Rage, rage against the dying of the light: a call to action.

I have been using a term: “treatment on demand.” Why, treatment on demand? “Why not?” should be the question, by now. For twenty years, perhaps more, we have been watching an escalating overdose death rate climb until it outstrips every other form of death for persons 18 to 60 years of age. Most, though not all of those who are dying, are persons with addiction. Given that the Substance Abuse Mental Health Services Administration (SAMHSA) has said that nearly 93% of those with addiction are not receiving treatment or benefitting from recovery—this has become a plague that operates with our nearly dumb acquiescence. This is the modern version of a “slaughter of innocents.” Folks are dying without ever realizing that the disease is treatable and death might be forestalled.

If most of the dying belonged to a minority population of any other kind, legal action would have begun, civil disobedience protests would be underway, boycotts organized, and the actions of the movement would be prominent in the news. As it is, even the September Recovery Day Celebration has trouble finding page one at the news stand. I am sickened by the numbers of people slipping shamefully un-noticed into the grave. Well, this article is a call to action: in Dylan Thomas’ words, “Rage, rage against the dying of the light.”

No politician running for even the most humble office without substantive thought on this issue will get my vote. At political events and rallies, I am going to demand their views on the overdose death problem. I want them to understand that this issue must be the major focus of their health agenda. They need to understand that they can meet their constituents more frequently by mourning with them at funerals for loved ones than they can by attending their children’s weddings. I want saving Social Security to be a problem again. The death rate has taken that debate off the table for anyone paying attention. Abortion? Your stand on abortion is immaterial if you ignore this issue. “Tinkling bell, sounding cymbal.” And I don’t care who marries who. There are fewer dollars at stake there for individual tax payers than there are for the thousands whose overdose medical costs have to be paid whether they live or die. Typically, there are five overdoses, with the last adding a funeral expense. Want to bring down medical costs? Really? Then what is your plan to reduce overdose rates? How are you going to fund treatment on demand?

I understand that men of faith must deal with issues like caring for an aging population, abortion, and gay marriage. Try as we might to pretend that we have no social obligation to deal with these issues—they will continue to press into our every-day living and demand from us a moral response. What I do not understand is how anyone can ignore, as we have, the immoral and downright shameful loss of so many of our citizens, cut down in their prime by overdose death. If you believe that our morality is slipping—I will tell you it went off the rails when we began to barter with death for taxes on liquor, drugs, and gambling—without making any accommodations for treating persons who might come to harm as a result of their use. Providing for treatment on demand is an attempt to right a poorly run and badly listing ship of state.

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Lessons From Vernon Johnson’s Feeling Chart

Today, I am loosely following concepts incorporated in a Vernon Johnson “Feeling Chart” chalk talk, heard at the Rutgers School for Alcohol and Other Drug Studies in 1979. I am grateful to him, for his work in the field of addiction, and for helping me find my road to recovery through it.

Defenses are the usual physiological (using organ/muscle-energy connected to thought) behaviors by which we mediate and manage our feelings. Using drugs teaches us a no-energy way to manage feeling states, one that varies from person to person—though each has his or her idiosyncratic palette of substances to choose from, in our culture. This brain training happens at a preconscious level in the Pons/Medulla/Limbic system of the brain. As such, the neural pathways are too central for a lobotomy to be a safe option—though that is the only way one could completely alter the brain training outcome.

Persons with addiction do not respond well to retraining—partly because their complex neuro-structures conform to genetically engineered changes in the brain’s cellular structures. In non-addicted persons, a great degree of behaviorally conditioned re-routing of these pathways occurs—when the individual has a negative outcome from drug use. At present, the only way of marking the distinction between addicted persons and those who are not is behavioral. Both experience using a chosen substance as having a positive effect on one’s feeling state. Practiced repeatedly, all drug users begin to think “it works every time.” A second bit of information that becomes grooved and is also socially reinforced by DUI programs, and other legal and social sanctions is that “I control how, when, and where to use, and how much.” These commonly held beliefs may be changed in the non-addicted person, if negative outcomes occur as a result of drug use. The defense mechanism of questioning oneself comes into play and the individual alters pre-peak-feeling use patterns to say: “I’ll never do that again.” And s/he doesn’t do that again.

The person with addiction has defenses that protect the using behavior—so, rather than questioning oneself, s/he wonders, “What in the environment or events surrounding the use was responsible for the negative outcome I experienced?” Invariably, some paltry excuse or reason is found for the negative outcome. The initial confidence in a positive outcome (“it works every time’) and in my power to control my use (“I control how, when, and where to use, and how much”) is reinforced by my “reason” for the negative outcome. And so it rolls: the non-addicted person challenges and changes his or her own behavior leading to the peak feeling one gets from using; and the addicted person challenges or alters the environment to find the problem, thereby assuring the negative outcomes will continue to occur.

After a period of time of flying in the face of reason, the addicted person loses the ability to reason. Literally, s/he becomes unable to critically challenge his or her own behavior; and s/he becomes convinced by the negative reactions of society or persons around them that the problem really does lie with others rather than self. The defenses completely support using substances to mediate feeling states, and normal emotional give and take with others becomes less and less possible. The person with addiction may believe that s/he would be OK if certain other persons would change. S/he may even change friends and life partners in an effort to find the “right” kind of people. Typically, this has the effect of surrounding the person with others with whom s/he might never have associated—prior to becoming a drug user.

Standards and values once held as sacred are also gradually lowered to be within reach of a more relaxed (read: “less critical”) state of mind. The person develops an alibi system to explain the distance between reality and dreams of once-hoped-for life outcomes. “If my wife/husband had been more understanding—we would never have separated or divorced.” “My boss really liked my work until s/he had to do more work because of the business that I brought him. I wore myself out for him/her and needed the extra time off. How dare s/he cite ‘unpredictability’ as a reason to pass me over for promotion. ” The person with addiction often retaliates, both aggressively and passively, to get even for resented insults to those once held dreams.

This is the insanity of addiction. It is so compelling and strong that fully 93% of person with addiction never succeed in realizing that they have it and cannot bring themselves to get help. Of those who get help, only about 3.5% achieve any success at leading a normal life. Because of shame and stigma surrounding addiction, many of those success stories are never told, because it is too painful to collect the prize by publicly owning the problem. Meantime, the 96.5% of persons with active addiction continue to raise families, work on assembly lines, run businesses, lead persons into battle, run for office and make laws. All such work is negatively impacted by addiction that society as a whole has accommodated so long that it no longer realizes the damage being done…or perhaps our denial just makes it easier to own our powerlessness in the face of obvious social decay. Nearly one fifth of US are addicted and/or will suffer from its direct effects in our lifetime.
One bright spot exists.

In September of every year for the past decade, those persons who are surviving and recovering from addiction are shouting about how it is done—getting more of their story told. In the process we are seeing heads of families discuss the roadmap to recovery, for self and family. We are seeing workers and business leaders explain how the crooked and damaged product of addicted commerce can be repaired and improved. We are hearing from respected leaders about the benefits derived from owning and walking through the pain to correct the damage done in a drugged past. Unavoidable human suffering can be redemptive: Celebrate Recovery in September.

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How much is a life worth? 07152014

Kentucky’s General Assembly had a bill before it to allow police officers to carry Narcan, since they are often the first responders to emergency situations in Counties without paid fire and rescue workers. The cost per dose of Narcan is about $20–far below the usual costs for failed life support on unconscious victims who never fully recover, if they recover at all.

Narcan works miracles. Sprayed up the nostril of a victim of overdose, blown by rescue breathing into the airway of an unconscious person whose heart is beating–Narcan temporarily reverses the overdose, and does it miraculously fast. Then one must get the victim to help and on oxygen fast. When the Narcan wears off, other measures may be needed to assure recovery. Narcan does not seem to have any harmful effect if it is given to an unconscious victim who is not overdosed but who is nevertheless unconscious when help arrives.

In Lexington alone, emergency workers have saved more than 54 persons a month for the past two calendar years. In that time, more than 1300 lives have been saved (about 650 each year). That cost comes to $26,000 spread over two years–well below the cost of the initial hospital stay of a victim of overdose with residual brain damage. Actually, only three of those victims would have had to die to leave behind a $26,000 bill for inexpensive funerals–not to mention the untold grief to families and friends.

If the program had only saved 21 persons in the two years, and if each had worked a minimum wage job for a year, their combined tax burden alone (21 x $1279.20) would have paid for the program. Over the two years, Lexingon stands to recoup better than 63 times, in taxes, what it spent on the program–from the people whose lives were saved, by making sure that fire and rescue workers were trained and equipped with Narcan to treat persons who had overdosed. It strikes me that there are few routine emergency runs that hold that much promise for the responsible bodies of government that fund them.

This year, Lexington is already projecting on the basis of monthly averages to use Narcan on 750 overdose victims, at a cost of about $1500. Those persons will likely add to legitimate local commerce more than $11,700,000 in wages, or in disability income. (The reader should bear in mind that many persons who overdose are making far more than minimum wage, so these projections are probably quite conservative.) While all the costs of such a lifesaving run are not represented in the cost of the dose of Narcan–few of these runs will be loss leaders. In other words, an organ of government that invests in saving lives from overdose is actually putting money in its coffers and assuring economic recovery.

Remember that Narcan Bill. The Commonwealth’s General Assembly failed to pass the bill, assuring that all first responders would be equipped to save lives. In effect, legislators are going to assure that the costs of life support, eventual recovery from brain damage, and vocational rehabilitation will be as expensive as possible, and borne by the taxpayers. The victims’ families who do not survive will become unexpected financial burdens to their devastated families who will bury them. And for this we must thank our legislators who made certain that a drug that is essentially harmless unless it saves a life will not be available to all first responders. I wonder if legislators are sending a message to persons with addiction that we are simply not ‘worth’ their time. Hopefully, this essay will dispel some of that idiocy.

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God is watching US…& I think She’s angry. 07092014

Several years ago, the President of Mexico characterized the US as “that big addict” up North. As hard as that was for us to hear, it is an accurate portrayal of the US role in illegal drug commerce issues facing most if not all of our South of the Border neighbors. Were it not for US and a consistent and increasing demand for drugs—legal or illegal—most countries would not have the “shadow governments with shadow economies” that drug cartels become operating within their borders. Were treatment on demand a policy for US drug addicted persons, craving would cease to be the driving force that it has become for international policy.

These drug gangs behave much the same way that gangs behave everywhere: they sell dope, sex, and protection; and they struggle within to control turf and status. It’s a bloody game, and the guys who are best at it run a tight ship, enlarge territory when they can, and continually look for ways to improve the “services” they offer. They terrorize 12-year old girls to find prostitutes for their brothels—age and lack of sexual experience is no barrier for the cartels: it improves their hold on “fresh meat.” Nor do boys escape the recruiters. A few years back, the “best” hit-man in the business in one of these countries was a 12-year old on a bike. Who’d suspect him?! Resist their methods and become another missing person in a shallow grave.

And all of this is driven by US, a neighboring country to the North with an addiction problem that is fed by the ease with which medication is dispensed, and a cultural expectation that all pain or suffering is unnecessary and useless—and that addiction happens to others who are lesser people. Numb behind the fuzzy thinking and the fog in our heads, we see these “unaccompanied children” crossing our borders and joining the ranks of other undocumented workers already trying to make a go of it here. Though most of US are unwilling to do the kinds of work these folks will do, we want something done about them!

Now, if it was some Middle East government forcing refugees at gunpoint to return to countries of origin where war and political upheaval have made life too unstable to plant a crop of wheat and harvest it—our diplomatic efforts would be to urge the receiving country to welcome and help the poor unfortunate refugees and we would back that up with aid. But, here, where we have created the pressure that causes these children to flee to safer parts—we just want to deport them and send them back into harm’s way with the least real dollar cost to US, and the least amount of fanfare possible.

Now, tell me again, just where did we come from? I am Irish and German, with a little French thrown in for good measure. Not one ounce of Native American blood in me. I am not bragging. I am grateful to the gentle folk we called “wild Indians” (with our usual ability to confuse fact with fiction). Interestingly, those indigenous people are still fighting to protect “rights” US lawmakers “gave” them. (Last time I checked, rights were inalienable, and cannot be given by one peer to another.) Only God gives rights. And God is watching US.

God is watching as we increase the emotional and life burdens already shouldered by children driven under fear’s lash to make treks most of us would shudder to consider: but we don’t want to know. We treat these new immigrants with the same insensitivity that we demonstrate when we allow overdose death to become the leading cause of violent death for US-born children. Do we think we can ignore human rights without cost? Persons fleeing danger have a right to safe harbor—no matter what the cost. We knew that when we were an immigrant nation. People who have the disease of addiction have a right to treatment on demand. We learned that under the Affordable Care Act—after half a century of struggling to manage the nation’s addiction health piecemeal. There is no debating the rights to life, liberty, and the pursuit of happiness that God has given US. God is watching.

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Undopedcut: today, Grok the un-Like-able, 07042014

Pity the child coming of age in a Facebook’d family setting. S/he will be taught to “like” all sorts of things. Recently, my daughters each suffered an insult to her health, and a host of friends and well-wishers “liked” that. My Friend’s Aunt died in an auto accident—a sweet old lady. Lots of friends and well-wishers “liked” that.

Language, and interpretation of it, is a subtle and changing process. But to take a word like “like” and bend it to its polar opposite to simply say: “Wow, I got that!” borders on dumber than hell. Robert Heinlein invented a word that would perform better than “like” and has the appropriate meaning. Though they may be too young to have read him, I would hate to think that the folks at Facebook are so illiterate that they did not know that there was already a handy four-letter word, invented by Mr. Heinlein, to cover every contingency that they want “like” to cover.

The word is “grok”. Wikipedia and its sources say it best:
“Grok /ˈɡrɒk/ is a word coined by Robert A. Heinlein for his 1961 science-fiction novel, Stranger in a Strange Land, where it is defined as follows:
‘Grok means to understand so thoroughly that the observer becomes a part of the observed—to merge, blend, intermarry, lose identity in group experience. It means almost everything that we mean by religion, philosophy, and science—and it means as little to us (because of our Earthling assumptions) as color means to a blind man.’
The Oxford English Dictionary defines to grok as ‘to understand intuitively or by empathy; to establish rapport with’ and ‘to empathize or communicate sympathetically (with); also, to experience enjoyment’.
Here, the ‘enjoyment’ experienced is the feeling of connection at a deep level with another human being—in the context of the book.”–Wikipedia

I want to say to Facebook, “C’mon. As heady as it is to twist the King’s English to your own ends, do you really want us to ‘like’ someone else being in pain, or losing a relative, having a communicable disease, being devastated by grief, losing their home to fire, or their job to outsourcing?” I really cannot grok how you twisted the logic of the internet to get us all on board. I suspect that we have become so jaded by drugs and whatever is trending that most of us simply accepted it with the same Lemming-Logic that allows us to consider hacks like Mitch McConnell a ‘venerable politician’, or violence and drugs a natural form of death for our youth.

Please know my thoughts are tracking in any direction but a direction you might “like.” Following your lead, sooner or later we are going to like making war, like rape, like genocide, like unintended overdose death, like mayhem. No thanks. I will try to grok your content so that I might empathize and rejoice, whatever is appropriate. I just can’t bring myself to “like” the unacceptable. I hope that those who agree will begin to Facebook Comment the word “grok” on items they cannot bring themselves to “like”. Peace!

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Undoped Cut: prescription for drug sanity

Well, this is the last installment of suggestions for improving the sanity of our drug handling in the Commonwealth of Kentucky. Someone told me that this could never fly–not because in would be too dangerous or expensive–it’s no more dangerous or expensive than doing nothing at all different, if the truth be known. No, it will never become our drug policy because it puts the pharmaceutical industry on notice that they will be held to a strict standard, and inflationary sales practices will be over. They would never allow any policy that will interfere with or even threaten their bottom line: They alone have profited during every quarter of the recession that has rocked this country–and they will not allow that to be threatened.

23) Publicize the spiral into death caused by gradual impairment of the amygdala from overdose.
Explanation: The amygdala alerts the brain to be ready for anything. If you will, it is the part of us that triggers the screaming when we go over the edge in the roller-coaster. An overdose causing unconsciousness and loss of oxygen affects this part of the brain first, and cell deaths occur here first. When it is no longer 100% efficient, a person loses the sense of danger posed by particular situations and becomes more prone to risk-taking behavior. When Mickey had her second to last overdose, she was carried out of the house, darting angry glances at me, by rescue squad personnel. The next day, her doctor told us, standing next to Mickey and facing me, “You made it just in time—a little longer and she would have been gone.” He could not see Mickey rolling her eyes. The impact of it all did not hit her until I burst into tears. Mickey said, “That will never happen again.” However, her early warning system had already been turned off. The next time was the last time.

24) Begin to explore therapies for rebuilding skill sets in which the amygdala plays a major role.
Explanation: Currently, there are no commonly used therapies to assist in re-sharpening this early warning system. The numbers of persons whose overdoses have not ended in death are left with brains poorly able to defend against risk—even after they have ceased using substances. “Their chances are less than average…”

25) Establish a national drug-related death registry.
Explanation: In the War on Drugs, there is a body count and we cannot accurately account for the numbers of our dead.

26) Develop effective and dependable drug testing for use in jails and hospitals to determine when a person is medically compromised by virtue of drug or alcohol toxicity.
Explanation: If we needed a test for an epidemic of testicular cancer, we would find some quick tools to accurately predict even its treatability. These drug tests might ultimately affect nearly one third of our population. Half of those who will be affected are men. The tools we have now are getting better—but not nearly as quickly as if it were an important population at risk.

27) Require medical facilities to develop secure rooms where uncooperative consumers whose lives are at risk may be safely housed until they are medically stable, as demonstrated by a reasonably safe or drug-free toxicology screen and stable vitals.
Explanation: Nearly every population has earned the right to be treated as a respectable group of people. Is it not time to extend that courtesy to persons affected by drug use and the disease of drug addiction?

28) Require jails and jailers to take toxic clients to these secure medical holding facilities.
Explanation: Addiction is a disease. The factors affecting drug-using people are matters of medical and physical safety. It is high time we made our practices conform to those facts.

29) Do a blood toxicology report on every 10th death ruled a myocardial infarction in every county in the state of Kentucky, testing for THC or other cannabinoids, as well as other drugs.
Explanation: In conducting the research for the Mickey S. Recktenwald Drug Related Death Survey, researchers came across many young people with myocardial infarctions. Most of the time, this cause of death was not complicated by a drug toxicology report. Five times, reports indicated this form of death in a person suspected of other drug use, when the only drug found was marijuana. Many more times, no toxicology report was done, simply because no one knew if the person was an addict, or not. A lot of young folks are dying of heart attacks. A high percentage of young folks use drugs, even occasionally. Without the toxicology reports, we will not know if the upturn in myocardial infarctions among young Kentuckians is simply stress related, or possibly drug induced. A one year study would be fairly inexpensive to do, and would yield life-saving information.

30) Enforcement of the law becomes a matter for the local Health Department, the Bureau of Standards, and the Revenue Department of the State, since the only things regulated are pure products, standard doses, and the tax per dose sold. (On the Federal level, obviously, the IRS, and the FDA, would also have regulations governing taxation, manufacture, and distribution.)
Explanation: In point of fact, the current system sets the Commonwealth up as the enemy of persons who use drugs, among whom are some of its leading citizens who live double lives to avoid detection. The changed system sets up as friendly to consumers of drugs as it is friendly to any other commercial operation and its customers. Anyone who violates those universal standards may be prosecuted freely, jailed for short terms (long enough to allow competition to make them nervous), and fined liberally. Promulgate the “filthy conditions” under which drugs are produced, or the amount of fillers used to sell “standard doses that are light on product,” or the amount of taxes-turned-profit this crook bilked his customers and the Commonwealth out of. Enforcement becomes a moral-neutral, citizen-protective process—and the overall effect paves the way for “drug busts, dealers, and runaway addiction rates” to become an interesting footnote in the history of the Commonwealth.

Next week: a rant about “liking” the unthinkable.

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Prescription for Drug Sanity, continued, Part 3

This is the third installment of observations and recommendations that arose from studying the deadly results of the drug related death epidemic directly from the report card: autopsy results. Some will say that making drugs more available to persons 21 and over will result in an awful increase in the death rate for that and youngre populations. I will respond that I cannot imagine how much worse the problem could be than what we are seeing (but not comprehending), now.
17) Develop and keep publicly-funded, researchable data-bases on all drugs on the market.
Explanation: This should include the relative frequency with which a substance appears in the toxicology reports for overdose. Research unrelated to patent information should become commonly held property.
18) Utilize feedback loops with consumers to develop lines of drug study on every impact from social functioning to fine motor skills, and everything in between.
Explanation: As stated elsewhere, an unwritten obligation of the decision to use substances should includes an implicit willingness to participate in general research about immediate and long-term drug effects.
19) Use these latter feedback loops to determine results of drug interactions, particularly, harmful ones.
Explanation: This is information that companies and manufacturers cannot now access. Their obligation to do ongoing research implies an obligation on the part of drug users to participate in that research.
20) Require companies to include mention, in all advertising, of their informal and formal support of “supposedly independent think tanks” until it becomes too cumbersome an expense.
Explanation: This “would-be” regulation is self-explanatory. A sham is a sham unless you pay me to call it a “shaaaaam.”
21) Pour federal money into marijuana research. Fund equal numbers of marijuana proponents and the opposition. Include questions regarding accidental deaths related to use. (Require any state considering legalization to open itself to civil litigation if it has not done marijuana research in advance and/or has not provided its citizens with the same.) Following production of the research, allow citizens to determine for themselves, armed with data, as to marijuana legalization.
Explanation: Currently, there is little actual research on marijuana before the fact of legalization, in most states. The federal government did not “waste” money on research of an illicit substance—albeit one already in use, before legalization, by a majority of the younger population.

22) The Benzodiazepine/Opiate Death Syndrome ( BOD Syndrome) risk list should be widely promulgated.
Explanation: In conducting the Mickey S. Recktenwald Drug-Related Death Survey, stories about the deceased whose records were researched revealed that among persons who had died of overdose many of the following were common findings:
1) the person has chronic pain;
2) there is history of regular long-term [beyond 30 days] use of benzos and opiates together;
3) there are multiple drug users among the individual’s constellation of family/friends;
4) s/he has a steady source of retirement or disability income or medical cost coverage,
5) s/he was not in treatment for addiction–including legally sanctioned treatment—or attended sporadically;
6) s/he routinely ignores or flouts black-box warnings about drinking or other drug use;
7) s/he chose medical providers who did not do drug screens or pill counts;
8) the deceased has multiple “dress rehearsals” for death including previous ER or hospital admissions for overdose; and
9) the deceased has had a family member or close friend die from overdose less than ten (10) years previously.
We named these common findings the “benzodiazepine/opiate death risk factors” and the “BOD Syndrome Risk List.”

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