NIH Study Yields Important Insight Into Addiction and Pain

From the web blog of Dr. Lora Volkow, director of the National Institute of Drug Abuse dated May 6, 2018.

We are on the verge of a new era in medicine, one that truly treats the patient as an individual and as a participant in his or her own care. New data-gathering and analytic capabilities are enabling the kinds of massive, long-term studies needed to investigate genetic, environmental, and lifestyle factors that contribute to disease. Fine-grained insight into prevention and treatment is creating a truly precision, individualized form of medicine, the payoffs of which are already striking in such areas as cancer treatment.

Recently, the NIH Precision Medicine Initiative launched All of Us, a massive study set to gather data from a million Americans across all demographic, regional, and health/illness spectrums. It will use electronic health records to track the health and medical care received by participants for a decade or more, incorporating surveys, blood and urine samples, and even data from fitness trackers or other wearable devices. For the time being, recruitment is limited to those 18 or older, but future stages will include children as well. The data will be open-access for researchers—and of course, anonymous.

The All of Us study will benefit addiction science in many ways, such as yielding valuable data on the influence of substance use and substance use disorders on various medical conditions. Information on use of alcohol, tobacco, opioids, and perhaps other substances is liable to be captured in the electronic health records used for this study, and surveys will also capture lifestyle-related information including substance use and misuse. Gathering these records and survey data over time will provide important insight into how common forms of substance use impact treatment outcomes for a range of common diseases. It could yield valuable insights into genetic risk factors for substance use and substance use disorders as well as predictors of responsiveness to treatment using different medications. Links between substance use, substance use disorders, and other psychiatric problems such as depression and suicide can also be explored with such a large sample.

Factors affecting pain and its treatment are also directly relevant to addiction, especially in the context of the current opioid crisis. All of Us could provide valuable data on demographic variations in pain prescribing, telling us what groups (ethnic, age, and gender) are being prescribed opioids as opposed to other medications or non-pharmacological treatments. It will also tell researchers how these treatments affect patients’ lives. This data set will help answer questions about the role opioid treatments may play in the transition from acute to chronic pain, for instance, and what role opioid treatment plays in development of opioid use disorders or other substance use disorders. It will also help us understand what other factors, such as mental health or other co-morbidity, affects trajectories associated with pain.

Like the ABCD study currently underway to study adolescent brain development, the All of Us study is deliberately open-ended. It is understood that rapidly advancing technology will give us the ability not only to answer new questions but also ask questions that might not even occur to researchers currently. Consequently, All of Us is being designed to allow the ingenuity of the research community to explore how this dataset can be utilized and design new ways of making it address their specific research questions.

Why is Early Childhood Important to Substance Abuse Prevention?

Abundant research in psychology, human development, and other fields has shown that events and circumstances early in peoples’ lives influence future decisions, life events, and life circumstances—or what is called the life course trajectory. People who use drugs typically begin doing so during adolescence or young adulthood, but the ground may be prepared for drug use much earlier, by circumstances and events that affect the child during the first several years of life and even before birth.

Intervening early in childhood can alter the life course trajectory in a positive direction.

The first, overarching principle drawn from research is that intervening early in childhood can alter the life course trajectory of children in a positive direction. Early childhood includes prenatal through age 8, as delineated by the following developmental periods:

  • Prenatal Period (conception and birth)
  • Infancy and Toddler (birth to 3 years)
  • Preschool (ages 3 through 5)
  • Transition to School (ages 6 through 8 years)

The “transition to school” period is actually part of the middle childhood and early adolescence period (6 to 13 years), but is addressed separately here because it is a major and significant transition in the child’s development. The middle childhood period is followed by adolescence (ages 13 to 18). The age range for interventions that form the basis for the principles of prevention described in this resource is prenatal through 8 years.

Life course perspectives show risk for drug abuse; How Do We Prevent it?

The period of development discussed above is typically characterized by rapid orderly progressions of normal patterns of physical, cognitive, emotional, and social development. Such development is marked by important transitions between developmental periods and the achievement of successive developmental milestones. How successfully or unsuccessfully a child meets the demands and challenges arising from a given transition, and whether the child meets milestones on an appropriate schedule, most certainly has an affect on his or her future course of development, including an elevated risk for drug abuse or other mental, emotional, or behavioral problems during adolescence.

A number of risk factors can interrupt or interfere with unfolding developmental patterns in all of these periods and, especially, in the transitions between them. Prevention interventions designed specifically for early developmental periods can address these risk factors by building on existing strengths of the child and his or her parents (or other caregivers) and by providing skills (e.g., general parenting skills and specific skills like managing aggressive behavior), problem-solving strategies, and support in areas of the child’s life that are underdeveloped or lacking.

The child’s stages of life, aspects of his social and physical environments, and life events he experiences over time all contribute to his physical, psychological, emotional, and cognitive development.

Life events or transitions represent points during which the individual is in a period of fluidity, sometimes referred to as sensitive, critical, or vulnerable periods. Although vulnerability can occur at various stages throughout the life course, it tends to peak at critical life transitions, which present risks for substance abuse as well as opportunities for intervention. Thus transitions such as pregnancy, birth, or entering preschool or elementary school are prime opportunities to introduce skills, knowledge, and competencies to facilitate development during those transitions. Therefore, interventions are often designed to be implemented around periods of transition.

What are the major influences on a child’s early development?

The changes unfolding throughout a child’s development are influenced by a complex combination of factors. One of them is the genes the child inherits from his or her biological parents. Genetic factors play a substantial role in an individual’s development through the course of life, influencing a person’s abilities, personality, physical health, and vulnerability to risk factors for behavioral problems like substance abuse. But genes are only part of the story.

Another very important factor is the environment, or the contexts into which the child is born and in which the child grows up. The family/home environment is the context that most directly influences the young child’s early development and socialization. This includes quality of parenting and other parenting influences such as genetic factors and family functioning. Also, siblings, if present, can influence a child’s development and adjustment (e.g., internalizing and externalizing behaviors and substance use, as well as positive behaviors). These influences may result from shared environmental experiences and interactions with parenting and other family factors. But conditions at home are also influenced by wider physical, social, economic, and historical realities—such as the family’s socioeconomic status and the affluence and safety of the community in which the family lives. As the child grows older and enters school, these wider environmental contexts influence him or her more directly.

Throughout early childhood, even when the child enters preschool or attends day care, the family remains the most important context for development. Parents play a number of roles in the development of a young child’s social, emotional, and cognitive competence, including establishing the structure and routines for parent-child interactions; maintaining a sensitive, warm, and responsive relationship style; and providing instructional practices and experiences that help the child acquire necessary developmental skills.

When a nurturing, responsive relationship does not exist, elevated levels of stress hormones can impede a child’s healthy brain development. Moreover, when a caregiver cannot provide attention and nurturing because of a history of trauma, chronic stress, and/or mental health problems, the child is more likely to develop behavioral, social, emotional, or cognitive problems. Likewise, impaired judgment related to substance use can reduce a parent’s ability to create a warm, supportive environment for the child. Child abuse and neglect, social isolation due to illness or disability, and lack of constancy in the primary caregiver (as in the case of a child in institutionalized care) are also linked to growth (including brain growth and neuronal connectivity), cognitive, motor, social, and emotional problems. Many of the prevention interventions discussed in this guide are aimed at facilitating constant, nurturing, responsive caregiving to reduce risk and prevent child behavior problems.

Transition to School.

As the child grows older, new transitions and associated challenges occur. A major transition for young children is beginning elementary school. Even children who attended preschool or had been in day care can find the rules for behavior and academic requirements associated with elementary school difficult to adapt to and achieve. Readiness for school is something that occurs over time with experience and practice. Early intervention can help parents and schools assist children through this transition. Once in elementary school, teachers can help children to adjust by providing positive classroom management.

Intervene early in childhood.

Research over the past three decades has identified many factors that can help differentiate individuals who are more likely to abuse drugs from those who are less likely to do so. Risk factors are qualities of a child or his or her environment that can adversely affect the child’s developmental trajectory and put the child at risk for later substance abuse or other behavioral problems. Protective factors are qualities of children and their environments that promote successful coping and adaptation to life situations and change. Protective factors are not simply the absence of risk factors; rather, they may reduce or lessen the negative impact of risk factors.

All children will have some mix of risk and protective factors. An important goal of prevention is to change the balance between these so that the effects of protective factors outweigh those of risk factors. Both risk and protective factors may be internal to the child (such as genetic or personality traits or specific behaviors) or external (that is, arising from the child’s environment or context), or they may come from the interaction between internal and external influences.

Some important early childhood risk factors for later drug use.

Some factors that powerfully influence a child’s risk for later substance abuse and other problems have their strongest effects during specific periods of development. Important examples include:

Prenatal Period

  • Maternal smoking and drinking can affect a developing fetus and may result in altered growth and physical development and cognitive impairments in the child.

Infancy and Toddlerhood

  • Having a difficult temperament in infancy may set the stage for the child having trouble with self-regulation later, as well as create challenges for the parent-child relationship.
  • Insecure attachment during the child’s first year of life can cause a child to be aggressive or withdrawn, fail to master school.
  • Uncontrolled aggression when a child is a toddler (2 to 3 years) can lead to problems when he or she enters preschool, such as being rejected by peers, being punished by teachers, and failing academically.

Preschool

  • Lack of school readiness skills such as failure to have learned colors, numbers, and counting will put a child at a disadvantage in a classroom environment, setting the stage for poor academic achievement.

Transition to School

  • Poor self-regulation can lead to frustration and constant negative attention on the child by peers and teachers at school.
  • Lack of classroom structure in the school environment can lead to additional social and behavioral problems in children who have trouble switching from one activity to another.

Other risk factors can affect a child in any developmental period. Some important ones are:

  • Stress: All children experience stress at some point, and in fact a certain amount of stress helps young children develop skills for meeting challenges and coping with setbacks that inevitably occur in life. But chronic stressors like family poverty and stress that is intense or prolonged—such as a parent’s mental health problems or a lingering illness—can diminish a child’s ability to cope. These types of stress can even interfere with proper development, including brain development, and aspects of physical health like proper functioning of the immune system. This is particularly true of children who have experienced the extreme stress of maltreatment, such as abuse or neglect, by parents or caregivers. Some children who experience a lot of stress early in life, even during the prenatal period, are more susceptible to the effects of later stressful life circumstances than other people.
  • Parental substance use: Parental substance use—including smoking, drinking, illicit drug use, and prescription drug abuse—can affect children both directly and indirectly. Substances used by a mother during pregnancy can cross the placenta and directly expose the fetus to drugs, and substances can pass to a nursing infant through breast milk. When parents smoke in the home, it can also expose children to secondhand smoke, putting them at risk for health and behavioral problems, as well as increasing children’s likelihood of smoking when they grow older. Parental substance use can also impact the family environment by giving rise to family conflict and poor parenting, which could increase risk for child abuse and neglect and involvement with the child welfare system. Poor family functioning can increase the risk for multiple problem behaviors in children and adolescents, including risk for substance use and abuse. Children with a family history of drug abuse also may have increased genetic risk for substance use, often manifested in combination with family or other environmental risk factors. Children can learn about substance use from a very young age, especially if exposed to parental substance use and abuse. However, children are less likely to smoke, drink alcohol, or use other drugs when parents are clear that they do not want their children to do so, even if they use substances themselves.
  • Emergent mental illness. Many mental illnesses have symptoms that can emerge during childhood and can increase risk for later drug abuse and related problems. For example, anxiety disorders and impulse-control disorders (such as ADHD) begin their onset prior to 11 years of age, on average, but frequently symptoms may appear in early childhood. Symptoms associated with impulse-control disorders, such as aggressive disruptive behavior, as well as those associated with affective and psychotic disorders all increase the risk of substance use disorders and related problems in adolescence.

If not successfully addressed when they initially present themselves, early risk factors and associated negative behaviors can lead to greater risks later in childhood and in adolescence, such as academic failure and social and emotional difficulties, all of which put an individual at increased risk for substance abuse.

https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood

 

 

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.

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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.

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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.

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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.

Disobedience-

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.”

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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.

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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.

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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.

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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.]

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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

FROM THE BLOG OF DR. NORA VOLKOW, EXECUTIVE DIRECTOR
NATIONAL INSTITUTE ON DRUG ABUSE

October 25, 2017

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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.

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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.

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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.

References

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.

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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.”

BETWEEN 23% AND 40% OF HIGH-ACHIEVING UPPER MIDDLE-CLASS BOYS ARE DIAGNOSED WITH DRUG OR ALCOHOL DEPENDENCE BY AGE 26 ACCORDING TO A STUDY OF NEW ENGLAND HIGH SCHOOL STUDENTS.

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.

23% OF FULL-TIME COLLEGE STUDENTS ABUSE OR ARE DEPENDENT ON DRUGS AND ALCOHOL – THAT’S TWO AND A HALF TIMES THE NATIONAL AVERAGE.

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.

CONCLUDING REMARKS

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).

 

REFERENCES

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.

 

COUNTERFEIT OXYCODONE WARNING!

COUNTERFEIT PAIN PILLS CONTAINING DANGEROUS SYNTHETIC OPIOIDS!

Originally posted July 18, 2017
National Institute of Drug Abuse
https://www.drugabuse.gov/

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.

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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.

BOTTOM LINE

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?

THE REASON I BROUGHT THIS UP

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.

“Moral?”

“You know.”

Moral.

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.

References

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

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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%.