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.
After 10 weeks we are finally finished with blaming, but what a way to end – let’s blame our politicians and our other public officials. Why? - Because if all our public officials showed the leadership and courage of Vermont Governor Shumlin, we would have another solution to curb the heroin epidemic. As I stated in an Op-Ed in the Boston Globe:
There should be just as many public service announcements about addiction as there are Viagra and Cialis commercials. In addition, expansion of addiction treatment services in jails would help to mitigate much of the revolving door phenomenon. Furthermore, we should demand that our medical schools and hospitals improve addiction training of our physicians. While there is plenty of blame to go around, let's focus on the solutions. The scourge of addiction is in all of our yards. The solution is to decrease the demand with bold public initiatives and a change in attitude. It is both the humanitarian and fiscally responsible thing to do.
We need our politicians and public officials to stand up for what is right and bring forward the real facts about addiction. I explained this further in another Op-ed submitted to the Boston Globe:
We must cut back on the demand to stand a chance of limiting the financial damage. And to our politicians, I know this is a politically hot issue, but lives and dollars are at stake and it is time to lead the charge to educate through scientific fact and not out of fear. I commend Governor 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 (treatment); recognizing that putting more people in jail may make us feel good on the short term, but does not solve the problem. Governor LePage of Maine addressed the issue of drug addiction as an economic issue as well, but he unfortunately spoke not of increased funding for treatment and access to care, but only of expanded law enforcement and judicial response.
As the death of Philip Seymour Hoffman’s has again reinforced, 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 backwoods … 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!
We can make great strides to solve the scourge of heroin addiction, but we need to stop blaming and put words into action. As I have discussed over the past ten weeks, there is plenty of blame to go around!
Addiction On Trial exposes many of the reasons why we have a heroin epidemic; Police Chief, François Bergeron, understood the political and emotional realities of heroin addiction. The story may be fiction, but it is based on medical, legal and political truths. IT IS TIME TO STOP BLAMING AND TIME TO START IMPLEMENTING SOLUTIONS! Thank you for continued interest in my blog site and I hope that Chief Bergeron’s insights will make a difference (Chapter 15):
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 … 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 … Presentations by illustrious speakers demonstrated the extent of the epidemic …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.
Thank you for coming back to my blog site. In case you have missed any of the previous eight blogs on the Ten Reasons for the Current Heroin Epidemic, please do scroll down to check them out. Today we will be discussing how Mental Health Treatment or actually the lack thereof has contributed to the overall increase in illicit drug and alcohol use, and opiate/heroin dependency.
It is well documented that patients with mental illness are still greatly underserved, and despite some positive movement to increase treatment funding and access, the drastic cuts from the distant and recent past have not been eliminated. NAMI, the National Alliance on Mental Illness, released the report State Mental Health Cuts: A National Crisis which documented the drastic cuts implemented by states between 2009 and 2011 for spending for children and adults living with serious mental illness. These cuts led to significant reductions in community and hospital based mental health services, with a direct effect also on access to psychiatric medications and crisis services. The Medicaid funding issue is a complex analysis, but there is no question that too many patients are left without viable treatment options. In an article by the Pew Charitable Trusts, Some States Retreat on Mental Health Funding, Medicaid expansion “may also have persuaded some states to pull back funding for community mental health centers and other mental health initiatives, including school and substance abuse programs.”
The lack of access is not limited to the Medicaid insured population, as many commercial insurers also do not cover mental health services in parity with medical and surgical illnesses. In addition to private insurance companies not abiding by parity laws, the federal and state governments, who are responsible for overseeing compliance, apparently are not doing a good job, Despite Laws, Mental Health Coverage Often Falls Short. It was also reported that “NAMI found that patients seeking mental health services from private insurers were denied coverage at a rate double that of those seeking medical services … [and] patients encountered more barriers in getting psychiatric and substance use medications.”
Enough with the statistics! How does this lead to the heroin epidemic? Simply stated, patients with mental illness are no different than patients with a wide variety of complaints – they all want to feel better. However, when there are roadblocks related to funding and access to treatment and medication for psychiatric illnesses, patients look elsewhere to feel better. It is a well-known phenomenon that patients who cannot access care are more likely to self-medicate. So it should not surprise us that patients with depression, anxiety, bipolar illness and other psychiatric health issues reach for drugs that make them feel better: alcohol, stimulants such as cocaine, and opioids such as OxyContin or heroin are commonly used.
When I started this blog series, I promised that I would not only assign blame for the Heroin Epidemic, but also offer solutions. So here is another solution: Federal and State Governments must enforce parity laws and we must increase access and funding for mental illness. As they say in the Midas commercial, “You can pay now or you can pay later, but you are going to pay.” Inadequate mental health treatment can lead to substance use, crime, dysfunctional family dynamics and an overall increase in financial costs to society.
Bad things can happen when mental illness goes untreated, and especially when drug use compounds the situation. In Addiction On Trial this is illustrated by Aunt Betty’s conversation with Jimmy’s father:
Adam continued, “Jimmy’s in jail. He was arrested for possession of drugs. But now they are trying to pin a murder on him, but there’s no proof, and well, it’s really a case of mistaken identity.” Adam tried to ground his runaway emotions, but with a trembling tone he blurted out what he so desperately wanted to believe. “Jimmy had nothing to do with it!”
Adam’s anxious moment gave Betty the opening she needed. “Adam, how can I help? And don’t lie to me. We both know that just because Jimmy may not have intended to do anything bad, well, you know what I am saying. When people are high on drugs, accidents happen and sometimes it looks like it wasn’t an accident.”
And during the trial, Venla Hujanen, the Finnish born District Attorney, also focuses on drugs and mental illness while cross examining Dr. Saul Tolson:
Dr. Tolson spoke softly while nodding affirmatively. The District Attorney proceeded, “So Dr. Tolson, it sounds like you do agree that if a person is addicted to drugs—even though he may have been ‘clean’ for a while, and even though when not using drugs he is able to process things better—if he returns to drug use and again becomes ‘high,’ his anger can resurface, poor choices can be made, and bad things can happen.”
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.”