The Opioid Issue: Part 3

Part Three: A System on the Brink

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Already under tremendous strain from a lack of qualified homes and social support, the American foster care system is staring down its toughest opponent yet: the opioid epidemic. Typically, when a mother or father in active addiction has young dependent children, agencies such as Children and Youth or Child and Family Services will remove the children from their parents. Of course, family court judges nearly always focus on possibly reuniting the children and their parents after they become clean and sober.

Consider the mother of a child who was born addicted to opiates. The court removed the infant from the mother’s care and placed him in foster care. After the mother was able to stay clean for one year and put her life back together, the child was returned to her. Sadly, the mother ultimately relapsed, and the child’s health and welfare were put in jeopardy. He would need to reenter the foster care system, this time with the goal of being adopted permanently. Foster Care CollageAccording to the U.S. Department of Health and Human Services (HHS), nearly half a million children nationwide were living in foster care arrangements in 2016—and that number has been rising for the last four years. One could say the very heart of the nation’s foster system is aching for any sort of relief.

A Century-Old Practice

Since creating a Children’s Bureau in 1912, the U.S. government has played a critical role when parents can no longer care for their minor children due to illness, death, criminal activity and/or substance abuse. That care—provided mainly by individual foster families or relatives, but also through group homes and institutions—has at times extended to other nations, such as the more than 8,000 European refugee children who were fostered in American homes during World War II.

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Though it has successfully kept millions of children fed, clothed, educated, sheltered and safe over the last 106 years, the American foster system hasn’t been foolproof. In 1972, when President Richard Nixon declared a “National Action for Foster Children Week” to recruit more foster families, the system has been highlighted mostly for its deficits: Too few willing foster parents, too many kids, too little funding and support, too hard on the heart for everyone involved.

Margie Nielsen deals with those shortcomings daily. As the director of Foster Care & Adoption Ministries at Louisiana Baptist Children’s Home (LBCH)—a nonprofit ministry founded in 1899, more than a decade before official government foster care was created—Nielsen’s organization is an official partner of the Louisiana Department of Children & Family Services. Certified foster parents run residential “cottages” that each accommodate up to six children between the ages of 5 and 17. LBCH exists to educate, inform, encourage, support, and strengthen current and prospective foster parents.

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While there are many families who clearly are not called to foster, everyone can and should be involved in supporting the families who are. In James 1:27, God’s Word teaches, “Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world” (NIV). It is our duty as the Body of Christ to help foster families to understand the call God has placed on their lives and to help equip them to answer that call. A joy, yes—but the last few years have greatly expanded the need for people to answer that call.

With opioid addiction soaring to crisis level, it certainly calls for more information to be disseminated. And while drug addiction of any kind affects everyone, the nation’s opioid crisis has upped the ante. The necessity of developing preventive strategies is felt more than before.

Little Victims

While the connection between drug abuse and children needing foster care is nothing new—think heroin in the 1970s, cocaine in the 1980s, and meth in the 1990s—what has changed the game for today’s foster care system has been the sheer percentage of Americans struggling with opioid addiction across all demographics. The cold hard truth: That number staggers at more than two million, according to the American Society of Addiction Medicine, a 60-year-old professional society for treatment providers based in Maryland.

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According to the National Institute of Health, 21 to 29 percent of patients suffering from chronic pain misuse their prescription opioids, and that often puts them on the path to harder drugs; about 80 percent of people who use heroin first abused prescription opioids, Tragically, around 116 people in the United States die from an opioid overdose every day—that’s one death every seven minutestranslating into tens of thousands of dead Americans annually. In fact, the U.S. Centers for Disease Control and Prevention reports more than 200,000 people died from prescription opioid overdoses between 1999 and 2016.

It stands to reason that a significant portion of those people who died, as well as the millions living with addiction, were or are parents of minor children. Indeed, HHS reports 30,000 more children were living in foster homes nationwide in 2015 than in 2012, and substance abuse (including, but not limited to, opioids) was cited as a reason in about one-third of those placements. Drug addiction does not discriminate; sadly, it can hit any family at any time. And often, when it does, children of those struggling with addiction enter the already-pressed foster system.

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Simply put, there are not enough foster homes in the United States to accommodate the burgeoning number of kids needing short- and long-term care. In California, for example, the Los Angeles Times reports the number of available beds in qualified foster homes fell from 22,000 in 2000 to just 9,000 in 2016. Massachusetts had more than 6,100 foster children in 2016, but less than 4,800 foster homes, according to The Boston Globe. Such shortages have led to reports of foster children sleeping in government offices and even hotels around the nation while their social workers scramble to find willing families.

But it’s not just the dearth of available foster parents that concerns child welfare advocates. Though government reports show about one-quarter of all formal foster care placements are with relatives (sometimes called kinship care), the vast majority of foster families are strangers to foster children. According to the National Center for Missing & Exploited Children, 88 percent of the 25,000 children who reported ran away from home in 2017 were in foster care at the time. Many of those runaways become the victims of sex traffickers.

We need to pray that as each day passes these foster children (who have had their tiny world shattered by drug abuse) survive—indeed, thrive—and that they live with hearts full of love and hope. Sadly, the future is yet unclear regarding America’s opiate epidemic. Moreover, we don’t know the full scope of opioid crisis’ on the foster system still has yet to be revealed. These little victims never had the choice to be exposed to the drugs. They can’t Just Say No.

Thousands upon thousands of little Americans are waiting to be seen, helped and healed.

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The Opioid Issue: Part 2

Part Two: Collateral Damage

As the nation grapples with opioid’s hold over millions, its smallest victims cry out to be heard, held, and healed. No Child Left Behind is a familiar battle cry. But to foster parents helping to care for children of parents addicted to drugs, those words have nothing to do with a political agenda or advertising campaign. One foster mom reported quietly watching another baby detox from opiates, its high-pitched wails unique with the sound of drug-induced anguish, and whispering, “A whole generation is being lost from the opioid epidemic. A whole generation.”

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That generation—with hundreds of thousands of America’s youngest feeling its physical, mental, and emotional impact, sometimes from the moment of conception—is staring down what doctors call Neonatal Abstinence Syndrome (NAS). The condition is not something that can be cured with a pill. There are so many children growing up without their parents that the long-term ramifications are still unforeseen. The United States has certainly faced its share of social and public health problems over the years, but when it comes to the opioid crisis, child advocates around the country warn, it’s a strange and scary new world.

Agony in the Womb

According to a study released by the University of Minnesota this spring, one baby struggling with NAS is born in America every 15 minutes. Furthermore, almost 90 percent of pregnancies among women struggling with opioid addiction are unintentional. When a woman takes opioids while pregnant—even exactly as a doctor might instruct, according to the March of Dimes—she runs the substantial risk of harming her unborn child.

One Baby Every Half Hour

Prescription painkillers like codeine, fentanyl, hydrocodone, morphine, and oxycodone (as well as the street drug heroin) are all classified as opioids and all negatively affect children in the womb. Common risks of opioid use during pregnancy, the March of Dimes says, include miscarriage, preterm labor, premature birth, birth defects, low birth weight (defined as weighing less than five pounds, eight ounces), and NAS. NAS is its own beast. The completely preventable condition can grip babies with tremors, fever, chills, weight loss, seizures, and even death. Dr. W. David Hager, member of Focus on the Family’s Physicians Resource Council (PRC), believes 55-94% of newborns delivered to women who used opioids in pregnancy suffer from NAS.

Clearly, it is nearly impossible for an unborn child to skate past the consequences of his or her mother’s opioid use, no matter how slight. Yet damage isn’t usually intentional. Instead, Hager says, addiction to opioids reaches far beyond the initial physical pleasure to something much deeper.

It All Adds Up

That’s a familiar story for J. Scott Moody and Wendy Warcholik, a married pair of economists. As the directors of Family Prosperity Institute (FPI), a New Hampshire-based think tank focused on measuring the health of the American family, Moody and Warcholik frequently hear about opioid-related crises—and have watched their own loved ones succumb to substance abuse along the way. Warcholik, for example, grew up in a family fragmented by her parents’ collective five divorces. Of all her siblings, she was the only one to have fully escaped the negative consequences. The others have experienced unemployment, substance abuse, government dependency, low educational attainment, unwed childbirth, and divorce.

FPI has created a family prosperity index—a formula-driven rankings list that measures the strength and prosperity of families and the nation by combining the most important economic and social data into a single number and then ranking those states based on which create the best environment for families to thrive. The index fills in the gaps around other measures like the gross domestic product, assembling all the pieces of the prosperity puzzle into a complete picture of the economy. No other measure takes into consideration both the economic and social choices of people in a state to create a holistic measure of human behavior in the States.

The latest FPI index ranked Utah first and New Mexico last. FPI’s formula calculates things like average welfare utilization, children in married households, religious attendance and infant mortality rate. That last category is most disconcerting because as opioid use has risen, so has infant mortality rate. (The U.S. Centers for Disease Control and Prevention defines that as the death of an infant before his or her first birthday), while the infant mortality rate is the number of infant deaths for every 1,000 live births.

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Between 2010 and 2015 twenty-one states saw an increase in their infant mortality rate. So many states, in fact, that while the national average dropped 16 percent between 2000 and 2015, the last five years only saw a decrease of 1.6 percent. Clearly, if trends continue, the country could see an increase in the infant mortality rate in the near future. Keep in mind that a rising infant mortality rate is typically only found in Third World countries. Besides the physical, emotional and mental cost to America’s children, opioid addiction doesn’t come fiscally cheap, either. For example, in 2015 Ohio paid more than $133 million to care for approximately 2,000 NAS babies born that year.

The True Cost

Interestingly, FPI’s research shows that devout beliefs and behaviors (consistent church attendance, daily prayer, Bible reading, etc.) reduce illicit drug use. The converse holds true as well. Moody says, “It is clear that people in despair who don’t turn to God for help will try to numb their pain some other way, whether it be with drugs or sex. Unfortunately, at least for the last decade, we’ve been seeing more and more people turning to drugs and sex than God. We have to reverse this trend.”

Ultimately, America truly has no idea what the long-term consequences of opioid addiction on our most innocent citizens will be. “We read horrifying stories in New England about parents shooting up their own children just to keep them quiet, or left in a freezing car with their parents passed out in the front seat,” Warcholik says. How far are we, as a society, willing to go in elevating adult desires over the health and well being of our children?

That is a question far beyond the scope of any research team—but one the Church must rise up to help answer.

 

 

The Opioid Issue: Part 1

Part One: Dangerous Prescriptions

The opioid crisis seems to hit everyone, everywhere, regardless of socioeconomic class, geography, age, profession, or religious affiliation. Overdosing on drugs, especially opiates and heroin, is now the most common cause of death for Americans under fifty years of age. I spent forty years embroiled in active addiction. It started innocently with a case of beer, but quickly led to marijuana, cocaine, and inhalants. The longer I struggled, the more hopeless I became. Friends stopped calling me or inviting me to parties. Family felt they could no longer trust me given the hundreds of broken promises and countless runs on their medicine cabinets for opiates. Although I was able to stop drinking and taking street drugs in 2008, I battled with benzodiazepines (Xanax, Ativan) and oxycodone for another eight years. I am blessed presently with nearly two years without taking narcotics.

Opiates in Pill Bottles

This epidemic has reached every corner of the United States. This is the first in a series of blog posts regarding opiate addiction in America. This series will address dangers of opiate prescriptions, collateral damage, impact on the nation’s foster care system, homelessness and addiction, troubling developments in drug rehabilitation, addiction and crime, and a Christian response to the crisis.

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Current medical opinion indicates the reason the U.S. is experiencing a disastrous epidemic of opioid abuse can be summed up in two words: pain avoidance. In the 1990s there was a proliferation of health care professionals trying to address the symptom [of pain] and not so much the underlying causes of the pain a person has. In 2015, opioid-related deaths stole the lives of over 33,000 Americans. To put this number into perspective, this outnumbers fatal car crashes and gun deaths during the same year. According to the federal government, in 2016 the nation mourned close to 64,000 deaths from drug overdoses. Two-thirds of those involved the misuse of opioids. Karl Benzio, M.D., a Christian psychiatrist and member of Focus on the Family’s Physicians Resource Council (PRC), fears the toll could reach 80,000 deaths in 2018.

We wouldn’t be here if opioids weren’t so effective. Americans want something for their pain—regardless of whether that pain is physical, mental, or emotional. We live in a psychologically compromised society that is impatient and entitled, whose citizens feel there should be no pain in life. Accordingly, greater demands have been made on providers to eliminate all pain with medication. The problem is—and I know this all too well firsthand—once a patient gets a taste of the relief, some develop a dependence that leads them down a dark path. Ironically, that path leads only to deeper struggles. For some, the exit will only come in the form of fatal overdoses as opioids shut down the body’s ability to breath.

It is time we start helping patients deal with life’s pain and its root causes head-on, rather than masking it through medication.

How it All Began

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The current crisis can be traced back nearly forty years. Medical researcher Hershel Jick and graduate student Jane Porter of Boston University Medical Center analyzed data from patients who had been hospitalized there. Close to 12,000 had received at least one dose of a narcotic pain medication during their stay. Of those, Jick and Porter’s analysis found only four had developed a well-documented addiction. Jick sent the findings to the New England Journal of Medicine, who published his analysis as a letter to the editor in 1980. “Despite widespread use of narcotics [sic] drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction,” Jick wrote. Unfortunately, this quote was given far more merit than it deserved. Moreover, the conclusion had not been subjected to peer review.

In 1990, Scientific American called the Jick/Porter research “an extensive study.” About a decade later, Time proclaimed it “a landmark study.” Most significantly, Purdue Pharmaceuticals, maker of the popular narcotic OxyContin, began a promotion asserting less than one percent of patients treated with their time-released opiate medication OxyContin would become addicted. In the 1990s, pain was correlated with a greater probability of a patient having ongoing health issues. So the medical community elevated it to the position of the fifth vital sign along with heart rate, blood pressure, body temperature, and respiratory rate. The medical community, thinking that reducing pain would help long-term patient satisfaction, health and outcomes, started to prescribe more pain meds.

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The ’90s also saw the development of stronger and more effective opioid painkillers. As the decade drew to a close, the opioid epidemic was ignited. It took some time for most of the country to realize the metaphorical fuse had been lit, but the numbers back up this concern. According to the U.S. Department of Health and Human Services (HHS), between 2000 and 2017 opioid prescriptions increased 400 percent. Between 2000 and 2010, misuse involving noncompliance with prescription instructions or using medications prescribed for another person doubled. Now, the results are playing out in heartbreaking fashion nationwide, which are impossible to ignore. Overdose deaths—116 per day, according to federal statistics—are shaking Americans of all incomes, ages, and ethnicity. From the rural back roads of Appalachia (Kentucky, West Virginia) to the urban sprawl of New York and Los Angeles, the epidemic is cutting a path that threatens to leave no family unscathed.

The Blame Game

It’s become quite popular (if not convenient) to lay the blame for the epidemic squarely at the feet of the big pharmaceutical companies. For example, according to an article in the Los Angeles Times in May of this year, more than 350 cities, counties, and states had filed lawsuits against makers and distributors of opioid painkillers. The LA civil action accuses drugmakers and distributors of deceptive marketing aimed at boosting sales, claiming the companies borrowed from the “tobacco industry playbook.” One of the companies most frequently put under scrutiny has been Purdue Pharma, maker of OxyContin.

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In May The New York Times called Purdue “the company that planted the seeds of the opioid epidemic through its aggressive marketing of OxyContin.” The Times article uncovered a disturbing report on OxyContin compiled by the U.S. Department of Justice, which found that Purdue Pharma knew about and concealed significant incidents of abuse of OxyContin in the first years after the drug hit the market in 1996. The article further noted that Purdue Pharma admitted in open court in 2007 that it misrepresented the data regarding OxyContin’s potential for abuse.

Overdose Deaths Not Just Related to Opiate Prescriptions

Government reports have recently stated that today’s increase of fatal opioid-related overdoses is being driven by abuse of heroin and illicit fentanyl. A study prepared by the National Institute on Drug Abuse last September found that overdose deaths from heroin and other drugs laced with fentanyl increased 600 percent between 2002 and 2015. Street dealers have increasingly been cutting their drugs with fentanyl—a particularly dangerous and relatively inexpensive substance 50 to 100 times more powerful than morphine—to boost their profit margins. In most cases, the users don’t even realize they’re buying fentanyl-laced products.

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It is important to note that although many people believe Big Pharma is complicit in fueling the epidemic and should shoulder the loin’s share of the blame, Dr. Benzio sees it differently. “Pharmaceutical companies only make the meds,” Benzio says. “Only about 6 to 8 percent of people who take an opioid will misuse or overuse it in a destructive way. It is the doctors who over-prescribe and a society that is looking for a quick fix and can’t tolerate any discomfort [that’s to blame].”

The Road Ahead

The opiate epidemic may have grown somewhat quietly, but the nation’s attention is riveted to it now and policymakers aren’t sitting still. In 2016, Massachusetts became the first state to limit the duration for painkiller prescriptions at seven days. Since then, more than two dozen other states have also established limits. In my home state of Pennsylvania, Governor Tom Wolf initiated a statewide prescription drug monitoring system to help prevent prescription drug abuse. Of concern is the practice of “doctor shopping,” which involves a patient visiting multiple doctors and emergency departments in search of opioids. Unfortunately, this is something I did quite often while in active addiction. This practice often necessitates filling prescriptions at multiple pharmacies. The governor’s new policy includes the monitoring program, a standing order for naloxone (Narcan, used to reverse the effects of an opiate overdose), a patient non-opioid directive (which allows patients to opt out of opioid pain medicine in advance) a “warm hand-off” where ER attending physicians and other providers can set up a face-to-face introduction between a patient and a substance abuse specialist, and revised prescribing guidelines relative to opiates.

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At the federal level, President Donald Trump declared the opioid crisis a public health emergency in 2017, and formed a commission to fight it. Meanwhile, HHS now has a multi-pronged strategy to get the crisis under control, including getting better data through research and improving prevention, treatment, pain management, and recovery services. The federal crackdown is estimated to cost $13 billion to $18 billion over the next two years. Dr. Benzio believes this is “a good start,” but said providers must resist the urge to automatically jump to the quick fix of narcotics for those in pain. “There are many ways to combat pain through physical therapy and fitness, relaxation, better sleep and nutrition,” says Benzio. It seems likely that we will not get a significant handle on opioid abuse until the core issues that lead people to the drugs are addressed.

The Christian Perspective

W. David Hager, M.D., a member of the PRC, notes three principle root issues in addiction: rejection, abandonment and abuse. Hager has been a facilitator for the Christian program Celebrate Recovery. He said, “Unless we enable [people] to identify their root issue and deal with it first, the rates of relapse are high. When they are able to deal with their root issues by offering forgiveness, making amends, and seeking a personal relationship with Jesus Christ, we find that large numbers are able to enter and maintain sobriety.” That is why the Church has the unique ability to make a difference in combating the opioid crisis.

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“We have to convince faith-based communities to get their hands dirty, to get involved and realize that this is an issue,” Benzio says. He suggests inviting laypeople to develop a working knowledge of dopamine, the brain chemical that provides the pleasure-inducing sensation many who use drugs are seeking. “There is only one [higher] power that can sever synapses in the brain that have been stimulated by a substance to achieve [a certain] dopamine level,” he adds, “and that’s the power of the Holy Spirit.”

Exactly how Christians appropriate the Spirit’s power to take on the opioid crisis will vary from case to case. The point, Benzio and Hager say, is that this needs to become a top-of-mind concern for the Church. But are North American churches up to the mission of addressing opioid use among their members? Pastors are in a unique position to proclaim and demonstrate the Gospel to individuals struggling with addiction. Many are too ashamed to confess an addiction to pain medication. As the opioid crisis deepens, so must the response of the local church. If the Christian church has anything to offer those hurting from drug addiction, it is hope and community. I was only able to break the bondage of addiction over my life through the Power in the Name of Jesus.

Power in the Name of Jesus

Programs such as Narcotics Anonymous and Celebrate Recovery have been extremely effective in changing lives, but it’s not always enough. Addressing the root of addiction is one of the most effective long-term solutions, which for Christians is about the heart. The church must be willing and capable of seeing those struggling with addiction as not merely a program of the church’s community outreach; these individuals are children of a God who loves them no matter their current condition. I believe America’s recovery can find its roots in the local church.

What does love look like? It has the hands to help others. It has the feet to hasten to the poor and needy. It has eyes to see misery and want. It has the ears to hear the sighs and sorrows of men. That’s what love looks like. -St. Augustine

 

 

Partnering With Dentists and Oral Surgeons to Fight Opiate Addiction

From the blog of Dr. Nora Volkow, Executive Director of NIDA, posted July 25, 2018

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Reducing the reliance of doctors on potentially addictive opioid pain relievers has been one of the pillars of federal efforts to reverse the opioid crisis. Because many dental procedures such as extractions and other types of oral surgery often produce severe acute pain, dentists are among the largest prescribers of opioids. Thankfully, the dental profession has made significant progress in reducing opioid prescriptions. Two decades ago, when the opioid crisis was just starting, dentists accounted for 15.5 percent of all immediate-release opioid prescriptions; by 2012, they only wrote 6.4 percent of such prescriptions. Still, those in the oral health professions can play a key role in further improving the treatment of acute pain and making it safer.

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In March of this year, the American Dental Association (ADA) released a new policy on opiods, supporting limits on dosage and duration of opioid prescriptions and mandatory continuing education on their use, as well as recommending that dentists make use of their regional prescription drug monitoring program (PDMP). This policy is an important step toward protecting patients and their families from the potential harms of opioids. Following a meeting between representatives of the National Institute on Drug Abuse (NIDA), the National Institute of Dental and Craniofacial Research (NIDCR), and the ADA, NIDCR director Martha Somerman and Dr. Volkow wrote an editorial in this month’s issue of the Journal of the American Dental Association about how a partnership between NIH and oral health practitioners can continue to alleviate the opioid overdose epidemic.

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Increased knowledge of opioid prescribing practices among dentists, as well as among emergency department physicians when managing acute dental pain, is an important research priority. While dentists have reduced their opioid prescriptions, recent studies suggest the same is not true of emergency department providers when patients have dental pain. A study of Medicaid recipients showed that physicians in the ER prescribed opioids for dental pain five times more often than dentists in their own practices, and nurse practitioners in the ER prescribed opioids three times as often. Understanding the ways opioids are prescribed and the decisions underlying opioid prescribing can inform new clinical guidelines and policies to reduce the risks of opioid misuse. 

Concluding Remarks

Dentists can play a role in minimizing opioid abuse through patient education, careful patient assessment and referral for substance abuse treatment when indicated, and using tools such as prescription monitoring programs. Research is needed to determine the optimal number of doses needed to treat dental-related pain. Besides reducing their prescribing of opioids, these practitioners can learn to screen for opioid misuse and opioid use disorders, ultimately referring patients to treatment when indicated. To this end, NIDCR plans to fund research studies of interventions in rural communities.

These practitioners cannot assume that their prescribing of opioids does not affect the opioid abuse problem in the United States. Dentists, along with other prescribers, take steps to identify problems and minimize prescription opioid abuse through greater prescriber and patient education; use of peer-reviewed recommendations for analgesia; and, when indicated, the tailoring of the appropriate and legitimate prescribing of opioids to adequately treat pain.

Ambitious Research Plan to Help Solve the Opioid Crisis

From the blog of Dr. Lora Volkow, National Institute on Drug Abuse Posted June 12, 2018

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In spring 2018 Congress added an additional $500 million to the NIH budget to invest in the search for solutions to the opioid crisis. The Helping to End Addiction Long-term (HEAL) initiative is being kicked off June 12th with the announcement of several bold projects across NIH focusing on two main areas: improving opioid addiction treatments and enhancing pain management to prevent addiction and overdose. The funding NIDA is receiving will go toward the goal of addressing addiction in new ways, and creating better delivery systems for addictions counseling for those in need.

NIH will be developing new addiction treatments and overdose-reversal tools. Three medications are currently FDA-approved to treat opioid addiction. Lofexidine—a drug initially developed to treat high blood pressure—has just been approved to treat physical symptoms of opioid withdrawal. Narcan (naloxone) is available in injectable and intranasal formulations to reverse overdose. Regardless, more options are needed. One area of need involves new formulations of existing drugs, such as longer-acting formulations of opioid agonists and longer-acting naloxone formulations more suitable for reversing fentanyl overdoses. Compounds are also needed that target different receptor systems or immunotherapies for treating symptoms of withdrawal and craving in addition to the progression of opioid use disorders.

Much research already points to the benefits of increasing the availability of treatment options for Opioid Use Disorder (“OUD”), especially among populations currently embroiled in the justice system. Justice Community Opioid Innovation Network is working to create a network of researchers who can rapidly conduct studies aimed at improving access to high-quality, evidence-based addiction treatment in justice settings. It will involve implementing a national survey of addiction treatment delivery services in local and state justice systems; studying the effectiveness and adoption of medications, interventions, and technologies in those settings; and finding ways to use existing data sources as well as developing new research methods to ensure that interventions have the maximum impact.

The National Drug Abuse Treatment Clinical Trials Network (“CTN”) facilitates collaboration between NIDA, research scientists at universities, and a myriad of treatment providers in the community, with the aim of developing, testing, and implementing addiction treatments. As part of the HEAL initiative, the CTN Opioid Research Enhancement Project will greatly expand the CTN’s capacity to conduct trials by adding new sites and new investigators. The funds will also enable the expansion of existing studies and facilitate developing and implementing new studies to improve identification of opioid misuse and OUD. Further, it will enhance engagement and retention of patients in treatment in a variety of general medical settings, including primary care, emergency departments, ob/gyn, and pediatrics.

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A great tragedy of the opioid crisis is that there are a number of effective tools not being deployed effectively in communities in need. Only a fraction of people with OUD receive any treatment, and of those less than half receive medications that are universally acknowledged to be the standard of care. Moreover, patients often receive medications for too short a duration. As part of its HEAL efforts, NIDA will launch a multi-site implementation research study called the HEALing Communities Study in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA). The HEALing Communities Study will support research in up to three communities highly affected by the opioid crisis, which should help evaluate how the implementation of an integrated set of evidence-based interventions within healthcare, behavioral health, justice systems, and community organizations can work to decrease opioid overdoses and prevent and treat OUD. Lessons learned from this study will yield best practices that can then be applied to other communities across the nation.

The HEAL Initiative is a tremendous opportunity to focus taxpayer dollars effectively where they are needed the most: in applying science to find solutions to the worst drug crisis our country has ever seen.

Find Help Near You

The following website can help you find substance abuse or other mental health services in your area: www.samhsa.gov/Treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org. We also have step by step guides on what to do to help yourself, a friend or a family member on our Treatment page.

Opioids

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as Fentanyl, and pain relievers available by prescription such as codeine, oxycodone, Vicodin, morphine, and others.

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All opioids are chemically related and interact with opioid receptors on nerve cells in the brain and on the spinal column. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to addiction, overdose, and death. 

An opioid overdose can be reversed with the drug naloxone (Narcan) when given right away. Improvements have been seen in some regions of the country in the form of decreasing availability of prescription opioid pain relievers and decreasing misuse among the Nation’s teens. However, since 2007, overdose deaths related to heroin have been increasing. Fortunately, effective medications exist to treat opioid use disorders including methadone, Buprenex and Vivitrol. 

A National Institute of Drug Abuse (NIDA) study found that once treatment is initiated, both a Buprenex/Vivitrol combination and an extended-release Vivitrol formulation are similarly effective in treating opioid addiction. However, Vivitrol requires full detoxification, so initiating treatment among active users is difficult. These medications help many people recover from opioid addiction.

What are Prescription Opioids?

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Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made by scientists in labs using the same chemical structure. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea. Opioids can also make people feel very relaxed and high, which is why they are sometimes used for non-medical reasons. This can be dangerous because opioids can be highly addictive. Overdoses and death are common. Heroin is one of the world’s most dangerous opioids, and is never used as a medicine in the United States.

How Do People Misuse Opioids?

Prescription opioids used for pain relief are generally safe when taken for a short time and as directed by a doctor, but they can be misused. People misuse prescription opioids by:

  • taking the medicine in a way or dose other than prescribed
  • taking someone else’s prescription medicine
  • taking the medicine for the effect it causes—getting high

How Do Prescription Opioids Affect the Brain?

Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience.

Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can have short- and long-term psychological and neurological effects, including coma, permanent brain damage, or death. Researchers are also investigating the long-term effects of opioid addiction on the brain, including whether damage can be reversed.

What are Other Health Effects of Opioid Medications?

Older adults are at higher risk of accidental misuse or abuse because they typically have multiple prescriptions and chronic diseases, increasing the risk of drug-drug and drug-disease interactions, as well as a slowed metabolism that affects the breakdown of drugs. Sharing drug injection equipment and having impaired judgment from drug use can increase the risk of contracting infectious diseases such as HIV.

Prescription Opioids and Heroin

Prescription opioids and heroin are chemically similar and can produce a similar high. Heroin is typically cheaper and easier to get than prescription opioids, so some people switch to using heroin instead. Nearly 80 percent of Americans using heroin (including those in treatment) reported misusing prescription opioids prior to using heroin. However, while prescription opioid misuse is a risk factor for starting heroin use, only a small fraction of people who misuse pain relievers switch to heroin. This suggests that prescription opioid misuse is just one factor leading to heroin use.

The Numbers

More than 64,000 Americans died from drug overdoses in 2016, including illicit drugs and prescription opioids. This number has nearly doubled over the past ten years. 2015 was the worst year for drug overdoses in U.S. history. Then 2016 came along. In that year alone, drug overdoses killed more people than the entire Vietnam War did.

A chart of US drug overdoses going back to 1999.

The Opioid Epidemic Explained

This latest drug epidemic is not solely about illegal drugs. It began, in fact, with a legal drug. Back in the 1990s, doctors were persuaded to treat pain as a serious medical issue. There’s a good reason for that: About 100 million U. S. adults suffer from chronic pain, according to a report from the Institute of Medicine.

Chronic Pain The Silent Condition

Pharmaceutical companies took advantage of this concern. Through a big marketing campaign they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term non-cancer related chronic pain is very weak despite their effectiveness for severe short-term, acute pain—while the evidence that opioids cause harm in the long term is very strong. So painkillers inundated society, landing in the hands of not just patients but also teens rummaging through their parents’ medicine cabinets, other family members and friends of patients, and the black market.

As a result, opioid overdose deaths trended up — sometimes involving opioids alone, other times involving drugs like alcohol and benzodiazepines (Xanax, Ativan, Valium) typically prescribed to relieve anxiety. By 2015, opioid overdose deaths totaled more than 33,000 — close to two-thirds of all drug overdose deaths. The numbers have grown exponentially over the past three years.

What Can We Do?

Seeing the rise in opioid misuse and deaths, officials have cracked down on prescription painkillers. Law enforcement, for instance, now threaten doctors with incarceration and loss of their medical licenses if they prescribed the drugs unscrupulously. Ideally, doctors should still be able to get painkillers to patients who truly need them — after, for example, evaluating whether the patient has a history of drug addiction. But doctors, who weren’t conducting even such basic checks, are now being instructed to give more thought to their prescriptions.

Yet many people who lost access to painkillers are still addicted. So some who could no longer obtain prescribed painkillers turned to cheaper, more potent opioids bought off the street, such as heroin and Fentanyl. Not all painkiller users went this direction, and not all opioid users started with painkillers. But statistics suggest many did. A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention (CDC) found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.

So other types of opioid overdoses, excluding painkillers, also rose. That doesn’t mean cracking down on painkillers was a mistake. It appears to have slowed the rise in painkiller deaths, and it may have prevented doctors from prescribing the drugs to new generations of people with drug use disorders. But the likely solution is to get opioid users into treatment. According to a 2016 report by the Surgeon General of the United States, just 10 percent of Americans with a drug use disorder obtain specialty treatment. The report found that the low rate was largely explained by a shortage of treatment options. Given the exorbitant cost of health care in America today, that is simply unacceptable. Federal and state officials have pushed for more treatment funding, including medication-assisted treatment like methadone and Buprenex.

Source: National Institute on Drug Abuse; National Institutes of Health; U. S. Department of Health and Human Services.

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.