Can We Treat Our Way Out of This?

I was reading the obituary of a young woman named Isabella Sammartano from suburban St. Louis, Missouri, who died from a heroin overdose suddenly after being clean from opiates for 16 months.

Her obituary doesn’t provide a lot of detail, but it does provide some. It sounded as if she spent a lot of time in rehab, then relapsed each time. Finally, when she looked to be putting the worst behind her, she relapsed again and overdosed and died.

It’s an extraordinarily sad story – and it must have been very difficult for her parents to write the obituary.

It made me think of what her death can tell us. First, all addiction seems to involve relapse. I quit smoking (and started again) nine times before I finally quit for good – at 37.

But I lived through my cigarette relapses. With opiates, particularly given the amount of supply of dope on the street, getting out of treatment is like Russian Roulette. People go in, detox, get clean. Their tolerance to narcotics drops. They leave rehab and do well, then they relapse. With these drugs, and their prevalence and potency on the street, relapse too often means death.

It feels good to say, `We can’t arrest our way out of this.’ I agree. We do need expanded treatment. But, frankly, that also feels too easy.

My feeling is, when it comes to opiates, we have to arrest our way out of this before we can treat our way out of it. That’s a bit discombobulated, I know. What I mean is that we need to address supply on the street. That comes only with arrests. It seems to me dangerous to assume that in modern America people can get out of rehab and go home to areas awash in dope and be expected to stay alive, given the likelihood of relapse and the potency and controlling nature of opiates. It’s not cigarettes people are relapsing on. It’s pain pills and, especially now, heroin and fentanyl.

This is a supply story and has been from the beginning. Huge amounts of very potent opiates were unleashed on the country – first in the form of prescription opiate painkillers. When millions of people grew addicted to these pills, a lot of them looked for cheaper alternatives. Heroin traffickers, mostly from Mexico, slowly realized that these folks were a growing market and expanded their offering.

But it all has to do with supply. No treatment has much chance against a cheap and plentiful supply of potent dope.

It’s why doctors and the medical establishment need to continue reassessing how they prescribe opiate painkillers.

It’s also why we need to make Mexico a sustained priority. I’ve written elsewhere that I don’t think building a wall — or rather, more walls — at the U.S.-Mexico border is likely to do much to slow heroin trafficking. That doesn’t mean we shouldn’t seriously address Mexico’s continued production and exporting of this drug. Ninety percent of our heroin comes from Mexico, according to the U.S. State Department. It’s unconscionable that one country should export so much of this junk. China fought a war with England in the 1800s, twice, over this issue. We don’t need wars with Mexico, but it does seem to me that we need to make this the priority it deserves to be – and walls are a distraction from the real work that needs doing.

This young woman’s death also shows why we probably need to make much greater use of what’s known as medically assisted treatment – the use of drugs as replacements, as shields. These include methadone, Vivitrol and Suboxone – they either take away the craving for heroin or block overdoses.

It’s unreasonable, I think, to assume that addicts can go back to these same neighborhoods, where opiate supply is plentiful, without some sort of protection, some kind of shield.

The last couple years have shown how dangerous that is.

10 Comments

Filed under Dreamland, Drugs, The Heroin Heartland

10 Responses to Can We Treat Our Way Out of This?

  1. Dan Sammartano

    I would have to agree with much of what Sam is advancing here because I’m angry knowing how easy it was for Bella to buy heroin…and cheaply. If there was a point source carcinogen Bella died of instead, and treatment for her cancer was confusing and at times out of reach, and her very cancer was directing her brain to behaviorally reject whatever treatment existed, I would certainly want that carcinogen outlawed as a start. I’m angry and frustrated not even knowing if anything at all is being done about eliminating this drug from our very accessible black markets. I have to admit, I haven’t even looked, so maybe someone could tell me what, if anything, is being done to kindle an all-out war on drugs. We were instead distracted by the war in the trenches with her addiction and treatment, and haven’t had the time or courage to lobby for change or hunt drug dealers. Back in those trenches, the loop involving treatment, out of treatment, relapse, back to treatment, is aptly portrayed by the author. However, I feel compelled to explain that we were fully taking advantage of these pharmaceutical treatments, and believe it was Suboxone, then Vivitrol by injection, then its pill form, Naltrexone that bought us what time we had with Bella as a clean member of our family again. We understand death by overdose and the underlying addiction is a provocative topic and ideal fodder for these open public discussions, but until one has studied this very complex problem, its treatment options, and known or been an addict yourself, it’s folly writing about it. I’ve spent more money than you can even imagine on these drugs, and on treatment facilities, and in the end, I’m still likely not your best source for understanding the best path to recovery. I will say, however, that essentially, and in a very simplistic sense, methadone and Suboxone are substitutes for the opioid (they’re opioids themselves, and the addict stays on the business side of the withdrawal). Vivitrol (and Naltrexone) however is the blocker, and one must be clean first before treatment. Bella had a choice to stay on the substitute (she was on Suboxone) and be a managed opioid user, or detox, go through withdrawal, then go on Vivitrol where use is really not an option as an opioid will not be effective, and can in fact kill you by overdose without the euphoria the addict is chasing. She chose to go clean and first through the horrors of withdrawal dope sickness, which is not for the faint of heart. Her mother and I were by her side throughout.

    As for the obituary, I can’t deny that some of what I wrote was directed at addressing what I think is a general ignorance of addiction as a disease (and some clearly don’t believe it’s a disease, but these are the uninitiated and uneducated, as I once was). And that’s okay, it doesn’t do anything to convince a non-professional that addiction is not an illness. That the AMA, ACP, NASW, APHA, AHA, and the NIAAA classify it as a disease is all that matters. In writing the obit, I just wanted to be honest with respect to her addiction, pay written respect to my daughter as is the purpose of an obituary, celebrate her in life, but also in small part take the opportunity to provoke some interest in learning more as I knew my community, friends, and family would be reading this. I really had no idea the obituary would have the reach I’ve seen just one week later; that was not my intention at all. Bella and I were very close, and this complex addict had a profound positive impact on those around her in life, and she was well loved. I still can’t comprehend a life without her, and yet I sit here typing this just yards away from where we found her dead on March 24. So I know this to be real, and an unbearable reality.

    Sam Quinones writes a good one here. We can’t arrest our way out of it, just like we can’t treat our way out of it, but we have to try to do both. Sam nails much of what makes me angry, and if something isn’t done soon, there won’t be one reader out there not touched by this awful epidemic.

    • samquinones

      Dan – very good of you to write in, and I really appreciated the obituary that you published. I’m sure it was quite painful to be that honest, but I do think your region and your country is indebted to you for doing so. As you may have seen, her obituary that I posted on my FB site has had an enormous impact on those who read it….Sam

  2. Charlotte Wolfe

    We lost our youngest son to a cocaine overdose in 1990. People who do not understand addiction do not have a clue the torment an addicted person experiences. It is a downward spiral. When you see someone who has lost a loved one to drugs, the only acceptable thing to say is, I am so sorry. Don’t talk behind their backs and wonder why “they” didn’t do something to cure it. Doesn’t work that way.

  3. Dennis

    Ciudado Sam. I think we have to be very careful when we speak about “arresting” our way out of this situation. I’m certain you think we need a much mote holistic approach. But I shiver when I see or hear words that suggest incarceration can have any significant impact. Have you read the book, “The New Jim Crow?” I might see you in Worcester. Keep the faith.

  4. Lin Lloyd

    I agree that “something” must be done about the supply chain so well documented by DreamLand as a complement to MAT. I fear that the polarization about the Wall will obstruct a serious discussion about that Mexican supply chain and how to effectively interdict the flow of drugs. Your work highlighted the interchangeability of low level distributors and the emphasis on functioning to not attract local law enforcement attention. I.E., the dealers won’t be caught in the “bad dude” filters. Problem needs new ideas.

  5. Joanne Schrimpf

    Vector-Pathogen-Host
    Drug addiction follows very closely the model of communicable diseases. A vector carries the infection or pathogen and transmits it to the susceptible host. A drug dealer is the vector supplying the pathogen of drugs to a drug seeker, host. Throughout the years, medicine and society has misunderstood and ignored diseases and their predictable progress. Ignaz Semmelweis, who proposed germ theory, literally went mad trying to get physicians to accept his ideas. Typhoid Mary was involuntarily quarantined, isolated for 30 years as she was a carrier of the disease. As recently as the early 50’s swimming pools, movie theatres and other gathering places were closed during polio outbreaks. Public health education and inoculations finally suppressed major disease epidemics that caused so much death and misery.
    By the time people are arrested for drug activity and need addiction treatment a lot of chaos has disrupted their lives. Incarceration and treatment are costly and insufficient at this time. When the creative pharmaceutical enterprises that have flooded our systems are re-directed towards affordable recovery we’ll be on the right track.
    Until then we’re in a pre-WWII state, waiting for antibiotics and immunizations. Most of us don’t have special skills relating to the current crisis. We are not chemists or pharmacists working on “cures”, or EMT’s, police, medical personnel or counselors who are arresting or treating the sufferers. But we can work in prevention. Immunization Through Education will augment the work of professionals. Teaching parents how to talk to their kids about drugs. Keeping ourselves current in the needs of our communities, through vigorous research, in-service, and out-reach.
    Immunization Through Education

  6. Joan Peters-Gilmartin

    Exactly Sam!

    • gail danie

      Sam, I am sorry, but you are highly mistaking about methadone, suboxone, and vivatrol. Do your research on these drugs. You can’t fight addiction with addiction, it just doesn’t work. My daughter recently died of a heroin overdose and trust me I did my homework. I am doing a heroin seminar on May 11 in St. James Missouri. We have a great prevention and awareness that will be represented. You should come. My phone number is 7578499996 if you want to talk. Many people have died on these drugs you mention. They really are awful.

      • Jennifer Pattee

        Wow..how sad, she was so young, with her whole life ahead of her ..I feel bad for the family and what they are going through right now..my heart goes out to them❤..I know exactly what its like to lose someone you love..my boyfriend and baby’s father passed away Oct. 28, 2016, he was an asthmatic and was using heroin and methamphetamines that awful night (R.I.P. Tucker Henry) he was just 26 yrs old..so intelligent, so much lost potential, not only that, my daughter will never know him, she was just 18 mo. when he died, only by what I tell her about him..it was big wake up call for me (I survived 4 overdoses only by the Grace of God, I got to celebrate another birthday, Im 38 yrs old..I still dont know how Im still here..all I know is God has me here for a reason, not only to be there for my beautiful daughter (my boyfriend’s legacy lives on through her) but He has a plan, a purpose for my life! Still trying to figure it out, but I really would like to give back and help or volunteer somewhere that assists people that are going through what I’ve already experienced, they might just need someone to listen to them, and tell them its gonna be ok..One Day At A Time..Thanks for sharing this heartbreaking story..I need to hear this because sometimes I think I have “one more in me”, that Im invincible..this just goes to show: It Can Happen To Anyone!

      • Jennifer Pattee

        Methadone saved my life..its much better alternative to street drugs, and you don’t have to lie, cheat, or steal..you can lead a very normal life and hold down a job..so I think you need to do some research, just sayin..

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