Leslie Glass's Blog, page 373
May 1, 2018
Be Very Afraid Of Fentanyl
The U.S. opioid crisis has passed a dubious milestone: Overdose deaths involving synthetic opioids like illicit fentanyl have surpassed deaths involving prescription opioids.
This switch occurred in 2016, according to data published Tuesday in the Journal of the American Medical Assn. And it seemed to happen pretty suddenly.
Data from the National Vital Statistics System show that there were 42,249 opioid-related overdose deaths in 2016. That includes 19,413 that involved synthetic opioids, 17,087 that involved prescription opioids and 15,469 that involved heroin. (In some cases, more than one type of drug was implicated in the death.)
That means synthetic opioids were a factor in 46% of all fatal opioid overdoses in 2016, compared with 40% for prescription opioids.
A bag of fentanyl seized in a drug raid. A new study says illicit fentanyl and other synthetic opioids overtook prescription opioids in 2016 as the most common drug class involved in U.S. overdose deaths. (Cliff Owen / Associated Press)
Just one year earlier, in 2015, 29% of all opioid-related overdose deaths involved a synthetic opioid (9,580 out of 33,091 deaths).
The year before that, in 2014, synthetic opioids played a role in just 19% of all opioid-related overdose deaths (5,544 out of 28,647 deaths).
Between 2010 and 2013, the percentage of fatal opioid overdoses that involved a synthetic opioid held relatively steady, ranging from 11% to 14%.
“We have been very focused on the threat of prescription opioid overdose deaths, and this paper shows us that we need to remain vigilant about the ever shifting nature of the crisis,” said Emily Einstein, a health science policy analyst at the National Institute on Drug Abuse and co-author of the JAMA study.
The drug that appears to be fueling the explosion in synthetic opioids is fentanyl, a narcotic that is “about 100 times more potent that morphine,” according to the Drug Enforcement Administration.
Medical versions of fentanyl have been in use since the 1960s, and about 6.5 million prescriptions for the drug were filled in 2015, the DEA says.
The problem with fentanyl is that it works too well.
“A very small amount of fentanyl can provide the same number of highs” as a larger amount of heroin or other street drugs, Einstein said.
“For an opioid user, it’s a very fast-onset high, and so it’s very rewarding,” she explained. “It’s also incredibly dangerous for the same reason. Its potency causes it to suppress respiration very quickly, and sometimes people will overdose with the needle still in their arm.”
Illicit fentanyl is not only being sold on its own. It’s also being combined with other street drugs, said Dr. Wilson Compton, NIDA’s deputy director and another of the study’s authors.
“We’re seeing fentynl being included in cocaine, we’re seeing it included in methamphetamine, we’re seeing it included in many classes of drugs sold on the street,” Compton said. “This toxic poison is now being seen both in fake pills as well as in the powders that are sold on the street, almost no matter what type of drugs people think they’re getting.”
It’s possible that illicit fentanyl and other synthetic opioids are doing even more damage than these new figures suggest, the researchers wrote in JAMA.
The National Vital Statistics System relies on information that coroners and medical examiners include on death certificates. But in 15% to 25% of fatal overdoses, the death certificate doesn’t specify the type of drug involved.
It’s also possible that synthetic opioids may have played a bigger role in previous years, but medical examiners didn’t see it then because there was less testing for these types of drugs at the time, they said.
Regardless, the new figures make clear that the surge in synthetic opioids “poses substantial risks to individual and public health,” the researchers wrote. “Clinicians, first responders, and lay persons likely to respond to an overdose should be trained on synthetic opioid risks and equipped with multiple doses of naloxone,” a medication that can reverse the effects of an opioid overdose.
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Teens Are American’s Loneliest
America’s next big public health issue may be loneliness, which a new study finds affects most Americans. But the group most at risk isn’t the oldest generation — it’s one of the youngest.
The research, conducted by health insurer Cigna and the market research firm Ipsos, found that young people ages 18 to 22 are the most likely to be lonely. Loneliness is a major threat to Americans’ mental, physical and emotional well-being and can have huge consequences for public health, given the well-researched connections between loneliness and health issues ranging from substance abuse to heart disease.
“The biggest takeaway is that most Americans are considered lonely. This is an alarming statistic,” says Dr. Doug Nemecek, chief medical officer of behavioral health at Cigna. “But more importantly, if everyone who comes into contact with this data can ask themselves what they can do in their communities to affect change, that would be a really meaningful first step.”
In the study, about 20,100 U.S. adults took the UCLA Loneliness Scale, a 20-question survey that asks people how often they agree with prompts such as, “There is no one I can turn to,” and “I feel part of a group of friends.” Loneliness scores are calculated based on those responses. The study authors classified anything above a 43 as loneliness. The average score was 44, suggesting that loneliness is reaching “epidemic levels” in the U.S., according to a release accompanying the report.
Some signs of loneliness were present throughout the study group. Almost half of people said they sometimes or always feel alone or left out, 43% said they sometimes or always feel that their relationships are not meaningful and only 53% said they have meaningful in-person interactions on a daily basis.
Yet certain demographics were worse off than others. Generation Z — adults between the ages of 18 and 22 — were the loneliest generation, with an average loneliness score of 48.3; more than half of respondents of this generation identified with 10 of 11 survey prompts associated with loneliness. And while it would be easy to blame rampant social media use for this effect, the study found that the most digitally active respondents’ loneliness scores weren’t very different from those of their peers, suggesting that other factors may be at play. However, the study didn’t look at what was causing people to feel lonely.
“While we know that this is a group that’s coming of age and making life transitions, these findings give us a very real and striking picture of how this generation perceives themselves,” Nemecek says. “It’s something that we, as a society, need to explore to understand how we can address it.”
Retirees and older generations, meanwhile, were the least likely to be lonely, according to the study. The “Greatest Generation,” or adults older than 72, had an average loneliness score of 38.6, far lower than any other age group. “It appears that this group has found a community of people they can rely on for mental and emotional support when they need it,” Nemecek says.
And while loneliness may be a risk factor for health issues, the report also says the relationship can work both ways — that is, ailing health may also be a predictor of loneliness.
“When a person has a chronic illness or is in poor health, it can limit their ability to get out and interact with others,” Nemecek says. “But also, when someone is lonely, it can impact how they take care of themselves, how they eat, manage their medicines and stay active, which can all lead to worse health outcomes.”
However, good health may also keep loneliness at bay. In addition to common-sense ways to improve your social life — things like staying engaged in your community and prioritizing face-to-face interactions with friends and family — everyday habits such as getting enough sleep, exercising regularly and maintaining work-life balance are associated with lower loneliness scores, according to the study.
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What Is Detachment?
When I first came into recovery, I was bitter and burnt out. I was fed up with my family’s problems and how they didn’t handle them. I heard the word detachment and ran. Today, I keep myself safe from family dysfunction the same way I stay safe on the golf course.
What Is Detachment?
Early in my recovery, my friend Chel explained detachment like this: In golf, it’s crucial to stand far away from the person swinging the club. If I stand too close to my fellow golfer, his club won’t get hurt. In fact, he won’t get hurt. I am the one who is at risk. The same principle applies to addiction and dysfunction. If I am too close emotionally to someone else’s problems, I am more likely to get hurt.
How Far Back Is Far Enough?
How far back I need to stay depends on the magnitude of the crisis. Before I found recovery, I was hyper-focused on curing Ricky of his addiction, and curing my Mom’s addiction to Ricky. Regularly, I pointed out how I thought the way they were handling their problems was 100% wrong. I “kindly” told them the “right” way to solve them. When they forgot my suggestions, I reminded them with great passion and fervor. And can you believe they didn’t want my help? Yet I kept offering and controlling.
When I finally found recovery, I literally moved hundreds of miles away from my mother and my brother Ricky. I fantasized about changing my phone number and never contacting them again. Standing back was the first step to my healing. I’ll never forget the first time I heard the truth:
The only person I can change is me.
How did I enter adulthood without knowing this basic truth about human nature?
Detachment Gave Me Time To Heal
My over-involvement in my Mom and Ricky’s dysfunctional relationship only hurt me, and I needed an extreme relationship makeover. I did end up giving my Mom my phone number, but I quit calling Ricky. I also quit taking all of my Mom’s phone calls.
In the beginning, I texted her back to let her know I was OK but couldn’t talk that day. Then I told her when I would be able to talk. This practice sounds so easy, but it took several weeks and my sponsor’s encouragement to orchestrate. I too was enmeshed in my Mom’s life.
I also quit asking my Mom questions like:
How are you?
How is Ricky?
What’s new?
Superficial questions like these invited my Mom to unload. Next, I stopped the unloading. After a few months of recovery, I was able to tell my Mom that Ricky’s drama was too sad for me. I could no longer discuss his problems.
Finding My Safe Distance In Detachment
Three years later, I’ve healed enough to see Ricky’s addiction for what it really is – a progressive brain disease. My Mom has also been affected by the disease of addiction. Neither of them have taken any steps towards recovery. In fact, they are getting sicker. Last month, Ricky moved back in with my parents.
This family disease often makes me sad. Even though they are all still alive, I’ve lost my brother, nieces, and my Mother to addiction. But thanks to detachment, I can see Ricky as a person with a sickness, and I can love him from afar. Loving my Mom is still a work in progress, but detachment keeps me safer from the wreckage and gives me a chance at loving her without hurt and resentment.
Melody Beattie On WHEN To Detach
My Mom is coming to visit me later this month, which means I must sharpen my detachment skills. To prep for her visit, I dusted off my copy of Codependent No More by Melody Beattie. Because detachment is so important to self-care, Beattie has devoted an entire chapter to this subject. She writes that we should detach WHEN:
“We can’t stop thinking, talking about, or worrying about someone or something;
“Our emotions are churning and boiling;
“We feel like we have to do something about someone because we can’t stand it another minute;
“We’re hanging on by a thread, and it feels like that single thread is frayed; and
“We believe we can no longer live with the problem we’ve been trying to live with.”
In closing, I have found what Beattie says about detaching to be true, “If you can’t detach in love, it is my opinion that it is better to detach in anger rather than to stay attached.” In both golf and dysfunction, we have to stand back far enough to keep from getting hit.
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Loneliness Has Same Effect On Mortality As Smoking 15 Cigarettes A Day
From Jayne O’Donnell and Shari Rudavsky @ USA Today: Young people are far more likely than senior citizens to report being lonely and in poor health, a surprising survey of 20,000 Americans released Tuesday shows.
The overall national loneliness score was alarmingly high at 44 on a 20-to-80 scale, but the prevalence of social isolation among those ages 18 to 22 raises even more concern. The younger people, part of Generation Z, had loneliness scores of about 48 compared with nearly 39 for those 72 and older.
The study was sponsored by the global insurer and health services company Cigna, which is concerned about loneliness as a societal problem but also because it’s not just making us sad: It can literally make us sick.
Loneliness actually has the same effect on mortality as smoking 15 cigarettes a day, which makes it even more dangerous than obesity, says Cigna, citing a 2010 report.
And while the new findings don’t draw any direct links to increased rates of suicide among teens or the opioid epidemic, Cigna CEO David Cordani says it’s clear addressing loneliness will help solve other problems.
“If their sense of health and well-being is more positive, then less destructive activities transpire,” Cordani says.
The market research firm Ipsos posed questions online between Feb. 21 to March 6 to more than 20,000 people 18 and older in the U.S. The questions were based on UCLA’s Loneliness Scale and used to create the Cigna Loneliness Index.
Also surprising: Young people with the highest rates of social media use reported very similar feelings of loneliness to those who barely use it, Still, Cordani says, “meaningful social interaction” was seen as key to reducing isolation so more face-to-face conversations are needed.
While some people may compensate by finding connections on social media, that can provide a false sense of relief, says Jagdish Khubchandani, a health science professor at Ball State University in Muncie, Ind. This type of socialization often leads people to spend time alone on computers in their homes, leading them to gain weight and shun face-to-face interaction, he said.
“I have students who tell me they have 500 ‘friends,’ but when they’re in need, there’s no one,” Khubchandani says.
Isolation is of such concern that young people 16 to 24 who are neither employed nor in school are now tracked and classified as “disconnected youth.” The former surgeon general, physician Vivek Murthy, made emotional well-being and loneliness a focus while he was in office and is now writing a book and setting up an institute focused on the problem.
“Stress from loneliness is an insidious type of stress,” Murthy says.
It creates a biological response, Murthy says, that leads to chronic inflammation, damaged tissue and blood vessels, and an increased risk of heart disease, arthritis and diabetes.
The Robert Wood Johnson Foundation has worked with the non-profit project Measure of America to publicize the problem because disconnection in young people is such a predictor of poor health and early death.
When people are disconnected at 16 or 18, it’s “not a spontaneously occurring event,” says Sarah Burd-Sharps, Measure of America’s co-director. “It’s an accumulation of all the events in teens’ lifetimes, experiences in your family, any trauma you faced.”
There’s considerable research on the 10 traumatic “adverse childhood experiences” (ACEs) that contribute to the poor mental and physical health associated with “disconnected youth” — and what should be done to address them.
More than half of these 18- to 24-year-old members of Gen Z identified with 10 of the 11 feelings associated with loneliness, while more than 90% of people 72 and older reported feeling close to others, having people to turn to and talk to, and feeling “in tune with others.”
Death by isolation?
When police arrived at a home in Hamden, Conn., late last month, Andrew and Maureen Lipko were found dead of natural causes. The Connecticut medical examiner’s office reports the elderly husband and wife both had heart disease, and Maureen also had diabetes.
Neighbors called police after realizing they hadn’t seen anyone come out of the house in weeks. Neighbors, including former New Haven schoolteacher Phyllis Grenet, say that wasn’t unusual for the couple. Andrew Lipko occasionally would leave the home wearing a medical mask in one of his old cars; his wife was almost never seen.
“You can be together and alone,” Murthy says.
Andrew and Maureen Lipko were found dead March 27 of natural causes in their home in Hamden, Conn. Andrew Lipko was the only one seen coming out of the house, and that was rare.
Seniors often report loneliness, especially as they age, step out of the workplace and lose family and friends, said Mary Durell, chief operating officer of CICOA, Indiana’s largest Area Agency on Aging.
Although older people reported being less lonely than the youngest respondents, the Cigna study confirmed earlier studies that showed more than 40% of people over 65 reported being occasionally lonely.
Moving closer to family can actually make matters worse, adds Dana Robinson, CICOA’s director of marketing and communications, as seniors lose social connections beyond the family. Before moving, adult children and their parents should devise a plan for how the seniors will be connected to the community in their new home.
Caregivers of seniors with cognitive impairment often experience loneliness and isolation, whether they are seniors themselves or an adult child caring for a parent with dementia, says Nicole Fowler, a Regenstrief Institute investigator at the Indiana University School of Medicine who studies the caregiver experience.
Spouses in particular may have an enhanced sense of loneliness because their partner is still there but can no longer interact as he or she might have in the past.
“They’re experiencing the loss even before that person is gone, which brings that unique sense of loneliness,” Fowler says.
Cigna is testing the integration of “mental wellness” into medical care at doctors’ offices in Denver, New Jersey and Virginia and plans to expand the pilot to ten office by the end of the year. The program will be offered to patients with chronic conditions such as type 2 diabetes, heart and gastrointestinal disease, depression, eating disorders and substance use disorders.
Other solutions include getting enough — but not too much — sleep, as well as spending just enough time with family, at work and exercising.
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Three Ways Instagram Can Improve Your Well Being
From Lancaster University @ Science Daily: Taking a photo each day and posting it online has complex benefits say researchers who say it supports improved wellbeing.
This is a popular social phenomenon, with Instagram having over 1.5million photos tagged #365 for each day of the year while there are thousands of members of Blipfoto, a key photo-a-day site.
A study co-authored by Dr Liz Brewster of Lancaster University and Dr Andrew Cox of the University of Sheffield recorded what photos people took, what text they added and how they interacted with others on the photo-a-day site for two months.
They found that taking a daily photo improved wellbeing through:
Self-care
Community interaction
The potential for reminiscence
Taking a moment to be mindful, and looking for something different or unusual in the day were seen as positive well-being benefits of the practice.
One participant said: “My job was a very highly stressful role… There were some days when I’d almost not stopped to breathe, you know what I mean… And just the thought: oh wait a moment, no, I’ll stop and take a photograph of this insect sitting on my computer or something. Just taking a moment is very salutary I think.”
It also led to more exercise and gave a sense of purpose, competence and achievement.
Another participant said: “It encourages me out of the house sometimes when I could just sit on my backside with a cup of tea. I’ll think maybe I’ll take a walk down on to the seafront and before I know it I’m two miles along the coast. ”
The online contact helped people to manage loneliness and grief as well as meeting new people with shared interests. Several participants had taken early retirement and found that the contact established via photo-a-day replaced some of the daily office chatter that they missed.
“There’s the banter in the workshop or the office or the place where you work. And perhaps [photo-a-day] offers that… Because I’m having conversations with people that I would perhaps have had in the workplace.
The online interactions created a community based on the photos and accompanying text.
“It could be a rubbish photograph but if somebody commented on it, it made it worthwhile.”
The online text was used to provide personal narratives, reminiscences, and explanations of repeated images.
“I’m ever feeling down or something it’s nice to be able to scroll back and see good memories. You know, the photos I’ve taken will have a positive memory attached to it even if it’s something as simple as I had a really lovely half an hour for lunch sitting outside and was feeling really relaxed.”
The researchers said the practice is “an active process of meaning making, in which a new conceptualisation of wellbeing emerges.”
Story Source:
Materials provided by Lancaster University. Note: Content may be edited for style and length.
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Avocado Smoothie With A Side Of Yoda Wisdom
May the 4th is rapidly approaching. If your response is, “So what?” you probably don’t live with a Star Wars fan. Being the only girl in my house, I found girly things to love about this day like sneaking Yoda green avocados into our food for the day and recovery-like Jedi quotes.
In case you haven’t been affected by the Star Wars franchise, you should know:
People dress up like Star Wars characters.
People also binge watch the movies.
At home, people make Star Wars themed food. I am serving crescent rolls wrapped around hot dogs. It’s a Jar Jar link. I am a hero.
Yoda is a furry green Jedi Master who switches up his sentence structure: Up to speed now you are.
Yoda’s wise messages taught Luke Skywalker how to use his mind to battle the dark side. Sounds a lot like battling addiction to me. Here are my favorites:
“Fear Is The Path To The Dark Side. Fear Leads To Anger. Anger Leads To Hate. Hate To Leads To Suffering.”
I am impacted by the generational sins of AUD (alcohol use disorder, formerly called alcoholism). This disease poisoned my family of origin, distorting our frame of reference. Before I found recovery, I was paralyzed by fear, people-pleasing, and anxiety. I know the power of that dark side.
“In A Dark Place We Find Ourselves, And A Little More Knowledge Lights Our Way.”
In the rooms of recovery, I met people whose happiness didn’t depend on someone else’s addiction, relapse, or sobriety. Learn more new Jedi ways I must.
“You Must Unlearn What You Have Learned.”
Recovery renews my mind, and each new slogan is as cryptic as Yoda’s wisdom. The messages are life changing. I’ll never forget the first time I heard I can only change me.
“You Will Know (The Good From The Bad) When You Are Calm, At Peace. Passive. A Jedi Uses The Force For Knowledge And Defense, Never For Attack.”
I came to recovery looking for peace. My co-dependency tools of controlling and manipulation were rusted and broken. They never led to peace. I’ve replaced those with The Serenity Prayer:
“God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”
At any time, I can ask my Higher Power, who is “The Force” to me, for serenity, courage, and wisdom. Only three tools a Jedi needs.
“Train Yourself To Let Go Of Everything You Fear To Lose.”
When my emotions are in an uproar, fear is the root of the problem. This is a common issue for adult children of alcoholics. Before recovery, I was alone and terrified. Like many others, I found peace in someone bigger than me. My Higher Power restores my sanity. This spiritual side of my recovery, reminds me of Luke Skywalker’s training with Yoda. Luke was blindfolded and had to use his light saber to hit a training droid. This is how I feel when I ask my Higher Power for guidance. Yet works it does.
“Clear Your Mind Must Be, If You Are To Find The Villains Behind This Plot.”
To recover, I must heal my body, mind, and soul. This week, I am using avocados to increase my potassium intake. Potassium is important in healing because it moves nutrients into cells and takes toxins out.
1/2 avocado – it’s Yoda green, high in potassium, healthy fat, and fiber
1 banana – also high in potassium and a good natural sweetener
10 frozen peaches – my favorite – because recovery is all about me, and they are a good source of potassium
20 frozen green grapes – again, Yoda green, naturally sweet, and
1 cup coconut milk – it has magnesium, which may help combat stress (Per Dr. Axe)
Blend all ingredients in a food processor and serve. Surprised I was that my young Jedi loved this. We had them for breakfast while watching The Empire Strikes Back.
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April 30, 2018
Women Addicted To Opioids Turn To Sex Work In West Virginia
From NBC News: There was a time when Beth would have laughed if somebody had told her she would wind up selling herself on the streets. She had loving parents. She had a high school degree. She was 19 and plotting her next move in life. Then her old friend Amber handed her a little green pill.
“It was an Oxy 80,” Beth said, using the slang for an 80-milligram tablet of the opioid painkiller Oxycodone. “She said, ‘C’mon, just try it one time.’”
“If I went back out on the street, I would die,” said one former sex worker and recovering opioid addict.
Five years later, Beth was walking a seedy stretch of Sixth Avenue in Huntington and Amber was watching her back while car after car slowed down to check them out.
“I was a little nervous, scared, but I got a pep talk” from Amber, Beth said as she recounted that first night. “She made it like it was fun. She convinced me there was a freedom in it. She said, ‘You’re making your own money.’”
By that point, Beth said she had already traded sex for drugs with several dealers.
(Beth, as well as Amber’s family, asked that they not be identified by their full names to protect their privacy.)
“I had been used to faking it, wearing a mask to survive,” Beth said. “I would pretend to absolutely adore somebody to get people to take care of me.”
But now she was so desperate for drugs she didn’t care how she got the money. And within minutes, a potential john pulled over.
“It was this guy who was well-known down there for picking up girls,” Beth said. “He slows down, gives me the head nod, makes a turn into the back alley.”
And she went to him.
‘WE STAND TO LOSE A GENERATION’
No place in America has been hit harder by the opioid epidemic than West Virginia. And no place in America was less prepared for the onslaught.
Already grappling with the loss of thousands of coal mining jobs, stagnant growth and an exodus of young people in search of opportunities elsewhere, the Mountain State was a sitting duck when Big Pharma began pumping prescription painkillers into the state.
The House Energy and Commerce Committee is now investigating the pharmaceutical companies and distributors who they say turned West Virginia into the epicenter of the crisis.
Last year, 909 people died in the state’s 55 counties, according to the West Virginia Health Statistics Center. Nationwide, opioids figured in two-thirds of the 63,632 fatal overdoses reported in 2016, according to the federal Centers for Disease Control and Prevention.
Some struggling small cities like Williamson (population 3,200) were swamped with an astounding 6,500 pills per person over a decade, creating a new generation of addicts and further fraying the already torn social fabric.
The epidemic also drove many desperate women, as well as some men, into the street for cash, lawmakers and police said.
“A lot of the addicts are from towns that went bankrupt when the coal industry collapsed,” said Matthew Perry, the Department of Homeland Security’s resident agent in charge, who investigates sex trafficking. “In some places, there just aren’t many other ways to make enough money to support a habit.”
They go from prescription painkillers to heroin to prostitution.
While some women in West Virginia choose sex work, others are victims of sex trafficking, forced into prostitution against their will. Sex trafficking “is a crime of opportunity, and the pivot point for that opportunity is opioid addiction,” said Assistant U.S. Attorney Andrew Cogar.
“Pimps often hold out [the] promise of drugs in return for women engaging in prostitution,” he said. “We think that’s fueling a lot of the demand and supply.”
It’s hard to quantify just how pervasive a problem prostitution driven by opioid addiction is in West Virginia, a conservative state that gave President Donald Trump a landslide victory in 2016 (68 percent, to 26 percent for Hillary Clinton).
The FBI compiles annual crime statistics from law enforcement in all 50 states for its annual Uniform Crime Report. But for reasons that are unclear, West Virginia is one of the few states that do not report crimes that fit in the category of “prostitution/commercialized vice.”
“The State Police does aggregate prostitution arrest data, and I do not understand why it hasn’t been forwarded to the FBI,” Cogar said. “But I do know that data exists. And it’s troubling.”
NBC News has requested those figures from the West Virginia State Police.
Matt Meadows, a probation officer in Huntington, said he sees the steady stream of prostitution arrest reports and there is a sad refrain running through them.
“They go from prescription painkillers to heroin to prostitution,” he said. “It’s very common.”
The West Virginia Human Trafficking Task Force, which includes social workers and concerned lawmakers, is trying to figure out how big the problem has become. The group aims to raise awareness about sex trafficking and fight it by developing a network of service providers, victim advocates, agencies and religious organizations to support trafficking victims — and their children, who are straining the state’s foster care system.
“I don’t want to lose any women to human trafficking at all, but we stand to lose a generation if we don’t act more forcefully,” warned Barbara Fleischauer, a member of the West Virginia House of Delegates who sits on the task force.
Amber’s dad told NBC News he fears it may be too late for his daughter.
“I wish she would go to prison because then I’d know she was alive,” he said. “I know she’s having to be hooking and you hate that for your kid. But what can you do but cry and pray every night, and that doesn’t seem to be working.”
‘I HAD A SWEET INNOCENT FACE’
Now 28, Beth said she didn’t drink or smoke marijuana in high school. She was already living on her own and working as a waitress when she first crossed that line.
(Beth, like other sex workers quoted in this article, is being identified by an alias. Her story has been corroborated by the local police, newspaper accounts and interviews with her social workers.)
“I had stopped being friends with people because they were using that stuff, I was that good,” Beth said. “Then a friend I hadn’t seen since high school called me and needed a place to stay. She was really sick.”
That friend was Amber. And she was sick because she was trying to get off drugs.
“So I gave her a place to stay,” Beth said. “When she got better, she said she wanted to do it one last time before she quit forever and asked if I would be interested. I said sure.”
Years later, Beth said she doesn’t know why she agreed, why she let her defenses down.
“I tried it with her and it just took off from there,” she said. “My mom’s an alcoholic in recovery and my dad may have smoked weed back when he was a teenager. But nobody in my family had been involved in drugs.”
One Oxy 80 became another, then another and another.
“In my mind it helped me work better,” she said. “I had more energy. I felt more social. There was no hangover.”
But already her world was starting to tilt.
Beth had to kick Amber out because she stole. “But I had gotten involved with her people,” Beth said. “I had an apartment, I had a car, and they jumped on that.”
Before long, Beth was driving dealers around and getting a cut of the money and drugs.
“They used me as the face of their operation,” she said. “I had a sweet innocent face and had never been in trouble before.”
Things were going so well that she didn’t worry when the restaurant fired her for failing to show up for shifts.
“Then I met this older guy who used to take people down to Florida to the pill mills,” she said. “They asked if I wanted to drive and they would pay for the gas and the food and I would get drugs. It was 14 hours down and 14 hours back.”
After a couple of trips, Beth decided “to get clean” — the first of some two dozen attempts to get off drugs.
“I wound up getting on suboxone for 10 months,” she said, referring to an anti-opioid dependency drug. “I found a good job. Then I used one time and I lost my job.”
That was in 2011.
“The pills were so expensive and heroin is so huge in Huntington, so I started doing that,” she said. “I got to the point that I would sleep with the dealers for drugs.”
I had given up on myself. I’d given up on the idea of having a normal life.
For the next three years, Beth said she was in and out of rehab. She lived with her mother for a time and then moved to Virginia to live with her grandmother.
“I started using again and wound up stealing from my grandmother,” she said. “I ran for a couple weeks before they caught me and I went to jail.”
When she got out, Beth said she tried to go home.
“I wound up back in Huntington with the first girl I used with,” she said. That was Amber.
‘ONE FOOT IN PRISON’
Women with stories like Beth’s often end up in Cabell County drug court, which is presided over by Circuit Court Judge Gregory L. Howard in an annex across the street from the imposing county building in Huntington.
Howard takes what the probation officers call a “carrot-and-stick” approach with this especially vulnerable population.
The carrots are modest — colorful rubber wristbands and $10 gift certificates from Subway and Pizza Hut. And when the judge does apply punishment, he generally does so after first consulting the social workers who are trying to help these women get back on track.
There was no carrot for Nicole, the first woman who went before the judge at a recent hearing.
Her transgression? She missed a drug screening to make sure she was not using.
“I’m sorry, I overslept,” she said.
Howard, who has heard this excuse many times, shook his head. He upped the number of spot drug screenings Nicole is required to do from two to four times a week. And he ordered her to retake a six-week drug awareness course that meets on Saturdays.
“Do I have to do the course?” a visibly unhappy Nicole asked. “I have kids.”
“That’s why you can’t miss screenings,” the judge replied, his voice even.
Nicole made a face.
“I guess,” she said, slumping in her chair. “I will do it.”
“It’s not really optional,” Howard said.
Nicole already knew that.
“The bulk of the people we deal with already have one foot in prison,” probation officer Lauren Dodrill said. “They are mostly great people, but they have a drug problem.”
More than 1,300 adults and nearly 300 juveniles statewide in 2016 and 2017 have appeared in drug courts like the one Howard presides over, according to the state Supreme Court of Appeals.
To avoid incarceration, many agree to take part in state-approved alternatives like the Women’s Empowerment and Addiction Recovery program, which is based in Huntington and specially designed to help women break the cycle of drug dependency and, in many cases, escape the streets.
“Not using drugs is actually the easy part,” Dodrill said. “Changing behaviors, habits, that’s the hard part.”
Meadows, the Huntington probation officer, said the women they monitor “are not the stereotypical prostitute.”
“They have done things they are not proud of just to buy dope,” he said. “There is a lot of shame. But here they have a chance to reclaim their lives — they’re treated with a bit of dignity.”
And yet, barely half make it through the program, which typically takes a little over a year, he said.
That is why — ahead of the court hearing — Howard met with the probation officers and social workers to review the cases.
For someone like Nicole, who had been doing well, the decision was made to sanction her in a way that wouldn’t be so harsh as to potentially derail her recovery — but was strong enough to reinforce the message that missing drug screenings is not acceptable.
Nicole was followed by several women who were in court to collect carrots.
“You are doing better than we thought you would,” Howard told a beaming woman named Linda and invited her to come up and take one of the gift cards arrayed before him — her reward for making it past one of the major mileposts on her road to recovery. “I’m proud of you.”
“Oh, thank you,” Linda replied as the courtroom erupted in applause. “My kids love pizza.”
There were more kudos from the judge and cheers for several other women who collected wristbands and gift cards, including a young woman, Carly, who informed the judge she had just landed a job at a McDonald’s. “They just took my sizes for my uniform,” she said.
All Carly needed now were shoes with nonslip soles. But rather than give her money — and perhaps endanger a person still wrestling with temptation — activist Necia Freeman volunteered to find a pair for her.
Because that is what Freeman does.
For half a dozen years, Freeman has been running a ministry through the Lewis Memorial Baptist Church called Brown Bag and Backpacks that provides sex workers with meals, a Gospel tract and a number they can call when they are ready to leave the life.
“The girls love Vienna sausages and Capri Sun drinks,” she said, adding that many of them rarely eat more than once a day. “We give them a pack of Pop-Tarts and soft snacks like yogurt because a lot of them have dental issues. And we give them spoons because we saw them trying to scoop yogurt out of the containers with their fingers.”
HITTING ROCK BOTTOM
All the johns became a blur as Beth worked the streets. All she could think about was getting high.
“I had given up on myself,” she recalled. “I’d given up on the idea of having a normal life, of having a marriage, children, the white picket fence. Any ambition like that was just gone.”
All she wanted, needed, was another fix.
“You literally live from moment to moment,” she said. “You don’t want to be sober because that’s when reality sets in.”
Beth said she did things she would never have dreamed of doing sober, like trying to rob a CVS in September 2015 with a note that said she had a gun.
“I wound up doing some time for that,” she said. “I got clean in jail, got out, came back, and relapsed.”
When the drug dealers she relied on most began getting arrested, Beth said she took a friend’s advice and decamped for Lynchburg, Virginia. There she posted an online ad for men “looking for a ‘date’ and within five minutes there were five guys hitting me up.”
One encounter went really bad.
“There was a guy I met up with at a motel and we did some stuff and I passed out,” she said. “I woke up 45 minutes later and he had taken me to some trailer out in the country. He took my phone and chained me up. I had to drug him to get the chains off and get away.
Beth said she didn’t dare report this to police. But it rattled her and she moved on to Roanoke, Virginia, where she tried again to get straight.
“I had dried out after an eight-month run,” she said. “I called my mom and told her I wanted to come home for Christmas.”
Warily, her mother agreed. Soon, Beth was on a Greyhound Bus home to West Virginia. Once there, she ran into an old friend who she “used to use with” who told her about a place for women like her in Charleston called Recovery Point.
“I looked at my mom and said this was the kind of place I need,” Beth said. “So I called, packed my bag, and have been here ever since
That was 14 months ago.
PATH TO SOBRIETY
Recovery Point is a 92-bed long-term facility for women in Charleston that is supported by federal grants, donations and fundraising drives. It is in a low, gray industrial-style building, and many of the patients have walked in Beth’s shoes.
It is also a stone’s throw from some of the seediest streets in the West Virginia capital. And every time Marie, a social worker at the center, drives by and sees “the girls” working the street, her heart breaks a little.
“I did it for six years,” said Marie, who is from a nearby state and was a college student when she came down with lupus and got hooked on the painkillers prescribed by her doctor.
Within weeks, Marie said, she graduated to heroin and soon started doing sex work to support her habit.
“You’ll do anything for the next high,” she said. “You’ll meet somebody who will act like some kind of Prince Charming, and they wind up selling you.”
Several stints in jail convinced her she needed to make a change.
“The last time I got paroled, it was to a long-term treatment program in Kentucky,” she said. “I was ready. I wanted a different life. I knew if I went back out on the street, I would die.
Marie, who is 27 and asked not to be identified by her full name, got sober, finished school and landed a job at Recovery Point.
As a phase coordinator, she helps recovering women transition from one phase of treatment to the next. Women start with the detox program, which takes three to seven days and introduces them to the Twelve Steps, the philosophy pioneered by Alcoholics Anonymous.
If they make it through the grueling first few days, they are assigned a bunk and a shelf for their belongings. They are required to attend daily drug awareness classes. And they are assigned a “72 hour buddy,” the first of several peers who help them adjust and get back on their feet.
Needless to say, no drugs or alcohol are allowed. Residents are also barred from using cellphones or driving cars. They must refrain from violence, making racial threats and having sex.
If they break any of those rules, they’re out.
“All of our girls, they do all the cooking, cleaning, yard work, maintenance,” Marie said. “They learn all those life skills while they are here.”
As they move up from one phase to the next, they are given more freedom — and more responsibility.
They are required to find jobs on the outside, but they have a strict curfew. In time, they are allowed to spend some nights away until they are ready to live on their own again.
At that point, some get tapped to be mentors for the newbies.
Marie said it takes from nine to 14 months for most patients to graduate, although some like Beth take longer.
Since the program started two-plus years ago, 18 women have completed it, and 16 of them are still sober, Marie said.
Eleven of the graduates are still at Recovery Point, working as staffers, she said. And they are now building an apartment building behind the facility “where the girls can live.”
But many women don’t make it. And many arrive with a mindset forged by years on the street that everybody can be conned
“They learn really quick that they can’t pull that stuff with me,” Marie said. “I know when they’re lying.”
‘I JUST WANT TO BE HAPPY’
Beth’s days now begin at 6:30 a.m., when she wakes up in a dorm room crowded with bunk beds that she shares with 44 other women.
The rest of the day is structured around chores and meetings where the women sit in a circle and smoke cigarettes and share their stories and draw support from one another.
At 10:15 p.m., it’s lights out. And another day of sobriety is in the books.
I don’t want other people to go through what I went through.
I don’t want other people to go through what I went through.
Beth is close to completing Phase 1 of her recovery and preparing for the next phase, which will require her to get a job outside the protective cocoon she has been living in.
“The last time I held a job was back in 2012,” she said.
Beth said she has some short-term goals, like the 10th high school reunion this summer that she is thinking about attending. She also has a court date coming up for the attempted CVS robbery where she hopes the judge will take her rehab into consideration and expunge the arrest from her record.
Long term? “I just want to go back to school — I am a super nerd,” she said, adding that she doesn’t know what she would study, but that she finds the idea of being back in a classroom is comforting.
What she doesn’t see in her future right now is a man.
“I don’t crave a husband anymore,” she said. “I just want to be happy. I don’t want other people to go through what I went through. I don’t want people to feel like they can never be loved.”
But the past is always present for a recovering drug addict.
Last fall, Beth said she was doing her chores and found herself staring at an all-too-familiar face: Amber.
“We caught up some,” Beth said. “She told me this time she was going to get sober. She lasted three days and she was gone.”
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April 29, 2018
Labeling Alcoholic Drinks As Lower In Strength Could Encourage People To Drink More
From Science Daily:
Wines and beers labelled as lower in alcohol strength may increase the total amount of alcoholic drink consumed, according to a study published in the journal Health Psychology. The study was carried out by the Behaviour and Health Research Unit at the University of Cambridge in collaboration with the Centre for Addictive Behaviours Research at London South Bank University.
Alcohol is the fifth leading cause of disease and premature death both in the UK and globally. Reducing consumption of alcohol is a public health priority in many countries. In the UK, as part of a range of steps to reduce overall alcohol consumption, policymakers are currently interested in allowing industry to label a wider range of alcohol products as lower in alcohol.
Proposed legislative changes include extending the variety of terms that could be used to denote lower alcohol content, and extending the strength limit to include products lower than the current average on the market (12.9% ABV for wine and 4.2% ABV for beer*).
“For lower strength alcohol products to reduce consumption, consumers will need to select them in place of equal volumes of higher strength products,” says Dr Milica Vasiljevic from the University of Cambridge. “But what if the lower strength products enable people to feel they can consume more?”
In this study, two-hundred and sixty-four weekly wine and beer drinkers — sampled from a representative panel of the general population of England — were randomised to one of three groups to taste test drinks in a laboratory designed to mimic a bar environment. The drinks varied only in the label displayed. In one group participants taste-tested drinks labelled ‘Super Low’ and ‘4%ABV’ for wine or ‘1%ABV’ for beer. In another group the drinks were labelled ‘Low’ and ‘8%ABV’ for wine or ‘3%ABV’ for beer. In the final group participants taste-tested drinks labelled with no verbal descriptors of strength, but displaying the average strength on the market — wine (‘12.9%ABV’) or beer (‘4.2%ABV’).
The results showed the total amount of drink consumed increased as the label on the drink denoted successively lower alcohol strength. The mean consumption of drinks labelled ‘Super Low’ was 214ml, compared with 177ml for regular (unlabelled) drinks. Individual differences in drinking patterns and socio-demographic indicators did not affect these results.
“Labelling lower strength alcohol may sound like a good idea if it encourages people to switch drinks, but our study suggests it may paradoxically encourage people to drink more,” says Professor Theresa Marteau, senior author and Director of the Behaviour and Health Research Unit.
While this study shows that people may drink more if drinks are labelled as lower in strength, the researchers do not yet know if this effect is sufficient to result in the consumption of more units of alcohol overall from lower strength alcohol drinks. Furthermore, participants in this study were tested in a bar-laboratory setting. To learn more about the impact of lower strength alcohol labelling, research in real-world settings is needed.
The study was funded by the Department of Health.
*ABV denotes alcohol by volume, the standard measure of how much alcohol is contained in a given volume of an alcoholic drink.
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New FDA-Approved Diabetes And Obesity Drugs Could Help Prevent Addiction
From Science Daily:
Cocaine and other drugs of abuse hijack the natural reward circuits in the brain. In part, that’s why it’s so hard to quit using these substances. Moreover, relapse rates hover between 40 and 60 percent, similar to rates for other chronic conditions like hypertension and Type 1 diabetes. University of Pennsylvania behavioral pharmacologist and neuroscientist Heath Schmidt studies how long-term exposure to drugs such as cocaine, nicotine, and prescription opioids affects the brain and how these changes promote relapse in someone who has kicked the habit. A recent paper, published in the Nature journal Neuropsychopharmacology, investigated a novel treatment for cocaine addiction, something that touches 900,000 people in the United States annually.
“As a basic scientist I’m interested in how the brain functions during periods of abstinence from cocaine and other drugs and how neuro-adaptations in the brain promote relapse back to chronic drug taking,” he explains. “From the clinicians’ perspective, they’re looking for medications to try to prevent relapse. Our goal as basic scientists is to use animal models of relapse to identify novel medications to treat cocaine addiction.”
Schmidt and colleagues from Penn Nursing and Penn Medicine had hypothesized that the neural mechanisms and neural circuits in the brain that play a role in food-seeking might overlap with those key to drug-taking. Through several experiments, they discovered that drugs that activate receptors for glucagon-like peptide 1 (GLP-1), a hormone that reduces food intake and blood glucose levels, could actually decrease the desire to seek out cocaine. What’s more, there are several FDA-approved medications used to treat diabetes and obesity that already target GLP-1 receptors.
“One of the first questions we had — and we were really just kind of curious — was, does cocaine at all affect circulating levels of metabolic factors like leptin, insulin, GLP-1 that have been shown to regulate food intake?” says Schmidt, whose primary appointment is in Penn’s School of Nursing.
The research team got its answer from a simple experiment with a rat animal model: Blood drawn after 21 days of cocaine intake revealed decreased levels of the GLP-1 hormone. Though the primary cells that synthesize and release this hormone are found in the small intestine, there’s also a source in the brain called the nucleus tractussolitarius.
“Knowing all of this got us interested in GLP-1,” Schmidt says. “Does it actually play a role in modulating cocaine-mediated behaviors?”
From there, the research team homed in on GLP-1 receptors and the drugs that activate them, what are known as receptor agonists. To test the efficacy of the medications in question, Schmidt and colleagues used an animal model of relapse with rats. For a three-week period, the rats could press a lever for intravenous infusions of cocaine as frequently as they desired. On average, the animals self-administered 28 infusions of cocaine each day.
The scientists then swapped out the cocaine for saline, leading to a period of withdrawal. Lever-pressing rates dropped significantly.
“At that point, we considered drug-taking to be extinguished,” Schmidt says. “We then reinstated drug-seeking by re-exposing the rats to the drug itself or to cues paired with the drug during the self-administration phase, like a light that comes on when the lever gets pressed.”
Once again rats depressed the lever at high rates, an indication that they were seeking the drug — akin to relapse in a human who is addicted.
The researchers next pretreated the animals with one of the FDA-approved drugs intended for diabetes and obesity treatment, Exendin-4, to determine whether it might reduce or altogether block cocaine-seeking. Results showed a significant decrease in drug-craving and -seeking, both after an acute injection of cocaine and from re-exposure to environmental cues during withdrawal.
“This tells us Exendin-4 can block the effects of cocaine itself but also condition stimuli previously paired with cocaine,” Schmidt notes. “This was really exciting because it’s the first demonstration that the GLP-1 system, and the drugs that target this system, could potentially play an important role in cocaine seeking and relapse. The other really interesting aspect of these studies are the doses.”
GLP-1 receptor agonists are known to cause nausea and vomiting at pretty high rates in diabetic and obese patients who use them, so Schmidt and colleagues wanted to ensure that the reason for a decrease in cocaine-seeking wasn’t from animals being sick. They identified doses that both reduced cocaine-seeking and did not produce adverse effects. A follow-up experiment that infused the GLP-1 agonist directly into the brain replicated the findings. Taken together, these findings indicate that low doses of a GLP-1 receptor agonist can selectively reduce cocaine-seeking without causing nausea.
As a final step, the researchers isolated the brain pathway able to boost GLP-1 signaling, by using a fluorescent dye to track where the drugs actually went in the body after they were administered.
“We’ve shown for the first time that central GLP-1 signaling plays an important role in cocaine-seeking,” Schmidt explains. “We’ve identified systematic and intra-cranial doses of GLP-1 receptor agonists that reduce cocaine-seeking and don’t produce adverse effects, and we think that if you increase GLP-1 signaling in the brain in general, you can reduce cocaine-seeking in rats and, potentially, craving-induced relapse in humans.” To begin testing this, Schmidt’s team is collaborating with researchers at Yale University to screen the efficacy of these drugs in a population of humans addicted to cocaine.
Beyond that, Schmidt says he’s hopeful these results have potential for drugs of abuse beyond cocaine, too. However, he adds, much more research is needed before this can be stated conclusively. “There is a lot we don’t know about the GLP-1 system in the brain,” he says. “What is the exact circuitry in the brain? Is this signaling the same as what mediates food intake or is it slightly different? Does cocaine change it in any way? We’re working on that.”
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April 27, 2018
One In Six Deaths In Young Adults Is Opioid-Related
From Science Daily:
One out of every six deaths among young adults in Ontario is related to opioids, suggests a study led by researchers at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES). The study, published today in the Journal of Addiction Medicine, found that the rate of opioid-related deaths nearly tripled in Ontario from 2000 to 2015, with one in every 133 deaths in Ontario related to opioid use by 2015. However, this number varied importantly by age group. The study expands on earlier research from Dr. Tara Gomes, which showed that one in 170 deaths in Ontario was related to opioid use in 2010.
Rate Of Opioid-Related Deaths In Ontario Has Tripled In Past 15 Years.
“It is striking to see that despite the efforts put into harm reduction, proper prescribing practices, and education around opioid use, the number of opioid-related deaths continues to rise,” said Dr. Gomes, a scientist in the Li Ka Shing Knowledge Institute of St. Michael’s. “The other alarming fact is how this crisis is increasingly impacting our youth and young adults.”
Researchers reviewed all deaths in Ontario where prescribed or illicit opioids were determined to be a contributing factor between 2000 and 2015. In the last five years examined in this study (2010 to 2015), the most dramatic increase in opioid-related deaths occurred among those aged 15 to 24 years. By 2015, more than 1 in 9 deaths in this age group were opioid-related — up from 1 in 15 deaths five years earlier.
Dr. Gomes, who is also an ICES scientist, and her team found that a total of 29,410 years of potential life were lost prematurely due to opioid-related causes in 2015, which exceeds the years of life lost prematurely annually from diseases such as pneumonia, HIV/AIDS and influenza in the most recent data available.
“These shifting patterns show us that we have to better understand the dynamics of drug use in younger populations who are succumbing to opioid-related deaths,” Dr. Gomes said. “We can only truly understand this by talking directly to affected communities to learn what they need to create a safer environment in which to live.
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