Jesus Calling

EXCERPT FROM JESUS CALLING
©2014 Sarah Young
July 19

Bring Me all your feelings, even the ones you wish you didn’t have. Fear and anxiety still plague you. Feelings per se are not sinful, but they can be temptations to sin. Blazing missiles of fear fly at you day and night; these attacks from the evil one come at you relentlessly. Use your shield of faith to extinguish those flaming arrows. Affirm your trust in Me, regardless of how you feel. If you persist, your feelings will eventually fall in line with your faith.

Do not hide from your fear or pretend it isn’t there. Anxiety that you hide in the recesses of your heart will give birth to the fear of fear: a monstrous mutation. Bring your anxieties out into the Light of My Presence, where we can deal with them together. Concentrate on trusting Me, and fearfulness will gradually lose it foothold within you.

EPHESIANS 6:16; 1 JOHN 1:5-7; ISAIAH 12:2

The Roof (Reprise)

Up here
on the roof,
I am tall,
taller than all,
at the apex:
not of height,
nor of stature;

just here
at the edge
where anything
is possible:
creativity,
destruction,
enlightenment,
apostasy;
whatever I choose
begins up here
at the edge
of heaven and hell

where God waits,
and angels watch;
where birds soar
without awareness
of my struggle,
or my questions,
or my potential,
good or bad;

below, a community
ekes out its
existence,
parading
up and down
the streets
and avenues,
with no inkling
of what comes
next;

life in
pieces, its
very blood spilled
on the macadam
of tomorrow.

©2017 Steven Barto

The above is a revised version of my initial poem The Roof. Something was missing. Then it hit me: This is a commentary on the increased gun violence in America. It is not an anti-gun poem. It is not an anti-Second Amendment poem. It is an annotation on an extremely prevalent and entirely serious problem. American citizens are killing each other at a rate higher than in any other industrialized nation. We’re using every imaginable weapon and method, from bludgeoning to strangulation; from stabbing to poisoning. We just happen to be using GUNS at an alarming rate. The closing stanza uses the phrase “its very blood spilled on the macadam of tomorrow.” THIS reference is about gun violence.

Jesus Calling

EXCERPT FROM JESUS CALLING
©2004 Sarah Young

July 14

Keep walking with Me along the path I have chosen for you. Your desire to live close to Me is a delight to My heart. I could instantly grant you the spiritual riches you desire, but that is not My way for you. Together we will forge a pathway up the high mountain. The journey is arduous at times, and you are weak. Someday you will dance light-footed on the high peaks; but for now your walk is often plodding and heavy. All I require of you is to take the next step, clinging to My hand for strength and direction. Though the path is difficult and the scenery dull at the moment, there are sparkling surprises just around the bend. Stay on the path I have selected for you. It is truly the path of life.

ISAIAH 40:31; PSALM 37:23-24; PSALM 16:11

Where Is This God of Yours?

Whenever I am feeling lost or frustrated, or think God is not there, I remember the trials and tribulations of David, which prompts me to open my Bible to the Psalms. Today I opened my copy of “The Message//Remix” translation by Eugene H. Peterson and remarkably the ribbon bookmark was at Psalm 42. I decided to share it with you.

A white-tailed deer drinks
from the creek;
I want to drink God,
deep drafts of God.
I’m thirsty for God-alive.
I wonder, “Will I ever make it –
arrive and drink in God’s presence?”
I’m on a diet of tears –
tears for breakfast, tears for supper.
All day long
people knock at my door,
Pestering,
“Where is this God of yours?

These are the things I go over and over
emptying out the pockets of my life.
I was always at the head of the worshiping crowd,
right out front,
Leading them all,
eager to arrive and worship,
Shouting praises, singing thanksgiving –
celebrating, all of us, God’s feast.

Why are you down in the dumps, dear soul?
Why are you crying the blues?
Fix my eyes on God –
soon I’ll be praising again.
He puts a smile on my face.
He’s my God.

When my soul is in the dumps, I rehearse
everything I know of you,
From Jordan depths to Hermon heights,
including Mount Mizar,
Chaos calls to chaos,
to the tune of whitewater rapids.
Your breaking surf, your thundering breakers
crash and crush me.
Then God promises to love me all day,
sing songs all through the night.
My life is God’s prayer.

Sometimes I ask God, my rock-solid God,
“Why did you let me down?
Why am I walking around in tears,
harassed by my enemies?”
They’re out for the kill, these
tormentors with their obscenities,
Taunting day after day,
“Where is this God of yours?”

Why are you down in the dumps, dear soul?
Fix my eyes on God –
soon I’ll be praising again.
He puts a smile on my face.
He’s my God.

©2006 Eugene H. Peterson. The Message//Remix: The Bible in Contemporary Language

Fatigue Performance

Tonight the wind is in your voice.
And the gods are nervous
about the drinking water.
Someone hijacks the background
with three simple dance moves.
Or maybe the clouds
paused on the television
set during a ball game.
The silence inside
the photograph
of you eating alone
in an old yearbook.
This is going to be over
before you know it.
But not before your hands
become small birds
in celebration
of the present snow.
An expressed panic
attack of harmonics.
It’s like listening to your heartbeat
in a club, all the lights off,
all by yourself.

©2017 Noah Falck

The Role of Science in Addiction

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

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

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

Overdose-Reversal Interventions

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

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

Treatments for Opioid Addiction

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

Non-Addictive Treatment for Chronic Pain

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

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

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

Public-Private Partnerships

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

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

References

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

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

What Good Is Work? Is Government Assistance Biblical?

“Christians must revive a centuries-old view of humankind as made in the image of God, the eternal Craftsman, and of work as a source of fulfillment and blessing, not as a necessary drudgery to be undergone for the purpose of making money, but as a way of life in which the nature of man should find its proper exercise and delight, and so fulfill itself to the glory of God. That it should, in fact, be thought of as a creative activity undertaken for the love of the work itself; and that man, made in God’s image, should make things, as God makes them, for the sake of doing well a thing that is well worth doing.”
                                                                                                                                Dorothy L. Sayers

Public Assistance

I know from experience that lack of work almost always leads to complacency, stagnation, negativism, and laziness. It can eventually lead to serious financial woes, including insolvency and lack of preparedness for emergency. I suffered a back injury in 2004 while helping a gentleman “flip” houses for a living. I did a lot of concrete work, tear outs of old kitchens and bathrooms (oh, the cast iron tubs and old radiators!), and hanging drywall. I spent hours at a time on extension ladders painting the eves of houses. Due to my injury, and the subsequent collapse of discs in my lumbosacral spine, it became impossible to work in any capacity for several years. I subsequently began receiving welfare benefits, then, ultimately, social security disability benefits. Recently, I have been able to hold a part-time job or two while still collecting SSDI benefits.

A sense of guilt eventually set in, and I felt it necessary to return to the “world of the working,” which to me is akin to the world of the living. I am currently attending online classes at Colorado Christian University to finish my undergraduate degree in psychology, and will graduate next year. I have applied for admission to the master’s degree program in professional counseling at Lancaster Bible College (with a concentration in addictions). Classes begin September 2018. It is thrilling to me to be able to finally complete my education in psychology which I started at the University of Scranton in 1982. It is my intention to work as an addictions counselor until the day I can no longer make it out of my house and to the office.

It’s is sad to see the extent of “welfare as a way of life” in America today. Indeed, it often spans generations. There are so many factors that feed into this dilemma; too many to get into here. I think there are two ways we can help break that cycle. One is through an incentive-based public assistance program. We have to STOP allowing people to collect benefits while doing nothing whatsoever to improve their station in life. The other is to make college much more accessible to lower income families. According to the Pennsylvania Department of Human Services, approximately 25.3 percent of the Commonwealth’s population (one in four) receive some type of vital support, ranging from cash benefits and food stamps to medical assistance and low income home heating grants.

Welfare Benefits Pie Chart

In the matter of people who are incarcerated, it is paramount that we focus on vocational, psychological, spiritual, and educational programs and not merely on warehousing of criminals. In addition, we have to do something about the stigmatizing of felons, which is disenfranchising them from the workforce upon their release. Then there’s the nationwide opiate epidemic, mainly heroin, and our tendency to criminalize what is actually a brain disease. Yes, the individual makes a choice to get high, but the power of the morphine molecule is impossible to resist by sheer willpower, and the result is relapse and recidivism.

From a Theological Perspective

I read Courage & Calling by Gordon T. Smith for a class at Colorado Christian University. It’s available on Amazon.com by clicking here, and I highly recommend it. Gordon believes God calls us first to Himself, to know Him and follow Him, but also to a specific life purpose, a particular reason for being. This second calling or “vocation” has implications not only for our work or occupation, but also includes our gifts, our uniqueness, our life community, and what we do day-to-day. When we fulfill our specific vocation, we are living out the full implications of what it means to follow Jesus.

There seems to be this huge assumption in our social context today that work is bad (or, worse yet, something to be avoided) and leisure is good. Billions of dollars are spent every year on ways that help us relax or escape from the toils of work. God made man to work, and that work was to be meaningful. I believe God made mankind workers so that they could be co-creators with Him – not in the sense that they are creators of the Earth, but that their work was a part of God’s continual re-creation. Man is to be a steward over creation. Over all there is.

In Courage & Calling, Gordon says it is important to have a biblical theology of work. The witness of the Scriptures and of Christian spiritual heritage suggest that responsible human life includes stewardship of our capacities and opportunities. A biblical theology of vocation provides us with a critical and essential lens through which to view our lives and what it means to be stewards of our lives. So, we can ask not only “What good is work?” but “What is the good work I am called to do?” Living well, surely, is a matter of taking seriously the life that has been given us – the opportunities and challenges that are unique to us, to our lives, our circumstances. Taking our lives seriously means that we respond intentionally to these circumstances and the transitions of life. This is something I had no concept of, or capacity for, while in active addiction.

I had to come to understand three things. First, our lives are of inestimable value. Second, living our lives to the full is precisely what it means to be good stewards of our lives. Third, we live fully by living in a way that is deeply congruent with who we are. In the Scriptures there is a clear proclamation of what it means to have human identity – a person created by God, with worth and significance. It is also true that the field of psychology has enabled many to appreciate the full significance and weight of this scriptural insight. No lives are dispensable. No one can say that their life or work does not matter. Each person brings beauty, creativity and importance to the table.

Let’s Go To The Scriptures

The Bible has much to say about work, which in its different forms is mentioned more than 800 times. This is more frequently than all the words used to express worship, music, praise, and singing combined. The Bible begins with the announcement, “In the beginning God created…” It doesn’t say He sat majestic in the heavens. He created. He did something. He made something. He fashioned heaven and earth. The week of creation was a week of work. From the very beginning of the scriptures we are faced with the inescapable conclusion that God himself is a worker. It’s part of his character and nature.

Proverbs beautifully illustrates the work ethic. “Take a lesson from the ants you lazy bones. Learn from their ways and become wise! Though they have no prince or governor or ruler to make them work, they labor all summer, gathering food for the winter. But you, lazybones, how long will you sleep? When will you wake up?” (Proverbs 6:6-9, NLT)

In Genesis 2:15 we read, “The Lord God took the man and put him in the Garden of Eden to work it and take care of it.” (NIV) [Italics mine.] We were created by God to be stewards of His creation through our work. Work is actually a gift from God, and by it we employ useful skills to glorify Him and to help our neighbors. The Fall did not create work, but it did make in inevitable that work would sometimes be frustrating or seemingly meaningless. I believe Adam’s work in the garden can be seen as a metaphor for all work. In the story of Creation, we see God bringing order out of chaos. A gardener does the same thing by creatively using materials at his disposal. Adam was called by God to essentially rearrange the raw materials of a particular domain to draw out its potential for the benefit of everyone.

I believe our true calling evolves over time, and tends to emerge as we discover and hone our God-given talents into skills and useful competencies to be used for the glory of God and the service of our fellow man. Frederick Buechner said, “The place God calls you to is the place where your deep gladness and the world’s deep hunger meet.” Here’s the key: When it comes to work, there is no distinction between spiritual and temporal, sacred and secular. All human work, however lowly, is capable of glorifying God. Work is, quite simply, an act of praise. Colossians 3:17 says, “And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through Him.” (NIV) Our work matters profoundly to God. We must be committed to the idea that we express our Christian discipleship through our employment, which is an important part of life. It is in this realm that we are called to stewardship.

Certainly, it can be argued that we will not have a meaningful life without work, but we cannot make our work the meaning of our life. As Christians, we must find our identity in Christ, not in our work. Yet, work is the major way we respond to God’s call in our life. It gives us the platform from which we can be salt and light in a tasteless and dark world. Interestingly, the idea of rest must also be in the picture. God rested from his labors on the seventh day, and so should we. Please know I’m not talking about a dogmatic observance of “the sabbath.” There are literally dozens of interpretations of sabbath from a religious perspective. In Courage & Calling, Gordon tells us the pursuit of diligence can sometimes become the burden of perfectionism, which is a burden to you and to those with whom you work. It can easily lead to a person feeling overworked and exhausted. Our only hope is to keep a balance.

This is only possible with a clearly defined pattern of sabbath renewal in our lives. The word sabbath comes from the Hebrew shabbat, which is derived from the verb shavat, meaning “to cease.” By regular sabbath rest, we are freed from seeing work as a burden; it is ultimately God’s work that is entrusted to us for six days a week, but we are not responsible for, nor should we feel the need to, feel the burden of carrying this work seven days a week. The sabbath gives us perspective. I will go so far as to say we should not call it a “day off,” because this does nothing more than define our day of rest negatively in terms of the absence of work. Sabbath actually builds a sense of rhythm into the whole of creation.

Closing Remarks

Work is a lifelong endeavor. Genesis 3:19 says, “By the sweat of your brow you will eat your food until you return to the ground, since from it you were taken; for dust you are and to dust you will return.” (NIV) It is important to realize that through the doctrine of work God changes culture, society, and the world. The entire world has fallen into a state of injustice and brokenness. Redemption is not just about helping individuals escape this world, or saving souls condemned to eternal spiritual death (although this is certainly the message of the Good News), it is about restoring the whole of creation. I can think of no better way to contribute to this goal than through fulfilling God’s call on our lives. We must integrate our faith and our work. It is critical that we perform our jobs with distinctiveness, excellence, and accountability.

You and I were designed by God to work. Work is not a curse that we must endure, it is the way we experience purpose, meaning and joy. It’s what we were created to do: work and produce. In fact, not working takes a greater toll on us in the long run. Our attitude toward work should be without parallel. Ecclesiastes 9:10 says, “Whatever your hands find to do, do it with all your might.” God wants us to work in a vocation that compliments the way we were designed to act. Ultimately, this means discovering our skills or talents and using them rather than burying them in the ground or hiding them away. As Paul wrote in Ephesians 2:10, “For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.”

Fentanyl Becomes Deadly Force

Some Excerpts taken from an article By Eric Scicchitano
The Daily Item
July 10, 2017

Fentanyl

The deadly heroin and opioid epidemic is expected to become even deadlier with the increasing presence of Fentanyl in America. According to the DEA, Fentanyl is 50 to 100 times more powerful than morphine, and substantially more potent than heroin. As little as 2 grams of Fentanyl can be deadly. Alarmingly, it is fast becoming the most prevalent active ingredient in counterfeit drugs like Adderall, Xanax, and OxyContin being sold on the streets. During the first quarter of 2017, heroin combined with Fentanyl was detected in 61% of opioids seized for evidence and inspected in DEA labs. It is also frequently laced into marijuana and smoked.

The DEA’s Philadelphia Division warns that Fentanyl is on the rise, with seizures of shipments more than doubling from 167 kilos in 2015 to 365 kilos in 2016. Investigators are trying to determine if an outbreak of Fentanyl is responsible for 51 overdoses which occurred in Williamsport (Pennsylvania) in forty-eight hours. [See my post 51 overdoses in 48 hours] Three of those cases ended in death. According to the National Institute on Drug Abuse (NIDA), heroin and opioids killed an estimated 280,000 people nationwide between 2002 and 2015. Based upon preliminary figures put together through state coroners, more than 4,800 people died of an overdose in Pennsylvania last year. Experts are concerned that the next chapter in the opioid crisis could dwarf what we’ve seen so far. Their concern is based on the proliferation of Fentanyl.

Fentanyl Deaths Map

Let’s take a few moments to discuss Fentanyl. It is a man-made (synthetic) opioid, meaning it is manufactured in a laboratory, but it acts on the mu-opioid receptors in our brain and spinal column in the same manner as the morphine molecule found naturally in opium. Typically, these receptor sites are meant for naturally-occurring endorphins, our “feel good” chemical released by the pituitary gland. Fentanyl is usually prescribed to patients suffering from intractable cancer-related pain and, in some cases, debilitating back pain. My father was given Fentanyl patches for compression fractures near the end of this life. Initially, it was believed Fentanyl would not be abused. Unfortunately, addicts decided to start opening the patch in order to scrape out the medicine and abuse it.

Fentanyl Mapping.gif

As if that were not enough, Fentanyl is being illegally manufactured in labs (primarily in China). It is produced in powder form, and is also pressed into pills, and smuggled into the United States. These knock-off pills are catching users off guard. Fentanyl is 50 to 100 times more powerful than morphine. DEA and border patrol seized more than 10,000 counterfeit pills containing Fentanyl in 2015. An amount as small as 2 milligrams can be deadly. First responders and ER physicians have to use extreme caution in order to avoid accidental exposure. According to the article in The Daily Item, an Ohio police officer accidentally overdosed in May of this year after brushing Fentanyl powder from his uniform during an arrest.

After the recent overdose surge in Lycoming County (Pennsylvania), Todd Owens, Mount Carmel police chief and head of the Northumberland County Drug Task Force, advised first responders to take measures to protect themselves. Chief Owens said his own department stocks medical masks, coveralls and heavy-grade gloves in their cruisers to be worn in the event they encounter heroin.

Heroin Fentanyl and Carfentanil Pics

The above is an illustration of potency betwen heroin, Fentanyl, and Carfentanil.

Carfentanil

Carfentanil is an extremely powerful derivative of Fentanyl. While Fentanyl is up to 100 times more potent than morphine, Carfentanil is 100 times more powerul than Fentanyl. In other words, it is 10,000 times more powerful than morphine. It is not approved for use in humans; rather, it is used in veterinary medicine to sedate large animals, primarily elephants. Yes, elephants! Carfentanil is so powerful that when veterinarians handle it, they use protective gear to avoid breathing it in or absorbing it through their skin. The amount of Carfentanil that can be safely administered to a human is 0.1 mg., compared to 13 mg. needed to sedate an elephant. It is obviously rather easy for an addict to accidentally take too much Carfentanil.

Interestinly, there are no statistics showing Carfentanil leading to addiction. That’s because even in the case of a seasoned addict a dose the size of a grain of salt can rapidly lead to an overdose and death. Frighteningly, drug dealers have begun cutting heroin with Carfentanil because it is extremely cheap to acquire. Even more disturbing is the fact that addicts in search of the ultimate high are deliberately trying this deadly drug. Rangers at Yellowstone National Park have recently begun issuing warnings to avoid eating the meat of bison killed in the park because the bison might have been sedated with Carfentanil for tagging or medical treatment. The drug can easily enter the bloodstream of those who eat the bison meat. It is most chilling to note that Carfentanil rapidly latches on to the mu-opioid receptors in humans, causing overdose almost immediately.

Moving Forward

Fentanyl moved up the rankings, from the 9th most common drug involved in overdose deaths in 2013, to the 5th most common drug involved in overdose deaths in 2014. The singer-songwriter Prince died of an overdose of Fentanyl in April 2016, according to officials in Minnesota. Philip Seymour Hoffman, a very successful indie film star (and one of my favorites), died of a heroin overdose on February 2, 2014. Although he had a drug problem while in college, he was clean for twenty years. No doubt his system was not able to handle the strength of today’s heroin.

Reports from the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) showed that deaths from heroin more than tripled during a five-year period, from 3,020 deaths in 2010, to 10,863 deaths in 2014. These deaths are yet another symptom of the broader epidemic of opioid addiction. Just as deaths from AIDS are due to untreated HIV, deaths from overdose are frequently due to untreated addiction. I know of many addicts attending 12-step meetings who are positive for hepatitis-C secondary to sharing needles while injecting heroin. Prince’s death is a reminder that opioid addiction is a disease that can and does affect people from all economic classes and all walks of life.

References

Scicchitano, E. (July 10, 2017). Fentanyl Becomes Deadly Force. Daily Item. Sunbury, PA.

Wakeman, S. (Aug. 5, 2016). Fentanyl: The Dangers of this Potent “Man-Made” Opioid. [Web Blog Comment.] Retrieved from: http://www.health.harvard.edu/blog/fentanyl-dangers-potent-man-made-opioid-2016080510141

Rettner, R. (Dec. 20, 2016). Deaths From Fentanyl Overdoses Double in a Single Year. LiveScience.com. Retrieved from: https://www.livescience.com/57268-fentanyl-overdose-deaths-double.html

 

And Death Shall Have No Dominion

And death shall have no dominion.
Dead man naked they shall be one
With the man in the wind and the west moon;
When their bones are picked clean and the clean bones gone,
They shall have stars at elbow and foot;
Though they go mad they shall be sane,
Though they sink through the sea they shall rise again;
Though lovers be lost love shall not;
And death shall have no dominion.

And death shall have no dominion.
Under the windings of the sea
They lying long shall not die windily;
Twisting on racks when sinews give way,
Strapped to a wheel, yet they shall not break;
Faith in their hands shall snap in two,
And the unicorn evils run them through;
Split all ends up they shan’t crack;
And death shall have no dominion.

And death shall have no dominion.
No more may gulls cry at their ears
Or waves break loud on the seashores;
Where blew a flower may a flower no more
Lift its head to the blows of the rain;
Though they be mad and dead as nails,
Heads of the characters hammer through daisies;
Break in the sun till the sun breaks down,
And death shall have no dominion.

By Dylan Thomas

Local Opioid Abuse: A Piece of the Nation’s Newest Health Crisis

By Steven Barto

I am no stranger to addiction. I started drinking and getting high the summer after high school graduation. It was 1977 and pot and southern rock went hand-in-hand. I found my answer to all the anger, anxiety, depression, insomnia, and feelings of not belonging. Of course, I had no idea where it would lead, or that it would take me nearly four decades to get clean. I’ve said it before: No one wakes up one day and says, “I think I want to be a full-blown alcoholic or drug addict when I grow up. I want to loose all self-respect, most of my teeth, two wives, four jobs, three cars, and my sense of ambition. I’d love to be estranged from family and friends. It’ll be great. Just me and my drugs!” Anyone whose not an addict or alcoholic and thinks it is a moral or deliberate choice doesn’t understand addiction.

Opiate Use Map (2)

Map shows areas of opiate use, with the most prevalence noted in dark pink.

Nationally

The “perfect storm” that got us to a nationwide opiate epidemic is intertwined with influences you’d never expect. Heroin used to be limited to the beatniks, poets, jazz musicians, wild-and-crazy rock stars of the 1950s, 60s and early 70s. But things were about to break loose. Congressmen Robert Steele (R-CT) and Morgan Murphy (D-IL) released an explosive report in 1971 covering the growing heroin epidemic among U.S. servicemen in Vietnam. America saw thousands of military personnel coming home from Southeast Asia addicted to heroin. As a result, President Richard Nixon declared a “war on drugs.” In fact, Nixon called drug abuse “public enemy number one.” Initially, the lion’s share of monies thrown at the drug problem went for treatment, which was a good thing. Unfortunately, this did not remain so in subsequent years. Politicians saw the opportunity to “take back the streets” of America from hippies, druggies, liberals, love children, people of color, and other “subversives” who did not seem to be conforming to the American lifestyle. Emphasis changed to criminalizing addicts and locking them up.

Admittedly, cocaine and crack became a serious concern before America fell face-first into the current opiate epidemic. Interestingly, one of the major factors contributing to increased cocaine trafficking was the North Atlantic Free Trade Agreement (NAFTA) signed into law under President Bill Clinton. Goods began to flow into the United States from Mexico at such an increase that border patrol was unable to adequately assure drugs were not coming over the border. There simply were not enough agents to keep up with inspection and enforcement. Prior to the climate of unrestrained trade, President Nixon had ordered that every vehicle returning from Mexico must be searched for drugs. Long lines ensued, and there was no appreciable reduction in drug trafficking.

Heroin and a Handgun

In 1995, The Food and Drug Administration (FDA) approved OxyContin for prescription use. Its active ingredient, oxycodone, was believed since the 1960s to be highly addictive. Purdue Pharma, the inventor of OxyContin, claimed their formula of delayed-release oxycodone would all but eliminate the “rush” experienced by taking the drug in its original form. Purdue launched an extremely aggressive marketing progam, sending drug reps to virtually every family practitioner and pain management specialist, armed with what was eventually deemed a falsified report that less than 1% of OxyContin patients became addicted. Doctors were offered outrageous incentives to prescribe the drug. Purdue Pharma began the practice of sponsoring trade shows and symposiums, often plying physicians with lavish meals and “entertainment.” On the heels of this marketing blitz, the American Pain Society began arguing for medical providers to view pain as the “fifth vital sign.” This is precisely the basis for the How would you rate your pain on a scale of 0-10? question that is asked in every emergency department in America today. Well-intentioned doctors believed it was unconscionable to let patents suffer through severe pain. They didn’t believe Oxy would do more harm than good.

By 1996, Purdue Pharma reported $45 million in sales of OxyContin. As of 2000, the number jumped to over $1 billion. That’s a two-thousand fold increase. Misuse and abuse of opiate painkillers (OxyContin, Vicodin, Lortab, oxycodone) increased significantly beginning in 2000. In 2002, 6.2 million Americans were abusing prescription drugs, and emergency room visits resulting from the abuse of narcotic pain relievers had increased dramatically. By 2009, the total number of visits to ERs for overdose on opiates was 730,000, which was double the number of five years before. More than 50,000 Americans died of a drug overdose in 2016. Heroin accounted for 12,898 of those deaths that year. Synthetic opioids (such as Fentanyl) killed 5,880. Prescription painkillers like OxyContin and Vicodin claimed 17,536 lives.

Companies like Purdue Pharma have restructured the formula of opiate medications in order to make them even harder to abuse. No doubt this had a lot to do with the $635.5 million fine levied against Purdue for intentionally misleading the medical community regarding the potential to become addicted to OxyContin. Typically, addicts crush and snort the drug, or cook it down and inject it. What’s disheartening today is that most people who started out taking and then abusing OxyContin and other opiate pain medication are now using heroin because it’s cheaper – $5 to $7 dollars for enough to be high most of the day versus $10 to $80 for one Oxy, depending on its strength. Heroin is readily accessible virtually everywhere you go, and it is easily converted to a form that can be smoked or injected.

Locally

Front page news in my hometown paper, The Sunday Item, indicates that drug overdoses in Pennsylvania killed nearly 11,000 people in the last three years, fueled largely by heroin and prescription painkillers. The number of deaths has steadily increased year after year. As fatal overdoses have increased, so has public awareness, access to addiction treatment, and legislative initiatives against an epidemic the U.S. Department of Justice describes as the leading cause of death of Americans under the age of 50. It is important to note that this is a disease that affects everybody. Let’s stop playing the New Jim Crow game and stigmatizing, criminalizing, and institutionalizing drug addicts based upon skin color. Heroin and opiate drug addiction is rampant today in all socioeconomic classes, to be sure, but surprisingly it is most prevalent in white males age 18 to 25.

heroin-graph_1185px

The Sunday Item interviewed a man named Steven C., 27 years old, who is a recovering heroin addict attempting sobriety after fifteen years of opioid abuse. When he heard the news of an overdose outbreak in the Williamsport (Pennsylvania) area that sent 51 patients to the hospital in 48 hours, with three patients now dead, Steven couldn’t help but realize, “That could have been me.” Steven was brought back to consciousness from a heroin overdose on August 9th of last year. EMTs adminstered naloxone, which is used in the field to reverse the effects of an overdose, but it didn’t work. His heart had stopped. Thankfully, CPR eventually restarted his heart.

The Official Response

Federal and state funding for the opioid and heroin problem in Pennsylvania has been increased 19% to $76 million for the current fiscal year. The funds include $5 million for grant money to provide naloxone for emergency responders, which is proven to reverse the effects of narcotic overdose in most cases, and $2.3 million to establish specialty courts for handling drug-related criminal cases. Great strides have already been taken in fighting this epidemic. Pennsylvania restricts opioid prescriptions to seven days for minors and those discharged from hospital ERs. Emergency room physicians are not allowed to see patients for follow-up visits or refills. Each instance where an opioid prescription is filled is recorded on a state-wide database in order to stop “doctor shopping” or getting refills “too early.” According to the Sunday Item article, the prescription database has been accessed by doctors 8 million times since it was launched.

An estimated 2 million Americans are addicted to painkillers, and another 591,000 are addicted to heroin. Although we’re beginning to made headway regarding opioid prescriptions, much remains to be done regarding heroin addiction. It is noteworthy that taking opioid pain medication for longer than three months makes patients up to forty times more likely to become addicted to heroin. Senator Gene Yaw (R-23) of Williamsport told reporters, “I have said many times that I don’t expect to see positive results for at least ten years. It took a long time to get into the situation we find ourselves and we can’t expect a change to happen overnight. We are addressing many issues and eventually together they will make a difference.” It is abundantly clear that there is a risk of progression from alcohol and other drugs (especially opioid painkillers) to heroin.

heroin-use_1185px

Concluding Remarks

What can you do? Most importantly, as public service announcements state on TV in Pennsylvania, “Mind your meds.” Please don’t react to this suggestion by simply saying drug addicts should be able to be trusted, otherwise they’re just thieves. Or, that they should have better impulse control. Addiction is not about willpower, nor is it a matter of a moral deficiency. Virtually anyone who uses opiates for pain for longer than three months can become addicted. That is the very nature of the morphine molecule found in these medications. It is extremely difficult for an opiate addict to “just say no” to the screaming of their mu-opioid receptors in the brain and spinal cord once the morphine molecule has latched “lock-and-key” into place. Opiates are far more potent than naturally occurring endorphins.

I really had no idea how difficult it can be to quit drinking or taking opiates once your body gets used to the chemical reaction and the euphoria. I have not had a drop of alcohol, a line of cocaine, or a joint since 2008. It was not so easy for me to give up opioid painkillers. It’s a two-edged sword. First, there’s the initial legitimate need for pain relief. Doctors recognized this in the 90s when they decided to not let their patients suffer in chronic agony. Although I was in recovery for other substances, I thought I could use pain medication safely. I’d abused it in the past, sure, but now I was “sober” and I needed help with severe back pain. I didn’t want the drug in order to “party.” The other edge of the sword is the neuropsychology of the addiction itself. These types of medications actually restructure the brain. Sometimes the effects are permanent, as when memory or IQ or motor skills are compromised. Thankfully, this is not the case for me.

If you or someone you know is struggling with a drug or alcohol problem, please consult your physician for a phone number to the nearest help line. You will also find AA and NA phone lines in the phone book or online. If you are a Christian facing addiction, consider Celebrate Recovery. Facebook has numerous groups you can join. You call also email me at stevebarto1959@gmail.com and I will reply as soon as I can.

References

The Sunday Item. (Sunday, July 9, 2017) Sunbury, PA http://dailyitem.com

Karlman, J. (February 16, 2017). Timeline: How Prescription Drugs Became a National Crisis. Retrieved from: http://fox5sandiego.com/2017/02/16/timeline-of-how-prescription-drugs-became-national-crisis/

Moghe, S. (October 14, 2016). Opioid History: From Wonder Drug to Abuse Epidemic. CNN Online. Retrieved from: http://www.cnn.com/2016/05/12/health/opioid-addiction-history/index.html

Sandino, J. (May 13, 2015). A Timeline of the Heroin Problem in the U.S. Addictionblog.org Retrieved from: http://drug.addictionblog.org/a-timeline-of-the-heroin-problem-in-the-u-s/

Tribune News Services. (December 8, 2016). More than 50,000 Overdose Deaths. Chicagotribune.com. Retrieved from: http://www.chicagotribune.com/news/nationworld/ct-us-overdose-deaths-20161208-story.html