Addiction on Trial

Addiction on Trial: Tragedy in Downeast Maine, with Steven Kassels

Thursday, October 27th, 2016, 5:30 p.m.

http://www.gibsonsbookstore.com/event/addiction-on-trial

Addiction and Emergency Medicine physician and internationally acclaimed author, Dr. Steven Kassels, will discuss his book Addiction on Trial: Tragedy in Downeast Maine, and his medical experiences. He will also discuss the reasons why we are experiencing a heroin/opioid epidemic and possible solutions.

Q & A to follow.

About the author: Doctor Steven Kassels has had the privilege of treating patients from all walks of life during his years of practice in both Emergency Medicine and Addiction Medicine. He believes that everyone deserves compassion and access to medical care regardless of the nature of the illness. He wrote Addiction on Trial to both entertain and educate, and to depict the struggles of addiction for an audience of avid readers who may expand their understanding of addiction on the basis of evidence. Doctor Kassels lives in Downeast Maine and Massachusetts with his wife, Ali; and enjoys spending time with their four children and life partners; and four delightful grandchildren. Dedicated to his work in Addiction Medicine, he is also passionate about tennis, backcountry skiing, biking, music, and the Boston Red Sox.

Dr. Kassels will be donating his author proceeds to the Concord Coalition to End Homelessness

Event date: 

Thursday, October 27, 2016 - 5:30pm

Event address: 

45 South Main St

Concord, NH 03301

Dr. Kassels was a guest on The Attitude with Arnie Arnesen on October 14. It was an important and enlightening discussion - and we urge you to attend his author event. 

http://www.wnhnfm.org/attitude-arnie-arnesen-october-14-2016/

Problem Solving 101

NH has a drug problem. Our drug problem didn’t didn’t get much attention until middle class white kids started dying. Suddenly our politicians are paying attention, and using addicts as a political football. Here are the NH numbers for the last 5 years:

2011 – 201 deaths.
2012 – 163 deaths.
2013 – 192 deaths.

2014 – 326 deaths.

2015 – 433 deaths.

So far this year there have been about 200 overdose deaths. The state epidemiologist’s office predicts there will be about 482 deaths by the end of the year.

All of the gubernatorial candidates that have websites have plans for dealing with the opioid crisis. They’re all pretty much the same. Education, treatment, and law enforcement. Some candidates have a stronger focus on law enforcement. Even the cops will tell you that they can’t arrest their way out of this. While educating  kids is never a bad thing, education is not enough to solve the problem.

The one thing no one ever brings up when they talk about strategies and solutions is the why. Why do we have so many addicts? Why do we have so many people experimenting with heroin? What is the root cause? It seems likely to me that we can’t solve a problem until we begin to try to understand why we have the problem in the first place. What is lacking in the lives of so many people?

I believe it is hope.

I’m going to saunter out into the old fart zone, and reminisce. The phrase “the common good” was in vogue when I was a wee lass. A high school graduate could get a job and have the potential to move up the advancement ladder. (Heck, a high school drop out could, too.) Companies valued their employees and rewarded years of loyalty with things like regular raises and retirement pensions. It was a time when many people had a job with the same company for their entire working life. The American Dream was a reality for most people.

Then along came the 80’s. An actor from California was elected president. We learned that everything that was wrong was because the government was bad. The phrase “the common good” was discarded in favor of phrases like “welfare queen,” “trickle down economics,” and “evil empire.” Greed and selfishness began their takeover of the American mindset. The belief in the common good morphed into a Galtian version of “you’re on your own, Jack.”

A young person in the north country has little chance of finding or creating a good job. The failure of our state to invest in infrastructure works against them. In fact – the failure of our state to invest is part of the problem. We begrudge every dime we spend on education, and we make sure to tout that at every opportunity. NH ranks dead last in spending on post-secondary education. If we tripled the amount tomorrow, we’d still be dead last. Mississippi – the poorest state in the nation spends more on state colleges than NH – and NH is the seventh wealthiest state in the nation. (We aren’t ashamed of this.) The cost of a college education means taking on a lot of debt for students that don’t qualify for scholarships. Once that education is complete – then what? NH is not exactly a mecca for good paying jobs.

We are surprised when our kids leave our state and don’t return; yet we offer them few reasons to stay. Working two or three jobs to try to stay afloat isn’t anyone’s idea of a life plan. It used to be that if you worked that hard, you could at least afford a modest little house and a family, but those days are long gone.

I grew up in a more innocent and idealistic time. JFK was reminding us to ask what we could do for our country. His question was aimed at far more than donning a uniform and going off to fight in one of our endless wars. Kennedy was one of the founders of the Peace Corps. Young people coming of age today haven’t experienced anything but endless war. They’ve grown up in a country where the corporate media monopolies mostly fail to inform us about anything other than celebrity gossip and sports.

The goal-oriented kids will almost always turn out okay. It’s the kids who don’t have a gravitational pull toward a particular area of study or career that are more likely to get lost. 

They see a nation at odds with itself, in a state of perpetual war. They live in a state that fails to invest in them – or anything else. Climate change is damaging the planet – yet politicians with no scientific background deny science. Every message is conflicting. There is no cohesive vision of a shared future – only the promise of more conflict and endless war. It’s only a surprise that the 30-year slide into national nihilism didn’t start killing us sooner. 

As long as the medication of choice for hopelessness was alcohol, we didn’t care. It was bought in our state stores, after all, and kept our economy afloat. In 2000, the Alcohol Fund was created, to take 5% of the profit from our multi-million dollar booze biz, and use the money for treatment, education, and prevention. The fund became active in 2003, the only year that it was fully funded. Since then, every year, the funding mechanism has been suspended, and the monies go right to the general fund. Over the last twenty years, the treatment and mental health systems that were once in place have been systematically dismantled. No one cared much, as long as it was just booze. It is cynical, but it is how we fund our state. Cheap booze and butts, sold on the highways.

Now that middle class kids are dying from heroin overdoses, suddenly everyone cares. Don’t read me wrong, I’m glad people are starting to pay attention. I just wish it hadn’t taken so long. This is NH, where we’d prefer to pay the pound of cure, and we do, at every exhausting opportunity.

NH is now rebuilding treatment infrastructure. Everyone running for office has a plan for “solving” the opioid crisis. The plans provide a good starting point, but the deeper issues must be examined. We cannot prevent what we don’t fully understand.

“Everybody, sooner or later, sits down to a banquet of consequences.” Robert Louis Stevenson

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

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. 

Feeding the Unicorn

At the end of the last legislative session, Governor Hassan vetoed the state budget that was written by the far right libertea crowd, with an assist from the Koch brothers. This week, the Governor announced that a compromise had been reached.

All summer long, the NH GOP has attacked the governor for vetoing their budget. Their budget enacted business tax cuts that would have left $90 million dollar holes in future budgets, yet they claimed it was responsible. Somehow, magically, a pristine white unicorn would ride in on that wave of tax cuts and fart rainbow fairy dust all over the state, and all that needs funding would somehow magically be funded. Infrastructure! State parks! State employees! Feed that unicorn some beans!

NH does not ever budget in a fiscally responsible way. Most of us wouldn’t patronize a business that was attempting to run with broken equipment and a leaky roof, because the owner was too cheap to invest in his business. That is exactly the business model by which we run our state.

Our Republican brethren are still mired in the trickle down theories embraced by their beloved/invented Saint Ronnie. That those theories have been disproven time and time again doesn’t matter to these folks. They are incapable of grasping reality. They have no plan for the future.

The Democrats aren’t much better. They make a little noise, but ultimately they cave in to the pledge politics that rule our state. Governor Hassan has made a deal that is politically expedient, but it’s not responsible. It will, however, allow her to run for the US Senate, without too much GOP braying about how she vetoed their budget. The agreement also gives cover to those House Republicans pondering a run for governor.

This budget does not ensure that there is enough money to run our state in a responsible way. The Department of Corrections doesn’t have sufficient staff, so they are soliciting volunteers to work as file clerks. The site reminds us that these are unpaid, volunteer positions. There will be a background check, they say. There will be a two-hour orientation. There is no mention of confidentiality.  This is a perfect illustration of how dysfunctional our state has become.

Volunteers. Remember former Governor Craig Benson’s volunteers? He had an entire shadow government comprised of his Cabletron cronies who were called “volunteers.” He refused to give us the names of the volunteers or list their duties – at least not until the scandals started breaking. Volunteer Linda Pepin negotiated a no-bid contract for state employees health care, despite the fact that she wasn’t qualified or empowered to do so. She took only one bid. Benson fired Pepin. He asked his AG, Peter Heed to look into the matter. Heed was a Benson appointee, (that was bad enough) and he included Kelly Ayotte, (then assistant AG) in the investigation. Ayotte had been Benson’s attorney only months before. The Benson administration was rife with corruption, which is why he only served one term. It’s also why Republicans never trot him out as a success story. Oh, and he still hasn’t paid the artist he commissioned to paint his portrait which was intended to hang in the State House. Sleazy till the end.

Volunteers are wonderful. We rely on them to keep our towns running, in so many ways. We should not rely on them to fill positions that should be filled by paid employees, or to run our state government, a la Benson.

The budget agreement does not include reauthorizing the NH Health Protection Program, (aka expanded Medicaid) which insures some 40,000 low-income working folk in our state. The NH GOP spent the summer carping about the heroin epidemic, and how the governor was allegedly contributing to it by refusing to sign off on their odious budget. As treatment experts have said again and again, the NHHPP is one of the best tools they have in the fight against addiction, because it pays for substance abuse treatment. It appears their concern for the dead and the dying was no more than a cudgel for them to beat the governor with. In the governor’s statement, on this agreement, she states that she is taking Republican leadership at their word that they will take up legislation reauthorizing the NHHPP as soon as possible. Given that these are the same folks who refused to honor the contract negotiated in good faith between the state and the state employees, I don’t share her willingness to take them at their word.

What this budget does is tread water in the name of political expediency. What it does not do is move our state forward in any way. This budget kicks the infrastructure can down the road, as it has been kicked by previous legislatures for decades now. We will still have hundreds of bridges on the state’s red list for being structurally impaired. It will not move us from our pathetic ranking of 50^th place in state spending on our state university system. NH college students will continue to graduate with the highest debt load in the nation.

None of this, by the way, is attractive to business. Big businesses locate in states that have robust infrastructure. They want good roads, bridges, ports, and airports. They want to move their employees to states where housing is affordable. NH has the second highest property taxes in the nation. Our telecommunications infrastructure is lacking, especially in the top half of the state. The companies that serve our telecommunication needs are few and hardly competitively priced.

Better feed that unicorn some beans.
  

Published as an op-ed in the Sept. 18 edition of the Conway Daily Sun newspaper.