Oh, the Opioids!

It’s the season of giving, of looking back and looking forward as one year ends and another begins. What better time to consider a fresh outlook on drugs?

Here we are amid the Opioid Crisis, the latest in a long line of similarly heralded events sparking fear, outrage, and call for action. One hundred years ago, it was the Cocaine Crisis quickly followed by the Marijuana Crisis, then the Heroin Crisis. By the late 60s, it was LSD that elicited our fear and loathing.

Doomed to fail from the start, the so-called Drug War was about ‘just saying no’ alongside arming our friendly local cops with military weapons. What we’ve since discovered is that ‘saying no’ meant not talking about it, and that’s a direct route to where we are now. Even worse, we failed to recognize that a war on drugs was actually a war on Americans who use drugs. Now we have embattled inner cities rampant with gun violence and police who dress/act/think like commandos.

What we as a society desperately need to realize is that DRUGS ARE NOT THE PROBLEM. Substance abuse is a SYMPTOM of a much larger and more insidious problem. We’re self-medicating for existential despair.

Existential philosophy arose in the 1950s and early 60s as a way to discuss the unique condition of modern man. Due to mechanization and urban living, the ancient traditions that have helped us cope no longer apply. We are isolated from Nature and its rhythms and lessons that used to sustain us. We are isolated from the sorcery and magic we used to believe was God. We are isolated from our fellow man, often living alone or in nuclear family settings instead of tribal or extended family groups. And most difficult, we are isolated from ourselves, distracted from our thoughts and feelings by constant chatter and material diversions. This is, briefly, the four-fold alienation that describes modern existentialism.

Exacerbating the problem of our modern age are the failures of education, lack of job opportunities, lack of self-esteem, and poor health.

Public or private, schools are missing the target for many youngsters who desperately need logic and critical thinking. Trades we’ll always use, from plumbers to carpenters to seamstresses, are not taught nor are the fundamentals of operating a self-owned business.

Our culture fails to offer a buy-in for young people who need to know they matter. Public service options in avenues other than military are few and far between. Self-esteem has been relegated to displays of material wealth even when no such wealth exists. Debt to last a lifetime is the price we pay for these trappings of social status.

Even more critical is our declining health. Not only are fast food and prepared meals low in nutrition, they’re more expensive than basic foods prepared at home. We’re overeating and starving at the same time, piling on calories in sugar and fat while missing out on the micronutrients, vitamins, and proteins that lead to an uplifted mood and greater energy. No one is advertising chard sautéed with garlic.

Yet the greatest fraud about drugs is perpetuated by the very industries that bear the name of ‘drug manufacturer.’ Since the 1950s, the insidious promotion of drugs by companies like Pfizer, Eli Lilly, or Merck (to name a few) has increased proportionately to the nation’s substance abuse problem.

Slick advertising convinces consumers that with one magic pill, all of life’s ills will go away.

Television especially holds out the false promise. The suffering victim is cast in a muted gray-tone atmosphere while around them everyone else is blissful. With the magic pill, suddenly the victim joins the bliss, bathed in golden light. Meanwhile the precautions about negative effects from the medication are described in a hurried low monotone that fails utterly to overcome the visual imagery.

The message? Consume a drug and your life will be better.

It’s a message that’s not lost on the audience, young and old alike. Who doesn’t want to be part of that golden bliss? Who doesn’t want to live without pain, without worry? All you have to do is take a drug.

It’s exactly this message that has led to the current opioid crisis. It’s not that doctors are overprescribing, although some are. It’s not that manufacturers falsely claimed that OxyContin and its family of synthetic opioids are safe to use, although some undoubtedly did. It’s that all of it is part of a bigger scam wrought upon the American citizenry—that the inevitable aches and pains of life can be made painless.

When we read about the pioneers and ‘old timers,’ we’re aghast at what they endured. No indoor plumbing? No central heat? No food unless they grew it? We marvel at their toughness, their ingenuity.

Yet amid all the labor saving devices and easy consumer goods, we find ourselves without any test of our endurance or strength. We spend too much time in activities that show us nothing at the end of the day. How can we prove ourselves without any proof?

We’re looking for adventure and new horizons. Our natural tendencies as humans drive us toward activities that may result in trauma, pain, or even death. How do we turn back the very features of our make-up that have brought us out of the caves?

The hazard of certain drugs that lead to laws against them is the fear that persons under the influence will harm us. By escaping rationality through intoxication, people may unleash violent tendencies. No abused substance in history lives up to this threat more than alcohol, but our failed war on alcohol should have taught us important lessons about the harm such policies cause.

The need for a national conversation about drugs is long past due. All drugs. Pharmaceutical advertisements should be banned, particularly those requiring a prescription. After all, why are we encouraging people to decide what drugs they need instead of allowing doctors to do their job? Profits for pharmaceuticals should be heavily taxed despite the persistent whine that the money only funds research.

… evidence that Gilead itself uses its profits to “innovate” is thin at best. In 2016, the company reported profit of $13.5 billion. It spent $11 billion to repurchase its own shares, and about $2.5 billion on stock dividends.[1]

Drug manufacturing ranks among the most profitable industries in the world.

Until we set aside our conditioned response to the drug problem, we cannot solve this escalating crisis. We are throwing people away by failing to address fundamental issues that lead people to hide in a drugged haze. We are throwing them away a second time when we stigmatize their drug problem by involving them in the criminal justice system. Or when we force them into a drug court program with limited resources and over-dependence on 12-step programs and which fail to address underlying conditions such as inadequate nutrition.

Treatment programs generally fail in many ways partly because they are set up to create profit. Instead of looking to make money off of people suffering from addiction, we should be looking for ways to express our collection compassion and concern. We should make sure that intake is immediately available for any and all comers, that they’ll be offered a safe setting full of comfort and light, that individual counseling is the best money can buy. When we invest in our fellow man, it’s a win-win for everyone.

So I urge you to give it some thought and talk about this over the holidays as you meet with friends and family. Enjoy that glass of wine as you celebrate the season. Acknowledge the difference between use and abuse. Love your neighbor as yourself. Be part of the change we so desperately need.

~~~

[1] http://www.latimes.com/business/hiltzik/la-fi-hiltzik-gilead-profits-20171023-story.html

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On Legalizing Drugs

“Americans must confront the reality that we are the market,” Secretary of State Rex Tillerson said this past Thursday. “We Americans must own this problem.”[1]

Meeting with his Mexican counterpart, Tillerson acknowledged the role of American drug consumption in the proliferation of violent Mexican drug cartels. Citing the enormous demand for heroin, cocaine, and marijuana by Americans eager to get high, he argued that “drug trafficking had to be addressed as a ‘business model,” attacking cash flow, gun procurement, production and distribution.’”

Oh, please. You’d think that an administration that promised new approaches would make some tiny effort to think outside the prohibition box. But never once in Tillerson’s comments or those of his colleague Homeland Security Secretary John Kelly did a new idea appear. Never once did they hint at any effort to consider the success of other nations where various types of legalization and regulation have greatly reduced drug problems.

Take, for example, the success of states like Colorado now in its fifth year of marijuana legalization. Sales of the legal herb generated tax revenues exceeding $150 million between January and October 2016, $50 million of which the state is using to pump up its school systems.[2] Significant shares of this revenue stream will support improved drug treatment, drug education programs, and various projects targeting at-risk populations.[3] All these expenditures help increase education, job skills, and opportunity for persons who might otherwise fall victim to substance abuse.

Yes, Americans are the market. But instead of devoting resources to learning more about why Americans are uniquely prone to drug use and abuse, outdated policies continue to treat Americans as children to be scolded and punished. This attitude helps foster voters’ disgust with government.

Punishment has become increasingly more severe as subsequent generations of policymakers have embraced the government-as-nanny model. Any incremental step away from prohibition has come wrapped in controversy, implemented only in states where the voice of reason has a chance to be heard. Now with the Trump Administration and its appointment of Jeff Sessions as head of the Justice Department, we face the prospect of a full-bore return to the good old failed policies of the past.

Why is there no discussion of legalization and regulation? A modest approach might be similar to that of Portugal, who years ago legalized all drugs. “Weed, cocaine, heroin, you name it – Portugal decided to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one.”[4]

While our nation’s drug warriors lament that such an approach would lead to higher use rates among the young and greater ease of availability would increase use rates, the fact in Portugal is that youth aren’t using more, adults are using slightly less, the rates of HIV and Hep C infection are down, and – hear this – hardly anyone dies of overdose.

Compare that to the alarming rise in U. S. deaths from opiates which more than tripled between 2010 and 2015.

Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin.[5]

It’s way past time to face reality: people are going to use drugs. As far back as we can peer into human history, people have consumed everything from beer to cannabis to opium to hallucinogens. These practices are part of who we are, part of our religions, part of our ability to think outside or within ourselves.

Legitimate questions await answers about why various types of drug use throughout the millennia have transformed into today’s raging torrent of human suffering, but we’re not devoting any resources to answer those questions. Have the pressures of our fast-paced modern age forced us to seek refuge in intoxication? Is our multicultural society at fault in erasing old customs and rites of passage that could help us confront our existential crisis? Have the conveniences of our technological age created too much leisure time? What is the impact of a pharmaceutical industry’s marketing campaign flooding us with ads suggesting that the solution to every human ill is a drug?

We simply don’t know.

We should have learned a hundred years ago that criminalizing a popular intoxicant only creates bigger problems. Those who championed alcohol prohibition wanted to stamp out drunkenness. The blissful concept assumed that if alcohol were made illegal and its producers and users criminalized, everyone would simply stop drinking.

New York City Deputy Police Commissioner John A. Leach (right) watching agents pour liquor into the … New York World-Telegram and the Sun Newspaper Photograph Collection/Library of Congress, Washington, D.C. (neg. no. LC-USZ62-123257)

Far from it. For their trouble in passing the Eighteenth Amendment, the “dry” crusaders found their cities overrun by heavily armed criminals fighting over territory. People flaunted the law, patronizing highly popular speakeasies where drinking served as joyous rebellion against overweening authority.[6] No matter how many barrels of liquor were spilled into public gutters, ever more enterprising moonshiners set up shop in hidden hollows.

It took just over fourteen years for prohibition fervor to sour. Amendment Twenty reversed it in 1933.

As Lincoln famously said in 1840:

“Prohibition… goes beyond the bounds of reason in that it attempts to control a man’s appetite by legislation and makes a crime out of things that are not crimes… A prohibition law strikes a blow at the very principles upon which our government was founded.”[8]

Sadly, it seems little of this lesson actually sank in. Prohibition policies continue to frame our national approach to substance use and abuse, siphoning money into hit squads of heavily armed urban police and burgeoning prisons instead of desperately needed research and treatment of addiction.

Reality is that prohibition does nothing to reduce the market for drugs, but it does create a thriving underworld where dealers make huge profits. Stamp out every drug producer/dealer in the nation and tomorrow another crop will rise to the surface. Among the poor, especially those in marginal economies of Mexico and other Latin American countries, the potential benefits far outweigh the risks. Our inner city youth’s only hope of achieving the American dream seems to lie in the profitable drug trade. It’s about supply and demand.

The economics of prohibition can’t be overstated. Trade in illegal drugs generates so much profit that gangs can afford all the expensive weapons they might ever want. The spiraling up of urban warfare now involves military gear and tactics among the police and armor-piercing bullets in automatic weapons carried by adolescent criminals. The payoff comes in fancy cars, jewelry, and a lifestyle not achievable by legal means. Tax free.

A war on drugs is, after all, a war on our people, with rising collateral damage to our cities, institutions, and most of all, innocent bystanders.

Ironically, prohibition policies fail utterly to accomplish the goal of eradicating drug use/abuse. A smattering of evidence from states with legalized marijuana shows that teen use has dropped, suggesting that by removing the ‘forbidden fruit’ aspect of the drug, rebellions teens may lose interest. Meanwhile on the black market, no ID is required for purchase, and studies have found that teenagers can obtain marijuana more easily than beer. [9]

We the people have to decide what we’re going to do about this, because our so-called ‘leaders’ won’t make the first move. We have to decide and then make our voices heard. Compare:

  • a militarized police force versus friendly neighborhood police to protect and serve.
  • urban warfare versus reclaimed neighborhoods and inner cities
  • illegal search and seizure and loss of property even you’re not convicted of a crime versus government butting out of private lives
  • an overwhelmed judicial system versus our Constitutionally-guaranteed due process
  • half of federal prisoners in jail for drugs and the fact that drug offenses comprise the most serious offense for 16% of state prisoners versus an enormous reduction of prison population
  • our ever-growing investment in prisons versus a renewed investment in schools, mental health care, and state-of-the-art addiction treatment centers.
  • taxpayers struggling under drug war costs versus a regulated, taxed drug industry ensuring purity, restricting sales to adults only, and producing substantial new revenue streams
  • American citizens treated as children by government deciding what they can do in their personal lives versus each person responsible for his/her welfare. Want to be homeless, die in a ditch? Go ahead. Ask for help, we’ll be there for you.
  • overdose of drugs like heroin often resulting from zero information about purity or strength versus a regulated market that includes labeling for purity and precautions about use.

There are no upsides to the drug war. By any tally, this approach has been an enormous policy fiasco partly responsible for the decline of inner cities and disrespect for government in general. Government has never bothered to assess the effectiveness of its policies. No one can cite data showing that getting tough on drug traders and users has reduced supply or demand.

Indeed, judging by the rhetoric of our newest batch of politicos and the news flowing to our ears and eyes on a daily basis, we can say with certainty that drug prohibition continues to be an abysmal failure.

~~~

[1] http://www.latimes.com/politics/washington/la-na-essential-washington-updates-tillerson-puts-onus-of-drug-trafficking-1495131274-htmlstory.html

[2] http://fortune.com/2016/12/13/colorado-billion-legal-marijuana-sales/

[3] https://leg.colorado.gov/sites/default/files/15-10_distribution_of_marijuana_tax_revenue_issue_brief_1.pdf

[4] https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/

[5] http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

[6] https://en.wikipedia.org/wiki/Prohibition_in_the_United_States

[7] http://www.autofoundry.com/293/the-best-moonshine-cars-of-all-time/

[8] http://www.americanantiquarian.org/proceedings/44807229.pdf

[9] http://www.cbsnews.com/news/teens-pot-easier-to-buy-than-beer/

Newborn Abuse — the latest atrocity in our war on drugs

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Another story of government overreach.

In 2003, the federal government began requiring states to develop strategies to deal with drug-dependent newborns. This came in response to an increasing number of babies born with opioid dependence. The government’s concern directly reflects the rise in opioid addiction nationwide.

“The number of prescriptions for opioids (hydrocodone and oxycodone products) have escalated from around 76 million in 1991 to nearly 207 million in 2013, with the United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet).”[1] Most recently, tightening availability of prescription opioids has shifted abusers to heroin, an early pharmaceutical derived from the opium poppy and grandfather of the modern ‘codone’ products. Heroin is cheaper and in most cases more available than the pharmaceuticals.

No matter what form, opioids pose a real threat of addiction for many users. According to Wikipedia, “opioid addiction and opioid dependence, sometimes classified together as an opioid use disorder, are medical conditions characterized by the compulsive use of opioids (e.g., morphineheroincodeine, oxycodonehydrocodone, etc.) in spite of consequences of continued use and the withdrawal syndrome that occurs when opioid use stops … The opioid dependence-withdrawal syndrome involves both psychological dependence and marked physical dependence upon opioid compounds. Opioid use disorders resulted in 51,000 deaths in 2013 up from 18,000 deaths in 1990.”[2]

It’s not like opioid-dependent pregnant women don’t know they’re sharing their addiction with their fetus. But like all addicts, these women are severely challenged in overcoming their need for the drug not only because of the nature of the drug but also because whatever led them to abuse drugs in the first place has not been addressed. After all, not everyone legitimately prescribed opiate drugs becomes an addict.

Within one to three days after birth, infants born addicted to opioids suffer neonatal abstinence syndrome (NAS). This withdrawal experience may require doctors to administer slowly decreasing doses of morphine or methadone to ease the process. Providing medical protocols to deal with this condition was the intent of the federal law.

Despite this initial specific focus on opioid withdrawal among newborns, states have begun implementing laws that target mothers who test positive for any illegal drug use. The National Institutes of Health agree that “Alcohol and other drugs used during pregnancy can also cause problems in the baby. Babies of mothers who use other addictive drugs (nicotine, amphetamines, barbiturates, cocaine, marijuana) may have long-term problems. However, there is no clear evidence of a neonatal abstinence syndrome for these drugs.”[3]

Notably, millions of American women have used and continue to use alcohol, marijuana, nicotine, and/or prescription drugs during pregnancy with no known ill effect to their offspring. Yet in many states, zealous, usually conservative lawmakers have seized on the situation as yet another way to attack illegal drug use. Newborns and mothers are profiled and drug tested without consent. Infants are separated from their mothers. Mothers are sent to jail.

The State of Arkansas is one of eighteen states which requires health care professionals to profile mothers and newborns to determine who should be drug tested. In 2014, Tennessee became the first state in the nation to pass a law allowing women to be charged with a crime if their babies are born with symptoms of drug withdrawal. Other states, such as Alabama and South Carolina, use interpretations of existing laws to prosecute pregnant women who use drugs.[4]

The potential penalties under Alabama law are especially stiff: one to 10 years in prison if a baby is exposed but suffers no ill effects; 10 to 20 years if a baby shows signs of exposure or harm; and 10 to 99 years if a baby dies.[5]

There is no known law which requires prosecution of fathers for their use of any substance which might have contributed to a newborn’s impairment.

The American College of Obstetricians and Gynecologists guidelines recommend that in cases where substance abuse is suspected, doctors use a separate form to seek consent for drug testing; women can opt out simply by not signing. These guidelines are widely ignored. In Arkansas, for example, if a health care provider or allied professional such as a social worker believe an infant might have been exposed to illegal substances in utero, a claim of probable cause meets the criteria of child abuse and federal laws protecting privacy don’t apply. Mothers are tested without consent and the case is turned over to authorities.

Such professionals employ a widely varying and undocumented set of criteria to identify newborns and mothers to be tested. Conspicuous symptoms such as premature delivery, low birth weight, seizures, fever, hyperactive reflexes, or rapid breathing are among the more obvious reasons to test the newborn. Yet hospitals also single out mothers who obtained little or no prenatal care even though this unfairly targets the poor or those who live far from medical facilities.

Persons who fit certain cultural stereotypes may also be at risk of greater scrutiny: compare the likelihood for suspicion of drug use in a young woman with dreadlocks and reeking of patchouli compared to that of a well-to-do woman with no counterculture identifiers. Racial profiling is also widespread in these cases as is suspicion of women who have engaged a midwife.

Aside from all the outrages involved in these policies, the fact is that they close the barn door after the horses are out. Once the child is born, whatever fetal harm might have occurred is already done. The rational approach would recognize that a few newborns may need intervention treatment and their mothers need access to counseling. End of story.

Instead, state lawmakers take whatever injury might have occurred to a fetus and explode that into the worst case scenario for the newborn infant by separating it from the mother—no cuddling at the breast for milk (one of NIH’s recommended treatments of NAS is breastfeeding), no mother’s heartbeat, no familiar voices. If we wanted to ensure that an already-challenged newborn suffer the greatest possible harm, we can rest assured that arrest of the mother fits the bill.

[I concede that in a very few cases, the mother’s behavior is so out of control that the infant is better off not in her custody. Very few.]

Legislators eager to punish mothers ignore the fact that the damage is already done. They justify punitive action in the belief that punishment serves as a deterrent. But—point of fact—if threat of punishment served as a deterrent, no one would use illegal drugs.

Marijuana use is not known to result in birth defects or NAS. One study even shows benefits to infants born to marijuana-using mothers.[6], [7] But according to a 12/18/15 report in the Arkansas Democrat-Gazette, of the 970 new Arkansas mothers referred to social services in 2014, 65% were for marijuana use.

Lawmakers also skim past the obvious hypocrisy in screening mothers only for illegal drugs when fetal alcohol syndrome has long been identified as a common cause of birth defects. Many of the distress symptoms in newborns can also result from the mother’s use of tobacco.

If punishment for theorized harm to the child is the state’s objective, then why aren’t alcohol and tobacco included in the screening? Why aren’t those mothers arrested and separated from the child?

I’ll tell you why. Because a driving purpose behind such laws is to punish mothers for illegal drug use.

If the real goal is to reduce the number of impaired newborns, a bureaucracy will need to be established which monitors all women of childbearing age with monthly testing for evidence of pregnancy. Once pregnant, women would be placed on 24-hour watch to ensure proper nutrition and adequate exercise. Prospective parents will undergo genetic testing  and embryos will be screened for congenital defects and aborted when appropriate. Controlled environments for gestating women will need to eliminate potential stressors such as spousal abuse and financial troubles. Any possibly harmful substances such as alcohol, tobacco, or illegal drugs would not be allowed.

Ah, brave new world with our Alphas and Epsilons.[8]

There’s nothing wrong with states supporting protocols by which medical professionals can more adequately address NAS in compromised newborns. But compromised newborns should not be used to indict the mothers for real or imagined crimes. There’s no proof that illegal substance abuse alone is the cause of a particular newborn’s problems. A majority of distressed and/or premature newborns come from poor mothers and/or mother who use alcohol and nicotine and/or mothers who don’t exercise or eat properly.

Keep in mind there’s no scientific evidence that an addicted newborn suffers subsequent permanent damage.[9], [10]

The rush to prosecute illegal substance-using mothers of newborns does not assure that their future pregnancies will produce perfect children. Nor, in most cases, does it provide any benefit to the child.

Are women now fetus delivery systems answerable to the state?

Proactive encouragement toward good health and responsible behavior is as far as a free society can go to ensure the best possible outcome in any life pursuit of its citizenry, including parenthood. This approach involves all those abhorrent liberal ideas like sex education in the public schools and easy access to birth control. Access to abortion. Clean air and water. Greater public understanding of proper nutrition. Excellent education. Good job training and job opportunities. Community clinics with affordable, high quality mental and physical health care.

If we want to decrease the American trend toward ever greater substance abuse, we need to take immediate steps to stop commercial advertising of prescription drugs. There is not and never will be a magic pill for most of life’s troubles even if these ads insinuate otherwise.

We need to reorient our medical community toward prevention instead of pharmaceuticals.

We need to devote more resources toward understanding the factors that contribute to substance abuse and addiction and address these problems at their roots: disenfranchisement, poverty, lack of opportunity, low self-worth, racism, mental illness.

Have we done this before rushing to prosecute mothers?

No.

 

Learn more and offer your help at http://www.advocatesforpregnantwomen.org/ 

[1] http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse

[2] https://en.wikipedia.org/wiki/Opioid_addiction_and_dependence

[3] https://www.nlm.nih.gov/medlineplus/ency/article/007313.htm

[4] http://www.huffingtonpost.com/entry/pregnant-drugs-crime_5692ea9ee4b0cad15e653dd0?section=politics

[5] http://www.al.com/news/index.ssf/2015/09/covert_drug_tests_child_abuse.html

[6] http://www.ncbi.nlm.nih.gov/pubmed/1957518

[7] http://www.druglibrary.org/schaffer/hemp/medical/can-babies.htm

[8] https://en.wikipedia.org/wiki/Brave_New_World

[9] http://healthland.time.com/2012/05/01/number-of-babies-born-suffering-drug-withdrawal-triples/

[10] http://www.adoptivefamiliescircle.com/groups/topic/Baby_born_opiate_addicted….terrified/