Tag Archives: Steven Kassels

As you may recall, the first blog in this series, Reason #1 for the Heroin Epidemic was “Blame the Doctors”.  And now here we are again implicating the medical profession as a contributing factor. But this week I want to focus on the medical education process.  To state it bluntly, Addiction Medicine training and emphasis on the complexity and interrelationship of addiction and underlying associated illnesses is lacking in our medical schools and residency programs. This not only leads to a lack of appreciation of the importance of screening patients for predisposition to and/or ongoing addiction, but also creates biases.  In general, misconstruing of complex societal issues can lead to preconceptions that are not based in fact.  When this hypothesis is applied to physicians who are asked to treat the difficult and the multifactorial aspects of addictive disease, bias can prevail. There are certain diseases that are more time consuming to manage than others, especially when the patient is either in denial and/or non-compliant. Examples may include Diabetes, Cardiac Disease and Lung Disease.  But physicians in general receive the appropriate training to deal with the demands of these patients. That is not the case with addictive illnesses and bias is compounded by the other societal factors that influence perceptions, such as jailing patients (please see excerpt below).

However, inroads are being made to correct this deficiency. COPE (Coalition on Physician Education in Substance Use Disorders) is one such organization that is making great inroads within the medical educational process, and I felt honored to be chosen as a speaker at a recent event.  I presented some facts such as:

  • The changing face of addiction now includes aging baby boomers andsk1

heroin addiction is no longer just an inner city problem, as it has migrated to college campuses and to white suburban men and women in their late 20’s;

  • Physicians can make a tremendous difference by implementing a brief discussion or form with their patients to rapidly identify patients at risk.  The tool is called SBIRT (Screening, Brief Intervention and Referral for Treatment); and most importantly
  • “Drug addiction is a brain disease that can be treated” (Nora D. Volkow, M.D., Director, National Institute on Drug Abuse)

Physician bias is another roadblock to solving the heroin epidemic, because biased doctors are less likely to treat patients with addiction, and as discussed in last week’s blog, it is essential to attack this scourge to society by decreasing demand through treatment and education.  We need more doctors willing to treat patients and also to be more involved in educating our citizens and public officials that treatment works.  Our medical schools and residency programs need to do more.

I am pleased that I have been asked by a medical school to use my book as a teaching tool to destigmatize the disease of addiction. And yes, it is time to stop jailing patients, as best discussed by Saul Tolson in the following excerpt from Addiction On Trial.

Pausing while attempting to make eye contact with each and every individual in the audience before proceeding, Dr. Tolson delivered his next few lines in a compassionate tone. “With no disrespect, but as a way to reinforce the point I am trying to make, I’d like to ask you to please tell me the difference between a nicotine or alcohol addict, who in some cases may even receive a heart or liver transplant, and someone addicted to heroin or cocaine? Why are those afflicted with the disease of addiction to certain drugs treated so differently than patients who suffer from nicotine or alcohol addiction or other chronic diseases like diabetes? Are they really any different?”

Dr. Tolson never relinquished the podium without one last attempt to convert the naysayers. “Now for those of you who fail to agree with me, and I know you’re out there, let me appeal to your wallets. To incarcerate one addicted patient—that’s right, jailing patients—costs between $40,000 and $50,000 per year. A one-year stay for a patient in a halfway house costs society about $20,000 per year and this does not include any medical care. But to treat one heroin addict as an outpatient with regular individual and/or group counseling sessions, ongoing urine drug testing to monitor for illicit drug use, a complete admission physical exam including laboratory tests that screen for contagious diseases such as Hepatitis C and HIV, and the daily monitoring of medication administration costs approximately $5,000 per year! That’s right—only $5,000 per year or about one-tenth the cost of putting this patient in jail!

Like they say in the Midas commercial, ‘you can pay now or you can pay later, but you’re gonna pay.’  Thank you all for your attention. I am able to stay for questions.”

Uncomfortable with the inevitable applause, Dr. Tolson kept repeating through the clapping, “So, there must be some questions.” The questions came, but none of his answers carried the consequences of those he would have to give to questions posed while under oath at the murder trial of James Frederick Sedgwick in Downeast Maine.

 

 

 

 

Author : Meghan
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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.

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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 : Meghan
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I recently had the honor of receiving the 100th review for Addiction on Trial on Amazon.  I am truly honored and appreciative to all who have left such remarkable and heartfelt reviews of my book.

I wrote Addiction on Trial with the goal to entertain as well as educate, and I immensely enjoy hearing feedback about the impact the book is having.  This blog is simply a special thanks to all the reviewers and to take the opportunity to share a few reviews that represent a theme. These types of comments have further inspired me to  finish the sequel to Addiction On Trial and I will continue to work diligently to make Lost To Addiction as enjoyable and as educational as it's predecessor.

Most importantly, I am pleased that Addiction On Trial is appealing to such a diverse group: lovers of mysteries and legal thrillers; followers of Crighton, Cook and Grisham; addiction professionals; folks concerned about how to educate high school students or personally touched by addiction; and page turning fanatics 🙂  A SPECIAL THANKS TO ALL !!!

This Book Reads Like a Screenplay..and I Can't Wait to See the Movie!

The timing of the publication of Dr. Kassel's book could not have happened at a better time. Since Philip Seymour Hoffman death, there's been a lot of long over due attention to the topic of addiction. Dr. Kassels' book is a gripping tale that graphically illustrates what the disease of addiction brings to a family, and how from there it trickles throughout the community at large. It is in all of our lives, on one level or another. His book reads like a screen play and it wouldn't surprise me if it is made into a movie one day. Plus, there's bound to be a sequel which I can't wait to read it as well.

Riveting Stuff

Once you pick up this book, you find yourself moving faster and faster to the dramatic conclusion. Its an absolute page turner and the courtroom drama was smart and believable! A story that keeps you guessing to the end but more importantly a raw and compelling insight into the complexity and desperation of addiction. I confess to a slight addiction to John Grisham. This was every bit as good. And the fact that Kassels is a guru on addiction gave the book a feel of substance and gave me a base of knowledge that I did not have before. It truly was interesting and enlightening. Cant wait for the next one!

Nuanced Medical Thriller

"Addiction on Trial" is a serious medico-legal mystery and page-turner. If you're a fan of the big names in this field like Crighton, Cook, Grisham, etc, then give Kassels a try as well. My usual complaint with the genre of "medical thrillers" is that the "medical" side of the story is usually grandiose and non-believable. Not so with "Addiction on Trial". Dr. Kassels has weaved a medical storyline that is nuanced, entertaining, factually accurate, and keeps you guessing until the very end. Well done! I'm looking forward to the sequel already!

Don't Miss Out On This Book

WOW, I could not put this book down. Every chapter got better and better. It was loaded with suspenseful moments just when I least expected it. I felt myself getting wrapped up in all of the characters lives and gaining a greater understanding around the challenges of addiction. Kassels is a master of valuable information and experience along with a creative powerful writing talent. Absolutely a dynamite combination. I look forward to the sequel with great anticipation. I wonder what Shawn Marks will get into next?

Page Turner Extraordinaire

I could not put it down, and stayed up till 3AM to finish it. Besides being very entertained, I learned much about an unfamiliar realm.

The book casts a new and sympathetic light on a problem we tend to relegate to unfair stereotypes.

So Insightful!

Dr. Kassels weaves a captivating mystery thriller that takes the reader into the entangled world of drug addicts. He not only skillfully shows the emotional havoc drug addiction creates for the individual, his or her family, and the community at large, but also explains the medical and legal implications of the disease. I think young people would greatly benefit from reading this book and suggest that it be required reading for high school health classes.

Dr. Kassels hits a first serve ace...

Addiction on Trial was a great read and I breezed right through the book. The story line, the characters, their interactions and the author's descriptions throughout kept me engaged. I came away with a better understanding of what doctors and nurses go through in emergency room settings, and the helpless feeling many families have when dealing with addiction issues. The timing of the release comes when coverage of heroin overdoses has taken off. Over prescribed, expensive pain killers morphing into heroin have become a challenge to treatment and rehabilitation. This book gives an accurate account of the perils of addiction and how it affects many lives. By bringing awareness to addiction, Dr. Kassels is shedding light on the problem without being preachy or judgmental. His book is a great vehicle for opening discussions about a topic that is obviously wreaking havoc on all walks of life.

Fantastic, smart, captivating, frustrating and so satisfying!

Fantastic read! Where do I begin? A close loved one was/is affected by addiction, so years ago I started reading blogs by opiate addicts--both active in their addictions and in recovery. I was trying to understand more about the experience of addiction itself and the recovery insights that survivors could share. I learned that addiction IS a disease, harm reduction helps keep more people alive to have a chance at recovery, and maintenance treatment is an important, valid, effective and "respectable" path to being a functional, happy, healthy person. I eventually stopped reading the blogs, but I am still fascinated by the topic.

Imagine my excitement when I found that an expert in addiction treatment wrote a novel about this! Addiction on Trial gives a deeper look into the larger world around an addict: family, relationships, medical treatment and the legal system. It's a fascinating thriller--and so frustrating (and real!) to see how addicts can be their own worst enemies, by trying to do what's "right" for themselves and other addicts. It's heartbreaking to see how a community will judge addicts, when it's a harder experience than any of us can imagine.

The characters are also so fascinating! Each one has their own motive, and they work perfectly together to form one cohesive mission. More like two sides at war, actually. If you have any interest in addiction, or you just enjoy legal or medical thrillers, this is a great read.

Riveting and Educational! Fantastic Read!

As a licensed addiction treatment professional I am always looking for information that can help educate the public about the issues of addiction and recovery. This book is the ideal balance of providing basic education on addiction side by side with understanding the human side. Dr. Kassels does this exceptionally well by blending them in a way that keeps the reader engaged and informed at the same time. This is a must read that should be in the arsenal of all treatment professionals!

I loved every aspect of this book and really it should …

Rarely would I give a book five stars and I have been meaning to review this book for months, I loved every aspect of this book and really it should be characterized as Literary Fiction because not only was I engaged and entertained, I was thoroughly educated as well. I heard the author today on NPR and his passion and his dedication reminded me that I needed to write this review. Without question it is a five star winner.

 

 

 

Author : Meghan
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Welcome back to Ten Reasons for the Heroin Epidemic. This is the second and final primer to lay the foundation before launching into the ten reasons we currently have a heroin epidemic raging across our country.  But before I proceed, I hope you all will read the recent article published in the New York Times on April 17, 2015 entitled, Serving All Your Heroin Needs. Here are two quotes that are extremely revealing:

heroin1

“… selling heroin across the United States resembles pizza delivery.”

“… a new home for heroin is in rural and suburban Middle America …”

To better understand why pizza delivery of heroin works and how it found its way into suburban and rural America, there are three related terms that are essential to understand:

  • Tolerance
  • Dependency
  • Addiction

Tolerance refers to not getting as much bang for the buck.  In medical terms, it is the body’s adapting to a drug which then necessitates consuming more of the drug to achieve the same effect.

Dependency refers to the state of having symptoms in the absence of the drug. Examples of withdrawal symptoms are the “shakes” after a heavy drinker stops drinking; or the chills, nausea, vomiting, abdominal cramping, etc. when a heroin addict is deprived of his/her next “fix”.

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Addiction is the drug seeking behavior of an individual.  However, a person who is dependent may not necessarily be addicted.  Remembering from the last blog that the disease of addiction has bio-psycho-social aspects, a person may become dependent but not have the components of addiction.

For example, if sweet Aunt Tillie ends up in the hospital with severe intractable pain from a tumor pressing on her spinal column, she may be given an opiate such as morphine to reduce her pain until the tumor size can be minimized by radiation or chemotherapy or surgically removed.  A few weeks of medication may be needed and during that time Aunt Tillie develops tolerance and dependency to morphine.  After the tumor size is reduced and the pressure on the spinal nerves is diminished, the frequency and amount of morphine is gradually decreased to avoid withdrawal symptoms. After a week or so, Aunt Tillie will no longer require an opiate to eliminate her pain and will be showing no signs of withdrawal. After she is discharged home, she is happy taking an occasional non-narcotic pain medication like Tylenol or Ibuprofen. But how about the person who goes home and has some bio, psycho and/or social components of the disease of addiction. He/she may very well start looking for that euphoric “high” and start seeking drugs.  That is the essential difference between dependency and addiction!

We are now ready to delve into the 10 reasons we have a heroin epidemic. Next blog we will focus on the injudicious prescribing of opiates by doctors as reason #1. But first let’s get a look at Jimmy, Annette and Travis – they are dependent and also addicted.

Annette laid out several lines of cocaine, one definitively larger than the other two. Everyone knew the “fat line,” as they jokingly called it, was hers. Travis prepared the portions of heroin, which had already been processed to a fine powder for snorting. They were now ready to snort their speedballs, a combination of heroin and cocaine. Annette much preferred an amphetamine rush, so her drug cocktail was heavily weighted with the cocaine powder and contained only a small amount of heroin. The reverse was true for the boys….

Within an hour after the speedball, Annette craved more cocaine, but she wanted to set an example for Travis, who undoubtedly would soon be itching for more heroin. Her cocaine buzz was starting to dissipate and numbing herself with alcohol served as a distraction to the hollow depressed feeling as a result of the depleted levels of the chemical dopamine in her brain. Dopamine, a neurotransmitter, is an essential naturally occurring compound that is required to stimulate the portion of the brain that elicits the feeling of pleasure. The greater the frequency and amount of cocaine used, the greater the amount of dopamine is depleted. This results in longer lag times for the brain to produce sufficient quantities of dopamine and therefore progressively longer periods of pleasure deprivation and sadness. This vicious cycle encourages more use, which only partially rectifies the effects of the depleted dopamine stores. Annette did not need a course in neurochemistry to understand that doing more and more lines was a never-ending journey.

 

Author : Meghan
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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 : Meghan
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