Maia Szalavitz, Unbroken Brain

Maia Szalavitz, Unbroken Brain: A Revolutionary New Way of Understanding Addiction.

Overdose Deaths in the U.S. Are Rising at Troubling Rate

One can't possibly imagine the loss of a loved one to opioids, among other things.

I mean, the loss of a loved one is tragic in any case, but death from overdose doubly so, as it creates so many "what ifs." It's not like losing a parent in the twilight years of life, for as sad as that is, it's an inevitability. (And both my parents are gone, so I'm speaking from experience.) But if I lost either one of my sons right now, to overdose especially, I think I'd probably fade away. My psychology hasn't been so great this last two years. I've had a lot of anxiety (especially in March 2020 and the overnight shift to emergency remote online instruction) and bouts of depression. The last thing I need is death in the family.

In any case, God bless those facing this crisis. It's unbearable, and worse, it's not one on the top of the radar of public policy. 

At the New York Times,  "A Rising Death Toll":

Drug overdoses now kill more than 100,000 Americans a year — more than vehicle crash and gun deaths combined.

Sean Blake was among those who died. He overdosed at age 27 in Vermont, from a mix of alcohol and fentanyl, a synthetic opioid. He had struggled to find effective treatment for his addiction and other potential mental health problems, repeatedly relapsing.

“I do love being sober,” Blake wrote in 2014, three years before his death. “It’s life that gets in the way.”

Blake’s struggles reflect the combination of problems that have allowed the overdose crisis to fester. First, the supply of opioids surged. Second, Americans have insufficient access to treatment and other programs that can ease the worst damage of drugs.

Experts have a concise, if crude, way to summarize this: If it’s easier to get high than to get treatment, people who are addicted will get high. The U.S. has effectively made it easy to get high and hard to get help.

No other advanced nation is dealing with a comparable drug crisis. And over the past two years, it has worsened: Annual overdose deaths spiked 50 percent as fentanyl spread in illegal markets, more people turned to drugs during the pandemic, and treatment facilities and other services shut down.

The path to crisis

In the 1990s, drug companies promoted opioid painkillers as a solution to a problem that remains today: a need for better pain treatment. Purdue Pharma led the charge with OxyContin, claiming it was more effective and less addictive than it was.

Doctors bought into the hype, and they started to more loosely prescribe opioids. Some even operated “pill mills,” trading prescriptions for cash.

A growing number of people started to misuse the drugs, crushing or dissolving the pills to inhale or inject them. Many shared, stole and sold opioids more widely.

Policymakers and drug companies were slow to react. It wasn’t until 2010 that Purdue introduced a new formulation that made its pills harder to misuse. The C.D.C. didn’t publish guidelines calling for tighter prescribing practices until two decades after OxyContin hit the market.

In the meantime, the crisis deepened: Opioid users moved on to more potent drugs, namely heroin. Some were seeking a stronger high, while others were cut off from painkillers and looking for a replacement.

Traffickers met that demand by flooding the U.S. with heroin. Then, in the 2010s, they started to transition to fentanyl, mixing it into heroin and other drugs or selling it on its own.

Drug cartels can more discreetly produce fentanyl in a lab than heroin derived from large, open poppy fields. Fentanyl is also more potent than heroin, so traffickers can smuggle less to sell the same high.

Because of its potency, fentanyl is also more likely to cause an overdose. Since it began to proliferate in the U.S., yearly overdose deaths have more than doubled.

No one has a good answer for how to halt the spread of fentanyl. Synthetic drugs in general remain a major, unsolved question not just in the current opioid epidemic but in dealing with future drug crises as well, Keith Humphreys, a Stanford University drug policy expert, told me.

Other drug crises are looming. In recent years, cocaine and meth deaths have also increased. Humphreys said that historically, stimulant epidemics follow opioid crises.

Neglecting solutions

A robust treatment system could have mitigated the damage from increasing supplies of painkillers, heroin and fentanyl. But the U.S. has never had such a system.

Treatment remains inaccessible for many...

Still more.

 

Slow-Motion Suicide in San Francisco

From Michael Shellenberger, "The city is carrying out a bizarre medical experiment in which they are helping homeless drug addicts use drugs. ‘It’s handing a loaded gun to a suicidal person":

Something very different is happening in San Francisco. The city is carrying out a bizarre medical experiment whereby addicts are given everything they need to maintain their addiction—cash, hot meals, shelter—in exchange for . . . almost nothing. Voters have found themselves in the strange position of paying for fentanyl, meth and crack use on public property.

You can go and witness all of this if you simply walk down Market Street and peek your head over a newly erected fence in the southwest corner of United Nations Plaza. You will see that the city is permitting people to openly use and even deal drugs in a cordoned-off area of the public square.

The city denies that they are operating a supervised drug consumption site. “This site is about getting people connected with immediate support, as well as long-term services and treatment,” a spokesperson for the city’s Department of Emergency Management told the Chronicle.

The official line is that they are running what they call a “Linkage Center” in a building next to the open drug market in the plaza. The idea is that the center is supposed to link addicts to services, including housing and rehab. When Mayor London Breed announced it, she promised it would get people into treatment so they could stop using drugs, not simply hide their use.

But city officials have told me that in the 19 days that the site has been open, just two people total went to detox so far. And they serve some 220 people per day.

“In that tent on Market Street everyone is shooting dope,” complained a senior employee of a major city service provider, speaking of the scene at the plaza. “It’s insane. All the staff standing around watching them. It’s fucking ridiculous. I don’t know how anybody thinks that helping a drug addict use drugs is helping them.” “What’s happening is that everyone that comes in gets a meal, can use the bathroom, gets drug supplies (needles, foil, pipes) and signs up for a ‘housing assessment,” a person with firsthand information about the operation told me over text message. “But there’s no housing. So nothing happens. They just get added to a list.”

The parents whose children live on the streets are adamant that the status quo is broken. “I agree with the Linkage Center,” Gina McDonald told me. Her 24-year-old daughter Samantha is a heroin and fentanyl addict who has been on and off the streets for the last two years. “But allowing open drug use does not help. It’s handing a loaded gun to a suicidal person.”

If you appreciate groundbreaking reporting about important stories that are overlooked, please consider becoming a subscriber. Last Thursday I returned to the Linkage Center to find out what, if anything, had changed since I first visited. I saw (and video recorded) much more drug use within the supervised drug consumption site, and much more drug dealing around it, than I had two weeks ago...

RTWT.

 

Angels Pitcher Tyler Skaggs O.D.'d on Fentanyl, Oxycodone, and Alcohol

I knew it.

I just knew it immediately when the news broke in July that Skaggs didn't die of natural causes. What exactly killed him? No one knew at the time. But it was suspicious and anyone with a brain probably had it figured out.

Prayers for his family and his soul.

At the Los Angeles Times, "Tyler Skaggs’ autopsy: Fentanyl, oxycodone and alcohol led to death by choking on vomit."

And, "Details of Tyler Skaggs’ death could trigger legal battle with millions at stake":

Investigations into that question could determine whether the Angels and the family of one of their most popular players face off in legal proceedings that could take years and be worth tens of millions of dollars — or more.

The Skaggs family and the Angels each have retained attorneys based in Texas, where Skaggs died July 1 on the first day of a team trip to play the Texas Rangers and Houston Astros. The prospects of a wrongful-death lawsuit appear significant, given that the family‘s assertion in a statement Friday that they had learned the “circumstances surrounding Tyler’s death … may involve an employee of the Los Angeles Angels.”

That statement prompted Major League Baseball to launch an investigation. Police in Southlake, Texas — where the Angels were staying that night — have been investigating since Skaggs’ death. The attorney hired by the Skaggs family, Rusty Hardin, intends to pursue his own probe.

“We’re going to want to know how it came about that those drugs were ingested,” Hardin told The Times, “and whether or not others are responsible for what happened.”

The prospects of success for any wrongful death suit could depend on whether attorneys can identify a party besides Skaggs that might be at least partially responsible for his death, said Julie Cantor, who teaches law at UCLA.

“You need to have a wrongful act,” said Cantor, speaking generally because she has not reviewed any records in the Skaggs case...

RTWT.

Decriminalizing Hard Drugs

It's Nicholas Kristof, with a long piece at NYT, FWIW:

Seattle is in effect decriminalizing the use of hard drugs, @NickKristof writes. It is relying less on the criminal justice toolbox to deal with drug abuse and more on the public health toolbox. https://t.co/3YvnxDaxAM

— New York Times Opinion (@nytopinion) August 23, 2019

Barry Meier, Pain Killer

At Amazon, Barry Meier, Pain Killer: An Empire of Deceit and the Origin of America's Opioid Epidemic.

Drug Overdoses Caught on Video

This is a devastating, heart-wrenching piece, at the New York Times, "How Do You Recover After Millions Have Watched You Overdose?" (Via Althouse, "'In October 2016, Ron Hiers and his wife, Carla, feeling despondent after years of addiction, had made a suicide pact to get high until they were dead, and ended up passed out by a bus stop in Memphis'.")

Like Althouse, I'm not embedding videos --- for me, they're just too sad and they seem like things that shouldn't be watched.

From the article:

It's a new genre of horror film — the drive-by video, often taken by a stranger, of someone who has overdosed. What is it like when millions have seen your worst moment? https://t.co/NI8cglsTsD

— NYT National News (@NYTNational) December 12, 2018

In Lawrence, Mass., a former mill town at the heart of New England’s opioid crisis, the police chief released a particularly gut-wrenching video. It showed a mother who had collapsed from a fentanyl overdose sprawled out in the toy aisle of a Family Dollar while her sobbing 2-year-old daughter tugged at her arm.

“It’s heartbreaking,” James Fitzpatrick, who was the Lawrence police chief at the time, told reporters in September 2016. “This is definitely evidence that shows what addiction can do to someone.”

Mandy McGowan, 38, knows that. She was the mother unconscious in that video, the woman who became known as the “Dollar Store Junkie.” But she said the video showed only a few terrible frames of a complicated life.

As a child, she said, she was sexually molested. She survived relationships with men who beat her. She barely graduated from high school.

She said her addiction to opioids began after she had neck surgery in 2006 for a condition that causes spasms and intense pain. Her neurologist prescribed a menu of strong painkillers including OxyContin, Percocet and fentanyl patches.

As a teenager, Ms. McGowan had smoked marijuana and taken mushrooms and ecstasy. But she always steered clear of heroin, she said, thinking it was for junkies, for people living in alleys. But her friends were using it, and over the last decade, she sometimes joined them.

She tried to break her habit by buying Suboxone — a medication used to treat addiction — on the street. But the Suboxone often ran out, and she turned to heroin to tide her over.

On Sept. 18, 2016, a friend came to Ms. McGowan’s house in Salem, N.H., and offered her a hit of fentanyl, a deadly synthetic painkiller 50 times more potent than heroin. They sniffed a line and drove to the Family Dollar across the state line in Lawrence, where Ms. McGowan collapsed with her daughter beside her. At least two people in the store recorded the scene on their cellphones.

Medics revived her and took her to the hospital, where child welfare officials took custody of her daughter, and the police charged Ms. McGowan with child neglect and endangerment. (She eventually pleaded guilty to both and was sentenced to probation.) Two days later, the video of her overdose was published by The Eagle-Tribune and was also released by the Lawrence police.

The video played in a loop on the local news, and vaulted onto CNN and Fox News, ricocheting across the web.

“For someone already dealing with her own demons, she now has to deal with public opinion, too,” said Matt Ganem, the executive director of the Banyan Treatment Center, about 15 miles north of Boston, which gave Ms. McGowan six months of free treatment after being contacted by intermediaries. “You’re a spectacle. Everyone is watching.”

Ms. McGowan had only seen snippets of the video on the news. But two months later, she watched the whole thing. She felt sick with regret.

“I see it, and I’m like, I was a piece of freaking [expletive],” she said. “That was me in active use. It’s not who I am today.”

But she also wondered: Why didn’t anyone help her daughter? She was furious that bystanders seemed to feel they had license to gawk and record instead of comforting her screaming child.

“I know what I did, and I can’t change it,” she said. “I live with that guilt every single day. But it’s also wrong to take video and not help.”

Nobody recorded the chaos that unfolded next. After Ms. McGowan was released from treatment, the father of her daughter died of an overdose. Two months later, that man’s 19-year-old son also died of an overdose.

Reeling, Ms. McGowan had a night of relapse with alcohol. She checked herself into treatment the next day. But at the same time, she had stopped reporting to her probation officer, a violation of parole that led to 64 days in jail. She was kicked out of a halfway house and stayed briefly at a shelter. She said she was raped this year. She checked herself into a hospital psychiatric ward for five weeks.

Ms. McGowan finally felt ready to start actively rebuilding her life. This spring, she moved to a halfway house in Boston, where her days were packed with appointments with counselors and clinicians, and meetings of Narcotics Anonymous and Alcoholics Anonymous. She had weighed just 90 pounds when she overdosed; now she was happily above 140.

Just after Thanksgiving she moved in with relatives, and now hopes to find a place of her own. Her treatment continues. If she stays sober and shows progress, the charges against her will be dropped in April.

She spends part of her day doing volunteer outreach along the open-air drug market in Boston known as Methadone Mile. One recent drizzly afternoon, as she made her way down the sidewalk, she hugged old friends, asked them whether they had eaten, if they were O.K. On her rounds, she picks up hundreds of used needles that carpet the streets...

RTWT.

This whole epidemic makes me very sad, and fine-grained stories like this are frankly out-of-this-world to me.

There but for the grace of God I go...

Adam Alter, Irresistible

*BUMPED.*

At Amazon, Adam Alter, Irresistible: The Rise of Addictive Technology and the Business of Keeping Us Hooked.

FOMO

At Wired, "We Can't Stop Checking the News Either. Welcome to the New FOMO."

It's "Fear of Missing Out."

I've had it before, although not so much lately.

The science behind the regret, shame, and anxiety that comes from constantly monitoring your feeds for news https://t.co/UdEXeUPrxF

— WIRED (@WIRED) August 26, 2017

Internet Addiction Resistance

Following-up, "Adam Alter, Irresistible."

Here's a great piece, with the reference to the book, from Ross Douthat:

My Sunday column: Resist the Internet:https://t.co/BNR0FYxWpQ

— Ross Douthat (@DouthatNYT) March 12, 2017

Deadly Fentanyl

This is gnarly, at NYT:

Fentanyl Outpaces Heroin as the Deadliest Drug on Long Island. #Opioids https://t.co/SZ7ArqAvPA

— Donald Douglas (@AmPowerBlog) December 31, 2016

Generation Adderall

This is an excellent essay, from Casey Schwartz, at NYT:

Generation Adderall. https://t.co/gYvyrZNBaZ

— Donald Douglas (@AmPowerBlog) October 14, 2016

'Timbuktu'

The most beautiful moment in this film is the wonderful singing scene featuring Fatoumata Diawara.

My God I almost fell out of my seat.

You can hear her at the trailer, "Timbuktu Official Trailer 1 (2014)."

Once she's found out by the jihadists, however, you'll cry as she screams while being whipped. Forty-lashes was her punishment from the sharia court. No music allowed, praise be Allah, the Beneficent, the Merciful.

I visited Laemmle's Royal Theatre last Tuesday to catch the show, the same day that Moaz al-Kasasbeh was burned alive.

Unfortunately, I can't wax ecstatic about the movie, as do so many of the MSM reviewers. The peace and happiness of the residents of Timbuktu is overtaken by the horror of Islamic jihad. The filmmakers try to use satire to make the terrorists look like bumblers, but sheer stupidity doesn't prevent them from wreaking death on the people in the community. It's pretty depressing. The problem is ISLAM. Until Muslims of the world abandon their religion, convert to Christianity or Judaism --- or Buddhism, for goodness sake --- then no amount of lush storytelling will transcend the existential horror.

See Joe Morgenstern, "‘Timbuktu’ Review: Artful Cry Against Thug Theocracy: Jihadists impose Shariah law in a West African village, suppressing joy in the process." And also Betsy Sharkey, at the Los Angeles Times, "'Timbuktu' a compelling exploration of extremism's absurdities," a mistake ridden review, pathetically. (Fatoumata Diawara does not play "La chanteuse ... roaming the streets, singing, laughing, taunting passersby, remnants of a black chador dragging in the dust behind her.")

Thankfully, A.O. Scott takes off the gloss, at the New York Times, "A Fury Arrives. Hypocrisy, Too: ‘Timbuktu,’ an Abderrahmane Sissako Film About Radical Islam."

Dodgers, #Angels Have Mixed Reaction to Tobacco After Death of Tony Gwynn

I guess Tony Gwynn attributed his cancer to smokeless tobacco.

I thought "What the heck?" when I heard he'd passed. He was only 54.

In any case, at the Los Angeles Times:

For many players, the use of smokeless tobacco becomes entwined with playing the game. It becomes difficult to imagine baseball without it.

I can see that. But times are changing.

In any case, read it all at that link.

Bill O'Reilly on Internet Addiction

I just watched this. The 8:00 o'clock O'Reilly is on right now.

An interesting discussion at the clip. I took my youngest son to the doctor today and I was on mobile Twitter on my iPhone while waiting for the nurse to come into the examination room. After she came in and started updating my son's information, asking me some questions, my wife texted me with a reminder about the doctor appointment. I was holding my phone and started to reply to my wife. I'm in the doctor's room and my wife telling me the appointment's not until later. Huh? I start writing my wife back and then stopped. The nurse was still asking me questions. I apologized and put my phone away and concentrated on what was going on in real time.

Now, I don't use the phone very much so that was strange. On the other hand I'm on the laptop all day, while I'm having coffee in the morning, while I'm watching the afternoon news shows on CNN and Fox News, and later in the evening if I'm watching a game. I'll usually be blogging and tweeting through all these things. I'm just connected all the time. It's some kind of addiction. I wouldn't be happy if I couldn't go online and do all the things I do. And I wouldn't be able to work and teach effectively. It's just part of what I do.

But there's a time and place for it. And especially for young people, children, teenagers, and college students, people who grew up on the technology and is not a part of their lives but is their lives, I think it's creating a dangerous rewiring of human consciousness. As I mentioned the other day, I rarely see young people readings books. When I was young I always had a book. I never went somewhere without a book. If someone saw me and I wasn't holding a novel or something they'd say, "Hey, where's you book?" Nowadays, what students have read --- at least what I find from my students when I ask what they're reading --- is what they've been required to read in school, often some great literature. But I come across few students who are independently rich in reading skills, who read widely unprompted. The culture has changed, and this problem with Internet addiction, along with the larger issue of entire lives built around this social media, has led to a deterioration of social skills, literacy, and who knows what else. The Daily Mail reports today that young boys sext girls because their personal development has been completely arrested --- they don't know how to talk to girls even if they wanted to.

As people aways say, with all things, moderation is key.