Arrested For Substance Use? In the UK, That Means Time in Treatment
Last month, England’s Ministry of Justice announced a new pilot program that will divert people with substance use disorder into treatment, not prison. The program aims to reduce reoffending by replacing “ineffective” short prison sentences with programmes that “will tackle the root causes of criminality.”
England’s National Health Service (NHS), Public Health England, and Department of Health are testing the program in five areas before the government hopes to roll them out nationwide. So far, the results are promising. Mental health support and recovery programs are a key element of the program, where psychologists are stationed in courts to assess offenders for eligibility for a community order. Local panels of judicial and health officials also liaise with magistrates and judges to ensure positive outcomes for communities and individuals. The Ministry of Justice said that 29 percent of offenders currently starting community sentences say they have mental health problems, a third misuse drugs and 38 percent misuse alcohol.
Understanding the link between recovery and recidivism is key to reforming criminal justice policies that punish people with substance use disorder. In the United States, 80 percent of inmates have substance use problems, and over half of the population is clinically addicted. “Incarceration rates in the U.S. are nine times greater for young African-American men between the ages of 20 and 34 years,” according to the National Association of Drug Court Professionals. Data for the UK is similar: a new survey from the United Nations confirms that developed, industrial countries have the highest rates of unsafe substance use.
David Gauke, England’s justice secretary, has been pushing against the use of short prison sentences amid a crisis driving drug abuse and record self-harm and violence in overcrowded jails. According to The Independent, he said, “We are all clear that we need to do more to support vulnerable offenders in the community. I want to improve confidence in community sentences, and early evidence from these sites has shown that treatment requirements can have a significant impact in improving rehabilitation and addressing the underlying causes of offending.”
Incorporating mental health into courts and criminal justice produces better outcomes. According to The Independent, the lead judge in Merseyside’s complex case court, which is part of a pilot in Sefton, said having psychologists in court meant judges can make community orders without having to delay a case by adjourning it.
District Judge Richard Clancy said that the new program “is a remarkable and innovative move which I fully support. This is an excellent joint venture, and I have seen firsthand how this allows us to ‘nip in the bud’ one of the major causes of crime.”
A 2017 joint report by the Ministry of Justice and Public Health England showed a stark drop in offending by people who underwent treatment, with the number of crimes committed down a third over two years and 59 percent for alcohol treatment. After the pilot is implemented nationally, these outcomes may continue improve further. The UK’s new perspective on justice and people with substance use disorder is creating a progressive, effective program that could potentially be replicated or adapted to courts in the United States.
CEOs Ask For More Regulation of Treatment Center Ads, Marketing
Most industries lobby for less government involvement. In treatment, however, CEOs are pushing for more government oversight to protect people from bad actors who use unethical practices. In a July hearing, multiple CEOs called for a “federal intervention” on questionable marketing practices.
According to Pacific Standard, “Members of the House of Representatives’ Energy and Commerce Committee organized the hearing as a part of their months-long examination of unethical practices among addiction treatment facilities. Oversight and Investigations Subcommittee Chair Gregg Harper (R-Mississippi) asked all the witnesses to take an oath to tell the truth, which typically only happens during investigative and confirmation hearings. All the witnesses agreed.”
The hearing focused on call centers, which may masquerade as a general “help line” but is really a service that screens and refers callers to treatment facilities. Rehabs may pay a per-head fee and give salespeople incentives for convincing callers to check into their facility. Pacific Standard said, “News investigations have found that unscrupulous call centers refer patients to shoddy facilities—especially patients with private insurance that they can bill—and often hide the fact that they’re paid by the treatment clinics to do so.”
Questionable marketing practices conceal the intention and abilities of treatment centers. One witness, according to a Florida grand jury report on unethical practices in the state’s treatment industry, described how “online marketers use Google search terms to essentially hijack the good name and reputation of notable treatment providers only to route the caller to the highest bidder.”
Fake help lines and call centers are easy to find in internet searches, often the first result to appear when someone searches for help for substance use disorder. Marketing these call centers as treatment has become such a problem for patient safety that web companies like Facebook and Google elected to shut down treatment marketing completely.
Greg Williams, Co-CEO of Facing Addiction with NCADD, was instrumental in helping set limits on treatment marketing practices. He praised Google’s decision to pull the plug on marketing that targeted vulnerable people with misinformation about recovery. He said, “This is a bold move by one of the world’s biggest companies, saying people’s lives are more important than profit.”
Sick of bad actors sullying their industry’s reputation, treatment CEOs are putting people first and calling for more regulation. That includes ethical standards of treatment, guaranteed referrals to outpatient care and sober living, and crackdowns on insurance fraud. These serious problems, unchecked, may frighten people away from seeking help—and considering that less than 10% of people will ever seek medical care of any kind for their substance problem, shutting down treatment centers puts lives at risk. Treatment CEOs are pushing for reforms and asking for federal support in eliminating bad actors. So far, they’ve taken matters into their own hands, with success. Pacific Standard said the National Association of Addiction Treatment Providers updated its Code of Ethics in December and has kicked out dozens of members since. American Addiction Centers, a company headed by one of the other witnesses, was one of those expelled, for not branding its ownership clearly enough on the websites it owns, Ventrell said. And American Addiction Centers only started paying their call center workers salaries, instead of compensating them based on commission, on July 1st.
Committee Chairman Greg Walden (R-Oregon) said that people who seek help by calling an addiction treatment number listed online “have a right to know what type of facility they’re calling and what treatment is offered.” The risk is significant; shame and stigma related to asking for help expose people to greedy, unethical practices like insurance fraud. For example, journalist Cat Ferguson found that the companies involved in the care of one call center user billed her insurance more than $3,600 for a urine test, for which Medicare reimburses less than $80, and nearly $75,000 overall for 11 days of alcoholism treatment. Some companies, she reported, also use “reviews” or other SEO-boosting practices to seem more legitimate than they really are.
Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers, said, “We support the committee’s efforts to clean up the practices that are harming us all.”
The bottom line? People must come before profit. Transparency, honesty, and consistent care is essential to ensuring safety and saving lives.
When You’re Sick or Incomplete, Open Up Your Heart
Tough love. Hard boundaries. Ultimatums. Many families use “tough love” to “help” loved ones with substance use disorder. However, research shows that empathy, not isolation, punishment, or tough limits is a more effective approach.
According to NPR, studies show that a compassionate approach and voluntary treatment work better than tough love. Kindness and empathy engage people in active addiction and can keep them alive and connected to their support network. For parents, whose support often comes from other families of people in recovery, empathy is a key ingredient. Some parents describe a sense of shame when they help their sick children by offering a hot meal or a place to stay; others say they’ve been ostracized by their ‘support’ groups when they refused to set zero-tolerance boundaries with their children.
Some of the programs that support parents, families, and loved ones are parent support network Learn to Cope, the parent coaching program through the Partnership for Drug-Free Kids, and Community Reinforcement and Family Training (CRAFT).
Nora Volkow, director of the National Institute on Drug Abuse told NPR that, in this era of fentanyl, the old ways may not be worth the risk. The bottom is much closer, and the person’s next use could be their last. She said, “The concept of letting their children hit bottom is not the best strategy. Because in hitting bottom they may die.”
There is no uniform path to healing for the drug user or parents, and no widespread agreement on the best approach for families. Empathy-based programs help support people switch from enforcing family consequences, like kicking a family member out of the house, to supporting them as they face other challenges, like losing a job because of substance use or mourning friends who have died of the disease.
It also helps families heal and come through the storm of addiction in one piece. Empathy helps maintain trust, which is essential. Asking for help from someone who’s been consistent in their love and support is much easier than going to someone who takes a punitive approach. Families are affected by addiction as well: the feelings of guilt or loss when a loved one or family member has a recurrence of use or struggles with substance use can have a profound effect on their mental health, too.
Michael Botticelli, who served as drug czar in the Obama administration, told NPR, “They don’t call this a family disease for no good reason. The whole design of these services [is] to promote tools and information for families, so they know how to approach a situation and can heal.” If a child had cancer, he said, parents “wouldn’t disengage with them or be angry with them. So I do think it aligns our scientific understanding that addiction is a disease and not a moral failure.”
Recovery can be a family solution to a family disease. Contrary to what some critics say, empathy doesn’t enable substance use or make the person sicker. “That’s a misconception,” Fred Muench, president of the Partnership for Drug-Free Kids, told NPR. “CRAFT is authoritative parenting, creating a sense of responsibility in the child, and at the same time saying, ‘I am here for you; I love you; I’m going to help you; but I can’t help you avoid negative consequences if you’re not looking to do that on your own.’”
Addiction Doesn’t Affect Me, But It’s Personal
I stumbled into harm reduction by accident. In 2010, I was a struggling writer, trying to figure out how to translate a passion for words into paying the bills. I came across an unusual job posting on Craigslist. The job had some unusual duties: among other things, whoever they hired would have to take a life-sized rubber vagina behind Home Depot department stores to educate migrant day laborers about safe sex.
Well, that sounds interesting, I thought. As a writer, I was always looking for a good story, and what better way to find an interesting story than to live one? I applied right away, and miracle of miracles, got the job.
I spent a few months lugging rubber genitalia behind department stores for show-and-tell with day laborers. But after a while, I learned that my employer, the North Carolina Harm Reduction Coalition, did much more than just sex education. We brought syringes to people who injected substances and hormones for gender transition; we taught violence prevention techniques to sex workers; we trained incarcerated people on how to reverse a drug overdose.
To someone from my sheltered background, this kind of work was fascinating. I admit that my first forays into harm reduction were for all the wrong reasons: more morbid curiosity than understanding or respect for the autonomy of people who use drugs.
From the beginning I felt compassion for people impacted by drugs, but I saw them as victims of poor choice and powerful substances. I considered it my job to scoop them up in my rescue boat and steer them towards abstinence. All I needed was a hero cape.
But after months, and then years, working in harm reduction, up close and personal with people with substance use disorder and the policies that impact them, all my previous beliefs were challenged, tested, and flipped around. I started to see how broken mental health and criminal justice systems contribute to addiction. I saw how sometimes well-intentioned efforts, like assuming that everyone who uses drugs should go to treatment and stop, can be just as stigmatizing and harmful as criminalization. I started to understand the hypocrisy of demonizing heroin and prescribing its sister drugs, opioid pain relievers. I started to realize that the entire way that we approach addiction is based on stigma and lies.
Can someone explain to me why it is illegal to smoke marijuana but not to cheat on your partner, which arguably, causes a lot more pain? Can someone explain why there are 11 million people addicted to illicit drugs and 14.7 million people addicted to sex in the United States, yet no one suggests we imprison people for having sex? Can someone explain why, even though there are 15.1 million adults addicted to alcohol, instead of prohibiting it, our cultural obsession with the substance borders on worship? Or maybe, someone can explain why we declare the exact same drug (such as fentanyl) legal or illegal depending upon who makes money off its sale.
No one can provide a good reason for these policies, because there isn’t one. Our drug laws are arbitrary, based on stigma and politics rather than science and sense.
After years working in harm reduction and advocating for more sensible drug policies, I am starting to realize that addiction is not a disease, it’s a symptom. The disease is that we, as people, don’t know how to treat one another. It’s all the fronting and posturing, the building ourselves up by tearing others down, the judging others’ flaws while justifying our own, the loneliness we refuse to admit, the pretending to be people we aren’t, the swallowing of pain so we appear strong, the dividing into ‘us’ and ‘them’ so that ‘us’ can dominate and ‘them’ can be shamed.
For these reasons and many more, we are all broken in some way. We all search for ways to heal the brokenness. For some people, those methods are socially acceptable. For others, they are criminalized.
I think it’s important for people like me, who have not been personally impacted by addiction, to nevertheless become involved and advocate for reform. It will take collaboration across all fronts to address the root causes that fuel addiction: poverty, unemployment, loneliness, mental health issues, grief, lack of self-love, and many more.
We can start by trying to break down the barriers that divide us. We must realize that no matter our political, ideological or religious beliefs, or where we born, we all want to feel happy, safe and loved.
So let’s start by making our brothers and sisters feel happy, safe and loved, even—no, especially—if they struggle with addiction.
Suboxone Helped Me See What My Addiction Did To Me
Fourteen years ago, I developed addiction to pain pills. I had a C-section with my son and after three days in the hospital I was sent home with not only a beautiful baby boy but also a prescription for Percocet.
I loved the way it made me feel. I could do anything. I thought I was the best mother ever. I also thought I could keep my newfound love for opioids under control. Sadly, I was very mistaken.
When my OB-GYN stopped my prescriptions, I started buying the pills on the street. I worked 60 hours a week but couldn’t afford to buy shampoo or diapers. I relied on neighbors, friends, and family to help with bare essentials. I also relied on these same people to care for my son while I was at work, busting my butt just to support my habit. It was a habit that I said I’d never have, a habit that made me such a great mom, and a habit I was convinced no one knew about.
I remember trying my first line of heroin and thinking how disgusting it tasted. It tasted like a barn full of animal waste. But that didn’t stop me. Not even the taste of animal waste would make me stop and reevaluate my life, my decisions, or my choices. Of course, even using heroin I thought I was still a great mom—for two hours a day, at least. I can remember, clear as day, pushing my son down the street in his stroller, thinking I looked great even though I had to stop to throw up every five minutes.
Shortly after that that, I made a decision to get on the waiting list for the suboxone program. I was tired of not having shampoo and conditioner. The program was fairly new and not many doctors were able to prescribe this medication that would end up saving many lives. I’ll never forget where I was the day that I received that phone call. I felt relief, mixed with gratitude and topped with hope.
A little piece of a orange pill alleviated all the symptoms that I dreaded the most. I got relief from the intolerable aches in my arms, sweating, nausea, anxiety, lack of motivation, and my inability to care for myself or my son. I stayed on the suboxone program for six years. At some point, I realized I had the ability to articulate to the doctor that I wasn’t ready to drop doses. I started getting my life back together, looking back, and realizing that I was not a good mom. I saw that I did not look good: in fact, I looked awful.
Sadly, my brother John, who went to the program with me, didn’t make it. He died of a combination overdose of heroin, benzodiazepine, and Valium on January 29, 2016. He’d been abstinent for 11 days. My family identified his body via email to the coroner by describing his tattoos, noting that he just had a haircut, his height, his weight, his eye color, and his hair color.
I have done everything in my power to honor my brother, including going to Washington DC to advocate for the Comprehensive Addiction Recovery Act. I will continue to honor his name until the day I die. He was my only sibling and my best friend. He will continue to sit in a box next to our mother’s bed.
Substance use disorder is a serious matter. Over 60,000 people died in 2016. That’s more people than died in Vietnam. This epidemic has got to stop and change starts with each and every person making a choice! There is help out there.
Time To Change The Way We Fish
The Federal Government recently released the annual data showing some modest changes in substance use and the prevalence of substance use disorders. However, one number continues to stick with me every single year – nearly a 90% addiction treatment gap in America continues to persist.
That means of the over 20 million Americans who meet medical criteria for substance use disorder, only approximately 10% or just over 2 million people actually get any specialty medical care at all for what is now the leading cause of death for those under 50.
This addiction treatment gap ratio hasn’t changed in any substantial way in decades and has persisted even after allocating billions in new government resources toward it in recent years, mandating insurance coverage (parity), and expanding access to health insurance. While the death toll from a preventable and treatable condition continues to rise in spite of the existence of a more than $35 billion industry attempting specialty care today.
Perhaps we’ve been looking for fish in the wrong pond? Approaching the problem from the wrong direction? By continuing to invest in an acute care specialty system, that operates in isolation and isn’t well-matched to succeed against a massive persistent chronic health problem, it is no wonder we haven’t been getting positive outcomes. The landmark Surgeon General’s Report on Alcohol, Drugs, and Health, Facing Addiction In America, synthesizes decades of research and clear protocols about what works in intervention, treatment, and recovery support. The report also includes a robust call-to-action to integrate and coordinate addiction health services across a long-term continuum of care similar to other chronic disease models.
Our approach has been to drop the bobber into the water, sit back, and wait for the fish to come to us. Then, when someone doesn’t seek out care for their addiction or they don’t sustain recovery after receiving treatment for their chronic health problem in an infectious-disease modeled system, we blame the individual.
“They weren’t ready yet to change their life,” or “they need to hit a bottom.” As we let ourselves continue to believe this lie, we simply keep fishing for the same 10% of people who might check all the boxes to fit well into our existing acute addiction treatment infrastructure rather than taking a hard look at perhaps changing the way we fish.
The truth is harder to look at and to solve for. The truth is the system we have in place just failed the 18.2 million Americans who couldn’t get or didn’t seek care for their substance use disorder in 2017. 18 million people didn’t fail. How could they? The health system in place for their problem isn’t designed, well-matched, or aligned to produce wellness for the illness they have.
System change isn’t easy, and as Facing Addiction with NCADD’s reach has grown in all 50 states across the United States there is a shared complaint no matter how urban or rural, conservative or progressive a community is. Nobody in our network is satisfied that their community’s health care entities are responding adequately to alcohol and other drug problems. How could they if a 90% treatment gap has persisted for decades?
The time has come for us to demand a systemic overhaul of how we engage, treat, and support people on a person-centered pathway to recovery (of their choice) in America. What if we started learning how others in the chronic healthcare management field fish and really went hard at closing the addiction treatment gap in America from another direction? What would that look like?
For one, it would require business as usual to end. No longer can we only have specialty providers who sit back and wait for their phones to ring or their internet marketing tactics to pay off after a Google search. We have to stop incentivizing a system that fishes in a catch and release mentality. There are 18 million people falling through the cracks and we have to figure out how to urgently fill these cracks.
If we are going to think differently about how to serve the 18 million people in need who are falling through the cracks, my big questions to you are:
- In your community what happens when an individual presents with an alcohol or other drug problem in the local ER, or a family member walks into the pediatrician or primary care office worried about their loved one, or when the police pick up someone for a DUI or public intoxication?
- Are they assertively engaged, connected, and embraced by the health providers in the community the same way a patient with heart disease is? Or does your community catch and release?
The rest of our health care system doesn’t catch and release for other chronic conditions. They provide years of assertive engagement, education, training, and multiple doorways of entry to wellness. Part of the reason they can do this is that mainstream health systems are directly involved and serve that condition. Your local hospital or health system most likely has an entire cardiology team, an entire floor, and a network of outpatient providers in your community that is interconnected with the primary care providers in the community. They probably have a full NFL-style team focused on endocrinology with different providers playing different positions, perhaps even with a quarterback to navigate patients throughout the system and levels of care an individual might need depending on the severity of their illness.
Does your community have a team or entire floor dedicated addiction at your local hospital? Why not? It’s more prevalent than 1.5 times all cancers combined.
The reason is actually astonishingly simple in my mind. They haven’t been incentivized to do so. Insurance companies, patients, and policymakers have never come together to demand and provide the resources for health systems to get involved in addiction before. But we can’t afford to allow the status quo to persist any longer.
- Are you collecting data for how many people passed away from overdoses in our community within 90 days of interacting with your health care system?
- Are you collecting data for what percentage of ER visits are related to alcohol and other drugs? What percent of these patients were discharged with a robust treatment and recovery plan?
- Are you collecting data on the percentage of patients your primary care providers identified with a substance use disorder last year? Were any of these patients engaged in person-centered treatment and recovery plans?
If they aren’t collecting these data points then it is hard to address the specific system problems related to those who are falling through the cracks. It’s time for us to demand they start looking to diagnose the specific system problems for people facing addiction in their community. To not accept a catch and release mentality any longer.
The good news is for the first time in the history of addiction treatment and recovery the payers are starting to embrace a willingness to think and act differently. I can tell you from first-hand experience they are not only at the table, but some are actually setting the table.
In August 2017, Leavitt Partners and Facing Addiction with NCADD convened a group of 40 healthcare thought leaders. This group was comprised of senior representatives of various health care organizations ranging from health insurers, hospital systems, behavioral health experts, employers, and others.
The purpose of this meeting was to begin a discussion about solving systemic issues for addiction health services. The group set out to determine if the conditions were right to explore the creation of alternative payment and delivery pathways for long-term treatment and recovery. In the months that followed, this group organized the Alliance for Recovery-Centered Addiction Health Services to develop and promote an innovative approach to payment and delivery of addiction treatment and recovery services.
The Alliance published the first draft of The Addiction Recovery Medical Home Alternative Payment Model (ARMH-APM) on September 7th during the Summit for Addiction Recovery Payment Reform. The ARMH-APM is a consensus learning model representing an attempt to establish a structure that promotes the type of integration and patient care capable of producing improved outcomes for patients, payers, and health systems by aligning all incentives. This Alliance is committed to further promoting the approach, pilot it in various markets, evaluate outcomes, and refine the model over time, but we need your help.
Individuals and families in communities drive market demand for the availability of local healthcare resources. The time has come to teach our health systems to start fishing for the 18 million people falling through the cracks. We need you to stand with this Alliance and demand that your community health system stop catching and releasing and start incentivizing long-term recovery! You can tell your local health system executives that for the first time ever the payers are ready to meet them wherever they are, whether it is the full ARMH-APM or just a few recovery coaches in the ER or training their primary care doctors — sweeping change won’t come easy or fast. But I know for sure it won’t come unless we demand it. The size and scope of the problem hasn’t moved the health system for decades, so now the time has come to see if our stories, passion, and collective vision for a better future for the next generation can.
Oregon Recovers, By The Numbers
Data is a valuable asset, but it doesn’t necessarily give a complete picture of the national drug epidemic. Every year, SAMHSA releases its annual National Survey On Drug Use and Health (NSDUH). The study tracks substance use, mental health issues, and negative health outcomes in the populations it surveys. However, an Oregon advocacy group is suggesting that we need to be tracking more than just overdoses. NSDUH has never included questions related to the most positive outcome of having a substance use disorder—recovery from it.
A recent op-ed by Brent Canode, Executive Director of the Alano Club of Portland and co-founder of recovery advocacy group Oregon Recovers, pointed out that recovery isn’t the absence of addiction. It’s the presence of wellness.
The op-ed, which appeared in STAT earlier this month, makes an important point about recovery, which is that it’s a real, possible outcome for some people with substance use disorder. “Losing sight of that can skew public policy and funding priorities to narrowly focus on preventing deaths instead of aiming more broadly to both reduce unnecessary deaths and promote long-term wellness,” Canode said. Robert Ashford, PhD, and another writer contributed to the op-ed.
To fill in the blind spot, Oregon Recovers will partner with Oregon’s state Public Health Division to measure recovery rates biannually. To do this, they’ll use the Adult Behavioral Risk Survey (BRFSS). This survey is done between states and the federal government, in collaboration with the Centers for Disease Control and Prevention. It is an ongoing data collection program designed to measure behavioral risk factors in the adult population. Health departments use the data for a variety of purposes, including identification of regional and demographic variations in health-related behaviors, targeting services, addressing critical health issues, proposing legislation for health initiatives, and measuring progress toward state and national health objectives.
BRFSS gathers uniform, state-specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases in the adult population. It isn’t perfect: data is collected over the phone, and excludes populations that are under 18 or homeless. However, according to the 2000 Census, 98.4 % of Oregon households have telephones, which means that the state is an excellent fit for this method of survey. The big win is adding recovery outcomes: a significant step toward refocusing anti-addiction efforts on recovery instead.
Oregon Recovers was created in response to Oregon’s place as last in the nation for access to recovery services. Although substance use is not a new problem in Oregon, it was recently declared a public health crisis thanks to the efforts of recovery advocates. Oregon Governor Kate Brown signed an executive order that declared addiction a public health crisis. Studying addiction as a local or regional issue is important to understanding how Oregon can recover.
Sharing Scooby’s Story
My son Jaron was a person with substance use disorder and now he is an angel. I will not let his addiction define him! He was so much more. He was a brother, an uncle, nephew, cousin, best friend, and son! He was my only son. My baby, my Scooby.
Jaron was like a shooting star that burned out too fast. He could walk in the darkest room and make it so full of life and happiness. Jaron got his first pain pill at 14 yrs old from a friend who took it from their house’s medicine cabinet. Jaron’s 18-year battle with addiction began with that pill.
After those 18 years, Jaron ended up homeless. For a while, he had his own place, then he lived with family. He slowly lost everything to his addiction. He sold his cars, his pool table, TVs and stereos, you name it. He got rid of it so that he could keep using.
He went to drug court while looking at time for four felonies. His bail was way too high for anyone to get him out. He pleaded with me: “Mom, please borrow the $20,000 to get me out.”
He spent Thanksgiving, Christmas, New Years Eve, Easter, and his birthday in jail. We did get to have a few minutes together on Christmas when we did a video visit.
Now, we will never ever have another Thanksgiving, Christmas, New Years Eve, Easter, or any birthdays or Mothers Day with him again. All we have are pictures and memories.
On a Friday night, Jaron lost his battle with substance use. I thought this time he had it, and he thought he had it too. He was so convinced he had won and he took one last chance. Jaron never thought he would lose his life on that last ride, but what he thought was heroin was 100% fentanyl.
When I got to him, his body was still warm. He looked like he was sleeping, except he was not on the couch, he was on the floor. I hugged him and I kissed his hand were the needle was. I covered him, because he hated to be cold.
A part of me died right then and there with him. It seemed like forever before the paramedics, police, and medical examiner were finished. They loaded my baby up in a van and stuck him in a cold black bag.
I did his eulogy. it was the last thing I could do for him. At his funeral, he was all dressed up in his favorite clothes: shorts, a white T-shirt, his sneakers, and a Giants jacket. Pictures and little mementos were placed in with him. He looked like he was sleeping, but he was cold and hard. It was like touching a stone, but I couldn’t stop touching him and kissing him because I knew I would never do it again.
The hardest part of that day was walking out of the funeral home, knowing I would never see his beautiful face again on earth. My Scooby, my baby.
I know many people are fighting the same demon Jaron did. If just one person gets sober because of his death, it will make some sort of sense.
That Hole In Your Heart…
It never heals. For some of us, it grows larger, causes even more pain and despair, and wakes us in the middle of the night more often than before – if that is humanly possible.
Losing a child is the worst thing that can happen to any parent; a piece of us dies when our child dies. And while the death of every child is soul-crushing to any loving parent, losing a child to addiction or overdose creates an extra burden of anguish. He or she might have struggled for years; the family was likely torn apart and perhaps went bankrupt; the medical system invariably failed us, and the criminal justice system seemed to play a huge role although we were battling an illness. Then there is the crippling stigma that does not surround any other illness: the often unasked questions from others, lingering beneath the surface; the unspoken moral judgment; even self-doubt.
I know this because I lost my beautiful boy, Austin, to an accidental overdose after a nearly six-year journey, just when it seemed he had turned the corner and was finally on the mend. The call came saying he was gone. A few days later I waited on the stoop for FedEx to bring me Austin’s ashes in a box. My world would never be the same.
We want to bring families of loss together once and for all. Today we are announcing the creation of a private Facebook group that I will be actively involved in, called Loved Ones Facing Addiction. If you lost a loved one to addiction/overdose, I urge you to join. I hope you will also consider holding a fundraiser on Facebook on National Overdose Day — August 31 — to help Facing Addiction with NCADD raise much-needed funding for our critically important work.
Families of loss have never been unified so their powerful voice could be heard and influence felt. Sadly, it is a massive, determined group. We lose 350 people, usually young adults, to addiction/overdose each day — the equivalent of a huge jet falling from the sky…with no survivors. Some 140,000 people a year — twice as many as we lost over two decades in Vietnam. More than two and one-half million families devastated just since the year 2000.
I co-founded Facing Addiction (now proudly with NCADD) to help build a movement to finally do something about America’s addiction and opioid crisis. Through our partnership with former US Surgeon General, Dr. Vivek Murthy, we know what needs to be done in America to slay the addiction dragon, we just have never done it. And so Facing Addiction with NCADD is now “doing it.”
We need your support. And I promise we will never let you down. We all have way too much invested in this cause.
Medical Records for Addiction: To Integrate or Segregate?
Healthcare providers face new challenges in improving medical care for people with substance use disorder. This can be as simple as prescribing certain medications to people in recovery from opioid use disorder and ensuring continuity of care for someone exiting treatment. As more people seek help, it’s clear that we need a coordinated, integrated approaches to care to help patients succeed. Yet, at the same time, compromising confidentiality might put people at risk.
One of the addiction-related bills now pending approval in the Senate is the Overdose Prevention and Patient Safety (OPPS) Act. This bill would remove barriers that prevent records related to care for substance use disorder (SUD) from being included in a patient’s overall medical record. Instead of keeping substance use treatment records separate and secret, they’d be part of a patient’s medical record. Jeremiah Gardner, in The Hill, points out that “SUD is the only illness in health care subject to this kind of separation, secrecy and institutionalized stigma.”
Patient privacy laws have made it difficult to integrate care for people with substance use disorder. Currently, medical records that specifically pertain to SUD treatment are protected by a law called Confidentiality of Alcohol and Drug Abuse Patient Records, 42 Code of Federal Regulations 2 — also known as 42 CFR part 2 (part 2). Under this law, “most SUD treatment records are maintained separately and partitioned from a patient’s other medical history, and healthcare providers can only look behind the partition if a patient has signed a specific, written consent allowing it.” That means that, from a medical standpoint, addiction can hide in plain sight—even in the examination room.
From a patient’s perspective, however, that additional protection could be all-important. Deborah Reid and Mark Parrino argue, “Substance use disorder patients need Part 2’s stronger confidentiality protections precisely because they face more significant discrimination and other harmful consequences than people living with other illnesses.” Although advocates have taken huge steps to reduce the stigma of addiction, it is still seen as an illness with a moral component. Unlike diabetes or heart disease, disclosing a diagnosis of substance use disorder could have far-reaching consequences, including loss of employment, housing, public benefits, and even custody of one’s children.
Addiction medicine is increasingly accepted as a medical sub-specialty and is in the process of integrating into mainstream medical care. That means, from a practical standpoint, it’s more likely that patients with SUD will need to share that aspect of their medical histories in order to get good care in other areas. In addition to seeing the “whole patient,” providers may be able to avoid prescribing problematic medications that trigger a recurrence of use. Current laws put the onus on the patient to disclose their history of alcohol or other drug-related problems.
The OPPS Act would eliminate the partition and ensure that people’s medical records are complete. Some advocates say that keeping substance use disorder-related records separate creates huge problems for both providers and patients, “from the incompatibilities and costs of separate systems to the challenge of patients and providers finding a way to reconnect when new consents are needed, sometimes long after treatment has ended.” Furthermore, maintaining a separate database of SUD-specific records reinforces the stigma of addiction. In an age that is moving toward electronic-only records, the benefit of the OPPS Act is a complete, accessible medical record for every individual. The drawbacks are lack of privacy for some patients, negative consequences, and vulnerability to data breaches.
Integrating medical records doesn’t mean that patient privacy goes out the window. However, it may be too soon to enact legislation that will make the changes the OPPS Act creates. If it’s passed, the Health Insurance and Portability Protection Act (HIPAA), which provides strong, enforceable privacy protections, would still cover substance use disorder as a protected medical condition.
Recovery is a right for all patients. Privacy laws, which are intended to protect patients, can sometimes work against people with substance use disorder, and actually set them up for future medical issues. Continuing to eliminate stigma is key to making progress in the healthcare industry. When addiction is treated with the same attitude as other chronic illnesses, privacy laws might be more relaxed. Until then, supporting patient rights is critical.
Catch The Wave of Recovery
12 Steps? Get SMART? Try hanging 10. Using a surfboard, the waves, and recovery support, surf therapy is helping people with substance use disorder find their balance.
According to Surfer Today, addiction therapists found that surf therapy, which is also known as ocean therapy, can help treat substance abuse disorders and other, co-existing disorders linked with addiction. Carly Rogers, an occupational therapist, studied the effects of surfing as a psychotherapy on more than 400 war veterans through a program she started with the Jimmy Miller Foundation.
Rogers noted that special needs children thrived in response to ocean therapy. While completing her Master’s in Occupational Therapy at University of Southern California, Rogers created a therapy program for children recovering from abuse. Rogers said, “Having worked as a Los Angeles County Lifeguard for the past nine years, and instructing children in ocean safety for the last seven, I have been able to witness the therapeutic effects of surfing. I’ve seen children jump out of wheelchairs, trying to get to the water’s edge. Now imagine the impact of being able to actually ride a wave?”
Rogers adapted the ocean therapy program to help adults, and found that it was effective in helping them recover from substance use disorder, post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, and other life-threatening injuries. Rogers extended the program to Marines and war veterans. It now runs about 60 sessions a year in Manhattan Beach, Calif., and farther south at Camp Pendleton and has served over 400 veterans.
Veterans have high rates of substance use disorder, although it’s slightly lower than the national average. According to the 2013 National Survey on Drug Use and Health, 1.5 million veterans aged 17 or older (6.6 percent of this population) had a substance use disorder in the past year. Overall, about 1 in 15 veterans had a past year substance use disorder, whereas the national average among persons aged 17 or older was about 1 in 11, or 8.6 percent. Ocean therapy can help people cope with multiple mental health issues at once, and is ideal for veterans or other people who may be recovering from physical injuries as well.
Surfer Today says that ocean therapy is effective in treating addiction because of the nature of surfing. It’s a physical, mental, and emotional challenge and pushes surfers to get out of their comfort zones. “Getting on a surfboard translates to increased confidence. The physical challenges associated with surfing are similar to the mental and emotional affairs patients try to avoid during addiction.” The therapist leading the session guides the person to process their experiences.
Rogers said in her Ted Talk that surfing offers “infinite possibilities to heal.” From substance use disorder to co-existing issues such as PTSD, physical limitations, and depression, the ocean can be a source of healing. Surfing, as therapy, is yet another treatment modality that can help people recover—and find new horizons within themselves.
Addiction is Nonpartisan, But Not Apolitical
Americans agree that the drug epidemic is a serious problem. Addiction is likely to be a top issue in the upcoming midterm elections. The crisis is expected to affect the midterms race by race and candidate by candidate, rather than along party lines.
According to a recent poll, substance use disorder is important to people of many political affiliations, from vastly different backgrounds. Although the national health crisis is a nonpartisan issues, not everyone agrees on the best strategies for solving the problem.
A recent poll from the Pew Research Center showed that 9 in 10 Americans in rural areas consider drug addiction a problem in their communities. The statistics are similar in cities and towns: 87 percent of people in urban areas and 86 percent of people in suburban areas said that addiction was a problem.
According to Yahoo News, “In 2016, the most recent year for which we have full data, more than 63,600 people died from drug overdoses, and preliminary information suggests this has only increased.” The health crisis, in other words, is impossible to ignore. Voters and recovery advocates are calling for solutions at the state and federal level.
John Hudak, a senior fellow of governance studies at the Brookings Institution, a public policy think tank in Washington, D.C., told Yahoo News that the two major political parties perceive the crisis very differently. Whose responsibility is it to help, and what is the best path to take? Parties disagree about how much to spend on the epidemic. Hudak said Democrats see the crisis as a problem of such magnitude that a significant amount of federal funding is required to assist states and localities. Republicans, on the other hand, don’t think it requires as much spending.
“We’re talking differences of opinion in the range of $100 billion in some cases. That creates what ends up being gridlock on an issue that would otherwise appear to avoid it,” Hudak told Yahoo News. “In the current political environment, anything that has an opportunity to cause gridlock is ultimately going to win the day.”
More funding, support of recovery groups, and federal involvement are all important to voters. However, it’s not clear that this opinion translates to election wins for candidates. As a nonpartisan issue, substance use disorder falls outside of party lines. Solutions can be found on both sides of the aisle: the best idea is the one that gets voters’ support.
Hudak believes that the health crisis will be handled on an individual candidate and individual race basis. As a nonpartisan issue, addiction can be the “exception to the rule” for some candidates. For example, a candidate may not support Medicare expansion or giving more funding for healthcare—unless the money is earmarked for people with substance use disorder.
Long-term solutions that address the deeper issues fueling the crisis are critical. Healing the epidemic is not an overnight matter. Hudak said there are members of both parties who are serious about fixing the problem and members of both parties who are guilty of “finding something that will pass,” even if it’s is far less meaningful than what is necessary, so they can hang their hat on that “success.”
“Where the opioid crisis and opioid policy matters will be on an individual race basis and an individual candidate basis,” Hudak said. “You will probably have a handful of candidates in 2018 who are going to talk seriously about the opioid crisis, and they are going to have a plan that’s convincing.”
Recovery Is For Families, Too
I was quietly sober until my son needed treatment for addiction. (Yes, it is a family disease). My son was denied treatment. As a willing patient, he was turned away.
That ended my quiet anonymity. I joined an advocacy group, Recovery Advocacy In Saratoga (RAIS), and found my voice. I have joined with other warriors to share the good news. Recovery is real, recovery is fun, and recovery gives us everything.
I have also become an active advocate to increase access to treatment. We must get healthcare to the people who need it. We must start opening hearts and doors instead of letting providers turn us away. We must change the system so we are admitted and given treatment instead of stabilized and discharged.
If I could change just one law or one requirement, I would destroy the portion of the Controlled Substance Act that limits methadone and other addiction treatments to addiction centers.
We deserve to recover. It is a long struggle that happens one patient and one hospital at a time. But it is a struggle we must win.
New FDA-Approved Device Eases Withdrawal Symptoms
The FDA approved a wearable device that blocks the symptoms of opioid withdrawal. The Drug Relief device, which is manufactured by DyAnsys Inc., is an “auricular neurostimulation device” that can be prescribed to people in the detox phase of withdrawal.
Drug Relief works without narcotics or any medication. It is a small, metal device that clips onto the skin near a person’s ear, kind of like a hearing aid. The device sends electrical pulses through tiny needles inserted in the ear and can alleviate symptoms such as anxiety, agitation, depression, nausea, and opiate cravings within 30-60 minutes.
Drug Relief is described as “a percutaneous electrical nerve field stimulator designed to administer auricular neurostimulation treatment over 120 hours. The non-addictive treatment allows for continuous nerve stimulation over five days while offering the patient a high degree of comfort and mobility. According to providers, patients may see a reduction in the symptoms of opioid withdrawal within 30 to 60 minutes of beginning treatment.”
In the five-day period, when detox symptoms are blocked, the person using the device could undergo treatment for substance use disorder, get help for acute health problems, and participate in their own recovery. The first weeks of opiate withdrawal can be brutal, and many people say that they are afraid to try stopping because of the extreme detox symptoms. This is true whether the person wants to use medication-assisted treatment such as methadone, try quitting cold turkey, or use a doctor-aided tapering program.
“This device offers hope to those who are suffering from opioid addiction,” said DyAnsys Chief Executive Officer Srini Nageshwar. “We are in a full-blown crisis and we need non-narcotic options and alternatives like this that can make a significant difference for individual patients and their families.”
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 11.5 million Americans age 12 and older misused prescription pain medicine in 2016. More than 2.5 million Americans suffer from opioid use disorder, according to the National Institutes on Drug Abuse (NIDA). The need for accessible, safe recovery support is apparent. Once a person is stabilized and able to participate in their own recovery by attending peer support groups, going to doctor’s appointments, eating and sleeping normally, and meeting with recovery mentors, their chances of avoiding a relapse increase.
Drug Relief is not the first device of its kind. The BRIDGE medical device, which is also FDA-approved, works through neuro-stimulation and is an auricular peripheral nerve field stimulator that connects topically to the patient’s ear, blocking pain signals from getting through the brain. Like Drug Relief, BRIDGE is also minimally invasive. Field research shows that, within half an hour of putting the device on, a person can go from extreme detox symptoms such as sweating and vomiting to talking and behaving normally.
Medical interventions such as these wearable devices help people make the most of the first days of their recovery and may take away the fear of discomfort that prevents some from attempting detox.
Protecting People from Post-Op Addiction
Prescription painkillers are highly addictive, even when they’re taken as prescribed. Yet, for people who are recovering from surgery, painkillers are not optional: they’re necessary. Up to seven percent of all patients who were prescribed such painkillers following surgery develop a persistent habit. A recent review in the Journal of General Internal Medicine suggests that addiction rates can be reduced for post-op patients.
Michael Klueh of the University of Michigan in the US led the retrospective review of medical specialty areas to find out which are most likely to prescribe opioids for the first time to postoperative patients. Klueh’s team analyzed insurance claims filed by patients between 18 and 64 years old who had undergone surgical procedures between 2008 and 2014. All of the patients were first-time users of opioid drugs as a form of pain relief. “In all, the researchers identified 5276 patients who had developed persistent drug habits and continued filing opioid prescriptions three to six months after their operations had taken place—well past the stage that the use of such medication is deemed normal.”
The researchers identified which medical practitioners prescribed the most painkillers. They noticed that surgeons wrote 69 percent of prescriptions in the three months following surgery, followed by primary care physicians (13 percent), emergency medicine personnel (2 percent) and physical medicine and rehabilitation staff (1 percent). All other specialties accounted for 15 percent of such prescriptions. “In contrast, nine to twelve months after surgery, the majority of opioid prescriptions were provided by primary care physicians (53 percent), followed by surgeons (11 percent). Even with increased awareness of the risk of addiction by both patients and doctors, additional action is needed to prevent people from developing substance use disorder.
The review calls for “enhanced care coordination between surgeons and primary care physicians to allow for the swift identification of patients at risk of developing new opioid use issues so that further misuse and dependence can be prevented. Surgeons and physicians should also consider the use of specific non-opioid postoperative painkillers.” More pain management options, as well as support for opioid tapering, need to be standard options for post-op patients.
“Shorter initial opioid prescriptions after surgery would trigger a feedback loop between patient and physician, allowing surgeons to rapidly identify patients that continue to require opioids,” says Klueh.
Prescription painkillers given after invasive, painful surgery increases the risk of addiction. Although opioid painkillers may not be avoidable for someone in recovery from surgery, improved communication and aggressive tapering of opioids while still in the acute surgical period can reduce the risk of developing a dependency that may become substance use disorder.
Addiction’s National Profile
A new Pew Research Center survey shows that Americans overwhelmingly view drug addiction as a problem in their local communities. That’s true whether they live in urban, suburban, or rural areas.
The survey data was gathered from 6,251 adults and conducted earlier this year, between February 26 and March 11.
Substance use disorder, especially opioid use, has drawn widespread media attention. Advocates’ efforts have brought the issue to policymakers, leaders, and everyday Americans. According to Pew, “President Donald Trump last year declared the epidemic a national public health emergency, and statistics from the Centers for Disease Control and Prevention underscore the deadly toll that opioids and other drugs have taken.”
Finally, Americans seem to be getting the message that we are in the midst of a massive public health crisis. Substance use disorder isn’t a moral issue: it’s a social one, and it’s claiming lives on a monumental scale.
The new survey reported that nine of every ten Americans who live in a rural area say drug addiction is either a major or minor problem in their community. The same is true of 87% of people surveyed in urban areas and 86% of people surveyed in suburban areas. Suburban counties had the most overall drug overdose deaths in 2016 as well as the highest age-adjusted rate of deadly overdoses. However, suburban people were least likely to say that addiction was an issue. Pew reported, “Substantial shares in each community type say addiction is a major problem, though people in urban and rural areas are more likely to say this than those in a suburban setting (50% and 46%, respectively, compared with 35%).”
Nationally, more than 63,600 people died of a drug overdose in 2016. About two-thirds (66%) of the fatal overdoses in 2016 involved an opioid. The number of deaths for 2017 is projected to be even higher. The number of overdoses has increased significantly in urban, suburban and rural counties, according to the CDC. “There were 19,172 fatal overdoses in urban counties in 2016, up 25% from the year before. Suburban counties experienced 36,424 such deaths, up 22%, while rural counties saw 8,036 deaths, up 9%.”
Lethal overdoses among urban black men are rising significantly, increasing 40% between 2015 and 2016, from 12.2 deaths per 100,000 people to 17.1 per 100,000. According to Pew, “Among black men in urban counties, specifically, the fatality rate rose 50% – from 22.6 deaths per 100,000 people in 2015 to 34.0 per 100,000 a year later.”
Additionally, “In the Center’s new survey, about half of blacks (49%) say drug addiction is a major problem where they live, as do 45% of Hispanics and 40% of whites. Majorities of eight-in-ten or more across the three groups say this is at least a minor problem in their community.”
The new survey research confirms that awareness of the drug epidemic is rising. However, awareness and action are not the same thing: to effect real change and save lives, it is necessary to take steps to help people with substance use disorder access viable solutions, recovery support, and compassionate care.
Addiction Is A Human, Not Partisan Issue
My friend Tyler died earlier this year from an accidental heroin overdose – on the sofa in his recovery home. His death was preventable, and not because, as some people say, he had a “choice” not to use. Tools like evidence-based treatment, recovery supports in the first five years of recovery, and naloxone to arrest overdoses could have saved his life.
Addiction is a public health crisis that is abetted by many corporations, ignorant policies, and business leaders. Some of the people pouring gas on this fire are the very people to whom we trust our friends, children, and loved ones.
In three and a half years of recovery, I’ve met many unscrupulous and negligent opportunists in our country’s $35 billion addiction treatment industry. These bad actors charge exorbitant amounts of money in exchange for basic services that people new in recovery need. They supposedly provide early recovery support such as housing, but there is virtually no accountability and zero oversight.
That’s what I found when I visited the recovery home in Pasadena, CA where Tyler died. In a house full of people with a substance use disorder, all of whom were at great risk for an overdose, there was no naloxone. The staff did not have an overdose protocol. When I asked them what had happened, they threw their hands in the air, waving off accountability.
They had the audacity to tell me, “Tyler clearly just didn’t want to get sober.”
My friend tried hard, multiple times, to achieve sustained recovery. The failure of this recovery house cost him his life. His death affects his family, his loved ones, and his entire community. The stakes are too high, for people who are extremely vulnerable. There is a Tyler in every family, in every school. I knew it was too late to help my friend, but our community had to take action to protect other people just like him.
Full of grief and desperately seeking a solution, I drove to Congresswoman Judy Chu’s office and brought two other members of our recovery community. We asked for a meeting and educated our member of Congress on what was happening in her own backyard. Congresswoman Chu listened to our stories, nodded, and gave us a very rational reply: “It sounds like we need better policy.”
Using our experience as people in recovery who had gone through the treatment and recovery home continuum, my best friend Garrett Hade, who was also friends with Tyler, and is in recovery from heroin himself, joined the team at Facing Addiction with NCADD to help author the legislation that would address and prevent deaths like Tyler’s. With our help, Congresswoman Chu introduced H.R. 4684, the “Ensuring Access to Quality Sober Living Act” in March of 2018. It passed the House earlier this month without a single opposing vote.
A unanimous vote in support of H.R. 4684 is a signal of meaningful change in the midst of the opioid epidemic. It shows that facing addiction is a non-partisan issue for Congress. H.R. 4684’s unanimous vote demonstrates that elected officials can cooperate when they’re voting with their heads and hearts. It also provides a roadmap for citizen engagement for the future. Good policy can come from policymakers who invite people in recovery and families to the table.
To stop this epidemic, and save the people we love from preventable deaths, we need to ensure that the people affected by the crisis have a seat among the decision makers. There is no substitute for lived experience. That means No decisions about us, without us.
As multiple pieces of legislation make their way through the House, they’ll be bundled together with packages currently taking shape in the U.S. Senate. Yet, without voter support, loud voices calling for action, and families demanding that our tax dollars fund solutions to this crisis, some of the most important elements of these bills might collect dust on the shelf. If we want funding for life-saving recovery supports that actually work, we need to contact Congress members and demand that this public health crisis is addressed as a crisis, not used as window dressing to look good in the midterms.
Otherwise, we’re turning our loved ones over to people who are unprepared and unwilling to help. If something goes wrong, our families and communities need to have recourse. We deserve accountability. We deserve transparency. And we deserve to know that the people treating and caring for people with this chronic health disorder are ready to handle the worst.
To build a safer, healthier nation and ease the massive strain addiction places on our communities, businesses, social services, and criminal justice system, we must work together to become a constituency of consequence. We have the power to demand accountability, action, and funding from Congress. We won’t settle for empty promises. This recent unanimous vote shows that our leaders are willing. We need to show them the way.
RYAN HAMPTON is an outreach coordinator at Facing Addiction with NCADD, author, and person in recovery from heroin addiction. His book AMERICAN FIX: Inside the Opioid Addiction Crisis — and How to End It is being published by St. Martin’s Press in August.
What Are The Most Dangerous Addictive Drugs?
A new report shows that alcohol and tobacco are still more deadly and damaging than heroin. Although illicit substances often capture the focus of the media as well as prevention efforts, “socially acceptable” substances are worse for your health.
New research shows that alcohol and tobacco are more commonly used, and more dangerous than other substances. Science Alert said, “On average, smoking accounts for 110.7 deaths per 100,000 people. In the same size sample, alcohol accounts for 33 deaths, and illicit drugs like cocaine account for 6.9 deaths. Nearly one in seven adults (15.2 percent) are regular tobacco smokers, the study shows, while more than one in five adults have reported at least one occasion of ‘heavy alcohol use’ within the last 30 days.”
The data was gathered from various sources, including the World Health Organization (WHO), the United Nations Office on Crime and Drugs (UNODC), and the Institute for Health Metrics and Evaluation (IHME). The research showed problems related to substance use are increasing, worldwide. The study says that alcohol and tobacco cost humans a quarter of a billion disability-adjusted life years: that is “years lost to premature death, or lived with the burden of diseases like cancer and cardiovascular problems.” Illegal substances add tens of millions more years, which is significant but still only a percentage of the damage caused by alcohol and tobacco.
“Smoking and alcohol are always well ahead [of illicit drugs],” one of the researchers, Robert West from University College London in the UK, told The Independent. “There’s nowhere that it even comes close.”
Although the study was not able to give a perfect account of substance use, it paints a very clear picture of substance use around the globe. The study suggests that more information from some areas, such as regions of Asia and Africa, would show how substance use affects other populations, as well. Unrecorded consumption of illicit substances occurs in every part of the world.
Ultimately, the research shows that alcohol and tobacco are the most damaging addictive substances that people use, around the world. Their cultural acceptability, as well as ease of access, also make them more prevalent. That means that new public health policies need to focus on prevention and creating cultural change that will help people choose to avoid harmful substances. The benefits are more than just better health for more people.
“Their health burden is accompanied by significant economic costs, namely expenditure on healthcare and law enforcement, lost productivity, and other direct and indirect costs, including harm to others,” writes the team of researchers.
The negative impact of substance use is more complex than one person’s health. On a global scale, addressing substance use can give more people more quality years of life, and help build a better, healthier world.
Smash The Stigma
On Saturday night June 9th, the Young Leadership Team of Facing Addiction with NCADD hosted over 250 people for an engaging and successful educational event. The free event allowed young people the option to register for a round-robin ping-pong tournament, cleverly providing the name for the event: Smash the Stigma. Upon arrival, competitors were matched up with opponents and played four games against different players, each of whom had collected pledges for their points won. Not only did the tournament serve as a fun activity for the young people on a Saturday night it also raised over $100,000!
There were several other activities for those not playing ping-pong players; shopping vendors who donated a portion of their proceeds included Peter Elliot, Loeb Jewels, Encircle NYC, MC Bags, and Blushington offered free makeovers. Ravenous shoppers and ping-pong players were nourished with Juice Press beverages and delicious donated Tao catered food.
Midway through the event, the speaking program began. One of the founding Young Leaders, David Levine, MC’d the speaking program, introducing each speaker and providing humor between speeches. Robin Aviv, a board member of Facing Addiction with NCADD, spoke about the Young Leadership Team’s mission, the sense of community it provides its members, the importance of erasing the stigma associated with addiction and, of course, the real and growing dangers of mixing opioids and alcohol. Then, some of the young leaders spoke about what the leadership program means to them. Tyler Kaplan shared his personal journey dealing with the shame of having addiction touch his family and how the young leadership program created a safe space for him to feel comfortable, understood and unashamed. Joesph LMS Green joined us all the way from Washington DC and inspired the crowd with a profoundly personal and motivating spoken word performance. Lastly, three young leaders Jake Sandler, Addie Ezersky, and Bella Kaplan spoke about why they got involved with the group and the support, knowledge, and leadership skills with which the program has provided them.
After the speaking program and once ping-pong players completed their four round robin matches, the top eight competitors played in a single-elimination tournament. Other attendees played “beat the pro,” in which they had the opportunity to win incredible prizes such as Macklemore concert tickets, VIP Giants, Jets and Mets tickets, gift certificates and shopping experiences, restaurant certificates and tickets to a Broadway show. It was a great evening of awareness and fun!
Understanding Opioid Demand and Dependence
Prescription opioid painkillers are linked to rising overdose death rates. Prevention efforts focus on limiting the supply of opioids. However, a new approach suggests that concentrating on reducing demand could be effective also.
Medical sociologist and professor Susan Sered says that current legislation, which calls for expanding prescription monitoring programs, amping up the ability to seize illegal drugs at U.S. borders, training health care providers in proper prescribing practices, and improving drug disposal systems are directed toward supply reduction. As a form of “secondary prevention,” she suggests, we need to look at the root causes of opioid addiction.
Sered asks, “Why are so many Americans willing to ingest substances that, they most likely know, can lead to grievous harm?”
The answer is in the factors that cause people to need addictive medications: specifically, pain.
For the past decade, Sered has conducted research in Massachusetts, studying women who were incarcerated and have substance use problems. She said, “The Massachusetts women with whom I have been conducting research for the past decade began their substance abuse careers in pain, either mental or physical. In some cases, the pain was a consequence of childhood or intimate partner abuse. In other cases, the pain set in because underlying health problems were not attended to properly or in a timely manner.”
Sered says that understanding pain, and changing the way that we cope with it, is a method of primary prevention that is being overlooked by lawmakers. She points out, “Primary prevention – which deals with the reasons that people turn to opioids in the first place – is mentioned in the Senate bill in only a few places but is not developed either in terms of a research plan nor in terms of public health strategies.”
Furthermore, prevention efforts focus on shallow, ineffective social and media programs like “Just Say No.” Pain is a complex issue, and for many people, especially those who cope with chronic pain, saying “no” to opioid medication isn’t an option.
Neither is taking time off from work, or pursuing alternative pain treatment that may take longer than popping a pill. Sered said that when substantive help wasn’t available to her research subjects, they turned to psychotropic and pain medication from doctors or drug dealers or both. Unable to take time to heal, the women relied on medication that they may not have needed. Sered said, “Often, the pain wasn’t taken seriously by employers, who insisted that minimum wage workers show up even when they are unwell, family members or health care providers.”
Sered also acknowledged that gender, class, and race are potentially predictive factors in addiction. She pointed out that data indicates opioid use is primarily a male problem, and that white men in low-income ZIP codes are more susceptible to developing an issue with opioids. That means, she says, that we need to look at not just the neurological aspects of addiction, but the sociological ones, too.
She asks, “Information of this sort lays the groundwork for primary prevention. What is it about being male in a white low-income community that causes pain and makes opioid use attractive as a means of dealing with pain? Are there occupational or educational policies that encourage or discourage substance abuse? And can those policies be adjusted in ways that reduce pain as well as substance abuse?”
Identifying the root causes of pain, both physical and cultural, and offering a more complex, compassionate solution that focuses on primary prevention may stem the tide of the drug epidemic. Painkillers cause people to lose their lives. To create life-saving, meaningful change, we need to dig deeper into the issues that precede addiction.