Tag Archives: Addiction On Trial

war on drugs photo

 

Welcome back to my addiction blog and I hope that as we discuss the final four reasons for the heroin epidemic, you will remember that there are solutions within reach.  The issue of Supply & Demand directly relates to both the problem and the solution.  Let me explain further.

supply demand 1

 

Heroin production and distribution seems to be an unending saga; especially after the consequences of the War in Afghanistan.  No matter how many drug lords and kingpins we kill or arrest, there is always someone willing to fill the void.  Money and power is the “addiction” that attracts people to the illicit drug world.  Interdiction and attempting to close our borders to drugs is a losing battle; and increasing tax payers’ burden by growing law enforcement and judicial budgets has been unsuccessful.  Yes, we can arrest and incarcerate all the current drug pushers, big and small, and we can continue to burn the fields of the countries that produce opium; but the profits of this organized industry of drug production and distribution is so great that there is a continuously replenishable supply of people who want to be the next kingpin or the next local drug pusher.

Let’s look at this from a different perspective, using an economic analysis.  If we cannot limit the supply, then we must look at the demand side of the equation.  If there is decreasing demand, there will be decreasing profits and therefore decreasing production.  I am not saying that we should abandon attempts to bring to justice those who are poisoning our communities with a constant flow of illicit drugs.  What I am saying is we should attack the demand side of this problem with greater vigor.  We spend $400 Billion Dollars annually dealing with the consequences of addiction.  This should be incentive enough to advocate for more preventive programs and more treatment centers to decrease demand.

As I stated earlier in this blog series of the Ten Reasons for the Heroin Epidemic, there is plenty of blame to go around.  We must focus on the solutions.  The last blog dealt with NIMBY, which is interconnected with the Supply and Demand issue discussed today.  Moving forward, over the next several weeks, we will address three more interrelated reasons and pose other solutions.  I hope you will stay tuned for Reasons 8 - Physician Training & Biases; 9 - Mental Health Treatment and 10 - Public Officials.

Please enjoy the following excerpt from Addiction On Trial that gives insight into Jimmy’s inner struggles and I hope to see you next week.

What the defense team did not appreciate was the inappropriate loyalty one drug addict feels for another and the risks they will personally take to protect a drug-dependent comrade. As time went on, Jimmy would become more forthcoming, but a degree of brotherly protection persisted…

Jimmy struggled with this dilemma as it ripped away at his core, tossing and turning night after night in the confines of his cell until he felt soulless. He wished he could have just one session with his therapist. He dreamed, mumbling aloud as he conjured up Saul Tolson’s response.

“Saul, I just can’t tell on Travis…. His life is ruined. And then if I rat him out as the one who bought the heroin and the cocaine for Annette and me . . . I can’t do it! Just because he offered me the drugs, I didn’t have to use them. I knew better, or I should’ve.  Damn it, if I could trade my life and bring back Annette and make Travis whole again, I’d do it. Why won’t they believe me?...

“Jimmy, I don’t think it’s that simple. And I think what you are saying is that you feel like you really let yourself down.”

Jimmy tossed in his hard cot, with sweat dripping off his body. “Oh, Saul, if I had a belt, I’d hang myself. I’ll never rat on Travis! Even if I did, who would believe me? I just can’t go on.” Jimmy let out a scream, “I want to die!”

“Hey keep the noise down. Just because you killed someone doesn’t mean you need to wake us all up. It’s three o’clock in the morning. If you want to die, then just go do it and shut up!”

Jimmy did not respond to the incarcerated voice a few cells away, but now fully awakened, Jimmy just laid there, crying softly to himself.

Author : skassels [hupso]

NIMBY – Not In My Back Yard is the rallying cry heard from many politicians and citizens when asked if there is a drug problem in their neighborhood or if they would welcome a drug treatment facility.  “Sure, maybe we have a problem, but it’s not that bad” or “it’s really worse in the next neighborhood over”, or “the next town over” or “the next state over.”  Baloney – it’s in all of our yards and is as prevalent as the ragweed that grows in all of our lawns!  It does not matter if we live in the city, suburbia, the Northeast Kingdom of Vermont, Downeast Maine or in the farmlands of America – it is truly everywhere!

To truly understand the magnitude of this problem we need to examine the economic impact of addiction to society.  There have been reports that when one considers the cost of drug use related to law enforcement, crime, judicial costs, incarceration, emergency room visits, hospitalizations, lost worker productivity, and workers compensation; not to mention the deterioration of societal priorities or the overall risk to the public in terms of spread of disease (Hepatitis C & HIV) or secondary health and safety consequences such as domestic abuse or childhood asthma … the overall national annual cost exceeds 400 Billion Dollars.  Moreover, as an example, to treat one heroin addict in an outpatient medication based treatment center with admission and yearly annual exams, laboratory screening for HIV and Hepatitis C, group and/or individual counseling on a regular basis, and frequent random drug testing, the cost for this patient is approximately $3,000 - $5,000 per year.  Halfway houses can cost $20,000 or more per year and incarceration of this patient costs upwards of $50,000 per year.  And even if one wants to ignore the scientific evidence that treating a heroin or “Oxy” opiate addict with a replacement medication such as methadone or buprenorphine is not simply trading one addiction for another, one cannot deny the documented fact that patients who enter into this type of treatment have an approximate tenfold decrease in criminal activity.

State legislators, our local politicians and our neighbors need to look critically at the facts and not adopt a NIMBY approach to drug addiction that is ruining lives and stealing our tax dollars by inadequately treating and preventing this epidemic from expanding.  Heroin deaths are rising each year and one of the fastest segments of society developing dependency on opiates and heroin are suburban women in their 20’s and 30’s.  The disease of addiction is in all of our back yards!

Drug addiction, including heroin abuse, is an equal opportunity disease affecting all socioeconomic strata; and knows no boundaries.  This is not a problem of the welfare state or the poor or less fortunate.  It is NOT NIMBY!!  The disease is present in our impoverished neighborhoods as well as our wealthy suburban communities and in our resort towns and rural areas.  Establishing treatment centers for addiction in one’s own locale should be worn as a badge of honor, no different than establishing a cancer treatment center or cardiac center; both of which are illnesses that may be related to the disease of addiction.  NIMBY no longer works!

Please enjoy this week’s excerpt from Addiction on Trial.  Police Chief François Bergeron is keenly aware that disease of addiction is all around us!

The Chief was perturbed that Annette’s death and some of the circumstances were leaked within minutes, not hours. He had already received calls from the local TV stations. Bergeron did not welcome the added pressure created by the dramatic news reports of a murder with blood splattered all over the deceased’s car and the primary suspect from away in jail for heroin and cocaine possession…

Although Chief Bergeron had witnessed first-hand the increasing influx of drugs into not only his community but into all of Downeast Maine, Annette's death and the likelihood it was drug connected posed challenges never before encountered. Although the chief understood that drug addiction was a complicated topic and a burgeoning problem, this view was not shared by most, many of whom even refused to believe that Downeast Maine had a significant drug issue despite the fact that a methadone treatment center about two hours away had recently opened to treat the epidemic of heroin and Oxycontin addiction in the region. There had been a prolonged battle within the ranks of city government and among the citizens who irrationally opposed the siting of the treatment center, delaying its opening for years. Eventually, there was some acknowledgment that Downeast Maine, no different than innumerable regions and communities up and down the east coast, had a heroin and Oxycontin problem, but it was greatly minimized. The clinic was finally approved after much rancor, but treatment was initially limited to one hundred patients. Since no one ever wants to believe its municipality has a significant drug problem, it was decided that opening up one hundred outpatient slots would more than satisfy the need and help to quell the escalating controversy. The clinic filled all its patient slots within a month and droves of needy patients were placed on waiting lists.

This struggle to establish treatment centers was not unique. There were similar controversial and heated discussions in many cities and towns throughout New England. Lawsuits between municipalities against well-intentioned medical providers were not unusual. Paradoxically, at about the same time, a New England Governor’s Council Forum had convened at the old City Hall near the waterfront at Faneuil Hall in Boston. Presentations by illustrious speakers demonstrated the extent of the epidemic. New England had a significantly higher heroin use rate than the rest of the country. Portland, Maine, and the Massachusetts cities of Boston and New Bedford were primary ports used for smuggling. Chief Bergeron had attended this forum as a member of Maine’s Drug Task Force Committee. What Bergeron remembers most from the conference was the statement by a prominent elected official that “these are telling times when elementary and middle school children are offered a bag of 70-80 percent pure heroin for the price of a double scoop ice cream cone.”  The forum’s mantra was interdiction, education, and treatment. This battle cry was good in theory, but in practice it was a different story at the local level. NIMBY—“Not In My Back Yard”—was the rallying cry of most municipalities. No town would admit to having a significant drug issue; it was always the next town over that had the problem. The rationale was based on the fear that if a drug addiction center was established in one’s own town, which of course did not have a problem to begin with, all the addicts from the neighboring townships would spread the scourge as they migrated for treatment, thereby creating a drug problem that never before existed. Despite the documented epidemic of drug abuse across the nation, hardly any individual town, if you spoke to the locals, had much of a problem.

Chief Bergeron understood the apprehension of the townsfolk, that a drug treatment center in West Haven Harbor would label the town as a drug haven. The tourists would be frightened and stay away, the local economy would falter, and everyone would suffer. As a result, many in need of treatment never got it. Chief Bergeron’s concern for the lack of treatment options was now a secondary issue. He recognized that the townsfolk's anger directed at an addict from away was irrational, especially before all the facts were known, but he also understood their desire for retribution for Annette's murder.

Author : skassels [hupso]

Steven Kassels Book Signing Addiction on TrialOver the past several weeks I have received several emails from readers and others inquiring about my background and why I decided to write Addiction on Trial. I want to use this week’s blog to explain why I wrote a novel, albeit based on medical and legal truths, and to share my background. So, bear with me as I babble along!

I am a physician who is the youngest son of a physician. My father came to the United States at a very young age, worked his way through college and medical school and chose to practice medicine in two offices attached to our home in Everett, Massachusetts. My mother was the bookkeeper, secretary, cook, laundry service and most importantly, my Mom. When the home phone rang (which was also the office phone) we all answered it the same, “Doctor Kassels office; may I help you.” Not infrequently, patients would come to the front door on holidays and weekends with “specimens”. These were the same patients that would make holiday gifts for my brother and me. I can still hear my Dad, “Put that bag with the bottle in it on the counter in my little office and then wash your hands – and wash them thoroughly – did you hear me Stevie?” I heard my Dad then and I still hear him now.

Why did I write Addiction on Trial: Tragedy in Downeast Maine? Simple answer: I wanted to.

Through my years of practice in Emergency Medicine and Addiction Medicine I have had the privilege to treat patients from all walks of life. From a medical perspective, it is very clear that we have differences but we are more similar than not – we all need hearts to pump in order to sustain our organs and to perfuse our brains. When we are sick, we all benefit from compassion and care. Society should not differentiate between diseases! But who wants to read another scientific book about addiction? Not me! That's why I wrote Addiction on Trial as a mystery thriller to both entertain and educate through the depiction of the realistic struggles of addiction. I hope you enjoy reading Addiction on Trial as much as I enjoyed writing it.

Author : skassels [hupso]

There are ten reasons that I can think of why we have a heroin/opiate epidemic, but before I go into all the reasons, let’s first get a few points established.

A. The disease of addiction has three components:

1.Biological
2.Psychological
3.Sociological

B. There are three related terms that are essential to understand:

1.Tolerance
2.Dependency
3.Addiction

C. And there are ten reasons of who or what to blame for the heroin/opiate epidemic raging through our cities, suburbs and rural America:

1.Injudicious Prescribing by MD’s
2.Patient Expectations
3.Internet Sale of Pain Pills
4.Oxycontin Reconstitution
5.War in Afghanistan
6.NIMBY
7.Supply & Demand - “War on Drugs
8.Physician Training & Biases
9.Mental Health Treatment
10.Public Officials

Over the next weeks in a series of blogs, I will explain each of the issues in the three categories. Then we will have a template of understanding to further engage in conversation of how best to approach the heroin/opiate epidemic. I hope you will stay tuned. And as we go along, if you want to put some real faces on this scourge to society, I hope you’ll read about Jimmy, the heroin addict from away who is accused of murdering Annette; and Travis, the hard working fisherman who is able to head out to sea by trading his heroin for oxycontin (“Oxys”); and when called to duty to save another shipmate’s life, he does not fail!

“He would meticulously safeguard his supply of Oxys until out at sea, where it was nearly impossible to snort lines on the Margaret Two without being discovered … Because Oxys can last up to twelve hours, Travis could perform his job at a very acceptable level and in a relatively normalized state of mind and body … Tuned into the first signs of early withdrawal symptoms, he always carried a pink Oxy in his pocket … Before heading topside each morning, Travis secured his dependability for the hard work ahead by making certain his concentration was not distracted by physical discomfort. While brushing his teeth in the confines of the head, he slipped a yellow Oxy into his mouth just before taking the last swig of water.”

Author : skassels [hupso]

I am overwhelmed and appreciative of the many inquiries I have been receiving, so much so, I am compelled to give answers to the questions, “What is taking you so long and when will the next Shawn Marks Thriller be finished?”  I am humbled by the interest in the sequel to Addiction on Trial, which is entitled, Lost to Addiction.  But as we all know, once editors and publishers get hold of the manuscript, who knows what the title will be☺.

But that won’t affect the story line and for those of you who want a taste of the coming action, and without giving away anything to the readers who have not yet finished the first adventure of Shawn Marks, that egotistical but likable big shot Boston attorney, let me give you a peek through the window.  The opening chapter of Lost to Addiction has Shawn Marks sitting at dinner with District Attorney Venla Hujanen at the French restaurant overlooking Somes Sound.  Just as the conversation is about to fall into the crevasse of legal entanglements, with each struggling to ignore personal attraction and maintain appropriate professional etiquette between two adversarial attorneys, Marks get a phone call from shipping magnate George Kreening.  You remember Mr. Kreening – he’s the one who allowed Marks to stay on his yacht in West Haven Harbor while defending Jimmy, the heroin addict from away, who was accused of murdering Annette.  Apparently, Kreening’s son has found himself in a bit of trouble, to say the least – a dead roommate is never a good thing.

Okay, sorry I got sidetracked, but I am as anxious to get the sequel finished as you are to read it.  And yes, that bombshell reporter Sally Jenkin may even return, along with the likes of Hanny!  But I have some good reasons for the delay.  As you know, I wrote Addiction on Trial to entertain while also educating about what addiction really is; to enthrall while sending a message of societal discrimination toward drug addicts; and to weave intrigue and suspense culminating in a riveting murder trial while relying on medical and legal truths.  I am pleased to say, that I have accomplished my goals, and more so than I ever imagined.  As a result I am being pulled me away from finishing the sequel.  But if I sound like I am complaining, au contraire.

And if you think that the relentless New England blizzards this winter would allow me to nestle up next to a fire, while writing voraciously, I think these photos show a different perspective ☺

Steven Kassels

Snow 18

But on a more serious note, my worlds of doctor and author have both collided and merged.  As you may know, there is an opiate (Heroin, OxyContin, etc.) epidemic raging across our country, most notably along the east coast.  Our politicians are not responding in concert, as you may have read in my previous Blogs & Op-eds.  My medical administrative responsibilities have increased significantly with the surge in demand for treatment, and the requests for my participation in educational and legislative matters have grown as well.  This week, I will be in on the road for three days.  First, I will have a meeting at a medical school to discuss how to incorporate Addiction on Trial into the general education of students; to help them understand at their embryonic stages of becoming doctors that addiction is the precursor to many diseases and societal ills.  The following day I will be on the MBPN/NPR Radio Call-In Show along with a patient to discuss my book and more importantly the legislative budget proposals to cut certain funding for addiction treatment in Maine.  From there I will travel to meet with students in Psychology courses at a local college to review the characters of my book and to discuss potential treatment strategies, as if the characters  were real, which they are, at least in my mind, and based on thirty years of Addiction Medicine experiences.  In May, I have been invited to speak to medical school deans and curriculum advisors at a meeting of the Coalition of Physician Education in Substance Use Disorders – “COPE”.  I also appreciate the interest by book clubs and groups to meet with me in person and by Skype, and these interactions are always engaging and fun; so please let me know if you want to schedule an event.

But none of this would be possible without the tremendous support I have received from all of you who have read, enjoyed and embraced the messages of Addiction on Trial.  It may take me a little longer than we all want to get the sequel on to bookshelves, but in the interim, I hope that I do not lose your passion for more of Shawn Marks, as he takes us on another adventure of murder and intrigue, passion and denial, and the “what-ifs” of life.  A special thanks to all the readers who have written Amazon Reviews and my utmost appreciation for your spreading the word.

Please feel free to post comments and let me know what characters you definitely want back in the sequel, as it is not too late!  And be sure to let me know what actor should play Shawn Marks in the movie ☺

Author : skassels [hupso]