Secret Opioid Memo

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

Bottles of Opiate Prescriptions

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

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

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

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

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

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

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

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

For more information, click here: OxyKills.com

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.

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

Chronic Pain The Silent Condition

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

 

 

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

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

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

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

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

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

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

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

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

Consider the song “Perfect” by Alanis Morissett:

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

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

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

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

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

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

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

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

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

CONCLUDING REMARKS

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

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

 

REFERENCES

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

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

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

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

 

The Things They Carried

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

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

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

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

THE REASON I BROUGHT THIS UP

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

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

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

From The Things They Carried.

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

Henry Dobbins asked what the moral was.

“Moral?”

“You know.”

Moral.

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

Henry Dobbins thought about it.

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

“There it is, man.”

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

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

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

References

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

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.”