Sunday, November 13, 2016

"Opioid and Heroin Use in White, Middle-Class USA"

opioid and heroin use in white, middle-class usA
by Douglas Messserli

 As my own recounting of “pain,” after knee surgery in 2014 reveals, there is sometimes good reason for pain-killers such as OxyContin and other powerful drugs. And most Americans, some doctors have indicated, have a difficult time with such pain, particularly long-term back pain and serious bouts with arthritis—pains which I endured for many years before the surgery. Today I still have a daily stiff knee, although, strangely, my left knee—where the bones are still literally rubbing against one another—no longer hurts. I also have a strong aversion to drugs, so, as I reported, I insisted that I receive less powerful painkillers immediately after the first week, despite my continued suffering.

       Thank heaven! For in the years since, it has increasingly become clear that hundreds of thousands of Americans—particularly in the rural areas of New Hampshire, West Virginia, Ohio, and Michigan, as well as in parts of California and elsewhere, are now addicted to such pain-killers, and, unable to afford the high costs of their addictions, have turned to slightly cheaper drugs such as heroin.

       Even during my operation word had begun spreading about such problems. But in 2016 and into 2017, it became even clearer that the US was suffering a kind of mass epidemic of serious addictions.

     On August 19, 2016 the small city of Huntington, West Virginia, according to the Los Angeles Times endured 26 overdoses in just a few hours, sending the small police force and emergency servers in chaos. At one location, police arrived to one house where they found seven people passed out, 4 within the house, and 3 outside. Throughout Cabell County, in which Huntington is located, police report that they see from 18 to 20 cases of overdosed people each week. 

      Earlier in the year Sacramento, California saw 11 deaths from opiate mixes in one short period. New Hampshire has one of the nation’s highest number of people addicted to opioids, resulting in a suit from that state against OxyContin’s maker, Purdue Pharma. Ohio sued all the major producers of narcotic pain-killers by mid-year.

The New York Times reported that
on September 18, 2016 in Lawrence, Massachusetts, that in a local Family Dollar store, police discovered an unconscious woman lying on the floor from a drug overdose, while her 2-year old daughter lay next to her, attempting to tug her mother into consciousness. The local police force commented that at about 10% of the drug calls they receive, children are present. There has been a 7.62% increase in child neglect investigations in that area in 2016 alone.

      According to the Associated Press, there were 3,050 people who overdosed during the year, most from powerful painkiller fentanyl. And on September 15th, in the Western part of that state, a couple was found parked on the street, passed out from a heroin overdose, with a toddler in the back seat. The 8-year old boy who discovered them went running off to his parents living nearby, screaming for them to come help. The pictures that were taken of this event have become something close to poster statements of the serious of what is happening throughout the US.

       Similar problems have been discovered among the homeless in Los Angeles who, unable to afford even marijuana are consuming a cheaper, man-made drug called “spice,” which is often sprayed with chemicals that cause deadly results. In LA’s skid row, 38 people had to be transferred to hospitals in one August Friday after consuming a batch. And the very next Monday 14 others were found with similar symptoms. The Los Angeles City Council has now requested an ordinance to ban the substance, which can also kill. Perhaps the recent legalization of marijuana, at least in this particular case, will help with the problem.

       But the above reports represent just a few of the numerous stories that reveal that we are slowly turning into a kind nation of zombies, formerly hard-working men and women who, facing pain and aging becoming hooked on devastatingly powerful drugs, often by over-prescribing doctors and clinics. If job-loss can account for much of the private suffering faced by so many individuals in the poor areas of the country such as upstate New England and the midland’s rust-belt—areas where, incidentally, Donald Trump did very well in the election—drugs have clearly contributed to our cumulative pain instead of relieving it.

     An editorial in The New York Times on January 16, 2017, not only reiterated the national tragedy of opioid and heroin-substitute abuses, but spoke to a previously unexplored problem about its effects upon the children of those who abused and died.

     The editorial began by expressing that “Opioid overdoes have claimed more than 300,000 lives in the last 15 years, including some 33,0000 in 2015 alone.” But it immediately brought up the fact that nationally, the number of children, often removed from parents for drug abuse, had risen substantially. Between the years of 2012 and 2015, foster care had jumped 8% nationally, and suggested that at least 32.2% if these cases in 2015 were a result of parental substance abuse. Citing a particularly tragic situation in Pennsylvania, where a couple, having died from apparent overdoes, and left their baby behind to die from starvation, the editors went on to suggest that the problem was possibly even far worse, citing that one group, Generations United, had estimated that 2.5 million children now live with relatives of family friends rather than their parents. “In Texas” (where funding has been substantial cut),“conditions have gotten so bad that officials have assigned dozens of foster care children to sleep in state offices and other temporary shelters.”

     A major contribution to the problem, argued the Los Angeles Times in a June 2, 2017 article by Karen Kaplan, had to do with a simple-minded argument expressed in just five sentences in the 1980 edition of The New England Journal of Medicine. Those sentences argued that of the cases on report to date, only four cases of 11 reported from major medical centers could be traced to actual addiction among individuals who had no history of previous addiction.

     As Kaplan makes clear, however, these examples were only from patients who still remained in hospitals, while making no account of those who had returned home and might have had more private problems with addiction. Moreover, no specific examples in these sentences were included. Yet, even as millions of Americans became addicted to opioid painkillers from 1999 to 2015, these same sentences were cited again and again, among 608 papers arguing for the drugs non-addictive qualities. Even as the major drug producers began to see more and more evidence that their products had led to more than 183,000 deaths as a result of patients with addiction, they continued to obfuscate through restatement the 1980 article and outrightly lied to doctors and others who proscribed the drugs. Kaplan sites as a major example was a 2002 statement by Dr. Sian Iles, associate professor of radiology at Dalhousie University in Nova Scotia in the International Journal of Clinical Practice:

                   Fear of addiction may lead to reluctance by the physician 
                   to prescribe. However, there is no evidence that this occurs 
                   when prescribing opioids for pain.

In a 1999 report in Nursing Economics, nurse-practitioner Nancy Kowal, at the University of Massachusetts Medical Center in Worcester, Massachusetts, wrote:

                   This pain population with no abuse history is literally at 
                   no risk for addiction.

     The very same week when the Los Angeles Times piece was published, The New Yorker featured a long essay by Margaret Talbot, focusing in on just one city in West Virginia, Martinsburg, population about 18,000. This city, reports Talbot, along with the entire “eastern panhandle” of West Virginia in which it is located, has “devastated” the population where nearly everyone has family members or knows someone who is a heroin addict, brought about by an addiction to painkillers. Just a few paramedics must work as long as 24-hour shifts for the Berkeley County Emergency Medical Services in order to save dying addicts by providing does of life-saving Narcon.

     The essay begins with a dramatic event—the kind we are now hearing daily in newspapers and magazines across the nation—where at a Little League baseball game, two individuals suddenly collapsed and lay dying from a heroin overdose. Talbot captures the horror of the event:
                 Two of the parents were lying on the ground, unconscious, 
                 several yards apart. …The couple’s thirteen-year-old daughter 
                 was sitting behind a chain-link backstop with her teammates, 
                 who were hugging her and comforting her. The couple’s 
                 younger children, aged ten and seven, were running back 
                 and forth between their parents, screaming, “Wake up!
                 Wake up!” When Barrett and Mulligan [the paramedics] knelt 
                 down to administer Narcon…some of the other parents got 
                 angry….saying “This is bullcrap.” “Why’s my kid gotta see 
                 this? Just let ‘em lay there.’”

     Although many in the community express similar sentiments in the local newspaper, others, particularly those with family members who suffer similar addictions, are more sympathetic. And some have even gathered into groups, such as the Hope Dealer Project, run primarily by three women, who, recognizing that the small town of Martinsburg has little available to help addicts, take in those who are willing to try to break their addiction, traveling with the to sometimes long away destinations in other states to help them get care. But even after, they continue to try to place them on further programs that work to help their patients from relapsing. Nonetheless, the possibility of falling back into addiction is common, and Talbot’s article is dotted with stories of families who sons, daughters, husbands, and wives, had broken the habit only to take up heroin again, often ending in their deaths.

      West Virginia, with its hard-working miners and poor, often uninsured, often sickly citizens, was particularly hard-hit by Purdue Pharma OxyContin marketing.
                 Some states became inundated with opiates. According to 
                 the Charleston Gazette-Mail, between 2007 and 2012 drug 
                 wholesalers shipped to West Virginia seven hundred and 
                 eighty million pills of hydrocodone (the generic name 
                 for Vicodin) and oxycodone (the generic name for 
                 OxyContin). That was enough to give each resident four 
                 hundred and thirty-three pills.

      The addiction, moreover, is not limited to hard working fathers and mothers, but to their children, observing their own parents taking drugs and, sometimes, even being encouraged, perhaps, to imbibe. West Virginia has an overdose death rate today, so Talbot reports, of 41.5 per hundred thousand people, with New Hampshire having the second highest, at 34.5 per hundred thousand.

      Affecting the state even harder, is the number of children removed from parental care because of drug abuse, which rose from 970 in 2006 to 2,171 in 2016. Entire families have been uprooted, now living with aunts, uncles, grandparents, and foster parents. And people are dying daily in private and public spaces. How could we imagine a more destructive world other than conjuring up a city under the siege of a war?

       Finally, if anyone might imagine that the attention this drug crisis has now received might have meant that there has been some resolution of the problem, the June 6, 2017 front page of The New York Times revealed it as a delusion. In fact, deaths from drug overdose have startlingly risen in the last year, and are likely to be even worse by the end of this year. With more than 59,000 deaths in 2016, reporter Josh Katz summarizes, “Drug overdoses are now the leading cause of death among Americans under 50.” And beyond the states named above, there have been significant increases of such deaths in other East Coast states, particularly in Maryland, Florida, Pennsylvania, and Maine. As Dr. Tom Frieden, the former director of the Centers for Disease Control (C.D.C.) concluded, it’s the only aspect of American health that is getting significantly worse. It is now estimated that over two million Americans are dependent on opioids, and an additional 95 million used prescription painkillers in the past year.

       If the Senate were to pass the new health care act approved by Paul Ryan and the House of Representatives and approved by Trump, even the few services already provided would become nonexistent or severely curtailed, and the possibility of recovery made even more difficult with the cuts to Medicaid. Even the small offering of hope the thousands of addicts now have would be dimmed, and an entire generation of small-town, mostly white, hometown citizens would ultimately disappear, leaving their lost children behind.

       There have been many instances, unfortunately, of derelict behavior by the government in American history, but this may be one of the worst.     

Los Angeles, January 10, 2017, January 16, 2017, June 1, 2017, and June 3, 2107, June 6, 2017

Wednesday, November 9, 2016

"Behind the Wall" (on the Election of Donald Trump)

behind the wall

I woke up this morning terrified. I now live in a country I no longer know, run by a man with no humility, boundless ego, utterly no experience and, evidently disinterested in learning anything about the job.
     Our President is not only a bully, but a demagogue who would, so he claimed several times, send millions now living in this country away from it and would bar people based on their religion and ethnicity. Our new President is a compulsive liar, who has refused to be transparent about his own international dealings and his personal taxes.
      He is a man who has proudly proclaimed that he will get rid of many of the checks and balances by selecting only conservative Supreme Court justices. He and his followers have repeatedly demanded that he arrest his presidential opponent. He and his followers have loudly insisted on constructing a costly and unbuildable wall between my country and another, Mexico. He is opposed to most international trade deals, and wants to undo many of our military and political alliances with other countries. This man highly admires, so it appears, one of the world’s most dangerous dictators, Vladimir Putin, and has even jocularly praised the most brutal leader of all, Kim Jong-un of North Korea.
      Our new president jokes loudly and openly about having groped women and getting away with it because of his celebrity. He and his Vice-President have spoken out against gay marriage and a woman’s right to abortion. Although he has boasted about giving many a woman a chance to serve in his operations, it is also has become clear that he sees them as objects incapable of truly competing in the male-controlled world. Although the press has been quite quiet about it, there are rumors that he raped a 13-year girl.
      Our new—my new president—would take away affordable health care and “reconsider” social security. He is a man who, apparently, believes that if we have nuclear weapons we should use them, that only he can solve world crises such as the rise of ISIS and other international terrorist groups. He wants to return us to water-boarding terrorist suspects and restore other inhumane methods of torture. He knows more than the generals, he proclaims—although it’s been clear all along that he knows very little about international politics, and that, in fact, he knows very little about American politics except for his great displays of bluster. It may be that this president has never read a book—except, perhaps, for his own, written by others.
      Several newspaper journalists have repeatedly described this new President as the least self-reflective person they have ever encountered. In his hate of the media he has banned journalists and entire newspapers criticizing him from attending his conferences and even public gatherings.
     Trump is not a man who truly believes in global warming, and we can surely fear that he will not support further attempts at working against environmental problems in our country or elsewhere.  
      He has denigrated nearly all his Republican opponents, and continually mocked others for illness or any other disability. In his business affairs he has shown that he is racially bigoted, and has, in this campaign, attracted—without rejecting—the worst of racists, including members of the Klu Klux Klan. It is important to recall that he, personally, led the “birther” movement in an attempt to disqualify the black President, Obama, and then, tried to pin that viewpoint on Hillary Clinton. Many of his statements have given evidence of strong anti-Semitic sentiments. His own religious convictions are scanty at best, relating primarily to the “Power of Positive Thinking” tenants of The Reformed Church in America touted by Norman Vincent Peale.
       Although he claims to be a wildly successful business man, it is also apparent that numerous of his business endeavors have been poorly managed and fell into bankruptcy. He is currently facing charges, in fact, for having defrauded mostly poor people in connection with his “Trump College,” a made-up institution that was neither a true educational system nor actually disseminated any knowledge to the so-called students Trump might have been able to provide. He has sued and been sued by more people than any President in our history.
       As Harry Belafonte astutely wrote in yesterday’s The New York Times, Mr. Trump argues for “making America great again,” without really even trying to comprehend what America is, or what he might truly make greater, “reducing all the complexity of the American experience to a vague greatness…a promise that we will return to ‘winning’ without ever spelling out what we will win.” 
       Mr. Trump has shown time and again that, in his self-centric world view, he is a borderline sociopath, if not worse. Esteemed commentator, Fareed Zakaria, has described our new President as a “cancer on democracy.
       Today, I now live in a country where basically the uneducated decided for and against the better educated citizenry. Certainly the very fact that they have been left uneducated and are permanently angry about their denigrated conditions ought to have been taken into better account by the left and even the more moderate of our voters. Historically, we know that it was precisely such rich-poor, educated-uneducated, urban-rural dichotomies that helped contribute to the fall of the Weimar Republic and the rise of Hitler’s fascism in the mid-20th century. And it is sad that we never remembered that fact. But now, I am terrified by what lies ahead. 
      Yesterday, many journalists spoke of healing, but now the wounds have been so completely revealed. As Dana Bash reported on CNN soon after I finished this piece, Trump has ripped off the Band-Aid of American politics. Now we must face the fact that the infection may possibly kill us.

Los Angeles, November 9, 2016