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Profit or Prejudice?
By lindamuralidharan on 2016-12-23 05:33:10
Some readers already know that I was employed for many years as a substance abuse counselor and a case manager for
those with mental health issues. I continue some volunteering in the field although my direct knowledge of current in house
practices and issues is less direct than it once was.|.prince I am writing at this time because of the current attention being
paid to deaths from various permutations of opioid addiction. It is being reported that nationally there is an increase in
addiction to heroin and prescription pain killers and to illegal distribution of fentanyl and fentanyl look alikes (chemical
copycats). Some states appear to be more heavily impacted than others. Ohio, West Virginia, New Mexico, New Hampshire,
Delaware, Rhode Island, and Utah are among the latter as reports are currently being made. In the case of Utah, it is notable
that it has an abnormally high incidence of mental illness in its population, and of many states counts of fatal opioid
overdoses a significant number of the dead had mental health problems compared to the rest of the population. The most
recent full statistics come from 2014 and in the seriously affected states there had been a massive increase in the number of
fatal overdoses in the previous decade. Additionally, almost weekly we have anecdotal evidence from police departments or
local officials who are distressed at the incidence of opioid overdoses and related fatalities. Of course, hospitals are reporting
many cases where the patient survived so the overall impact of the abuse is huge as medical costs soar, families are
disrupted, and communities as a whole see both human and dollar costs reach painful levels. |*.;overdose-deaths Apparently,
the 47,000 overdose deaths occurring nation wide each year now surpass deaths from guns and car accidents. Despite the
huge increase in opioid abuse and deaths, I would not dismiss the problem of abuse of many other mood altering
substances...from alcohol to cocaine to designer drugs and there are sometimes fatal overdoses caused by the abuse of these
substances. The point of the national alarm, however, is that in recent years the proportion of such deaths caused by street
heroin or prescribed pain killers is more than half the total. Maybe none of this is news to folks who follow current affairs
even a little bit. I want to highlight several aspects that most disturb me. Naturally I would like to see lives saved and
families function well. Certainly this requires much more in the way of substance abuse prevention, mental health services,
and easily accessible treatment programs than we now provide nationally, and in my state of Hawaii we are woefully short
of what is needed. It is said here that many mental health services were gutted as a result of the recession. I did not live here
at the onset of that national disgrace, but whenever there is a shortage of public funds, it has been my experience that the
neediest and least powerful segments of our communities lose out. Cowardly or selfish politicians refuse to increase taxes on
those who are still doing well at such times or to strip some of the more affluent of their perks. |».;vc-naloxone-kit [caption
id="attachment_9236" align="alignright" width="229"]|.administer antidote administer antidote[/caption] Thus I am
addressing here the long term problem of why our society does not recognize the seriousness of addiction, the devastating
nature of abuse of alcohol or so many other mood altering indulgences, does not demand the kind of response we demanded
over the years to making automobiles safer, and does not demand an end to the counterproductive and very expensive war
on drugs. I posed the question in the title of whether we are so illogical because of the influence of profit or of prejudice.
Let's look at the profit side. Many years ago I noticed doctors prescribing risky medications for the recovering addicts for
whom I was providing treatment and support. There are specific kinds of medications for physical problems or mental health
issues that can create cravings in folks trying to stay clean and sober. These medications are usually not the only alternative
to help the patient but the doctors seemed not to care or be oblivious of the risk they were asking their patients to take.
Sometimes the medications were as obviously addicting as opiate pain killers. |#.police-work
|».fentanyl-and-opiate-addiction-dearborn-cop-overdose At that point I often told people in frustration that all "pushers"
were not on street corners but rather many were wearing white coats in fancy buildings. It seems that few people in power
are willing to listen to people who are either recovering addicts, former homeless people, or human service workers who see
the problems up close and personal on a day to day basis. So little gets done until some academic produces a study that
comes to conclusions that could have been examined and tested much sooner and with on the job expertise available during
implementation of any needed reforms. This specific problem began with the greed, the profit motive of the pharmaceutical
companies which is the same as the motivation of the dealer in illegal drugs or stolen prescription meds. It has not really
abated in the years since OxyContin was aggressively marketed to doctors even though the author states that "In 2007,
Purdue Pharma and three top executives pleaded guilty to misleading regulators, physicians, and patients about OxyContin's
hazards and agreed to pay 600 million in fines and damages." As with drugs in general, the body accommodates to a given
dose and requires every increasing amounts to achieve the previous effect. It is said that particularly in the poorer
communities of the eafected states...certainly West Virginia and Kentucky are known for rural poverty...people often run out
of funds for the painkillers and turn to street heroin and thus heroin addiction itself has been increasing.
\#opioids-overdose-1-family A very good article appeared recently in "The Johns Hopkins Magazine." The author, Julie
Scharper, traces some of the history of the profit motive that turned so many physicians into pushers. She quotes physicians
who literally remember being told by the drug reps that OxyContin, introduced by Purdue Pharma in 1996, was not
addictive like previously marketed pain killers. Purdue presented several arguments to that effect, one being that a person
who was not an addict and had real pain would not become addicted. (Of course it did not suit their bottom line to add the
caveat that doctors needed to be very cautious when prescribing to people who were in fact already addicted to substances.)
The part about non addicts not becoming addicted resonated with me at the time. I understand now this is more complicated.
Certainly, a person in severe pain needs pain medication...whether there has been an injury or a medical procedure. All
persons, however, need to be guided with respect of how to deal with the medication and how to get off it when the pain can
be managed by something else. Addicts in recovery often have another clean and sober person hold the medication supply
and support them in not abusing the drug. Others of us perhaps not originally addicts..might get to liking the feeling too
much or simply find the withdrawal symptoms more than we wish to cope with. In my case of taking OxyContin for
recovery from hip surgery I knew what to do without any advice...well, I did double check on my own with my primary care
doc to see if I was using the best approach to slowly reducing the dosage down to nothing. And I did have withdrawal
symptoms which I kept to a minimum by the very gradual reduction or titrating of the hourly and then daily amounts. I now
appreciate even more how terrible withdrawal can be especially if a person has been a daily user for long periods of time. I
understand how the non addict citizen can have a great deal of trouble getting off the medications if someone does not give
them the right information and support from the get go. It may be more problematic for those who had an addictive
personality to begin with but did not abuse street drugs. However, the physical addiction of the body is real and withdrawal
is real. In other words, there are times and individuals who mood alter in addiction for the emotional release. There are
others for whom the primary motive is avoidance....avoidance of the discomfort of withdrawal symptoms....which can be
mini seizures, vomiting, diarrhea, flu like aches and pains, agitation...all to a severe degree. A related issue is the failed war
on drugs. Again the profit motive plays a role in terms of the many vested interests who benefit from keeping the war going.
Law enforcement and other government officials like their jobs and their pay. Politicians like having an easy target to direct
voter ire toward. Corrupt officials and successful drug cartel organizers like their profits. |».'syn-mari Again, there is recent
ratcheting up of debate about the drug war debacle. A number of recent studies by prestigious organizations have endorsed
what many people and common sense have touted for years. There is more addiction, not less; there is no real stopping the
supply (too lucrative); the US has wasted tax dollars and prestige in countries like Columbia without putting much of a dent
in cocaine trafficking and so forth. The drug "war" is a failure and a counterproductive distraction from facing the inevitable
presence of recreational drugs and the dire need to help people avoid disastrous types of indulgence. Then there is the
causative factor of prejudice that holds the public back from insisting on good "mental health" the way it insists on good
roads or good parks and even sometimes competent military forces and public schools. We have the left over puritanical,
Biblical influence that claims people who are poor or mentally ill or addicted are somehow "bad" or at the very least
"flawed". If only they would straighten up and fly right! Stigma attaches to homelessness, poverty, mental illness, addiction.
And crime is stigmatized if you are not an affluent white collar criminal. In fact, Scarfer quotes a researcher, Bloomberg
School Assistant Professor Beth McGinty, who found that identical case histories involving drug abuse were viewed more
leniently by the research subjects if the case were presented as that of a relatively wealthy person vs. a person with low
income. And we know all too well that the US has historically punished crack cocaine users (more often than not black
people) more harshly than powder cocaine users....the latter represented by relatively more Caucasians. And our whole
history of condemning or treating, criminalizing or socializing drugs has been strictly racist. While middle class women
(largely white) took all kinds of patent medicines with laudanum (an opiate) regularly and legally in the nineteenth century,
when it was noticed that opium was being smoked regularly by Chinese immigrant laborers, opium soon became illegal.
Then people noticed black people used cocaine in their communities....communities the white community thought contained
over sexed, violent, and lazy people made more so by cocaine. Thus cocaine use became a felony like opium use and the law
even is referred to cocaine in terms of "narcotics" even though cocaine is a drug of another sort and not chemically a
"narcotic" the way opium or OxyContin or Demerol are. Alcohol....seen more as a white person's drug of choice has
remained legal and socially acceptable (except during the failed experiment of Prohibition...and even then it was more
socially acceptable than the street drugs). And today, it is an uphill battle to get the public or the press or maybe even the
police to recognize that alcohol itself is a drug. Like it or lump it, abstain or indulge, it is what it is. Much more can be
written about the history of illogical treatment of substances and their use in America and the slowness with which
Americans embrace alternative management techniques to help addicts and to minimize overdoses. And to save tax dollars.
As an intelligent voter, I suggest each citizen do some reading on the history of recreational substance legislation and use in
the US. Today's newspaper brought another AP story (under the byline of Erika Kinetz) about the constant revising of street
level fentanyl. Usually in labs in China the formula is revised so often that the substance sold is legal. Laws cannot keep up
with the labs. Fentanyl is extremely dangerous and very small amounts can result in fatal overdoses. Insofar as the public
knows, it played a role in the overdose death of iconic entertainer Prince. Last Sunday I saw an AP article under the byline
of Jim Salter detailing an epidemic of synthetic marijuana that is wreaking havoc among homeless people in some big city
areas. The symptoms involve disorientation, lack of motor control, violence, and near catatonic states in some instances. The
substance is cheap and the users may already be extra vulnerable to its effects from poor nutrition, existing mental health
and addiction problems. Real, live human beings are suffering and dying from untreated addiction. Outdated perspectives on
mood altering substance, apathy, greed, ignorance, self-centeredness (too many politicians are more interested in being
reelected, in holding office, than in serving the needs of the public), class and economic bias.....we have an amalgam of
forces that interconnect to exacerbate the age old human habit of seeking to escape through chemicals. Without intervention
we have people guilty of low level drug offense cut off from their families and added to our insane levels of incarceration.
We have disrupted families and too many orphaned children. We have an awful lot of hand wringing without action. We
have some innovative programs that crop up in isolated instances but don't seem to have the will to make the better ones
universal.
