Tag Archives: Doctors

The Sheriff and the Country Boy

I meet a lot of great folks as I talk about Dreamland across America – and hear amazing stories, too.

In Richmond, Virginia recently, where Virginia Commonwealth University had chosen Dreamland as the Common Read for their incoming freshmen, I happened to meet Sheriff Karl Leonard, of nearby Chesterfield County.

We got to talking about a recovery pod – which he calls the Heroin Addiction Recovery Program (HARP) – he instituted in his jail. HARP allows inmates to begin their recovery from addiction, with a nurturing, inmate-led environment. This replaces the stress and tedium of traditionally run jail.

Traditional jail has always been a prod to crime and drug addiction. But sheriffs like Karl Leonard are rethinking how it’s done. I find this transformation of jail, which is growing as a response to our opiate-addiction epidemic, to be one of the most radical and positive ideas happening in America today.

I wrote about another jail, in Kenton County, Kentucky, doing the same thing a while back.

Later, Sheriff Leonard sent me an email with the following story. Please read:

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I work very hard with our Heroin Addiction Recovery program (HARP) to educate the public and to break down the stigma that is attached to not only being an addict but a criminal as well. I take recovered addicts from our program out into the community all the time so they can put a face with this disease. And once I do that I have personalized this crisis with them and they can no longer look away. I have these addicts tell their stories which are always compelling and gut wrenching. But just when I think I have heard it all, I get educated myself.

Just a few weeks ago after one such public engagement in the community with two of the HARP members, one male and one female, I decided to take them to lunch at a local Burger King as a reward, which I do often. (They are placed in civilian clothes when we take them out of the jail).

When we pulled into the Burger King parking lot, the male asked me what this was. I was dumfounded by the question and told him it was Burger King. I then asked him if he’d ever been in a Burger King before, thinking he was messing with me. But he said no. I then asked him if he was ever in a McDonald’s before; he again said no.

I shrugged it off and took him inside. He spent several minutes looking at the menu above his head like a child on Christmas morning. He turned to me and asked me if he could get whatever he wanted. I said yes. He then asked me if he could get the biggest thing on the menu and I again said yes, knowing that jail food probably didn’t satisfy this 6’4”, strapping 26-year-old. He then ordered the mushroom Swiss triple burger and a large Coke and fries.

I watched him devour his meal. I asked him if he liked it and he replied he did very much, especially the Coke. I asked him if he had Coke before and he told me he had not. This kid who never had a Burger King or McDonald’s hamburger or a Coke is a heroin addict.

He told me he grew up in a very rural county in Virginia and his father was very strict with him about eating junk food, sugars, sodas, etc. His father made sure they only ate good fresh food without sugars. It is also why he led a life that was drug free – not even marijuana.

His father also helped him with his athletic skills, which helped him become a very good football player in high school. So good he was given a scholarship to play football at a prominent four-year university in our state. I was intrigued by how this seemingly innocent guy became a heroin addict.

Then the common thread to almost all of our heroin addicts revealed itself.

While at the university, he said, he was involved in a bad car crash and suffered a broken femur, shoulder, and other bones. Eventually his doctor gave him Oxycontin and Dilantin pills. He was directed to take four Oxycontin pills a day for 30 days in addition to the Dilantin.

Once the prescriptions ran out he said he started to become very sick but he didn’t know why. He spoke to a friend who told him he was in withdrawal from the painkillers, which was causing his sickness. So he went back to his doctor, who refused to prescribe him any more. He was very sick and tried to get pills on the street but they were hard to get and expensive so he turned to heroin. And that was all it took.

He eventually had bad drug screens at school and was kicked out of the university and lost his full scholarship. When his father found out he was using drugs he disowned him. So now, without a dorm room or family to take him in, he turned to criminal activity to sustain his life.

These stories go on and on. They are all heartbreaking but also examples of how these are not bad people trying to be good but sick people trying to get well. And we are making a difference here with our very unconventional approach to recovery.

Thank you for enlightening a Nation with your book!

Karl

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Filed under Dreamland, The Heroin Heartland

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