WLBZ2 Portland Maine from Steven Kassels on Vimeo.
Many thanks to Channel 2 WLBZ Portland for allowing me to explain some of the issues regarding the current Heroin/Opioid Epidemic - and don't think for a minute that it is only affecting Maine. In fact, it has become a worldwide issue, so maybe we should more appropriately be refer to it as a Heroin/Opioid Pandemic.
I have known Geoff for many years and he is not only an extremely competent physician, but also possesses the highest degree of compassion for patients and the utmost commitment to assisting those afflicted with the disease of addiction. Dr. Kane is the Chief of Addiction Services at the Brattleboro Retreat in Brattleboro, VT. He is board Certified in Addiction Medicine and Internal Medicine, a Fellow of the American Society of Addiction Medicine, and Chairs the Medical-Scientific Committee of the National Council on Alcoholism and Drug Dependence.
If you want to learn more about Dr. Kane, please visit: geoffkane.com
Thank you Geoff for permitting me to post your insightful and thought provoking blog, which was also posted by the National Council on Alcoholism and Drug Dependence, Inc. (“NCADD”).
Curbing Addiction Is Everybody’s Business
By Geoff Kane, MD, MPH
Addiction statistics are scary. For example, excessive alcohol causes an estimated 88,000 deaths per year in the United States. Deaths from cigarette smoke exceed 480,000 per year. In 2013, about 100 Americans per day died from drug overdoses. The annual cost to this country of addiction and other substance abuse—including healthcare, crime, and lost productivity—is over $600 billion.
Such damage ought to prompt interventions that are swift and sure, but that is not the case. Not only have severe social and economic consequences of addiction been with us for a long time; some measures are getting worse.
Conflicts of interest impede the prevention and treatment of addiction by inhibiting individuals throughout society from adopting alternative actions that would reduce the toll of addiction. If we attribute all responsibility for addiction to addicted persons themselves, we are like a naïve family member who says, “It’s your problem. Take care of it.”
People in all walks of life contribute to the proliferation of addiction—whether they realize it or not. The clearest conflict of interest, however, may indeed lie within the individual with addiction. More addictive substance will surely forestall withdrawal and ease emotional and physical distress, and perhaps cause pleasure as well. In the “logic” of addiction, competing priorities such as family, career, and citizenship are eclipsed by the drive to obtain more substance.
Yet others’ conflicts are also part of the problem. Such as well-intentioned family members who long for loved ones to get sober but later undermine their loved ones’ sobriety when abstinence reconfigures the distribution of power in the household. Or well-intentioned addiction treatment professionals and mutual-help members who are so attached to specific treatment approaches that they fail to engage newcomers who don’t align with them. Or well-intentioned community members who only support addiction treatment centers located someplace else, making treatment less accessible in their own neighborhoods.
Conflicts of interest often involve money. Do some doctors prescribe controlled substances too freely? Could some addiction treatment facilities provide less than rigorous care so that patients will return? Are some health insurance companies more invested in restricting access to care than providing it? Are some managed care reviewers rewarded when they deny coverage instead of certify it?
In order to be used, addictive substances must first be available. Use increases when these substances are easily obtained, which promotes new addiction along with recidivism among the abstinent. The business interests of large segments of the pharmaceutical, alcoholic beverage, tobacco, and legal marijuana industries are in conflict with the health interests of the public. Might the business interests that boost substance availability also influence decisions of government and other policymakers?
Besides availability, belief that the risk of harm is low or otherwise acceptable is a second condition to be met before many individuals will initiate use of addictive substances. Numerous people who subsequently developed addiction were given a false sense of security from well-intentioned peers, family members, healthcare providers, and the media including advertisers, reporters, and editors.
Respectful, nurturing interpersonal relationships in families and throughout society reduce the vulnerability of young people to addiction and make recovery more attainable for those seeking a way out. Yet people continue to depersonalize one another, reacting to stereotypes rather than appreciating individual human beings.
Addiction statistics are not likely to improve until we all identify and accept our own unavoidable share of responsibility for curbing the problem. Individuals seeking recovery are responsible for accepting support and changing elements of their lifestyle. Communities—meaning everyone, including law enforcement, business, government, healthcare providers, third party payers, and the media—are responsible for reducing the availability of addictive substances and permissive attitudes toward their use; making individualized addiction treatment accessible; reducing barriers to transportation, employment, and housing; and replacing stigma with respect.
A collective desire to be part of the solution may not be sufficient to make a difference. Healthy change proceeds more reliably when individuals are held accountable. For example, recovery from addiction often requires that family, professionals, and recovering peers keep tabs on those entering and maintaining recovery and impose consequences if they get off track. Likewise, we may all better meet our responsibilities if we gently but firmly hold one another accountable to act on addiction in ways that address the overall picture rather than just our own narrow point of view.
To think about: Will manufacturers and distributors of illegal addictive substances ever support the common good? Is accountability under the law the only possible incentive for them to change?
Posted March 06, 2014, at 2:34 p.m. Bangor Daily News
NIMBY — “not in my backyard” — is the rallying cry when asked if there is a drug problem in one’s neighborhood.
“Sure, maybe we have a problem, but it’s really worse in the next town over.” Or maybe it’s “the next state over.”
That’s just malarkey — it’s in all of our yards, and it does not matter whether we live in the city, suburbia, the mountains or Down East Maine. It is everywhere.
The national annual cost of illegal drug use related to law enforcement, crime, judicial proceedings, incarceration, emergency room visits, hospitalizations, lost job productivity and workers compensation exceeds $180 billion.
The cost to treat one Maine heroin addict in an outpatient, medication-based treatment center with frequent random drug testing is approximately $3,000 per year, while incarceration costs more than $50,000 per year.
Even if one wants to ignore the scientific evidence that treating a heroin or “oxy” addict with a replacement medication is not simply trading one addiction for another, one cannot deny the documented fact that patients who enter into treatment have at least an eight–fold decrease in criminal activity.
Here are some statistics in Maine:
— The number of residents seeking treatment for prescription drug abuse tops the nation.
— Maine’s Medicaid cutbacks leave 400 patients with no access to state-funded treatment.
— More than 7 percent of babies born are addicted to opiates.
— Fatal heroin overdoses quadrupled from 2011 to 2012.
— More people die of drug use than from motor vehicle accidents.
— Maine drug-induced deaths exceed the national rate.
As a nation, we have tried to cut back on the drug supply for decades, yet we are again facing a heroin and opiate epidemic in New England. We can incarcerate all the current drug pushers, big and small, and we can continue to burn the fields in the countries that produce opium. But the profits of drug production and distribution are so great that others rapidly fill the void.
Expanded access and funding for treatment makes fiscal sense, regardless of whether we believe addiction is a disease or a weakness of moral character.
It is time for our politicians to lead by educating through scientific fact and not out of fear. I commend Gov. Peter Shumlin of Vermont for spending his entire State of the State address on this essential economic issue and his call to attack the epidemic on the demand side through treatment. He recognizes that putting more “addicts” in jail may make us feel good in the short term but does not solve the problem.
Gov. Paul LePage, in contrast, focused on expanded law enforcement and judicial response. Unlike many other governors from both parties, he apparently opposes placing the life-saving drug Naloxone in the hands of first responders and others to treat heroin and opiate overdoses.
Naloxone availability will not send the wrong message to heroin addicts that they can use the drug with impunity; heroin users, who are sons and daughters, are dying because the heroin on the street is stronger than they think or cut with other opiates. Without Naloxone readily available over the past couple years there has been a quadrupling of heroin overdoses; so when our politicians state that increasing Naloxone availability will lead to more drug use, well, it’s just baloney.
We allow for life-saving medications and oxygen to be readily available to treat diabetics and smokers with emphysema without speculating that, by doing so, we encourage more smoking or poor dietary compliance.
As the death of Philip Seymour Hoffman has again reinforced, drug addiction is an equal-opportunity disease and has no socioeconomic boundaries. This is not a problem of the welfare state or the poor or less fortunate. Making treatment available should be worn as a badge of honor, no different than establishing a cancer treatment center or cardiac center. NIMBY no longer works.
Dr. Steven Kassels resides in Southwest Harbor and Boston. He has been board certified in addiction medicine and emergency medicine and currently serves as medical director of community substance abuse centers throughout New England, including in Portland and Lewiston. He recently authored the book, “Addiction on Trial: Tragedy in Downeast Maine.”