political will – Opiate Nation

HEALTHCARE – Privilege or Basic Need?

(Translation into most languages at tab to right)

If access to health care is considered a human right, who is considered human enough to have that right?

I critique market-based medicine not because I haven’t seen its heights but because I’ve seen its depths.

~Paul Farmer, M.D., Ph.D. (1)

In sorting through bins of old notes and letters, I knew one bin in particular would bring up painful memories. It was our son, JL’s. It was difficult, as I had imagined. And one of the – no, THE – most painful reminder related to his death from an overdose. It was the fact that we played a role in his preventable death. And so does the American capitalistic healthcare debacle.

The previous New Year’s eve, he was with two of his friends who overdosed and one died. It shook him to his core and he came to us and asked for help. We went together to his addiction doctor and after separate sessions, we then talked together. His doctor said: “This young man cannot start using again because if he does, he will die.” This came from his years of experience working with young people who had been inadverntently caught up in the opioid epidemic of the 2000’s. He felt JL would need to be on Suboxone for a long period of time and maybe for the rest of his life.

JL was hesitant because he had been on Suboxone years ago when it was very expensive and being prescribed at 32 mg a day – a huge amount that left patients feeling like they were drugged. And the worse part was trying to get off it. Tapering off was extremely difficult and took forever – like extended withdrawals.

Aside from the physical hurdles was the cost. It was very expensive and, guess what? It was, of course, not covered by our private health insurance (which cost us almost $1000/mo as self-employed workers) because addiction was not considered a healthcare issue. As a matter of fact, if a person said they had an illegal drug addiction, they would likely be dropped from health insurance coverage and be reported to the police.

What is so painful for us now is that we made the decision that January to drop JL from our costly policy and to not cover his getting Suboxone due to the expenses (it would have been hundreds of dollars a month for the Rx). And in the mistaken belief that he just needed to try harder. We thought this would force him to stay clean – good old fashioned will power and hard work. He did go into a detox program for a month and then into a great sober living program where he did so well we thought we had turned the corner in his 10-year struggle with opioid addiction (which had started when he was 14 and experimenting with Oxy’s).

What we didn’t understand at that time was that opioid addiction is not overcome by willpower. The result was after 6 months, he finally had impacted wisdom teeth surgery and weeks of opioid pain meds – because we thought there was no other option and we thought he could handle it. Within 3 weeks he began using heroin again and after a few days, overdosed and died. August 2, 2014.

What our family did not have as an option was what was finally put into law in 2014: The Affordable Care Act (ACA). This law mandates that all new individual and small-group plans cover substance use disorder (SUD) treatment as one of the ten essential health benefits. It also prevents insurers from denying coverage or charging more because of a pre-existing condition, including addiction.

Sadly, there are politicians who want to revoke the ACA or limit much of its coverage. As the supposed leading nation in the developed world, we are the only one without universal health care for every person from cradle to grave. All of our peer nations have it. Some systems work better than others. Regardless, health care is not seen as an option or a privilege for those who can afford it. It is considered part of a healthy and egalitarian society.

But in order for our government to save money (since our elected officials don’t want to tax millionaires and billionaires equitably), there have been significant cuts to Medicaid and SNAP and changes to the Affordable Care Act (ACA), that are projected to increase costs and reduce coverage for millions. There are too many details to go into here, but the bottom line to me is this:

Why are we even debating how much coverage these programs and health insurance companies offer when we should be pressing for complete health care coverage for all Americans – especially for the least of us who can barely afford food?

If we consider ourselves a nation built on Judeo-Christian principles, how can we not believe that as a society it is our responsibility to care for the sick – as people of faith have always done?

If how we viewed health care changed – as a basic need instead of a privilege – then the necessary changes to our taxing structure and health insurance would change. Where there is a will, there is a way.

Dr. Paul Farmer. https://www.pih.org/paul

An Entire Generation

Translation into most languages at tab to the right.

A generation is usually considered the years during which children are born, grow up, become adults, and begin to have children of their own. Approximately 20-30 years, averaging 25 years. Each generation becomes known by what characterizes the lives of those in it – what they do and how they impact society.

I’ve been thinking about my son, who would be 36 this year – if he had survived the opioid plague that began in the 1990’s with the prescribing of opioids for every ache and pain. What Purdue Pharma did is old news and well documented. But the effect of the immorality of the Sackler family set a course that destroyed the lives of an entire generation – the “Millennials” generation of my son and his contemporaries.

Far more than a million Americans have died due to a drug overdose in the past 25 years and the majority of those deaths are from opioids. (1) Initially it was prescription opioids, then heroin, then fentanyl. And now a daily variation of synthetic opioids mixed in with every variety of street drug. These are made from precursor chemicals from China and shipped around the globe where they are “formulated” into fake prescription pills or street drugs in jungle or backyard labs. Quality control is non-existent.

Beyond the deaths, there are millions of Americans who are suffering from life-threatening addiction. They will either be another statistic or live the life of an empty shell surviving from one fix to the next just to not feel “dope sick.” Many are homeless and jobless. All experience despair and hopelessness. It will take years to gain long-term recovery if they can access health care and programs.

There has been some good news. After the peak years of the Covid pandemic, when the rates of addiction and deaths from overdoses rose substantially, the statistics for 2024 finally show a decline in both. (2) It may be due to less anxiety and depression since the pandemic ended. It may also be due to more awareness of Medicated Assisted Treatment and better access to Harm Reduction tools such as pill testing and overdose reversal medication naloxone.

I think the best area for hope is the common knowledge the “Gen Z” kids are growing up with about the deadly dangers of drug addiction. That their parents are also more aware of the drug supply than parents of Millennials like me. The 2023 National Survey on Drug Use & Health found that the majority of adolescents (12-17 yrs. old) in the USA are not using substances, alcohol, tobacco products or vaping. (3) But ongoing effort is imperative. “Continued prevention programming, education, and public messaging focused on adolescents can delay or prevent substance use and avoid the negative impacts of substance use that have been widely documented.”

If we truly want to see future generations of children have the opportunity to grow up without the continual pull to use drugs, we need to keep our relationships with them open and healthy. Every year we can delay experimentation with addictive substances allows children’s brains to develop more fully in the area of judgment. We must all stay informed and aware and work in whatever arena we are able. As Barack Obama told Michelle when he was working for her as an intern, that he was in law school because grass roots organizing had shown him that meaningful societal change requires not just the work of the people on the ground, but stronger policies and governmental action as well. (4)

Fentanyl and the U.S. Opioid Epidemic

https://www.cfr.org/backgrounder/fentanyl-and-us-opioid-epidemic

2. The Opioid Crises and The Pandemic

Opioid overdoses soared during the pandemic, spreading to previously less-affected groups including teenagers and the elderly

3. NSDUH Data Show Most Adolescents in the US Are Not Using Substances

Click to access 2023-nsduh-spotlight-nonuse.pdf

4. Becoming, by Michelle Obama, Chapter 8

If my son were alive today during the Covid-19 pandemic…..

I would fear for his life more than ever.

“Drug Overdoses Soaring: Suspected overdoses nationally jumped 18% in March, 29% in April, 42% in May, data from ambulance teams, hospitals, and police shows.”

As a young man in America who wanted more than anything to be free of his deadly heroin addiction, how would he be weathering the Covid-19 pandemic?

“The drug-overdose-and-death epidemic already was hurting communities before COVID-19, but during the pandemic there have been reports from every region of the country on spikes in opioid-related calls to first responders, visits to emergency rooms, fentanyl and tainted-drug-related overdoses. There also have been challenges to accessing sterile needle and syringe and exchange services.”