Celebrities We Lost to Overdose

It is a tragedy when anyone dies of a drug overdose. Drugs are no respecter of persons. It takes anyone at anytime, killing without prejudice. Why do humans like to get high? One answer is that drugs provide shortcuts to religious and transcendental experiences. If something can be ingested, injected, inhaled or absorbed into the human body, it can be abused. In the United States alone, nearly one-third of the population either abuses drugs or has a relationship with someone who is chemically dependent. Other countries face a similar problem.


Nearly half of drug abuse in the United States involves the misuse of prescription drugs. This is not only deliberate misuse, such as forged prescriptions, Medicaid fraud, and black market sales, but also errors made by physicians and accidental misuse of prescribed drugs—especially by the elderly. Many observers have become concerned about the astonishing increase in the use of Ritalin, a physician-prescribed drug given to American children diagnosed with attention deficit hyperactivity disorder (ADHD).

Many widely-used chemical substances damage the brain, heart and lungs of the user, as well as the bodies of the user’s unborn children. Drug use contributes to the leading causes of death in the world—heart disease, stroke and various types of cancer. It also generates an incredible financial burden for society. The total cost of substance abuse in America has been estimated at more than $240 billion per year. According to the World Health Organization, approximately one out of five hospital beds in the United States is occupied by someone with substance abuse as a contributing factor, and nearly 50 percent of all preventable deaths are related to some aspect of substance abuse. Substance abuse and its consequences are major medical and social problems.

Today, the medical model of addiction dominates the thinking in much of the Western world. This model suggests that people who abuse chemical substances or have behavior-related problems are victims of faulty genes that produce internal chemical imbalances. This can promote the notion that people have little control over their lives, and at times is used as an excuse for lawlessness by wildly mixing up moral responsibility with diagnosis. Indeed, much conventional wisdom about substance abuse undermines personal responsibility.

Factors Preventing Substance Abuse:

  1. Purpose in life
  2. Strong system of values
  3. Positive parental example
  4. Close relationship with parents
  5. Positive peer influences
  6. Academic achievement
  7. High educational aspiration
  8. Regular school attendance
  9. Regular church attendance
  10. Realistic long-term goals
  11. Knowledge of consequences
  12. Hope of a reward

It is alarming how many celebrities who have died secondary to drugs and alcohol over the years.

  • Corey Monteith, age 31, who played Finn Houston in the Glee TV series, was found dead in his Vancouver hotel room after taking a lethal cocktail of heroin and booze.
  • Sid Vicious, the bassist for the punk rock band Sex Pistols, died in his sleep after partying with heroin the night of his 1979 release from New York’s Rikers Island. His drug dealer that fateful night was his mother.
  • Dee Dee Ramone, Ramones founding member, bassist, singer and songwriter, died of a heroin overdose. Police found a syringe and five balloons of heroin near Ramone’s body.
  • Kurt Cobain, the Nirvana front man, was found in 1994 at his Lake Washington home. Although he shot himself—a suicide note was found—a high concentration of heroin and a small amount of diazepam was found in his bloodstream.
  • Peter Farndon, the founding member of The Pretenders, was found in his bathtub by his wife following a heroin overdose.
  • Lenny Bruce, standup comedian, died in 1966 after overdosing on heroin.
  • Jim Morrison, front man for the Doors, died on July 3, 1971, at age 27. He was found in a Paris apartment bathtub, reportedly dead from a heroin overdose after snorting what he thought was cocaine.
  • Jimi Hendrix was arrested in 1969 for possession of heroin, but was acquitted after claiming the drugs were planted in his belongings. He died of a heroin overdose the following year.
  • Hillel Slovak, founding member of the Red Hot Chili Peppers, died on June 27, 1988 of a heroin overdose.
  • Elvis Presley died at age 42 on August 16, 1977 after being found unresponsive in his upstairs bathroom. Cause of death was cardiac arrest secondary to an overdose of prescription drugs, including codeine, Valium, morphine, and Demerol.
  • Chris Farley died in 1977 after a night of partying with a hooker. An autopsy revealed a cocaine and morphine overdose.
  • John Belushi, of Saturday Night Live fame, was found dead in his room at the Chateau Marmont hotel in 1982 from speed-balling: injecting a combination of heroin and cocaine.
  • Whitney Houston, 48, was found unconscious and submerged in the bathtub of her suite at the Beverly Hills Hotel just hours before a pre-Grammy party. She died of an accidental overdose of cocaine and other drugs.
  • Corey Haim, the former child star who played in The Lost Boys, died of an accidental drug overdose. It was determined that he’d been obtaining prescription drugs through various aliases.
  • Janis Joplin died of a heroin overdose. She was found wedged between a table and the wall with a cigarette in her hand.
  • Heath Ledger, 28, who won a posthumous Oscar for playing the Joker in The Black Knight, was found unconscious in his bed by his housekeeper. Ledger died of acute intoxication due to taking six different prescription drugs.
  • River Phoenix, 23, who was scheduled to perform on stage with the Red Hot Chili Peppers, died from an overdose of heroin and cocaine.
  • Philip Seymour Hoffman, Oscar winning actor who starred in over 40 films, was found dead of an apparent heroin overdose on February 2, 2014. He had been clean for 20 years. Hoffman was 46.
  • Len Bias, pro basketball player, died of a cocaine overdose in 1986.
  • Christopher Bowman, professional figure skater, died of a overdose of cocaine, diazepam, alcohol, and cannabis.
  • William Holden died at 63 after he fell and bled to death following a night of intoxication.
  • Michael Jackson died in 2009 of an accidental overdose of lorazapam and propofol administered by his private physician.
  • Marilyn Monroe died in 1962 at age 36 from an overdose of barbiturates. Officially ruled as a private suicide, although several conspiracy theories still persist.
  • Amy Winehouse, a talented singer with a unique take on jazz, died in 2011 at age 27, from alcohol intoxication.
  • Prince died of an accidental fentanyl overdose in 2009.
  • Anna Nicole Smith succumbed to an overdose of methadone and medication for anxiety and depression in 2007.
  • Tom Petty died from a fatal combination of fentanyl and oxycodone in 2017.
  • John Entwistle, bass player for The Who, died of a heart attack due to a cocaine overdose in 2002.
  • Len Bias, Boston Celtics second overall NBA draft pick, suffered cardiac arrhythmia after an accidental cocaine overdose, and passed away in 1986.
  • Truman Capote died of liver failure secondary to drug and alcohol abuse in 1984 [Ironically, he was brilliantly played by the late Philip Seymour Hoffman in Truman.]
  • David Kennedy, fourth son of Robert F. Kennedy, died from  an overdose of cocaine, meperidine, and thioridazine in 1984.
  • Judy Garland died in 1969 secondary to a barbiturate overdose.

Concluding Remarks

If you know someone who is struggling with active addiction, please talk to them about treatment. If you need help, contact your local Al-Anon chapter. If you are stuck in the bondage of addiction, there is hope. First things first: Contact your local chapter of Alcoholics Anonymous or Narcotics Anonymous. I struggled with active addiction for forty years. Step One says, “We admitted we were powerless over alcohol, and that our lives had become unmanageable.” Drug overdose is the leading cause of death in the United States, with 64,000 deaths last year alone. President Donald Trump said in the State of the Union Address this week that 700 Americans die every day from drug overdose.

The Law of Powerlessness

pow·er·less·ness –ˈpourləsnəs/ noun: lack of ability, influence, or power.

The first step of a 12-step program is to admit that you are powerless over your addiction, and consequently, your life has become unmanageable. For many, this is one of the hardest things to do. While it is important to believe in your ability to overcome your addiction, you first must admit that you have an addiction and you need help in order for things to change. Until you do so, drugs, alcohol and other addictions will continue to exert their power over you and control every aspect of your life. The power of admitting powerlessness is that it is the first step to taking back your life.

power of powerlessness.jpg

We struggle with the concept of powerlessness because it feels so much like helplessness. But God often works through our weakness to bring healing to our lives. It may seem like a contradiction, but there is great strength to be found in recognizing that, within ourselves, we do not have power over an aspect of our lives. The idea that powerlessness will result in strength is the most difficult law to understand and embrace. It is paramount, however, that recovery begin with an understanding of powerlessness. Of note is the fact that powerlessness is vividly portrayed throughout the Bible. In the Book of Judges, for example, we see a pattern in the lives of the Israelites that is similar to the pattern of our own lives.

Our thinking goes something like this. We get so caught up in our own plans and schemes that we stop caring about other people, and we refuse to acknowledge that there is a real God, who deserves respect and obedience. Blinded to the needs of others and the commands of God, we become trapped in our deficient, defective, and devastating ways of trying to find peace and comfort in the midst of all of the problems we have caused for ourselves. Refusing to give up, we try harder and harder to make things work the way we want them to. As we do, we hurt our families and communities and move further away from God.

rock bottom.jpg

Finally, we hit bottom, and there is no way to go but up. Our willingness to change is still weak, and the thought of giving up our addiction is just about the last thing we want to do, but the truth starts to seep into our pores and eventually saturates enough of our being that we begin to see and feel our powerlessness—which has been there all along, throughout our egotistical rants and maniacal attempts to regain control of our lives. As we awaken to our own powerlessness, we begin, for the first time, to allow God to provide us with His strength and to show us His love. As we see even the faintest hint of His strength, we begin to understand how ridiculously powerless we are—and always have been—and we start to allow God to work with us.

As we continue to rely on God’s strength, we begin the step-by-step march toward recovery, transformation, restoration, and victory. As long as we awaken each day to the reality that we are powerless to change ourselves, God will provide His strength as needed, and everything will come together for us.


As we so often do, the Israelites brought tremendous trouble on themselves by thinking they had everything figured out and under control. Instead of being obedient to the ways of God, they did all sorts of evil and unwise things and fell into the hands of a marauding people called the Midianites. The Midianites either ate or destroyed the Israelites’ crops until God’s people were starving. In fact, the Midianites were so cruel that the Israelites made hiding places for themselves in the mountains, caves, and strongholds.

Though the precise details may differ, the Israelites were just like us. We seek comfort in gluttonous amounts of food, alcohol, pornography, adultery, drugs, possessions, and many other compulsions. Rather than connecting us with God and others, these pursuits eventually send us to the hills and caves to hide our shame—that is, if we’re fortunate enough to still possess a conscience. We sometimes spend years of disconnection, fighting for our lives; until, one day, in a state of powerlessness we do what the Israelites did: We cry out to God for help.

Does any of this sound familiar? “Oh Lord, help me and I will never go back to my old ways.” “God, if you will allow me to live, I promise I will live for you.” “God, if you really are God, please show up in my life and get me out of this mess I’ve created for myself.” “Oh God, this time I mean it. Help me now and I will serve you forever.” Interestingly, God would rather hear us say, “Lord, I repent of my wanton lifestyle. I admit I am powerless over [insert addiction], and can do nothing without you. Whether you get me out of this mess or not, I choose to serve you.”


God heard the Israelites and responded, just as He responds to us when we finally realize that we have no power. This is precisely where I failed. I seemed incapable of admitting that I was powerless. I simply did not want to see myself as weak or helpless. We read in Judges 6 that Gideon, who was sent by God to strike down the Midianites, is the weakest of the weak, from the weakest clan in Manasseh. When the angel of the Lord appeared to Gideon, he said, “The Lord is with you, mighty warrior” (Judges 6:12). Did you get that? Up to this point, Gideon had done nothing but be afraid and whiny, yet God called him a hero. God knew what Gideon was going to do, and He addressed him according to what He saw Gideon becoming in the future.

So how often have you gotten in trouble because you felt weak and alcohol, sex, cocaine, opiates, or other addictions made you feel strong—or maybe less weak? You probably thought you were not blessed but cursed by God. When our physical, mental, or emotional handicaps have seemed to disqualify us from making a difference, in the pain of that rejection we have sought comfort from things that could not cure us or even help us. But if we would have read, understood, and believed God’s Word, we would have known that we were perfectly situated for God to do great things through us. People would know that, because of our blatant weakness, it was the power of God and not our own power that produced the result.

Right now, if you are feeling as if there is no hope for your broken life, you’re wrong. You are missing God’s invitation. Maybe you’ve committed a heinous act, and your actions have shown that you are powerless over the urges that lead you to that darkest of places. God is calling upon you to admit your powerlessness and allow Him to give you the strength to confess what you’ve done, pay the legal penalty for the offense, and make restitution for the pain you have caused. Yes, you—a child molester, a wife beater, an arsonist, a drug dealer, a prostitute, an embezzler, or a murderer—are nonetheless a creation of an all-powerful God. When you are willing to admit to Him that you are powerless and are willing to make things right in His way, He will give you the strength to do it. Just as He did with Gideon.


Back to Gideon. The weakest man from the weakest family in the weakest clan in Israel was now put in charge of the weakest imaginable fighting force and told to go into battle—but to do it God’s way. The battle wasn’t pretty, but with jars and ram’s horns and swords and shouts, 300 men, led by an unlikely hero, defeated 135,000 enemy troops. Here’s the point: Gideon was able to admit he was powerless. He knew that without the strength of God, he was still the same powerless, fearful, least-of-the-least man who had cowered in the bottom of a wine press. In the areas of our greatest weakness, God’s strength has allowed us to do the impossible.

Where are you when it comes to the law of powerlessness? Do you still feel as if you have some power left to try a little harder and do a little better and fix yourself? I wanted to be able to fix myself. I guess I thought mom, dad, my brothers and sister, my sons, and the girl in my life would determine I was finally “okay” if I had the personal power to deny my craving for drugs and alcohol. Just stop. I hope you are not holding such an opinion about yourself and your situation. You must come to the end of your rope and turn to God. He has not forgotten you. He has never left you. He has actually been waiting for you to decide to do what He will not force you to do. Remember, we’ve been given free will. He has been waiting for you to call upon Him, admit your powerlessness, and ask for His strength to empower your life.

The law of powerlessness says that if you truly understand and acknowledge that you are powerless, you are about to be provided with all the power you need. If you will simply do the next right thing, one day at a time, a time will come when you will feel as if you are soaring high on eagles’ wings. Don’t miss the remarkable recovery and restoration God has designed for you. If you feel too weak to move forward, admit your weakness to God. Remember what we’re told in 2 Corinthians 12:9: “My grace is enough; it’s all you need. My strength comes into its own in your weakness” (The Message).

If you are feeling weaker than you have ever felt, you are right where God does His very best work. If you will continue to allow Him to, He will do His best work in you, through you, and with you. Don’t give up or give in. Great changes are about to happen in your life and in the lives of those around you. I have been as good as dead in my sin and addiction, truly unable to help myself, pridefully convinced I could pull myself out of a tailspin that was sure to end in a complete crash-and-burn. I was embroiled in active addiction, in bondage to pornography, and committed to protecting my secrets at any cost. But God stayed with me. He continued to reach out through others. Conviction of the Holy Spirit laid bare my sinful conduct. I was completely powerless, but couldn’t bring myself to admit it.

If God can turn my weakness into strength, He can turn your weakness into strength as well. Admitting that we’re powerless is not a decision in the same way that surrendering would be. It is simply a realization of our limitations as human beings. If you’re finally ready to admit your own powerlessness, take a few minutes to memorize the truth in Philippians 4:13: “I can do all things through Him who strengthens me” (NASB). Then get on your knees and admit to God that without Him you cannot break the bondage of addiction. The dichotomy is that there is power in being able to accept your powerlessness.

God bless.


Mobilizing Citizen Science to Address the Overdose Epidemic

From the blog of Dr. Lora Volkow, National Institute of Drug Abuse, posted November 16, 2017.

In the terrorist attack in New York City on October 31, citizens on the scene shared information and pictures in real time via their smartphones, using social media apps like SnapChat. index.png  The social media site recently introduced a location-sharing feature called Snap Maps, which was also used during the Las Vegas shooting, the Mexico City earthquake, and the hurricanes that devastated the Caribbean and some US cities. Could existing social media or new, built-for-purpose apps, be used to attack the opioid problem? It is an area where additional research and partnerships with technology startups could potentially make a big impact.


Social media and crowd-sourcing apps could be particularly useful for gathering and sharing information in real time about overdoses and using that information to prevent overdose deaths, thereby translating “citizen science” into “citizen prevention.” In October, 2016, NIDA partnered with the FDA and SAMHSA in a competition to develop an app that would use a crowd-sourcing approach to facilitate access to naloxone during opioid overdoses. The winning entry (out of 45 submissions) was an app called “OD Help” that will be developed by a Venice, California startup called Team Pwrdby. OD Help will link potential opioid overdose victims with a network of naloxone carriers; it will give instruction in administering the medication; and it can optionally be interfaced with a breathing monitor to detect signs of an opioid overdose and automatically alert the network.

Naloxone kit.jpg

Crowd-sourcing apps could potentially be used to facilitate access to evidence based care in specific regions of the country by sharing information about treatment capacity, waiting lists, and available beds in treatment centers. They could also help opioid-addicted patients in treatment, by enabling them to share their withdrawal experiences, ease fears, and offer suggestions. Families could also share ideas for encouraging loved ones to seek treatment. Crowd-sourcing capabilities like this might also augment mobile health (or mHealth) tools being developed as treatment and recovery aids. One mobile app, the Addiction Comprehensive Health Enhancement Support System (ACHESS) tool, developed with NIH support, utilizes GPS to warn users recovering from alcohol addiction when they are near locations that may be personal triggers for alcohol use; but it can also link users to other ACHESS users via text messaging or to pre-approved family members, friends, or peers for help, thereby bringing the power of crowd-sourcing to recovery support.

Crowd-sourcing is already beginning to change the face of public health. Since 2011 a participatory disease surveillance system called Flue Near You has collected reports of flu-like symptoms encountered by volunteer users via its Website, Facebook, or a mobile app. Similar tools are being used to crowd-source information on food-borne illnesses, toxic waste hazards, and other health threats. They could readily be applied to monitor drug overdoses. [Crowd-sourcing is featured in the new Jeremy Piven crime drama Wisdom of the Crowd. Piven’s software company created a program called “SOPHE,” which is basically Twittr for crime solving, where people can post any evidence or information they have related to a crime.]


The NIDA-funded National Drug Early Warning System (NDEWS) already crowd-sources emerging drug trends from its nationwide network of researchers, such as regional spikes in overdose deaths or emergency department admissions caused by particularly dangerous batches of heroin or counterfeit pills. If augmented with smartphone technology, this information could be more readily used to warn the public and share with public health authorities so that resources could be quickly mobilized to prevent further deaths in an area where a pocket is detected.  Such information could be a boon to implementation research by allowing researchers to determine if a prevention or treatment intervention or a new model for delivery of care was successful in achieving its goals.

The Office of National Drug Control Policy (ONDCP) funded the Baltimore/Washington High Intensity Drug Trafficking Area (HIDTA) to develop an app for first responders and emergency personnel called the Overdose Detection Mapping Application Program (ODMAP). Data gathered through this system can be used to identify localized spikes in overdoses over a 24-hour period, enabling a public health and safety response to be swiftly mobilized. Additionally, the app enables users to enter how many administrations of naloxone were used (if any) and whether the overdose proved fatal, which in turn can help identify areas where more potent opioids or mixed drugs might be responsible for the naloxone failure.

There are obvious issues of privacy protection and bystander legal protection, among others, that will need to be addressed in developing crowd-sourcing apps. But we should not allow the inevitable challenges in this relatively unexplored domain dissuade us from studying the possibilities. If we are going to end the opioid overdose epidemic we need “out of the box” thinking, and must avail ourselves of the new crowd-sourcing possibilities smartphones and social media apps are making possible.


Addressing the Opioid Crisis Means Confronting Socioeconomic Disparities


October 25, 2017


The brain adapts and responds to the environments and conditions in which a person lives. When we speak of addiction as a chronic disorder of the brain, it thus includes an understanding that some individuals are more susceptible to drug use and addiction than others, not only because of genetic factors but also because of stress and a host of other environmental and social factors in their lives that have made them more vulnerable.

Opioid addiction is often described as an “equal opportunity” problem that can afflict people from all races and walks of life, but while true enough, this obscures the fact that the opioid crisis has particularly affected some of the poorest regions of the country, such as Appalachia, and that people living in poverty are especially at risk for addiction and its consequences like overdose or spread of HIV. The Centers for Disease Control (CDC) considers people on Medicaid and other people with low-income to be at high risk for prescription drug overdose.

Below is a pic of teens in Allegheny County, Pennsylvania, the heart of Appalachia.

Teens in Appalachia.jpg

Some of the reasons have to do with access and quality of health care received by people in economically disadvantaged regions. According to the U.S. Department of Health and Human Services, people on Medicaid are more likely to be prescribed opioids, at higher doses, and for longer durations – increasing their risk for addiction and its associated consequences. They are also less likely to have access to evidence-based addiction treatment. But psychological factors also play a role. Last year, economists Anne Case and Agnus Deaton attributed much of the increased mortality among middle-aged white Americans to direct and indirect health effects of substance use, especially among those with less education, who have faced increasing economic challenges and increased psychological stress as a result.

Environmental and social stressors are an important predictor of many mental disorders, and decades of research using animal models have told us a great deal about how such stressors increase risk for substance use, and even make the brain more prone to addiction. Among the best-known animal models of environmental stress and addiction risk are those involving social exclusion and isolation: Solitary animals show greater opioid self-administration than animals housed together, for example – a finding originally made famous by the “Rat Park” experiment of Bruce K. Alexander in the 1970s and replicated by other researchers over the subsequent decades.

Even more pertinent to the question of how low social status might affect addiction risk is research by Michael Nader, who showed that male monkeys who are dominant in their social group demonstrate less cocaine self-administration than lower-ranked (subordinate) animals or solitary ones. Some evidence points to brain circuitry in the insula – a region important in processing social emotions – that may link feelings of social exclusion to increased drug craving, as well as possibly altered dopamine-receptor availability in the striatum – part of the reward circuit – depending on social status. The relationship may be bi-directional. In other words, exclusion not only increases risk for using drugs, but increased drug use can increase social isolation further, creating a vicious cycle. Similarly, when people have strong family or community relationships, this often acts as a protective factor against the risk of becoming addicted, and can facilitate recovery among those striving to achieve it.


Another animal model of environmental stress is an environment without opportunities for play, exploration, and exercise. Rodents housed in non-enriched environments have been shown to be more sensitive to the rewarding effects of heroin compared to those in more enriched environments. A team of researchers at the University of Texas Medical Branch in Galveston recently explored the molecular mechanisms that mediate the protective effects of enriched environments. They analyzed the transcriptome – or the parts of the genome that are expressed – in the nucleus accumbens, which is part of the reward circuit, following cocaine exposure in animals raised in either enriched or dull environments. They identified a number of molecules and signaling pathways, including a pathway involving retinoic acid – a product of Vitamin A metabolism – that may underlie the effects of an enriched environment on the brain’s processing of reward. The researchers suggest that the mild stressors and surmountable challenges presented by an enriched environment act to “inoculate” against stress, making individuals in those environments more resilient.

Although highly simplified, animal models of social and environmental stress can tell us a great deal about how stressful human environments may act as risk factors for substance use and other adverse outcomes and, conversely, how socially supportive and rewarding environments may offer protection. Prevention efforts targeting some of the environmental determinants of substance use, especially in young people, have already shown great success by applying the principles of boosting social support and creating the human equivalent of “enriched environments.” For example, a primary prevention model implemented in Iceland drastically reduced teen substance use in that country by increasing parental involvement and youth participation in team sports.  

opiate painkillers

Blame for the opioid crisis now claiming 91 lives every day is often placed on the supply side: overprescription of opioid pain relievers and the influx of cheap, high-quality heroin and powerful synthetics like fentanyl, which undoubtedly have played a major role. But we cannot hope to abate the evolving crisis without also addressing the lost hope and opportunities that have intensified the demand for drugs among those who have faced loss of jobs and homes due to economic downturns. Reversing the opioid crisis and preventing future drug crises of this scope will require addressing the economic disparities, housing instability, poor education quality, and lack of access to quality health care (including evidence-based treatment) that currently plague many of America’s disadvantaged individuals, families, and communities.


Volkow, N. (October 25, 2017). “Addressing the Opioid Crisis Means Confronting Socioeconomic Disparities.” [Web blog comment.] Retrieved from:  https://www.drugabuse.gov/about-nida/noras-blog


High-Achieving and Religious Students At-Risk Youth For Substance Abuse?

New research shows high-achieving kids are more likely to drink and use drugs during their teen years and develop addictions by adulthood.


DO YOU ASSUME THAT since your kid gets good grades and goes to a good school that they’re not drinking or doing drugs? Think again. That’s the takeaway from two new studies suggesting that academically gifted youths are more likely to abuse substances, both as teens and adults. One surveyed 6,000 London students over nine years. Those with the highest test scores at age 11 were more likely to drink alcohol and smoke marijuana in adolescence – and were twice as likely to do so “persistently by age 20.”

Notably, a study taken by Arizona State University (ASU) study found that high school students who were more afraid their parents would punish them were less likely to drink or get high as adults. One professor, Luthar, said her guidance for parents is to start the conversation in middle school, and not to downplay the seriousness of underage or or excessive drinking. She says, “Tell them it only takes one arrest, and all the things they are working for so hard can be derailed.”


The ASU study followed 330 high-achieving high school students from suburban New England schools. It found that their frequency of drunkenness and use of marijuana, stimulants, cocaine, and other drugs was substantially higher than the norm for their peers. By age 26, they were two to three times more likely to have been diagnosed with an addiction.

“The assumption has always been that if there is a group of kids that are at greatest risk of addiction, it is those living in poverty. Our data shows there is another group at great risk here,” says Suniya Luthar, lead author and ASU psychology professor. Luthar suspects pressure to excel at AP courses and extracurricular activities and get into a good college may drive some to self-medicate. While not all students in her study came from wealthy families, the schools were in affluent neighborhoods where access to disposable income makes it easier to purchase fade IDs, alcohol, and drugs.

Parents with high cognitive ability and socioeconomic status also tend to drink more themselves, thereby modeling a relaxed disposition regarding alcohol consumption as a means of reward or a way to unwind after a hard day. Some of these parents take a laissez-faire attitude when they catch their high-achiever child drinking alcohol. Luthar says, “People assume, ‘How bad can it be? She’s still on the honor roll.'”

We all have a basic need to receive positive regard from the important people in our lives (primarily our parents). Those who receive unconditional positive regard early in life are likely to develop unconditional self-regard. That is, they come to recognize their worth as a person, even while concluding that they are not perfect. Such people are in a great position to actualize their positive potential. Unfortunately, some children repeatedly are made to feel that they are not worthy of positive regard. As a result, they acquire conditions of worth; standards that tell them they are lovable and acceptable only when they conform to certain guidelines. Next comes acquiring a distorted view of themselves and their experiences.

Consider the song “Perfect” by Alanis Morissett:

Sometimes is never quite enough;
If you’re flawless, then you’ll win my love.
Don’t forget to win first place,
Don’t forget to keep that smile on your face.

Be a good boy,
Try a little harder,
You’ve got to measure up,
Make me prouder.

How long before you screw it up?
How many times do I have to tell you to hurry up?
With everything I do for you
The least you can do is keep quiet.

Be a good girl,
You’ve gotta try a little harder;
That simply wasn’t good enough
To make us proud.

I’ll live through you,
I’ll make you what I never was;
If you’re the best, then maybe so am I;
Compared to him compared to her,
I’m doing this for your own damn good,
You’ll make up for what I blew;
What’s the problem, why are you crying?

Be a good boy,
Push a little farther now,
That wasn’t fast enough
To make us happy;
We’ll love you just the way you are
If you’re perfect.


Daily marijuana use is at its highest level among young adults of college age since the early 1980s, with 4.9% of college students reporting daily use, and 12.8% of non-college peers admitting to smoking pot every day. What’s wrong with a little pot smoking? you might ask. There has been a major movement toward legalization of medical marijuana, as well as recreational marijuana, giving the impression that opponents of marijuana are guilty of much ado about nothing. According to a September 2017 study, however, new research suggests that marijuana users may be more likely than non-users to misuse prescription opioids and develop prescription opioid use disorder. The study was conducted by the National Institute on Drug Abuse, part of the National Institutes of Health, in conjunction with Columbia University.

Heavy alcohol use appears to be higher in college students than in non-college peers. Binge drinking (consuming five or more drinks in a row) is practiced by 32.4% of all college students, compared to 28.7 % among those in the same peer group who are not enrolled in college. 40.8% of college students report frequent intoxication (having been drunk) According to Nowinski (1990), a certain degree of rebelliousness develops in the adolescent. This seems to be linked to tension that exists between teens and authority, and reflects the underlying dynamic of individuation. This basic developmental process is the pathway that leads from childhood to adolescence. If it is successful, individuation ends in identity and autonomy. One key dynamic in individuation is the development of willpower. It is important to note that willpower without the ability to plan and delay gratification – this is what the Bible calls temperance or self-control – is dangerous; both are necessary, and teens who develop willpower without self-control are apt to be reckless and to get into trouble. This is especially true of substance abuse.


Substance abuse has fast become America’s number one health problem. Of primary concern is the opiate epidemic, including misuse and abuse of opioid painkillers, especially OxyContin and Fentanyl, and heroin. The substance abuse problem touches the life of every American child, family, congregation, community, and school, and is no respecter of socioeconomic status or culture. Interestingly, however, the opiate epidemic seems to be primarily hitting the category of white low and middle class males between the ages of 18 and 49. Geographic evaluation of the trend shows an initial explosion from within the Appalachian region. This seems to be due to the prevalence of occupations requiring hard labor, with frequent work-related injuries, and eventual economic collapse secondary to joblessness.

Given the tremendous negative impact of substance abuse, researchers, policy makers and practitioners look to identify factors that protect people from initiating the use of drugs, and help people who have become addicted to recover. A growing body of research suggests that religion is an important protective factor against substance use, and that religion may help people who are trying to recover from substance abuse by helping them find meaning, direction and purpose in life. Given the likely impact clergy can have on their congregation, they should pursue continuing education about the causes, consequences, risks and protective factors for substance abuse. Additionally, clergy and faith-based leaders should take a public stand against the use of drugs that is consistent with their personal and denominational beliefs and values.
I believe clergy and church leaders should identify and use congregation members with training, expertise, and experience in the area of addiction (e.g., social workers, addictions counselors, doctors, nurses, and people in recovery) to educate the congregation and create programs and ministries that address the problem. This is especially important for churches who also operate or are affiliated with a Christian-based school. It is advisable for churches to make space available for prevention activities, as well as for people affected by substance abuse (such as Celebrate Recovery).



Community Commons. (October 27, 2016). “Mapping the Opioid Epidemic in the U.S.” [Web blog article.] Retrieved from: https://www.communitycommons.org/2016/10/mapping-the-opioid-epidemic-in-the-us/

Marshall, L. (October 2017). “Smart, Privileged, and At-Risk.” WebMD. 55.

NIH. (September 26, 2017). “Marijuana Use is Associated With an Increased Risk of Prescription Opioid Misuse and Use Disorders.” National Institute on Drug Abuse. Retrieved from: https://www.drugabuse.gov/news-events/news-releases/2017/09/marijuana-use-associated-increased-risk-prescription-opioid-misuse-use-disorders

Nowinski, J. (1990). Substance Abuse in Adolescents & Young Adults: A Guide to Treatment. New York, NY: W.W. Norton & Co.




Originally posted July 18, 2017
National Institute of Drug Abuse

Health and safety agencies in Iowa have issued an advisory to warn Iowans of counterfeit pain pills containing dangerous synthetic opioids. The Iowa Division of Criminal Investigation’s (DCI) laboratory analyzed pills made to resemble the prescription pain reliever oxycodone, finding them to contain more powerful and illicit synthetic fentanyl and U-47700, putting users at higher risk of opioid overdose. U-47700, also known as “Pink” or “U4” on the streets, is a synthetic opioid pain medication currently being distributed as a dangerous designer drug. Since 2015, reports have surfaced of numerous deaths due to street use of U-47700. Law enforcement agencies have traced illegal importation into the United States primarily from clandestine chemical labs in China. It is available through the Dark Web.

Heroin and a Handgun

U-47700 has been seized by law enforcement on the street in powder form and as tablets. Typically, it appears as a white or light pinkish, chalky powder. It may be sold in glassine bags stamped with logos imitating heroin, in envelopes and inside knotted corners of plastic bags. In Ohio, authorities seized 500 pills resembling a manufacturer’s oxycodone immediate-release tablets, but they were confirmed by chemical analysis to contain “Pink.” U-47770 has also been identified and sold on the Internet misleadingly as a “research chemical” at roughly $30 per gram.

Pink is very toxic or deadly in even small doses. Labels on the packaging may state NOT FOR HUMAN CONSUMPTION or FOR RESEARCH PURPOSES ONLY, most likely to avoid legal detection. Fatalities due to U-47770 in the United States join the growing incidents of drug overdose deaths from opioid pain medication. Those who abuse U-47770 may be at high risk of addiction and substance abuse disorder, overdose and death. Fatalities have been reported in New York, New Hampshire, Ohio, Texas, Wisconsin and North Carolina.

In July 2016, a toxicology case report was published in the Annals of Emergency Medicine that detailed events in which fentanyl and U-47700 were being sold misleadingly as the prescription opioid pain medication Norco or Vicodin (acetaminophen and hydrocodone) on the streets of Northern and Central California. In one patient who presented to the emergency room, nalaxone (Narcan) was administered which reversed respiratory depression and pinpoint pupils. After additional chemical analysis, it was found the Norco contained hydrocodone, fentanyl, and U-47700.

Reports indicated that Pink and prescription fentanyl may have been contained in the drug cocktail that led to the death of pop star legend Prince in April 2016. In Utah, two 13-year old boys died in September 2016 reportedly due to use of U-47770 purchased from an Internet website. U-47700 (“Pink”) is a novel synthetic opioid agonist with selective action at the mu-opioid receptors in the brain and on the spinal column. It was originally developed by chemists at Upjohn Pharmaceuticals in the 1970’s as a potent pain reliever for use with cancer patients, post-operative patients with intractable pain, or extremely painful trauma injuries. Although it was never commercially made available, the patent and chemical details remained available, and have been produced on the black market.


U-47700 has a similar chemical profile as morphine and other mu-opioid receptor agonists; however, it has been reported by the National Institute of Drug Abuse (NIDA) that Pink is “far more potent than morphine” –  possibly by seven to eight times. Unfortunately, the strength of the product can never be assured, and may be much stronger, especially when manufactured overseas in illicit labs as a designer drug. On November 14, 2016, the DEA placed U-47700, as well as its related isomers, esters, ethers, and salts into Schedule I of the Controlled Substances Act due to an imminent hazard to public safety and health. Substances in Schedule I have a high potential for abuse, no currently accepted medical use, and a lack of accepted safety for use under medical supervision.

Temporary emergency scheduling of dangerous illicit drugs is one tool the DEA uses to help restrict potentially fatal and new street drugs. Scheduling will last at least 24 months, with a possible 12-month extension if the DEA needs more time to determine whether the chemical should remain permanently as a Schedule I drug. According to the Federal Register, there are no current experimental or approved new drug applications for U-47700, which can typically hinder its permanent placement in Schedule I if approved. DEA’s Final Order is available in the Federal Register with details on threats to public safety. Prior to DEA’s scheduling, several states had already outlawed the drug under emergency orders, including Florida, Ohio, Wyoming and Georgia.


U-47700, known on the streets as “Pink” or “U4”, is a dangerous designer drug exported from illegal labs in China to the U.S. It is a strong opioid analgesic, reportedly 7 to 8 times more potent than morphine. Authorities in many U.S. cities have reported that Pink is sold on the streets or over the Internet, often falsely promoted as a prescription opioid like Norco or Percocet, or as heroin. In fact, many of these products have contained the potent designer drug Pink, as well as fentanyl. U-47700 is now illegal in all forms, and the DEA has temporarily placed the substance into Schedule I of the Controlled Substances Act, pending further review, due to an imminent hazard to public safety and health. It is considered not safe for human consumption, and has no acceptable medical use.

Clusters of overdoses and deaths of Pink were reported in U.S. cities in 2015 and 2016. Some of these deaths involved children. According to one case report, the use of naloxone (Narcan) in an emergency setting reversed the effects of U-47700, but this may not always be the case. Emergency physicians should contact their local poison control center, medical toxicologist or public health department in cases where there is a reasonable suspicion of ingestion of designer drugs to help protect the surrounding community. Special lab analysis is typically needed to identify drugs like “Pink,” leaving communities at risk.

The public should be aware that drugs obtained on the street, even though they look like an authentic prescription medication, may be fake and deadly. Don’t take any prescription drug, legal or otherwise, unless it is prescribed specifically for you by a doctor and is dispensed by a reliable pharmacy.

The Things They Carried

I met an older gentleman at church last Sunday who served in Vietnam. The conversation actually started with the current opiate epidemic in America. I said unfortunately thousands of young men came back from Southeast Asia hooked on heroin. He saw many soldiers smoking weed in order to cope with the horrors of what they were being asked to do, but did not personally see any servicemen using heroin. He was aware that it was going on. He related how he was able to avoid the hell of alcoholism and drug addiction that took hold of countless young men.

I became great friends with a minister who lived across the street from my parents for several years before he and his wife, also a minister, returned to Santa Barbara, California. He related to me the horrors of serving in the Vietnam war. He was a sergeant, and said several of his men died in his arms. In the interest of his traumatic experience and his privacy, I will not give any further details here. I will simply say I was shocked to see that he made it out alive, and is living a life of love and service, in full commitment to the Lord. My uncle also served in Vietnam. I know from family conversations that it was very hard on him. I never felt comfortable asking him to divulge the details. He died several years ago after fighting non-cancerous lumps in the back of his lungs, immune deficiency, and kidney failure. He’d been on dialysis for years. My aunt was told his death was due to exposure to Agent Orange. She receives an additional widow’s benefit specific to his exposure.

My conversation with the fellow churchgoer regarding heroin use among the troops in Vietnam made me think of Air America. Air America was an American passenger and cargo airline covertly owned by the United States government as a dummy corporation for the Central Intelligence Agency (CIA). The National Security Agency farmed out the airline to various government agencies. Air America was used by the U.S. government covertly to conduct military operations, posing as a civilian air carrier, in areas the U.S. armed forces could not go due to treaty restraints contained in the Geneva Accords. Air America’s slogan was, “Anything, Anywhere, Anytime.” The airline flew many types of cargo to countries such as the Republic of Vietnam, the Kingdom of Laos, and Cambodia. It operated from bases in those countries, and also from bases in Thailand, and as far afield as Taiwan and Japan. It also on occasion flew top secret missions into Burma and the People’s Republic of China.

Air America flew civilians, diplomats, spies, refugees, commandos, sabotage teams, doctors, war casualties, DEA officers, and even visiting VIPs like Richard Nixon. Air America moved tons of food, water and livestock into villages devastated  by Agent Orange, as well as ammunition and other materials for troop support. During the CIA’s secret war in Laos (you might remember Nixon’s secret bombings), the CIA used the Hmong population to fight local rebels. The Hmong happened to depend on poppy cultivation for hard currency. Amazingly, poppy has been used for trade in commerce for centuries. When rebels captured the Plain of Jars in 1964, the Laotian air force was unable to land their transport aircraft for opium transport. They had no light planes that could land near poppy fields to load opium. Consequently, the Hmong were facing economic ruin. Air America was the only airline available in northern Laos. Air America began flying opium from mountain villages. How can we not think some of that opium smuggled out of Laos by the CIA ended up as heroin on the streets of America?


I have become captivated by the history of America’s war on drugs. Sometimes, during research, we get led down paths we never expected. This is what happened when I started looking into heroin and Southeast Asia. I found a wonderfully written, haunting, vitally important piece of literature written by Tim O’Brien called The Things They Carried. I began reading, and I was there, in the jungle, with my uncle. With the gentleman from my church. With the men in the story. This was no Full Metal Jacket experience. It was not like I was watching Platoon or Hamburger Hill. Please understand me: Those movies do a great job, as does Saving Private Ryan relative to World War II. This book, however, is literature. It’s like a living, breathing journal. I could not stop reading. It’s been several months since I’ve done a book review, and this is sort of like that, but it’s more like a peek inside a piece of literature that captures the daily life of soldiering in Vietnam. The scene where I pick up the action is graphic, so please be prepared. I don’t make political statements on this blog, and I will not do that in this post. This is more about heroism, service, dedication, obedience, fear, and the raw experience of hell on earth. It’s about literature. Robert Louis Stevenson said, “The difficulty of literature is not to write, but to write what you mean; not to affect your reader, but to affect him precisely as you wish.”

I know what I want you to think, to consider, to feel, about this issue. I would love to hear your feedback. Maybe you know someone who served in Southeast Asia. Perhaps you have a family member or loved one fighting ISIS in the Middle East or the Philippines. Don’t stay silent. If this post sparks an emotion, post your reply. Literature at its best provides us with a blueprint of human civilization. It should remind us of what we’re feeling inside. It should provoke us. Literature plays the vital role of preserving knowledge and experience and passing it on to our successors. Literature might even make us ask the big questions: Why are we here? Who are we? What are our responsibilities? In the instant case, The Things They Carried causes us to think about the idea of war. Is war ever just? What does it mean to be noble? When should we help another nation? When is it proper to back away?

I thought you should know that this book is as much memoir as it is literature. O’Brien served in the 23rd Infantry Division.

From The Things They Carried.

The things they carried were determined to some extent by superstition. Lieutenant Cross carried his good luck pebble. Dave Jensen carried a rabbit’s foot. Norman Bowker, otherwise a very gentle person, carried a thumb that had been presented to him as a gift by Mitchell Sanders. The thumb was dark brown, rubbery to the touch, and weighed 4 ounces at most. It had been cut from a VC corpse, a boy of fifteen or sixteen. They’d found him at the bottom of an irrigation ditch, badly burned, flies in his mouth and eyes. The boy wore black shorts and sandals. At the time of his death he had been carrying a pouch of rice, a rifle, and three magazines of ammunition. “You want my opinion,” Mitchell Sanders said, “There’s a definite moral here.” He put his hand on the dead boy’s wrist. He was quiet for a time, as if counting a pulse, then he patted the stomach, almost affectionately, and used Kiowa’s hunting hatchet to remove the thumb.

Henry Dobbins asked what the moral was.


“You know.”


Sanders wrapped the thumb in toilet paper and handed it across to Norman Bowker. There was no blood. Smiling, he kicked the boy’s head, watched the flies scatter, and said, “It’s like with that old TV show, Paladin. ‘Have gun, will travel.'”

Henry Dobbins thought about it.

“Yeah, well,” he finally said. “I don’t see no moral.”

“There it is, man.”

They carried USO stationery and pencils and pens. They carried Sterno, safety pins, trip flares, signal flares, spools of wire, razor blades, chewing tobacco, liberated joss sticks and statuettes of the smiling Buddha, candles, grease pencils, The Stars and Stripes , fingernail clippers, Psy Ops leaflets, bush hats, bolos, and much more. Twice a week, when the resupply choppers came in, they carried hot chow in green mermite cans and large canvas bags filled with iced beer and soda pop. They carried plastic water containers, each with a 2-gallon capacity. Mitchell Sanders carried a set of starched tiger fatigues for special occasions. Henry Dobbins carried Black Flag insecticide. Dave Jensen carried empty sandbags that could be filled at night for added protection. Lee Strunk carried tanning lotion. Some things they carried in common. Taking turns, they carried the big PRC-77 scrambler radio, which weighed 30 pounds with its battery. They shared the weight of memory. They took up what others could no longer bear. Often, they carried each other, the wounded or weak. They carried infections. They carried chess sets, basketballs, Vietnamese-English dictionaries, insignia of rank, Bronze Stars and Purple Hearts, plastic cards imprinted with the Code of Conduct.

They carried diseases, among them malaria and dysentery. They carried lice and ringworm and leeches and paddy algae and various rots and molds. They carried the land itself — Vietnam, the place, the soil — a powdery orange-red dust that covered their boots and fatigues and faces. They carried the sky. The whole atmosphere, they carried it, the humidity, the monsoons, the stink of fungus and decay, all of it, they carried gravity. They moved like mules. By daylight they took sniper fire, at night they were mortared, but it was not battle, it was just the endless march, village to village, without purpose, nothing won or lost. They marched for the sake of the march. They plodded along slowly, dumbly, leaning forward against the heat, unthinking, all blood and bone, simple grunts, soldiering with their legs, toiling up the hills and down into the paddies and across the rivers and up again and down, just humping, one step and then the next and then another, but no volition, no will, because it was automatic, it was anatomy, and the war was entirely a matter of posture and carriage, the hump was everything, a kind of inertia, a kind of emptiness, a dullness of desire and intellect and conscience and hope and human sensibility. Their principles were in their feet. Their calculations were biological. They had no sense of strategy or mission. They searched the villages without knowing what to look for, not caring, kicking over jars of rice, frisking children and old men, blowing tunnels, sometimes setting fires and sometimes not, then forming up and moving on to the next village, then other villages, where it would always be the same. They carried their own lives.

The pressures were enormous. In the heat of early afternoon, they would remove their helmets and flak jackets, walking bare, which was dangerous but which helped ease the strain. They would often discard things along the route of march. Purely for comfort, they would throw away rations, blow their Claymores and grenades, no matter, because by nightfall the resupply choppers would arrive with more of the same, then a day or two later still more, fresh watermelons and crates of ammunition and sunglasses and woolen sweaters — the resources were stunning — sparklers for the Fourth of July, colored eggs for Easter — it was the great American war chest — the fruits of science, the smoke stacks, the canneries, the arsenals at Hartford, the Minnesota forests, the machine shops, the vast fields of corn and wheat— they carried it like freight trains; they carried it on their backs and shoulders — and for all the ambiguities of Vietnam, all the mysteries and unknowns, there was at least the single abiding certainty that they would never be at a loss for things to carry.


O’Brien, Tim. (1990). The Things They Carried. Boston, MA: Houghton Mifflin.

Community: The Answer to the Opiate Epidemic

The following is taken directly from the Afterword of Sam Quinone’s bestselling book “Dreamland: The True Tale of America’s Opiate Epidemic.” You can purchase a copy of this vital publication here.

BY THE TIME I BEGAN research for this book in 2012, we had, I believe, spent decades destroying community in America, mocking and clawing at the girdings of government that provide the public assets and infrastructure that we took for granted and that make communal public life possible. Meanwhile, we exalted the private sector. We beat Communism and thus came to believe the free market was some infallible god. Accepting this economic dogma, we allowed, encouraged, even, jobs to go overseas. We lavishly rewarded our priests of finance for pushing those jobs offshore. We demanded perfection from government and forgave the private sector its trespasses.

Part of the private sector developed a sense of welfare entitlement. Certainly, in this opiate scourge, it is the private sector that has taken the profits; the costs of dealing with the vast collateral damage have fallen to the public sector. A couple months after this book’s publication, Forbes counted the Sackler family ¹, and Raymond Sackler, the last remaining of the brothers, as the richest newcomer to the magazine’s list of “America’s Richest Families” – with an estimated net worth of $14 billion. All of that was due to sales of OxyCotin, which the magazine estimated at $35 billion since the drug’s release in 1996.²

We seemed to fear the public sphere. Parents hovered over kids. Alarmed at some menace out in public, they accompanied their kids everywhere they went. In one case, a couple was actually charged with allowing their nine-year-old daughter and her sister to go to the park alone. The term “free-range parenting” was coined to describe the daring parents who let their kids out of their sight. No wonder so many kids – boys mostly – were diagnosed with ADHD and prescribed Adderall and other drugs. (I wish someone would study the incidence of opiate addiction [in] teens and young adults of people who as kids were diagnosed with ADHD and prescribed drugs like Adderall.) They spent their lives indoors, cooped up, bouncing off the walls. I can say this because I was one: Boys are like dogs; they need to run and run and run.

When I was a boy in suburban Southern California, we spent our entire free time outside playing – football, basketball, riding bikes, or just running around. We probably ran three or four miles a day every day. My knees were in an almost permanent state of being skinned, with scabs growing and being torn off by my roughhousing. My mother had a bell from her family’s farm in Iowa that she used to ring us home at dinnertime – because we were always running around out of the house. I’ve been back to the street where I grew up eight times in the last few years and have yet to see a human being outside. The park where I used to play is always empty.

Keeping kids cooped up seems to be connected to the idea that we can avoid pain, avoid danger. It doesn’t surprise me to hear that in universities, students, raised indoors on screens, apparently lived in some crystalline terror of any kind of emotional anguish. A 2015 story in the Atlantic called “The Coddling of the American Mind” reported on the phenomenon of college students – kids who grew up in the era of hyper-protection from physical pain – demanding to be protected as well from painful ideas. They were demanding professors provide “trigger warnings” in advance of ideas that might provoke a strong emotional content – for example, a novel that describes racial violence. This new campus ethos, the authors wrote, “presumes an extraordinary fragility of the collegiate psyche, and therefore elevates the goal of protecting students from psychological harm. The ultimate aim, it seems, is to turn campuses into ‘safe spaces’ where young adults are shielded from words and ideas that make some [people] uncomfortable.”

Psychology Today ran a story on “Declining Student Resilience” that [sic] noticed increased neediness in college students, that students had called campus police after seeing a mouse, blaming teachers for poor grades, and “increasingly seeking help for, and apparently having emotional crises over, problems of everyday life.” Professors, the authors continued, “described an increased tendency to see a poor grade as reason to complain rather than reason to study more, or more effectively. Much of the discussions had to do with the amount of hand-holding faculty should do versus the degree to which the response should be something like, “Buck up, this is college!” All of this seems the predictable result of the idea that we should be protected from pain at all costs.

As a country, meanwhile, we acted as if consumption and the accumulation of stuff was the path to happiness. We leave family Thanksgivings to go stand in line to buy products – Xboxes, tablets, and the like – that keep us isolated and that poison our kids, and we go do it as if we have no choice in the matter. We have built isolation into our suburbs and called it prosperity. Added to that mix is the expansion of technology that connects us to the world but separates us from our next-door neighbor. We wound up dangerously separate from each other – whether in poverty or in affluence.

Kids no longer play in the street. Parks are underused. Dreamland lies buried beneath a strip mall. Why then do we wonder that heroin is everywhere? In our isolation, heroin thrives; that’s it’s natural habitat. And our very search for painlessness led us to it. Heroin is, I believe, the final expression of values we have fostered for thirty-five years. It turns every addict into narcissistic, self-absorbed, solitary hyper-consumers. A life that finds opiates turns away from family and community and devotes itself entirely to self-gratification by buying and consuming one product – the drug that makes being alone not just all right, but preferable. [Emphasis added.]

I believe more strongly than ever that the antidote to heroin is community. If you want to keep kids off heroin, make sure people in your neighborhood do things together, in public, often. Form your own Dreamland and break down those barriers that keep people isolated. Don’t have play dates; just go out and play. Bring people out of their private rooms, whatever forms those rooms take. We might consider living more simply. Pursuit of stuff doesn’t equal happiness, as any heroin addict will tell you. People in some places I’ve been may emerge from this plague more compassionate, more grounded, willing to give children experience rather than things, and show them that pain is part of life and often endurable. The antidote to heroin may well be making your kids ride bikes outside, with their friends, and let them skin their knees.

Sam Quinones


1 The richest newcomer to Forbes 2015 list of America’s Richest Families comes in at a stunning $14 billion. The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, flew under the radar when Forbes launched its initial list of wealthiest families in July 2014, but this year they crack the top-20, edging out storied families like the Busches, Mellons and Rockefellers. How did the Sacklers build the 16th-largest fortune in the country? The short answer: making the most popular and controversial opioid of the 21st century – OxyContin. Purdue, 100% owned by the Sacklers, has generated estimated sales of more than $35 billion since releasing its time-released, supposedly addiction-proof version of the painkiller oxycodone back in 1995. Its annual revenues are about $3 billion, still mostly from OxyContin. The Sacklers also own separate drug companies that sell to Asia, Latin America, Canada and Europe, together generating similar total sales as Purdue’s operation in the United States.

2 OxyContin is a dying business in America. Literally. With the nation in the grip of an opiate epidemic that has claimed more than 200,000 lives, the U.S. medical establishment is turning away from painkillers. Top health officials are discouraging primary care doctors from prescribing them for chronic pain, saying there is no proof they work long-term and substantial evidence they put patients at risk. Prescriptions are declining amid increased scrutiny over drug addiction, down 12% since 2012 according to data from healthcare information firm IMS Health. OxyContin saw prescriptions fall 17%.

The Worst Man-Made Epidemic in History

The following is comprised of excerpts from Sam Quinones’ Dreamland: The True Tale of America’s Opiate Epidemic. I want to praise Quinones for this seminal work. Personally, it has defined for me the very nightmare I, and countless others, have lived, each to his or her own level, after discovering the morphine molecule through seemingly acceptable pain medications like Vicodin, Percocet and OxyContin. You can purchase a copy of Dreamland here: Dreamland

AS HEROIN AND OXYCONTIN addiction consumed the children of America’s white middle class, parents hid the truth and fought alone. Quietly. Friends and neighbors who knew shunned them. “When your kid’s dying from a brain tumor or leukemia, the whole community shows up,” said a mother of two addicts. “They bring casseroles. They pray for you. They send you cards. When your kid’s on heroin, you don’t hear from anybody, until  they die. Then everybody comes and they don’t know what to say.”

These parents made avoidable mistakes, and when a son died or entered rehab for the fourth time, they again hid the truth, believing themselves alone, which they were as long as they kept silent. This pervasive lie was easily swallowed. It often lay buried beneath lush lawns, shiny SUVs, and the bedrooms of kids who lacked for nothing. It was easier to swallow, too, because some of these new addicts were high school athletes – the charismatic golden youth of these towns. Athletes opened the door for other students who figured that if cool jocks were using pills, how bad could it be?

One addict was Carter, from one of of California’s wealthiest communities, the son of a banker. Carter had been a high school star in football and baseball. With no break from sports during the year, he battled injuries that never healed. A doctor prescribed Vicodin for him, with no warning on what Vicodin contained, or suggestions for how it should be used. Sports were king in Carter’s town. It was a place of gleaming mansions, but he felt no sense that education was of value in providing choices in life, much less for the love of learning. These kids’ futures were assured. Sports were what mattered. Dads would brag to friends about their sons’ athletic exploits, then berate their boys for poor play, urging greater sacrifice. From the athletic director down to parents and teachers they heard, “You need grades so you can play. That was the vibe we got,” said Carter.

Many new athlete-addicts were not from poor towns where sports might be a ticket out for a lucky few. The places where opiate addiction settled hard were often middle- and upper-class. Parents were surgeons and developers and lawyers who provided their kids with everything. Yet sports were as much a narcotic for these communities as they were to any ghetto. Love of learning seemed absent, while their school weight rooms were palatial things, and in many of them pain pills were quietly commonplace. Just as opiates provided doctors with a solution to chronic-pain patients, Vicodin and Percocet provided coaches with the ultimate tool to get kids playing again.

Carter’s coach told him stories of players years before who were gulping down Vicodin before practices and games. “In my town, the stands were always filled. You wanted to be the hero. So you think, ‘I can’t look weak. I gotta push myself.’ I would get these small injuries. The coaches wouldn’t pay any attention. I taught myself to not pay attention to any injuries.” Most athletes on every team on which Carter played used pills, for injury or recreation. Soon Carter grew addicted to Vicodin, and then to OxyContin. From there, as a student athlete at a Division I university, he began using heroin.

Football players were seen as symbols of this American epidemic. Their elevated status on campus left some of them unaffected by consequences. Carter was caught selling pills and was told not to do it again. Above all, though, players were in constant pain and were expected to play with it. If opiates were now for chronic pain, well, football players endured more chronic pain than most. Necks, thighs, and ankles ached all season. Medicating injuries to get athletes playing through the pain was nothing new. But as oxycodone and hydrocodone became the go-to treatment for chronic pain, organized sports – and football in particular – opened as a virtual gateway to opiate addiction in many schools. Thus, with the epidemic emerged the figure of the heroin-addicted football player. Though, of course, few wanted to talk too much about that.

By 2008, when Jo Anna Krohn’s son died, these kinds of delusions had been accepted for almost a decade in places like Salt Lake, Albuquerque, Charlotte, Minneapolis, and other cities that had for that same decade been the drivers and beneficiaries of the greatest boom in the history of U.S. consumer spending. But it was in beat-down Portsmouth, Ohio, where one mother had the gumption to own the truth and say something about it.


ACROSS PORTSMOUTH, AT THE Counseling Center, Ed Hughes thought silence was a huge part of the story. Opiates had exploded all those plans Hughes had in the mid-1990s to consolidate the Counseling Center’s operations and focus on improving its internal workings. The center opened years before in a small house. By 1992 it began residential treatment with 16 beds. This quickly increased to 150 beds, with a huge waiting list, and a staff of close to 200. It moved its outpatient center into an abandoned three-story school due entirely to the swarms of new opiate addicts.

“We’ve never seen anything move this fast,” said Hughes. A decade and a half in, Ed Hughes was still waiting for the arc of addicted clients to plateau and curve downward. Kids were coming to the center from across Ohio. Many, said Hughes, grew up coddled, bored, and unprepared for life’s hazards and difficulties. They’d grown up amid the consumerist boom that began in the mid 1990s. Hughes believed parenting was changing as well. “Spoiled rich kid” syndrome seeped into America’s middle class. Parents shielded their kids from complications and hardships, and praised them for minor accomplishments – all as they had less time for their kids.

“You only develop self-esteem one way, and that’s through accomplishment,” Hughes said. “You have a lot of kids who have everything and look good, but they don’t have any self-esteem. You see twenty-somethings: They have a nice car, money in their pocket, and they got a cell phone… a big-screen TV. I ask them, ‘Where the hell did all that stuff come from? You’re a student.’ ‘My mom and dad gave it to me.’ And you put opiate addiction in the middle of that?” Hughes added, “Then the third leg of the stool is the fifteen-year-old brain.”

Hughes saw this all the time: Adult drug users incapable of making mature choices. This happened because opiates stunted the part of their brain controlling rational action. ¹ “We’ve got twenty-five- to thirty-year-old, opiate-addicted people who are going on fifteen. Their behavior, the way their brain works, is like an adolescent,” said Hughes. “It’s like the drug came in there and overwhelmed that brain chemistry, and the front of the brain did not develop.” He added, “The front of the brain has to develop through mistakes. But the first reaction to the addicted person is to head back to the family: ‘Will you rescue me?’ Whatever the person’s rescued from, there’s no learning. There’s no experiences, no frontal brain development. They’re doing well and then some idea comes into their head and they’re off a cliff. It may not be a decision to use [drugs]. Most relapse comes not from the craving for the drug. It comes from this whole other level of unmanageability, putting myself in compromising situations, or being dishonest, being lazy – being a fifteen-year-old.”


FIVE YEARS AFTER PORTSMOUTH found itself swept up in a national epidemic, the victims of America’s opiate scourge had emerged from the shadows and the silence. They were everywhere now. Heroin had traveled a long way from the back alleys of New York City and William Burrough’s Junky. The town of Simi Valley agonized over a spate of opiate overdose deaths – eleven in a single year. Simi Valley, conservative and religious, has long been an enclave for cops. Many LAPD officers live in the town. Simi’s vice mayor at the time was a Los Angeles police officer. So for years Simi was one of America’s safest towns. According to the crime statistics, it still is. But with pills everywhere and heroin sold in high schools, its kids were now also dying of dope. Simi youths clogged the methadone clinic. Nearby, Thousand Oaks, Moorpark, and Santa Clarita told similar stories. Low crime and high fatal overdoses was the new American paradigm.

Susan Klimuski, whose son Austin died from a heroin overdose, formed a coalition to fight back. It was called Not One More. It received support from city council and the town’s retail core. Yet these were times when heroin was still invisible, conveniently hidden away, at least to anyone who wasn’t a junkie, or a parent of one. Then, on Super Bowl Sunday 2014, America awoke to the news that one of its finest actors was dead. Philip Seymour Hoffman, forty-six, was found that morning in his Greenwich Village apartment, a syringe in his arm and powder heroin in packets branded with the Ace of Spades near his corpse. Blood tests showed he had heroin in his system, combined with cocaine, amphetamine, and benzodiazepine. The Oscar-winning actor – a father of three- had checked into rehab the previous May for ten days, and then, pronouncing himself sober again, left to resume a hectic film schedule. This death hit me right between the eyes. I was a die-hard fan of Hoffman’s acting. He had a heroin habit in college (twenty years ago), but managed to get clean. At least for two decades. Hoffman’s death awoke America to the opiate epidemic.

Within days of covering the story of Hoffman’s death, media outlets from coast to coast discovered that thousands of people were dying. Heroin abuse, the news reports insisted, was surging. Almost all the new heroin addicts were hooked first on prescription painkillers. It was not just the pain, however. This scourge was connected to the conflation of bigger forces: of economics, of aggressive prescription drug marketing, of poverty and prosperity. But this was tough to articulate in four-minute interviews, and a lot of it got lost in the media’s rush to discover and report the new plague. Attorney General Eric Holder described an “urgent and growing public health crisis,” and called on police and paramedics to carry naloxone, an effective antidote to opiate overdose. The problem also prompted Surgeon General Vivek H. Murthy, M.D., M.B.A. to issue a report in November 2016 on alcohol, drugs and health. This is the most comprehensive health crisis report issued by a surgeon general since cigarette smoking. You can read a PDF of the entire report here.

Two decades since the evolving pain revolution,² a consensus emerged that opiates are not helpful for some varieties of chronic pain, including back pain, migraines, and fibromyalgia. In fact, it was finally decided that opiate use is risky. Many clinics and physicians developed policies against using opiates for chronic non-cancer pain. One 2007 survey of studies of back pain and opiates found that “use disorders” were common among patients, and “aberrant” use behavior occurred in up to 24 percent of the cases. It was unclear whether opiates had a positive effect on back pain in the long term. Personally, I have found that opiates do nothing more than create a euphoria that tends to distract me from the pain for a few hours, only to ebb, thus requiring more opiates. By the end of the 2000s, it was already common for people to go from abusing opiate painkillers to a heroin habit. Purdue Pharma, the inventor of OxyContin (who paid a $635.5 million fine for falsely claiming their formulation of the drug oxycodone in time-released pills was far less addictive) recognized this, and in 2010 they reformulated OxyContin with an abuse deterrent, supposedly making the drug even harder to deconstruct and inject.

Unfortunately, by this time, heroin had spread to most corners of the country because the rising sea level of opiates flowed there first. “What started as an OxyContin and prescription drug addiction problem in Vermont as now grown into a full-blown heroin crisis,” said Governor Shumlin. What made New York City the dominant heroin market for much of the twentieth century – its vast number of addicts, and its immigrants from poppy-rich regions of the globe – was now true of most of America. Most of the country’s heroin was coming from Mexico, through the Southwest, trucked into New York. The entrepreneurial Xalisco brothers from Nayarit, Mexico, devised a system for selling heroin across the United States that resembles pizza delivery. An addict calls and places an order, and an operator directs him to an intersection or parking lot. The dealer carries balloons of heroin in his mouth. He simply spits out what the addict ordered. If the cops move on the dealer, he washes the balloons down his throat with a swig from a nearby bottle of water. No evidence, no arrest. The dealers have also been known to deliver to the door for “clients” that are home-bound due to illness or disability.

What started as a concern among physicians for a solution to chronic pain was hijacked by greedy Big Pharma, eventually morphing into nationwide heroin use and addiction resulting from the medical community and the government tightened the reins on prescriptions. Of course, whenever drugs are involved, there is always someone at the ready to provide a system of delivery to dope-sick addicts and chronic pain sufferers hankering for release.


¹ Adolescence and young adulthood is a period of continued brain growth and change. The frontal lobes, key to executive functioning, such as planning, working memory, and impulse control, are among the last areas of the brain to mature. Age is a risk factor that is associated with the onset of drug use in adolescence and young adulthood. Adolescence is a developmental period associated with the highest risk for developing a substance use disorder.

² During the 1990s changes in attitudes and techniques in pain treatment were coming quickly. In 1996, the president of the American Pain Society, Dr. James Campbell, proposed that pain should be assessed in the same manner as other vital signs. They trademarked the slogan, “Pain: The Fifth Vital Sign.” This led to the 0-10 pain intensity scale now prevalent in every ER and doctor’s office in America. Essentially, doctors were finally given more power in prescribing opiates to patients suffering from chronic pain who were not cancer patients.


Quinones, Sam. (2015). Dreamland: The True Tale of America’s Opiate Epidemic. New York, NY: Bloomsbury Press

Winters, K. and Arria, K. (2011). “Adolescent Brain Development and Drugs.” The Prevention Researcher, 18(2), 21–24.

The Role of Science in Addiction

From the New England Journal of Medicine
May 31, 2017
By Nora D. Volkow, M.D, and Francis S. Collins, M.D., Ph.D.

Opioid misuse and addiction is an ongoing and rapidly evolving public health crisis, requiring innovative scientific solutions. In response, and because no existing medication is ideal for every patient, the National Institutes of Health (NIH) is joining with private partners to launch an initiative in three scientific areas:

  1. developing better overdose-reversal and prevention interventions to reduce mortality, saving lives for future treatment and recovery;
  2. finding new, innovative medications and technologies to treat opioid addiction; and
  3. finding safe, effective non-addictive interventions to manage chronic pain.

Overdose-Reversal Interventions

Every day more than 90 Americans die from opioid overdoses. Death results from the opioid’s antagonistic effect on brainstem neurons that control breathing. In other words, the victim succumbs to respiratory failure. Naloxone can be used effectively to reduce the effect of opioid intoxication, thereby reversing the overdose, if it is administered in time. Although naloxone has saved tens of thousands of lives, overdoses frequently occur when no one else is around, and often no one arrives quickly enough to administer it.

Overdose fatalities have also been fueled by the increased availability of very powerful synthetic opioids such as fentanyl and carfentanil (50-100 times and 5,000-10,000 times more potent than heroin respectively). Misuse or accidental exposure to these drugs (e.g., when laced in heroin) is associated with very high overdose risk, and naloxone doses that can often reverse prescription-opioid or heroin overdoses may be ineffective. New and improved approaches are needed to prevent, detect and reverse overdoses.

Treatments for Opioid Addiction

The partnership will also focus on opioid addiction (the most serious form of opioid use disorder), which is a chronic, relapsing illness. Abundant research has shown that sustained treatment over years or even a lifetime is often necessary to achieve and maintain long-term recovery. Currently, there are only three medications approved for treatment: methadone, buprenorphine, and extended-release naltrexone. These medications, coupled with psychosocial support [such as rehab and 12-step programs] are the current standard of care for reducing illicit opioid use, relapse risk, and overdoses, while improving social function. There is a clear need to develop new treatment strategies for opioid use disorders. New pharmacologic approaches aim to modulate activity of the reward circuitry of the brain.

Non-Addictive Treatment for Chronic Pain

The third area of focus is chronic pain treatment: over-prescription of opioid medications reflects in part the limited number of alternative medications for chronic pain. Thus, we cannot hope to prevent opioid misuse and overdose without addressing the treatment needs of people with moderate-to-severe chronic pain. Though more cautious opioid prescribing is an important first step, there is a clear need for safer, more effective treatments.

Foremost is the plan to develop formulations of opioid pain medication with built-in abuse deterrent properties that are more difficult to manipulate for snorting or injecting, the routes of administration most frequently associated with misuse because of their more immediate rewarding effects. Such formulations, however, can still be misused orally and still lead to addiction. Thus, a more promising long-term avenue to addressing pain treatment will involve developing a powerful non-addictive analgesic. There are some fascinating x-ray crystallography studies going on that look promising.

Non-pharmacologic approaches being explored today, including brain-stimulation technologies such as high-frequency repetitive transcranial magnetic stimulation (rTMS, already FDA-approved for depression), have shown efficacy in multiple chronic pain conditions. At a more preliminary stage are viral-based gene therapies and transplantation of progenitor cells to treat pain. NIH researchers are investigating the use of gene therapy to deliver a potent anti-inflammatory protein directly to painful sites. Pre-clinical studies show powerful and long-lasting effects in reducing pain without side effects such as numbness, sedation, addiction, or tolerance.

Public-Private Partnerships

In April 2017, the NIH began discussions with pharmaceutical companies to accelerate progress on identifying and developing new treatments that can end the opioid crisis. Some advances may occur rapidly, such as improved formulations of existing medications, opioids with abuse-deterrent properties, longer-acting overdose-reversal drugs, and repurposing of treatments approved for other conditions. Others may take longer, such as opioid vaccines, and novel overdose-reversal medications. For all three areas, the goal is to cut in half the time typically required to develop new safe and effective therapeutics.

As noted throughout the history of medicine, science is one of the strongest allies in resolving public health crises. Ending the opioid epidemic will not be any different. In the past few decades, we have made remarkable strides in our understanding of the biologic mechanisms that underlie pain and addiction. But intensified and better-coordinated research is needed to accelerate the development of medications and technologies to prevent and treat these disorders. The scope of the tragedy of addiction and overdose deaths plaguing our country is daunting. The partnership between NIH and others will take an all hands on deck approach to developing and delivering the scientific tools that will help end the opiate epidemic in America and prevent it from reemerging in the future.


Volkow, N. and Collins, F. (May 31, 2017). “The Role of Science in Addressing the Opioid Crisis.” The New England Journal of Medicine. DOI: 10.1056/NEJMsr1706626

Volkow, L. (May 31, 2017). “All Scientific Hands On Deck to End the Opioid Crisis.” [Web blog comment]. Retrieved from : https://www.drugabuse.gov/about-nida/noras-blog/2017/05/all-scientific-hands-deck-to-end-opioid-crisis