie, I was in a severe depressive downswing. I was desperate to feel less alone in my isolation, and this movie helped. It was like a friend sitting down next to me and accepting me without me needing to explain myself.

    The story circles around two sisters as Justine prepares to be married (clearly unhappily). There are many moments that capture the listlessness of depression, such as when Justine is served her favorite meal, but she can’t taste it. Other characters try to support Justine in completing basic tasks such as bathing and eating, things that can be excruciatingly difficult for someone with depression. It touches on the compulsive urges that drive self-destructive behavior and the dull ache of depression.

    “It tastes like ashes.” – Justine
     

    What Dreams May Come

    Another fantastical meditation on the complexities of the human condition, What Dreams May Come stars Robin Williams as Chris Nielsen, a bereaved father who then dies himself, leaving his widow to her severe depression. We follow his journey through “heaven” and “hell” to save his wife who later dies by suicide. The colors in this film are out of this world, and the ideas it presents about severe depression and mental illness are beautifully depicted. There are some problematic ideas about a cure for depression, such as saving yourself to save someone else or that someone can save you from the pain of depression. But these potentially troubling aspects of the movie are overshadowed by poignant lines such as:

    “Everyone’s Hell is different. It’s not all fire and pain. The real Hell is your life gone wrong.” – Albert

    “What’s true in our minds is true, whether some people know it or not.” – Chris

    I had a hard time rewatching this movie after my own father passed away, because there is something about Robin William’s thin-lipped smile that was reminiscent of my dad’s closed mouth grin.
     

    Prozac Nation

    Released in 2001, Prozac Nation stars Christina Ricci as real-life Elizabeth “Lizzie” Wurtzel, a college student with atypical depression. The narrative connects early trauma with current depression as we see Lizzie’s traumas via flashbacks. Lizzie makes risky decisions and alienates people she once pulled close. Despite her success as a journalism student and writer for The Harvard Crimson, Lizzie can’t find happiness. Eventually by seeking professional mental health support and taking the antidepressant Prozac, Lizzie’s life stabilizes.

    “Hemingway has his classic moment in ‘The Sun Also Rises’ when someone asks Mike Campbell how he went bankrupt. All he can say is, ‘Gradually, then suddenly.’ That’s how depression hits. You wake up one morning, afraid that you’re gonna live.” – Lizzie
     

    Inside Out

    A Disney-Pixar success, Inside Out takes place in the mind of a young girl going through a big life transition. We see the complications of memory formation play out through the personification of five basic emotions: Joy, Sadness, Fear, Disgust, and Anger. We come to understand the importance of each core emotion, even Sadness. Memories are more complex than depicted in this film, but the basic premise is solid — our life experiences become memories which power our personalities. In this movie, the young girl at the center of the story experiences a breakdown of her personality until all her core emotions can learn to work together.

    “Do you ever look at someone and wonder, what is going on inside their head?” – Joy
     

    It’s Kind of a Funny Story

    Released in 2010, It’s Kind of a Funny Story is an honest portrayal of what can manifest from depression. Following a teenager after a near suicide attempt, Craig Gilner (played by Keir Gilchrist) is admitted into a hospital’s psychiatric ward. What this film doesn’t do is challenge notions about the success and helpfulness of psychiatric wards, which vary greatly in quality and care. And there’s an element of romanticism that is problematic. What this film does well is show the negative self-beliefs that can accompany depression. The film also addresses the common fears that people seeking psychiatric care experience because of the stigma around mental illness.

    “Okay, I know you’re thinking, ‘What is this? Kid spends a few days in the hospital and all his problems are cured?’ But I’m not. I know I’m not. I can tell this is just the beginning. I still need to face my homework, my school, my friends. My dad. But the difference between today and last Saturday is that for the first time in a while, I can look forward to the things I want to do in my life.” – Craig
     

    Helen

    Helen is a 2009 film starring Ashley Judd as Helen Leonard, a college music professor living with severe depression. What is particularly poignant about this story is that it captures the irrationality of depression. There is no trigger, there is just depression. No matter how many times someone asks “why?”, there is no answer that fully explains the underlying causes of depression. From an outside perspective, Helen’s life seems wonderful and successful. Feeling like you have no good reason to be depressed is a common experience for many people with depression. No amount of self-flagellation helps ease the pain, and we see that played out in this movie as Helen spirals.

    “Your wife is not unhappy, Mr. Leonard. Your wife is ill.” – Dr. Barnes

     

    View the original article at thefix.com

  • Ibogaine: Promising Addiction Treatment or Snake Oil?

    Ibogaine: Promising Addiction Treatment or Snake Oil?

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

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

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

    Like Years of Therapy in One Day

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

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

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

    Why Is Ibogaine Illegal in the U.S.?

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

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

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

    Like Other Hallucinogenics, Proven Benefits but Not a Panacea

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

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

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

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

    Legal Status of Treatment Creates Financial Barrier and Increased Risk

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

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

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

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

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

    View the original article at thefix.com

  • Let’s Talk About Suicide

    Let’s Talk About Suicide

    Changing misconceptions and long-held stereotypes won’t happen overnight, but making the conscious decision to talk openly and honestly about suicide is a strong start.

    Suicide is everywhere. We hear about it on the news, we see the headlines, we read the sad statistics. But here’s the thing: We don’t talk about suicide. We’re not having the kind of open, honest conversations that will start breaking down harmful prejudice and stigma – about people who die from suicide and also the people left behind.

    We know the facts and figures, but that’s only part of the story. We don’t know how to actually communicate about suicide to learn what’s behind the statistics. We can’t fill in the blanks because we’re afraid: We worry that we’ll say the wrong thing, or unintentionally offend someone. So instead we say nothing at all. But staying silent is far more damaging; it further stigmatizes suicide, which is already misunderstood and has so much judgment attached to it in the first place.

    Start a Conversation

    September is Suicide Prevention Awareness Month – a time the National Alliance on Mental Illness (NAMI) describes as a time to share stories and resources in an effort to start meaningful conversations on the taboo of suicide.

    “We use this month to reach out to those affected by suicide, raise awareness and connect individuals with suicidal ideation to treatment services,” reads NAMI’s website. “It is also important to ensure that individuals, friends and families have access to the resources they need to discuss suicide prevention.”

    Suicide is the 10th leading cause of death in the United States overall, but it’s the second leading cause of death in people ages 10-34. In 2017, there were twice as many suicides (47,173) in the U.S. as there were homicides (19,510).

    How Can We Help Prevent a Leading Cause of Death if We Can’t Talk About It?

    There’s a catch-22 when it comes to suicide: People are reluctant to talk about it because it’s a sensitive and deeply personal topic, but it remains a sensitive topic because people don’t talk about it. So we find ourselves tip-toeing around suicide altogether, which doesn’t help anyone. For years, I’d find myself at a loss for words whenever someone would mention suicide, so I’ve been there.

    And yet, I also found myself desperate to talk about it after my father died from suicide in 2003. In the months and years following his death, I began to see up close just how much people are unwilling to talk about suicide. I never realized just how uncomfortable the topic makes people, whether they’d personally lost someone to suicide or they’d seen one of the many headlines about celebrities who die by suicide. It really is a taboo topic. 

    How can we help prevent a leading cause of death if we can’t even talk about it? And how can we help people who have been left behind if we can’t acknowledge the cause of their pain?

    That’s why I’ve been trying to change suicide’s shameful stigma. For the last 16 years, I’ve been vocal, unafraid to talk about the very things people don’t want to talk about. In the beginning, I talked about my father as a way to process my grief. I saw it as a way to keep my father’s memory alive, but as the years went on, I began to realize that my talking about his suicide wasn’t just for me. Sure, it may have started out that way, but the more statistics I read and the more stories I heard, the more I learned how many people are affected by suicide. I began to feel a responsibility to share my story.

    I Want People to Know They’re Not Alone

    Today, I talk about suicide because I want people to know they’re not alone. I talk about suicide because I want people who have lost a loved one and people who suffer from suicidal ideation to know that they shouldn’t feel ashamed or like there’s something wrong with them. And not talking about it? That silence only reinforces harmful stigmas and can even be a significant barrier to someone seeking help.

    Instead of silence, we need to start regularly engaging in an open and honest dialogue, including debunking common myths associated with suicide. For example, misconceptions like the belief that most suicides happen without warning, and that people who die from suicide are selfish and “taking the easy way out” are false and incredibly damaging.

    So where do we go from here? Perhaps the best place to start is to realize that we all have a responsibility to create a safe space, says Forbes contributor Margie Warrell, who lost her brother to suicide.

    “While we may not all suffer from mental illness, we each have a role to play in ensuring that those who do suffer feel less afraid to reach out and get the support they need in the moments when they need it most,” she wrote in 2018. “If people felt as comfortable talking about their PTSD, bipolar or anxiety as they did talking about their eczema or tennis elbow, it would markedly reduce the suffering of those with mental illness and the ability of those around them to support them.”

    The stigma of suicide is far too strong, and any chance you get to talk about it is another opportunity to break down those walls of stereotypes. Don’t say the word suicide in a hushed tone, as if you’re talking about something you shouldn’t; the statistics show that most people have been impacted by suicide in some way. And try not to lie about how your loved one died because you think it will be easier than dealing with the looks and questions from people. When you lie, you’re sending the message that what your loved one did was shameful, and that further contributes to the misconceptions and prejudice people have about suicide. It might be difficult to be open about this, but it’s also freeing (and it gets easier each time you do it). 

    Mental Illness Is Physical Illness

    I’ll never understand why people don’t treat mental health the same as physical health. Why is someone “heroic” for battling cancer, but “weak” for dying from suicide? At its core, mental illness is a physical illness, so we can’t separate the two. The more we start talking about mental illness in the same way we talk about physical illnesses like cancer or diabetes, the more we lessen the stigma surrounding suicide. Changing misconceptions and long-held stereotypes won’t happen overnight, but making the conscious decision to talk openly and honestly about suicide is a strong starting point. 

    If you are in crisis or are experiencing difficult or suicidal thoughts, call the National Suicide Hotline at 1-800-273 TALK (8255).

    If you’re uncomfortable talking on the phone, you can also text NAMI to 741-741 to be connected to a free, trained crisis counselor on the Crisis Text Line.

    For more information about suicide prevention, or to get involved and learn how to help someone in crisis, visit #BeThe1To.

    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

  • Ithaca Drug Users' Union: Changing Perceptions and Fighting Stigma

    Ithaca Drug Users' Union: Changing Perceptions and Fighting Stigma

    “We don’t discourage use, but we don’t promote it either. We encourage people to participate in whatever kind of treatment would give them a better quality of life.”

    Since the Introduction of the Ithaca Plan in 2016, Ithaca, New York has been part of the national conversation of progressive drug policy. The plan includes the use of Safe Injection Facilities where drug users can safely use under the supervision of a medical professional. Supporters of the facilities argue that users will never have the chance to get clean if they overdose first, and this facility allows them to stay alive until they are ready for treatment.

    Three years later, Ithaca remains a politically progressive area with fairly progressive drug policies, but local drug users and former drug users see room for improvement in the way that they are treated in the legal system, health care, and treatment, to name a few. So, they’re forming a union.

    Raising Awareness and Breaking Down Sterotypes

    According to the Ithaca Drug Users’ Union mission statement, it is a group of former and current substance users “who confront the stigmas and injustice long suffered by drug users to replace them with fairness and compassion for all.” Since being formed earlier this year, the union members have already started planning protests and will be creating a television show to air on the local public access network every other week.

    “We really felt it was a good way to get out our message and be out front and open with it,” said Brian Briggs, the union’s director and founder, about why the union decided to pursue a television show. “The other [drug user’s] unions are fighting for stuff that we think are basic rights and we have. If we don’t take the next step and take up that mantle and be willing to take that risk and be out front on TV, then who will?”

    Local organizations like the Southern Tier AIDS Program (STAP) and the Ithaca REACH Project, which operates a low threshold harm reduction medical practice in Ithaca, have helped fight for harm reduction practices that many other places with drug unions don’t have. But it’s on the drug users, Briggs said, to fight for themselves and their rights. Part of that fight includes pushing back against stigma and breaking down stereotypes. By putting their authentic selves on television, Briggs wants to show people that drug users are just people.

    “We’re not trying to antagonize anybody,” Briggs said. “We want people to just hear us and basically enjoy us. We’re a group of fun people and we have a blast. Maybe people can see us for that and just enjoy it.”


    Brian Briggs shows off a potential logo for the union designed by one of the members.

    Briggs has been a drug user since 1991. He was put on methadone for a spell then tried quitting cold turkey because he wanted to be done. When he got hurt playing hockey in the early 2000s, he became dependent on pain killers and tried going back to a traditional treatment center but didn’t feel like he could get the help he needed. In 2003 he went on Suboxone and went back to school with the goal of getting a master’s degree in social work, but he said that even though his urine tests were clean, his provider stopped prescribing him Suboxone because he wasn’t attending group meetings, which were part of his treatment plan. He used all the medical leaves he could with the community college he was attending but couldn’t go back to finish his degree.

    Since 2007, Briggs has been a volunteer with STAP doing peer-delivered syringe exchange and spreading the word about harm reduction services in the community. In STAP he found a like-minded community that understood that traditional treatment and its strict rules doesn’t work for everyone.

    “They agreed with me and believed me and I got involved in this whole movement,” he said. “I felt like I was sane again. I could say stuff like I want to be treated like a diabetic who needs insulin. If a diabetic goes to the doctor and the doctor says ‘How are you doing?’ and his blood sugar is all messed up, his health is bad because his diet has been terrible and he’s been eating Twinkies and Ho Hos, well he’s not following his treatment plan but he needs insulin to live.”

    He was inspired to start a union after attending a conference last year and speaking with Jess Tilley, the creator of the first drug user’s union in New England. Earlier this year he started collecting members and holding regular meetings. It didn’t take long for him to find people who bring personal investment to the union’s mission, including his best friend Tony Sidle.

    At first, Sidle, a former heroin user and dealer, said he didn’t want to be part of the union because it was Briggs’ thing. He went to the meetings when his friend asked him to but mostly to observe. He understands what Ithaca Drug Users Union sounds like. In his words, it sounds like “a shooting gallery.”

    “That’s not what it’s for,” he said. “We don’t discourage use, but we don’t promote it either. We encourage people to participate in whatever kind of treatment would give them a better quality of life.”

    Prohibition Feeds the Beast of Mass Incarceration

    People in active addiction and people in active use, Sidle said, don’t get a fair shake or a voice. It’s part of why he joined the union and has become a very active member. Like Briggs, Sidle takes issue with the narrow ideas of treatment currently being used and sees prohibition as another way to feed the beast that is mass incarceration in the United States.

    The union is not afraid to be public, as demonstrated by their participation in the recent Ithaca Festival parade, an annual community event that celebrates dozens of local organizations. Four of the members, including Sidle and Briggs, regularly attend meetings of the Criminal Justice and Alternatives to Incarceration committee (CJAI), headed by Dave Sanders, Tompkins County Criminal Justice Coordinator. The committee is made up of representatives from local organizations and municipal offices that work with incarcerated, or formerly incarcerated, individuals, with the goal of reducing the jail population and supporting the formerly incarcerated community. Sanders said he is impressed by the union members’ knowledge of the systems at play and the questions they bring to each conversation. He sees the union as an advocate group for drug users seeking help. 

    “I think that their ideas are very important, especially with how we’re moving things forward,” Sanders said. “I think there’s a place for that right now.” 

    The union’s next big stand will be a protest at the local hospital, Cayuga Medical Center, where multiple members of the union say they have been treated badly because of their history of drug use.

    “If people are afraid to go into hospitals because of the way they are treated because of the drug addiction, then the chances [increase] of people dying from things that they shouldn’t die from, and losing arms, and making things exacerbated and further complicated than they need to be…that needs to change,” Sidle said.

    Sidle was incarcerated for about 13 years on drug-related charges and was an active drug user for about 20 years. Now, he’s taking Suboxone, works at the local homeless shelter, and is the vice president of the union (even though he and Briggs both agree that titles don’t really matter). He’s been through traditional treatment a number of times but didn’t feel like he was actually being listened to, just judged. He doesn’t apologize or make excuses for his past use and dealing, but he wants people to stop treating him and other users like that is all they are. 

    Herb Howland-Bolton is a longtime friend of Sidle’s who started using drugs as a teenager. He joined the union because he doesn’t want other kids to go through what he did, and has had too many friends die from an overdose that could have been helped if the system was different.

    “People died before they could advocate for themselves,” Howland-Bolton said of the shame and stigma that causes drug users to hide their use and put themselves in unsafe situations because of their addiction.

    The union’s main goals are to confront the stigma against drug use that makes users hide and to promote treatment options outside of what is traditionally offered. While marching in the parade, and at the eventual protest, members will be holding signs that list the names of their dead friends and acquaintances, drug users who were sent through traditional treatment (sometimes multiple times) but for one reason or another, it didn’t work.

    Traditional Treatment Can Be a Setup for Failure

    Over and over, members of the union described the precariousness of traditional treatment methods. Missing a meeting could mean mandatory volunteer hours that they have to fit in between more meetings and work and life. A parole violation could mean being sent back to jail where their treatment plan would be interrupted. Getting out of rehab without a support system to help them find housing that isn’t with other users means they are often right back where they started. 

    Jane* is a member of the union who is also going through Ithaca City Drug Court, which is specifically for offenders whose charges are associated with drug use. Drug Court participants are expected to stay clean and get treatment and find a job or go back to school. It’s set up to be a nine-month program but she’s been in it for two years. Jane has done inpatient treatment multiple times and said she’s a perfect patient while there, but it’s never enough time to address the trauma that fuels her addiction. She’s currently doing an outpatient program, and thankfully she has a counselor who allows her to be honest and gives her flexibility.

    “Right now, I’m free. I’m not in jail, I’m not in rehab, I’m out in the real world,” she said. “But, if one thing goes wrong, that’s gone. That’s all taken away. And that’s terrifying.”

    Often, she feels, with traditional treatment, they aren’t given the opportunity to succeed. She sees the union as a place for support and connection for users or past users, support that isn’t offered in the current system.

    *Not her real name

    View the original article at thefix.com

  • “Crack Pie” Is No More

    “Crack Pie” Is No More

    The restaurant industry is moving away from describing food as “crack.”

    Crack Pie is no more. Milk Bar’s buttery, gooey signature dessert Bar is taking on a new name: Milk Bar Pie.

    The change is part of a larger shift in the restaurant industry toward abandoning the use of the word “crack” to describe delicious food.

    Milk Bar founder and James Beard award-winning chef Christina Tosi explained the decision to her team in a statement. “Our mission, after all, is to spread joy and inspire celebration. The name Crack Pie falls short of this mission.”

    Gastropub chain HopCat made a similar decision last December, when it decided to drop the name “crack fries”—referring to beer-battered french fries in cracked pepper seasoning. The menu item’s new name was announced in January—Cosmik Fries.

    “When we came up with it 11 years ago, it was tongue-in-cheek, and we didn’t put a lot of reflection into it,” said HopCat spokesman Chris Knape. “Times change, we’ve changed and we decided to make a change.”

    As far as we know, this issue was first raised by The Fix contributor Dean Dauphinais in his 2015 blog post “Why Do People Think Crack Cocaine Is Funny?”

    “Why crack has been singled out as the go-to drug when trying to be witty is completely lost on me,” Dauphinais wrote.

    A recent Washington Post article also questions the idea of “so good it’s like crack.”

    “The callousness with which people throw around the word ‘crack’ isn’t the same with other drugs,” writes Maura Judkis. “We don’t call any desserts ‘opioid pie,’ even though those drugs… are highly addictive, too.”

    San Francisco Chronicle food critic Soleil Ho listed “crack” and “addictive” among her “Words you’ll never see me use in restaurant reviews”—an article published in February.

    “No matter how delicious something might be, its effect on me is nothing close to what crack does to people and their families,” wrote Ho. She doesn’t fail to mention Milk Bar’s “Crack Pie” and how Tosi has been playfully referred to as a “crack dealer.”

    “Addictive” is another word thrown around when describing food so good that you can’t put it down. “I’ve used this before in a few contexts, and I realized after talking to friends and colleagues who struggle with real-world addiction that it’s a word that I need to ease out of my food writing,” Ho says.

    While stuff like this may not appeal to old-school folks who aren’t down with the PC police, HopCat spokesman Knape says it’s less about being politically correct and more about recognizing a serious issue that should be treated as such.

    “It’s not a reflection of us wanting to be politically correct as much as wanting to present an image to the world that’s inclusive and recognizes that what may have been funny 11 years ago never really was,” he said.

    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