Leslie Glass's Blog, page 243

10 Excuses Not to Drink, but Still Have Fun at Parties

The sober culture seems to be growing. That means people attending parties may be less interested in picking up a beer and more interested in a can of soda. So, what are some fun, creative excuses you can use to avoid drinking?

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10,872 New Yorkers to See Their Marijuana Convictions Disappear

Sealing these records would ensure that a person’s marijuana-related conviction would not come up in most background checks, state officials said.

A method for expunging the records, which has never been done in New York, is still being developed, the officials said. The process could take up to a year, a spokesman for the State Office of Court Administration, Lucian Chalfen, said.

The Drug Policy Alliance, a nonprofit group, said the number of people who would have their records cleared could be many times higher than the number cited by the state; the alliance cited figures showing that between 1990 and 2018, 867,701 arrests were made in New York State for low-level marijuana offenses.

Under the new law, the classification of the penalty for possessing between one and two ounces of marijuana has been lowered to a violation, and fines have been capped at $200. Previously, such possession was a Class B misdemeanor. The fine for possessing less than one ounce of marijuana has been lowered to $50, from $150.

The move to reduce fines and clear people’s records has been embraced by advocates of criminal justice reform, many of whom said criminal penalties for using marijuana fell disproportionately on black and Hispanic residents.

Khalil A. Cumberbatch, an advocate who was pardoned by Mr. Cuomo in 2014 after serving time for a robbery conviction, said in a statement that expunging marijuana records “gives people a new lease on life, removing the suffocating stain of stigma that prevents so many from reaching their highest potential.”

State Senator Zellnor Myrie of Brooklyn, a co-sponsor of the bill, said he hoped lawmakers will build on this “first step.”

“I represent Brownsville; that was ground zero for a lot of this,” he said of marijuana enforcement. Expunging records “is just the beginning of the state recognizing the errors of that war.”

In February, a study from John Jay College found that “blacks and Hispanics consistently had higher rates of arrest for misdemeanor marijuana possession compared to whites.”

Kevin Sabet, director of Smart Approaches to Marijuana, an advocacy group, said he embraced expunging low-level offenses, but not full legalization.

“We don’t want people in prison for marijuana use,” Mr. Sabet said. “But the criminal sanctions on marijuana is not a reason to commercialize and normalize marijuana.”

Mr. Sabet said he wanted to see marijuana possession likened to driving over the speed limit. “It’s something discouraged,” he said, “but it’s not something that is going to destroy your life if you’re caught doing it.”

This content was originally published here.

The post 10,872 New Yorkers to See Their Marijuana Convictions Disappear appeared first on Reach Out Recovery.

Is Overdose Antidote ‘Enabler’ Of Opioid Use

Alberta’s associate minister of mental health says he’s worried that kids are deliberately taking larger doses of opioids.

Jason Luan says he thinks youth may do so, knowing that naloxone can be used to reverse an overdose.

That distribution of naloxone kits, he says, might be enabling greater drug use — a suggestion strongly opposed by a top Calgary medical professional.

Luan made the comments after meeting with Albertans directly impacted by addictions in Calgary on Friday for a round-table discussion. He told reporters afterward that he learned naloxone has been used as a sort of safety net to push the limits of opioid dosing.

“You know the naloxone kit that we send as an emergency recovery for people with overdose? Actually, the kids take that, knowing they have the kit, because now you’re safe,” Luan said.

“They want to push it to their limit, how far they can go to overdose, because they’re safe, because the kit is there,” he said. “So it begs the question of, you know, lots of times we’re trying to make it easier, wanting to help but it’s a fine line. If you cross that line, you become an enabler.”

Two parents in particular, his chief of staff later noted, believed their children had done this. Luan’s spokesperson said on Saturday that the provincial government remains committed to naxolone “100 per cent” and will continue to fully fund its distribution.

After Friday’s round-table, Luan told reporters this was the first time he had heard about naloxone being used “in the wrong way.” He said it affected his thinking about the overdose-reversing agent.

“For me as a policy maker, as a minister, my thinking is, ‘wow, this is interesting,'” Luan said. “We’ve got to find the balance. We can’t just be one way of thinking, believing we are doing something good, when in fact that can be utilized in the wrong way.”

ER physician disagrees

But Dr. Eddy Lang, an ER physician and head of emergency medicine at the University of Calgary’s medical school, said he hasn’t seen evidence that naloxone is being misused in the way Luan describes.

“I wouldn’t agree necessarily with the idea that giving naloxone is enables someone to pursue their addiction,” Lang said.

“While that’s a possibility and maybe that does occur, it’s a really small proportion — a drop in the bucket of how naloxone is being used in the community…

“What usually happens is that someone who has an opioid use disorder, who is addicted to illegal or legal opioids, if they’re using outside of a safe-consumption site, they will often get into trouble.”

“If for whatever reason one of them goes overboard and then becomes unresponsive and then starts breathing very slowly, the naloxone is a life-saving opportunity to bring that patient around from what occurred,” the physician said.

“But I’ve never gotten the sense from the patients coming to the emergency department that they had the naloxone at the ready, trying to push the limits on what they were using.”

Lang said naloxone routinely saves lives and needs to be readily available.

“You cannot limit its distribution for that reason, because the results would be catastrophic,” he said.

“I don’t think that we’re enabling or contributing to the problem by offering a life-saving intervention that can be used in a moment of crisis.”

In emergency rooms, Lang said doctors are training overdose patients to use naloxone and sending them home with the overdose-reversing drug.

Luan told reporters naloxone is just one tool of many needed to combat the opioid crisis.

This content was originally published here.

The post Is Overdose Antidote ‘Enabler’ Of Opioid Use appeared first on Reach Out Recovery.

This Is What Happened To My Body When I Cut Sugar And Alcohol For A Month

A man in Holland has demonstrated firsthand the impact of a healthy diet by cutting out alcohol, sugar, additives, and preservatives from his consumption for a month. Correspondent Sacha Harland filmed himself for a whole month for the Dutch website LifeHunters to share the experience with the world; here are the main lessons to learn.

As Harland’s body starts detoxing from the added sugars and chemicals he normally consumes, Harland is “constantly hungry” and irritable after just the first week. He expresses discontent at being bombarded by signs and advertisements for things he can’t have like hamburgers and sodas. “I didn’t think it would already be this hard,” he says.

Harland’s attitude does not agree with detoxing.

During a visit to a nutritionist, Harland learns that sweet things make you crave more. “As your blood sugar rises, insulin is created to bring it down, and then your body wants more to replace it,” she tells him. “Sugar makes you tired. Alcohol does that too, you dehydrate.”

Harland speaking with his nutritionist.

But on day 25, Harland films himself sitting down to a breakfast of oatmeal, black coffee, and a banana, and remarks that “this is the first time since I started that I don’t want sweet stuff in the morning.”

At the end of his last week, Harland is surprised to find that it is easier to wake up and that he has more energy to spare. “I didn’t think it would make this much difference to my physical constitution,” he remarks.

The difference in Harland’s fitness is numerically quantified by sports physician Jessica Gal, who performed tests at the start and at the end of the month. Before changing his diet, Harland was fairly healthy, though his cholesterol was a little high.

Returning to see Gal after the experiment, Harland is surprised to learn that he has lost eight pounds, his blood pressure has dropped from 135 to 125, his cholesterol went down 8% and his blood sugar is significantly lower.

Before (“voor”) and after (“na”) of Harland’s weight (“gewicht”), fat (“vetpercentage”), blood pressure (“bloeddruk”), cholesterol, and hemoglobin after a month eating a more natural diet.

“The beginning was very hard,” says Harland, “but eventually I detoxed from the sugar and it went very well.” When asked whether he will maintain this restricted diet, Harland confesses that he will not keep a “completely healthy diet”, but that he understands the value of eating healthy and treating things like candy bars and beer as a more occasional treat.

Interested in Harland’s experience? Here are a few more facts about sugar consumption and its effect on the body:

This content was originally published here.

The post This Is What Happened To My Body When I Cut Sugar And Alcohol For A Month appeared first on Reach Out Recovery.

Vaping Lung Injuries: People Use E-Cigarettes For THC, Marijuana Oil

People are vaping THC. Lung injuries being reported nationwide. Why is the CDC staying quiet?



Jayne O’Donnell and Ken Alltucker





USA TODAY



Published 9:32 AM EDT Aug 28, 2019

Federal health officials are under fire for their unclear public warnings following one death and nearly 200 cases of vaping-related lung illnesses, which some say are related to the far riskier practice of vaping marijuana oil rather than nicotine. 

Some state health department and news reports suggest many of the cases of lung problems involve tetrahydrocannabinol, known as THC, the chemical in marijuana that causes psychological effects.

Boston University public health professor Michael Siegel said the Centers for Disease Control and Prevention is being “unnecessarily vague” about describing the injuries as simply vaping-related when many people might have been injured by vaping THC oil. 

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5 vaping facts: It’s worse with THC oil but it’s safer than smoking cigarettes

“Based on what we know now, I think there’s enough to tell people: Don’t vape THC oils — especially products that are bought off the street,” said Siegel. “There are certain things the agency could be recommending right now that could potentially save lives and prevent this from happening by being much more specific.”

In this Monday, July 29, 2019 photo, Dylan Nelson, of Burlington, Wis., and his sister, Andrea, sit for an interview. He was rushed to the hospital in June by his sister last month with severe breathing problems. Doctors believe he and about two dozen other young adults suffered serious lung injuries after vaping nicotine or THC, or both.

Rick Wood, AP

CDC, the Food and Drug Administration and state health agencies say they are completing the painstaking work of tracing common factors that may have triggered the spate of vaping-related lung illnesses mainly harming young adults.

Siegel acknowledged he is not privy to all the information the CDC has gathered so far. The agency likely does not know whether THC is the only culprit, he said, but the public would likely benefit if the agency warned vapers to avoid THC oil. 

Michael Siegel is a professor in the Department of Community Health Sciences at the Boston University School of Public Health.

Boston University

“There are millions of people vaping out there,” said Siegel, who supports vaping as a way for adults to quit smoking. “When they get this advice, ‘Well, we don’t know what it is. It’s vaping.’ That doesn’t help anyone. So I think they need to try to be specific.”

Marijuana oil vaping was cited in at least 21 cases of severe lung illness reported by the San Francisco Chronicle last week. In Utah, officials said marijuana oil was a likely culprit in most cases of lung illnesses in teens. A Wisconsin man had so much trouble breathing after he vaped nicotine and THC oil that doctors put Dylan Nelson into a medically induced coma and hooked him up to a ventilator. 

Most nicotine-laced liquids in e-cigarettes are alcohol-based and can’t cause “lipoid pneumonia,” the type cited in many of the lung cases, according to Siegel. The oil used when marijuana is vaped can, he said.

New York University public health professor Ray Niaura said the recent spate of lung illness means “it is unlikely it is e-cigarettes that have been on the market for a long time” unless “something was either changed or a new product was introduced into marketplaces.” Niaura also supports vaping for smoking cessation by adults if the proper safeguards are in place for the products. 

Ray Niaura is a professor in the College of Global Public Health at New York University and interim chair of its Department of Epidemiology.

New York University.

“If it’s nicotine, it’s like a bad batch or a new player that is unknown,” says Niaura, a former science director at the anti-tobacco Truth Initiative. “More likely, it’s what others are saying and people are vaping a lot of other things besides nicotine, such as synthetic cannabis or contaminated THC that is making an appearance and leading to these bad consequences.”

Dixie Harris, a pulmonologist at InterMountain Healthcare in Salt Lake City, says a “large portion” of the hospital system’s 13 vaping-related injuries involved THC. 

Harris said she advises people to avoid vaping THC products — or any vaping product that contains oil — because research suggests that can be a risk factor for lipoid pneumonia.

“If somebody is going to insist on vaping, use the products that are from a reputable place and don’t add extra material to your vaping,” Harris said. 

The vaping industry blamed tainted THC sold by unlicensed retailers. The American Vaping Association wants federal officials to clarify where the problems lie. 

One of the challenges for investigators is that teens and even some adults “are going to be reluctant to disclose the use of THC to their parents or doctors,” said Gregory Conley, president of the vaping association. He said his group was contacted by a patient with one of the less serious respiratory illnesses who said that he was only vaping THC, but he worried going public would jeopardize his college scholarship. 

“The truth is that in every case so far in which a specific e-liquid has been identified, that product has been a THC-containing e-liquid, typically purchased off the street and often in open cartridges such that they could contain a contaminant or other drug,” said Siegel. 

Siegel noted that in at least some of the cases, the use of a THC oil, such as butane hash oil, was blamed. In January, someone vaping butane hash oil developed severe acute respiratory illness that was attributed to the hash oil. 

CDC and Food and Drug Administration officials defended themselves Friday, telling reporters the investigations are time intensive and are being conducted in cooperation with states. 

Dr. Brian King of the CDC’s Office on Smoking and Health told reporters that harmful ingredients in traditional nicotine vape liquid had been identified that included ultrafine particulates, heavy metals such as lead, cancer causing chemicals, and flavoring used in e-cigarettes to give it a buttery flavor.

Those ingredients had been related to severe respiratory illness, he said. While they haven’t been linked to the current cases, “we know that e-cigarette aerosol is not harmless,” said King.   

While the government knows people use substances including THC in vape pens, Kind said, “the bottom line is there’s a variety of things in e-cigarette aerosol that could have implications for lung health.” 

Public health investigators need to gather more information about each case, including details such as what substances and products triggered the lung illnesses, said Mitch Zeller, director of the Food and Drug Administration’s Center for Tobacco Products.

He noted, “many of these cases have involved the presence of compounds like THC, and we need to get to the bottom of every single case.”

In a statement, Juul said it was monitoring the reports. The e-cigarette maker added that “reporting also suggests many patients were vaping both nicotine and THC,” and underscores the importance of keeping tobacco and nicotine products away from youth. 

“We also must ensure illegal products, such as counterfeit, copycat, and those that deliver controlled substances, stay out of the market,” said the statement. 

Monday, the California branch of the National Organization to Reform Marijuana Laws warned consumers not to buy THC vape products from unlicensed retailers.

Kim Barnes, Dylan Nelson’s mother, urged other families to come forward if their loved ones have suffered similar injuries to prevent more people from getting sick.

“I don’t want somebody else’s son to end up like this,” Dylan Nelson’s mother, Kim Barnes, told the Milwaukee Journal-Sentinel. “That’s why when they told me I just thought, ‘Well, why isn’t anybody saying anything about this?’” 

Published 9:32 AM EDT Aug 28, 2019

This content was originally published here.

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How America’s Opioid Epidemic Could Get Even Worse

From Vox:

A new report warns about the possibility of fentanyl, a synthetic opioid, going west.

The latest news on America’s opioid epidemic seems positive: Based on preliminary data, drug overdose deaths may have fallen in 2018 — for the first time since the crisis began in the 1990s.

But a new, exhaustive report by RAND, led by researcher Bryce Pardo, points to one way the opioid crisis could still take a turn for the worse, possibly leading to thousands more deaths each year, if the market for fentanyl were to become more widespread.

The report documents the rise of the synthetic opioid fentanyl and its analogs, which have increasingly been mixed with — or outright replaced — heroin and opioid painkillers in the illicit drug market. This trend toward fentanyl is known as the third wave of the opioid crisis, following the first wave of prescription opioids and the second wave of heroin.

The trend has led to a steep increase in overdose deaths, because fentanyl and its analogs are far more potent than other illicit opioids, and they’re a less-known quantity than heroin, making it hard for people who use opioids to properly calculate a safe dose. RAND’s report finds the introduction of fentanyl doesn’t increase the number of people who use opioids — the past decades’ increase continues to be linked primarily to the proliferation of painkillers — but instead increases the number of overdose deaths.

But while fentanyl and its ilk have already led to an increase in overdose deaths, that has mostly happened in the eastern parts of the US and especially the Northeast and Midwest, largely due to differences in drug trafficking networks and the kinds of heroin that fentanyl was initially laced in. And that means, in a terrifying possibility, that fentanyl still has a lot of room to grow.

“One of the most important — and depressing — insights in this analysis is that however bad the synthetic opioid problem is now, it is likely to get worse before it gets better,” the report explains. It goes on:

In 2017, ten states accounted for one-third of all mentions of synthetic opioid overdoses, despite making up a little more than one-tenth of the nation’s population. Conversely, almost three in ten states report synthetic opioid overdose death rates that are one-quarter of the national average of nine per 100,000. The math is simple and distressing: If the rest of the country had a synthetic opioid–involved death rate of half of New England’s in 2017, that would come to about 38,000 synthetic opioid–involved fatal overdoses.

If this estimate held, Pardo told me, it would translate to almost 10,000 more synthetic opioid overdose deaths compared to 2017, or about a third more than the over 28,000 synthetic opioid overdose deaths (excluding methadone) that actually happened that year.

Why fentanyl might go west

Fentanyl could remain a mostly New England and Midwest phenomenon for the same reasons it hasn’t spread west yet. For one, the kind of heroin that’s most common east of the Mississippi River is simply much easier to mix with fentanyl than the kind of heroin out West. That dynamic, along with the drug trafficking networks that have maintained it, could spare the West from a much bigger fentanyl crisis.

Still, it’s possible fentanyl could spread. Fentanyl became the illicit opioid of choice in the eastern parts of the US, based on the RAND report, not because people who use opioids wanted it. Instead, the sellers wanted it, because fentanyl is much more potent and cheaper — and therefore more lucrative — than heroin.

Those economic realities apply just as much to heroin markets out West as heroin markets in the East, so it could be a matter of time before illicit drug trafficking networks make the change. Once that happens, RAND found, fentanyl can spread quickly, and there aren’t any examples of a market going back to heroin once fentanyl takes over. (Estonia, in Europe, has now maintained a fentanyl market for 20 years.)

The US’s preliminary 2018 data, while generally positive, doesn’t rule out the possible spread of fentanyl. While the data suggests overdose deaths went down overall, that was mostly due to falling painkiller overdose deaths, which went from around 15,000 in 2017 to below 13,000 in 2018.

But according to the same data, overdose deaths linked to synthetic opioids, like fentanyl, went up from more than 29,000 in 2017 to nearly 32,000 in 2018. The RAND report provides one way that increase in fentanyl deaths could continue — if the drugs spread to other parts of the country.

There are solutions to fentanyl, but innovation is necessary

The RAND report is grim about the prospects of dealing with fentanyl, but it argues that there are some steps that could help.

More investment in and access to addiction treatment could save lives. In particular, studies show that medications like methadone and buprenorphine reduce the death rate for opioid addiction patients by half or more. But in the US, just one in 10 people with a drug addiction get specialty treatment, and the majority of treatment providers don’t offer the medications.

Efforts to better detect fentanyl at the border could also save lives, especially at mail and shipping routes, particularly from China and Latin America, through which most fentanyl is believed to come. Harm reduction efforts, like more access to the opioid overdose antidote naloxone and more needle exchanges, could help as well.

RAND’s report, however, argues that fentanyl is a new kind of drug problem that requires new modes of thinking. Some of the ideas RAND points to try to adapt to the internet era of drug markets, like one proposal to make fake drug-selling websites to lure would-be buyers away from the growing number of actual drug-selling operations on the web.

The report also points to some ideas that are far more controversial in the US. One is a prescription heroin program, in which treatment-resistant patients who use opioids are prescribed heroin and use it in a medically supervised setting. Another idea is supervised consumption sites, safe spaces where people can use drugs with medical supervision. A report from RAND last year found strong evidence that prescription heroin programs can save lives and reduce all sorts of drug-related problems, and positive, though weaker, evidence for supervised consumption sites.

By acknowledging that it’s not going to be possible to stop some people from using drugs, these ideas may feel strange or even dangerous, especially after decades of a “just say no” approach. But if the evidence shows these new approaches save lives (which it does), and if there’s a risk that fentanyl may spread and wreak more havoc in the US (which remains possible), then maybe it’s time to think differently about drugs and drug policy.

RAND’s report is clear about just sticking to the status quo in the face of fentanyl: “Limiting responses to small tweaks on existing approaches in the United States is likely to condemn many people to early deaths.”

The post How America’s Opioid Epidemic Could Get Even Worse appeared first on Reach Out Recovery.

How America’s Opioid Epidemic Could Get Even Worse

From Vox:

A new report warns about the possibility of fentanyl, a synthetic opioid, going west.

The latest news on America’s opioid epidemic seems positive: Based on preliminary data, drug overdose deaths may have fallen in 2018 — for the first time since the crisis began in the 1990s.

But a new, exhaustive report by RAND, led by researcher Bryce Pardo, points to one way the opioid crisis could still take a turn for the worse, possibly leading to thousands more deaths each year, if the market for fentanyl were to become more widespread.

The report documents the rise of the synthetic opioid fentanyl and its analogs, which have increasingly been mixed with — or outright replaced — heroin and opioid painkillers in the illicit drug market. This trend toward fentanyl is known as the third wave of the opioid crisis, following the first wave of prescription opioids and the second wave of heroin.

The trend has led to a steep increase in overdose deaths, because fentanyl and its analogs are far more potent than other illicit opioids, and they’re a less-known quantity than heroin, making it hard for people who use opioids to properly calculate a safe dose. RAND’s report finds the introduction of fentanyl doesn’t increase the number of people who use opioids — the past decades’ increase continues to be linked primarily to the proliferation of painkillers â€” but instead increases the number of overdose deaths.

But while fentanyl and its ilk have already led to an increase in overdose deaths, that has mostly happened in the eastern parts of the US and especially the Northeast and Midwest, largely due to differences in drug trafficking networks and the kinds of heroin that fentanyl was initially laced in. And that means, in a terrifying possibility, that fentanyl still has a lot of room to grow.

“One of the most important — and depressing — insights in this analysis is that however bad the synthetic opioid problem is now, it is likely to get worse before it gets better,” the report explains. It goes on:

In 2017, ten states accounted for one-third of all mentions of synthetic opioid overdoses, despite making up a little more than one-tenth of the nation’s population. Conversely, almost three in ten states report synthetic opioid overdose death rates that are one-quarter of the national average of nine per 100,000. The math is simple and distressing: If the rest of the country had a synthetic opioid–involved death rate of half of New England’s in 2017, that would come to about 38,000 synthetic opioid–involved fatal overdoses.

If this estimate held, Pardo told me, it would translate to almost 10,000 more synthetic opioid overdose deaths compared to 2017, or about a third more than the over 28,000 synthetic opioid overdose deaths (excluding methadone) that actually happened that year.

Why fentanyl might go west

Fentanyl could remain a mostly New England and Midwest phenomenon for the same reasons it hasn’t spread west yet. For one, the kind of heroin that’s most common east of the Mississippi River is simply much easier to mix with fentanyl than the kind of heroin out West. That dynamic, along with the drug trafficking networks that have maintained it, could spare the West from a much bigger fentanyl crisis.

Still, it’s possible fentanyl could spread. Fentanyl became the illicit opioid of choice in the eastern parts of the US, based on the RAND report, not because people who use opioids wanted it. Instead, the sellers wanted it, because fentanyl is much more potent and cheaper — and therefore more lucrative — than heroin.

Those economic realities apply just as much to heroin markets out West as heroin markets in the East, so it could be a matter of time before illicit drug trafficking networks make the change. Once that happens, RAND found, fentanyl can spread quickly, and there aren’t any examples of a market going back to heroin once fentanyl takes over. (Estonia, in Europe, has now maintained a fentanyl market for 20 years.)

The US’s preliminary 2018 data, while generally positive, doesn’t rule out the possible spread of fentanyl. While the data suggests overdose deaths went down overall, that was mostly due to falling painkiller overdose deaths, which went from around 15,000 in 2017 to below 13,000 in 2018.

But according to the same data, overdose deaths linked to synthetic opioids, like fentanyl, went up from more than 29,000 in 2017 to nearly 32,000 in 2018. The RAND report provides one way that increase in fentanyl deaths could continue — if the drugs spread to other parts of the country.

There are solutions to fentanyl, but innovation is necessary

The RAND report is grim about the prospects of dealing with fentanyl, but it argues that there are some steps that could help.

More investment in and access to addiction treatment could save lives. In particular, studies show that medications like methadone and buprenorphine reduce the death rate for opioid addiction patients by half or more. But in the US, just one in 10 people with a drug addiction get specialty treatment, and the majority of treatment providers don’t offer the medications.

Efforts to better detect fentanyl at the border could also save lives, especially at mail and shipping routes, particularly from China and Latin America, through which most fentanyl is believed to come. Harm reduction efforts, like more access to the opioid overdose antidote naloxone and more needle exchanges, could help as well.

RAND’s report, however, argues that fentanyl is a new kind of drug problem that requires new modes of thinking. Some of the ideas RAND points to try to adapt to the internet era of drug markets, like one proposal to make fake drug-selling websites to lure would-be buyers away from the growing number of actual drug-selling operations on the web.

The report also points to some ideas that are far more controversial in the US. One is a prescription heroin program, in which treatment-resistant patients who use opioids are prescribed heroin and use it in a medically supervised setting. Another idea is supervised consumption sites, safe spaces where people can use drugs with medical supervision. A report from RAND last year found strong evidence that prescription heroin programs can save lives and reduce all sorts of drug-related problems, and positive, though weaker, evidence for supervised consumption sites.

By acknowledging that it’s not going to be possible to stop some people from using drugs, these ideas may feel strange or even dangerous, especially after decades of a “just say no” approach. But if the evidence shows these new approaches save lives (which it does), and if there’s a risk that fentanyl may spread and wreak more havoc in the US (which remains possible), then maybe it’s time to think differently about drugs and drug policy.

RAND’s report is clear about just sticking to the status quo in the face of fentanyl: “Limiting responses to small tweaks on existing approaches in the United States is likely to condemn many people to early deaths.”

The post How America’s Opioid Epidemic Could Get Even Worse appeared first on Reach Out Recovery.

Tyler Skaggs’ autopsy: Fentanyl, oxycodone and alcohol led to death by choking on vomit

Angels pitcher Tyler Skaggs had the opioids fentanyl and oxycodone along with alcohol in his system when he was found dead in his Texas hotel room July 1, according to a toxicology report released Friday by the Tarrant County medical examiner’s office.

The cause of death is listed as a mixture of “alcohol, fentanyl and oxycodone intoxication with terminal aspiration of gastric contents,” meaning Skaggs, 27, essentially choked on his vomit while under the influence. The death, according to the report, was ruled an accident. He was found on his bed, fully clothed, and there were no signs of trauma.

The Southlake, Texas, Police Department is investigating the death, and a statement from Skaggs’ family issued Friday mentions that an Angels employee may have some involvement.

The statement: “We are heartbroken to learn that the passing of our beloved Tyler was the result of a combination of dangerous drugs and alcohol. That is completely out of character for someone who worked so hard to become a Major League Baseball player and had a very promising future in the game he loved so much.

“We are grateful for the work of the detectives in the Southlake Police Department and their ongoing investigation into the circumstances surrounding Tyler’s death. We were shocked to learn that it may involve an employee of the Los Angeles Angels. We will not rest until we learn the truth about how Tyler came into possession of these narcotics, including who supplied them. To that end, we have hired attorney Rusty Hardin to assist us.”

Major League Baseball plans to assign its investigative unit to probe the claim that an Angels employee might have been involved in Skaggs’ death.

“We were unaware of this allegation and will investigate,” MLB spokesman Pat Courtney said.

The Angels have hired Fort Worth trial attorney John Cayce to represent them, according to a person familiar with the matter but not authorized to discuss it publicly.

Cayce, a former chief justice of Texas’ Second Court of Appeals, has been working for several weeks as a liaison between the team and Southlake police during the investigation. He was hired to represent the Angels and not necessarily the employee mentioned in the Skaggs family statement.

The Angels were staying at a hotel in Southlake ahead of a four-game series against the Texas Rangers the night Skaggs died. The team arrived the evening of Sunday, June 30, and Skaggs’ body was found in his room at approximately 2:18 p.m. the next day after a teammate became concerned when Skaggs did not return repeated text messages and phone calls about joining him for lunch.

What authorities learned about Skaggs’ hotel room is not publicly known because police reports have not been released. The L.A Times and other news outlets requested police, fire department and emergency medical services records related to the incident, but an attorney representing the city of Southlake asked the Texas attorney general whether many of the records are exempt from disclosure. No decision has been reached.

The Southlake attorney said in the letter to the state attorney general that release of some of the materials requested could “interfere with the detection, investigation or prosecution of crime.”

Fentanyl is a powerful synthetic opioid similar to morphine but 50 to 100 times more potent on a weight-by-weight basis. When taken in uncontrolled concentrations by unsuspecting users, or by users whose opioid tolerance has not been heightened by long-term use, the drug is more likely even than prescription opioids to suppress respiration and cause death.

Blood tests showed 3.8 nanograms per milliliter of fentanyl in Skaggs’ system, which experts said is a significant amount but not outrageously high. Autopsy blood tests have shown nanograms per millileter levels of over 100.

Toxicology report on Tyler Skaggs from the Tarrant County Medical Examiner’s Office.
(Tarrant County Medical Examiner’s Office)

“The level of fentanyl is a significant amount that could produce death,” said Cyril Wecht, a Pittsburgh forensic pathologist with 40 years of experience. “In this case, oxycodone and alcohol were also present and would have contributed to the death because they are also central nervous system depressants.”

The autopsy report noted the absence of norfentanyl, a metabolite of fentanyl, which Wecht said “means that fentanyl was ingested not long before death occurred.”

Tests showed 38 nanograms per milliliter of the prescription-strength pain killer oxycodone, the use of which is prohibited by Major League Baseball’s Joint Drug Prevention and Treatment Program, and a blood-alcohol level of 0.122%. A 0.08% limit is considered legally impaired. Fentanyl is not specifically listed on MLB’s banned substance list, but as a “drug of abuse” on the federal Drug Enforcement Administration list, its use is automatically prohibited by MLB.

A dozen or so Angels players and a few broadcasters were on the 3 p.m. bus about to depart the Hilton hotel in Southlake, Texas, for Globe Life Park on Monday when traveling secretary Tom Taylor delivered the devastating news.

Skaggs was on a one-year contract for $3.7 million in his second year of arbitration. He would have been eligible for free agency after the 2020 season.

Hardin is a renowned Houston criminal defense attorney who has represented and won favorable verdicts for athletes such as Roger Clemens, who was accused of lying before Congress over alleged steroid use; Warren Moon, Scottie Pippen, Rudy Tomjanovich and Wade Boggs.

“I think the thing to keep in mind is they’re just still so devastated, both the wife and the family, about this young man’s death, and they just want to know what happened and how it happened,” Hardin said by phone from his Houston office. “We’re going to want to know how it came about that those drugs were ingested and whether or not others are responsible for what happened.”

Angels starting pitcher Tyler Skaggs walks through the dugout during a game against the Minnesota Twins in May 2018.
(Gina Ferazzi / Los Angeles Times)

Hardin said he has seen the autopsy report but has not seen police reports or spoken to investigators about the case. He said it’s “way too early for us to speculate” on whether there are grounds for legal action.

“You know, if you lose a son, or a husband, or a spouse, it’s just a tremendously horrible experience, and you want to know how it happened,” Hardin said. “So that’s where the family is right now. How did it happen? Was anyone else involved? They just want to get answers.”

Skaggs was found unconscious two days after his final pitching performance June 29, three days before he was scheduled to make his next start. His body was clad in black denim jeans, a decorated belt and dark brown western boots when it arrived at the medical examiner’s office, according to the autopsy report. The outfit appears to be the same one Skaggs wore June 30, when he coordinated a western-themed trip to Texas to celebrate his team’s back-to-back series against the Rangers and Houston Astros.

Skaggs was one of the most popular players in the clubhouse, and he was also one of the Angels’ most reliable pitchers this season, going 7-7 with a 4.29 ERA in 79 2/3 innings across 15 starts. He was 28-38 with a 4.41 ERA during a seven-year major-league career that was interrupted by an elbow surgery in 2014 and several other injuries in subsequent years.

1/17
Fans create a makeshift memorial for Angels pitcher Tyler Skaggs at Angel Stadium in Anaheim.  (Irfan Khan / Los Angeles Times)
2/17
Fans place flowers at a growing memorial for Angels pitcher Tyler Skaggs at Angel Stadium in Anaheim.  (Irfan Khan / Los Angeles Times)
3/17
Angels fan Eric Lopez brings flowers to a growing memorial for Angels pitcher Tyler Skaggs at Angel Stadium in Anaheim.  (Irfan Khan / Los Angeles Times)
4/17
An Angels fan pays his respects by lighting candles at a growing memorial at Angel Stadium.  (Allen J. Schaben / Los Angeles Times)
5/17
Los Angeles Angels starting pitcher Tyler Skaggs towels off before the game against the Minnesota Twins at Angel Stadium on May 11, 2018.  (Gina Ferazzi / Los Angeles Times)
6/17
Tim McCann, of Anaheim, views a memorial to Angels pitcher Tyler Skaggs on the Big A at Angel Stadium.  (Allen J. Schaben / Los Angeles Times)
7/17
Angels fans leave items at a growing memorial for Tyler Skaggs at Angel Stadium.  (Allen J. Schaben / Los Angeles Times)
8/17
Karl Arriola, left, and his son, Jonathan, of Santa Ana, spend a quiet moment at a growing memorial for Tyler Skaggs at Angel Stadium.  (Allen J. Schaben / Los Angeles Times)
9/17
Angels fans Reza Agahi, 18, left, William St. Marseille, 18, center, and Grant Gaynor, 18, all of Anaheim, spend a quiet moment looking at a sign and growing memorial for Tyler Skaggs at Angel Stadium.  (Allen J. Schaben / Los Angeles Times)
10/17
Angels fan Nancy Dodson of Garden Grove spends a quiet moment by herself at a growing memorial for Tyler Skaggs at Angel Stadium.  (Allen J. Schaben / Los Angeles Times)
11/17
Angels pitcher Tyler Skaggs is congratulated in the dugout after finishing pitching against the Rangers at Angel Stadium on June 3, 2018.  (Allen J. Schaben / Los Angeles Times)
12/17
Santa Monica High School’s Tyler Skaggs pitches against Diamond Ranch High School at Santa Monica High School on May 16, 2008.  (Lori Shepler / Los Angeles Times)
13/17
Tyler Skaggs  of the Angels delivers a pitch against the St. Louis Cardinals in the first inning at Busch Stadium on June 23, 2019, in St. Louis.  (Dilip Vishwanat / Getty Images)
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Tyler Skaggs of the Angels can be seen in the dugout during the third inning of the game against the Oakland Athletics at Angel Stadium on June 29, 2019.  (Jayne Kamin-Oncea / Getty Images)
15/17
Tyler Skaggs of the Angels pitches in Angel Stadium in Anaheim.  (Jayne Kamin-Oncea / Getty Images)
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Los Angeles Angels pitcher Tyler Skaggs watches from the bench in the fifth inning of a baseball game against the Detroit Tigers in Detroit on May 8, 2019.  (Paul Sancya / Associated Press)
17/17
Los Angeles Angels starting pitcher Tyler Skaggs throws to an Oakland Athletics batter during the fifth inning of a baseball game in Anaheim on June 29, 2019.  (Marcio Jose Sanchez / Associated Press)

The onslaught of injuries pushed Skaggs last offseason. He worked out with mobility coach Sarah Howard in Los Angeles and consulted with renowned strength coach Eric Cressey in Florida. Only two minor ailments slowed Skaggs in 2019: He experienced soreness in his forearm after experimenting with a new pitch during spring training and missed a start; and he rolled his ankle in an April game against the Chicago Cubs, leading to a 10-day injured list stint.

Skaggs’ death rocked the baseball world. Players around the league saluted Skaggs by etching his initials and jersey number onto their hats and into the dirt on mounds. Teammate Andrew Heaney opened his first start after Skaggs’ death by throwing Skaggs’ signature curveball.

Tributes continued in the July 9 All-Star game in Cleveland, where Angels Mike Trout and Tommy La Stella wore Skaggs’ number underneath their last names and others wore No. 45 patches like the ones the Angels have worn since Skaggs’ death.

The Angels paid homage to their late teammate in their first home game following his death by donning No. 45 jerseys with the name “SKAGGS” on the back in a July 12 game against Seattle. His mother, Debbie, followed a 45-second moment of silence by throwing a strike for the ceremonial first pitch, which was caught by Heaney.

Taylor Cole and Felix Pena threw the second combined no-hitter in franchise history that night in a 13-0 rout of the Mariners, Cole opening with two perfect innings and Pena following with seven no-hit innings. After the final out, players shed their jerseys and arranged them on the mound before saying a prayer. They left the jerseys there as they departed the field.

Angels starter Tyler Skaggs delivers against the Chicago Cubs on April 12.
(Matt Marton / AP)

“You can’t make this stuff up,” Trout said after driving in six runs and noting that the Angels scored seven runs in the first inning and 13 overall and faced 28 batters on the day before Skaggs would have turned 28. His birthday was July 13, or 7/13. “Tonight was in honor of him, and he was definitely looking over us.”

The Angels have set up Skaggs’ locker in every stadium they have visited since his death. Clubhouse managers even made him a throwback jersey when the Angels celebrated 1970s weekend and acquired the necessary materials in Houston last week to customize his Players Weekend jerseys with the nickname he chose for the festivities — “Slick.”

Many of Skaggs’ friends dedicated their Players Weekend jerseys last week in his memory, including Nationals pitcher Patrick Corbin, who was drafted by the Angels in the same year as Trout and Skaggs and was traded with Skaggs to the Arizona Diamondbacks in 2010.

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Angel players place their Tyler Skaggs jerseys at the pitchers mound after no-hitting the Mariners.

 

2/16

A portrait of the late Angels pitcher Tyler Skaggs sits atop the jerseys on the pitcher’s mound after the Angels no-hitted the Mariners.

 

3/16

The Los Angeles Angels lay their jerseys bearing the number of the late Tyler Scraggs on the pitchers mound after defeating the Seattle Mariners.

 

4/16

Debbie Hetman, mother of the late Tyler Skaggs, looks up after throwing the first pitch.

 

5/16

Angels Albert Pujols is hugged by an unidentified Anaheim police officer next to a framed jersey of Tyler Skaggs who was memorialized before a game with the Seattle Mariners.

 

6/16

Angels center fielder Mike Trout gestures towards a memorial of pitcher pitcher Tyler Skaggs before the game.

 

7/16

Angel players bow there heads for teammate Tyler Skaggs during a moment of silence.

 

8/16

Angels pitcher Taylor Cole places his hand on the number 45 on the pitchers mound in memory of the late Tyler Skaggs before the start of the game against the Seattle Mariners.

 

9/16

Angels starting pitcher Taylor Cole pays tribute to Tyler Skaggs before throwing out the first pitch.

 

10/16

An Angels fan holds a sign for Tyler Skaggs before a game with the Mariners.

 

11/16

A marker is seen in the outfield in memory of the late Tyler Skaggs.

 

12/16

Emma Palacios, 15, and her father, David Palacios, 40, of Covina take pictures of a marker in memory of Tyler Skaggs.

 

13/16

Angel fans look at a memorial for Tyler Skaggs in front of Angel Stadium.

 

14/16

Julian Segura, 3, hugs his mom, Sylvia Menchaca, of the San Fernando Valley, in front of a memorial for Tyler Skaggs, after Julian placed a helmet with a message to the late Angels pitcher.

 

15/16

Karl Arriola, kneels in front of a memorial at the front gate to Angel Stadium before the start of the game.

 

16/16

Karl Arriola, 48, of Santa Ana kneels before a memorial for Tyler Skaggs, out in front of Angel Stadium.

 

In a memorial service at St. Monica Catholic Church in Santa Monica last month, hundreds paid tribute to a man described as passionate and caring. Skaggs’ wife, Carli, spoke of their love. His mother listened from the front pew as family members and Skaggs’ closest confidants shared their goofiest — and most heart-rending — memories.

The Angels did not make players available in their Angel Stadium clubhouse before Friday night’s game against the Boston Red Sox. Angels general manager Billy Eppler declined to comment on specific aspects of the police investigation.

“I can just say that we were saddened by that report that came out and completely heartbroken,” Eppler said. “Everyone is searching for facts, and everyone in the organization wants facts, which is why we are actively cooperating with an investigation.”

Eppler said the manner in which Skaggs died would not tarnish the pitcher’s memory in his mind.

“We miss Tyler every day. That clubhouse misses him every day,” Eppler said. “We miss him in our lives, and we pray for him and his family every day, and we pray for our own healing, as well, and nothing that we learned today changes those feelings, not one thing. But this is like a shot to our core, and it brings back a lot of pain from that tragic day.”

Times staff writers Nathan Fenno and Bill Shaikin contributed to this report.

This content was originally published here.

The post Tyler Skaggs’ autopsy: Fentanyl, oxycodone and alcohol led to death by choking on vomit appeared first on Reach Out Recovery.

What’s Your Alcohol IQ? Part 1

It’s everywhere. Face it. But how much do you know about alcohol? Do you know about its effects on us?

1
True or False: Alcohol effects women differently than men












True





False







Correct!


Wrong!



True

Biologically, women tend to have more fat than men, which means alcohol is absorbed more slowly and remains in the bloodstream longer. 

2
How many calories are in one glass (5 oz) of red wine












50





200





125





150







Correct!


Wrong!



125 calories

125 empty calories. What's a good, healthy food that you can have instead?

3
What is considered moderate drinking












Men: 2 drinks; Women 1





Men: 1 drink; Women 1





Men: 3 drinks; Women 2





Men: 2 drinks; Women 2







Correct!


Wrong!



Men: 2 drinks; Women 1

That's right. Two drinks for men and one for women. Don't forget about the biological make-up of each gender. 

4
True or False: It’s safer to drink on a full stomach












True





False







Correct!


Wrong!



True

Techincally, it's better to drink on a full stomach. But, is drinking really ever truly safe?

5
Which of the following is NOT a sign of alcohol poisoning












Blue-tinged skin





Passing out and can’t be woken up





Diarrhea





Vomiting







Correct!


Wrong!



Diarrhea

Alcohol can cause diarreah and a slew of digestive issues. But for the purpose of being aware of Alcohol poisoning, 

What's Your Alcohol IQ? Part 1
Created on 02 Sep 2019




Quiz result
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Correct!



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You could use a little brush-up on your knowledge of alcohol
You scored

It can be a dangerous substance and can easily be abused or misused. Here are some other articles to help you build your knowledge about alcohol. 

The Gateway Drug is Alcohol Not Marijuana

Alcohol: It Really Is Everywhere

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A little more studying won't hurt
You scored

Whether you’ve never had a drink, you’re well into your recovery, just beginning, or still drinking, you should know a little more about this substance. It’s legal, yes, but can still have such an impact on the body, brain, and behavior. Here are some more articles to help you build your knowledge! 

What To Know About Alcohol and Brain Damage

Alcohol Math For Girls

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You know a little about alcohol but could use a little more information about it. You’re aware of what it can do to your body; however, maybe no one has told you about the differences between men and women when it comes to processing a drink. Here are some articles to help you grow! 

The Gateway Drug is Alcohol Not Marijuana

Alcohol: It Really Is Everywhere

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You only got two wrong
You scored

Your basic knowledge of alcohol is pretty good, but maybe you’re unsure of the signs of alcohol poisoning what moderate drinking is. Here are some informational articles to help you learn more! 

What To Know About Alcohol and Brain Damage

Alcohol Math For Girls

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You only got one wrong
You scored

Keep up the good work on your studies. It helps to know more about the effects alcohol can have on people and what to look for if someone has consumed too much. Here are some helpful articles.  

The Gateway Drug is Alcohol Not Marijuana

Alcohol: It Really Is Everywhere

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100%
You scored

You have a great understanding of basic alcohol facts. Great job! To learn more, here are some other articles. 

What To Know About Alcohol and Brain Damage

Alcohol Math For Girls

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The post What’s Your Alcohol IQ? Part 1 appeared first on Reach Out Recovery.

How To Get Sober

So, maybe you’ve been thinking about how to get sober. Maybe you’ve even been considering quitting drinking for a while, but now you’re ready to take the first step. The trouble is, you don’t know where to begin. You’re not alone! No one really knows how to get sober. Well, maybe there’s one person out there who figured it out alone, but they are the exception to the rule! 

Deciding to stop drinking is a process

There are steps. But that’s good news because that means there are formulas to follow. To begin, let’s answer some questions that might be floating around your head. Grab a pen and notebook, or your trusty handheld gadget, get yourself a nice coffee, Chai, or whatever happens to be your beverage of choice, and let’s put some answers in black and white before your eyes to help you decide if you need to get sober. 

Do I think I have a problem with alcohol?Have I thought about quitting? How often? Do I wake up ashamed/guilty for drinking the night before? How long have I gone without drinking? Do I have a STOP button, or do I keep going? Can I stop after one drink? Do I have the urge to look for more alcohol after finishing a whole bottle of wine or a few beers at home? Am I angry or agitated if I choose not to drink for more than one day? Do I look for reasons to drink or make up stories to justify drinking? Do I feel the need to sneak drinks or hide my drinking?

Now that you’ve answered the questions honestly, how do you feel about your responses? 

Is it time to get sober 

Set yourself up for success by finding the correct treatment. Do you need medical intervention to stop drinking because you may be addicted? Do you need some formal type of in-patient treatment? Could you be a dual diagnosis case—meaning addiction and depression or addiction and eating issues?

Treatment centers specialize in different issues so take the time to find the one that services your needs. Or, maybe you’re just dependent and a recovery support group or meeting with a therapist or addiction specialist will be enough for you. To begin to figure this out, let’s answer some more questions. 

Let’s take the formal test, “Do I have a drinking problem?” Which you can find at 12step.com, aa.org, or drugrehab.com. This is only meant to be seen by you, so be sure to answer honestly!

Next question

How bad is it? When you’re physically addicted to alcohol and/or drugs you shake when you wake up, you sweat and get withdrawal symptoms if you don’t drink or use regularly. If you have a physical addiction, quitting cold turkey can be risky, or even deadly. If this is your situation, you may need to check into a facility to safely detox. So, the first step for you is to get in touch with rehabs and find out which kind is right for you.

Disclaimer: if you are dependent on drugs or alcohol, it’s important to know the warning signs of withdrawal. 

Headaches, shaking, sweating, nausea/vomiting/cramps/diarrhea, anxiety/restlessness, trouble sleeping/concentrating, increased heart rate and BP 



May be life-threatening if: Severe vomiting, confusion/disorientation, fever, hallucinations, extreme agitation, seizures/convulsions 

Or, you may want to further inspect some rehab centers by searching for Treatment Center Finders or looking on drugrehab.org. 

Eliminate triggers

OK great, you’re someone who doesn’t need medical intervention and are going to try and stay sober with support groups, 12 step, yoga, religion, spirituality, or whatever feels right to you. This means you’re staying in your own space and continuing with your normal life. That’s awesome but there are some things to consider.

For example, removing alcohol or pill bottles and avoiding drinking buddies for a while. If you pass by a bar you used to frequent after work, take a different route home. Maybe your grocery store has an isle dedicated to wine or beer; avoid it. Start in the middle or at the other end of the store. Use common sense and make your life easier by removing people, places, and things that will make it easy to stray.

Talk to a professional

Whether this is to help figure out what kind of treatment or long-term recovery plan you need, support for early recovery, or maybe some outside help to discover why you started drinking in the first place, any kind of addiction specialist or mental health professional will know how to help.

Work on building a support team to help you get to where you want to be and help keep you safe. Sometimes this means you have to leave those old drinking buddies behind and find new, sober friends. Maybe you’re at the beginning of your journey and wondering who to tell that you’ve made the decision to quit drinking. If you have a trusted friend or relative around, tell them.

Check out some resources

This is to help you find a treatment plan for yourself. There are different avenues you can take as far as treatment in concerned. You may be familiar with AA or the Alcohol Addiction Center. But there are others to help you find local communities such as SAMHSA’s Treatment Finder, the Alcohol Rehab Guide, and SAMHSA’ National Help Line. 

Getting sober is the turning point for so many people who have had alcohol or drug issues. There’s nothing wrong with deciding to quit drinking or using drugs, and everything right about it. It is crucial to make sure you’re setting yourself up for the best result possible and that means getting informed on what you’re dealing with and what path of recovery will help you succeed. 

The post How To Get Sober appeared first on Reach Out Recovery.