Pain and Suffering in New England

 

imageHere in New England, it’s hard to get through a news cycle without at least one mention of the region’s opioid epidemic. Every media outlet covers it; governors are creating task forces faster than you can count; and the presidential candidates expect daily questions on the matter, often from parents who lost a child to an overdose. (Notably, Jeb Bush’s daughter has struggled with addiction for years, and Carly Fiorina’s stepdaughter died of an overdose.)

Is the problem worthy of the hype? More so than I had thought. In Massachusetts last year, there were nearly 1,100 confirmed deaths from opioid poisoning, and that number is likely to crawl higher as some investigations are completed. That’s up from 711 deaths in 2012, which constituted very nearly 30 percent of all accidental deaths in the state. Most depressingly, confirmed overdose deaths have increased every year since 2010, when the number was just 555. New Hampshire has only a fifth as many people as Massachusetts, but almost a third as many fatal cases. These rates are significantly higher than national averages.

Now, statistics like this are only a reflection of reality and often a distorted one: It’s wholly possible that the increase in the number of recorded incidents reflects, at least in part, a growing awareness of such causes of death (when you start looking for things, you tend to find them). Still, that’s a staggering number of deaths, both in absolute numbers and as a proportion of preventable deaths. I’m hesitant to use the word “epidemic” to describe things short of the Spanish Flu, but there’s a undoubtedly a very serious problem here.

One of the more interesting aspects of this is that a large and growing percentage of addicts start with prescription opioids and then progress to illegal ones. That is, they get hooked on OxyContin or similar pain killers — dangerous in itself — and then switch to heroin when their prescription runs dry or they can’t afford to refill it. (Like many folks, I know someone who got hooked on prescription narcotics. It was a mess. She’s recovered, but she had a really strong support network).

Indeed, the numbers of legal painkillers prescribed are astonishing (for a really interesting piece on pain treatment, do check out this one we published earlier this week). Via the Boston Globe, consider:

The council also received new data on prescriptions for controlled substances, such as painkillers, derived from the monitoring program. It showed that prescriptions had declined slightly in 2014, returning to 2011 levels. But the numbers remain staggering: In a state with 6.7 million people, 4.4 million opioid prescriptions — including 240 million pills, capsules, or tablets — were dispensed in 2014.

One of the more interesting responses to the crisis has been the distribution of naloxone, a drug that can reverse the effects of an opioid overdose. Though effective, safe, and available to medical professionals for more than three decades, some municipalities have experimented with distributing it widely, including to treatment facilities, police, family of addicts, and — controversially — the addicts themselves. A few years back, the police department in Quincy, Mass. spearheaded a program of training all officers to carry and administer emergency doses; they’ve saved dozens of lives locally in the last few years and have trained other departments in the region. Also controversially, the Gloucester, Mass. PD has unilaterally decided not to arrest addicts who walk in the door, and to divert them to treatment instead.

On the other hand, Massachusetts Governor Charlie Baker is considering a number of responses, including short-term involuntary treatment, restricting the number of pills that can be prescribed at any given time, and requiring pharmacies to do more reporting.

Of course, there’s only so much state and local agencies can do, and the real work is almost certainly best done by private institutions and churches. Laws and regulations might be able to mitigate the damage, but family and religion stand a much better chance of addressing the underlying human crisis.

Published in Culture, Healthcare, Policing
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  1. Annefy Member
    Annefy
    @Annefy

    You know, I haven’t thought of the guy I know for a long time. It’s a case of addiction that would break your heart.

    His father was a diagnosed paranoid schizophrenic and an alcoholic; of his four kids, three have battled substance abuse and / or mental illness.

    The son, my friend, was the kindest guy I ever knew. He tried mightily to quit drinking and smoking pot more times than I can count, sometimes remaining sober for long stretches. But he would always relapse.

    His father eventually committed suicide by hanging himself in his trailer. It was my friend who found him. After he’d been dead for a week. In August. There’s a back story of what drove his father to suicide that is just wild, but that’s a story for another day.

    I knew then and there the gig was up; any energy left to fight his own demons was gone. And the family was exhausted.

    One sister remained committed and managed to get him into the assisted living facility where he now lives. Last I heard he was doing okay; I’m certain without the structured environment and care he would have been dead long ago.

    • #91
  2. Tom Meyer, Ed. Contributor
    Tom Meyer, Ed.
    @tommeyer

    Fred Cole:I wonder how these numbers compare To deaths from Tylenol overdoses.

    From Propublica:

    Data compiled by the U.S. Food and Drug Administration has linked as many as 980 deaths in a year to drugs containing acetaminophen… Data obtained from the U.S. Centers for Disease Control and Prevention show that more than 300 people die annually as a result of acetaminophen poisoning.

    The latter statistic is probably the more accurate, as the former includes drugs (like vicodin) that contain both acetaminophen and opiates, but let’s make it easy and call it 500 deaths from acetaminophen.

    So, in answer to your question, Massachusetts has about twice as many deaths from opioids annually as does the nation from tylenol each year.

    • #92
  3. Tom Meyer, Ed. Contributor
    Tom Meyer, Ed.
    @tommeyer

    Manny: Hmm, yes.  The constitution guarantees you the freedoms in the bill of rights.  Nothing else.  Everything else is open for legislation.

    The Founders’ intent was for the states to delegate specific, enumerated powers to the federal government. That is, if a power is not explicitly granted by the federal constitution, then the federal government has no authority over it. As Midge said, one of the negative consequences of the Bill of Rights has been to sow some confusion into the matter (which isn’t to say that the Bill of Rights wasn’t worth it).

    Now, whether the states and local governments should act under similar principles (i.e., only be empowered to do specific things, rather than only prohibited from doing certain things) is a little more complicated, though I’ve pretty strong feelings that it should.

    • #93
  4. Tom Meyer, Ed. Contributor
    Tom Meyer, Ed.
    @tommeyer

    Midget Faded Rattlesnake:

    Merina Smith:Let me ask you libertarians–do you oppose prescription drugs in general?

    Opposing available-by-prescription-only is not the hill I want to die on.

    That said, I do question many aspects of the existing prescription-drug regime, and would not be surprised if a laxer regime (ranging from marginally less encumbered than our current system to totally unencumbered) would be better.

    Seconded.

    • #94
  5. Tom Meyer, Ed. Contributor
    Tom Meyer, Ed.
    @tommeyer

    Manny: The softening of pot legalization has doubled pot use in the last five years, and made the quality of the pot much more potent.

    I’d be surprised if the latter were both true and connected to legalization. It’s my understanding that a lot of the pressure to increase potency/concentration comes from prohibition, on the grounds that it’s a lot easier to smuggle and hide the concentrated stuff than its alternative.

    If you’re trying to sneak booze in somewhere it’s not allowed, you’re better off going with liquor than beer.

    • #95
  6. Larry3435 Member
    Larry3435
    @Larry3435

    Merina Smith:But before that, they are children. There are always children in the world, and we need to fashion the world to some degree to deal with this reality. That means it cannot be a libertarian nirvana.

    I don’t know any libertarians who think that children should be treated just like adults.  That is a total straw man.  Children have virtually no rights – legal or personal.  It’s not just that they can’t legally drink alcohol, or drive, or enlist in the military, or sign a binding contract.  Every aspect of their life is controlled by adults.  They are told what to eat, when to go to bed, whether they can go out and play, what they can watch on TV, and on and on.

    I don’t believe that you actually want adults to be treated that way.  And I can’t imagine who you think should have the authority to come into your home and tell you to go to bed or to do your homework.  We do not care for children by prohibiting adults from doing anything that children are not free to do.  That’s an argument that people trot out when they have no real argument.  Straw man.

    • #96
  7. Larry3435 Member
    Larry3435
    @Larry3435

    Merina Smith:But before that, they are children. There are always children in the world, and we need to fashion the world to some degree to deal with this reality. That means it cannot be a libertarian nirvana.

    And, by the way, what is this “libertarian nirvana” stuff?  Libertarians do not want or expect nirvana.  Unlike socialists or some religious people, we do not believe in Utopia.  Utopians are the people who envision some perfect society, and try to impose it on everyone else.  By force.

    Libertarianism is about what is right.  It’s about morality.  It is a philosophy that addresses how a government (that’s the guys with the guns and billy clubs) should treat its citizens.  It is a philosophy that says that government is necessary, but tyranny is wrong, and tries to balance those principles.

    The alternative is what Manny has been arguing here.  Raw power.  Nietzsche.  The government has the power to do something, and that’s the end of the story.  No consideration is given to whether it is right, or fair, or just to do that thing.  If it’s not banned in the Constitution, then Woohoo!  Anything goes.

    You don’t have to believe in nirvana to believe that morality should play a role in our most important and most dangerous social interaction – that between the state and its citizens.  It is not Utopian to believe that the state should be constrained not just by raw power, but by principle.

    • #97
  8. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    I will respond later today with what I would like to see as requested. Sitting at Driver services at the moment

    • #98
  9. Jojo Inactive
    Jojo
    @TheDowagerJojo

    Annefy:

    Nicotine is indeed highly addictive. So what? As I said in my original comment, smoking will not prevent you from functioning to your God-given ability, nor will it impede in the slightest your ability to be a good friend, a good spouse, a good parent.

    If only we could say that about all addictive substances. And even some non addictive ones.

    My mom would have loved you!  Going through her papers after she died, I found a letter to the editor (unpublished I imagine) with a pretty good rant about how alcohol causes a lot more damage than smoking.  And yes, she died of lung cancer, but she was 88 and had been smoking heavily since 16.  By some calculations I guess she should have lived to 110 but she would have rather smoked, I think.

    • #99
  10. Manny Coolidge
    Manny
    @Manny

    Midget Faded Rattlesnake:Practically speaking, federal lawmakers no longer bother to think, “Is the power we want granted by the Constitution?” Instead, they proceed as if every power is available to the legislature unless someone can prove that it violates the Bill of Rights or subsequent amendment.

    You and I may be saying the same thing at the level of each state’s government, which is where police and parliamentary powers are supposed to reside. But even then, while the police and parliamentary powers vested in each state grant each individual state government plenty of power, a state legislature using that power however it wants without regard to the Anglo-American heritage of rights is not acting traditionally (or justly).

    OK, I see the distinction.  I’m thinking about laws over all.  Either way, the libertarian approach was never part of the US government, or even envisioned.  It doesn’t matter to me whether say drugs are restricted on a federal level or a local level.  Society would be better off restricted.  The people still have the right to make laws which restrict freedoms, as long as they don’t violate the bill of rights.

    • #100
  11. Manny Coolidge
    Manny
    @Manny

    Tom Meyer, Ed.:

    Manny: The softening of pot legalization has doubled pot use in the last five years, and made the quality of the pot much more potent.

    I’d be surprised if the latter were both true and connected to legalization. It’s my understanding that a lot of the pressure to increase potency/concentration comes from prohibition, on the grounds that it’s a lot easier to smuggle and hide the concentrated stuff than its alternative.

    If you’re trying to sneak booze in somewhere it’s not allowed, you’re better off going with liquor than beer.

    My thought was purely a speculation; I don’t know one way or the other.  But we’ve long had prohibition on pot and never had this potency out there.  It’s only now that it’s become legal in places and legally prescribed as a medicine in many states where it has all of a sudden changed for the worse.  The coincidence is noteworthy.

    • #101
  12. Kate Braestrup Member
    Kate Braestrup
    @GrannyDude

    Annefy:You know, I haven’t thought of the guy I know for a long time. It’s a case of addiction that would break your heart.

    His father was a diagnosed paranoid schizophrenic and an alcoholic; of his four kids, three have battled substance abuse and / or mental illness.

    The son, my friend, was the kindest guy I ever knew. He tried mightily to quit drinking and smoking pot more times than I can count, sometimes remaining sober for long stretches. But he would always relapse.

    His father eventually committed suicide by hanging himself in his trailer. It was my friend who found him. After he’d been dead for a week. In August. There’s a back story of what drove his father to suicide that is just wild, but that’s a story for another day.

    I knew then and there the gig was up; any energy left to fight his own demons was gone. And the family was exhausted.

    One sister remained committed and managed to get him into the assisted living facility where he now lives. Last I heard he was doing okay; I’m certain without the structured environment and care he would have been dead long ago.

    Could you let me know where this is? Is it just for addictions or mental illnesses as well?

    I have a loved one who is, at the moment, in a very expensive, very wonderful residential treatment program that I wish more young people with mental illness could have access to.  As it happens, this isn’t for addicts —not enough external control—but it has successfully taught people with mental illness to live real lives. With support, but real lives all the same. That’s what we want for our brothers and sisters, isn’t it? That they get to live real, whole lives.

    One of the many lessons learned from my mentally-ill loved one is that mental illness doesn’t happen in a vacuum. The disordered brain functions (or fails to) in a particular social context. To name the most obvious example, a schizophrenic Catholic is more likely to hallucinate the Virgin Mary than to hallucinate, Kwan Yin. And a mentally-ill person raised to be kind, self-disciplined, honest, hard-working and trusting will be all those things, to the best of his/her ability, and this will be a very good thing. My particular loved one, despite her illness, made a conscious decision to avoid drugs and alcohol because, as she put it, “I knew my brain chemistry was already complicated enough.” Among other things, she knew how to think in terms of “brain chemistry…” I am so grateful she wasn’t raised to think “a martini is the answer to all problems” or “if I hear voices in my head, it must be God… or Satan?” and that she wasn’t a party girl (social stress + drugs anyone?).

    • #102
  13. Annefy Member
    Annefy
    @Annefy

    Kate : I am on the road for the next couple of days; I will respond to you via pm when I return. I do know the facility is in San Pedro CA.

    • #103
  14. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    In answer to the question of what I want to see, let me dismiss Fred’s reducto absurdum snark. I am not for forcing people addicted to Oreo’s into treatment. Nor do I see dragging people smoking into treatment. While it is good and well to be snarky, it does not advance the debate. However, in this post I will clarify why all addictions are not created equal.

    Smoking is an addiction, and it may be one of the hardest to break. It certainly is one that many people suffer from. While it does have long term effects, it does not significantly impair functioning on a day to day basis for those that are addicted. The same applies to caffeine.

    When I am talking about proscribing liberty, I am talking about those addictions that cause day to day dysfunction. People chronically missing work because they are hungover. Running up debt to buy drugs. Using dirty needles. Trading sex for drugs.

    While smoking might shorten your life, it does not impair your functioning on a day to day basis until the future when the side effects kick in.

    • #104
  15. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Now, onto Bryan G. Stephens, tyrant who presumes to take away the liberty of men already slaves.

    What I would like to see is illegal drugs continue to be illegal. This is not to punish, but to give us a chance to intervene by the courts. It seems the easiest  pathway, and far safer than having the state define impairment.

    This does mean that drinkers are going to get less chances to be forced into interventions, though DUI seems a good pathway. Personally, I think if someone gets a second DUI, it is clear that he has a problem.

    With the courts, I want to use the threat of incarceration to get people to choose treatment instead. Those programs need to be funded, and supported. There needs to be safe housing and assistance with employment to support the therapy.

    These arrests and convictions should not show up on a background check as long as the person is following the rules.

    Until we have medications that can block or reverse the effect addiction has on the brain, I believe this is the best we can do. It is a more expensive strategy than “Just make it all legal and let God sort them out”, but it is more humane in the long run.

    • #105
  16. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    Kate Braestrup: …And a mentally-ill person raised to be kind, self-disciplined, honest, hard-working and trusting will be all those things, to the best of his/her ability, and this will be a very good thing. My particular loved one, despite her illness, made a conscious decision to avoid drugs and alcohol because, as she put it, “I knew my brain chemistry was already complicated enough.”

    True. I also think it’s well to point out that mentally-ill people, to the extent that their illness remains poorly-controlled, are unlikely to reap as many benefits from staying sober, self-disciplined, honest, and hard-working as they would if they were sane. (There are so many ways mental illness can screw up your life, even when all the conventional moral niceties are observed.)

    As I said earlier, if a person stays in bed all day because he’s high, or because he’s perfectly sober but mentally ill, either way, he’s still dysfunctional.

    So, while I believe “I’m so messed up already there’s no way I should get involved with drugs, too” is a healthy attitude for a mentally-ill person to have, I can also see how a mentally-ill person might succumb to despair and think, “Sobriety and virtue have rewarded me so little because I’m so messed up. What’s the point of staying good anymore?”

    • #106
  17. Kate Braestrup Member
    Kate Braestrup
    @GrannyDude

    Midget Faded Rattlesnake: So, while I believe “I’m so messed up already there’s no way I should get involved with drugs, too” is a healthy attitude for a mentally-ill person to have, I can also see how a mentally-ill person might succumb to despair and think, “Sobriety and virtue have rewarded me so little because I’m so messed up. What’s the point of staying good anymore?”

    Definitely. This is why it seems such a miracle to me that my loved one was able to think so clearly and choose so sensibly. She’s described her symptoms to me, and all I could think was “I would take anything—ANYTHING—to make that stop.”

    And her mental illness causes suffering and is disabling—I am not claiming that being raised to be (or destined by the luck of the genetic draw to be) a fine human being makes mental illness anything other than what it is… but even for a person with a mental illness, it remains an advantage to have the things that we all try to give our kids: a sense of self, an assurance of being loved and supported, a good education, a degree of self-discipline, a work ethic,  and so on. This, along with a generally agreeable personality, some creativity and intelligence,  allows my loved one to take advantage of what opportunities life does afford her.

    Incidentally, knowing what I know now, I would definitely advise any pregnant woman or  young mother with a family history of mental illness (moi aussi) to make a top priority of just being happy, by any  means necessary (including medication). That sounds silly, I know, but when I was a young mother I was always trying (usually in vain) to achieve things, and making myself miserable (and arguably, stressing out my fetuses/children)  in the process.

    • #107
  18. Tonguetied Fred Member
    Tonguetied Fred
    @TonguetiedFred

    And what of the doctors who are unnecessarily prosecuted and accused of being “Dr. Feelgood” because they are doing their best to help those suffering from chronic pain to live full productive lives?

    • #108
  19. Tonguetied Fred Member
    Tonguetied Fred
    @TonguetiedFred

    Manny: Hmm, yes. The constitution guarantees you the freedoms in the bill of rights. Nothing else.

    NO, NO, NO!  (or rather Yes, presuming you actually follow all the Amendments)

    This is precisely why James Madison didn’t want a Bill of Rights.  He was frightened that people would start to think that they were only granted the rights spelled out in the Constitution.   The 9th Amendment* should ensure that such a misconception does not exist but is, sadly, routinely ignored.

    • “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”
    • #109
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