Opioid Epidemic

In January, Blue Cross Blue Shield of Massachusetts surveyed 601 Massachusetts adults about the opioid crisis. A majority know someone who has been addicted to opioids and three in ten know someone who has died from drug addiction.

The respondents felt that this was the most important issue to then and that it wasn’t getting better. A clear majority think it is a public health issue rather than one of law enforcement. There is large support for increased treatment. However a majority also think the addicted person shares some of the blame.

Over half of the respondents think that prescription drugs are too easy to get and legal drugs are seen as more of a problem than illegal.  22 % of the people had themselves taken a prescription pain killer in the past two years.

Rural areas appear to be the most affected by the problem. 16 percent of the sample came from rural areas  and 77 percent of them thought opioids was a very serious problem.

81 percent of the same was white while 7 percent was black.  As the opioid crisis has become more pronounced it is clear that people are paying attention because it is affecting white rural or suburban areas. Heroin has been a problem in urban minority neighborhoods for a long time but has not received the same focus.

The fact that most of the respondents saw prescription drugs as the problem is also a change. Although President Trump thinks that gangs are the major source of drugs the current crisis has been fueled by d0ctors with prescription pads.

The other major culprit in the current crisis is the pharmaceutical industry which aggressively marketed opioids as a appropriate response to pain. In nursing school I learned that pain was the fifth vital sign and had to be adequately addressed.

Of course chronic pain sufferers are the other side of the coin. In clamping down on misuse of prescription drugs we may inadvertently be limiting access to pain relief for this population.

Drinking Responsibly

Someone recently wrote a letter to the editor of The Roanoke Times complaining about the ubiquity of beer related stories in the paper. Writing from a public health perspective, Mr. Klein found it bewildering that a women’s health event that a local clinic was sponsoring was being held at a brewery. He wrote, “Have we really gotten to the point as a society where alcohol is so pervasive that it has to be used to entice people to every social event even those designed to promote a healthy lifestyle.”

Klein finds the integration and normalization of alcohol throughout society troubling. This was a big point of contention for the public health activists on the Massachusetts Alcohol Tax Force sub-committee that I served on. They were all people who were working to prevent underage drinking. They also felt that the presence of alcohol at so many community events sends mixed messages. This is something Klein also pointed out.

Klein reminded readers that alcohol consumption can lead to addiction; something that is overlooked in the promotion of events. He apparently lives in Blacksburg, Virginia which is a college town. I also live in a college town where students periodically drink to excess.

There were seven comments in response to Klein’s letter. One pointed out that college students are probably not drinking craft beer which has a higher price point. Most of the other comments focused on the economic benefits of beer to the local economy This is the perennial tension between the public health movement and officials seeking economic development.

Understanding Addiction

Last Thursday I attended a seminar on “Understanding addiction.” The Institute for Natural Resources sponsored the one day seminar which was a way for nurses and other medical professionals to collect continuing education credits.

Much of the material was familiar to me and I don’t think I learned that much that was new. One interesting thing is that alcohol, tobacco, and even caffeine are now seen as drugs with psychoactive properties similar to the illegal drugs such as opioids or cocaine. In fact the legal drugs cause more societal problems than the illegal drugs. The seminar handout states that alcohol and tobacco costs the United States over $400 billion a year  due to crime, lost work productivity, and healthcare. Costs associated with Illegal drugs are about $181 billion a year.

There is an opioid crisis but the speaker did not spend that much time on it. He made the point that at different times different drugs are in fashion. Unfortunately heroin seems to be in vogue right now. It is clear that the War on Drugs has failed and we need to invest much more money on treatment. We also need to find a balance between maintaining pain medicines for people with chronic pain while reducing the more casual prescribing of opioids.



Cirrhosis and Liver Cancer

Several times a year I listen to CancerCare telephone workshops on different aspects of cancer research and treatment.  Today’s workshop was an “Update on the Treatment of Liver Cancer.” One of the speakers discussed the various risk factors for liver cancer. Cirrhosis underlies 50 to 60 percent of all the liver cancer cases in the United States. Hepatitis C and alcohol abuse are the most frequent causes of cirrhosis. According to the speaker, one can never ignore the degree of underlying damage to the liver when considering treatment for liver cancer. A patient would have the symptoms from the cirrhosis, such as ascites and varices, as well as the cancer symptoms. A few years ago, I wrote a post, “Your Liver on Drugs” which looked at some of the issues connected to maintaining good liver health. I am linking to it again because it still seems relevant.

Heroin Maintenance

The Alcohol and Drugs history site has a item about a new book that looks at how Britain has treated heroin addicts in the twentieth century. I find it interesting that the British maintain heroin addicts with heroin. In the United States we use methadone for maintenance of heroin addicts. I worked for four years in a methadone maintenance treatment program (MMTP)

Drug War Policies

The Alcohol and Drugs History website has a notice about the drug czar, Gene Kierlekowske, and his visit to Colombia to evaluate how  the drug war is doing in that country. He is doing this instead of being  in El Paso,attending a three day policy summit on  the drug war. For background on Kierlekowske , see an earlier post of mine.

Tobacco Legislation

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 starling.

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 substance, 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.

Beyond Amethyst: The Conference

This past Friday I attended a conference at Hampshire College about the drinking age and whether it should be changed. Alex Torpey, a graduating student , organized the conference as part of his Division III, or senior project.

Ralph Hexter introduced the keynote speaker and indicated that he feels the issues around the drinking age and drunk driving hinge on responsibility. President Hexter is a signer of the Amethyst Initiative which called for lowering the drinking age to eighteen. Continue reading “Beyond Amethyst: The Conference”

New Drug Czar

Yesterday Vice President Joe Biden announced the appointment of Gil Kerlikowske as the country’s drug czar. Kerlikowske is the Chief of Police in Seattle, Washington. Both the city and the state have been in the forefront of harm reduction. Although Kerlikowske has not been a strenuous advocate of such policies, he has not opposed them.

In 2008 drug policy reformers sought lessons from  Prohibition and Repeal and hope from the election of Barack Obama. Many now feel that the appointment of Kerlikowske justifies that hope. Activists might have preferred a public health expert as  the new czar, but  Kerlikowske’s neutrality represents a significant change in policy from the Bush administration.

Most of the money the federal government spends on preventing illegal drug use is on the supply side rather than on treatment. For four years,I worked as a  nurse  in a  methadone clinic. That experience convinced me that education, support, and ongoing treatment are the keys to reducing our country’s drug addiction problem.