There Are No More Heroin Overdoses

Report by Terry Gotham

Enough people sent me the NY Times article about Fentanyl overtaking Heroin that I had to say something about it. If you’ve not seen it and the plurality of think pieces surrounding it, the only piece you need to read on it is by the person who runs The Dose Makes The Poison, Kevin Shanks. He’s been one of my go to sources on novel psychoactive substances for years now, and he, along with a handful of others have been yelling as loud as they possibly can. The point he raised almost a month ago is one I’ve not seen a single mainstream medical journal begin to grapple with in any kind of meaningful way.

As I’ve said for a while now, this ain’t your father’s heroin. At what point do we stop calling it heroin and refer to the standard “heroin” product on the street as fentanyl?
~Kevin Shanks (9/2/17)

While drug overdose deaths are up 22% from 2015 alone, fentanyl deaths doubled. That’s not including the fact that cases are severely under counted, given the volume of fentanyl analogs in circulation right now. I previously reported on the report coming out of Ohio with 24 analogs & active metabolites being identified. That, combined with the increased cost in testing for analog substances, we’ve arrived at a place where medical staff have no idea how many chemicals they’re not testing for. How many rural communities are testing for acrylfentanyl or butyrylfentanyl? How many rural communities are seeing analogs that we don’t even know about yet? Communities along the migratory arc that fentanyl takes from China into Western Canada or Mexico into border communities, that see these substances first, are they still getting the same analogs, or is there already something new? At this point, it’s likely the unknown unknowns are already on the ground and slowly being consumed for the first time.

Continue reading

Do No Harm: Safe Injection Facilities in Fentanyl’s World

Analysis by Terry Gotham

But until recently, politicians dismissed the idea of a safe-injection site as being too controversial. More controversial than people dying in libraries and babies picking up needles on the beach? Please. San Francisco has essentially become one big unsafe injection site.
~Heather Knight, SF Chronicle “Safe injection sites offer hope in scourge of discarded syringes”

I wasn’t sure how to start this piece, a feeling I think mirrors the paralysis many policymakers feel when it comes to moving away from puritanical, expensive & needlessly harmful criminalization of controlled substances. In the case of the city policymakers, the opioid overdose epidemic has gotten so bad, they may be getting over it.  The SF Department of Public Works collected 13,333 syringes in San Francisco. In March. That’s 430 a day. In Ohio, there were 100 accidental drug overdoses in Mongomery County, Ohio in January & February alone, with an average age of 40. Here’s the kicker, 99 tested positive for fentanyl, and, 56% tested positive for acryl-fentanyl, 3 carfentanil cases, and 24 total fentanyl analogs and metabolites were found in total. 24. The majority of the cases tested positive for more than one “fentalog.” But of course, straight from the report:

All acryl fentanyl and furanyl fentanyl cases also tested positive for fentanyl; about 45% of acryl fentanyl cases also tested positive for furanyl fentanyl.
~Research Update on Fentanyl Outbreaks in the Dayton, OH Area: Acryl Fentanyl & Furanyl Fentanyl Commonly Found in Overdose Death Cases.

Continue reading

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.

Continue reading

Cannabis and Kratom: A Light in the Opiate Dark

philip-seymour-hoffman

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.

Continue reading

Louisa May Alcott: Breadwinner, Frustrated Creative and Opiate Addict

littlewomen

 

by Terry Gotham

While I was never that big of a Louisa May Alcott fan, her impact on American literature cannot be denied. Alcott is an adored and fiercely protected author, in no small part because of just how impeccably written and potentially life-changing Little Women can be.  Her eight YA novels have remained in print continuously for the 140 years since they were written. There are two anime adaptations of Little Women, plus half a dozen other adaptations. Her creative output is a fundamental piece of American literature. Today is her 185th birthday, so I wanted to tell you a story about her. You probably didn’t know she smoked hashish and used opium for most of her life to deal with the side effects of mercurous chloride to treat typhoid pneumonia, which is believed to have eventually killed her (though an alternative diagnosis of Lupus was suggested in 2007).

Previously, I was delighted to dismantle the myth that the Civil War created a flood of heroin addict veterans. However, that doesn’t mean everyone managed to escape the clutches of substance abuse. Nurses, doctors and surgeons were far more exposed to the dangers of these substances than the Union soldier who only saw the inside of a field hospital once during his service. Repeated use of alcohol in the form of whiskey and opium in the form of laudanum, morphine, and heroin to treat hundreds of soldiers a week, in addition to essentially zero oversight when it came to use was a one-two punch that created a tempting proposition for those who tended to the wounded on both sides. There are a number of isolated reports, documenting the odd doctor or surgeon who got a little too sauced at work, or needed to be relieved of his duties because he was incapacitated. This implies that there could have been more of these medical practitioners who didn’t get caught, but still ended up using to cope.

Louisa May Alcott, one of the most influential and beloved American writers of the 19th Century, was one of these medical practitioners. She worked under Dorothea Dix who administrated military hospitals as a nurse.   Before leaving for the Civil War, she’d already assumed her station at the head of the household. Her father, one of the pre-eminent thinkers of their day, couldn’t keep it together for long enough to keep them out of poverty. When she left for the Civil War, her father was reported to have said he was “sending his only son to war.”

It was during the Battle of Fredricksburg that she contracted typhoid pneumonia, an ailment that would alter her life forever. The prescription for typhoid was calomel, and to ease the side effects of literally consuming mercury every day, she started using opium, in the form of morphine & laudanum. She didn’t enter into this habit by accident. She was a very smart lady and knew the potential dangers in consuming it daily. Alcott assisted Catherine Beecher in writing The American Woman’s Home in 1869, a year after Little Women was published, in which she stated:

“The use of opium, especially by women, is usually caused by at first by medical prescriptions containing it. All that has been stated as to the effect of alcohol in the brain is true of opium; while to break a habit thus is almost hopeless. Every woman who takes or who administers this drug, is dealing as with poisoned arrows, whose wounds are without cure.”
~Alcott & Beecher, The American Women’s Home (1849), revision of A Treatise on Domestic Economy (1841)

But a little thing like typhoid pneumonia & a daily opiate habit didn’t stop her. She built herself into the powerhouse of an author by sheer force of will. Realizing that her success and financial stability was depending on her career as a writer, Alcott built herself and her writing into a brand that we remember to this day. While she had made money previously from writing pulp fiction, this was light years away in propriety from Little Women and the branding and recognition that followed. The pulp was published anonymously or under a man’s name (A.M. Bernard) for similar reasons to why women writers today publish using a man’s name.

By 1870, she had grown so dependent on opium that she no longer expected to be able to sleep without it, as she described at the end of this letter to her father:

Our hotel is on the boulevard, and the trees which are in really good care thanks to http://www.treeservicekingsport.com, also the foundations, and fine carriages make our windows very tempting.. We popped into bed early; and my bones are so much better that I slept without any opium or anything, a feat I have not performed for some time.
~Louisa May Alcott to her father, Hotel D’Universe, Tours, June 17,1870

As discussed in the Seattle Pi article that I’ve cited a few times, it’s important for stories like this to be told. Not because I think famous people should be knocked down off their pedestal, but just the opposite. We treat substance use/abuse as almost integral to the creative process, especially when it comes to strong drink and writing. This seems to be heavily amplified in men while minimized in women. The idea that alcoholism is this noble part of the developing male writing process has been so deeply embedded in the work that I have friends who honestly didn’t pursue significant study in writing because they were Irish and didn’t want to fall in love with Jameson. This is going on while we eulogize female writers in the exact opposite way, discussing them as pure or without stain, objectifying them in hugely problematic ways. Then, when someone like Amy Winehouse, Billie Holiday or Janis Joplin struggle and die from drugs, we pretend there was nothing we could do and that it just “happened again.” That needs to stop. As a dear friend reminds me, we celebrate drug use in men and totally ignore it in women.

Creative women are no different than creative men and their processes should be laid bare for all to see, scars and stumbles included. Louisa May Alcott probably pursued her habit away from her family or those who could help her. Given her status as the household’s main income generator, I think it’s easy to see her habit in line with the alcoholism of Don Draper, or the cocaine usage of a street dealer. They use because they have to, in order to provide for the people they love. Louisa May Alcott was able to produce Little Women & Perilous Play, a story about hash, in the same year. That’s nothing if not professional. She inspired generations of women to be better than the brand she created. Which is the point of art in the first place. She may not personally be this amazing protagonist hero that she write about, but in striving to be so, even if it’s only to feed her family and take care of your idealist, lazy ass family, she created the possibility for those who looked up to her to become exactly that. As a biographer of hers said on NPR: “You don’t grow up to walk two steps behind your husband when you’ve met Jo March.”