Category: Addiction

Harm Reduction

During President Biden’s State of the Union this past February, he endorsed harm reduction as one strategy to reduce the epidemic of drug overdoses. What harm reduction means on the ground can vary from state to state, city to city. The goal of harm reduction is to provide drug users with tools, enabling them to use drugs safely. Harm reduction doesn’t seek, in the short run, to end drug use. Rather these programs work to reduce deaths due to overdoses.

Harm reduction which can include needle exchange, fentanyl strip testing, and the use of the overdose reversal drug, naloxone[1], can be controversial. Critics often see these programs as encouraging drug use. Many conservatives feel abstinence, just saying no, is a better approach. In general, the country’s drug control policy for many years has focused on military style interdiction and punitive measures for drug addicts.

A critical component of any harm reduction program is needle exchange. The CDC states that new users of needle exchange services are “five times as likely to enter drug treatment as those who don’t use the programs.”[2] Needle exchange also reduces infections including HIV and hepatitis.

Despite the science behind harm reduction programs, the country remains ambivalent about it. Many states prevent the use of fentanyl test strips, another critical part of most programs. The laws consider the strips to be drug paraphernalia. According to the New York Times, “While the Centers for Disease Control and Prevention encourages the use of syringe exchange programs, … federal funds typically cannot be used to purchase syringes for drug use.”[3]

Because of this ambivalence, most harm reduction programs run on a shoestring budget and face legal peril every day. There needs to be concerted advocacy for harm reduction funding and a push to make needle exchange fully legal. These actions would save lives.

[1] https://www.cdc.gov/stopoverdose/naloxone/index.html#:~:text=Naloxone%20quickly%20reverses%20an%20overdose,opioids%20like%20fentanyl%20are%20involved.

[2] https://www.cdc.gov/ssp/syringe-services-programs-faq.html#:~:text=Some%20states%20have%20passed%20laws,the%20state%20and%20local%20levels.

[3] https://www.nytimes.com/2023/02/10/us/politics/harm-reduction-overdoses-iowa.html

 

Methadone

In February of this year, Points, the blog of the Alcohol and Drugs History Society, had an interesting post by Sam Roberts which explored the history of methadone treatment in the United States. Roberts looked at the history of a 1976 documentary, Methadone: An American Way of Dealing to explain the complicated history of addiction treatment.

I worked in a methadone treatment center for four years and thought that it was helpful for preventing some people from relapsing and going back to heroin use. Since the time I worked  in the clinic, more treatments, especially buprenorphine, have become available. Buprenorphine has the advantage that a doctor, after training, can prescribe the medicine, freeing the patient from daily attendance at a clinic.

After my experience with Noom, which is a form of cognitive behavioral therapy (CBT), I have mixed feelings about people seeking addiction treatment not having to attend a clinic daily. In my quest to lose weight, one of the most effective things I did was weigh myself daily. This helped me develop a habit of thinking consciously about my food choices, Attending a methadone clinic daily could have the same effect for some people.

Support while one is changing behavior is critical for success. How to provide and maintain that support is the open question in the area of opioid addiction.

 

Why Meths Drinkers?

For a long time now, my most widely viewed post has been the one I wrote almost 10 years ago about methylated spirits. I had heard a paper at an Alcohol and Drug History Society conference about people in Britain in the 1950s and 60s who became addicted to methylated spirits.

About two years, I had a sudden and brief uptick in views, and they were all of that original post. You can read about that here. On April 3 of this month, I had 1,151 views of which 1,120 were of the original post on methylated spirits. I believe this huge increase was due to a Call The Midwife episode which aired that Sunday and was about a meths drinker who was nearing the end of his life.

The episode described the symptoms of prolonged drinking of methylated spirits. They include rotting flesh, ulcers, gastritis, and gangrene. The show was preaching tolerance and understanding, even love, for the homeless, many of whom were meths drinkers.

For a few days following the episode, I had many more than usual views and visitors. By this week it is settling down, but I still am having slightly increased viewership. I really don’t understand why this is my most popular post, but I guess it is a topic that interests a lot of people.

Many years ago, prior to writing the post on methylated spirits, my most popular post was one I did on seeing a production of Mary Poppins in Israel. I also never understood why that was so popular. There is no accounting for what people will be interested in and try to seek more information about on the Internet.

Of course, posting this will probably lead to another temporary uptick in views. Maybe I should  find a way to stick the term “methylated spirits” in all my posts.

 

 

Smoking

Any practicing nurse in Massachusetts has to renew his or her license every two years. As part of the license renewal process every nurse has to have done 15 hours of continuing education credits otherwise known as CEU’s. Before I retired it was very easy for me to acquire those 15 hours because of trainings and in service workshops that the agency I worked for provided.

This year the renewal process snuck up on me and I had to figure how to meet the CEUs requirement. There are places online that allow you to fulfill the requirements by reading scholarly articles on various topics and then filling out a questionnaire. One of the essays I chose was about tobacco and smoking cessation.

I found the article informative. Something that stood out is that young people are continuing to become smokers. This is concerning because once you have the habit it is very hard to break it. Reading the essay about tobacco reminded me that in 2009 I had written a blog post about the liquor industry facing new regulations that the Obama administration had passed. I am reposting it below.

The interesting thing about the original post was that I discussed how tobacco’s fortunes had fallen while brewers and distillers were enjoying a great deal of public support. Public health advocates were not gaining much traction in their attempts to convince the public to drink less.

Society approval of the liquor industry, particularly beer, has only continued to increase in the 13 years since I posted about those tobacco regulations. Not only did the liquor industry get a tax break from the Trump legislation but most municipalities are thrilled to have a craft brewery in their town or city.

Neither the article I read for my CEUs or the blog post from 2009 talk about marijuana, but marijuana has also gained in public approval as many states including Massachusetts where I live now have recreational sale of THC.

Tobacco Legislation

6/16/2009

Last week, Congress passed, and President Obama signed legislation that greatly enhances federal regulation of the tobacco industry. As a historian, I generally think change happens slowly but the rapidity with which American society has transformed from cultural acceptance, even approval of smoking, to a completely negative view is startling.

When I was growing up, my parents and almost all the adults I knew smoked. As a teenager and young adult smoking was both everywhere – bars, restaurants, public events, and arenas – and heavily advertised on television. In the forty-five years since the Surgeon General’s report on the harm smoking causes, there has been a warning label, a ban on television advertising, the creation of smoke-free indoor space and, recently, smoke-free outdoor spaces.

The newspaper stories discussing the pending legislation use the term “addiction” to describe the practice of smoking. This also represents significant change. For much of American history, society has characterized nicotine, caffeine, and alcohol as legal, primarily harmless habits. Alcohol was usually the most problematic of the three. Now, nicotine, although legal, falls under the broad category of psychoactive, addictive substances, similar in their effects on the body.

Moralists have always viewed smoking as undesirable behavior. This attitude kept women from smoking for many years. When smoking and exposure to second-hand smoke became a public health issue, the battle lines changed. If alcohol use and or abuse ever became predominantly a public health issue rather than one of individual choice or morality, brewers and distillers could face more of an uphill battle to maintain the legitimacy of their industry.

 

Methylated Spirits Revisited

On Sunday my site got 155 views. On Monday  121. That is a lot more views than I usually get. Most of them were to read my post on methylated spirits which is almost seven years old. I don’t really get it since when you google “methylated spirits” my post doesn’t come up.

I was going to tweet about this, but since Twitter still won’t let me tweet my URL, I decided to write a short post about it instead. The problem with Twitter is over 2 years old. I don’t think it will ever get fixed.

I am little afraid that the sudden increase in views  was some kind of hack, but everything seems okay. If anyone knows why there would suddenly be so much interest in methylated spirits, please let me know.

Denatured alcohol

Social Drinking

Can you be a social drinker? I recently read an article in The New York Times that would suggest the answer was no. The article itself was interesting and the comments were even more interesting. The vociferousness of the comments that defended drinking indicates that drinking in America has been normalized. The recent Atlantic article that asked why there is no anti-alcohol movement explored some of the reasons for that normalization. When I was at my writing retreat this fall, one of the other attendees was a woman who has recently stopped drinking and has a blog about it.

Prior to Prohibition, the temperance movement saw drinking as being both a moral and societal issue. They sought a civil response to the problems of drinking. Although prohibitionists counseled individuals to have the moral and individual strength to stop drinking, the movement sought to remove drinking from society through political and legislative means.

Since Prohibition, the liquor industry has been very successful in framing drinking and the serious issues it can cause as an individual disease. There have been some moments where the public health analysis of alcohol and the society-wide problems it causes, have been in ascendance. Both the movement to decrease drunk driving and the 1991 tax increase on alcohol had public health components.

Today the liquor industry is completely in control and health information detailing problems with liquor go nowhere. On television you see public service announcements on tobacco and vaping. There are none about drinking.

Here is a picture of a cirrhotic liver as one example of the damage excessive drinking can do to your body and health.

Cirrohotic Liver

Second time around

Looking over my last few posts I thought I would revisit some of the topics. In Summer I outlined what I was doing during this season. The Take Back the House (TBTH) opening was a huge success. You can see a video about it here. I am still working there and I feel, now more than ever, it is critical to turn the house Democratic.

Skating Camp, which I talked about in Summer and Off to Camp, was terrific. There were only nine of us and the coaches and assistant coaches were so helpful and supportive. It really improved my skating, making me more adventuresome and less fearful. I plan to start some off ice work which should further strengthen my skating.

I am still having trouble sleeping. At least once a week I have a bout of insomnia. My latest thought is to try hypnosis to change my sleeping habits. If anybody has tried that, please me know.

It has been two weeks and I  have watched two  Youtube videos that were on Feedly. I am also reducing my watching of Reality TV since it feels very connected to the rise of Donald Trump, something I fervently wish had never happened. I do not want to be complicit with his fascism in any way,

Several of the posts reference how hard it has been to do weekly posts. That remains true. I put all of the potential changes to my website which I discussed in Half Year Update out of my mind but  it is probably time to start thinking about them again.

Finally in the last month my most viewed post was the one on Methylated Spirits which I wrote five years ago. It had 229 views in 30 days. I average about 20 reads a day. The day I post is not always the day with the most readership which is a bit of a puzzle to me. I am  still thinking about ways to increase readership. If you have any ideas, let me know.

If these more personal posts are not your taste, let me know that as well.

 

I got rid of YouTube

Wednesday, I removed YouTube from my phone, blocked it on my computer using LeechBlock, and removed the app from my Vizio Smart TV. Why, you might ask.

In general most of the internet and the world-wide web is a total time sink. Most people probably find social media like Facebook, Twitter, and Instagram the most egregious but recently YouTube – particularly makeup videos has taken over my life.

YouTube makeup videos function in exactly the same way as all forms of advertisements. Generate anxiety about a physical characteristic, a social or economic status or the lack of some possession and then provide the solution to the problem the video created in the first place.

As a women of a certain age, YouTube videos about “makeup for mature skin” have sucked me in. Many of the women producing these videos are in their 30s and 40s. The fact that the skin of women of this relatively young age is “mature” seems inherently misogynistic.

For most of my life I was thin and wore little to no makeup. To be honest, menopause changed all that so I was a ripe candidate for the anxiety and advice of YouTube videos.

Ironically many of the women who are in their 60s and even 70 who are making these videos seem to be sincere about helping other women but makeup videos on YouTube is big business and these women are part of it. The production values of the video with professional lighting and filters that remove all wrinkles are the same techniques that television advertisers use.

Makeup videos on YouTube and Instagram  have changed the makeup industry. There are now a set of people, mostly women and mostly makeup artists, who are “influencers”. Makeup companies send them products to review; the subsequent videos are part of the company’s marketing campaign. Thus, your average YouTube makeup video, even if it is a women in her 60s, presents as unreal and unattainable a vision as any Revlon or Maybelline commercial on TV does.

The degree of anxiety and self-dissatisfaction that watching a lot of these videos generate is immense, deeply distracting and even addicting. I therefore did a self-intervention and am going cold turkey. I’ll let you know whether I stay on the wagon or not.

Cirrhosis

Cirrhosis of the liver is on the rise, according to the New York Times. From 1999 to 2016, deaths increased 65%. The largest increase in deaths was in the population group aged 25 to 34. From 199 to 2008, in some groups including Native Americans and African Americans cirrhosis rates stayed steady or decreased. After 2008 both groups saw increase in  cirrhosis deaths.

The author of the study cited in the newspaper article hypothesizes that the increase can be attributed to the Great Recession and economic despair among young men.  He does acknowledge, however, that “almost every one of these deaths, particularly in the young, is completely preventable.”

Cirrhosis deaths are usually preventable because alcoholic abuse is the major cause of the illness. I have written about this in a previous post which you can read here.

This is the picture from that post.

Addiction Treatment

Yesterday I listened to Preet Bharara’s podcast, Stay Tuned with Preet. The topic was the opioid crisis. The guests were Susan Salomone, a parent advocate and Dr. Abigail Herron, a psychiatrist who works with addicts.

Part of the discussion was on treatment and what is available to help addicts. Salomone believes that currently there are not enough days for treatments. When I worked in an inpatient detox unit, the addicts were only there for 5 days and then placed in outpatient care.

Dr. Herron discussed the medical treatments that are available. There are three.

Methadone is the oldest treatment available. It is dispensed in licensed clinics and the clients usually attend every day. After a certain number of clean random drug screens, some people can get take-home privileges and reduce the number of days they have to attend the clinic.

Because methadone is an opioid and can be abused, methadone as treatment for addiction is controversial. If a person wants to stop taking methadone they will suffer withdrawal symptoms just like heroin. However, when I worked at a methadone clinic I saw many people whose lives were saved by being on methadone

Naltrexone is an opioid inhibitor. It can be used for alcohol addiction as well as opioid addiction. It reduces cravings. Unlike methadone which stays in the body for a long time, naltrexone only works if you take it. There are no withdrawal symptoms. It is available as a pill or inject-able. The injection, which is very expensive, is supposed to last for thirty days but often wears off before that period is up.

50 mg is the usual dosage for the oral medication. Low dose naltrexone, approximately 4.5 mg, is used for a variety of illness including ALS, urinary issues and Crohn’s disease.

Buprenorphine is an opioid but only partially attaches to opioid receptors. With this drug there is supposedly no euphoria. Physicians are required to take a special course before prescribing buprenorphine. Because it is an opioid, stopping the drug does cause withdrawal symptoms.

All three of these treatments have some negative aspects. It is clear that a drug alone will not prevent a relapse. I think you would have to also be under the care of a therapist and attend support groups regularly. Many people believe that addiction causes brain changes that are difficult to undo. Addiction is a disease of relapse. Just ask anyone who has tried to stop smoking.

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