KNOW YOUR ENEMY

“Know your enemy” is a phrase that repeatedly returns to my mind when I am looking back on the years of our children’s adolescence. Regrettably, what we have learned is too late for our son, but not for millions of other sons and daughters. I believe that we are at war with an enemy that, as it is taking the lives of our children, it is also taking the future of our nation and our world.

If you know the enemy and know yourself,

         you need not fear the result of a hundred battles.

If you know yourself but not the enemy,

         for every victory gained you will also suffer a defeat.

If you know neither the enemy nor yourself,

          you will succumb in every battle.

The Art of War by Sun Tzu (Chinese military strategist, 5th century BC)

The wisdom from Sun Tzu holds such significance for all of us at this point in the battle against opioids. Knowing ourselves includes knowing and understanding our children well, and knowing their friends and their families. Knowing our enemy is knowing what our culture currently believes and how our society is battling our mutual challenges––as all other parents through the ages had to know in order to survive.

It is well-known that during adolescence when the brain experiences dramatic developmental changes, it is more vulnerable and primed for risk. Add the normal lack of defense for dangerous experimentation to families like ours – and perhaps yours? – who are drawn to risk and you have double jeopardy. Experts believe that the time when “An ounce of prevention is worth a pound of cure” is during pre-adolescence. We need to inform parents when their children are in late grade school, 5th and 6th grade, before their children are exposed to alcohol, pot, and pills in middle school – yes, middle school. All the statistics confirm that is the age when my child, your child, my grandchildren and your grandchildren are being presented with life-threatening substances by their peers at school and at their peers homes.

What advice I can offer?  Know your children’s friends and families – well.

Get informed. Listen. Read. My top recommended books are:

Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones

The BEST comprehensive overview and detailed story of how America got to the point we are at now with opioids (synthetic derivatives from the opium poppy) and opiates (direct derivatives such as morphine and heroin). A MUST READ.

Woman of Substances: A Journey Into Drugs, Alcohol, and Treatment by Jenny Valentish

Not just a great book for young women since it highlights the ways in which studies on, and treatments for, addiction have been based mainly on men. A very informative narrative for everyone based on current research while also sharing Jenny’s personal experiences with addiction and recovery.

Fentanyl & Breathing Under Water

BREATHING UNDER WATER

I built my house by the sea.
Not on the sands, mind you;
not on the shifting sand.
I built it of rock.

A strong house
by a strong sea.
And we got well acquainted, the sea and I.
Good neighbors.
Not that we spoke much.
We met in silences.
Respectful, keeping our distance,
but looking our thoughts across the fence of sand.
Always, the fence of sand our barrier, always, the sand between.

And then one day,
-and I still don’t know how it happened –
the sea came.
Without warning.

Without welcome, even
Not sudden and swift, but a shifting across the sand like wine,
less like the flow of water than the flow of blood.
Slow, but coming.
Slow, but flowing like an open wound.
And I thought of flight and I thought of drowning and I thought of death.
And while I thought the sea crept higher, till it reached my door.

And I knew, then, there was neither flight, nor death, nor drowning.
That when the sea comes calling, you stop being neighbors,
Well acquainted, friendly-at-a-distance neighbors,
And you give your house for a coral castle,
And you learn to breathe underwater.

(Sr. Carol Bieleck, RSCJ, from an unpublished work)

I first heard this poem as it was read at our son’s memorial by the director of a recovery program we had attended with JL in Tucson. It is full of spiritual metaphors and allusions to addictive behaviors. It came back to me this week as I received the latest information on fentanyl deaths in a report from the Centers for Disease Control (CDC), summarized by CNN.
Fentanyl deaths skyrocketed more than 1,000% over six years in the US.
By Nadia Kounang, CNN, 03/21/2019
https://www.cnn.com/2019/03/21/health/fentanyl-deaths-increase-study/index.html

While the report is startling, it only confirms what we have heard. In 2011, there were under 2,000 deaths per year from fentanyl. Beginning in 2014, fentanyl related deaths began to double, from 4,223 to 8,251 in 2015, to 18,335 in 2016. Men are dying at a rate three times the rate of women, and the largest increases were among younger adults between the ages of 15 and 34.

Although heroin has been on a consistent climb as the leading drug for overdose deaths, fentanyl pushed past heroin for the first time in 2016. It’s no wonder. It is cheap to produce Non-Pharmaceutical Fentanyl (NPF) in illicit labs in China and Mexico compared to growing poppies and processing them. The synthetic drug is so potent that a slight error in the process can result in a bad batch that can kill multiple users almost instantly. Reports from around the country confirm mass overdoses becoming increasingly common.

Lethal amounts of fentanyl in heroin and other drugs is causing active drug users the greatest risk of dying. And because the fine white crystals are so potent, drug dealers can add undetectable amounts of fentanyl to heroin, cand ocaine to create more desirable products with higher highs and steeper price tags. The vast majority of deaths are the result of fentanyl mixed with heroin or combined with an inert white powder and sold as heroin.

But it’s not just those who have been addicted to heroin and opioids who are dying from fentanyl. Reports from the US and Australia indicate that fentanyl is being made into look-alike Xanax, ecstasy, cocaine, OxyContin, resulting in young people taking a drug for the first time at a party or music festival and dying.

Do drug cartels and dealers want to kill their customers? The evidence says they do not, rather, their production is inconsistent. And other than the minority who use fentanyl, active drug users are fearful of fentanyl-laced products.

Drug distributors are experimenting with how to make synthetic drugs, and unsophisticated local dealers are often sloppy when mixing fentanyl with other substances. That’s expected to change as the business of fentanyl trafficking matures. But Customs and Border Protection says that even if drug traffickers become more sophisticated and stop killing so many of their customers, that won’t necessarily decrease the overall number of U.S. overdose fatalities, since the number of users of fentanyl is expected to grow, not shrink. For the first time since 1918 life expectancy has dropped due to drug overdoses and suicides.

After reading these reports, I wonder: Is there any hope?

At international mail terminals, parcels are X-rayed to identify those that might contain fentanyl and other illicit drugs. They also use dogs, trained to sniff packages and alert agents when they detect fentanyl. Even when agents find a white powder they think is fentanyl, it can take days to confirm because dealers continuously change the chemical formulas to elude law enforcement.

“When the sea comes calling, you stop being neighbors…
And you give your house for a coral castle, and you learn to breathe underwater.”

The sea has come, like the flow of blood. We all––as a community, young and old alike––need to learn “to breathe under water,” to learn new skills, become educated about subjects we never had to learn previously, in order to survive and to leave a posterity, a future generation who are not destined for ruined lives but ones that are rewarding because they are purposeful.

https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/10/17/how-fentanyl-changes-the-opioid-equation

https://adf.org.au/insights/insight-research-around-fentanyl-telling-us/

A Missed 30th Birthday

Tomorrow would have been our son, John Leif’s, 30th birthday. Sadly, he is not here and we are not celebrating. Instead, we are remembering his life and honoring our son by sharing his story with a local recovery group.

In anticipation of our time with a group of 18 and over individuals, including parents or partners, who are trying to recover from a variety of drugs including alcohol, John and I discussed what we might possibly have to say that would be helpful.

We looked back at our journal and our upcoming memoir for options. And we asked a young friend who has been clean and sober for the past five years after over a decade of intense drug addiction. We all had the same idea: discuss shame and its role in addiction and recovery. Because the sense of shame that hangs like low black clouds gathering over our lives any time we as humans engage in something we know is not good for us – or others – is the ultimate loss of self-worth. As shame erodes the very core of our being, I believe it is the hardest obstacle (aside from the physical addiction) for addicted individuals to surmount in seeking recovery. Shame paralyzes us.

We began by sharing JL’s timeline of addiction and his death, showing some clips from his memorial video montage, and reading some excerpts from our upcoming memoir. We discussed the many mistakes we made and regrets we have, information that we did not know, advice we did not take. We discussed the role of genetic links in addiction and the importance of uncovering those family secrets so that we can be better prepared to openly discuss and warn our kids during those high-risk adolescent years.

And we discussed shame and guilt, the difference between them, and how to deal with both. Hazelden Betty Ford Recovery says their “fundamental addiction stigma-smashing strategy is to shine a light on people who are in recovery and expose the reality that people actually do recover from addiction; that it’s a chronic disease that can be successfully managed for life; and that it affects individuals who are every bit as moral, productive, intelligent, talented—and humanly flawed—as the next person.”

Our great hope and fervent desire is to shine a light and help bring encouragement to those battling addiction and alcoholism – to help them not feel “less than” but to know they are precious people who are fighting a disease. We were blessed at the acceptance we felt by the group and their receptivity to us sharing our story. One client said that, although she could not imagine losing a child like we did, she could encourage us that by our openness and empathy we will help save many other lives. Our hope and prayer is that sharing about JL’s death will bring life and wellness to all who hear.

Coming Out of the Black Hole

In doing further research in support of the upcoming publication of our memoir, I have found many new groups, websites, and blogs about the opioid epidemic. It is very encouraging. And I was thinking back to 2005 when we first discovered that our son was using Black Tar Heroin. We were in an absolute black hole of information––there was nothing to be found on the internet or in our community, even though it had been a decade since this new way of producing and marketing heroin had hit the streets of the west coast. Eventually we discovered Black Tar Heroin: The Dark End of the Street, a1999 documentary directed by Steven Okazaki. Filmed from 1995-98 in San Francisco.

As our son went through weeks of withdrawals without any medication, we finally found an outpatient recovery program for teenagers and their families in our town. (We had found inpatient programs that were in the $75-100K range, but that was beyond our resources.) Just a few weeks before we found out about our sons’ use, there had been a drug bust at his high school with many students who were using opioids sent away for rehab. What is sad and frustrating, still, is that no one––not school officials or the nurse or parents––no one let the rest of the school community know. No one shared information and I don’t think we have to wonder why.

The shame and stigma associated with having kids who use dangerous drugs is something that is still very much a taboo for many people. I continue to hear about young people who “died suddenly” but with no explanation of how. Sadly, we have learned from experience that 20-somethings do not die suddenly for no reason.

This makes the growing number of parents who are coming forward and sharing their stories worth celebrating––along with the many new organizations for helping families handle the complexities of addiction, detox, rehab, and recovery. All the awareness and action brings me hope to think that there will be fewer kids getting addicted in the first place and fewer families planning memorial services.

Here are just a few websites worth visiting and passing on, especially to anyone who has children starting with middle school age and up. It is never too soon for parents and their kids to be informed.

CRAFT PROGRAM: Community Reinforcement and Family Training  https://alliesinrecovery.net/about-craft/

Denial is a common theme among those suffering from addiction. If someone is regularly abusing alcohol, prescription drugs, or illicit substances, denial might have them convinced that there is no problem or that any problems are only the perceptions of their loved ones.  50% of people suffering from substance use disorder, and who admit they have a problem, are resistant to getting help. CRAFT was designed with these individuals in mind. Rather than target the person with addiction directly, CRAFT works with the concerned significant others so that they can assist the person to admit they have a problem and then seek help. It also helps show friends and family how to better communicate with their addicted loved ones.

Family Resource Center

http://www.familyresourcectr.org/
“Empowering families to understand and address a child’s substance use.”
Offers a variety of age-specific resources such as videos, articles, manuals, etc. to help understand what addiction is, who is susceptible, and the other long-term consequences associated with adolescent substance use. It can give you the resources you need to support your child before, during and after substance misuse begins.

https://humanizingaddiction.com/
“…a website that will introduce addiction to those not impacted in order to help prevent it from capturing a loved one and to bring awareness that the unthinkable is real. A place to share our love for ones that struggle to hopefully inspire others still fighting to come out from behind closed doors and to scream from the rooftops that our gracefully broken are the faces of those not aware that it can happen to them. A source that offers a private look into the day in a life of those captured by addiction. A site with personal journals of those that struggle against addiction each day.”

http://thealarmgroup.org/
“ALARM: A Living Amends Resource Media – The Voice of the Voiceless
To amend means to make a change.  We believe the epidemic proportion of the drug problem in the United States requires change, so we decided to act on creating the change we want to see. We’ve seen the raw results of this plague and couldn’t sit on the sidelines. It seemed like everyone we talked to knew or was related to someone who had died of an overdose or complications of opioid drug use.
We started interviewing and filming families who have lost loved ones to prescription opioids and heroin.”
YouTube link for short summary video of interviews:
https://www.youtube.com/watch?time_continue=131&v=HBkG0FxeMDU

JUST SAY “NO” TO FAILED DRUG POLICIES

I recently returned from Australia and began to connect with the addiction community there via several agencies and their newsletters and articles. One very thoughtful article published by Family Drug Support Australia (FDS) is excerpted here. Written by an emergency room physician who is on the front line with overdose victims, he is also a parent who is concerned for his children’s future unless drug policies in Australia change sooner rather than later. There, as in the US, bureaucrats spend years discussing options for change while people die in the tens of thousands. However, from people I’ve spoken with there and from all I’ve read, they are ahead of us in some significant areas. May we all learn from each other.

Stop sacrificing young lives at an altar of drug dogma
By David Caldicott
December 11, 2018

I am the very proud father of some very naughty children, and I would happily walk through fire for them. I am also an emergency consultant with an interest in illicit drug overdoses and, by obvious extension, how to reduce them.

Since the death of yet another young man at a music festival this weekend, from a presumed overdose, it is in this latter capacity that I have been asked, on several occasions now, “How do you feel about another festival death in New South Wales?”…

Put aside the politics & policy debates. A young man is dead before his time…Allow yourself, for one terrible moment, to let that wash over you, as if it were happening to your loved ones. And now tell me what you wouldn’t do, how far you wouldn’t go, to stop that happening to your family.

This is the perimeter around which I perpetually hover. I am the man who rings you to tell you that your child or partner is in our department, and that you need to come into hospital — right now. I am the man who will hold your hand if you need me to, and tell you that I am sorry…I am the man who will agree with you that you never suspected that your loved one, my patient, was in the slightest bit interested in using drugs. Every time I do this, part of me breaks, and I rush home to hold my own a little tighter.

Australia’s National Drug Strategy supposedly is based on the three pillars of demand reduction, supply reduction and harm reduction, but it is effectively a one-legged milking stool. Research conducted by the agents tasked with implementing drugs policy shows that the lion’s share of the money we spend on drugs policy goes into prohibition.

We are not without evidence to guide us from around the world. In the early 2000s, Portugal was in a worse place than where Australia is now. By flipping expenditure on drugs policy to shift the focus to health outcomes, Portugal now has a drug-related death rate 10 times lower than Australia’s.

…my heart breaks for the parents and loved ones of yet another curious, bright, naughty kid who was unlucky enough to eat the wrong thing at the wrong time…How would I cope with the loss of one of my own, in the knowledge that society has not implemented everything that it could to ensure the tragedy could be avoided? That some in society might think that it “serves them right”, dabbling with infractions of the law. Really? Death as a “learning outcome”? 

In the end, this issue is not going to be resolved… by opponents inspired by the un-attainable ideology of a “drug-free Australia”… This is an issue that will be bled out of Australia, life by life, until such time as parents decide: “No more.” I have yet to meet a parent who is prepared to sacrifice their child on this altar of ideology and I abhor those who embrace the rhetoric that suggests this is reasonable.

It’s not reasonable that young people should die before the generation that preceded them. It’s not reasonable to accept that as a norm. What is reasonable is for any civilized society to leave “nothing in the locker room” when it comes to keeping people alive.

Leadership requires bravery and wit, and whatever it is we’re seeing from politicians on drugs policy, it’s neither courageous nor clever. And if politicians of any shade can’t look down the barrel of a camera and say that they will commit to that, they don’t deserve the job with which they’ve been entrusted and for which we pay them.

David Caldicott is a consultant emergency physician at Canberra’s Calvary Hospital in Australia.
Original article can be found at:
https://www.fds.org.au/messageboard/opinion-piece-by-david-caldicott-from-canberra-s-calvary-hospital

 
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Grief – It’s Just Like That

I am sitting in our Arizona room looking out past our front garden, up to the soaring Rocky Mountains and the crystal clear cerulean blue sky. It is a view I love more than any other in the world. But my heart is heavy and I can’t seem to cheer it up.

And I realized, after a few days feeling like this, that grief is just like that. We can’t force the feelings to go away when they show up. We just have to ride them out. Like being on a river in a raft, floating along enjoying the peace and quiet and beautiful scenery when you come to a section of rapids. Hopefully you have your equipment in place: helmet, life vest, paddle. You know you need to hold on, gather up your energy and fortitude, and ride it out until you are through the rough water.

Where do we find the fortitude to be able to ride out the turmoil that this life can bring our way? This world offers many kinds of coping mechanisms, most of which offer only temporary relief – diversions – like watching a movie, going on a trip, shopping, eating, using alcohol, or a substance, etc. These may work for a small dip in the waves. But what if you are thrown out of the raft during a violent upheaval from the current? How will temporary diversions and coping mechanisms fare? As we all know from experience, not too well.

The equipment we need for a healthy and stable life on this planet should be in place so that when difficult times come, we can at least fall back on it: daily habits that promote well-being; a solid community support system like AA or 12-step groups or a small accountability group; a foundation of spiritual beliefs and practices.

My husband and I rely on that equipment – the only real stability we have known in the wake of our son’s death from a heroin overdose. We keep up our daily exercise and healthy diet and sleep; we call on our close community of friends who know us well and support us through thick and thin; and lean on our faith in a God who loves us, trusting His promises. We aren’t instantly removed from the tumultuous currents, but we know we will get through. I need to remember this today.

Memories

I am surprised when, although it has been over four years since our son died of a heroin overdose, memories surface and grief follows. The surprise comes because the memories seem to come ‘out of the blue’, from no particular trigger and for no particular reason.

My husband just had a memory that was triggered when he heard our seven year old granddaughter express trepidation over seeing a bird that had died and fallen into the back yard. It was as if our son was seven again, full of wonder and normal childhood fears. His voice, his emotions, him.

I have had memories of our son as I’ve been working in our daughter’s garden or driving to the grocery store. JL as a young adult, just his face in some everyday interaction, triggering the sadness that he is no longer on this earth, part of our life, living the life that most 29 year olds are living.

It seems that memories don’t need a reason to rise to the surface from out of our hearts. Our son has been in our hearts since the day he was born and he continues to live there. It is the strongest ‘evidence’ we have that life does not stop after we die and physically leave the land of the living. We are eternal beings and I am very thankful for that.