Tag Archives: NIMBY

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I am honored to have Geoff Kane, MD, MPH as a guest blogger this week.

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.

Geoff Kane Steven Kassels Addiction on Trial

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?

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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.

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‘Not in my backyard’ attitude doesn’t work with drug addiction

By Steven Kassels, Special to the BDN

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.
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“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.”