substance use disorder – 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

The Tattoo – Stigma

(Translation into most languages at tab to right.)

In the Greek and Roman worlds, a stigma was a tattoo or brand, especially for a slave, identifying the person as “inferior.” As stigma moved into English, it referred to a mark you couldn’t actually see but which was nonetheless powerful. Social stigmas are based on perceivable characteristics, associated with certain behaviors that distinguish a person from other members of society. They convey disapproval and disgrace. Dis-approval. Non-approval. Dis-grace. Non-grace.

In an article on The Stigma of Addiction from Hazelden Recovery we learn: “The stigma of addiction stems from behavioral symptoms of substance use disorder…which can result in negative consequences including legal, occupational and relationship problems. Understandably, these consequences cause embarrassment and shame among those affected. They also create stigmatized attitudes and perceptions among the wider public, a response that perpetuates and exacerbates the private shame associated with drug addiction. For generations, this combination of personal shame and public stigma has produced tremendous obstacles to addressing the problem of alcoholism and addiction. Today, the stigma of addiction is seen as a primary barrier to effective addiction prevention, treatment and recovery efforts at the individual, family, societal levels. Addiction stigma prevents too many people from getting the help they need.” Yes, only one in 10 people struggling with addiction receive treatment. The article goes on to discuss the irony that many of these stigmatizing behaviors diminish and/or disappear when a person is appropriately treated in recovery.

When talking recently with some of our son’s friends, they have been unwilling to let their past drug use become public knowledge because of the potential negative repercussions they justifiably fear in their careers and relationships. How much worse would it be if they were still living with addiction? What does this say about us as individuals, communities, employers, and society in general? When an individual is seen as having a moral failure instead of a chronic health condition, stigma is the logical result. But no one makes the decision about how their brain will react to a substance and whether they will become addicted after minimal use or hate how it makes them feel and never use it again.

Negative labels stick like glue to our hearts and soul and, for those struggling with addiction and alcoholism, the personal shame becomes how they define themselves. The public stigma that follows is the tattoo they never asked to have. If we can reject stigmatizing and instead provide a safe and listening ear to those struggling with addiction, inviting them to share their stories and encourage them to consider recovery options, they may be willing to join the many people who do learn to manage their disease and successfully recover. Let’s remember that they are just as valuable and able and worthy of love – and as human – as you and me.

https://www.hazeldenbettyford.org/recovery-advocacy/stigma-of-addiction

Anne’s Story: Cultural Influences

(Thirty-fourth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

This week’s Story of Hope is from a young friend of ours, Anne (not her real name). Here are some excerpts from her story in Opiate Nation (5 min read):

I was eleven years old when I first experienced shooting heroin. Looking back, I can hardly believe it and I am so thankful to be alive, and to be sharing my story.

My boyfriend and I watched the movies Trainspotting and Requiem for a Dream and they really piqued our interest in drugs. The way it was portrayed in those movies made me think using heroin would be an amazing dream sequence, when in actuality, it made me violently ill. My boyfriend insisted we keep trying. He became obsessed with all drugs: ecstasy, LSD, cocaine, and various pills and so I tried them all.

The Cost of Secrets

(Fourteenth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

When Breaking Bad was released in 2008, our son, and most of his generation of young people, watched it. He told us about it and encouraged us to watch it while also warning us that there would be some parts we wouldn’t like – but to keep watching. We did and he was right. But JL knew that we wanted to be connected to his life through the media he viewed and so we became fully engaged and finished the series.

When I think back about it now I realize that we didn’t fully ‘get’ why JL wanted us to watch this series. I believe now that he wanted us to understand the complications and conflicts that drug use brings into a life, perhaps knowing it would reveal secrets that he just couldn’t talk about with us directly. His life was complicated and so he lived with many inner conflicts. It is the inescapable nature of any addiction.

The In’s and Out’s of Grieving & Mourning

(Eighth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

When I was young, I only went to one funeral. I can’t remember who it was for or where it was, but it must have been for a close relative or I wouldn’t have been there. I do remember seeing everyone dressed in black. It was a very somber setting, people talking in hushed voices, and I didn’t comprehend what was happening. I just knew everyone was sad. After that day, I never thought about that person again – and even if my parents thought about him or her, their acts of mourning seemed to stop with the funeral. And I had no knowledge of any grieving on their part because at that time and in their cultural setting, people kept feelings regarding their grief to themselves.

It wasn’t until 20 years ago when my younger brother died from AIDS that I was faced with a death that was so close I felt a personal loss that tore at my heart. There was no way to just quickly plan a funeral and burial and then move on. My life as I had known it, now had a gaping chasm where my brother had once been and it was not going to close up anytime in the near future. I needed someone who had travelled this path before me to guide me through the overwhelmingly disturbing and depressing feelings. None of my friends had experienced a close loss like this. So, I looked to the books that were most recommended: On Grief and Grieving by Elisabeth Kübler-Ross and A Grief Observed by C. S. Lewis.

In Over Your Head

(Third in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

Chapter 1: The Letter

Most of us have felt like we were “in over our head” at some point in our lives. Maybe it was in a job, or a class, or a relationship. Perhaps in the ocean, or on a steep mountain trail or having made a commitment to an event or project that turns out to be more involved and time consuming than we thought. When we finally realize there are more problems than we can handle or a difficulty that we just can’t surmount, what do we do?

I remember one time when John and I were in Morocco and the friends we were traveling with were gone for the day. We decided to explore a lighthouse we saw ahead. As we walked through an opening in a wall that surrounded it, we started to feel we might not be in a safe place. We felt fearful as we saw trashed looking apartments and expensive cars with black tinted windows. What made us turn and literally run was the sound of mean dogs barking. As we ran back through the opening, several came in view with their spiked collars and bared teeth. Thankfully, as we hit the main street, their owners called them off.

Lifespan of Heroin & Opioid Addicts

(Second in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right. If you feel this blog is important, please repost to your social media using the buttons below. Thank You!)

When our 25 yr old son died of a heroin overdose in 2014, the statistics for the average life-span of a heroin addict was 5 years. Five years. Not very long if you are 15 or 20 or even 30, the age when most young adults’ nowadays are just getting in gear with their career, a long-term relationship, and planning a family. To have your life swept away before you have a chance to experience some of the most wonderful years of living on this earth is painful to consider.

Woefully Unprepared

(Today begins a series of topical blogs based on excerpts from Opiate Nation, chapter by chapter, that will run for 28 weeks. Translation into most languages is available to the right.)

It’s a bit ironic that as I begin blogging through Opiate Nation we are in the midst of a pandemic. Ironic in several significant ways.

Opiate Nation was written because of the opioid epidemic – which, in reality, is a pandemic. Every industrialized nation, and many emerging and third-world nations too, are dealing with the results from the ease of availability of opioids, whether natural and home-grown, or synthetic and imported. Or both, as is the case in America.

And like the Coronavirus pandemic that crept up on us so gradually that it’s deadliness caught us by surprise and mostly unprepared as nations, the opioid epidemic crept up on us too. In both cases, certain international players were unscrupulous for various reasons, causing delays in awareness when there might have been a chance for all of us to not be caught off balance.

The “inoculation” that should have happened, especially in the United States, by way of accurate scientific information disseminated by responsible leaders, didn’t happen. Instead, false information fueled by political agendas and financial motivation created a scenario that so crippled a timely public health response that, for many nations, it became too little too late.