Thursday, October 01, 2015

The Newly Concerned

Drug problems and overdoses are not new. It’s just that everyone turned a blind eye until middle class kids started dying of heroin overdoses. Now, everyone is talking about the heroin epidemic. Jennifer Horn, the Chair of the NH GOP spent the summer bleating on twitter about how the budget stand off was a failure to act to help addicts. The GOP hasn’t given 2 rusty farthings about addicts in my memory. Their concern is of a very recent vintage, and one that is politically motivated.

One of the best tools the state has to help addicts is the NH Health Protection Plan, aka expanded Medicaid. The NHPP is due to sunset in December of 2016. The legislature refused to extend the program this year. Republicans are opposed to helping those 40,000 working poor folks get health coverage. This same health coverage pays for addiction treatment – something the GOP claims to be concerned about.

Over the last 30 years the number of treatment facilities in NH have dwindled considerably. We’ve chosen to send people to jail rather than invest in treatment. Here in the Live Free or Die state, our jails and prisons have become what passes for mental health and substance abuse treatment. Treatment is cheaper, but as I’ve said many times, NH will always choose the pound of cure.

I’ve read a number of pieces on addiction lately, some written by well meaning people who chose to use stereotypes to describe addicts. They’re poor, they’re from broken homes, they’ve had terrible lives … and so on. And indeed, as long as we thought the only addicts dying were THOSE people, we didn’t waste a minute of time being concerned about them.

Now that it’s hitting the middle and upper levels of the socioeconomic strata, suddenly we see some interest. Middle class parents are losing children. They aren’t being silent about it any more, either. A number of obituaries have been written in the last year or so that are very candid about their child’s battle with addiction and how they struggled to help him or her.

The opiate drugs are some of the hardest to kick. Many people get to heroin through the back door of painkillers. We’ve all read that Oxycontin and Oxycodone are incredibly addictive. When I was hospitalized last year with 4 compression fractures in my mid vertebrae, 8 broken ribs, and a crushed, split femur, I was given painkillers. The first week of my hospitalization was spent in a morphine haze. I was switched from morphine to Oxycontin when it looked as if I was going to live, and I could swallow oral medications. A couple of weeks before I left the hospital, I asked to be taken off the painkillers. I discussed it with my doctor, who put me on a tapering off regimen before we stopped. Even with the tapering off, I experienced 2 days of withdrawal.

I asked to come off the drugs. If I hadn’t, I might have left the hospital with a prescription for the drugs I’d developed a level of physical dependence on. When my prescription ended, I might have turned to heroin as the replacement. My doctors weren’t nefarious over-prescribers. I was hurt very badly, and they were trying to help manage my pain.

I asked, because I knew the drugs were affecting my thought processes, and making me tired. I worried it would affect my physical therapy, and more than anything I wanted to walk again. The opiates made me itchy and nauseous. I asked because I know about addiction. I asked because I am an addict.

Substance abuse research and treatment are lagging behind in the US. Other developed countries are way ahead of us. The US still relies heavily on the 29-day stay in a rehab facility that uses the 12-Step model of recovery. Twelve step programs aren’t for everyone – nor should they be. There should be a variety of options for treatment, the way there are for any disease.

The 12-step model comes to us from Alcoholics Anonymous, a fellowship where alcoholics come together to help each other get sober and stay sober. They are not treatment professionals. AA is very loosely organized and doesn’t have any sort of records of how successful it is. AA emphasizes the anonymous part in a couple of ways. People who attend meetings are expected to refrain from naming those whom they see at meetings. Some of the 12 traditions focus on anonymity, and the need to maintain public silence about recovery.

We don’t know who most recovering addicts are, because of that anonymity. The stories we read are full of stereotypes. We only hear the success stories of the famous. We don’t know that people in recovery walk among us, every day, in all levels of our society.

And so we continue to stigmatize addicts, which only serves to keep people who need help from coming forward. Addiction is regarded as a moral failing (read any online comment section) instead of what it truly is – a public health problem.

We are failing our young people. The cost of a college education leaves them buried under a mountain of debt. We aren’t creating decent paying jobs any more. We create a lot of low wage service jobs. The property taxes in our state mean that home ownership is no longer part of the American dream for many. They’ve been conditioned to understand that government is the root of all evil, that our elected officials don’t believe in science but do believe strongly in obstruction, and that there is really little hope for the future. Upward mobility is a thing of the past. It can’t be a surprise that some turn to the relatively inexpensive comfort of heroin. In fact, if they were spending their escapist dollars at our state liquor stores, we might not hear so much from the newly concerned.

A good place to start is renewing the NHPP. We need all the resources we can muster to fight the pernicious evil of opiate addiction. We need more and better treatment options in our state. We need more compassion and fewer fingers waving and stereotyping. I wish I were more optimistic.

This was published as an op-ed in the October 2 edition of the Conway Daily Sun newspaper. 


Tom McLaughlin said...

Good piece Susan. I didn't know you were so badly hurt. Glad you recovered.

Bob Clegg said...
This comment has been removed by the author.
susanthe said...

Thank you Tom. I had excellent surgeons and medical care.

susanthe said...

Bob, I accidentally deleted your corrected comment - I'm so sorry. I hope you'll try again.

susanthe said...

I accidentally deleted, but I was able to copy and past Bob's comment:

Bob Clegg has left a new comment on your post "Feeding the Unicorn":

Corrected spelling Susan you did what should be done every time we are given an addictive medication. No discharge until your clean. As for treatment centers I watch the methadone clinic in Hudson some days while I eat breakfast. The clients come racing in, some leave little children in the cars while they go inside. None wait the time required before driving, in and back driving in 7 minutes or less. Some have violent reactions but the clinic doesn't allow them to use the bathroom so they run to the restaurant when they are sick. One man didn't make it to the toilet and feces flew all over the floor. A women from the clinic ran in sick and it took 45 minutes to clean the vomit off 3 of the 4 walls in the ladies room. The owners of the clinic state they have a sign that tells clients to go find a public bathroom. They say it says they can't use the one in the clinic. have heard the security guard ignore pleas and tell them to buy a coffee and use the restaurant restrooms One lady talked with a waitress and said she wants to be weaned of methadone but they refuse to help her. She doesn't want to be on any drugs and they appear to not want to lose the money she brings in. So we have a for profit system that makes money off the ill and they treat them like dogs so they will continue to need something to make them not care. We can't expect any better result until we actually designate the money we spend will be used, not for people to get rich, but as it should be used to help people out of the hole. I see how they are just dollar signs for the clinic it's no wonder the death toll is rising.

susanthe said...


I don't know that I'm a good example. I wanted off the pills because I'm an addict. Not an opiate addict, but I've been sober/clean for 28 years. I know more than most people do about addiction. My recovery had also progressed to a point where my pain was lessened - but those 8 broken ribs started singing again when I got off the drugs.

Not everyone is ready to be off pain medication when they leave the hospital. My husband had multiple myeloma - cancer of the bone marrow and blood plasma. His bones broke constantly. Taking him off pain medications while his bones were breaking during the end of his life would have been monstrous.

I think there needs to be much better communication between doctors and patients about pain and about medication.

We also need to stop stigmatizing addicts and actually help them in ways that make sense. Recovery from opiate addiction isn't easy, but it is possible.

Tom St.Martin said...

Well written and spot on as always, Susan. Saw this piece in the Sun a few weeks back, this is first opportunity I've had to say I'm glad to hear of your recovery, though I didnt even know of your injury. In the words of one of my mountain biking idols, sounds like you were really quite tweaked. :O !
I congratulate you on your wisdom & strength to get away from the meds. I know 5 opioid addicts. Every one of them got their start on prescription painkillers. I'm pretty sure not one of them woke up one morning and thought 'You know, I'd really like to be an addict'. And I'm equally sure none of them wants to be. But getting out of that hole is lots harder than falling into it.