Sermon: A Series of Three Reflections by Members of CESA (Committee on Ecology and Social Action) at the Brookfield Unitarian Universalist Church
Given at the Brookfield Unitarian Universalist Church
April 24, 2016
ACE in hand; Fighting Addiction
Reflection by Diane Oliver-Jensen
A funny thing happened on the way to finding a cause for the obesity epidemic. You see, a group of doctors from the Kaiser Permanente system had been noticing that a surprising number of their patients, who were struggling with obesity, also had reported having adverse childhood experiences. So between 1995 & 1997, they recruited approximately 1,700 patients from within the Kaiser Permanente system and launched a long term study on the health effects of those Adverse Childhood Events, or ACEs, to test their connection to obesity. They developed a simple 10-question, yes-or-no survey, polled the 1,700 participants for their recollections and began collecting health data. Each “yes” answer received one point.
Their initial findings surprised them. Indeed, ACEs were correlated to increases in:
• Risky behaviors like smoking, heavy drinking, poor diet choices and inactivity
• Chronic health conditions such as obesity, diabetes, hepatitis, heart disease and cancer
• Low life potential through higher drop out rates, greater absenteeism from school and work, etc
• Early death
But they found much stronger correlations to other issues they had not, initially, gone looking for.
ACE scores of 4 or more are:
• 6 times more likely to have sex before age 15
• 2 x more likely to have cancer in their lifetime
• 4 x more likely to develop emphysema
• 7 x more likely to become an alcoholic
The very strong links to substance abuse were not expected. That study continues to this day looking at more and deeper questions as more detailed information unfolds.
(Read the ACE study questions here)
One group who was not surprised by the correlation between social isolation and addiction though, was a team of psychologists at Simon Frasier University in British Columbia. Way back in the late ‘70s, they gradually came to realize that the subjects of their behavioral research, white lab rats, are actually highly social animals. They began to question so many research results that isolated those social animals in small, unstimulating metal cages. You may recently have seen a widely shared post on Facebook describing this “Rat Heaven” study that has been making the rounds recently. The study basically repeated a famous earlier study that wanted to explore just how addictive opiates may be. In the original study, rats were isolated in a small cage and given their choice of drinks as much as they wanted, whenever they wanted. One was plain water, the other was water mixed with morphine. The rats chose the morphine and drank so much that they eventually overdosed themselves. The folks in the Rat Heaven study repeated that experiment, but instead of placing rats alone in boring little cages, they put them in a big, happy, social setting. They had girl rats and boy rats and allowed them to be active together. They had toys and games for the happy rats to explore and enjoy. The rats raised families in Rat Heaven, and all of them largely ignored the morphine choosing plain water almost all the time. The Rat Heaven researchers were not at all surprised by the ACE study findings because they’d predicted as much almost 15 years earlier, but nobody listened.
They’re listening now.
Dr. Nadine Burke Harris has a TED Talk you can watch related to this, and I highly recommend you do. After she graduated from medical school, she wanted to do something to help… really help. She went to one of the poorest and most underserved communities in San Francisco and, through the early years of her practice, saw many of the same anecdotal connections that led the ACE study doctors to begin their study. And then she heard of their early study results. She convinced coworkers and other community resources to combine efforts to address this new understanding into cooperative practice techniques with noticeable improvements. Surely everybody would follow their lead, right? She admits now that she was naïve.
But, like I said, that ACE Study is still going on. The ACE researchers went back and looked closer to see if one ACE point had more impact than the others. They thought going in that it would probably be the sexual abuse question, maybe the physical abuse.
Nope. Only one stood out from the rest which were all basically equal one with the other. The one that had the most impact, by about 15%, was the question about humiliation. Having a household member repeatedly tell you that you are worthless, stupid, ugly, never going to amount to anything… that is more damaging than anything else. They now include school bullying in that category.
With more information and understanding, there is beginning to be some change. It is now understood that, while stress is vital to growth and success, long term stress is toxic and especially so for young, developing brains. Further analysis has shown that while only 3% of the children with ACE scores of 0 show signs of learning, behavioral or emotional problems at school, 51% of kids with ACE scores of 4 or more do.
51%…
Paul Tough, in his book, How Children Succeed, says that, “Childhood stress can gave long lasting neural effects, making it harder to exercise self-control, focus attention, delay gratification and many other things that contribute to a happy life.”
Still, an ACE score of 4 or 5 or 6 doesn’t guarantee addiction or obesity or prison. If 51% of kids with a score of 4 or more display learning and behavioral problems, 49% do not.
A highly rated, long term remedial education program called KIPP, or Knowledge Is Power Program, worked with severely disadvantaged youth to prepare them for and get them into college and with very good success. However, when they followed up with their KIPP scholars, they found that fully 3/4s were not graduating from the colleges they’d worked so hard to get into. What was going on?
The ones who weren’t making it through were the pessimists.
What is it that allows one kid in horrible circumstances to rise above and make it to the top while another crashes to the bottom? The answer is defined as resiliency. It comes out of a sense of hopefulness, a positive attitude.
And where do they get it? From an adult; from a nurturing, caring, supportive adult. It can be a parent, an aunt or uncle, a grandparent, a teacher, a neighbor, a minister or a mentor. It can come from a community like Alcoholics Anonymous, like a boys & girls club, or Camp Putnam, or a church. The key is a caring adult who believes in and encourages that kid, no matter how old that kid is today.
What can we do? Individually, if you know a kid, LOVE a kid. Be a friend, be a teacher, be a mentor. Share a skill or a passion. Become a Big Brother or Big Sister. As a congregation, we keep on doing what we already do. Simply by being a Welcoming Congregation we have already done so much. You don’t realize how small, seemingly insignificant things can be earth shaking to somebody else. Just by welcoming and accepting a big, scary looking ex-con you have helped to shatter a life long belief, an immovable boulder blocking their path to hope and happiness, the belief that “people like you would never accept somebody like…” like them. I cannot tell you how many times I’ve heard “I never thought people like that could be nice to me.” Just the simple act of asking for their assistance carrying things up from the basement has made somebody feel wanted, needed, valued and NOT judged negatively or fearfully. Such a small moment for one person, probably not even remembered, is a huge and shining memory, a real highlight to another.
No, we will never save everybody.
We cannot save them, they have to save themselves.
But we CAN plant a seed of hope, of faith, of kindness. It may not grow today, but if it grows, when it grows, small roots are capable of shattering immovable boulders with quiet persistence and confidence.
Plant that seed of hope.
Thank you.
Citations, Sources and Related Links
Www.thefix.com/content/trauma-and-addiction9180
http://www.nytimes.com/2012/09/28/opinion/brooks-the-psych-approach.html?_r=0
http://www.brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park
http://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean
https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_Study
http://www.cdc.gov/violenceprevention/acestudy/about_ace.html
Contemplating Drug Legalization Reflection by Wendy Newhall
Once my son turned about 13, I started to encourage him to try a sip of my alcoholic drink whenever we had them available at family parties. What I did was illegal butI'm not ashamed of what I did. I felt that it would be better for my son to learn what it feels like to be a little buzzed at home, rather than having his first experience with alcohol outside the home. As it was, my son was very typical of many teenagers who want to do the opposite of whatever their parents encourage. So whether it was my son's obstinance or the school dare program, I'm pretty sure my son never had any alcohol before he turned 25.
Talking with other people I think my experience is pretty common. It seems that in families where there is a strict rule that children are denied any access to alcohol, they are wanting to get their hands on some the first chance they get but in families where it is encouraged, teenagers being teenagers are suddenly not very interested.
And so I wasn't surprised to read just a few weeks ago that a group of 22 medical experts have called for decriminalization of all nonviolent drug use and possession. This group called The Commission on Public Health and International Drug Policy But back to the medical experts that were put together by Johns Hopkins University and the Lancet.
Their report came out just prior to the special UN General Assembly Session on drugs that was held last week, where countries representatives met to reevaluate the world's drug policies. Now the UN group did not call for drug legalization but they did call for less emphasis on supply reduction and more of an emphasis on demand reduction.
In a lengthy review of the state of global drug policy, the Hopkins-Lancet experts conclude that the prohibitionist anti-drug policies of the past 50 years "directly and indirectly contribute to lethal violence, disease, discrimination, forced displacement, injustice and the undermining of people’s right to health." They cite, among other things:
A "striking increase" in homicide in Mexico since the government decided to militarize its response to the drug trade in 2006. The increase has been so great that experts have had to revise life expectancy downward in that country;
The "excessive use" of incarceration as a drug control measure, has been the biggest contributor" to higher rates of HIV and Hepatitis C infection among drug users;
Stark racial disparities in drug law enforcement, particularly in the United States;
And human rights violations arising from excessively punitive drug control measures, including an increase in the torture and abuse of drug prisoners in places like Mexico.
For a role model, the commissioners point to Portugal, which decriminalized not only cannabis but also possession of heroin, cocaine and methamphetamine. HIV transmission, hepatitis C and incarcerations all decreased, Beyrer said, and there was about a 15 per cent decline in substance use by young people in Portugal.
And beyond decriminalization, the commissioners recommend experimenting with the full legalization and regulation of certain types of drug use, as several U.S. states have done with marijuana.
The authors found the biggest factor driving higher rates of infection among drug users was that they were excessively incarcerated and excluded from HIV and hepatitis C prevention, treatment and harm-reduction programs. These include needle and syringe exchanges, safe injection facilities and opioid substitution therapies such as methadone.
Russia is the opposite extreme, the authors said. Opioid substitution is prohibited by law, and needle and syringe exchanges are allowed only sporadically. The official estimate of Russians living with HIV rose to 907,000 by the end of 2014, up from 500,000 in 2010. More than 57 per cent of the cases were attributed to unsafe drug injection. Globally, HIV transmission linked to drug use is also increasing.
After Mexico's government turned to the military instead of police in a literal war on drugs, there was an increase in lethality and civilian deaths, noting it reduced life expectancy measurably.
Medical Conundrum
Reflection by Mary Ann Adams
There is a Dr. Doolittle creature, a two headed llama called pushmepullyou, and the scenario of the opioid prescription problem is a bit like that creature. It's all about pain relief, and the course the medical community of physicians in conjunction with the pharmaceutical industry took to alleviate the suffering of the people that they treat. Here is some background on how and when we got into this problem of prescription drug abuse. For years now, a component of the National Patient Safety Guidelines, which all hospitals work diligently to adhere to, has included the recommendation to assess and grade patient pain and treat it accordingly. If you have been in a hospital, you probably were asked about your pain and to rate it on a scale of 1 - 10...with smiley faces (no pain) graded as a 1 progressing to a grimace as a 10...
Yes, of course we want to reduce patient pain, HOW we reduce it is part of the push me pull you issue. How long we deliver pain medication is also an issue. What we use to reduce pain is the crux of the issue.
The pharmaceutical industry was able to design an opioid based drug that took away pain, allowing people with a high index of pain, debilitating pain, to move and function with greater ease. Perfect ! But, one of the problems with this drug called oxycontin was that the physicians prescribing it were not aware of it's seriously addictive quality. In the past several years a ground swelling of issues from the communities dealing with the repercussions of drug abuse has hit the fan, so to speak and the government is now responding. More on that in a bit.
As we have all been made aware, Opioids are very addictive. People who want to get prescriptive opioids have not had much of a problem getting them. Automatic refills, two or more doctors prescribing, without the other's knowledge, or even unscrupulous prescribing,-- the opportunities to become addicted have been ripe for the taking.
Opioids are a slippery slope. I was recently told the story of a person who went to the urgent care center with back pain, and without being given any education regarding the addictiveness of the medication, that person was prescribed painkilling narcotics. Medical research shows that in as little as four days of taking an opioid, our bodies become habituated to the drug and require more to attain the same pain relief.
The statistics are staggering. Here are just a few.
There has been a 300% increase in prescription opioid sales in the US Since 1999. This is Without a corresponding change in the amount of pain reported by the same number of patients. . And more importantly, alternative medication (non narcotic) use was not discussed
259 Million prescriptions for opioid pain relievers were written by providers in 2012. That's enough for every adult in America to have his or her own prescription.
in 1999 4,000 deaths were attributed to opioid pain relievers. in 2013 that number quadrupled to 16,000 deaths
in 2013 Two million americans were documented to have developed a dependency on opioid painkillers.
TO bring this closer to home, In Worcester County in 2000 there were 59 deaths from opioids. 14 years later that number had more than doubled to 126. Middlesex County has had a tremendous increase. In 2000 they had 56 deaths from opioids. In 2014 - 238 deaths. This mirrors the national data --quadruple the number of deaths in a 14 year period...
We have been examining pain relief prescribed by physicians and the problems of addiction. The slippery slope is the increasing transition from prescribed medications to the use of heroin.
1. Most heroin addiction starts with a legitimate pain prescription.
People who misuse prescription pain relievers are 40 times more likely to become addicted to heroin than those who don’t, according to the Centers for Disease Control and Prevention. Research also shows that 75 percent of patients in heroin treatment started their opioid use with prescription medications, not heroin. That sounds like pain treatment is at the root of the problem, and the CDC is targeting doctors with new guidelines aimed at reining in prescriptions.
But overwhelmingly, prescription-drug misusers are not pain patients. According to the National Survey on Drug Use and Health, more than 75 percent of recreational opioid users in 2013-14 got pills from sources other than doctors, mainly friends and relatives. Even among this group, moving on to heroin is quite rare: Only 4 percent do so within five years; just 0.2 percent of U.S. adults are current heroin users.
The real risk factor for opioid addiction is youth. Like 90 percent of all addictions, the vast majority of prescription-drug problems start with experimentation in adolescence or early adulthood, typically after or alongside binge drinking, marijuana smoking and cocaine use. Having a prior or current addiction to another drug is the best predictor of developing problems with prescription drugs — not pain care.
There is a current commercial that shows an adult going to the medicine cabinet, opening the mirrored cabinet door and taking out a prescription bottle and taking a pill, but when that individual closes the cabinet the mirror shows is her son, checking out the drug store, and grabbing one of mom's pills, experimenting.
Since CESA, the Committee on Ecology and Social Action, decided to speak to this topic of opioids and drug abuse and what it means to us as a community there has been a waterfall of information published in the community of medical journals. I have had so many articles available to review that it's overwhelming. This is due in great part to the new guidelines that have been instituted regarding the use of addictive drugs in the hospital setting. The Commonwealth of Massachusetts just passed a law on March 14th of this year that establishes a maximum seven day prescription of opioids to non cancer patients, when issued to an adult for the first time.. A prescriber may issue more than a seven day supply if, in their medical judgment, a greater supply is necessary to treat an acute medical condition, but they have to document their decision to do so with medical justification. We now have better regulations in place, so that those who prescribe cannot escape the responsibility of the dangers of addiction. We the public also need to become better educated about what we put into our bodies and not rely solely on the prescriptive authority of a physician.
With these new regulations in place, the hope is that the opportunity for addiction will be slowed , and a reality check will be put in place with a dialogue between patient and physician that addresses the issue of specific drug prescriptions, their effect and the length of use as medically judicious.
As a religious community what are we to do? Stay educated. Don't say "it can't happen to me". Challenge your physician with educating you if prescribed narcotics or opioid based medications. Keep our children educated to the dangers of addiction. And, reach out to the larger community, --supply a helping hand to those who have slipped down that slope and be an example to them and a support in helping them back to a life where they can say no.
Given at the Brookfield Unitarian Universalist Church
April 24, 2016
ACE in hand; Fighting Addiction
Reflection by Diane Oliver-Jensen
A funny thing happened on the way to finding a cause for the obesity epidemic. You see, a group of doctors from the Kaiser Permanente system had been noticing that a surprising number of their patients, who were struggling with obesity, also had reported having adverse childhood experiences. So between 1995 & 1997, they recruited approximately 1,700 patients from within the Kaiser Permanente system and launched a long term study on the health effects of those Adverse Childhood Events, or ACEs, to test their connection to obesity. They developed a simple 10-question, yes-or-no survey, polled the 1,700 participants for their recollections and began collecting health data. Each “yes” answer received one point.
Their initial findings surprised them. Indeed, ACEs were correlated to increases in:
• Risky behaviors like smoking, heavy drinking, poor diet choices and inactivity
• Chronic health conditions such as obesity, diabetes, hepatitis, heart disease and cancer
• Low life potential through higher drop out rates, greater absenteeism from school and work, etc
• Early death
But they found much stronger correlations to other issues they had not, initially, gone looking for.
ACE scores of 4 or more are:
• 6 times more likely to have sex before age 15
• 2 x more likely to have cancer in their lifetime
• 4 x more likely to develop emphysema
• 7 x more likely to become an alcoholic
The very strong links to substance abuse were not expected. That study continues to this day looking at more and deeper questions as more detailed information unfolds.
(Read the ACE study questions here)
One group who was not surprised by the correlation between social isolation and addiction though, was a team of psychologists at Simon Frasier University in British Columbia. Way back in the late ‘70s, they gradually came to realize that the subjects of their behavioral research, white lab rats, are actually highly social animals. They began to question so many research results that isolated those social animals in small, unstimulating metal cages. You may recently have seen a widely shared post on Facebook describing this “Rat Heaven” study that has been making the rounds recently. The study basically repeated a famous earlier study that wanted to explore just how addictive opiates may be. In the original study, rats were isolated in a small cage and given their choice of drinks as much as they wanted, whenever they wanted. One was plain water, the other was water mixed with morphine. The rats chose the morphine and drank so much that they eventually overdosed themselves. The folks in the Rat Heaven study repeated that experiment, but instead of placing rats alone in boring little cages, they put them in a big, happy, social setting. They had girl rats and boy rats and allowed them to be active together. They had toys and games for the happy rats to explore and enjoy. The rats raised families in Rat Heaven, and all of them largely ignored the morphine choosing plain water almost all the time. The Rat Heaven researchers were not at all surprised by the ACE study findings because they’d predicted as much almost 15 years earlier, but nobody listened.
They’re listening now.
Dr. Nadine Burke Harris has a TED Talk you can watch related to this, and I highly recommend you do. After she graduated from medical school, she wanted to do something to help… really help. She went to one of the poorest and most underserved communities in San Francisco and, through the early years of her practice, saw many of the same anecdotal connections that led the ACE study doctors to begin their study. And then she heard of their early study results. She convinced coworkers and other community resources to combine efforts to address this new understanding into cooperative practice techniques with noticeable improvements. Surely everybody would follow their lead, right? She admits now that she was naïve.
But, like I said, that ACE Study is still going on. The ACE researchers went back and looked closer to see if one ACE point had more impact than the others. They thought going in that it would probably be the sexual abuse question, maybe the physical abuse.
Nope. Only one stood out from the rest which were all basically equal one with the other. The one that had the most impact, by about 15%, was the question about humiliation. Having a household member repeatedly tell you that you are worthless, stupid, ugly, never going to amount to anything… that is more damaging than anything else. They now include school bullying in that category.
With more information and understanding, there is beginning to be some change. It is now understood that, while stress is vital to growth and success, long term stress is toxic and especially so for young, developing brains. Further analysis has shown that while only 3% of the children with ACE scores of 0 show signs of learning, behavioral or emotional problems at school, 51% of kids with ACE scores of 4 or more do.
51%…
Paul Tough, in his book, How Children Succeed, says that, “Childhood stress can gave long lasting neural effects, making it harder to exercise self-control, focus attention, delay gratification and many other things that contribute to a happy life.”
Still, an ACE score of 4 or 5 or 6 doesn’t guarantee addiction or obesity or prison. If 51% of kids with a score of 4 or more display learning and behavioral problems, 49% do not.
A highly rated, long term remedial education program called KIPP, or Knowledge Is Power Program, worked with severely disadvantaged youth to prepare them for and get them into college and with very good success. However, when they followed up with their KIPP scholars, they found that fully 3/4s were not graduating from the colleges they’d worked so hard to get into. What was going on?
The ones who weren’t making it through were the pessimists.
What is it that allows one kid in horrible circumstances to rise above and make it to the top while another crashes to the bottom? The answer is defined as resiliency. It comes out of a sense of hopefulness, a positive attitude.
And where do they get it? From an adult; from a nurturing, caring, supportive adult. It can be a parent, an aunt or uncle, a grandparent, a teacher, a neighbor, a minister or a mentor. It can come from a community like Alcoholics Anonymous, like a boys & girls club, or Camp Putnam, or a church. The key is a caring adult who believes in and encourages that kid, no matter how old that kid is today.
What can we do? Individually, if you know a kid, LOVE a kid. Be a friend, be a teacher, be a mentor. Share a skill or a passion. Become a Big Brother or Big Sister. As a congregation, we keep on doing what we already do. Simply by being a Welcoming Congregation we have already done so much. You don’t realize how small, seemingly insignificant things can be earth shaking to somebody else. Just by welcoming and accepting a big, scary looking ex-con you have helped to shatter a life long belief, an immovable boulder blocking their path to hope and happiness, the belief that “people like you would never accept somebody like…” like them. I cannot tell you how many times I’ve heard “I never thought people like that could be nice to me.” Just the simple act of asking for their assistance carrying things up from the basement has made somebody feel wanted, needed, valued and NOT judged negatively or fearfully. Such a small moment for one person, probably not even remembered, is a huge and shining memory, a real highlight to another.
No, we will never save everybody.
We cannot save them, they have to save themselves.
But we CAN plant a seed of hope, of faith, of kindness. It may not grow today, but if it grows, when it grows, small roots are capable of shattering immovable boulders with quiet persistence and confidence.
Plant that seed of hope.
Thank you.
Citations, Sources and Related Links
Www.thefix.com/content/trauma-and-addiction9180
http://www.nytimes.com/2012/09/28/opinion/brooks-the-psych-approach.html?_r=0
http://www.brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park
http://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean
https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_Study
http://www.cdc.gov/violenceprevention/acestudy/about_ace.html
Contemplating Drug Legalization Reflection by Wendy Newhall
Once my son turned about 13, I started to encourage him to try a sip of my alcoholic drink whenever we had them available at family parties. What I did was illegal butI'm not ashamed of what I did. I felt that it would be better for my son to learn what it feels like to be a little buzzed at home, rather than having his first experience with alcohol outside the home. As it was, my son was very typical of many teenagers who want to do the opposite of whatever their parents encourage. So whether it was my son's obstinance or the school dare program, I'm pretty sure my son never had any alcohol before he turned 25.
Talking with other people I think my experience is pretty common. It seems that in families where there is a strict rule that children are denied any access to alcohol, they are wanting to get their hands on some the first chance they get but in families where it is encouraged, teenagers being teenagers are suddenly not very interested.
And so I wasn't surprised to read just a few weeks ago that a group of 22 medical experts have called for decriminalization of all nonviolent drug use and possession. This group called The Commission on Public Health and International Drug Policy But back to the medical experts that were put together by Johns Hopkins University and the Lancet.
Their report came out just prior to the special UN General Assembly Session on drugs that was held last week, where countries representatives met to reevaluate the world's drug policies. Now the UN group did not call for drug legalization but they did call for less emphasis on supply reduction and more of an emphasis on demand reduction.
In a lengthy review of the state of global drug policy, the Hopkins-Lancet experts conclude that the prohibitionist anti-drug policies of the past 50 years "directly and indirectly contribute to lethal violence, disease, discrimination, forced displacement, injustice and the undermining of people’s right to health." They cite, among other things:
A "striking increase" in homicide in Mexico since the government decided to militarize its response to the drug trade in 2006. The increase has been so great that experts have had to revise life expectancy downward in that country;
The "excessive use" of incarceration as a drug control measure, has been the biggest contributor" to higher rates of HIV and Hepatitis C infection among drug users;
Stark racial disparities in drug law enforcement, particularly in the United States;
And human rights violations arising from excessively punitive drug control measures, including an increase in the torture and abuse of drug prisoners in places like Mexico.
For a role model, the commissioners point to Portugal, which decriminalized not only cannabis but also possession of heroin, cocaine and methamphetamine. HIV transmission, hepatitis C and incarcerations all decreased, Beyrer said, and there was about a 15 per cent decline in substance use by young people in Portugal.
And beyond decriminalization, the commissioners recommend experimenting with the full legalization and regulation of certain types of drug use, as several U.S. states have done with marijuana.
The authors found the biggest factor driving higher rates of infection among drug users was that they were excessively incarcerated and excluded from HIV and hepatitis C prevention, treatment and harm-reduction programs. These include needle and syringe exchanges, safe injection facilities and opioid substitution therapies such as methadone.
Russia is the opposite extreme, the authors said. Opioid substitution is prohibited by law, and needle and syringe exchanges are allowed only sporadically. The official estimate of Russians living with HIV rose to 907,000 by the end of 2014, up from 500,000 in 2010. More than 57 per cent of the cases were attributed to unsafe drug injection. Globally, HIV transmission linked to drug use is also increasing.
After Mexico's government turned to the military instead of police in a literal war on drugs, there was an increase in lethality and civilian deaths, noting it reduced life expectancy measurably.
Medical Conundrum
Reflection by Mary Ann Adams
There is a Dr. Doolittle creature, a two headed llama called pushmepullyou, and the scenario of the opioid prescription problem is a bit like that creature. It's all about pain relief, and the course the medical community of physicians in conjunction with the pharmaceutical industry took to alleviate the suffering of the people that they treat. Here is some background on how and when we got into this problem of prescription drug abuse. For years now, a component of the National Patient Safety Guidelines, which all hospitals work diligently to adhere to, has included the recommendation to assess and grade patient pain and treat it accordingly. If you have been in a hospital, you probably were asked about your pain and to rate it on a scale of 1 - 10...with smiley faces (no pain) graded as a 1 progressing to a grimace as a 10...
Yes, of course we want to reduce patient pain, HOW we reduce it is part of the push me pull you issue. How long we deliver pain medication is also an issue. What we use to reduce pain is the crux of the issue.
The pharmaceutical industry was able to design an opioid based drug that took away pain, allowing people with a high index of pain, debilitating pain, to move and function with greater ease. Perfect ! But, one of the problems with this drug called oxycontin was that the physicians prescribing it were not aware of it's seriously addictive quality. In the past several years a ground swelling of issues from the communities dealing with the repercussions of drug abuse has hit the fan, so to speak and the government is now responding. More on that in a bit.
As we have all been made aware, Opioids are very addictive. People who want to get prescriptive opioids have not had much of a problem getting them. Automatic refills, two or more doctors prescribing, without the other's knowledge, or even unscrupulous prescribing,-- the opportunities to become addicted have been ripe for the taking.
Opioids are a slippery slope. I was recently told the story of a person who went to the urgent care center with back pain, and without being given any education regarding the addictiveness of the medication, that person was prescribed painkilling narcotics. Medical research shows that in as little as four days of taking an opioid, our bodies become habituated to the drug and require more to attain the same pain relief.
The statistics are staggering. Here are just a few.
There has been a 300% increase in prescription opioid sales in the US Since 1999. This is Without a corresponding change in the amount of pain reported by the same number of patients. . And more importantly, alternative medication (non narcotic) use was not discussed
259 Million prescriptions for opioid pain relievers were written by providers in 2012. That's enough for every adult in America to have his or her own prescription.
in 1999 4,000 deaths were attributed to opioid pain relievers. in 2013 that number quadrupled to 16,000 deaths
in 2013 Two million americans were documented to have developed a dependency on opioid painkillers.
TO bring this closer to home, In Worcester County in 2000 there were 59 deaths from opioids. 14 years later that number had more than doubled to 126. Middlesex County has had a tremendous increase. In 2000 they had 56 deaths from opioids. In 2014 - 238 deaths. This mirrors the national data --quadruple the number of deaths in a 14 year period...
We have been examining pain relief prescribed by physicians and the problems of addiction. The slippery slope is the increasing transition from prescribed medications to the use of heroin.
1. Most heroin addiction starts with a legitimate pain prescription.
People who misuse prescription pain relievers are 40 times more likely to become addicted to heroin than those who don’t, according to the Centers for Disease Control and Prevention. Research also shows that 75 percent of patients in heroin treatment started their opioid use with prescription medications, not heroin. That sounds like pain treatment is at the root of the problem, and the CDC is targeting doctors with new guidelines aimed at reining in prescriptions.
But overwhelmingly, prescription-drug misusers are not pain patients. According to the National Survey on Drug Use and Health, more than 75 percent of recreational opioid users in 2013-14 got pills from sources other than doctors, mainly friends and relatives. Even among this group, moving on to heroin is quite rare: Only 4 percent do so within five years; just 0.2 percent of U.S. adults are current heroin users.
The real risk factor for opioid addiction is youth. Like 90 percent of all addictions, the vast majority of prescription-drug problems start with experimentation in adolescence or early adulthood, typically after or alongside binge drinking, marijuana smoking and cocaine use. Having a prior or current addiction to another drug is the best predictor of developing problems with prescription drugs — not pain care.
There is a current commercial that shows an adult going to the medicine cabinet, opening the mirrored cabinet door and taking out a prescription bottle and taking a pill, but when that individual closes the cabinet the mirror shows is her son, checking out the drug store, and grabbing one of mom's pills, experimenting.
Since CESA, the Committee on Ecology and Social Action, decided to speak to this topic of opioids and drug abuse and what it means to us as a community there has been a waterfall of information published in the community of medical journals. I have had so many articles available to review that it's overwhelming. This is due in great part to the new guidelines that have been instituted regarding the use of addictive drugs in the hospital setting. The Commonwealth of Massachusetts just passed a law on March 14th of this year that establishes a maximum seven day prescription of opioids to non cancer patients, when issued to an adult for the first time.. A prescriber may issue more than a seven day supply if, in their medical judgment, a greater supply is necessary to treat an acute medical condition, but they have to document their decision to do so with medical justification. We now have better regulations in place, so that those who prescribe cannot escape the responsibility of the dangers of addiction. We the public also need to become better educated about what we put into our bodies and not rely solely on the prescriptive authority of a physician.
With these new regulations in place, the hope is that the opportunity for addiction will be slowed , and a reality check will be put in place with a dialogue between patient and physician that addresses the issue of specific drug prescriptions, their effect and the length of use as medically judicious.
As a religious community what are we to do? Stay educated. Don't say "it can't happen to me". Challenge your physician with educating you if prescribed narcotics or opioid based medications. Keep our children educated to the dangers of addiction. And, reach out to the larger community, --supply a helping hand to those who have slipped down that slope and be an example to them and a support in helping them back to a life where they can say no.
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