Do No Harm: Initial Prescription Details Influence Chance of Opiate Dependence

By Terry Gotham

One of the biggest problems with writing about the War on Drugs is the almost exclusive focus on problems. There’s this myth that drug use is a combination between a ratchet & Russian roulette. It’s going to keep getting worse, and it gets harder and harder to “not be addicted” the longer you do it. This continued narrative is believed widely (just ask your family at Easter dinner), while being only lightly supported with evidence. Harm reduction & physician/client education is surprisingly effective at mitigating a lot of the factors that contribute to this “it’s probably going to kill you” problem, but outside of needle exchange/safe injection sites & drinking water while partying, complex harm reduction ideas rarely make it into non-academic circles. So, I’m going to start talking about constructive, modern ideas and research that have been either theorized, published or put into practice, about how to fight this deluge.

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RIP Lost Tom

Image: Facebook

The Burning Man blog has a lengthy eulogy about Tom LaPorte aka “Lost Tom”, a captain of the media team who passed away last week. Our thoughts and prayers go to his family and friends, vale Lost Tom from Burners. We will pour one out for another fallen comrade.

There aren’t enough adjectives in the English language to describe Tom and the effect he had on everyone who had the privilege to know him: Loving, kind, passionate, selfless, inspirational, collaborator, confidant, innovator, gentleman, mentor, the real deal, a class act, community organizer extraordinaire, an embracer of the chaos, “a grown-up amongst us kids,” and, to everyone, a dear friend. He truly loved people, individually and collectively. He found the best in everyone — and touched everyone.

…Tom’s first year at the Burn was 2005 as a member of Bop Camp, a fun-loving crew of Chicago Burners that had somehow achieved Esplanade frontage offering an ungainly jousting experience utilizing motorcycle helmets and stuffed animals duct taped to PVC pipes. He dove in with gusto, cheering the burning of the Man dressed as the ace of spades, his first and only costume of choice.

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According to Tom’s friends on Facebook, his first year at Burning Man was actually 2004.

He came up with the idea of broadcasting the BMIR radio station live from the Man base in 2009, the year he and his Chicago Crew took over Burners Without Borders camp and turned it into what it is today.

The playa was never big enough for what Tom had to offer. When participants left the event in 2005 to help communities ravaged by Hurricane Katrina, Tom followed. He immediately grasped how Burners could do work that matters not just in the desert but in the hearts of communities everywhere. In fact it was what he had been doing himself for years, bringing creativity to the streets of Chicago and creating unlikely connections.

Tom came back from Katrina and started promoting Burners Without Borders in Chicago, and suddenly all his projects became BWB projects. He was constantly pushing the boundaries of BWB. He initiated the Chicago takeover of BWB Camp in 2009 and turned the camp into what it is today.

He also started the Music Box Project, his attempt at explaining “Cultural First Response” to the world. Musicians could become first responders themselves and give the art of healing through music in the hardest of times.

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It doesn’t seem like anyone responded to the Cultural First Responder idea. I always thought Burners Without Borders was more about “send in DPW Heavy Machinery” than sending actual Burners in to, well, hang out and play guitar and stuff. Whatever it is we Burners do when in a group setting such as Burning Man, or the Standing Rock protests.

Coincidentally [ding], when Hurricane Katrina struck – being watched live via military satellite from the Playa – and Burners Without Borders was formed in response, Tom had gone to Burning Man to spend 2 weeks setting up an emergency broadcast system.

Image: Facebook

So his first second year at the Playa, he shows up with pre-recorded Public Service Announcements to hand out as part of a test of a pop-up emergency broadcast system in a place with no cell service. Because if it’s one thing everyone brings to Burning Man, it’s CD-ROM drives. This was an “art” project that several many people thought was worth spending 2+ weeks on. They tested it on Tuesday, Katrina hit on Thursday – and by Monday Tom was off to Katrina, large sum of money having been raised. Then he headed straight back to Chicago to found Burners Without Borders.

Where is that Emergency Public Service Announcement system today? Would’ve come in handy during last year’s false Amber Alert.

“Temporary art serves its purpose, it goes away and mankind goes onto the next step. It’s like a shooting star, it’s really beautiful, then it goes away, but the poetry doesn’t stop. We’ve found a way to achieve collective poetry, to achieve creativity in a group. It’s no longer the age of the lone genius working in isolation, waiting for the great discovery. It’s people working together, discovering stuff together, realizing what they have, taking time to celebrate it, but wondering what’s around the next bend.”
-Tom LaPorte (1953-2017)

 

Lost Tom died of heart failure, aged 63. He previously had a heart attack on the Playa.

Colleagues and friends are mourning the passing of Tom LaPorte, a versatile and innovative communicator over four decades throughout Chicago media. LaPorte, who was 63, died Wednesday of heart failure, according to multiple reports. He most recently served as Chicago’s assistant water commissioner and spokesman for the department. Before that he was webmaster for CBS Radio all-news WBBM AM 780, webmaster, editor and managing editor of former all-news WMAQ, and producer and news editor for news/talk WIND AM 560. LaPorte also headed media relations for Burning Man Project, a nonprofit arts and performance festival, and taught broadcasting and production at Columbia College Chicago. A graduate of Southern Illinois University and six-time Peter Lisagor Award winner, he began his radio career as public affairs director and news anchor at WCIL in Carbondale, Illinois.

[Source]

Communications guru Tom LaPorte reveals the five steps of persuasion artists can use to win attention from collectors, the media, and the public. He also provides a plethora of other practical advice, from how to write a press release to how to incorporate video and live presentations into one’s marketing.

“Artists, by their natures, are often not drawn to aggressive self-promotion…. The ability to communicate through the conventional channels, to get your work known, to get yourself known as an artist and build your communities is something that takes a little bit of practice. Just as your art does.”

Tom LaPorte is a public relations and communications expert based in Chicago. LaPorte was born in Boston in 1953, and his family moved to Chicago in 1960. He earned a Associate of Arts degree in Speech Communication and Rhetoric from the College of DuPage in 1976, and Bachelor of Science in Speech Communications/Radio-TV from Southern Illinois University, Carbondale in 1979. LaPorte held positions in the radio industry for approximately twenty years, including as a writer, producer, and manager of a news room. In 1996 he began working with the Internet, spearheading an effort to audio stream that year’s Democratic National Convention. LaPorte worked as a writer, editor, and webmaster for WBBM-AM for several years before becoming Assistant Commissioner for the City of Chicago in public and media relations. He spent nearly thirteen years in the role before leaving to act as an independent consultant. Since 2004 LaPorte has also coordinated media relations for Burning Man, an annual festival which brings approximately 68,000 artist-attendees to the Nevada desert. Through the festival, LaPorte acts as a pro bono consultant for artists and creatives of all types.

[Source]

Lost Tom was an Elf to his college roommate Jim Belushi’s Santa-con:

Long before his interest in Burning Man, Tom was already a Chicago legend. As Jim Belushi’s college roommate and partner in mischief, he went around to the Albanian homes in the suburbs dressed as “Frostbite the Elf” to Jim’s blotto Albanian Santa.

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Tom encountered Abbie Hoffman of the Yippies (not Albert Hofmann of the Trippies) as a teen with a high school radio show, before rising up to use the infamous Chicago political machine as a force for good:

Tom embodied the best of Burning Man before he ever set foot on the playa. He was first and foremost a storyteller. Inspired by an interview he did with political and social activist Abbie Hoffman for his high school newspaper during the Chicago 7 trial, he pursued a career in journalism, working for some of the top Chicago media outlets, eventually working for the City of Chicago as Assistant Water Commissioner, where he honed his second strength — collaboration — working with residents, local businesses, community and church groups to leverage the infamous Chicago bureaucracy and political machinery for the forces of good. He always looked out for the less fortunate and those in need.

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Lost Tom was involved with trippy visuals for the Grateful Dead and something called The Human Avatar Project:

Tom was a founding member of the Burning Man Chicago Steering Committee, which gave rise to the local Burner 501c3 Bold Urban Renaissance Network. He created and led art teams at the Rothbury and Electric Forest music festivals; Second Thoughts, which made videos that opened up for Bob Dylan and the Dead; The Human Avatar Project and Einstein Moments, which created participatory creativity games.

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There is only one festival, Electric Forest which is in Rothbury, Michigan.

The Human Avatar Project is a way for billionaires to achieve immortality by merging with the Internet. It has been endorsed by the Dalai Lama. It seems like the same idea as the “Singularity” being promoted by Billionaire Burners Elon Musk and Those Wacky Google Guys.

Image: Daily Mail

Image: 2045.com

In Tom’s case I think it’s more likely they were talking about this art project:

Image: Facebook

Einstein is someone you should have Second Thoughts about for a moment. There are a couple of amazingly coincidental [ding ding] links between Einstein and the Sixties counter culture that spawned the Grateful Dead, as we explored in 50 Years of Flower Power. Wavy Gravy aka Hugh Romney used to take walks around the block with Einstein as a child; Ram Dass aka Richard Alpert’s father George founded the Albert Einstein College of Medicine…but that’s another story.

Lost Tom’s Einstein Moments was an Electric Forest art project, perhaps symbolic:

Image: Facebook

Sounds like Lost Tom was quite a character to be part of the Burning Man media team, rising in the ranks to Captain, and a pillar of the Chicago Burner community. Rest In Peace, or come back to be born into a new life and a better future. May your flame burn on forever.

 

The Elephant In The Emergency Room: Heroin & “Standard” Treatment

By Terry Gotham

I know that sometimes I can seem all doom & gloom about the state of the drug-consuming universe, but once and a while I happen upon something that justifies my concern. This letter by Dr. Leon Gussow, published in the Emergency Medicine News (March 2017) journal is one of those things.

The filtration of fentanyl & fentanyl analogs into the recreational opiate supply has pushed us into a place where the simple “opiate overdose” prognosis in emergency rooms & EMT visits is no longer simple. Previously, treating an opiate overdose involved a single dose of narcan/naloxone, with a few hours of observation before the patient was back on their feet. The patient was then assessed for discharge and removed from the workload of the emergency room if released. This allowed even severe opiate overdoses to be handled in a timely, almost mundane fashion, if the EMTs were timely and the staff was experienced. But as Dr. Gussow explains, this is no longer the case.

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Cannabis and Kratom: A Light in the Opiate Dark

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Analysis by Terry Gotham

With the country currently gripped in fear that ACA will be repealed, I’ve started to ponder what options will be left for Americans in the throes of physical dependency if the cuts to medical/addiction funding are as deep as the ones currently being floated. While some proponents of the 21st Century Cures Act note that there’s been a scheduled $1 billion increase in funding for treatment, a repeal would remove at least $5.5 billion in funding to almost 3 million people suffering from substance use disorders. As dozens of states grapple with ever-increasing rates of opiate addiction and overdose, states that have legalized cannabis have discovered something startling.

A study published in the Journal of Pain by a trio of researchers out of the University of Michigan documents a reduction in opiate consumption in Chronic Pain patients who use cannabis. Specifically, medical cannabis uses was associated with a 64% reduction in opioid use. Additionally, 45% of the patients (118 out of the 244 sampled), reported reduced side effect frequency & intensity. In states that have medical marijuana available for their citizens, drivers between the age of 21 and 40 who were killed driving accidents tested positive for opiates significantly less often than drivers of the same age in states that didn’t have medical marijuana available. For example, Montana saw a 1.7% reduction in the number of drivers who tested positive for opioids after their MMJ laws went into effect. And that’s just numbers associated with people behind the wheel. When we evaluate the effect of cannabis consumption on opiate overdoses, the evidence becomes even more compelling.

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Cops Don’t Keep Festivals Clean: Hard Proof From Australia

Via The Village Voice

Via The Village Voice

I was sent this paper by a professor at NYU who I hold in the highest regard. While local authorities all around the world continue to argue about the best way to “secure” festivals, from crime and medical harm, the Aussies have done some real work. Published in this month’s International Journal of Drug Policy, Caitlin Elizabeth Hughes, Vivienne Moxham-Halla, Alison Rittera, Don Weatherburnb, Robert MacCounc of the National Drug & Alcohol Research Centre at the University of New South Wales in Sydney have made a fascinating discovery. One that, while novel, will seem obvious immediately once you understand what they proved. The core assumption they sought to evaluate the validity of seems almost common sense, yet has been at the core of the West’s strategy : Police can deter, discourage or prevent drug offending/consumption. Given that we’ve already spent $1.2 Billion in 2017 already to police and prohibit, you’d hope that the core tenet of “Police presence reduces drug offense” would be bullet-proof.

Over 4000 people took part in a Drug Policing Survey over a 5 month period. This survey asked takers (who had self-identified as regular festival/club attendees who consumed recreational drugs or had friends who did) to evaluate how certain types of police presence at clubs and festivals would cause them to change their drug taking tactics. As opposed to treating party people as some skittish, crack-addicted group that couldn’t be reasoned with, Dr. Hughes & her team depended on the festival/club attendees to evaluate scenarios where evading law enforcement was the goal. This might seem a little subversive to Americans, but even in cybersecurity, probing weaknesses using data from blackhats is worth its weight in gold. And this study was no exception.

Five different experimental vignettes were presented to the surveytakers. They were hypothetical scenarios that included an assortment of policing strategies: High Visibility Policing, Riot Policing, Collaborative Policing & Policing with Drug Detection Dogs, and a control scenario (No police presence). Essentially, how would your drug consumption or purchasing change if one of these police presence schema was used at the club or festival you attended. While any police presence led to a 4.6% reduction in overall illicit drug offending, it led to merely a reduction in people willing to carry drugs into an event or carry them on their person. Which makes sense. Ask any party person you know, they’ll probably regale you with tales of very minor substance use inside the club, maybe a few key bumps or lines in the bathroom. Very few people have the cajones to bring drugs into festivals or clubs that have big time security. They just assume they’ll purchase whatever they need inside the venue. And that’s exactly what the researchers found.

Via The Village Voice

Via The Village Voice

Given police presence, purchasing of drugs increased significantly within festival grounds. High Visibility Policing reduced overall drug offending, while Drug Detection dogs reduced drug possession the most, which makes sense. If you can see cops everywhere, you’re less likely to engage in risky shit. However, if you see drug dogs, you’re more likely to not carry, especially into the festival. And here’s the kicker. While you’re less likely to carry, you’re much more likely to buy and consume at the event.

This leads to all sorts of terrible shit, as people don’t test drugs they buy to consume immediately. Moreover, when you buy drugs from a dealer you’re likely to never have contact with again, because you’re not a regular customer, it’s that much more likely they’re going to sell you some bunk. If you’re a regular reader, you can probably guess why this concerns me. The idea that policing is not only ineffective, but also increasing the chance that drug consumers are going to take untested, is a significant departure from the “police just send drug use underground” talking point that we’ve been dealing with for years.

The truth is way more complicated of course. People do drugs in the safest way they’re able, exposing themselves to as little liability as they can while still achieving their ends. If that means buying LSD and taking it while they’re standing in line, they do that. If they prefer a drug that’s got a shorter duration, like MDMA or cocaine, some might be down to bring drugs in, but most are not willing to take that risk. That leads to the massive market opportunity that drug dealers at festivals & clubs exploit. This is simple market economics that most prohibitionists are unwilling to admit. Dealers, like life in Jurassic Park, find a way. Neatly tethered to the events of BPM, criminals will always find a way to ensure they profit from market demand. And in this case, our insatiable demand for drugs can’t even be stopped by the “North Korea with neon lighting” levels of policing that events like Electric Zoo have put forth. High definition cameras to capture buys, drug dogs and high visibility severe response policing can put a damper on drug possession or even perhaps trafficking into the event, but these types of enforcement mechanisms can’t stop consumption.

If anyone believes these findings don’t apply to the USA, I’d love to hear your reasoning. This is the type of bipartisan, public-health focused research that I think we should be relying on. As we’ve seen over the last month, attempting to appeal to morality, ethics, or some form of value system will fail and fail hard during the reign of Orange Xerxes. The only chance we have at winning is to force the conversation entirely into data and effects of current policies on the ground. A study like this is something that police, “family first” organizations and even straight up anti-drug advocates have a hard time responding to. It allows us to move the conversation from “What should America be like?” to “What actually works?” By doing so, you neatly remove the “People shouldn’t be doing drugs!” talking point from the repertoire of the advocate you’re debating with. Even if you believe people shouldn’t be doing drugs, you can’t ignore the fact that the policing schemes that are discussed in the study simply don’t work to achieve those ends.

There will always be people whose cognitive dissonance is so large that this will fall on deaf ears. But, for those who are willing to listen, discussing this study might just be a step in the door with your cop uncle or Catholic cousin. We need all the help we can get, so tread softly, avoid people who steal your bandwidth, and find consensus wherever you can. 2017 demands it.