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When we start to talk about this issue and the impact it has in our community, lots of words start flying around about it.  When told that Meth was causing a lot of trouble, a sherriff in Northern Kentucky earned some laughs by saying: “It’s a self-correcting problem.”  He quipped, “We have to do something about the others; but Meth users kill themselves.” That man should not carry a gun! Those Meth folk are someone’s brother or sister or child. The last time I checked our social values, there weren’t any expendable folk in our society.  However, to intervene in drug-related deaths will require some basic changes in the way we perceive addiction.

Addiction is not something one does to him-or herself by making wrong choices. Certainly there is an element of choice. A friend of mine is as much an addict as me. Both of us are in recovery. He was in recovery when his massive heart attack occurred. A physician friend of his knew his history with drugs and said, “I don’t know what to do for you.” My friend asked, “What would you normally do?” His physician friend said, “Why, I would give you a big injection of ativan–but that stuff is really addictive.” My buddy said, “Save my heart for now and we will worry about saving my ass later.” Addiction makes it hard to know what to do in lots of situations–but my friend had it right. He did get strung out on ativan, by the way. And he found his way back to healthy, drug-free recovery.  Why? Well, anyone who has enjoyed good recovery won’t find it easy to live with what drugs promise and never deliver. Recovery promises and delivers increased peace and joy in living under almost any circumstance.

Why then are so many people dying from their drug use.  The answer is that many more folks are using than ever before.  The Substance Abuse/Mental Health Services Administration (SAMHSA) gives Kentucky’s rate of addiction as about 8% out of our entire population.  I would estimate that they are underpredicting by about 12%.  This is not just true for Kentucky, though.  It is probably close to  20% of population anywhere in the country.  The Mexican president was right to characture US as “The big addict up north!”  The truth hurts, right before it sets you free!

In this kind of drug using culture, offering drugs in one form or another becomes a hospitable thing to do.  When was the last time you went to visit someone who offered you a glass of cold water to refresh your thirst?  Even when someone is trying to stop, we do not quite know what to say to them–because we feel sorry for them.  So, it stands to reason that the ways that drugs harm us multiply without our being too aware of it.

Drug-related death can obviously be what the coroners refer to as ‘ingestion of multiple substances at toxic levels.’  Drug overdose.  For that matter, it can be just one substance at a toxic level.  Any mix of benzodiazepines (xanax, valium, klonopin, and the like) with opiate type pain pills (lorcet, oxycontin, methadone) can become toxic–even to folk who have used them for years with no problem.  Something happens, and yesterday’s dose becomes too much for me to take today.  There is no way of knowing just when that is going to happen.  A diabetic who drinks alcohol is likely to overdose on the alcohol at some point and die.  Add a sleeping pill to either of those groups–and you have a recipe for eventual disaster.  Those folks are going to die.  We just can’t say exactly when.

Is it always wrong to use these pills or medicines?  No.  Somtimes, it doesn’t matter.  When a person has a chronic deadly illness, these combinations help him or her to be comfortable..  Using these combinations of drugs to help a terminally ill patient rest and avoid pain is good medical practice.  We have known for years that the use of these substances can speed death–but the purpose for giving them is merciful and kind treatment of terminal pateints.

When folks are in their late twenties to fiftie and not terminally ill–treatment of chronic pain in this manner is a death sentence.  Generally, these patients are dead within a few years.  For most, that was not their plan.  It happened to them.  Many are still trying to make a living and have fatal accidents on the road or at work.  Let’s look at some patterns that many of these folks have in common.

These may be considered “risks” for folks taking multiple medications–particularly for pain/anxiety/sleep management.  Risk factors include 1) regular long-term [beyond 30 days] use of benzos and opiates together; 2) chronic pain; 3) multiple users among an individual’s constellation of family/friends; 4) person routinely ignores or flouts black-box warnings about drinking or other drug use (those warnings may be found on the package insert for the drug); 5) the person has a steady source of retirement or disability income or medical cost coverage, 6) s/he has multiple “dress rehearsals” for overdose death including previous ER or hosptal admissions for overdose; 7) the person has had a family member or close friend overdose less than 10 years previously.

Though there is no known “safe” dose for benzo/opiates taken together, their use together has become a medical practice standard for handling chronic pain, and associated anxiety.  I sometimes wonder if the use of opiate pain meds actually gives rise to the anxiety as tolerance builds and the dose fails to manage the pain.  There is no known safe dose of the two taken together.  It is impossible to find a one to one correspondence that makes overdose predictable.  Instead, we discover how just enough becomes too much when the Coroners pronounce the cause: “due to multiple drug toxicity.”   No one understands the exact mechanism of these deaths: but the list of risks shared above is frequently discussed by the coroners and others who have dealt with these deaths.

Next time:   Ok, if these folks don’t want to die, how come many have more than one overdose?  Can’t they learn?  Peace!  Jim

Today I am going to begin a series of reports on a “drug-related death survey” of Coroner files in the Counties located in the 5th Congressional District. My interest in drug-related deaths is not new.  I conducted a workshop highlighting this growing problem as part of the start-up effort for Hope In the Mountains, a local women’s treatment center, then in the planning stages.  In conversations with our county coroner, I learned that such information was likely to be under-reported.  The shame and stigma attatched to the drug issue plays a major role in the final verdict at to the cause of death.  Attaching such a verdict to the death of a politician, a well-respected and loved member of the community, or to a family’s only child may seem a cruel insult to add to already poignant grief.  Often, another real but masked cause is given: “myocardial infarction” the last act of an oxygen-starved heart.  “Sudden unexplaned death.”  Even: “Suicide.”  I have to question the accuracy of this latter ’cause of death.’  We could not accept the court testimony of a witness as drug-affected as the decedent.  Nor is it likely that mothers with young children or young men in their prime intended to leave the stage at such a promising time in their lives.  It is not suicide when the disease of addiction claims a victim.

When Mickey died, I asked the family involved to report it as an overdose death, which it was.  And there was no way that Mickey would have chosen to die when she did, any more than she “chose” to become and be a person with addiction, an addict.  In our society, addiction picks its victims where it will.  There has been no institution and no law in our society that has proven effective at stopping that process in members of our citizenry.   There are effective tools for putting the problem on hold, once a person has it.  Still, recognizing that one has it is a major undertaking for anyone.  Successfully intervening in the process is not dumb luck but a matter of having the right help at the right time–a combination that multiple drug use in a family or community may make nearly impossible.

Mickey lived for her children and grand-children: couldn’t wait to see what new developments would unfold in their lives.  When able, not held back by the addiction, she participated in the events that Hannah and Connor had at school.  She enjoyed spending time with Kellie, and looked for opportunities to visit.  She was planning to babysit more, as the drug issue began to subside.  She began talking to me about that and offering her services to Megan and Jeremy.  She was not planning her funeral–neither of us had a burial fund yet.  We were planning the garden we would have this year–since we had too much going on last year to keep one.  Then, addiction claimed her.

When she died, I began to look for places where data on drug-related deaths were kept.  At the federal level, one can extrapolate such data from reports routinely made from death certificate findings reported to the states’ offices for public records.  When the report specifies that a death is caused by drugs, it is automatically forwarded on to the some federal data collection sites.  But, as I said above, there is a problem with such reports:  they are grossly under-reported. At Mickey’s funeral, the director, at that time the acting director, of the school where I work (the Carl D. Perkins Vocational Training Center) asked if she could do anything: “Is there anything you need?”  When I returned to work, the school physician, Dr. Don Chaffin, MD, also offered his services.  I told them I wanted to know how much dying was going on.  I told them that I wanted this health problem “outed.”  I wanted to study it in the Fifth Congressional District of Hal Rogers.  Operation UNITE is everywhere evident in this district.  In many ways, we are better prepared to ”handle” this problem than most other areas.  “Let’s see if we can learn from the process of accurately counting the deaths what is causing them to occur with increasing frequency.”  Doctor Chaffin contacted all the coroners by phone to make them aware of our effort and its purpose.  My employer has provided the time and manpower for gathering the data.  I am grateful for the opportunity they have created.

The only place to find the records is where they are kept in their entirety: the Coroner’s offices.  I want to take this opportunity to thank those offices who responded with full reports to our early querry about these deaths.  I also want to thank the offices where we have gone to gather the data ourselves.  Staff have gone out of their way to make us feel at home; and the records have been maintained in a fashion that makes collection of data a facile and efficient process.  The data we collect is anonymous–we have no desire to embarrass anyone who has died or family members left behind.
Next time: what exactly is a “drug-related death?”  Til then, Peace!

Sometimes grief is just a maudlin process: sluggish in movement, heavy about the shoulders, damp across the face, sticky and thick in the mind, angry in the heart, and bitter at the back of one’s throat.  Those times are best shared with close friends or perfect strangers in decently manageable doses—because everyone, sooner or later, will already have shouldered too much to carry with a light step.  I have no desire to turn Mickey’s passing into anything more than it was: her turn. Nobody gets to play the game the way she or he wants.  We play it the way it is ruled.  But before I return this rant toward grinding the grist for which it was founded, I would like to share some reflections of mine, and some shared with me by a friend.

Everything happened too fast on 5/8/11.  I woke in a panic and found Mickey dead.  3 hours earlier, more or less, I had showed her my newly collected token reflecting a long term commitment to recovery.  It made no sense.  It still begs reason—but I realize, now, that I have lived every day of my life since birth just to be there, right where I was, on May 8.  And so had Mickey.  Every decision and learning curve, each triumph, each mistake, each unfolded day of life—and the sum of each and every experience prepared us perfectly to do what we did and to be where we were that early pre-dawn hour, carrying our lives with dignity—in our own hands, freely.

Mickey and I had been slow about getting to the altar.  We had set a date for May 15.  That had been our original date some fourteen years earlier.  My issues got in the way.  Then hers.  Then ours.  Finally, we settled it.  I awokein the wee hours on January 2^nd  and told her that I was worried something might intervene and I wanted to get married, felt married already, had been living that way in my head for years, and so had she; so, why not?  She grinned, and agreed!   “Bans” needed to be published in the church bulletin for two weeks before we could marry.  Just made that deadline.  We got married.  Have wonderful pictures of a tiny wedding party, an intimate ceremony, and a tiny celebration, after.  We had lived every day of our lives since birth to be married to each other, on January 13, 2011.   Had we waited, we would have cheated ourselves out of that dignity, with death’s cooperation, by one week.   A merciful Power had been working with us.  I trust it still is.

Mickey’s death was not a tragedy.  Unfortunately, Who Has the Power knew: it was her turn in the barrel.  The tragedy is that it was entirely preventable.  This blog was begun to let the air out of the processes that are rolling over the lives of so many persons who could benefit from recovery.  Our next piece will pick up where we left off in May.  Thanks to anyone who has had the patience and kindness to hang in.

For anyone who is grieving, and for those of you better acquainted with 12-Step Processes, I will share this wonderful adaptation.  I do not know if my friend, Ken, originated this adaptation or found it—but he told me it had helped him through.  Peace!  Jim

12 STEPS THE OF ACCEPTING TRANSITION

(An adaptation of the 12 steps of AA, sent to me by Kevin J.
Kloubec following the passing of his wife, from cancer, after a relatively short illness.  Kevin, too, now rests in peace.  He was a quiet, steady, good-natured man, a co-worker in Vocational Rehabilitation and in the Recovery Field.  I pass it on as he shared it.  Betty was his wife.)

1.) Admitted that my wife Betty was dead, that I had no control
over death and my emotional life had become unmanageable.

2.) Admitted that my wife Betty as I knew her no longer needed
me and can no longer receive my love, companionship, care and friendship and I hers.

3.) Came to realize that God as I understand God, others, new
situations, things and experiences could restore a reasonable amount of peace of mind and emotional stability and that Betty would want me to do so.

4.) Became willing to engage God , others, new situations, things and experiences to restore a reasonable amount of peace of mind and emotional stability.

5.) Came to realize that by projecting my emotions into the future or into the past, I for the most part lose control of them.

6.) Came to realize that when memories arise that cause longing and emotional pain, these emotions do exert an influence on my consciousness but cannot control and dominate me unless I allow them to.

7.) Took a fearless, moral inventory of my marriage and all that I did which was right and wrong in the marriage and all that Betty did that was right and wrong in our marriage.

8.) Freely admitted the right and wrong I did in our marriage to God and to at least one other person and freely admitted the right and wrong Betty did in our marriage to God and to at least one other person.

9.) Became willing to forgive myself for the wrongs I committed and love myself for the right I did and became willing to forgive Betty of the wrongs she did and keep a loving memory of the good she did.

10.) Came to realize that grief is no justification for ignoring my responsibilities to my mental and physical well being and my obligations and responsibilities to others.

11.) Became willing to share this message with others in need and extend my support when needed.

12.) Became willing to practice these principles in all my affairs.

I have had the terrible burden of witnessing death and human suffering caused when stigma is allowed to determine the limits of care that persons with the disease of addiction may expect from social institutions and caregivers.  I have seen or experienced  everything I am going to say.  At an accident, a severely injured person was placed in an ambulance by EMTs who determined that this drug using “frequent flier” of theirs would not make it this time, though the person had a pulse and was breathing at the site.  They busied themselves with other victims. Their client was DOA at the hospital.

I don’t know if the man would have made it or not.  Diseases makes no distinction between hopeless cases and hopeful ones—we who are the family, friends, and helpers make those distinctions.  Only God should decide who gets to live.

The University of Kentucky sends specialists in endocrinology to local hospitals.  These
specialists can be very helpful to persons with addiction whose livers, pancreatic functions, and lives are at risk to addiction-driven conditions.  At a public agency as a
substance abuse counselor, I had several persons on my caseload with acute
pancreatitis.  A family physician must make the referral for this special care or consultation.  With permission from our client, I placed a call to his physician.  This respected doctor  informed me, “We do not use these specialists for hopeless cases!”  I
explained again who I was and informed the doctor that his patient was voluntarily seeking help for the disease of addiction from which he suffered and against which he was beginning to make some headway.  The doc’s next comment stunned me.  “Do you actually think that people like you do any good?”  He agreed to make the referral—though it was clear he had no real interest in pursuing this line of treatment for his patient.  Equally confounding was the call I received from the same doctor, sometime later, when a member of his family needed help with an addiction issue.

Hospital ERs around the country, can count persons with the disease of addiction as fully 50 to 60 percent of their admissions.  Some would say the figure is much higher.  Many such patients are given a palliative, sometimes a placebo, and sent home.  Occassionally, a sick addict with some other medical issue will be admitted.  Granted, many persons with addiction who arrive at the ER want a quick fix, a drug.  Then, they want to leave.  Many arrive at the ER not really aware that their complaint stems from the disease of addiction.  Almost never is the person given enough time to allow his or her head to clear, or enough straight talk from a medical person to know that the real issue is ongoing addiction which needs immediate treatment.  Often, the addicted person is subject to rude or rough talk, sometimes laughed at, and given the bum’s  rush.  One man whose withdrawal seizures prompted me to drive him to the hospital was discharged after being given a shot—only to fall and injure himself, shortly thereafter, suffering another seizure back at our program.  Threat of a lawsuit  stopped the same outcome a second time.

Lawsuits do not always remedy these situations.  A jury who may have their own biases about persons with the disease of addiction will not see issues in the same way that
they might if the person were in a diabetic coma.  A well-paid and competent attorney shrugged, ignorant of patient rights under the Americans with Disabilities Act, and urged his client who was in treatment for the condition to accept a plea—rather than
press on with their suit, saying “Well, you are a drunk, aren’t you?”

While I completed paperwork in another room—my family member, meek and trembling in withdrawal, was slapped by a nurse for not remaining still while an IV was inserted.  This occurred at a hospital with a treatment center.  The staff person was
reprimanded—but really it was his word against the word of my family member.  It is good practice to write the facts as you see them, right away, when it happens.  Put them in a very open letter to a hospital’s board, a business’s manager, or even to the editor of the local paper.  Don’t overstate, stick to what you have seen.  Name names.  Give quotes, if you heard what was said.  It is time for the professional community to treat this disease appropriately—or lose a measure of public respect.  When you are with your family member at the treatment site, advocate for them.  Speak up.  Raise your voice as you would if the individual were suffering a heart attack and not being treated
appropriately.  Advocacy works!  Next time:  ASAM and a new paradigm for addiction.  Til then, Peace! Feel free to e-mail comments to me at mijsold@hotmail.com., or on this site.

In the interests of transparency, before I resume answering my friend’s question about the the differences between advocacy and 12-Step Work, I am going to report about the
response I got to my letter to President Obama, on the drug deaths.  I got zilch.  Nada.  Nothing.  I got no response at all.  To be fair, he was in a wrestling match the likes of which this country has never before witnessed over budget and national solvency.  I get the impression that “Main Street” is a piece of literature they all read.  I don’t believe any of our elected reps have ever lived on it.  It is no help that Washington, D.C. does not have a “Main Street,” to my knowledge.  At any rate, hope springs eternal so I am thinking of writing Ms. Obama.  Who knows?   Back to today’s topic…

12-Step Programs are hugely successful at keeping members sober and at spreading word from one individual to another “affected” individual that recovery is possible.  12-Step Traditions protect individual recovery and the Group purpose very well.  For that reason, organizations like People Advocating Recovery (PAR) and Faces and Voices of Recovery (FAVOR) developed language to spread and promote ideas about how “Recovery Works” that would avoid “anonymity breaks” by 12-Step members and be respectful of all 12-Step Traditions.  “Addiction is a Disease without Stigma, Shame, or Discrimination.”  Even the
language used to discuss recovery stays away from conventional language used by
12-Step Programs, avoiding words like “clean time,” or “sobriety.”  Rather, PAR and FAVOR talk about “enjoying long term recovery” and suggest that individuals may define that any way they choose, such as: “I am enjoying the benefits of long term recovery which I define as having been illicit drug-free for thirty days.”  And “I have enjoyed the benefits of long term recovery for over 20 years.”

However, PAR and FAVOR are in the business of  publicly promoting the idea that “Recovery Works.”  There are thousands of persons whose long term recovery adequately demonstrates that persons with the disease of addiction routinely overcome the odds and
recover.  Given the odds against recovery—even today, 9 out of 10 persons with the disease of addiction die before they discover that they are sick—two weeks without use is nothing short of miraculous.  Even the person who has that much time can begin to see benefits from living a new way of life.  Recovery is so attractive that persons with lousy track records keep trying for it; and research shows that the odds favor such persons eventually finding long term recovery.  Once an individual has experienced the benefits of long term recovery, hopelessness begins to lessen and the person becomes more likely to live free from effects of the disease.

Getting the word out that hope is available has always been a problem.  Bill Wilson, a founder of AA, noted in a 1958 Grapevine article: “Then came Marty Mann (National Council on Alcoholism and Drug Dependence—NCADD—founder).  As a recovered alcoholic, she knew that public attitudes had to be changed, that alcoholism was a disease and that alcoholics could be helped.  She developed a plan for an organization to conduct a vigorous plan of public education and to organize citizens’ committees all over the country.  She brought the plan to me.  I was enthusiastic….”  Bill Wilson and Dr. Bob Smith, MD—both founders of AA—were on the Board of NCADD.  Since then, folks in recovery have proven to be the best evidence that “Recovery Works,” and its biggest advocates.

So, now, to answer the question: How does a 12-Step member follow Traditions and publicly advocate for addiction services?  Be clear about what hat you are wearing, and who your audience is.  In a 12-Step meeting, it would be inappropriate to only discuss life after active addiction. The listeners might wonder if the speaker ever experienced active addiction.  Nor is it appropriate to talk in a public setting about all the damages and suffering one experienced while actively addicted and the intervention that occurred due to participation in 12-Step programs.  This is doubly true where one might be quoted in the press, or where some of the more difficult episodes of one’s life might be electronically recorded.  Bear in mind, if one discusses his story including use of 12-Step assistance at depth in a public forum, and then “breaks over,” s/he puts a shadow of doubt on a very worthy but private (anonymous) process for dealing with the disease of addiction.  If one says publicly, “I am enjoying long term recovery,” but a week later is found to be again using drugs and her health is compromised—someone may publicize that information and the person will be embarrassed.  However, it will not reflect on anyone but him.  Either
way, it was a miracle that s/he ever managed to put recovery time together.  The less damage s/he does to recovery supports, that much more quickly will s/he be to use them again, when ready.  Focusing on the benefits of recovery—the contributions one is able to make to family and community, and personal accomplishments—is the best course of action for an advocate to take.  Next time: the deadly effects of stigma, and how to avoid
them.  Til then, Peace!  Besides leaving comments at the end of this article on the blog, you may e-mail comments to me at mijsold@hotmail.com.