Emergency Departments Can Help Prevent Opioid Overdoses

From the Blog of Dr. Nora Volkow
Executive Director, National Institute on Drug Abuse

Additional Writings by Steven Barto, B.S., Psych.

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Originally Posted at the NIDA Website on August 26, 2019

One of the biggest risk factors for overdose death from opioids is having had a previous overdose. Common sense and a growing body of research suggest that patients with Opioid Use Disorder who receive acute care in an emergency department will be at reduced risk for later overdose if they are initiated on medications to treat their Opioid Use Disorder. Unfortunately, too few Emergency Departments are making this a standard practice, and lives are being lost as a result.

According to a new report published by the Delaware Drug Overdose Fatality Review Commission, half of the people in the state of Delaware who died of an overdose in the second half of 2018 had suffered a previous nonfatal overdose, and more than half (52%) of the overdose deaths occurred within three months of a visit to the emergency room. Even when visits were not for overdose, signs of Opioid Use Disorder were apparent during the visit in most cases. The report thus recommended that patients who visit emergency rooms with obvious signs of Opioid Use Disorder should be immediately referred to rehabilitation treatment. Optimally, the initiation of medication for Opioid Use Disorder should be started before patients are discharged. This will improve their clinical outcomes.

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Even without a waiver, Emergency Department providers are permitted to administer Subcutex (buprenorphine) or methadone a limited number of times to patients under their care. In fact, several studies have now shown the benefit of initiating Subcutex in the Emergency Department rather than just referring the patient to drug treatment—it is called an “emergency” department for a reason! A recent NIDA-funded study by Yale researchers published in JAMA in 2015 showed that Subcutex treatment initiated by Emergency Department physicians was associated with decreased opioid use and improved treatment engagement in the 30-day period following discharge.

There is significant evidence that medications for Opioid Use Disorder prevent overdoses. For example, a prospective cohort study of 17,568 opioid overdose survivors in Massachusetts published last year in Annals of Internal Medicine found significant reductions in the risk of subsequent overdoses over the next 12 months in those who received treatment with methadone or Subcutex. Yet, only 30 percent of those who had overdosed received medication for Opioid Use Disorder. This statistic is extremely alarming, because the sample of patients was clearly at high risk for overdosing.

Bottles of Opiate Prescriptions

More alarmingly, 34 percent of those who had been treated for overdose received additional opioid pain prescriptions during the subsequent 12 months, despite their overdose history, and 26 percent received benzodiazepines, which as respiratory depressants further increase risk of overdose in those who misuse opioid drugs or who are being treated with high doses of opioid medications for pain management. [From my personal experience, benzodiazepines were hightly addictive and I tended to abuse them along with oxycodone. Family members noted my complete lack of sadness or empathy during my father’s funeral in December 2014. I stared at the floor and did not shed a tear. This is solely based on the fact that I was high on oxycodone and benzodiazepines at that time.]

It is crucial that acute care physicians, and the health care systems in which they practice, become aware of the importance of ensuring that patients be screened for Opioid Use Disorder and, if same is detected, that they receive treatment, ideally by initiating them on Subcutex before they are released.  Additionally, patients who visit an Emergency Department because of an overdose, or who otherwise show signs of Opioid Use Disorder, should be sent home with Narcan (naloxone)  and given instructions on how to use it to reverse an opioid-induced overdose. This was another recommendation of the Delaware report.

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Four out of five fatal overdoses reviewed by the Delaware state commission occurred in a private residence were Narcan was unavailable in nearly 93% of the cases. Abundant research has shown the life-saving benefits of distributing Narcan not only to people who are addicted to opioids or misusing them but also to pain patients being treated with high doses of opioid medications and their families and friends. After all, patients taking opiates for severe chronic pain are at risk of becoming dependent on the narcotic, and could suffer an accidental opiate overdose. It is simply a matter of brain neurochemistry that has no true moral component, and can impact patients of any socioeconomic class.

Making Emergency Department physicians more responsive to the opioid epidemic often means educating colleagues and changing hospital culture. Many emergency physicians do not feel adequately prepared to treat with Subcutex—there are real or perceived logistical impediments like obtaining prior authorization from insurers. Emergency physicians should be encouraged to complete the training necessary to get a waiver to prescribe Subcutext, which greatly enhances their confidence and ability to respond to patients with Opioid Use Disorder.

The NIDA-MED website includes firsthand stories from physicians implementing emergency department overdose treatment with buphrenorphine and prescribed Suboxone to patients suffering from Opioid Use Disorder. Gail D’Onofrio, the lead researcher of the 2015 JAMA study, translated the study findings into practical videos for Emergency Room clinicians now posted on NIDA-MED. NIDA has also developed a companion, comprehensive set of resources to help emergency physicians initiate buprenorphine. In fact, initiating buprenorphine treatment in the emergency room includes step-by-step guidance on buprenorphine treatment, discharge instructions, instructional videos for clinicians on interacting with Opioid Use Disorder patients, and other useful materials.

[PLEASE NOTE: I have added the following sections to Dr. Volkow’s blog post.

Let’s Take a Look at Opioid Use Disorder

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The American Psychiatric Association¹ included a comprehensive explanation of Opioid Use Disorder in their Diagnostic and Statistical Manual of Mental Disorders, Fifth Ed. (DSM-5), beginning at page 541. Essentially, Opioid Use Disorder (OUD) is a problematic pattern of opioid use leading to clinically-significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. Opioids are often taken in larger amounts or over a longer period than was intended [by the prescribing physician].
  2. There is a persistent desire or unsuccessful effort to cut down or control opioid use.
  3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
  4. Craving or a strong desire or urge to use opioids.
  5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
  7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
  8. Recurrent opioid use in situations in which it is physically hazardous.
  9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of opioids to achieve intoxication or desired effect; (b) a markedly diminished effect with continued use of the same amount of an opioid. NOTE: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.
  11. Withdrawal, as manifested by either of the following: (a) the characteristic opioid withdrawal syndrome (refer to Criteria A and B of the criteria set for opioid withdraw in the DMS-5, p. 547-548; (b) opioids (or a closely-related substance) are taken to relieve or avoid withdrawal symptoms. NOTE: This criterion is not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

Healthcare is not yet doing enough to avail itself of an effective referral system in the opioid crisis: using visits to emergency rooms to get patients with Opioid Use Disrder on medication and provide them with Naloxone. Intervening in these simple ways would greatly help reduce the shocking numbers of deaths from opioids in this country.

Are You Struggling?

I was obsessed with alcohol and drugs for nearly four decades of my life, which caused horrific and lasting consequences. I ended up serving three years in a state prison around the time I turned 20 years old. My history of using had started in early summer of 1977 shortly after graduating high school. I enjoyed the escape these mind-altering (numbing?) substances provided. Admittedly, it was quite fun at first. Within months, I became dependent on drugs and alcohol in order to function and to feel any degree of release from the demons of my past and the obsessive thoughts in my brain. I couldn’t laugh, relax, enjoy sex or food, or sleep unless I first got high or drunk. Sadly, I struggled with active addiction from shortly after my 18th birthday in 1977 to June 8, 2019.

I had started smoking cannabis and popping oxycodone pills during early Spring of 2018 in an attempt to self-medicate my depression, anxiety, and severe back pain secondary to a construction-related injury several years ago. Looking at the above description of Opioid Use Disorder established by the DSM-5, when in active opiate addiction I exhibit ten out of eleven of the criteria needed for a definitive diagnosis! I am sixty years old now, and I am finally looking at who I am in Christ. I am clean from opiates and cannabis for nearly 120 days, and I no longer dwell on the decades of constant failure. I should mention that I nearly took my own life several times during  my long history of active addiction. My struggle with opiates is fairly recent, and has taken me to places that I did not wish to go. Thankfully, I am confronting this issue with confidence in the power of the Name of Jesus and my unmitigated committment to change, never to be the same.

I work extensively today with a drug and alcohol counselor who is a believer in Christ. The ability to focus on Christ in therapy sessions provides an opportunity to examine the “spiritual malady” of addiction. I am constantly in contact with several elders at my home church who have become mentors. I am “coachable” today. I have started speaking regularly with Duche Bradley on the phone. He has a nationwide ministry of speaking in prisons and high schools about addiction and who we are in Christ Jesus. You can hear his “white chair” testimony here. He has led me through renouncing pharmacia and all nature of flesh-bound habits and addictions, and has encouraged my growth in Christ in order to move forward with my own ministry. Duche said to me, “Brother, if you do these things, you will be blown away about the many permanent changes in your character and your life.”

Nowadays, after having submited to Jesus Christ as my “higher power”—indeed, as my Savior and my Lord and Teacher—the obsession to use chemicals is gone. Likewise, the physical compulsion or craving has been defeated. I could never accomplish this under my own power. The Big Book of Alcoholics Anonymous tells us that alcohol is cunning, baffling, and powerful! No human power can relieve our alcoholism, but God can and will if we seek Him. The same applies to drug addiction. After all, a drug is a drug whether you drink it, snort it, or shoot it into your veins.

It is only through admitting my weaknesses and deciding to work with those who have risen above the evil and failure in their lives that I can get on with my life: studying theology on the master’s degree level, teaching weekly Bible study lessons at a local homeless shelter, and reaching out to newcomers at 12-Step meetings that are presently on a rapid decent into the living hell of active addiction. By accepting God’s “call” on my life, I can move toward a ministry of evangelism, applied apologetics, and lecturing, writing about, and teaching about Christianity and the release we all can have through Jesus. This is my life (as it was always meant to be), and I am happy to finally get on with living it!

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Given the near impossibility of quitting a mind-altering substance on your own, I highly suggest you reach out to someone who’s been there. Check your local government phone number pages in the phone book or, better, yet, do a Google search for A.A. or N.A. If, however, you are in the middle of a psychological or physical life-threatening crisis secondary to substance abuse, Please Call 911.

With suicides on the rise, the federal government wants to make the National Crisis Hotline easier and quicker to use. A proposed three-digit number — 988 — could replace the National Suicide Prevention Lifeline, 1-800-273-TALK (8255). The FCC presented the idea to Congress in a report earlier this month and is expected to release more information and seek public comment about the proposal in the coming months. PLEASE REMEMBER: You are not alone.

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¹ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth ed. (DSM-5). Arlington, VA: American Psychiatric Publishing (2013), pp. 547-548.

Overcoming Temptation (The Jesus Way)

“Let no one say when he is tempted, ‘I am tempted by God;’ for God cannot be tempted with evil and he himself tempts no one; but each person is tempted when he is lured and enticed by his own desire. Then desire when it has conceived gives birth to sin; and sin when it is full-grown brings forth death” (James 1:13-15, RSV).

By Steven Barto, B.S. Psych.

PERHAPS YOU’VE HEARD IT SAID “sow a thought, reap an action; sow an action, reap a habit; sow a habit, reap a character; sow a character, reap a destiny.” There is a basic concept at work here which involves obsession and compulsion. Watchman Nee (1903-1972) was a Christian leader and teacher who worked in China during the 20th century, helping to establish numerous churches in that region of the world. Nee wrote, “It is a pitiful and tragic thing to be obsessed. Those who are obsessed are in a very abnormal condition.” He said obsession encompasses lying and deception. The obsessed Christian lies to himself, pretending there is no problem with his behavior. This self-deception becomes thick like fog, making it nearly impossible to see beyond obsessive thought and habitual action.

What is Obsession?

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I have been prone to obsessions throughout my life. Psychology teaches us that obsessions are “recurring thoughts, urges, or images that are experienced as intrusive and unwanted and, for most people, cause anxiety or distress. The individual tries to ignore them, suppress them, or neutralize them with a different thought or action.” The specific details of obsessions can vary widely. For example, they might include thoughts about contamination, a desire for order, taboo thoughts related to sex or religion, or a compulsion to harm oneself or others. Obsessions can revolve around activities that provide pleasure or escape, especially relative to alcohol, drugs, gambling, shopping, watching pornography, or eating.

At this stage, the brain is typically focused on the so-called benefits of a particular action or habit rather than the negative consequences. One hallmark of an obsession involves what some addictions counselors refer to as euphoric recall. At first blush, this might sound “warm and fuzzy.” Relative to substance abuse, however, this is associated with remembering past drinking and drugging experiences in a positive light, while overlooking negative experiences associated with it. I heard someone at a 12-step meeting say, “Play the tape all the way through.” Huh? He expounded: “Look past the high and the fun and the escape, seeing the eventual consequences of taking that first drink or drug.” In other words, remember the ugly results. 

What is Compulsion?

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Compulsions are “repetitive behaviors or mental acts that one feels compelled to do in response to an obsession or based on strict rules.” Typically, such behaviors are meant to counter anxiety or distress or to prevent a feared event or situation, but they are not realistically connected to these outcomes, or they are excessive. Although rare, obsessive thoughts and compulsive actions can lead to Obsessive-Compulsive Disorder (OCD), as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). A person suffering from OCD is often plagued by obsessions or compulsions that take up more than one hour a day or cause clinically significant distress or impairment for the individual. In order for this diagnosis to stand, all other potential disorders involving similar symptoms must be ruled out. Psychiatrists and psychologists call this procedure differential diagnosis.

The Book of James

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James 1:13-15 explains the process of obsessive thoughts in the believer that lead to temptation and sin. The apostle gives us a few key points to think about.  We must remember that James said when we’re tempted, not if we’re tempted. It is inevitable that we’ll be coaxed or seduced (essentially “baited”) to disobey God’s Word. The foundation of such temptation can be demonic or fleshly. It can have physical or psychological roots, or, frankly, both. For example, the enticement to take a drug or to watch pornography has a physical component of pleasure and escape, but it might also have an emotional or psychological component. Depending on your circumstances, such as severe physical pain, the enticement can be nearly impossible to resist. From a psychological viewpoint, the inducement can be pride, anxiety, depression, or boredom. In my experience, both physical and psychological enticement can be equally compelling. The perfect storm, especially for me, is when both mechanisms are at play!

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James is quick to tell us that temptation is a solicitation from the devil to do wrong, and is never directed by God (1:13). Satan doesn’t want us to think about the how of our temptation. Instead, he wants us to obsess over the temporary pleasure to be gained when we give in to what is baiting us. The devil will deceive us about the results of taking the bait. Perhaps we’ll buy into this action as having some type of relief or benefit. That’s why deception is his “go-to” device. Our habitual sin is rooted in automatic (compulsive) behavior, focused only on temporary pleasure or escape. Hand-in-hand with the thought that God does not tempt us to sin is the fact that temptation is strictly an individual matter (1:14).

Eugene Peterson places verses 2 through 18 under the heading “Faith Under Pressure.” In his translation The Message, he writes, “Don’t let anyone under pressure to give in to evil say, ‘God is trying to trip me up.’ God is impervious to evil, and puts evil in no one’s way. The temptation to give in to evil comes from us and only us. We have no one to blame but the leering, seducing flare-up of our own lust. Lust gets us pregnant, and has a baby: sin! Sin grows up to adulthood, and becomes a real killer.” It’s critical that we see what James is teaching us on temptation. He is saying we are lured away from God in the midst of trials by our own desires. It is my experience that temptation is specific to that which I personally find pleasurable. Not everyone is prone to finding relief at the bottom of a bottle or from a handful of opiate painkillers, as I have been. Not all men or women are enticed by pornography. These wiles are specific to each of us, which makes them harder to resist.

On one level, we simply want to sin. Paul taught us this in the seventh chapter of Romans. He says, “But sin, seizing the opportunity afforded by the commandment, produced in me every kind of coveting. For apart from the law, sin was dead” (7:8, NIV) [italics mine]. He reminds us that the law is spiritual, but at our core, that is in the flesh, we are not spiritual. We’re sold as a slave to sin (7:14). Prior to giving his life to the Way of Jesus, Paul was a “Pharisee among Pharisees,” well-educated at the feet of the renowned rabbi Gamaliel. He knew the Law front-to-back. He felt justified in persecuting and murdering Christians as members of a heretical sect of Judaism. No doubt he believed he was helping to protect Israel from the wrath of God.

It is important to note that Paul, a highly-educated Jew who was called to preach the Good News to the Gentiles, and had undergone spiritual conversion on the road to Damascus, still recognized his struggle in the flesh. Exasperated, he said, “I do not understand what I do. For what I want to do I do not do, but what I hate I do. And if I do what I do not want to do, I agree that the law is good. As it is, it is no longer I myself who do it, but it is sin living in me. For I know that good itself does not dwell in me, that is, in my sinful nature. For I have the desire to do what is good, but I cannot carry it out” (7:15-18, NIV).

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Be careful, though, for it is possible to allow Paul’s struggle to become a loophole with which you will excuse your own wilful sin. I’ve been there, thinking, If even Paul can’t resist the flesh, then how can I? (See my blog article Do You Look for Loopholes as a Christian?) Wilful sin, however, is anathema to repentance, which literally means “to turn away from.” To repent is to do a 180 and never look back.

So Now What?

Repentance involves having the will to change; to never be the same again. If temptation is so difficult to resist, then what is its purpose in the life of the Christian? We know that sin occurs when we yield to enticement and make a wrong decision regarding our behavior. The dynamics of that mental and emotional process is complex. Although we’ve been freed from being a slave to sin (see Romans 6), we haven’t completely lost our taste for sin. Desires will remain in our flesh for as long as we live in a physical body. What we cannot excuse, however, is the practice of sin. Paul notes this problem in Romans 1:32, using the Greek word prasso to describe wilful sin. This refers to performing sin repeatedly or habitually. One definition specifically states, “to exercise, practice, to be busy with, carry on.”

If we are aware of a particular desire personal to us that entices or lures us into sinful behavior, we are responsible for addressing that behavior. Instead, many of us (me included) agree to be tempted, and we get on with practicing the sin. Looking at it this closely truly exposes the mechanism (the “come-on” if you will) and the chronic, repeated behavior associated with that temptation. Let’s be real: We simply “give in” once again and fail to resist the devil.

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Temptation that leads to sin always follows the same process.  There are four steps involved in giving in to temptation:  (1) the bait is dropped, (2) our inner desire is attracted to the bait, (3) sin occurs when we yield to temptation, and (4) sin results in tragic consequences.  To be aware of these principles is to be armed in the face of struggling with temptation. But can a true Christian habitually sin? Many believers wrestle with this question, and often give up and give in, thinking they must not be saved if they cannot stop sinning. Some will even teach that if you have habitual sin in your life you are not really a Christian. One pastor put it to me this way a few years ago: “You don’t have God in your heart.” Ouch! But unfortunately we can have head knowledge about God and Jesus, yet not have the required heart knowledge needed to act according to our beliefs or our intention to do that which is right.

Thankfully, the Bible takes no steps in hiding the sins of key Old Testament figures. Abraham, Isaac, Moses, and David were not super heroes. They were normal men who sinned as Adam did. There is no question that David is one of the Bible’s more prominent figures. Jesus Christ came from the House of David. We are easily inspired by his youthful willingness to fight Goliath, his tender friendship with Jonathan, his worshipful Psalms, and his enduring patience under wicked King Saul. It’s almost hard to believe that this beloved character who’s spoken so highly of in more than half of the Bible’s books would also be guilty of breaking half of God’s commandments. David coveted Uriah’s wife, Bathsheba (2 Samuel 11:2-3), committed adultery with her (11:4) effectively stealing her from Uriah (12:9), lying to him (11:12–13), and eventually having him murdered (12:9).

Others come to mind as well. Noah was a drunk (Genesis 9:20-21). Sarah doubted God and allowed Abraham to have sex with her maidservant in order to help fulfill God’s promise of a son (Genesis 16). Jacob was a pathological liar (Genesis 25, 27, 30). Moses had a bad temper (Exodus 2, 32:19; Numbers 20:11) and killed an Egyptian. Solomon was said to be the wisest man in the world, but he was a sex addict who took over 1,000 sexual partners (1 Kings 11). The prophets, even as they spoke for God, struggled with impurity, depression, unfaithful spouses and broken families. Looking to the New Testament men of God, we see Peter’s denial of Christ (John 18:13-27). Paul persecuted Christians, often sending them to death, before God chose him to lead the Gentile world to Christ (Acts 22:1-5).

Handling Temptation the Jesus Way

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Paul said God intends for us to work out our salvation daily with fear and trembling (Philippians 2:12). Unfortunately, the importance of this verse is lost on many Christians today. It is often used by certain teachers and preachers to instill fear into people, wrongly warning them that they can lose their salvation. (I am working on a blog article on this subject, which will be based on diligent exegesis, to be published at a later date.) Paul was certainly not encouraging believers to live in a continuous condition of nervousness and anxiety. That would contradict his many other exhortations of peace of mind, courage, and confidence in Jesus, the author of our salvation. The answer lies in the Greek word phobou (from phebomai) which Paul uses for the word fear, meaning “to be put to flight.” Paul was likely telling the believers at Philippi to work out their deliverance (salvation) from sin by fleeing from it or, in the alternative, by telling it to flee. This dovetails nicely with James’s admonition, “Submit yourselves, then, to God. Resist the devil, and he will flee from you” (James 4:7, NIV).

The Greek verb for “work out” (katergazesthe) refers to continually working to bring something to completion or fruition. This sounds a lot like the ongoing process of sanctification by which we are “set apart” from our sinful nature for God. Paul describes himself as straining and pressing on toward the goal of becoming like Christ (Philippians 3:13-14).  He teaches that the very essence of salvation is holiness—what he calls sanctification of the spirit. He says good works find their only root in salvation and sanctification. In other words, we are not saved by our good works, but rather we are saved for our good works. It is true that genuine Christians are identified by their fruits. Jesus reminds us that He is the Vine, and God is the Vinedresser (John 15:1). The Vinedresser cuts off every branch that bears no fruit, while pruning the ones that do, making them more fruitful (15:2). This is a great description of the process of sanctification through being pruned and made fruitful.

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The means by which we are able to work out our salvation and resist temptation is grounded in Jesus. If we want to participate in the salvation and restoration of the world, we must live in a manner that works toward that end. We follow Jesus. This includes coming to understand the power in the Name of Jesus: power to break chains, heal minds and bodies, build the Body of Christ, and rely on the Holy Spirit to clarify the truth of the Gospel. Accordingly, we must not cherry-pick the Gospel. We cannot decide to follow Jesus in some aspects of our lives, but go our own way (or, worse, the way of the devil) in others. If we are going to follow Jesus, we must learn the ways in which He leads. Moreover, we need to examine His relationship with the Father. We have to lock on to these methods and follow them with consistency and completeness. Paul reminds us that this is not easy, and James tells us it can only be accomplished by resisting Satan.

Concluding Remarks

The ways and the means promoted and carried out in the world today are designed to take God completely out of the equation. It is no coincidence that America is suffering at the hands of gun violence, murder, terrorism, hatred, bigotry, increased rates of abortion, brokenness (especially regarding the home), addiction, deception, selfishness, illness, and heartache. Surely, wars are fought and won, wealth is accumulated, elections are won, diseases are cured, and victories are posted, but at what cost? The means by which these ends are achieved leaves a hole in the soul of our country. Many people are killed, others are impoverished, marriages are failing apart, addicts are dying at an alarming rate, our schools and other venues have become soft targets for violence, children are being abandoned and neglected, and worldly churches are hawking their watered-down message in the name of Christ. As a result, we’re not moving toward spiritual maturity.

Simply stated, Jesus said, “I am.” He is the way, the truth, and the life. He is the Word in the flesh. The salvation of the world. The Head of the Body of Christ. He said we must repent, believe, and follow Him. We repent by making a decision to turn away from everything we were in the flesh and walk toward Jesus. This must include a change of heart and mind, which is the first step in becoming a new creation in Him. This requires a personal, trusting participation in the reordering of our reality. Lastly, we must follow the Way of Jesus. This involves every aspect of our daily lives, including what we think, how we speak, the manner in which we behave, and how we pray and interact with Christ. To follow the Way of Jesus implies that we enter into a brand new reality that necessarily shapes our character. We cannot separate what Jesus says from what Jesus does and the manner by which He does it, nor can we fail to walk in that same manner.

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Publishing, 2013.

Nee, Watchman. The Holy Spirit and Reality. Hatfield, South Africa: Van Schaik Publishers, 2001.

Peterson, Eugene. The Jesus Way: A Conversation on the Ways That Jesus is the Way. Grand Rapids, MI: Wm. B. Eeardmans Publishing, 2007.

 

Secret Opioid Memo

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A confidential government document containing evidence so critical it had the potential to change the course of an American tragedy was kept in the dark for more than a decade. The document, known as a “prosecution memo,” details how government lawyers believed that Purdue Pharma, the maker of the powerful opioid, OxyContin, knew early on that the drug was fueling a rise in abuse and addiction. They also gathered evidence indicating that the company’s executives had misled the public and Congress.

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There has been a recent wave of lawsuits against opioid makers and members of the Sackler family, which owns Purdue Pharma. Opioid abuse has ravaged America over the past two decades. According to the Centers for Disease Control and Prevention (CDC), from 1999 to 2017 more than 700,000 Americans have died from a drug overdose. Approximately 68% of the more than 70,200 drug overdose deaths in 2017 involved an opioid. In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999. On average, 130 Americans die every day from an opioid overdose.

The confidential Justice Department “prosecution memo” represents a missed opportunity that might have changed the course of the opioid epidemic. It also suggests that Purdue Pharma and members of the Sackler family knew far earlier than they admitted that OxyContin was being abused. The memo had the potential to change the course of the opioid crisis but was kept from circulation for more than a decade. The report states that Purdue Pharma executives were implicated in the crisis.

The Department of Justice chose not to pursue felony charges against those executives, paving the way for a settlement that ended a four-year investigation. The settlement did not produce any vital changes to industry behavior regarding the prescribing of narcotic painkillers. Secrecy surrounding the memo is emblematic of a legal process that favors the suppression of corporate information. If disclosed, this information could benefit the public’s health and safety. It is truly extraordinary to see after all these years that the opioid industry is finally being held to account.

Analysis of the DEA database obtained by the Washington Post reveals that a relatively small number of pharmacies—15 percent—distributed roughly half of prescription opioids nationwide from 2006 to 2012. It seems the DEA wasn’t paying attention to its own data, instead relying on drug companies and pharmacies to police themselves. In one engaging multimedia story, the Post took a close look at a southwestern Virginia area that was flooded with 74 million opioid pills over seven years—enough for 106 pills per resident every year. Journalists from over 30 states have now published over 90 separate articles based on the previously undisclosed DEA data.

It’s unbelievable that millions of oxycodone and hydrocodone pills flooded poor communities in Appalachia as pharmaceutical companies and the DEA failed to heed signs of large-scale inappropriate prescribing. Yet there is a certain liberation in being able to point to specific data, which might help assign responsibility for what may be U.S. health care’s most fateful systemic failure in recent history.

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It is bad enough that many doctors and pharmacies were little more than “pill mills” supplying untreated addicts with their drug of choice rather than treating legitimate pain patients. It is quite another to know that nearly 35 billion opioids — about half of all distributed pills — were handled by just 15 percent of the nation’s pharmacies between 2006 and 2012. A single drugstore in tiny Albany, Kentucky purchased nearly 6.8 million hydrocodone and oxycodone pills during that period, equivalent to 96 a year for all 10,000 or so men, women and children in surrounding Clinton County. This was the most on a per capita, per county basis in the United States.

There is always a tension between discretion and disclosure—between keeping the public informed about the workings of large medical treatment systems and permitting specialists who operate them to handle delicate matters in private. Nowhere is that tension more relevant than in health care, where medical expertise, proprietary information and patient privacy are all at a premium. Like all good things, however, those may be taken to an extreme or turned into excuses for unwarranted concealment.

Any ordinary person who learned that a single pharmacy in small-town Kentucky was handling millions of potentially addictive pills over a seven-year period might have sounded an alarm, even if government bureaucracy, industry leaders, and doctors did not. Unfortunately, no ordinary person could know—until now.

For more information, click here: OxyKills.com

What It Feels Like to do Nothing

By Steven Barto, B.S. Psych.
Excerpts from The Demon in the Freezer written by Richard Preston.

I feel like I’m hiding from responsibility. Or, more specifically, my calling. I feel stuck. Stymied. Like a deer caught in the frickin’ headlights. The more of nothing I do, the less I feel like there’s anything I can do. This hit me hard last evening while reading a chapter in Richard Preston’s book The Demon in the Freezer. Preston also wrote the best-selling book The Hot Zone, which was recently a featured mini-series on National Geographic starring Juilanna Margulies.

The Demon in the Freezer is Preston’s true account of the inside story on virus outbreaks and the history of biological weapons. [You can order a copy of the book at Amazon.com] In the chapter called “Strange Trip,” he takes us on a wild ride that begins with Dr. Lawrence Brilliant (his real name) and Wavy Gravy, who met at Woodstock, and ends with participation in the Eradication Program for smallpox started by the World Health Organization in New Delhi. As I read this chapter, I saw strange but convincing parallels to my own life. Like Dr. Brilliant did initially, I have been postponing the fulfillment of God’s call on my life. Not unlike Dr. Brilliant and Wavy Gravy, much of this hindrance has been fueled by chronic drug and alcohol use that became what the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) calls Substance Use Disorder (SUD).

I will provide a complete account of “Strange Trip” in this blog article, and will jump in here and there to describe how this tale mimics my sloth-like approach to life and to my mission. I’ll comment on the terrible danger of allowing your journey to be interrupted; explaining what it’s like to tune God out and concentrate on assuaging emotional and physical pain as if my life depended on it. I don’t intend to go easy on myself. This is an important story that will hopefully inspire someone else to get off their rump and begin the trip that God has laid out before them. Failure to do so will haunt you. A Christian friend of mine recently told me, “God wants you to know that if you don’t do what He has called you to do, He will get someone else to do it!”

LET’S GET STARTED

There is no other way to do life but to do it the right way.

IN THE SUMMER OF 1970, a twenty-six-year-old medical doctor named Lawrence Brilliant finished his internship at Presbyterian Hospital in San Francisco. He had been diagnosed with a tumor of the parathyroid gland and was recovering from an operation, so he was not able to go on with this residency. He was living on Alcatraz Island in San Fransisco Bay, where he was giving medical help to a group of Native Americans who had occupied Alcatraz in a protest. He ended up doing some interviews on television from the island, and a producer from Warner Bros. saw one of them and offered him a role in a movie. The movie was Medicine Ball Caravan, about hippies who go to England and end up at a Pink Floyd concert. Larry Brilliant played a doctor… The movie also featured Wavy Gravy, one of the founders of the Hog Farm commune in Llano, New Mexico. The Hog Farm commune had recently become famous for running the food kitchen at the Woodstock festival, where they also provivded security…

Medicine Ball Caravan was shot first in San Francisco and then in England, and during the shooting Brilliant and Gravy became friends… In England, Brilliant and his wife, Girija, and Wavy and his wife, Jahanara Gravy—she’s from Minnesota and is said to have been Bob Dylan’s girlfriend and perhaps even the model for the “Girl of the North Country”—pondered what to do next in life. A terrible cyclone had hit the delta of the Ganges River in the Bay of Bengal, in what was then East Pakistan (now Bangladesh), and the eye of the cyclone had passed over an island named Bhota. A hundred and fifty thousand people had drowned when a tidal surge had covered the entire island. The Brilliants and the Gravys hit on the idea of buying a bus and carrying food and medicines to the devastated islanders.

“Wavy and I and our wives—who, remarkably, are still our wives—drove to Kathmandu,” Brilliant said. They started with a rotten old British Leyland bus that they bought cheap in London. They painted it in psychedelic colors and filled the bus with medicine and food and a bunch of hippie friends. They bought a second bus in Germany and equipped it similarly, and the Brilliant-Gravy bus entourage made its way slowly through Turkey and Iran. The buses wandered around Afghanistan for months, and they made it over the Khyber Pass, following the same road that Peter Los and his friends had driven a little more than a year earlier in their Volkswagen bus.

The Brilliant-Gravy expedition wound slowly through Pakistan and crossed into India. Civil war had broken out between East and West Pakistan—this was the independence war of Bangladesh—and the border of Bangladesh had been closed, so they couldn’t get their buses into the country. They turned northward into Nepal, and eventually the buses pulled into Kathmandu. “Wavy got sick and ended up going back to the U.S. weighing about eighty pounds,” Brilliant says. The Brilliants abandoned their bus in Kathmandu and went to New Delhi, India. It seems that the Brilliants were pondering what to do next in life, and nothing was coming along.

Like the Brilliants, many of us tend to get derailed from our plans by difficulties and choose indecision. For me, I’ve had plans to serve the LORD in some capacity at numerous times during my life. I remember telling my grandmother many decades ago that every time I ignore God’s call on my life I end up failing miserably at whatever I decide to do instead. Invariably, that has always led to rather troublesome developments. It’s as if God pulled back on His blessings and waited for me to return to Him ready to serve. Dr. Brilliant and his wife stumbled around India for some time not sure what to do. One day they were in an American Express office in New Delhi collecting their mail, when they met Baba Ram Dass. Baba had recently been Professor Richard Alpert of Harvard University, but he and a colleague, Professor Timothy Leary, had been kicked out of Harvard for advocating the use of LSD.

Richard Preston’s book continues.

Baba Ram Dass spoke glowingly of a holy man named Neem Karoli Baba, who was the head of an ashram at the foot of the Himalayas in a remote district in northern India where the borders of China, India, and Nepal come together. Girija Brilliant was captivated by Baba Ram Dass’s talk of the holy man, and she wanted to meet him, though Larry was not interested. Girija insisted, and so they went. They ended up living in the ashram and becoming devotees of Neem Karoli Baba… He was a famous guru in India, and the people sometimes called him Blanket Baba. The Brilliants learned Hindi, meditated, and read the Bhagavad Gita. Meanwhile, Larry ran an informal clinic in the ashram, giving out medicines that he’d taken off the bus when they’d left it in Kathmandu. One day, he was outdoors at the ashram, singing Sanskrit songs with a group of students, watching them sing. He fixed his eye on Brilliant.

Preston reports that the guru wanted to know how much money Brilliant had. When Brilliant told him he had five-hundred dollars, Blanket Baba asked how much money Brilliant had back home in America. The answer was the same—five hundred dollars. The conversation got quite interesting at this point.

Blanket Baba got a sly grin and started chanting, in Hindi, “You have no money… you are no doctor… you have no money,” and he reached forward and tugged on Brilliant’s beard. Brilliant didn’t know how to answer. Neem Karoli Baba switched to English and kept on chanting. “You are no doctor… UNO doctor… UNO doctor.” UNO can stand for United Nations Organization.

The guru was saying to his student (or so the student now thinks) that his duty and destiny—his dharma—was to become a doctor with the United Nations. “He made this funny gesture, looking up at the sky,” Brilliant recalled, “and he said in Hindi, ‘You are going to go into villages. You are going to eradicate smallpox. Because this is a terrible disease. But with God’s grace, smallpox will be unmulum.'” The guru used a formal old Sanskrit word that means “to be torn up by the roots.” Eradicated. The word “unmulum” comes from an Indo-European root that is at least ten thousand years old—the word is probably older than smallpox.

“So I said, ‘What do I do?’ And he said, ‘Go to New Delhi. Go to the office of the World Health Organization. Go get your job. Jao, jao, jao.’ That means, ‘Go, go go.'” Brilliant packed a few things and left the ashram that night—the guru seemed to be in a rush to “unmulate” smallpox. The trip to New Delhi took seventeen hours by rickshaw and bus. When Brilliant walked into the office of the WHO, it was nearly empty. It had just been set up, and almost no one was working there. The government of India was then headed by Indira Gandhi, and she was skeptical of the Eradication Program and had not yet approved it. The first person Brilliant met was the head of the office, Dr. Nicole Grasset.

“I was wearing a white dress and sandals,” Brilliant says, “I’m five feet nine, and my beard was something like five feet eleven, and my hair was in a ponytail down my back.” Grasset had no job to offer him, so Brilliant returned to the monastery and, having not slept in at least thirty-six hours, reported back to the guru. “Did you get your job?” “No.” “Go back and get it.”

A PERSONAL MISSION

The guru was convinced Brilliant would get his job eradicating smallpox. It was, after all, his dharma—his “calling.” Brilliant returned to New Delhi. Dr. Grasset was quite shocked to see him again, but nothing had changed. There was no job. Brilliant went back and forth between New Delhi and the ashram at least a dozen times. I’m not sure if this indicated Brilliant was like a dog with a bone, determined to get his job, or that God had called him to this task, which would ultimately materialize. Each time he returned, the guru would say, “Don’t worry, you’ll get your job. Smallpox will be unmulum, uprooted.” Brilliant returned to the WHO in New Delhi.

“On one of my trips, there was this tall guy sitting in the lobby of the WHO office. He looked up and said, ‘Who are you? What are you doing here?'” “I’ve come to work for the smallpox program,” Brilliant replied. “There isn’t much of a program here.” “My guru says it will be eradicated. Who are you?” “I’m D.A. Henderson. I’m the head of the program.”

Henderson, for his part, was a little put off by Brilliant’s white dress and his talk of a guru predicting a wipeout of smallpox. That day, Henderson wrote a note in the employment record, “Nice guy, sincere. Appears to have gone a little native…” Indira Gandhi was herself a devotee of Neem Karoli Baba, and she had visited him at the monastery, where she had bowed down to him and touched his feet and asked for his advice. Blanket Baba wanted smallpox pulled up by the roots, and he was annoyed at Mrs. Gandhi for resisting the efforts of the World Health Organization to get on with the job…

Brilliant thought he’d increase his chances of getting a job if he looked more Western, so every time he returned to New Delhi he trimmed off some of his beard and shortened his ponytail, and he began to replace articles of clothing. He ended up with medium-long hair and a short beard, and he was dressed in a checkered polyester suit with extra-wide lapels, a thick polyester tie, and a lime green Dacron shirt. He had made himself unnoticeable, for the seventies. By that time, Nicole Grasset had decided to hire him, and D.A. Henderson agreed that he might have some potential as an eradicator. He started as a typist.

At this point, it is obvious Brilliant was determined to get the job he’d been called to do. He remained obstinate and did not take no for an answer. Moreover, he made the necessary changes to accomplish his goal, especially his outward appearance that was distracting people from seeing him for who he truly was: a man destined to help eradicate smallpox from the world. Interestingly, as we’ll see later, the simple decision to learn to speak Hindi allowed Brilliant to get through to the native Hindi people to get vaccinated. Had he known only English, or had to speak through an interpreter, I don’t believe he would have been as well received. Fulfilling our calling often revolves around similar commitments and changes.

I’m sure most of us can see ourselves in the example of Dr. Brilliant. When we feel compelled—indeed, called—to do something, we invariably go through stages of action and inaction, assurance and doubt, but if we believe in the call on our life we will remain tenacious. Unfortunately, on many occasions the devil throws every possible obstacle in our path to stop us from answering that call. For me, it was a number of things, ranging from materialism to pride, but the toughest hurdle has been my struggle with active addiction. In fact, the longest time I have remained at a job in my life was three years. I have a friend who’s had two jobs since high school, and both are in the same industry! Moreover, I have finally completed the first step in answering God’s call: I’ve obtained my B.S. in Psychology at age 59, and I am starting my Master’s in Theology in August.

Preston’s chapter continues.

Eventually, they sent Brilliant to a nearby district to handle smallpox outbreaks, where if he got into trouble they could pull him out quickly. He saw his first cases of variola major. “You can’t see smallpox and not be impressed,” he said. He began to organize vaccination campaigns in villages. He would go into a village where there was smallpox, rent an elephant, and ride through the village telling people in Hindi that they should get vaccinated. People didn’t want to be vaccinated. They felt that smallpox was an emanation of the goddess of smallpox, Shitala Ma, and that therefore the disease was part of the sacred order of the world; it was the dharma of the people to have visitations from the disease.

Brilliant traveled all over India with Henderson and the other leaders of the Eradication, and they came to know one another intimately. “D.A. read nothing but war novels and books about Patton and other great generals in history,” Brilliant said. “Nicole Grasset read nothing except scientific things. Bill Foege was reading philosophy and Christian literature—he’s a devout Lutheran. I was reading mystical literature.” They ran a fleet of five hundred jeeps. They had a hundred and fifty thousand people working for the program, mostly on very small salaries. For a year and a half, at the peak of the campaign, every house in India was called on once a month by a health worker to see if anyone there had smallpox. There were a hundred and twenty million houses in India, and Brilliant estimates that the program made almost two billion house calls during that year and a half.

After he helped eradicate smallpox—his “calling”—Larry Brilliant did other things. He became one of Jerry Garcia’s physicians. He became the founder and co-owner of the Well, a famous early Internet operation. He was the CEO of SoftNet, a software company that reached three billion dollars in value on the stock market during the wild years of the Internet. He and his wife had three children. He eventually obtained the position of professor of epidemiology at the University of Michigan, and, along with Wavy Gravy and Baba Ram Dass, he established a medical foundation called the Seva Foundation. Today, that operation has cured two million people of blindness in India and Nepal.

“I’ve done a lot of things in life,” Brilliant said, “but I’ve never encountered people as smart, as dedicated, as hardworking, as kind, or as noble as the people who worked on smallpox. Everything about them—D.A. Henderson, Nicole Grasset, Zdenek Jezek, Steve Jones, Bill Foege, Isao Arita, the other leaders—everything about them as people was secondary to the work of eradicating smallpox. We hated smallpox.”

There were numerous setbacks during the World Health Organization’s campaign to eradicate smallpox. In fact, there were two false conclusions that the virus had been wiped out. Each time, the eradicators implemented known procedures, creating vaccination “rings” around the outbreaks. On October 27, 1977, a hospital cook in Somalia named Ali Maow Maalin broke out with the world’s final natural case of variola. They vaccinated fifty-seven thousand people around him, and the final ring tightened, and the life cycle of the smallpox virus stopped.

CONCLUDING REMARKS

God calls upon believers and non-believers alike to do His work. Although I am a theist of Christian belief, I take nothing away from the actions and the determination of Baba Ram Dass and Neem Karoli Baba. It is important to note, for the record, that I believe such brave and dedicated non-believers have not earned their salvation in spite of their paramount accomplishments. Salvation comes from Christ alone through faith in Christ alone. I can only hope individuals such as these brave warriors against smallpox come to know the truth during their mortal lifetime and make a conscious decision to accept the saving grace of God through the shedding of the blood of Jesus on the cross.

I will say, however, that these people we’ve read about today convicted me to stop making excuses for my long periods of inactivity, disobedience, and selfishness. I am sure the conviction I felt when reading the chapter “Strange Trip” in Preston’s book, and, moreover, while writing this blog post, came from the Holy Spirit. It is, after all, through the worldview I hold as a Christian that I receive and believe in such guidance and conviction. It is my responsibility to listen to that small voice and take steps to stop the practice of habitual sin. To cease walking in and serving the flesh and begin to walk in the Spirit of God.

Only by coming to grips with our humanity—our total lack of inability to conquer the flesh and discontinue all sinning—can we hope to stop the practice of sin. Furthermore, the flesh and its myriad distractions will drown out the voice of God. We will fail to hear Him tell us who we are in His Son, Christ Jesus. We will miss the calling on our lives. How will we know if our failure to step up and listen to God’s plans for us will result in, for example, the deaths of millions of people because we did not become the “eradicator” He needs us to be. To wipe out whatever we’re called to wipe out, whether it be smallpox, addiction, human trafficking, terrorism, violence, or mental illness?

We don’t know unless we surrender and start listening to God.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Preston, R. (2002). The Demon in the Freezer: A True Story. New York, NY: Random House.

Do You Look for Loopholes as a Christian?

Written by Steven Barto, B.S. Psych.

The standard definition of a loophole is an ambiguity or inadequacy in a system, such as a law or a set of rules, which can be used to circumvent or otherwise avoid the purpose, implied or explicitly stated, of the system. It is basically a small mistake which allows people to do something that would otherwise be illegal. Generally, the cause of a loophole is a divergence between the text of the law (how it is written) and the meaning of the law (its intended effect).

Loophole Graphics

PHARISEES AND THEIR THEOLOGICAL LOOPHOLES

Pharisee Pointing

It’s no secret that the Pharisees of Jesus’ days were typically angry over infractions of the Sabaath. This was a huge issue between them and the Lord. Interestingly, the Pharisees created a loophole that allowed them to break their own rules regarding the Sabbath whenever convenient. According to Rabbinic teaching, a Jew could take no more than 3,000 steps on the Sabbath, nor carry more weight than half a dried fig. To circumvent this law, the Rabbis designed a small wearable tent. The tent had poles that rested upon their shoulders, lifting it from the ground. A chair was fastened to their rump Accordingly, they were not technically carrying anything. They would walk 3,000 steps, sit on the stool, then stand and walk 3,000 more steps, repeating the process over and over until they arrived at their intended destination. They declared the tent to be their home each time they sat down. Their “theology” gave them a loophole for travel and manual labor on the Sabbath if they found it necessary. Technically, they were in the clear. That’s what loopholes do for us—permit us to be “technically” right while breaking the rules.

CHRISTIANS AND THEIR LOOPHOLES

When Christians look for loopholes, they change Scripture to fit their circumstances. A believer with this mindset is not concerned with what Scripture dictates; rather, they are concerned about making Scripture say what they need it to say. Individuals who are Christian “in name only” look for loopholes. True followers of Christ don’t look for an out. Unfortunately, many believers today claim certain doctrines, proscriptions, or edicts in Scripture for “back in ancient times” rather than the modern church. This is basically a form of “progressive” Christianity, which flies in the face of God’s unchanging Word. Jesus is the same yesterday, today, and forever. Second Timothy 3:16 says, “All scripture is given by inspiration of God, and is profitable for doctrine, for reproof, for correction, for instruction in righteousness” (NIV). Ecclesiastes 3:14 says, “I know that whatever God does, It shall be forever. Nothing can be added to it, And nothing taken from it. God does it, that men should fear before Him” (NKJV).

PAUL

The Apostle Paul 001

Romans 7:19-21 says, “For I do not do the good I want to do, but the evil I do not want to do—this I keep on doing. Now if I do what I do not want to do, it is no longer I who do it, but it is sin living in me that does it. So I find this law at work: Although I want to do good, evil is right there with me” (NIV). It is important to note that Paul was not speaking about a non-believer, nor was he describing a carnal Christian. He was talking about a victorious disciple still at risk for sinful behavior. Admittedly, Paul is not speaking of the practice of sin by a believer—willfully sinning despite knowing the consequences.

Paul was leading a crucified life, putting on the righteousness of Christ (see verse 25). He delighted in the Law of God in the inward man (see verse 22). That means he was gratified by love, goodness, righteousness, and mercy. The part of his mind that was focused on serving God no longer practiced sin. His thoughts were on Jesus. He told the Christians at Corinth, “I resolved to know nothing while I was with you except Jesus Christ and him crucified” (1 Corinthians 2:2).

There were several aspects of Paul’s life where he had not yet received light. In such instances, he was taken captive by the law of sin in his flesh, causing him to do things he hated (see verse 23). Someone who is willfully committing sin is not doing what he hates. His mind approves of it. When desire is conceived, it gives birth to sin. We actually consent to the desire in our mind and sin is born. James 1:14-15 says, “But each person is tempted when they are dragged away by their own evil desire and enticed” (NIV). Such Christians are serving the law of sin with his or her mind.

THE LOOPHOLES OF ADDICTIVE BEHAVIOR

Addicts frequently use denial, rationalization, and loopholes to hide or downplay their abuse of drugs or alcohol. Heavy or chronic alcohol use leads to psychological and physical dependence and possible addiction. The Diagnostic and Statistics Manual of Psychiatric Disorders, Fifth Edition (DSM-5) says substance abuse related disorders encompass separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives; hypnotics; and stimulants. 

Here are four common loopholes used by alcoholics and addicts:

  1. I’ve already ruined everything. Addicts try to avoid or not acknowledge the consequences of their actions—at least until these consequences are severely compounded. Whether it’s losing a job, legal trouble, homelessness, dysfunction in the household, or all of the above, addiction progressively destroys lives. Although hitting “rock bottom” causes some to seek treatment, others justify continued addiction because they focus on the perceived irreparable damage they’ve caused. 
  2. I don’t deserve a happy, healthy life. According to the Journal of the American Medical Association, roughly half of all individuals diagnosed with a mental health disorder are also affected by substance abuse. Although this is a co-occurring diagnosis (often referred to in 12-step parlance as “double trouble”), it is not a loophole for addiction. Admittedly, feeling undeserving of a happy, healthy life due to mental health symptoms can be a trap. This often leads to drinking or drugging to self-medicate for chronic anxiety or depression. Accordingly, a loophole is created for continued use. 
  3. Now I can finally handle it. This justification is a loophole for relapse, as well as active addiction. When someone feels that their life is now more manageable—perhaps, due to a period of sobriety or fixing certain problems while in active addiction—they may justify drinking or taking drugs again or continuing to use. Unfortunately, the progressive nature of addiction quickly disproves this rationale. This loophole often rears its ugly head following inpatient treatment at a rehab. The individual feels he or she is “armed with” enough information to finally use safely.
  4. For me, it’s just normal life. For some, addiction is a solitary issue. For others, however, addiction may be shared with friends, family members, or partners. These individuals tend to justify their actions because they feel their behavior is part of the fabric of a relationship or social agenda. Even if someone believes their own addiction may be a problem, they can justify their dependency by referring to getting drunk or high as part of the “norms” of social life. 

MY FAVORITE LOOPHOLE

Unfortunately, I have often looked at certain habitual sins in the light of Paul’s own struggle, saying to myself, If the apostle Paul failed to resist the flesh and do what’s right, then how can I ever hope to do so? I am sure you see the hypocrisy of this conclusion. Basically, I have allowed this part of Paul’s teaching to serve as an excuse for what amounts to the “practice” of sin. Worse, the type of habitual sin that has been prevalent in my life involved deception, lying, and stealing narcotic painkillers from family members.

THE ADDICTED CHRISTIAN

Morgan Lee edited and published a provocative article in Christianity Today, called “Why a Drug Addict Wrote a Christianity Today Cover Story.” The article was written by Timothy King, a Christian who contracted very painful acute necrotizing pancreatitis. He was discharged on IV medication and given opiates for pain. Eventually, King’s doctor realized King’s reliance on narcotic painkillers was impeding his ability to eat and to recover from pancreatitis. Despite being a believer, King had become addicted to opiates.

Here is an excerpt from King’s article:

I use the term addicted. There are some medical professionals who use the word dependent because I didn’t go out and engage in behaviors typically associated with addiction. I chose to use the word addicted because it accurately describes my situation. It is a term I hope other people feel less stigma about in the future to describe their own situation. When we give the right name to something that is going on in our life, it kills its power over us. Naming something is incredibly important. Opioid addict is now tied to my name. I’ve had to think through that, but once again I have had a great community of support to encourage me about this story.

Whether deserved or not, believers struggling with an addiction are often shamed by the church rather than being provided an atmosphere for healing. Believers and non-believers alike are dying every day because of drug overdose. This should be cause for concern and a great opportunity for the church to be the church (the Body of Christ). After all, Christians are called to be a loving community of grace and healing. The church should not choose to see active addiction as a moral issue, ignoring the physical and psychological elements of the disorder. This only serves to ignore or sidestep this crisis, evidenced by believers (and some church leaders) who choose to sit on the sidelines, judging and ostracizing those who are suffering.

THE MINDSET OF A DISCIPLE

Paul answers his own question regarding his—indeed, our—struggle with sin that dwells within us. In Romans 7:25, Paul writes, “Thanks be to God through Jesus Christ our Lord! So then, on the one hand I myself with my mind am serving the law of God, but on the other, with my flesh the law of sin” (NASB). Before Jesus overcame the power of sin and darkness, leaving us with an example to follow, it was impossible to completely overcome all sin in the flesh. But Jesus sent the Holy Spirit Who can show us our sin (convict us) and teach us the way through it. Like Paul, when we repent and begin to serve God, we have a new mindset—it is no longer our conscious, daily choice to serve sin. What comes from our flesh is not necessarily done willfully.

When we are in Christ Jesus and choose to serve God with our mind and our spirit, there is no condemnation if we absentmindedly do the things we hate (see Romans 8:1). We aren’t condemned for being tempted (thoughts or feelings that entice us to sin), nor for actions we do which haven’t passed our conscious mind first, allowing us to make a conscious choice. But in order to accomplish this, we need to walk in the Spirit, which means acting according to the light that we receive. This comes only from allowing that light to illuminate our habitual sins. We will then be able to recognize the desires of the flesh—the body of sin that is to be crucified daily through Christ. How do we accomplish this? We count ourselves dead to sin. We can then be disciples of Jesus, denying ourselves and taking up our cross daily (see Luke 9:23-24).

Disciple is another word for a follower of Christ; one who is learning to be like his Master. originally meant pupil or apprentice. Too many Christians believe they became disciples of Jesus when they accepted His death, burial, and resurrection for forgiveness of their sins. We were certainly dead in our trespasses. Thankfully, we are forgiven through Christ. He made us alive together with Him (see Colossians 2:13). However, forgiveness of sin is not discipleship. Once we have received atonement for our sins and are reconciled with God through the crucifixion of Christ, we come to the beginning of a new us. We are now instructed to start following Jesus. Emulating the examples He provided to us during His life and ministry.

CONCLUDING REMARKS

If you or someone you love is struggling with addiction, closing the loopholes of active addiction may be imperative before seeking treatment. In reality, we can rebuild our lives. But this involves realizing that addiction is progressively destructive. Further, it is important to believe we deserved to be happy and healthy, and that active addiction is not a normal, fulfilling human existence. Jesus said, “The thief does not come except to steal, and to kill, and to destroy. I have come that they may have life, and that they may have it more abundantly” (John 10:10, NKJV). Eugene Peterson translates this verse as follows: “A thief is only there to steal and kill and destroy. I came so they can have real and eternal life, more and better life than they ever dreamed of” (MSG). Living life in bondage to addiction is certainly not an abundant life.  

Second Corinthians 5:17 talks about new life in Christ: “Therefore, if anyone is in Christ, the new creation has come: The old has gone, the new is here” (NIV). When we recognize that old things have passed away, we stand a better chance of living life without resorting to loopholes. Frankly, making decisions based upon loopholes is the hallmark of an unrepentant carnal Christian. When we are truly “in Christ,” we are a new creation. Old things have passed away. This is the “abundant” life we read about in John 10:10. We cannot hope to have an abundant and glorious new life in Christ if we excuse our occasion to sin as something not even the apostle Paul could avoid.

 

 

 

Hazelden Betty Ford Foundation Recovery Advocacy Update

Startling data recently made public show the details of how pharmaceutical companies saturated the country with opioids. In the seven years from 2006 to 2012, America’s biggest drug companies shipped 76 billion oxycodone and hydrocodone pain pills in the United States. The result? Opioid-related deaths soared in communities where the pills flowed most. These new revelations come from the Washington Post, which spent a year in court to gain access to a DEA database that tracks the path of every single pain pill sold in the United States.

Opioid Epidemic Pic of Vidodin

The database reveals what each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year-by-year, town-by-town. The data will be valuable to the attorneys litigating cases to hold manufacturers accountable, including a huge multi-district case in Ohio, where thousands of documents were filed last Friday. The data show that opioid manufacturers and distributors knowingly flooded the market as the overdose crisis raged and red flags were everywhere.

The Post has also published the data at county and state levels in order to help the public understand the impact of years of prescription pill shipments has had on their communities. Hazelden Betty Ford Foundation says to expect many reports from local journalists using the data to explain the causes and impact of the opioid crisis in their communities. The Post did its own local deep-dive, taking a close look this weekend at two Ohio counties that soon will be at the center of the bug multi-district litigation. Barring a settlement, the two counties are scheduled to go to trial in October as the first case among the consolidated lawsuits brought by about 2,000 cities, counties, Native American tribes and other plaintiffs.

Meanwhile, the CDC posted preliminary data suggesting that the number of Americans who died from drug overdoses finally fell 5% in 2018 after years of significant increases. This new data, while still preliminary, covers all of 2018, so it is firmer. And it is a rare positive sign. But it’s only one year and no cause for celebration or complacency—especially with continued funding for opioid crisis grants are uncertain and the decline in deaths anything but uniform across the states. For example, 18 states still saw increases in 2018. Policymakers must be reminded that we’re still very much in the midst of the nation’s worst-ever addiction crisis—one from which it will take years to recover. Federal funding remains essential, as advocate Ryan Hampton points out in his latest piece making the case for the CARE Act, a Congressional bill that would invest $100 billion over the next 10 years.

Chris-Herren

If you missed the premiere of  “The First Day,” a powerful, one-hour documentary that shows the evolved talk of former NBA-player-turned-recovery advocate Chris Herren, you can catch it again July 30 at 10:00 p.m. Eastern on ESPN. It is also now available for sale as a download. Herren has spoken to more than a million young people, and the film follows him on a dozen or so speaking engagements up and down the East Coast.

Delta Air Lines announced that naloxone, the medication used to treat (reverse) an opioid overdose, will be available in all emergency medical kits on flights beginning this Fall.

Delta’s decision comes after a passenger tweeted that a man died aboard a Delta flight last weekend from an opioid overdose. It’s unfathomable why naloxone isn’t already on all flights for all airlines. Last year, Hazelden Betty Ford Foundation joined the Association of Flight Attendants in urging the FAA to require it. No one should have to die before airlines take this common-sense step.

Oklahoma’s lawsuit against Johnson & Johnson went to the judge, who will decide later this summer whether to hold the drugmaker accountable for the state’s opioid epidemic. Oklahoma is seeking more than $17.5 billion to abate the costs of opioid addiction. Purdue Pharma and Teva Pharmaceutical settled their part of the Oklahoma case. But they and other drugmakers and distributors face some 2,000 similar lawsuits by states and local municipalities.

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Purdue Pharma, a pharmaceutical company owned by the Sackler family, invented the so-called non-addictive drug OxyContin. The company was found to have falsified the addiction rate at less than 1% when in fact it was over 10%. Raymond Sackler had a personal net worth of $13 billion in 2016. He passed away on July 17, 2017. The Louvre in Paris has removed the Sackler family name from its walls, becoming the first major museum to erase its public association with the philanthropist family linked with the opioid crisis in the United States.

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Dr. Nora Volkow, director of the National Institute on Drug Abuse, has written and spoken extensively about the importance of prevention in addressing the opioid crisis. NIDA studies have shown that teens who misuse prescription opioids are more likely to initiate heroin use. You can visit NIDA’s site by clicking here.

 

 

These Pesky Grapes of Wrath

I stumbled.
Turning, I looked in the
Bathroom and saw the
Evidence.

Shower curtain torn,
Laying on the floor
In a pool of vomit.
Not again!

Powerless.
Not my favorite word
To say the least.
Sounds like, failure.

Small.
Sweet.
Fermented.
Steeped in brokenness.

Killer of relationships
Thief of dreams.
The mortar of excuses,
Able to destroy.

Yet impossible to
Resist
No matter the cost.
Regardless of consequence.

I know where it leads,
Yet I have no human capacity
To resist
These pesky grapes of wrath.

©2019 Steven Barto