The “Opioid Crisis” and What it Means to Me

 

Most of you who read my blog know that I am a totally disabled veteran and that I live with chronic severe pain. Because of that, I have a very different take on the “Opioid Crisis” than most do, and I’d like to share that here.

There have been a recent spate of settlements in Federal and State lawsuits against pharmaceutical companies and large pharmacy chains for producing and dispensing opioids in various fashions.[i] Among these is the vilification of long acting opioids such as MS-Contin, OxyContin, Opana and Avinza.

Avinza was a 24-hour morphine capsule, but it is no longer available in the US.[ii] I can tell you, however, that Avinza enabled me to get my life back. Thus, I deeply resent the way the Government vilified this drug and others like it. Further, the long and delayed release drugs were formulated and constructed in such a way that it was very difficult to break them down to get the drugs out of them, so abusers really had a difficult time with them, contrary to what we may have seen on TV. It is much easier to abuse the immediate release pills, which haven’t been so much of an issue.

The push has been away from opiates to non-opiate therapy. In my case that has been an epic failure.  I have tried every alternative therapy at least twice with no success. Due to my genetic makeup, I do not respond to the drugs used to treat neurological pain (off label usage of anti-seizure drugs). Worse yet, it was just revealed that these drugs are not really effective against neurological pain anyway![iii] And when people suggest I try alternative drugs, my response is that I’ve tried cannabis and psilocybin under doctor’s orders, and they didn’t work either. I will not buy street drugs for many reasons.

The biggest impact that the government actions have had is on those like me, who suffer chronic pain. When the government first acted, it was a “knee-jerk” reaction, and most of us were cut off, essentially cold turkey, from our pain medications. I went through three months of withdrawal, and I literally had several life-threatening reactions to drugs meant to counter the effects of the withdrawal symptoms.

When we are cut off from the narcotics, and after withdrawal is complete, we have three choices.

1        1) Attempt to just live with it, which is what I did for about seven years, until things got so bad, and the pain got so unbearable, that I had to return to a pain doctor and go back on opiates. Yet, despite updated prescribing guidelines, he is still under-dosing me, so most of the time, I am still living with out of control, unmanaged pain. There are, in fact many studies that show that chronic pain literally kills. So this is a horrible option!

2        2) Use alternative therapies – if one is fortunate enough to find an alternative therapy that is successful, that’s wonderful.  As I stated above, none of them worked for me, but I’m sort of unique. Others are more fortunate.

        3) Turn to street drugs. There is, in fact, unfortunately a drug newer than fentanyl on the streets as well. Isotonitazene is a drug reported to be several times stronger than fentanyl, and also imported from China.

Those who have turned to street drugs have brought about (not by their own fault, however) the TRUE Opiate crisis.

Like me, all chronic pain patients develop substantial tolerances to opiates (and in my case Ketamine as well). This means that we need progressively larger doses for effective pain management.

Standard heroin turned out to be largely ineffective for many pain patients. So, the drug cartels contacted the Chinese producers, who mailed them Fentanyl, the extremely powerful synthetic opiate. The cartel then started cutting heroin (and everything else as it turned out) with Fentanyl.  For some users, Fentanyl wasn’t even strong enough, so they accessed CarFentanyl (designed for elephants and rhinoceri).

The issue is that these drugs are so powerful that if non-users such as first responders or others who try to render aid, inhale or touch the drugs, they can instantly go into respiratory arrest. Most do not know the protocols for treating overdoses in this case, and there is usually not enough Narcan (Nalaxone) available on scene to treat a heavy Fentanyl overdose anyway.

The government CAUSED this crisis by ill informed decisions and ignorance. And they refuse to walk it back because of egos. Further the damage has been done with the Fentanyl on the streets.  It’s just too lucrative, so I do not see the cartels willingly making a change, unless they are hugely incentivized by the DEA to do so (and I really do not see that happening either).

But as with all things, change can only come about by an overwhelming push from the electorate, so PLEASE contact your senators, congresspeople, governors, etc., and get the laws changed. Change the course of this opiate crisis so we stop killing people.

And stop prosecuting and persecuting those who provide opiates.  The result is that providers close and patients lose ability to get treatment. There is never a positive outcome from these actions.

I am quite certain that, like many things I say, people will disagree and argue with me vehemently, and that’s fine.  But I’m living with this issue. Unless you are living with it yourself, or have CONSTRUCTIVE ways of addressing the issue, please keep your comments to yourself or post them elsewhere. If you would like me to directly reply to a concern of yours about this, please use my contact form at http://www.rabbahrona.us/p/contact-me_27.html.

 

Thank you, Rona

 

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[i] See for instance: https://www.fiercehealthcare.com/finance/federal-jury-holds-cvs-walgreens-and-walmart-responsible-for-role-opioid-crisis, https://www.reuters.com/business/healthcare-pharmaceuticals/cvs-walmart-walgreens-reach-tentative-12-bln-opioid-pact-bloomberg-news-2022-11-02/, https://www.nytimes.com/2022/11/15/health/walmart-opioids-settlement.html. This is just a very small snapshot.

[ii] https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021260s017lbl.pdf.

[iii] https://today.oregonstate.edu/news/two-anticonvulsants-prescribed-pain-only-%E2%80%98modestly-effective%E2%80%99-and-not-without-risk-study-shows.

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My Take on Gun Violence - Updated 2022 Edition

 

I first published this piece after Sandy Hook, in December of 2015. Since then little has changed, except that our government has become more polarized and more people are dead. As I write this, we are in the Memorial Day weekend, rather than the winter holidays, and that feels worse.  But I need to make some updates to this piece with knowledge I have gained since my original post.

Many cultures observe a festival of lights in the darkest days of winter.  For us it is Hanukkah, for others Christmas; as well there are Pagan festivals of light in the winter.  For Jews and Christians, the winter festival also represents salvation.

This winter, however, no amount of candles, LED lights or bonfires, will lighten the darkness in our hearts.  In mid-December, there have been at least three mass shootings in public areas. The most heartbreaking of course is the loss of all those precious children at the school in Newtown CT.

In the Talmud, Sanhedrin 37a, we find:

          “Man was created alone, to teach you that whoever takes a single life... Scripture ascribes to him the guilt of having destroyed the whole world; and whoever saves a single life..., Scripture ascribes to him the merit of having saved the whole world.”

The world of those parents in CT, as well as in other places of mass murder, HAS in fact been destroyed.  No parent should ever have to bury a child; that it was from senseless murder makes it that much worse. 

There is no answer in Torah for such acts of violence. The Torah tells us we were created “B’tzelem El-him”, in G*d’s image.  The Torah also commands that we shall not murder.  These acts of murder, in essence serve as an attempt to destroy G*d from the world.

On December 19, 2012, President Obama gave a charge to his cabinet to find answers and real fixes for several problems in our country.  I would like to elaborate on what I see are the issues, and how we can address them:

1

• The glorification of gun violence in movies, TV and video games:  Just as it is not legal, according to interpretation of the First Amendment, to shout “Fire” in a crowded theater, other incendiary speech should be limited too. This includes, as I see it, limiting the glorification of gun violence in the media.

• This country has become, in the last few decades, morally bankrupt.  We no longer teach ethics, values and personal responsibility in schools.  I firmly believe that these topics CAN and should be taught, without resorting to the Bible or other religious teachings.

•  With the current trends in healthcare, mental health care has become very difficult to afford or access.  We need much more available mental health care in this country. 

• The Individuals with Disabilities Education Act (IDEA) has, based on my experiences as a teacher, forced, far too many students into inappropriate main stream settings.   The schools are not equipped or staffed for this, and most teachers do not have the requisite special training needed.  By mainstreaming such children, they are then shunned by their classmates, leading them to be socially isolated, and often hated for the disruptions they cause due to their difficulties. If these students were taught in special needs programs with similar students, they would be able to function at a higher level, and would be more socialized.  This would result in such developmentally or educationally disabled people feeling more at home in society.  Some Chabad schools have been very successful with this.

Since I wrote the original piece, people smarter than me have educated me on the special education system. A better approach would be to have small classrooms, with no more than 15 students per class, and two qualified EDUCATORS per classroom. Each student would be treated as if they are neurodivergent, and their own individual learning needs and goals would be addressed. By doing this, no student would be singled out, or left behind. This would greatly reduce the chances of what happens today, with students becoming demonized and isolated because of learning differences.

So, what can we do about this horrible trend?   I have seen many calls for more gun control laws.  In my opinion, adding broad based gun control is really tilting at windmills. In the case of the Newtown shooting, the rifle was apparently legally obtained.  One thing to observe is that these weapons are sold as semi-automatic, which means one shot per trigger pull.  Amazingly, while gun shops cannot legally sell full-automatic (one trigger pull, many bullets) versions of these rifles, they can sell the conversion kit to switch to full auto separately.  This is certainly one area where gun control might have effect.

However, rather than putting a spot Band-Aid on an arterial bleed, we need to stay focused on the root causes – guns are the tool but not the source of the violence. None of the ideas I have suggested are easy. Making mental health care accessible would be expensive, as is special needs instruction in schools.  We need to provide motivation for good people to go into these fields with scholarships for advanced degrees in mental health care and special needs education, with the recipients committing to at least four years of public service to pay for their scholarships.

People attached to gun control will be very quick to point to the UK and Japan as examples of locales where gun control works. However, those are island nations, with much lower populations. It is much easier to limit the inflow of guns and to control what happens.

In the United States we have over 10,000 miles of borders which are difficult to manage. In addition, less than 10% of container cargo that enters the country is even inspected, and this is post 9/11! Further, it is possible to download plans for guns off the Internet and 3D print them, and ammunition is made at people's homes every day. Thus, even if you somehow eliminated EVERY gun in the US today, it would NOT eliminate guns tomorrow.

Therefore we MUST turn to methods other than gun control to stop this scourge. Gun control can be part of it, but anyone who wants to hold on to gun control and ignore everything else is putting people's lives in continued jeopardy!

It seems to me that we have been placing a value on human life by refusing to confront these issues, which are mainly economic.  It is a very cynical calculus when people monetize the value of human life.  Please consider talking or writing to your State and Federal legislators to fully fund the fixes to these issues, so that we can restore some sense of freedom and safety in our lands, and restore value to human life, instead of having greed be the capital we operate on.

Rabbah Rona Matlow is a Veteran Pastoral Counselor in Las Vegas.  Ze has taught in Jewish Day Schools, in classrooms with students with special needs in the mainstream, and has seen first-hand how difficult mainstreaming can be.