Requiescat in Pace: Roger Nelson. May you rest in Peace! Amen.

Breaking with my usual format, I am reporting with sadness that a neighbor and friend, Roger Nelson who had been the Floyd County Coroner longer than I had been a local, died unexpectedly following a brief period of illness. It was Roger who first answered my questions about how many folk were dying of drug-related causes. He was concerned and alarmed that the numbers seemed to be growing with no official response, locally, at the state, or at the federal levels. He had been reporting the numbers! He provided information that allowed me to project future drug-related death numbers for a workshop I conducted, sponsored by Hope in the Mountains, in 2006. Hope was then a fledgling program for recovering women seeking to establish itself, and Roger commented on how much it was needed. Hope in the Mountains now provides long term recovery services to women seeking to recover from the disease of addiction. I was heartened, at that time by Roger’s response: reviewing his records and providing the first solid information I had found that the problem was indeed on the increase. Information he provided grounded my projections, and they have proven accurate. Just recently, I had the opportunity to thank him again for his hospitable and concerned response at that time. Of all the health providers and officials to whom I have expressed my concerns, Roger was the first to back his concern with an offer of help and suggestions as to how to get that information out. Floyd County has lost a dedicated public servant, a knowledgable health official, and a kind and examplary man. My deepest sympathies lie with his wife, children, and surviving family members. May he rest in Peace!

Throw the bums out!

Back in July, I used this theme.  I am going to revisit it, now.   It is about accountability. Currently, the General Assembly in Kentucky has proposals to consider that will toughen drug laws to turn off the tap for the free flow of addictive drugs in the state, restore the voting rights of citizens whose addiction ran them afoul of the law, and improve treatment options for persons with addiction.  The governor’s recent blue ribbon panel on prescription drug abuse returned the verdict that addiction is the state’s premier health and economic issue.  Kentucky has been hit by an economic recession like the rest of the country.  If we grow the industry of healing persons with addiction it is a no-brainer that it will produce a win for us.  The function of government is to maintain the body politic: literally to preserve the lives, liberties, and well-being of those whose government it is.

Report card time.  For sitting idly by and playing political chess with each other while citizens died by the score from the scourge of addiction, both Houses of the Assembly get poor marks.   Only our governors have shown any budgetary mercy on this score, but their grades are barely passing.

So how much dying actually has gone on in the past 20 years?   For comparison, let’s look at some real public health disasters from the past.  Philadelphia got hit with the Yellow Fever in 1793.  An estimated 5000 of its 62000 citizens died: 8.06%.  The United States was hit with Spanish Influenza in 1918.  This was the precursor to the modern Swine Flu.  195,000 of 103,208,000 total population died in that public health disaster: amounting to 0.188% of the population total.  The drug-death scourge in our part of Kentucky has been going on for over  2o years.  Regular readers of this blog know that I have been doing a death survey for Congressional District 5 in Kentucky.  With about 2/3 of those Counties surveyed, we have recorded 1860 deaths, in the last six years (2006-2011).   This includes mostly folks who were under the influence and died as a result of accidents, or directly from overdose.  It includes a smattering of persons who died as a result of the actions of a person under the influence.  In Kentucky’s Congressional District Five, the 2010 Census counts 673,670 persons.  Drug deaths amount to 0.276% of the population: not as bad as the plague that hit Philadelphia in the 1700s–but way more than what we experienced from the Spanish Flu in the early 1900s, in only one year.  Yet, we have had the ability to compare years and to know that it was getting worse.  What went on in the General Assembly?  You quibbled over gambling and the ten commandments.  Frankly, I wonder what God thought of your values.  From me, you get a big “F”.

We have waited patiently for over four years to get an up and down vote in both  Houses on a matter of simple justice for persons with the disease of addiction who have run afoul of the short-sighted legislation that effectively makes it a crime to be an addict.  Restoration of voting rights to folk who have paid their debt according to the law, who already suffer enough with the stigma of addiction, is a matter of simple justice.  If voting rights are not restored by our constitution, why not allow the rest of the voting public have their say without holding the process of amending our Constitution a hostage to your self-righteousness.  For patronizing your voters over this issue for the past four years and not using your powers to move past those who have used the process to bully persons incapable under our laws of protecting themselves,  the Assembled bodies earn a fat “F”

The best research and the latest studies all draw the same conclusion: addiction is a physiological disease of the mind. It is a chronic relapsing disorder of the brain. Folks who “get it” don’t seem to get over it—though the obvious signs of it disappear, sometimes, for years. National Institute on Drug Abuse officials say that addicts have “hijacked brains.”

Here we have this chronic relapsing disease of the brain, killing folks like Grandma kills flies in her kitchen—and all the political hacks can say is they are “against drugs,” ,gonna put more men on the job of finding them, and gonna put more of the folks who play with them in jail.  Ain’t that a novel idea!  Sounds like they might have borrowed a line from the 1930s, except that most of the time it is not Al Capone types they are catching up in it. It is some little kid we watched grow up down the hollow, who got caught in the web of addiction and can’t get away. Or it’s some kid in our family. Or some adult who didn’t realize the pain pills would get vicious.

Two yeads ago, our elected officials got really concerned about an outbreak of H1N1, known popularly as “Swine Flu.” People were held accountable for getting enough of the serum out to folks to prevent the likelihood of an epidemic. The danger represented by that epidemic was measured in terms of seven or eight per thousand infected population. Currently, ask your County Coroner, the drug epidemic is killing upwards of 2 to 10 per cent of our addicted population, and Frankfort’s elected elite just stand around clucking and bobbing and shaking their heads like a bunch of chickens contemplating a corn shortage.

After I became a drug counselor, government at every level started a War on Drugs. It has always looked to me like a war on drug addicts. Over-dose or drug-related deaths have always been our part of the battle to prevent. We know that treatment works. Studies have proven that treatment done long enough, done enough times, done under the right circumstances, tailored to the individual, using researched methods…treatment works. Like treatment for cancer…no cures yet; but we are getting better at it, as witnessed by the numbers of people who are in recovery.

Pardon folks in addiction recovery if they don’t shout it from the rooftops. And there are a lot of us around. In our society it casts a long shadow to admit that one has ever been under the control of substances…sort of like going to church and saying, “I used to be a prostitute; but I have given my life to the Lord.” The congregation will accept you; but women watch their husbands around you, and no one wants you giving ideas to their daughters. And it is a chronic problem: my own addiction is always there, just under the surface waiting for me to make a misstep. So we folk in recovery will be excused if we just don’t want to shout the news that we are better.

However, the scarce treatment resources that we have can’t stop the dying that is going on. And the public policies that we have in place: interdiction, drug courts, prisons (our number one industry in Kentucky,since we started this war)—none of that is stopping this epidemic of death that surrounds us.  How come we are just now hearing more about it? Well, families rarely want to tell the truth for the media when death occurs—again, wanting to spare their loved one the indignity that says s/he had lost control of life’s choices to a substance. And the whole culture of addiction, our culture, is rooted in lies and denial, so we cannot expect it to blow the whistle on itself soon!

Accountability. It comes down to accountability. We all know that our current public policy will not work a solution for us. It is as bankrupt, in that respect, as was the other Great Prohibition of the early 1900’s.  I am somewhat comforted to see several public officials making these statements.  I am heartened that the Governor formed a task force to study the issues, taking all of this experience into account.   Let us hope for a complete overhaul: devise a new public policy that effectively eradicates the stigma of reaching out for help, a policy which assures that help will be there when the individual is at all ready for it.

I must confess that I  would be even more comforted if I did not know that some of our public officials are part of this problem.  That will require more hard work on the part of the electorate to clean up the swill skimmers in public office–who profit from the problem.  Our problem won’t be arrested and jailed. It has to be treated. Drug courts are a step in the right direction.  The Targeted Assessment Program, piloted locally and being offered in more counties of the State through the Department for Community Based Services is a program that learns as it goes to help families remain together and treat the addicted parents.  Much more is needed to move hijacked brains toward help.

All of us at some level would do well to face ourselves, and ask how we contribute to the problem.  When that happens, Hope of recovery will be born.  Sometimes all we have of recovery is hope, but hope is enough to water a life into bloom.  We need fresh vision to deal with the addiction problems we face. Ask yourself if you can tolerate this miserable guessing game of “who’s next?” By all means, throw the bums out! Make our leadership accountable; or replace them with folk who are accountable!

Til next time: Peace! Jim Recktenwald

The Great American Medical Boondoggle

“Boondoggle” is Wikepeida-defined as a scheme to waste money and time.

Imagine that becoming HIV positive involved using “stuff”  and involved social activity.  Imagine that what you used was deadly to some, but the majority would be unaffected.  Imagine that the activity was only criticized for those affected negatively–all others liked it and planned opportunities to participate in it.  Stop imagining, now.  That is pretty much the way it happened that we have an epidemic of HIV.  The “stuff” is  human sexual activity.  Persons who initially contract HIV are unaware and possibly critical of persons who have it–being somewhat ignorant of the way it is contracted.  They may even “tsk-tsk” others who are newly reported as infected–wondering, “How could they let that happen to themselves?” grateful that it is not their problem to rock. The medical community was not very helpful, initially–uninformed and full of fear and prejudice–it allowed its ignorance to prevent it from mounting an immediate, scientific, and reasoned response to this fearful new killer.  In a routine test, conducted when s/he goes to donate blood, the person disscovers “I am positive?!!!”  In looking back, s/he discovers some little indiscreet sexual act that occurred once when s/he had a bit much to drink–easily dismissed the next day as harmless. “Not really a big deal…”  Suddenly, perspective on HIV becomes tragically informed and poignantly personal.  Gradually the medical response began to live up to its value to “at least do no harm,” and the fatal tide began to turn.  Today, persons with HIV are fighting back and the medical community is poised to assist them in their fight.  Equally important: scientific research supports health education and prevention efforts to reduce the incidence of the infection in the population.  The principal holdout in preventing the spread of the infection is the ignorance of the general public.

With some notable and important differences in perceptions of the the problem, the HIV story has a parallel in the deadly drug epidemic sweeping the country.  Drug deaths began in the 1950s and earlier.  Addiction, however, was considered to be confined to small pockets of marginal persons in our culture: artists, misfits, persons who could not be counted as representative of the American way of life in the USA.  For that reason, laws were passed to further marginalize the behavior, confine it, push it underground in hopes that it would die for lack of attention.  It has become the most virulent killer on the health scene today.

Like HIV, untold money, time, and effort has been spent conducting awareness campaigns, making attempts to curtail the destruction by legal interdictions, working to improve research and treatment options, etc.  Unlike HIV, those responsible for conducting the research, passing the laws, and developing sane public policy are all complicit in allowing the problem to worsen.  Their failure to find a paradigm common to health providers, to law enforcement groups, and to the general public has allowed senseless conflicts to arise and a very old problem to become hoary with age.  Is it profitable to do so?

We cannot seem to solve a relatively easy market analysis problem, having uncoupled drug supply from drug demand, since the time of the Harrison Narcotics Act in 1914.  Rememeber, when the law was formulated and for years after a very small segment of the population was directly involved in use. The Interdiction and Isolation paradigm made sense in that day and time.  In the 1950s, organized crime moved drugs, one  kind and then another, into mainstream America–using the bootlegging network left from Prohibition.    From then on, any successful paradigm for public policy, disease prevention, and health promotion would have to address both sides of the law of supply and demand.

There were plenty of attempts to grow both capabilities: interdiction of supply by law enforcement, and lessening of demand by health providers.

Infiltration of distribution networks by Narcotics Officers (Narcs) resulted in impressive dragnet operations.  Often several enforcement groups would cooordinate efforts to produce  good results.  That the effort is today bogged down in complete failure is demonstrated by the polarization of drug users and street vendors as bad guys while the production industry, pharmacists, and physicians have been given a pass as law abiding citizens whose products become the primary source of contraband.  As if the enforcement job were not difficult enough, the game has evolved into a stable source of income for whole communities who thread a thin line between outright disrespect for the rule of law (such that law enforcement is often complicit) and a veneer of respectability where besotted representatives of the law protected by their status or position stand in judgment over less fortunate citizens who get caught ”red handed.”  Indeed, considering the fact that most persons serving time today are there for drug related, and often drugged, criminality–one can deduce that enforcement is more a matter of catching impaired persons, than taking a bite out of crime.

On the side of the equation to improve health-provider capability with this problem, one can simply measure the relative weight of the funding for health and research versus that for interdiction to get a fair picture about the lopsided way the drug problem has been addressed at the federal, state, and local levels.  Initially, there were forays into medication assisted treatments, therapeutic communities, and street-level interventions that made sense–including walk-in health and screening clinics, social model detoxification centers, needle exchange programs, help-lines, etc.  Persons with the disease of addiction were encouraged to step away from it.  Programs kept crisis beds for the addict who had reached the end of his rope, run out of sources, was hurting, and called for help.  The desire for help often begins just as impulsively as an individual’s first decision to use a drug.  Often such interventions work.  Just as often they don’t.  But having access sends a clear message to persons suffering: “We want to help you.  We don’t need to punish you further.”  Today that message reads: “If you want to get help, it will take weeks.  Sometimes we ask you to narc on your buddies before we let you in.  If the police need a souped up vehicle to use as a ruse with which to bust you–they will have it within hours.  Your place on the waiting list for the program you want to go to will be weeks or months opening up.”   Jails make money on prisoners.  Drugs and drug busts are standard fare in our jails.

There is little doubt that the law of supply and demand will have to be tweaked a-plenty if we are going to make the numbers begin to work in our favor with the problems posed by illicit drugs and the disease of addiction.  Some ideas…

To start with, throw out the notion that punishment of any kind will deter use.  Punishment increases the defensive stance of the person with addiction.  Cool hand Luke is the paradigm for punishing persons with addiction to improve their behavior.  Intervene in antisocial behavior.  When safe, treat the addiction.   Re-examine the problem and let’s apply controls at all the leaky places where drugs are escaping to the street.  Consider legalization or places where some substances may be used–for instance, in labs–while we study these largely unknown street drugs to determine how to offset the health issues they cause and for which we eventually pay.  Insist that companies whose drugs are regularly mixed in prescribing practices do research to determine product safety on the mixed product.  Ensure that policy enforcement does not result in greater disrespect for law: do away with forfeiture laws that benefit the enforcement agencies directly and not the general fund.  Earmark funds emanating from large lawsuits and fines, confiscated properties,  direct taxes on drugs, etc. to be plowed back into the infrastructure for research, treatment, prevention, interdiction and enforcement, and the general fund so that the comparative proportions are maintained, and all other aspects of government benefit from the restoration of the rule of law.  Finally, fund treatment under the Casey Act, and fully fund treatment on demand at some level.

Current legislation before the general assembly, brought by Greg Stumbo, is a big step in the right direction. Restoration of voting rights to ex-felons with non-violent drug charges is another such step.  The Governor’s promise to put a lot of new money into treatment is yet another step in the right direction.  Let’s hope that party gridlock does not prevent these efforts from bearing fruit.  Kentucky, long the whipping boy for the nation, is in a unique position (with community mobilization around drug issues, and just plain awareness that the problem will only get worse if we continue to make unbalanced efforts at dealing with it)…a position to become the prototypical state for managing its drug crisis into an economic recovery.  It would be profitable to us all, in the Commonwealth, to do so.  The drug boondoggle has stolen hope from many, and killed many.  It is time for the cool wind of change to clear our consciences and stir our hearts to do what we can to help each other.

Next time, I will compare the current drug-related death rates to death rates like the Yellow Fever in 1780s, and to the Spanish Flu of 1918.  Til then, Peace!   Jim

DEATH SURVEY:We knew it would happen. Why didn’t they?

This is the third in a series of blogs sharing information being gleaned from the “Death Survey” of Coroner’s records: a survey of drug-related deaths.  Survey results are anonymous regarding the identity of the deceased.  Some of the infomation that follows is the result of reseach prompted by the study.

Today we will answer the question: if folks around them could see they were on a destructive path, and often told them about it, how come those who died behaved as if they couldn’t see it coming?  The easiest answer to give is, “They were ‘in denial.’”  The more correct answer is that they received a traumatic brain injury (TBI) when they overdosed and became  the least bit unconscious.  The brain became oxygen deprived, briefly.  The first part of the brain to pay for that is the Amygdala.

As it was explained to me, the Amygdala is a small part of the brain; but it plays a large role in setting up overdose death.  If you drew a cross by making an imaginary line between the openings of your ears and another line between the bridge of your nose and the middle of your skull at the nape of the neck–the amygdala would sit in the crosshairs.

The amygdala’s job is to jazz up your memory with emotional content.  For instance, most of us know how it feels to go over a high spot on the road–we get a funny feeling in our gut that may cause us to holler–even though it is not completely unpleasant.  The amygdala colored that  memory with an unusual feeling and most of you knew what I was talking about before I described it.  Now imagine that you are dying and the part of your brain that is supposed to wake you up and scream is getting no oxygen while the rest of it is sleeping peacefully.  By the good work of paramedics, an ambulance, and some hospital personnel, you go home the next day with a stiff lecture about using some form of reminder to let you know that you have already taken your medicine and you don’t need to take it again and overdose.  You feel embarrassed at having put some people out and worry that everyone will know what you suspect but haven’t yet admitted: you have become addicted to your medicine.  But you are not scared out of your mind that you nearly died.  The part of your amygdala that might have given you something to worry about is dead.  All you remember of that day is that you got a really peaceful nap.  You use a pill organizer to calm your family’s fears.  Sooner or later you will do it again, because you haven’ t got an experience recorded in your memory that you can automatically recall with very little prompting.

Once an individual suffers a TBI, the probability of them having another increases dramatically. Your family members are horrified when you ask the doctor to increase the pain medicine which seems to be wearing off too soon.  When they remind you again of the overdose, you assure them that you know what you are doing, and privately you wonder if they aren’t trying to manipulate you a bit.   The whole incident seems overblown to you.  Without therapy for your damaged amygdala, you are on a collision course for the next overdose, the next dress rehearsal for death.  As your confidence returns and everybody stops talking about your overdose, you stop using your little organizer/reminder pill bottles.  In the next week or so, you will OD again.  It will be so minor, that no one around you will notice.  You have begun your training run for the big event.

And that is how it happens.  Listen.  This is not happening to “kids” in their 20s.  It is heaviest in the 40 to 50 year age group.  Folks with a lifetime of experience, in the prime of their life, and just enough brain damage that prevents them from knowing how severely at risk they are.  If you are taking xanax or valium or klonopin and any kind of pain pill or sleeping pill regularly, talk to a pharmacist and another doctor and see if there is some other pill regimen that will not mix these substances.  Their package inserts warn against taking the other drugs at the same time.  One in five Americans is thought to be using drugs in a dangerous way, today.  Certainly the death rate from drug use is way up.  Wake up or plan for a long cold sleep.  If you cannot stop your current use, call someone who can help.  Treatment providers are listed in the yellow pages.  Peace!  til next time…Jim Recktenwald

Death Survey: Process Report 2, Defining Drug-Related Death

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

Death Survey: a process report.

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!

Medical Practice and Addiction

My Mickey, like me, was an addict. She did not ask to be an addict. Did not do it to herself. She gradually lost control of her use of substances in such a subtle way that she was still convinced she could get it right, sooner or later. Unlike me, after 30, she never quite achieved long term recovery, never got to spend a whole year away from substances that affected her, as they did me, in ways not predicted on the package inserts.  Package inserts generally hold for us a pale warning: “persons addicted to such medications should use caution.”   For those of us with addiction, they should read: “Run like hell and get away from this stuff.  It is going to affect you in ways you cannot imagine and in ways you certainly cannot predict. Drop it.  Run!!!”  Mickey was the third member of her family: a sister in law, her daughter, and Mickey: to die. Same doctor, same medications, same death, and they share the same hillside. If we had just known, when her sister-in-law died eight years before, we might have dug the hole wider and just waited for the other occupants. When I visit the grave, I visit the three, buried side by side. It mocks the meaning of research-based treatment to think that nothing in her doctor’s medical practice changed after the first death. Oops! I stand corrected. There was a change. Mickey was able to fill her prescriptions right there in the doctor’s office.

Mickey did not abuse medicine. The practice and use of medicine in our country abused and helped to kill Mickey. We all know that the outcome for an addict who won’t stop destructive use of substances is always: “…Jails institutions, and death…” to quote recovery literature. What we have failed to accept is that Dr. Kervorkian’s is not the only medical practice that deals in death. Nor are pain clinics the major purveyors of this deadly practice. It turns out that I don’t have to go far from home to “benefit” from such ignorance-based intervention.  Remember, doctors may get as  much as one week’s instruction on the patients and the illness that they will see and treat over 60% of the time: persons with addiction.  But the problem does not end with medical training.

It is interesting to me that the “X-Forge” medication I take to regulate my blood pressure must be put on back order at times, as did “diovan” before it. I have never heard a person with addiction complain that any of the meds s/he uses is in short supply. I really am not upset with Mickey’s doctor. I am upset with a culture so inured to the deaths of persons with addiction, from the effects of their addiction, that it overlooks all the ways that such deaths might be avoided. What drug rep has ever told a physician that the benzodiazepine or muscle relaxer s/he is advocating that week should never be prescribed at the same time as an opiate is being given to the patient? What doctor regularly and routinely investigates every death among his or her patients to see if s/he might improve medical practice? That “practice” should be a scientific caveat for those who practice medicine. What patient, today, routinely asks what s/he can do to manage symptoms without the use of medication? What manufacturer of pain pills or benzodiazepines is experiencing losses due to unpredictable sales of its products? What manufacturer runs the numbers on pills prescribed per sampled population of patients—to see if too many are going out over a set period of time—in order to assist doctors in monitoring their own compliance with the manufacturers’ labeling? Most of the illicit “pills” being consumed began their journey as licit prescriptions. Besides keeping the addicts in plain view, there are other “targets” to monitor, if we must find targets to handle addiction among us.

Addiction to alcohol or other drugs can only happen to one who uses those substances. But it does not happen to everyone who uses them. It is estimated to affect about one in every three or four who choose to use. No government program can stop that fact. Addiction does not happen only to folks with criminal records. With addiction, patients who carefully follow doctor’s orders become ill when the drugs affect them in ways they cannot control. Persons whose drug or alcohol use has seemed moderate for years may gradually succumb to the effects of addiction. These unsuspecting victims of the disease eventually discover the embarrassing facts—after friends and family have long since recognized their turn for the worse.

We have known for more than half a century that addiction is a disease of the brain, a  “relapsing disorder of the brain.” Addiction is recognized as a disease. This has been so since the American Medical Association (AMA) presented Alcoholics Anonymous with the Lasker Award in 1956.  Yet folks are dying among us with this problem, undiagnosed and unrecognized for what it is. It kills from a hundred different forms of associated cancer, heart disease, liver and kidney disease, as well as overdose. All those folks who die are ill. They have no desire to suffer and die this way. Arguments that they did it to themselves could as easily be laid at the doors of many persons with heart disease, diabetes, and other “life-style-related” illnesses.

It is time to accord those who have addiction the precautions, the courtesies, the respect, and the accommodations that we offer those with diabetes, heart disease, cancer, Alzheimer’s, and all the other medical conditions for which we provide care. Are we suspicious of the Alzheimer’s patient who keeps trying to return to some past location that s/he can no longer even name, and repeatedly sneaks away from caregivers? Of course we are. Do we blame the patient for making repeated attempts, or do we rather adopt respectful precautions and increased vigilance? Persons with addiction can be very convincing in defense of their runaway behaviors. Should we forget what we know because their siren song is so sweet? How often do doctors and nurses berate diabetics or heart patients in crisis who have failed to follow treatment protocols, resulting in the crisis? Do we use force with them when they curse or vilify staff? Routinely post security by the door? Openly show our disdain for their obvious failure to do self care? These practices are normal fare for persons with addiction who arrive in crisis under the influence—even when noncombative. How often with more than 20 years of continuous, long-term recovery has a medical person said to me upon reading my answers to addiction questions, “Oh, so you are one of them!”

Well, here is my answer: Damn right!   I am one of your patients.  I am a person in recovery from addiction every day of my life.  I have done typical “addict” behaviors, just as your diabetic patients have had their behavioral crises.  I have been in recovery for 31 years–aided first and foremost by persons like myself who made me aware of the signs and symptoms of my recurring illness.  I quickly learned to be on guard in your office, since you know so little about my illness and reach for solutions to health issues that will as quickly kill me if they don’t just send me into relapse.  As often as not, my recovery is daunting to you since it means I have answered questions for myself to which you may yet be avoiding the answers, since they will signal a problem for you or a family member.  Awareness of this disease is a form of power.  Pick my brain.  You need the information!