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.”
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 ☺
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 ☺
History repeats itself, unless we learn from prior experiences. This is true in many aspects of life, and unfortunately it takes a toll on all of us in terms of individual and community well-being and longevity of life. This is evident not only in the wars that are fought around the world, but in our approach to medical care. Knee jerk reactions have no place in medical decision making, and especially not by politicians who choose to ignore the data of scientifically proven treatments. This is why I felt compelled to speak out about the recent legislative proposal in Maine to limit treatment options for opiate (Heroin & OxyContin) addiction.
This is also why I wrote the book, Addiction on Trial – to demystify and destigmatize the disease of addiction, but through the back door to reach a wider group of readers. The book is written in a “novel” approach, as a murder mystery/legal thriller based on medical and legal truths – which will entertain, enthrall and educate; and I am appreciative of the 4.9 star Amazon rating. I hope you will enjoy both my Op-ed below as well as my page turning thriller, Addiction on Trial.
Thank you and please spread the word that repeating historical mistakes with politically motivated knee jerk reactions needs to end!
Steven Kassels: Drug addiction is a medical issue, not a political issue
By Steven Kassels
Lewiston Sun Journal: Published on Sunday, Feb 8, 2015 at 12:12 am
We, as a society, have arbitrarily differentiated between acceptable and unacceptable drug addictions. Why else would our politicians enter into medical decision making?
After 50 years of accepted science, we know that the cost of not treating opiate addiction is up to 12 times greater than the cost of the treatment itself (National Institute of Health). Likewise, the benefits of having multiple medications available to treat various illnesses (patients respond differently to treatment regimens) have been well documented.
So why do some politicians want to insert themselves into the medical world and make arbitrary decisions about which medications to pay for when it comes to the disease of addiction, particularly when the political decisions fly in the face of medical science?
For those who want to believe addiction has no biological, psychological or sociological components (like the disease of diabetes), surely you will agree that abusing substances can cause disease. It is commonly accepted that Vice President Dick Cheney smoked way too many cigarettes (nicotine addiction) and Hall of Fame baseball player Mickey Mantle drank way too much beer (alcohol addiction). To one we gave a mechanical heart, followed by a heart transplant, and to the other we gave a new liver. They had “acceptable” addictions.
But how about the Vietnam veteran who came home addicted to heroin? Or young men and women who become addicted to painkillers after suffering some type of accident? Are there really “good addictions” and “bad addictions”? Is there really a difference between addictions?
If the differences are so great, why does the medication naltrexone decrease cravings in alcoholics and also block the effects of heroin? Are the addictions really all that different?
Why does methadone treatment still carry such stigma? And why are some politicians in Maine considering defunding it? Is that based in science or bias?
If we look back in history, it was President Richard Nixon who stated in 1971, “ ... methadone is a useful tool in the work of rehabilitating heroin addicts, and that tool ought to be available to those who must do this work” (Special Message to the Congress on Drug AbusePrevention and Control). And in 1999, Mayor Rudy Giuliani — a mayor as tough on crime as any modern politician — initially recommended ending methadone treatment in New York, but upon review of the scientific data, he reversed his decision (Mayor Relents on Plan to End Methadone Use). Science won out.
By contrast, have you ever heard of politicians trying to prohibit coverage for other medications, such as Valium, because they have addictive qualities and thereby limiting doctors’ ability to treat certain illnesses? Have our politicians ever decided that people who smoke cigarettes should not get blood pressure medications because the condition is self-inflicted, chronic and might last years or decades?
Why do we have a heroin and opiate epidemic? We can blame doctors; we can blame pharmaceutical companies; and we can even blame our elected officials who decided to go to war in Afghanistan (U.S.’s $7 Billion War on Drugs Helped Grow Afghanistan’s Heroin) — but blame gets us nowhere.
Our focus should be a doubling of effort to limit the demand for drugs, and the way we limit the demand is through treatment. Incarceration, which is the failed and more expensive approach proposed by some politicians in Maine, just leads to a revolving door.
Some Maine politicians are also trying to claim that treatment with the medication Suboxone — which is a costly prescription medicine often provided through doctors’ offices, is superior to its less-costly relative Methadone — which is provided through heavily regulated clinics that are required to offer counseling and screening services to patients.
But, this is another political approach to a medical issue, and is short on science. Suboxone not only has a ceiling effect that makes it ineffective for many patients, it also has no mandatory requirement for patient counseling that is essential to effective addiction treatment.
We must remember that not all patients are the same, and every patient does not respond the same. Suboxone works for some and methadone is better for others. Should our politicians enter into the practice of medicine by defunding methadone, which is considered the gold standard for opiate addiction treatment?
Much has been made of government not getting involved between a doctor and a patient. I find the current proposal to defund methadone just that.
We cannot let decisions be based on fear, bias or a lack of understanding scientific studies. NIMBY does not work. Opiate addicts live in our communities and in our families, and they work in our businesses.
Politicians should not practice medicine, and they should not defund methadone. Treatment with this scientifically proven medication is fiscally responsible, and cutting it will put patients back on the street, increase crime, jeopardize public health and raise our taxes.
That is bad medicine for Maine.
Steven Kassels, MD, has been board certified in emergency medicine and addiction medicine. He serves as medical director of Community Substance Abuse Centers in Lewiston and Portland, and is the author of “Addiction on Trial — Tragedy in Downeast Maine.”
Unfortunately, life got ahead of me this summer as I went into a “full steam ahead” mode to get the word out about my book, interspersed with visits from three of my grandchildren. I apologize for not having kept up with my self-imposed schedule of blog postings about my author endeavors and current addiction medicine related matters. To all of you who have read Addiction on Trial, thank you; and if you posted a review on Amazon, an extra thank you 🙂
As you can see from my events listings, I will also be doing some traveling over the next few months. I am looking forward to presenting at the Flight Attendants Drug & Alcohol Conference in Baltimore and at the Union League Club in New York City. I must admit, the event in New York City is going to be a little extra special, as the Union League Club membership has included fifteen Presidents. I am honored to be asked to speak about my book and the disease of addiction; and will be returning to the club in December for their annual book fair. The College of the Atlantic has also chosen my book as part of their curriculum for Psychology courses, and I will be visiting the campus this winter to meet with students, who I am certain will keep me on my toes.
Speaking of students, learning about addiction and related diseases need not stop after formal education. I would like to share with you an article about how the National Basketball Association is educating its players about drugs and to again applaud the dedication and work by Chris Herren.
I hope everyone is having an enjoyable summer, and I again wish to thank all of you who have been so supportive of my book and my mission to entertain while educating through the back door … or maybe the side door 🙂 I will keep you posted on the progress of the next Shawn Marks Thriller, as I am currently working on the sequel, Lost to Addiction. Shawn Marks, that egotistical but likable big shot Boston attorney, will definitely have his hands full as he attempts to defend the son of a wealthy shipping magnate. The adventures with Marks will continue as he travels to Europe and to the seedy underground of drug distribution centers in Guadalajara Mexico to solve this murder mystery. Stay tuned!
Together we are spreading the word and effecting change, albeit one town at a time; maybe even just one person at a time - but changing hearts and minds requires patience and persistence! I hope you will all consider passing this blog along to others, and I hope my book will continue to convert the "naysayers". Please let me know your thoughts and also please consider signing up for a group discussion with me about the disease of addiction, spurred by my novel, "Addiction on Trial". Just go to the Book Clubs tab above. Thanks and keep up the fight!
The article below was written by Charles Eichacker in the May 2014 Health Quarterly, Ellsworth Maine. Thank you Charlie !!!
