Category Archives: Dreamland

Opiates & the Senate Health Care Bill

When the Senate’s health-care bill died this week, it was worth noting the few who led the revolt.

Most were senators from states hardest hit by our epidemic of opiate addiction:

Maine (Susan Collins), West Virginia (Shelly Moore Capito), Utah (Mike Lee), Ohio (Rob Portman).

“I didn’t come to Washington to hurt people,” Shelly Moore Capito said.

Let’s leave aside how the bill would have done away with basic health care for millions of working folks and provided a tax cut for wealthy people.

One of the biggest problems with it, I think, was that it would have reversed Medicaid expansion and that meant taking away coverage for drug rehabilitation from hundreds of thousands of people, maybe millions of them.

I could not understand how that was a good idea.

It was also interesting to see how, as the debate progressed through the spring to now, a lot of people began to realize what they were losing.

In so many areas where Donald Trump did best in November’s election, areas he promised to make great again, there is a documented need for massive investment in more drug rehabilitation capacity, not less. That is not an opinion. What exists is saturated. Getting into rehab takes weeks, months. Many addicts have no resources of their own with which to seek treatment.

I wrote in another post that opiate addiction was the crucial element in Trump’s victories in several states that were in turn essential to his capturing the presidency.

Eight months later, the Senate’s health-care carnival emphasized my belief that this issue is one of the most potent political forces of our time.

In the spring of 2015, shortly after Dreamland was released, I received a call from Hillary Clinton’s campaign advisor for health issues. Hillary was feeling the ferocity of parents in Iowa and New Hampshire from all walks of life, horrified at their children’s addiction and not knowing where to turn. This surprised the candidate, her advisor told me.

I spoke with her for about ninety minutes. I told her that I thought this was the great silent issue in America today and whoever truly owned it, embraced it, treated it as a thing of the heart, would have a good chance of getting votes from unexpected places, but that this probably would not be felt in opinion polls ahead of time. Mrs. Clinton did some of that, but never enough, and in the end she wrote a position paper and that amounted to most of her campaign’s attention to opiate addiction. I might be wrong, but she didn’t seem to understand the latent power of the issue. Least she didn’t act on it. That was a huge mistake.

Politicians would do well to better understand the deep well of pain and anxiety surrounding, and thus the political power within, this issue. It’s not something expressed easily in polls. People aren’t likely to admit to a pollster on a phone that a loved one is an addict.

But it’s there and dims the view of the future of so many people, the prospects of so many towns and counties, the economies of so many regions, and thus is of paramount importance to them. Right up there with jobs – connected inextricably with jobs, in fact. In so many depressed areas, huge numbers of folks can’t pass an employer’s drug test.

Nor does it take many addicts for that foreboding to spread. A few cases in a small town, I think, are all that’s needed. People see it hit almost anyone and seemingly at random – like a plague – including families who before had no connection to the drug world or the criminal justice system. Soon everyone’s view of the future turns negative.

On top of that, today we have the increasing nationwide notoriety of the issue as compared with just two years ago. An awakening has taken place in those short years – a reckoning and a truth-telling when before there was subterfuge and fabrication.

Overall, this is healthy – for the families now telling the truth and for the country, I think.

But one effect is that the knowledge, and thus dread, has spread to even families untouched by addiction.

In that room where 13 of them put that bill together, Senate Republicans didn’t seem to understand that.

That was a huge mistake.

Because in the small towns or suburbs where folks live, they now know the high school’s quarterback has landed in jail again, and that their pastor’s daughter died from an overdose and that it wasn’t a heart attack after all.

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Filed under Dreamland, Drugs, The Heroin Heartland

Dreamland Lifeguard! Lifting the Fog of Dope

Today a startup in the small town of Portsmouth, Ohio comes out with a line of t-shirts called DREAMLAND LIFEGUARD.

The shirts, designed by a company called 3rd and Court, also feature the words “Time to Turn So You Don’t Burn,” which was a jingle a local radio station broadcast every half hour, knowing that most of its listeners were at the legendary pool.

I’m proud that the designers say they were inspired by my book about our national opiate epidemic, which as many of you know has a lot to say about Portsmouth, and which took its title from the town’s Dreamland pool, which was razed in 1993.

But more than that, I’m impressed with the entrepreneurial DIY energy and imagination that 3rd and Court represents in a town that for years wallowed in a plague of narcotic negativity.

When the fog of dope lifts, creativity and passion have room to blossom. Something like that feels like it’s happening in Portsmouth. A lot of abandoned buildings are under renovation. Downtown has a lot of artists staking their claim.

I spoke with Connor Sherman, 23, who designed the shirts. Connor was partly raised in the Portsmouth area, then went to Shawnee State in town, and graduated with a degree in visual design.

“I see a lot of people, their mindset has changed to entrepreneurship and moving forward,” he said. “Not that I’m going to get out of school and somebody’s going to hand me something, like a job 9-to-5. It’s more about creating something out of nothing.”

The building at 3rd and Court streets in downtown Portsmouth has become a hive for small startups. Years ago, it was an auto shop. Then like so much of Portsmouth it stood vacant for a good while. Finally, it was renovated and PSKC Crossfit occupied the space. (This is part of Portsmouth’s recovery from opiates. Several workout gyms have opened in town. “A lot of people take pride in restoring themselves and restoring others,” Connor told me.)

The crossfit was a place for people to commune.

They began to share ideas and, in time, to discuss business possibilities. That had been lacking for many years in Portsmouth. Really ever since the pool closed in 1993. For years, with the town in decline, buildings abandoned, and half the population leaving, the only place people really saw each other was Walmart.

The new incarnation of the building at 3rd and Court emerged as part of some new alternatives to that isolation.

Soon, Doc Spartan, a maker of natural lotions and hand creams for workout aficionados, started in the building. They advertise their “Combat Ready Ointment” as made from coconut oil, beeswax, eucalyptus oil, vitamin E and more, and good for “cuts scrapes knicks rips rashes razor burn blistered feet rope burn diaper rash chapped skin and calluses.” (Check them out here.)

That was followed by 3rd and Court apparel, making “small town” summer clothes. “Apparel dedicated to the lovely Portsmouth, Ohio and other small towns like ours,” – reads their website.

“My desire to do design instead of something else that someone tells me to do all day is what made me want to start looking for opportunity,” Connor told me.

So the town where for years noxious pill mills were the only locally owned businesses to open is displaying capitalist effervescence of a more wholesome kind.

I get asked by people all over the country what the solution is to this nationwide pill-and-heroin epidemic. Honestly, I don’t always know what to say. But I do believe in harnessing the creativity of folks who are in recovery, or, like Connor, never did dope to begin with.

So here it is:

3rd and Court is offering DREAMLAND LIFEGUARD t-shirts in men’s and women’s sizes, plus a unisex tank top – each for $24.99.

The shirts are on pre-order now at www.3rdandCourt.com.

Go snap ‘em up!

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Filed under Books, Dreamland, The Heroin Heartland

Porter & Jick, Dreamland, and The New England Journal of Medicine

The New England Journal of Medicine startled everyone this week by a posting a one-sentence warning over the so-called Porter & Jick letter to the editor that the journal published in January of 1980.

The warning note reads:  “For reasons of public health, readers should be aware that this letter has been `heavily and uncritically cited’ as evidence that addiction is rare with opioid therapy.”

I find it remarkable that the NEJM did this, particularly so long after the letter itself was published in the journal. Apparently this kind of note is very rare.

But I think it confirms what I wrote in Dreamland – in which I interviewed the main author of the letter, Dr. Herschel Jick.

I think it’s important to reiterate the impact, as well as the intent, of the letter.

As written, it is entirely correct. That a data base of hospital patient records, that Dr. Jick ran, and still runs, found the following: of 11,800 patients given narcotic painkillers while in hospital, only four developed an addiction to those drugs.

Remember this was data taken from the 1960s and 1970s, a time when narcotic painkillers were rigorously controlled, and never given to patients to take home with them. So it stands to reason that patients, under such strict controls and administered the drugs only in hospital, would rarely develop addictions – as the letter’s headline in the journal read when it was published: Addiction Rare in Patients Treated With Narcotics.

They simply didn’t have access to large supplies of narcotics, and especially drugs to take home with them, as patients routinely do today. Hence they didn’t run much risk of addiction. (The whole thing, btw, helped change my mind about what ignites a scourge of addiction, which I now believe is not demand, but supply. Supply first sparks demand.)

The problem came not with how the letter was written, but how it was interpreted, then used, by others. Through the late 1980s and 1990s, it was widely cited, quoted, footnoted – as my research in Dreamland made clear and as a recent letter to the NEJM from the Canadian doctors confirmed. It was deemed to be proof that somehow science now knew that addiction was rare when opiates were used to treat pain. Through the years, it became known, through a process similar to a game of telephone, as some kind of “landmark study” that presumably refuted much about what we know about narcotic painkillers and addiction.

The Porter & Jick letter – 101 words – neither did, nor intended, anything of the kind.

It was also used, of course, by pharmaceutical companies – especially Purdue Pharma, manufacturer of OxyContin – as proof that their drugs no longer caused addiction when they were used to treat pain. The company used the statistic that “less than 1 percent” of all patients administered opiate painkillers drugs – especially OxyContin – grew addicted to it. This was not true nor supported by any science. It was not supported by Porter & Jick, which was making an entirely different observation. Yet the letter was used to convince a generation of doctors that science now knew new things about narcotic painkillers and one was that they were “virtually nonaddictive” when used to treat pain. A claim that, again, has no basis in science or the letter.

All this I wrote in Dreamland, which came out two years ago. I found the whole story to be an unsettling episode in how scientific thinking changes based on no evidence at all, but due instead to deft and relentless marketing.

I’ll add one more thing. The NEJM’s warning note was prompted, as I said, by a review of the letter and its influence in scholarly studies that was published by some Canadian doctors in the journal this week.

I read the letter these doctors wrote and I don’t see Dreamland credited or footnoted.

I’m trying to take it all in with equanimity. Yet I’ll admit to some frustration to have done so much research and storytelling that brought this to light as part of Dreamland’s larger story of how this opiate-addiction epidemic spread, and which others have read and learned from, and then not have it reflected in the work those people do. On the contrary, the Canadian doctors’ letter is presented as some new revelation, which it is not.

So I’ll just say that it would have been nice to see my work credited in the recent NEJM report by those Canadian doctors, as well as media coverage of that letter. I’ll leave it at that.

 

 

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Filed under Dreamland, Drugs, The Heroin Heartland

Writing Better Stories For Ourselves

Two weeks ago I had a heart attack at a high-rise hotel in Atlanta on the morning I was supposed to deliver a speech at a large conference on prescription-painkiller and heroin abuse.

Turned out one of my major arteries was completely blocked. I’ve written elsewhere about what happened that day and you can read it here.

I rebounded quickly because I was near help, and also because of an outpouring of prayers and good wishes sent from many you, which I greatly appreciated.

My wife and I were teary-eyed for days reading your posts and comments.

I went to visit my new cardiologist when I got home. I had never thought of what was happening during a heart attack.

“What you were feeling is the pain of the heart dying,” she told me.

This hit me much harder than anything else I’d heard from a doctor. I began to understand more deeply the enormous good fortune I’d had in being where I was when this happened. Another two or three hours without help, “and you’d have been in serious trouble,” she said.

I’ve spoken a lot about personal accountability in my talks about Dreamland. I believe it’s one of the lessons we ought to learn from our opiate-addiction epidemic: that as a culture, we almost demanded doctors cure our pain quickly and completely and we weren’t going to do much to help them do that – like eat better, exercise more, avoid processed foods. Opiate painkillers were quick, cheap and those were the tools doctors turned to.

So midway through writing the book, I stopped drinking sugary drinks; lots of junk food I’d already eliminated from my diet. I don’t buy food that’s advertised on TV. I’ve always walked a lot, but I added swimming. I had no clue that I had a blocked artery, or ought to believe I had one, because I thought I was doing a lot right. (My cardio rehab nurse said she thought the swimming had saved me, because through it my blood had found new ways of circulating around the blocked artery and used those when the attack came.)

Still, I’ve come to believe that our heroin/pill epidemic has a lot to say about who we are as Americans, how we do live and how we should live. I think I felt that a bit more deeply following my heart attack.

As part of that, I came across a discussion of the work of Viktor Frankl, a great philosopher and Holocaust survivor. It reads in part that what gave him the ability to survive Nazi concentration camps (four of them) was the search for meaning. That life is more than the pursuit of happiness; it’s the pursuit of meaning and with that comes fulfillment.

“We all said to each other in camp,” he writes, “that there could be no earthly happiness which could compensate for all we had suffered.” But it was not the hope of happiness that “gave us courage,” he writes. It was the “will to meaning” that looked to the future, not to the past. In Frankl’s existentialist view, we ourselves create that meaning, for ourselves, and not for others. … We must acknowledge the need to make sense of our lives and fill what Frankl called the “existential vacuum.” And we alone are responsible for writing better stories for ourselves.

That last sentence is the most important one.

Frankl’s work, I think, is hugely relevant amid this opiate-addiction epidemic.

I’m just beginning this new life – renewed approach to exercise, avoiding stress, and thinking of food differently than even I had. Feeling very fortunate to be alive and be around people who care – like many of you.

Hoping to continue writing a better story for myself, and wishing the same for you.

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Filed under Books, Dreamland, Storytelling

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.

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Filed under Dreamland, Drugs, The Heroin Heartland

House Republicans & Heroin

Governing is the opposite of dope.

It’s real world. It’s working the program. Accepting blame and accountability, breaking with fantasy. It’s hanging out with people who don’t think like you. It’s reminding yourself that life is full of constraints and you can’t just do whatever occurs to you. It’s realizing that you are not perfect and there are others whose opinions matter in this world.

That said, the recent health-care fiasco displayed House Republicans behaving like heroin addicts.

It’s easy to go on Fox News for years, blame someone else for everything when you don’t have to be accountable for finding solutions. It’s easy to rant about the endless failures of those people who do. Ranting is a narcotic; so is outrage; so is complaining and destroying. It gives us a big blast of dopamine to the brain. As does spending a lot of time insisting on all the nifty ways you’d do things better when you are king of the world. Feels so luxurious. Feels a lot like heroin, I suspect.

Being an opposition party means never having to put an idea to a constituent smell test. You get used to it – your tolerance for fantasy rises like an addict’s tolerance for a narcotic. Like addicts, you hang out with folks who think like you, talk like you, and never force you to face anything resembling reality, or the necessity of compromise.

Living without compromise is a nice idea in theory, but it’s possible only when you’re high on, and surrounded by, ideology — or dope.

A heroin addict brooks no compromise. He wants a world his way only. No messy complications, no one telling him no. Ask any parent of an addict.

What I think we saw was people addicted to a warm, euphoric ideological fantasy world in which they’ve lived for the last several years. Addicted to the idea that they could do it alone, didn’t need anybody, didn’t need to compromise. This Freedom Caucus seemed dead-set on depriving anyone but the wealthiest of what most would deem civilized health care: maternity care, ER visits, not to mention addiction-treatment coverage.

It was bizarre to watch them line up to take away benefits needed by so many who had just elected them and their president, and give them to our aristocracy.

Harold Pollack noted in this article in Politico that Democrats working to forge Obamacare held hearings over months and accepted more than 150 Republican amendments to the bill they passed. House Republicans this time took 18 days and “the payout to the top 400 families [in America] alone was estimated to exceed total ACA subsidies in 20 states and the District of Columbia.”

How do you come to the conclusion that thinking like the upper classes of pre-revolution France is okay?

Well, perhaps because House Republicans lived in a bubble for seven years, voting to repeatedly repeal Obamacare knowing it would be vetoed. Then the fantasy ended and they finally had the power to do it. They had nothing to replace it with. (John Boehner is, I’m sure, happy to be away from all that.) What they came up with would have savaged the very people who put them in office.

The word `compromise’ gets a bad rap these days, but it’s actually another way of saying something else. It’s saying, we’re behaving like adults. We’re not going to act like petulant children who want a world run according to their whims alone, which is, in turn, another way of describing how a heroin addict thinks.

Something like this, I suspect, is what Ryan was referring to when he spoke of House Republican “growing pains.” Getting off the dope of viewing compromise as a dirty word.

A big part of addiction recovery is relating to others again, accepting that your views are not the only ones that matter, that you have to modify your behavior, answer to others who may not think like you.

It’s like governing.

It’s messy and ragged; it’s hard and far from perfect. It’s adult, in other words, and it’s the opposite of dope.

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Filed under Culture, Dreamland, Drugs

A Doctor’s View of Pain Pills

Here’s a letter from doctor with a long exposure to the problem of addiction and pain pills. I get lots of email letters about Dreamland. I’ve put a few up on this blog – always with names and identifying details removed.

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 I have recognized for many years, at least since the late 1980s, that the chronic use of opioid medications was typically a barrier to recovery. I am a physiatrist, a physician procter-1specializing in physical medicine and rehabilitation, since 1986.  We manage patients who have catastrophic injuries: spinal cord injury, traumatic brain injury, amputations and those with multiple and severe trauma. I also treated many patients who had less severe injuries including strains, sprains and other soft tissue trauma. We often manage patients over many years. When the use of opioids became more frequent, in the late 1980s, I was perplexed. I did my best to manage pain, if at all possible, without the use of chronic opioid therapy. I was perplexed even more so in the mid to late 1990s when Oxycontin came on the scene. Physicians no longer were afraid to prescribe opioids for non-cancer pain and did so seemingly without caution. They were duped. Drug companies and their physician spokesmen duped them.

I grew up and later practiced medicine for many years in New Mexico. New Mexico, as you may know, has always had one of the highest drug overdose rates in the nation.  Heroin had been the drug of choice, at least until opioid medications came on the scene. I worked as a house painter’s apprentice in the late 1960s while in college. I worked on one crew that every journeyman painter was an ex-con related to heroin use.  I had plenty of opportunity to use heroin but it scared me. My co-workers told me how great it was. One guy, much older than me, made it sound so appealing. “Come over and we will shoot up and listen to jazz.”  I never tried it though I had lots of opportunity.

I knew quite well how dangerous heroin was and never believed that opioid medications were any less dangerous. When I started practicing in the late 1980s many of the patients I saw were on opioid medications when I assumed their care. Most of the more seriously injured patients I saw were successfully weaned off opioids. Many of the less seriously injured, especially those with work related injuries, were much more difficult to wean. Some patients of both categories ended up on long term opioids but were closely monitored to determine if they were benefitting from opioids and whether they were abusing them. Escalating doses were typically not allowed.

The work related injury group of patients who generally had much less severe injuries, were routinely on opioid medications when I took over their care. My job as a rehabilitation physician was to get them back to their usual activities including return to work. I found that opioid medications were a barrier to their recovery. Some of my referring physicians believed the standard of care was to treat pain with opioids as long as patients complained of pain. Some patients were never going to stop complaining of pain and the reasons were frequently psychosocial in nature. I never believed the hype from drug companies regarding the safety of opioids. I saw from up close as a young man and as a doctor that they were dangerous and in general not appropriate for long term use in non-cancer pain.

I knew little about Dr. Russell Portenoy at the time of the opioid prescription explosion but I knew plenty about what drug companies were saying about the safety of opioid medications and the unlikelihood for addiction. I now understand Dr. Portenoy’s role in this public health catastrophe.  I don’t believe Dr. Portenoy and other drug company marketer’s claims that they are now surprised about the addiction potential and danger of opioids. Intuitively it did not make sense. Oxycodone and hydrocodone are so similar to morphine and heroin both chemically and by their mechanism of action. Why would you believe they are so much safer? Those guys were either just plain dumb and so drunk with drug company money and self promotion that they refused to pay attention to what was happening to patients. I am sure they are not dumb. Dr. Portenoy is a brilliant and charming guy. Just view his video presentations and interviews. He is also a successful academic physician. That is what made him so dangerous.  I am just an average doc who has never had a higher academic position than a clinical assistant professor.  I have never authored a paper that made it to a medical journal. How could I know more than them and have been so right about the proper role of opioid medications?  Why didn’t they? Certainly not because I am smarter.Grand Canyon Trip 2015

I think your book was very even handed, maybe a little too much, with Portenoy and the other opioid selling/promoting physicians. I’m telling you they knew better. Their response of “If I knew then what I know now….” just doesn’t cut it. They are responsible for the hundreds of thousands of deaths and ruined lives. They should not get off the hook. I suspect their narcissism will prevent even one sleepless night for the damage they have done. But they and their benefactors, the drug companies, have created a horrible health crisis that was largely preventable in the United States. It is almost strictly a U.S. problem caused by U.S. physician “thought leaders”, drug companies and misguided bureaucrats.

I applaud your book. Bringing the black tar heroin story into your narrative was great. You connected the dots. I wasn’t aware of that part of the story. Thanks again for your book. It may just impact our legislators and government officials even more so, to focus on rehabilitation not punishment for those young kids who got caught up in a drug problem often caused by misguided or crooked doctors.

The punishment of “pill mill” docs and drug company marketers including their corrupt physician lackeys could never be equal to the suffering they have created. Glad you spotlighted the problem and did it in such a well-researched, entertaining and cogent way. Thank you.

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Filed under Dreamland, Drugs, The Heroin Heartland, Uncategorized

An Ohio Farmer: Trump, Dope, Jobs & PC

A DREAMLAND PODCAST – John Russell is 26 and an organic farmer, raising melons in rural Ohio, not far from Columbus. This year he ran for the Ohio state legislature as a Democrat – and lost badly.headshot-1

I had the chance to talk with Russell today.

We had a wide-ranging  conversation, about his decision to go into farming, about his campaign, about Donald Trump, as well as job loss and opiate addiction in America’s Heartland, PC culture, the challenges Democrats face in rural areas.

He’s one of the few, it seems, to go away to college then return to a rural community. So many towns have lost young people to the cities where the jobs are.

We talked about that as well, and about what happened to guys on his high school football team.

This is the first interview I did like this, via Skype, so I’m still working out the kinks, and there are a few buzzes and etc. So please bear with me.

Meanwhile, contact him at www.johnrussell.info, and follow him on Twitter: @JCruss

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Filed under Dreamland, Podcast, The Heroin Heartland

One Mother

On Facebook, I read the simple account – I’ve broken it out into four lines – from a mother from Kentucky. I’ve posted her story, and then the comments that followed:

I lost my son in August,

and my Daughter day after thanksgiving

the only two children I had

oh it’s so hard.

COMMENTS

I have no words. I’m sorry just doesn’t seem to be enough. May
you find the strength you need to carry you through.

I’m so sorry, I lost 2 sons in three years.if i can help you add me as a friend.hugs

img_4054may God give you the strength to survive the loss of both of your children. Hugs and prayers to you mom

So very sorry for your loss prayers and hugs to sister momma I have lost two sons and no words to heal your pain

We lost my oldest nephew Joe on 7/5/16, it is terrible and sad and I’m so glad for this group. You are not alone sister 💙💙💙💙 sending hugs

Why why do we have to suffer so

God be with you.

There are no words…how can i comfort you…may God give you strength…i a truly hurt for you…my daughter continues to fight the beast…

I am so sorry. Much love to you and those who grieve with you. Praying.

This is incomprehensible and insane to think that “god doesn’t give us more than we can handle” – it’s cruel and unmerciful. I share your pain and fear that I may also lose my only other child, having lost my youngest 10 years ago. Sending hugs and more hugs – and strength for when you need it most.

I lost my son I could never imagine the thought of losing another. Hugs and prayers your wayimg_3991

I am so sorry and feel how you feel I lost my son one month ago yesterday my heart has been torn out I don’t know how we’re supposed to go on like this

I lost my only child in 2013, I couldn’t imagine losing 2, and so close together! God bless

My” heart” hurts for you….Don’t know what to say….I lost my son 6-15-16 and the pain is unbearable with one… let along two.I have a daughter on heroin really bad also . I ‘m afraid I’m gonna lose her.

No words for this heartbreak.

 

 

 

 

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Filed under Dreamland, The Heroin Heartland

Many Thanks

I’m a reporter with an earring, from L.A., a Berkeley grad who doesn’t go to church. In the last year, I’ve spent a lot of time in small American towns, meeting people from fairly traditional, church-going places in the Midwest.

On paper, on social media, or on 24-hour cable news, we would seem to have little to share.IMG_0638

Yet in these places, meeting these people, I’m struck by how much we have in common. This may sound trite, but it is true. The commonality is there if you want to look for it. Not that hard to find when you look someone in the eye.

At each place, I’ve had the great privilege of talking with folks about their lives, their jobs. I’ve been struck by the intensity of feeling of the people with whom I’ve spoken, hugging folks I didn’t know. I remember a paramedic telling me of saving overdosing addicts, and of a chamber of commerce president telling me how many people couldn’t pass drug screens. I remember a grandfather in Portsmouth who wouldn’t let my hand go as he told me how he was raising his granddaughter, that his daughter was in prison. Many had lost children, and many others were cautious yet happy that their children were doing well now.

It is a humbling and powerful thing to be brought so quickly into the intimate lives of strangers, and I hope more than anything that I’ve been up to the responsibility.

Today, I want to say how thankful I am to the people I’ve met in those places – Peoria, Van Wert, Scottsburg, Logan, South Shore, Marysville, Portsmouth, Marion, Huntington, Albuquerque, Medford, Zanesville, Knoxville, Covington, Chillicothe – for their warmth and hospitality and, above all, their willingness to share a bit of their stories with a guy from out of town.

These are not towns typically on most authors’ book tour itinerary, and I feel so lucky that I was able to get there.

I’ve met folks at conferences of associations I didn’t know existed two years ago: Kentucky Association of Counties, National Association of Community Health Centers, Indiana Hospital Association, Ohio Association of School Nurses, Illinois Rural Hospital Association, Oregon Narcotics Officers Association, West Virginia Medical Association, National Association of Medicaid Directors, and the Iowa Association of County Medical Examiners, among them.

Meeting people at these conferences has been a real light of the last year as well. The Kentucky Association of Counties a couple weeks ago was an amazing event, as the state has 120 counties for four million people. So it was really like a small-town convention. Folks with strong Kentucky accents and me with my earring – yet I felt so welcome, and their reception to what I had to say was overwhelming.

I’m thankful for my family, who has been so important in all that’s happened. They were able to accompany me on a trip to Chillicothe, Ohio, which we’ll never forget.

I’m thankful that my wife and I are in good health, happy with our lives. My daughter is a cheerful, intelligent girl, healthy and polite to others. My wife and I are thankful for that.

It’s been a good, full year and I hope it was for you, too.

Happy Thanksgiving.

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Donald Trump & Opiates in America

This fall I traveled a lot to Heartland areas to talk about a book I’d written about opiate addiction in America, and this provided me with a close view of the rise of Donald Trump’s candidacy.

The areas where I spoke were particularly hard hit by narcotic abuse — rural Michigan, southern Indiana, West Virginia, Kentucky, and several towns in rural Ohio.

The prevalence of Trump/Pence yard signs in these areas, particularly by mid-October, was stunning. As I traveled, it seemed palpable, this connection between Trump support and opiate addiction.cropped-IMG_4841.jpg

Not that there weren’t other reasons people supported him. A suffocating political correctness on the left is another factor in his appeal, I believe.

But nothing darkens your view of your present and future prospects quite as thoroughly as addiction to opiates (pills or heroin) in your family, on your street, or in your town. With opiates comes a fatalism and negativity that clouds a town or a family’s feeling about its world, even as unemployment falls and the economy improves.

In theory, addiction knows no race. In reality, though, our national opiate scourge is almost entirely white. Very few non-whites are among the newly addicted to prescription pain pills, then heroin. In three years of book research, I met one.

Though this scourge has affected every region of the country, it is felt most intensely in rural, suburban – Heartland – areas of America where Donald Trump did extraordinarily well.

Some of these areas did not fully rebound from the Great Recession of 2007 (southern Ohio). Others fared much better (North Carolina). A common denominator, I think political scientists will find, is that in these areas since the last presidential election the incidence of opiate addiction spread, grew deadlier, more public, and went from pain pills to heroin. In southern Ohio, where heroin has hit like pestilence, particularly Appalachia, Trump trounced his opponent in counties that Mitt Romney barely won four years earlier – though unemployment in many of these counties is at its lowest level in years, sometimes decades.

Shannon Monnat, a rural sociologist and demographer at Penn State I talked with, found strong correlations between suicides and fatal drug overdoses in counties where Trump’s increase was larger that the share of the vote compared to Romney’s four years earlier – this in six Rust Belt states, another half-dozen state in New England and all or part of the eight states comprising Appalachia.

One place I spoke was Hocking County (pop. 28,000). Hocking has lost coal mining jobs in recent years, though its unemployment rate dropped this fall to 4.5 percent, the lowest in more than 20 years. (It hit 14 percent in 2010.) But Hocking has also grown far more aware of its pill/heroin problem. Overdose deaths are up. Its drug court is among the first in the state to use Vivitrol, the opiate blocker. Trump earned 66 percent of the vote in the county Romney carried with 49 percent four years ago.

Opiate addiction – to pain pills or heroin — is the closest thing to enslavement that we have in America today. It is brain-changing, relentless, and unmercifully hard to kick. Children who complain at the slightest household chore while sober will, once addicted, march like zombies through the snow for miles, endure any hardship or humiliation, for more dope.

In many of these regions, folks were unprepared for it and, what’s more, believed they had done nothing to deserve it. Kids with no criminal record, star athletes, pastors’, cops’, and mayors’ kids all got addicted. Parents who’d imagined some glowing life script for their newborns years before were, as those kids reached young adulthood, confronted instead by late-night collect calls from jail, lying, stealing, conniving and that child’s body seemingly occupied by a mutant beast. Then came a felony record. Suddenly parents were co-signing for apartments, providing money and transportation for their addicted beloved, now 24, to take a GED class.

Though the number of actual addicts is small, the epidemic’s political impact has been substantial.

First because the states where the epidemic is most intense were crucial to the victor – whoever it was going to be.

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Also, though, the opiate addiction rippled far beyond each individual addict. Addiction colored the lives of siblings, grandparents, uncles and aunts, friends and neighbors, pastors, teachers. As parents lost their fear of speaking out in the last two years, the problem emerged from the shadows, media coverage expanded, and now everyone for miles around was aware of it. County budgets buckled. Merchants saw theft increasing.

In several counties I visited, employers reported that more than half their job applicants couldn’t pass a drug screen. So though unemployment numbers fell, a good chunk of that was because many people were too hooked to seek work. Imagine what that does to a county’s productivity, and its buoyancy of spirit. It explains how a declining unemployment rate could create not optimism, but the foreboding that seemed to motivate many voters.

People also grew to understand that virtually all our heroin comes from or through Mexico – which is why it is cheaper and more potent than ever in our history. That did nothing to engender love for our southern neighbor in regions that had lost factories as well as kids. Nor did it make them feel that we have a serious and modern partner in Mexico when it comes to criminal justice and law enforcement.

This story plays out today with intensity in several of the states crucial to Trump’s victory – Ohio, North Carolina, Pennsylvania. It does the same in states he was assumed to win: West Virginia, Oklahoma, Utah, Kentucky, Indiana, Alabama, Georgia, Tennessee, and others. That these states – largely rural, religious, and white – are now our heroin beltways amounts to a stunning change in our national culture and one that most people in those areas became aware of only recently.

Equally stunning is that New York, California and Illinois – including New York City, Los Angeles, Chicago, once our heroin hotspots – are well down the list of states ranked by addiction rates. Hillary Clinton won each of them.

In many of the most affected regions, moreover, people, by and large, have taken as self-evident Ronald Reagan’s dictum that “government is the problem” — the starkest threat to personal freedom. The private sector and the free market are, therefore, to be exalted; government starved. (This despite a deep reliance on government programs: Medicaid, Medicare, SSI, SSDI, worker’s compensation, food stamps, welfare, farm subsidies, etc.) Confederate flags and 2nd Amendment bumper stickers were common amid the Trump signs I saw.

The irony is that behind this drug plague is a story of how the private sector introduced the most serious widespread threat to personal freedom in America today – opiate addiction. All profits from the massive prescribing of narcotic pain pills have accrued to the private sector, mainly pharmaceutical companies; all costs of addiction to those pills, and then heroin, are borne by IMG_4113the public sector. Indeed, for years, about the only people fighting the opiate scourge, my research showed, were government employees: cops and prosecutors, public health nurses and CDC statisticians, county social workers, judges and ER doctors, DEA agents, coroners and others.

The Sackler family, which owns Purdue Pharma, the company that makes OxyContin, has been estimated by Forbes magazine to be now one of the country’s wealthiest, with an estimated net worth of $14 billion, due to $35 billion in sales of the drug since it was released in 1996.

All this, I believe, helps explain the reception to Donald Trump’s populist message – including rejection of free trade and other sacred cows of Republican elites and conservative theorists. (“Worst Election Ever” proclaimed a post-election article from the conservative Hoover Institution.)

In these areas, too, the “throw away the key” approach to drug addiction was unquestioned dogma until the opiate scourge. That is changing. Democrats may still not get elected in a region like northern Kentucky, for instance, but Republicans who talk only tough on crime now have a hard time there, too – so harsh is the pill and heroin problem.

It’s likely that many of the regions where Trump enjoyed such support will require massive investment in drug treatment before they can be great again. (Ohio Gov. John Kasich realized that and went around his Republican-led state legislature a couple years ago to mandate Medicaid coverage for all Ohioans — largely because it gave people coverage for drug treatment.)

Will such an investment come from a president whose election seems to have so much to do with the opiate epidemic, yet who appears to have thought little about how to expand drug treatment?

How will people in these areas react to dismantling Obamacare, which provides coverage for addiction treatment that they didn’t have before?

In counties where half of job applicants fail drug screens, will the chambers of commerce line up to do away with the system?

Like so much that sprang from those Heartland yard signs, I guess we’ll see.

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Cab Calloway High School

Tomorrow (Thursday) I’ll be speaking at Cab Calloway High School of the Arts in Wilmington, Delaware.

The speech is open to the public and I’ll be talking about opiate addiction, America and Dreamland. Delaware, like so many parts of the country, is awash in opiate addiction and all its consequences.

But I love the idea that the school is named for Cab Calloway, an orchestra leader I’ve loved since I was a kid and first heard “Minnie the Moocher” (I was in junior high, I think). Here he is with the Nicholas Brothers, stunning tap dancers.

The school’s first board president was his daughter, Cabella Calloway. He had moved to Delaware shortly before the school was founded in 1992 and was involved in its formation before his death in 1994.

By the way, the school’s marching band has won the championship in its area six of the last seven years. Nice! Next Sunday, they’re in Hershey PA competing in the Atlantic Coast Tournament of Bands.

Good luck to the Cab Calloway High School Marching Band! A name like that, you better win! How could you not?

I’d love to see a marching band named for Cab Calloway.

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Judge Moses’ Court

I was in the town of Logan, Ohio last week, at the tail end of my speaking tour through Ohio, West Virginia, Kentucky and Indiana.img_3596

Logan, pop. 7,000, is an Appalachian coal town in the county of Hocking, about 40 miles southeast of Columbus in the farmland off of state Highway 33.

The morning after my talk, I spent an hour in the town’s drug court, which is now dedicated entirely to people with opiate addictions trying to expunge criminal records and keep their recovery going.

The court is run by Judge Fred Moses, who in this court looks and sounds more like a social worker. He asks each client about his or her recovery, job prospects, children – confers with prosecutors and probation and social workers. The idea behind drug court is that clients must get into addiction recovery, begin to repair their lives, before any record expunging takes place.

What struck me was, first, that there were such a court at all in a town like Logan. And then that all the 10 or so clients I met that day were addicted to opiates, heroin mostly.

All but one started into addiction on pain pills. A few began using them after they were prescribed the pills for some medical reason. Others began using them recreationally. But all of them got into their addiction because of the pervasive, massive supply of these pills that were, and are, available.

In Logan, according to a recovering addict I spoke with (whose interview I’ll post later), pain pills and benzodiazapines, and the insistence with which clients demand them, have made docs unimaginative it seems. At least, pills appear to be many physicians’ immediate go-to response.

Judge Moses has most of his clients on Vivitrol, the opiate blocker, paid for by Medicaid, which, in Ohio, has been available to anyone since 2014. This is due to a Republican governor, John Kasich, who expanded coverage to all Ohioans, largely, from what I understand, to give people without insurance access to addiction treatment – so big was the state’s problem.

Without that, Vivitrol would be too expensive for Hocking County. Sitting there that day, I wondered if at some point every heroin addict in America will have to be on Vivitrol.img_3600-copy

Judge Moses’ drug court is a standing testament to how opiate addiction is changing minds in rural areas. I suppose there was a time when the idea of giving a drug to combat drug addiction was viewed askance in Hocking County. But this addiction is different and requires different response. Hence Vivitrol.

What also struck me, though, was that this scourge spread across the country largely due to the private sector – pharmaceutical companies and doctors, urging the aggressive prescribing of narcotic painkillers.

There’s a role we all have, as American health consumers, in what’s taken place, and it’s an important one. But it’s striking to me how this began due to the private sector – not underground drug traffickers – and how the profits have accrued to the private sector.img_3577-copy

Yet dealing with the collateral damage has been charged almost entirely to the public sector: ERs, public health departments, cops, prosecutors, jails … and drug court, like the one run by Judge Fred Moses in the small town of Logan, Ohio.

I wish his clients well, as I do the town of Logan itself, where I met a lot of nice people (and received this Proclamation), and which now must battle this kind of persistent, costly addiction along with all the other issues facing small-town, rural America.

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just can’t do no more today

As I try to keep a gauge on the opiate-addiction epidemic in America, one place I go is to The Addicts Mom Facebook page, with 22,000 members, one of whom is me.

The posts are from mothers as they attempt to deal with the lacerating addictions of their children. Here are a few posts, with names removed, that I saw at random this morning. Those who listed a location are from Georgia, Wisconsin, upstate New York, Pennsylvania, and Alabama.

At times, it gets to almost an aching kind of poetry.

Note: AS means addicted son; RAS recovering addicted son

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Well my almost 21 year old AS will be spending another birthday in jail I am sure! Please pray for his healing and mine!IMG_9349

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I always knew it was going to be my child one day. On the Fourth of July I found my addicted daughter unresponsive and blue. I breathed for her until paramedics came. They saved her life this time. She spent three days in Icu and was released with no help at all. I live in Florida and I was wondering if this is enough for a marchman act? Doc is Xanax and snorting oxicodone. Any advise is appreciated. God bless all of us Mothers. I just can’t take much more.

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I love having a place where people actually listen when I talk bout my addict children. Most people in my town don’t want to hear that there are children addicted in their town people need to wake up sad for the addicts who are outcast. Having trouble getting police to put narcan in there cars also

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UPDATE: His PO is coming to see him tomorrow– I will let y’all know how it goes.
My Birthday overall was a good day. Thanks for the wishes and prayers. Blessings to you all.

Dilemma- my 18 almost 19 AS was released from jail last Friday to serve out his probation-14 months (it’s a joke; very seldom face to face visits with his PO). On Sunday he apparently used LSD; when I confronted him he said ‘no worries Mom; it won’t show up on a UI.’ He had no where else to go but our house and the court said our house is not an option for him to stay (we have a younger child at home). He was told the rules- no drugs or drug use. A small issue he flat out refuses to pick up his clothes (drives me crazy) states he’s just defiant; like I’m supposed to be ok with that answer.
Suggestions??? Oh yeah; today is my Birthday- I feel like hiding in a hole not celebrating life

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Last night my phone rang at 11:30 my heart automatically started racing. Then I seen the caller I.D it was my RAS instantly worry washed over me, I picked up the phone and the first words out of my mouth was ” what’s wrong? Are you okay?” His reply was ‘Yes ma’am I was just on my way to work and I seen a shooting star and it was the brightest most beautiful one I’ve every seen, and just wanted to call and share with you”.

Four years clean, still suffer from shell shock but feeling blessed.

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So another week and another dirty urine at probation. Told me he wants suboxone, I suggested vivitrol. Someone on the MAT (medically assisted treatment) site posted a link for a slide show on all the meds used. I sent it to him privately. He wants to do vivitrol now and I sent him the local dr name and address. He swears he wants to be sober. I asked him, you know how awful detox is, why isn’t that enough to not pick up? He CANNOT deal with stress. No coping techniques. We all have stress but you have to learn to cope. I get the whole disease thing I truly do, but I also struggle with the you know it’s not good for you, you know what you are running away from is gonna still be there and you are making more problems to deal with when you sober up. I know my mind doesn’t function as an addicts but they are all smart kids or adults. Dang fight for your sobriety hard the way you chase that freaking drug. He looks terrible. Lost weight again. And all he keeps saying is everyone is judging me and that makes me want to use. No that gives you a lame excuse to use. We aren’t judging we love you and are worried. I know my dealer he wouldn’t do that yadda yadda yadda. Won’t be long and he is gonna end up in jail, then maybe I can sleep:( I am ANGRY this time.

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My soul is tired, my heart hurts, I just can’t do no more today😥

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“My father went to a pain doctor…”

I received this note from a reader. I print it here as it came over the transom, though a few things were added at my prodding, wanting to know more. Has a feel like a beat poem somehow, just one long run-on sentence of how addiction comes to those aren’t looking for it.

No one in this reader’s family was on drugs before “my father went to a pain doctor.”

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Hi I know you get alot of people asking you things I think what your doing is great IMG_4113my father went to a pain doctor in Ohio and he was getting 224 80mlg oxy take four four times a day plus perk 15 I dont know the dose on them he was a drywaller and I have a old bottle so ppl wouldnt think I was crazy when I tell them what he got he would go every two weeks to pick up I just now am realizing how bad that was for him when u have a family of addicts and myself feel into that same pattern you dont wake up and do homework till ur own mind is right

when he got them thats when everyone got bad bc he got so many my mother and sister got them handed to them when he was alive I didnt do anything I did after the fact

he ended up passing Oct 2010 due to finally trying to use a needle to inject those pills and getting a blood infection my mother still is on dope and my sister was and has been clean for almost three years now I was did buy pills and dope on street for three years after my dad passed I then back in 2014 put myself in the Methadone clinic till Jan 28th 2016 in South Eastern Indiana I have been clean since and wanted to say we live in Tri State of Cincinnati and its bad in this 275 loop and see you came very close to NKY to speak I hope to see u when u come back but wanted to tell my past and I always thought for my dad that was way to much a Dr was giving a man who just had back problems thank you

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