January report from the Centers for Disease Control (CDC), drug overdoses killed more than 33,000 people in 2005, the last year for which firm data are available. That makes drug overdose the second leading cause of accidental death, behind only motor vehicle accidents (43,667) and ahead of firearms deaths (30,694).
What's more disturbing is that the 2005 figures are only the latest in such a seemingly inexorable increase in overdose deaths that the eras of the 1970s heroin epidemic and the 1980s crack wave pale in comparison. According to the CDC, some 10,000 died of overdoses in 1990; by 1999, that number had hit 20,000; and in the six years between then and 2005, it increased by more than 60%.
"The death toll is equivalent to a hundred 757s crashing and killing everybody on board every year, but this doesn't make the news," said Dan Bigg of the Chicago Recovery Alliance, a harm reduction organization providing needle exchange and other services to drug users. "So many people have died, and we just don't care."
Fortunately, some people care. Harm reductionists like Bigg, some public health officials, and a handful of epidemiologists, including those at the CDC, have been watching the up-trend with increasing concern, and some drug policy reform organizations are devoting some energy to measures that could bring those numbers down.
But as youth sociologist and long-time critic of the drug policy establishment's overweening fascination with teen drug use Mike Males noted back in February, the official and press response to the CDC report has been "utter silence." That's because the wrong people are dying, Males argued: "Erupting drug abuse centered in middle-aged America is killing tens of thousands and hospitalizing hundreds of thousands every year, destroying families and communities, subjecting hundreds of thousands of children to abuse and neglect and packing foster care systems to unmanageable peaks, fostering gun violence among inner-city drug dealers, inciting an epidemic of middle-aged crime and imprisonment costing Americans tens of billions of dollars annually, and now creating a spin-off drug abuse epidemic among teens and young adults. Yet, because today's drug epidemic is mainly white middle-aged adults -- a powerful population that is "not supposed to abuse drugs" -- the media and officials can't talk about it. The rigid media and official rule: Drugs can ONLY be discussed as crises of youth and minorities."
The numbers are there to back up Males' point. Not only are Americans dying of drug overdoses in numbers never seen before, it is the middle-aged -- not the young -- who are doing most of the dying. And they are not, for the most part, overdosing on heroin or cocaine, but on Oxycontin, Lorcet, and other opioids created for pain control but often diverted into the lucrative black market created by prohibition.
Back in October, CDC epidemiologist Leonard Paulozzi gave Congress a foretaste of what the January report held. Drug death "rates are currently more than twice what they were during the peak years of crack cocaine mortality in the early 1990s, and four to five times higher than the rates during the year of heroin mortality peak in 1975," he said in testimony before the House Oversight and Investigations Committee.
"Mortality statistics suggest that these deaths are largely due to the misuse and abuse of prescription drugs," Paulozzi continued. "Such statistics are backed up by studies of the records of state medical examiners. Such studies consistently report that a high percentage of people who die of prescription drug overdoses have a history of substance abuse."
But there is more to it than a mere correlation between increases in the prescribing and abuse of opioid pain relievers and a rising death rate, said Dr. Alex Krall, director of the Urban Health Program for RTI International, a large nonprofit health organization. Krall, who has been doing epidemiological research on opioid overdoses for 15 years, said there are a variety of factors at work.
"There hasn't been a big increase in heroin use," he said. "What's changed has been prescription opiate drug use. Oxycontin is probably a big part of the answer. The pharmaceutical companies have come up with good and highly useful versions of opioids, but they have also been diverted and used in illicit ways in epidemic fashion for the past 15 years."
But Krall also pointed the finger at the resort to mass imprisonment and forced treatment of drug offenders as a contributing factor. "What happens is that people who are opiate users go into prison or jail and they get off the drug, but when they come out and start using again, they use at the same levels as before, and they don't have the same kind of tolerance. We know that recent release from jail or prison is a big risk factor for overdose," he said.
"The last piece of the puzzle is drug treatment," Krall said. "Besides the tolerance problems for people who have been abstaining in treatment, there has been an increase in the use of methadone and buprenorphine, which is a good thing, but people are managing to overdose on those as well."
There are means of reducing the death toll, said a variety of harm reductionists, and the opioid antagonist naloxone (Narcan) was mentioned by all of them. Naloxone is a big part of the answer, said the Chicago Recovery Alliance's Bigg. "It's been around for 40 years, it's a pure antidote, and it has no side effects. It consistently reverses overdoses via intramuscular injection; it's very simple to administer. If people have naloxone, it becomes much, much easier to avoid overdose deaths."
"Naloxone should be made available over the counter without a prescription," said Bigg. "In the meantime, every time a physician prescribes opioids, he should also prescribe naloxone."
"For a couple of years now, we've been talking about trying to get naloxone reclassified so it's available over the counter or maybe prescribed by a pharmacist," said Hilary McQuie, Western director for the Harm Reduction Coalition. "The problem is that you don't just need congressional activity, you also need to deal with the FDA process, and it's hard to find anyone in the activist community who understands that process."
Harm reductionists also have to grapple with the changing face of drug overdoses. "We're used to dealing with injection drug users," McQuie admitted, "and nobody really has a good initiative for dealing with prescription drug users. In our lobbying meetings about the federal needle exchange funding ban, we've started to talk about this, specifically about getting naloxone out there."
But while the overdose epidemic weighs heavily on the movement, no one wants to spend money to bring the numbers down. "This is a very big issue, it's very present for harm reduction workers," said McQuie. "But we haven't done a lot of press on it because there is no funding for overdose prevention. We have a very good program in San Francisco to train residential hotel managers and drug users at needle exchanges. It's very cheap; it only cost $70,000, including naloxone. But we can't get funders interested in this. We write grants to do this sort of work around the state, and we never get any money."
Perversely, the Office of National Drug Control Policy also opposes making naloxone widely available -- on the grounds that it is a moral hazard. "First of all, I don't agree with giving an opioid antidote to non-medical professionals. That's No. 1," ONDCP's Deputy Director of Demand Reduction said in January. "I just don't think that's good public health policy."
But even worse, Madras argued that availability of naloxone could encourage drug users to keep using because they would be less afraid of overdoses. And besides, Madras, continued, overdosing may be just what the doctor ordered for drug users. "Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services," Madras said.
"The drug czar's office argues that if you take away the potential consequences, in this case, a fatal overdose, you facilitate the use, but betting someone's life on that is just cruel and bizarre," snorted Bigg.
RTI's Kraal noted that there are now 44 naloxone programs run by community groups across the country. "It would be wonderful if there were more of them, because they are staving off a lot of deaths, but they are controversial. The ONDCP says they condone drug use, but you can't rehabilitate a dead drug user."
While battles over naloxone access continue, said Bigg, there are other things that can be done. "We need to engage people, and that means overcoming shame," said Bigg. "Every couple of months, I get a call from a family that has lost a member to drugs and I ask them if they're willing to come forward and talk to reporters to stop it from happening again, and they say 'let me think about it,' and I never hear from them again.
Another means of reducing the death toll would be to start local organizations of people whose friends or family members have died or are still using and at risk. "We could call them 'First Things First,' as in first, let's keep our folks alive," he suggested.
"When people found out naloxone is out there, that it's this medicine that has no ill effects -- it has no effect at all unless you're using opioids -- and that it can't be abused, and that their family member could have had it and still be alive, that's a hard thing to realize," said Bigg. "Everyone who has lost a loved one wants him back, and to think he could still be alive today if there were naloxone is a bitter, bitter pill to swallow."
Despite the apparent low profile of drug policy reform groups, they, too, have been fighting on the overdose front. "We worked to pass groundbreaking overdose prevention bills in California and New Mexico," said Bill Piper, national affairs director for the Drug Policy Alliance. "We're working to advance overdose prevention bills in Maryland and New Jersey. We had a bill in 2006 in Congress that would have created a federal grant program for overdose prevention," he said, pointedly adding that not a single federal dollar goes to overdose prevention. "We've tried to introduce that in the new Congress but can't find someone to take a lead. To be frank, few politicians care about this issue. Their staff care even less."
A massive public education campaign is needed, said Piper, adding that DPA is working on a report on this very topic that should appear in a few weeks.
In the meantime, while politicians and drug war bureaucrats avert their gaze and deep-pocketed potential donors keep their purses tightly closed, while the nation worries about baseball players on steroids and teenagers smoking pot, the bodies pile up like cordwood.
Wednesday, April 23, 2008
Remembering Reproductive Rights for Prisoners
The recent news that the Supreme Court let stand a lower court ruling that incarcerated women have a constitutional right to access abortion services caught my attention. It highlights the issue of reproductive rights for incarcerated women and reminds us that women are the fastest growing part of America's prison population.
2,319,258 people are incarcerated in America. The staggering reality is that 1 in 100 adults are in prison. A Pew Center on the States report found that, although men are still ten times more likely to be in jail, the numbers of incarcerated women are growing at a faster pace. Among women ages 35-39 years old, one in 265 are incarcerated. The racial break-down in that age group shows that one in 355 are white women, one in 297 are Hispanic women and one in 100 are black women.
Within these numbers are mothers, sisters, daughters and friends all facing the variety of reproductive health issues any woman "on the outside" may face. The only difference is that they face them while incarcerated with prison policies being weighed against their reproductive rights.
In her article Women in Prison, Pam Adams explores the work of psychologist Susan George, who studied the impact of incarceration on Illinois families. The article points out that the number of Illinois women incarcerated has nearly tripled in a decade, with many of those arrested as a result of incidents related to drug addiction and poverty, and with histories of sexual abuse and physical abuse. Many women had parents who were incarcerated and children of incarcerated parents are five times more likely to go to jail.
Mentor programs like Amachi Pittsburgh attempt to break the cycle of multi-generation incarceration. Amachi, modeled after Big Brothers Big Sisters with a target of children ages 4 to 18, is a faith-based program that partners with local churches to match at risk children with mentors; the goal being to break the cycle where the children of incarcerated adults become incarcerated adults themselves. Though the mentor programs have seen success, communities and families are still paying the price for America's reluctance to fight the war on poverty, reform drug policies and support risk reduction programs with the same passion shown the building of new prisons.
Among the women arrested for drug related offenses, drug addicted pregnant women are also targeted for incarceration based on drug use during pregnancy. In 2007 I was privileged to blog the National Advocates for Pregnant Women (NAPW) Summit and hear the stories of women who have faced incarceration for using drugs during pregnancy. NAPW "seeks to protect the rights and human dignity of all women, particularly pregnant and parenting women and those who are most vulnerable including low income women, women of color, and drug-using women." Through their work NAPW gives a voice to women who are targeted for arrest and prosecution because of addiction and shines a light on the need for sane drug policies, affordable and quality healthcare and treatment options for pregnant women.
Women who continue their pregnancies behind bars face the challenge of poor nutrition, stress and the prospect of parenting from prison. Amie Newman's article Pregnant Behind Bars: The Prison Doula Project highlighted the work of The Birth Attendants who provide doulas to assist pregnant inmates. The doulas provide physical, emotional and psychological support before, during and after the birth of the baby. The article points out that some women are shackled during childbirth and that there are few resources available for keeping mother and child together after birth.
As activists we are constantly challenged to look beyond our world and connect studies with reality and policy to communities. One challenge before us is to vigilantly defend the reproductive rights of incarcerated women who remain vulnerable to the denial of access to abortion services. We are also challenged to include youth at risk due to the incarceration of a parent in our struggle. These young people need us to be mentors, participate in community programs and continue to demand the empowerment of comprehensive sex education.
Our struggle for reproductive freedom is key to the social justice movement and it must include the women within the one in 100 adults incarcerated in America.
2,319,258 people are incarcerated in America. The staggering reality is that 1 in 100 adults are in prison. A Pew Center on the States report found that, although men are still ten times more likely to be in jail, the numbers of incarcerated women are growing at a faster pace. Among women ages 35-39 years old, one in 265 are incarcerated. The racial break-down in that age group shows that one in 355 are white women, one in 297 are Hispanic women and one in 100 are black women.
Within these numbers are mothers, sisters, daughters and friends all facing the variety of reproductive health issues any woman "on the outside" may face. The only difference is that they face them while incarcerated with prison policies being weighed against their reproductive rights.
In her article Women in Prison, Pam Adams explores the work of psychologist Susan George, who studied the impact of incarceration on Illinois families. The article points out that the number of Illinois women incarcerated has nearly tripled in a decade, with many of those arrested as a result of incidents related to drug addiction and poverty, and with histories of sexual abuse and physical abuse. Many women had parents who were incarcerated and children of incarcerated parents are five times more likely to go to jail.
Mentor programs like Amachi Pittsburgh attempt to break the cycle of multi-generation incarceration. Amachi, modeled after Big Brothers Big Sisters with a target of children ages 4 to 18, is a faith-based program that partners with local churches to match at risk children with mentors; the goal being to break the cycle where the children of incarcerated adults become incarcerated adults themselves. Though the mentor programs have seen success, communities and families are still paying the price for America's reluctance to fight the war on poverty, reform drug policies and support risk reduction programs with the same passion shown the building of new prisons.
Among the women arrested for drug related offenses, drug addicted pregnant women are also targeted for incarceration based on drug use during pregnancy. In 2007 I was privileged to blog the National Advocates for Pregnant Women (NAPW) Summit and hear the stories of women who have faced incarceration for using drugs during pregnancy. NAPW "seeks to protect the rights and human dignity of all women, particularly pregnant and parenting women and those who are most vulnerable including low income women, women of color, and drug-using women." Through their work NAPW gives a voice to women who are targeted for arrest and prosecution because of addiction and shines a light on the need for sane drug policies, affordable and quality healthcare and treatment options for pregnant women.
Women who continue their pregnancies behind bars face the challenge of poor nutrition, stress and the prospect of parenting from prison. Amie Newman's article Pregnant Behind Bars: The Prison Doula Project highlighted the work of The Birth Attendants who provide doulas to assist pregnant inmates. The doulas provide physical, emotional and psychological support before, during and after the birth of the baby. The article points out that some women are shackled during childbirth and that there are few resources available for keeping mother and child together after birth.
As activists we are constantly challenged to look beyond our world and connect studies with reality and policy to communities. One challenge before us is to vigilantly defend the reproductive rights of incarcerated women who remain vulnerable to the denial of access to abortion services. We are also challenged to include youth at risk due to the incarceration of a parent in our struggle. These young people need us to be mentors, participate in community programs and continue to demand the empowerment of comprehensive sex education.
Our struggle for reproductive freedom is key to the social justice movement and it must include the women within the one in 100 adults incarcerated in America.
Health commissioner: Tobacco companies target girls
In Jefferson County, 30 percent of mothers smoke during pregnancy. Over 20 percent of Indiana high school girls smoke, along with over 10 percent of girls in middle school. Marketing may be responsible for some of those numbers."It's clear that the tobacco companies target women and young girls," said Dr. Judy Monroe, Indiana state health commissioner.Monroe spoke to an audience including doctors, nurses, community members and a handful of young girls during a special presentation at King's Daughters' Hospital on Tuesday night. The presentation was part of the Influence Women's Health Forum, a program to educate Indiana communities about women's health issues.The forum began last year in response to a marketing campaign featuring Camel No. 9 cigarettes, a brand Monroe said was targeted directly to young women. Part of the campaign featured "ladies only" nights where women were given a variety of free items including manicures, makeup, cell phone accessories and cigarettes."They really had to take me off the ceiling. I was outraged when I heard this," Monroe said.Yet marketing tobacco to women is nothing new. Brands like Lucky Strike started advertising directly to women around World War II. In the 1970s, Virginia Slims were introduced. One advertisement for the slender cigarettes proclaimed that they were made "especially for women because they are biologically superior to men."Advertising, especially in magazines, has continued to feature women smoking in the hopes of conveying various messages to target audiences."There has been an increased effort to target young women in recent times," Monroe said.In Indiana, smoking rates are higher for middle school girls than boys. "They've got a market," Monroe said. "They're going to go where the money is."Part of the Influence Women's Health forum, which is an ongoing state initiative, is to empower women to become educated on the issues and advocate for change. Monroe praised KDH for its smoke-free campus."That's really a powerful message for a hospital to give the community," she said.In response to an audience member's question about what else can be done at the community level to decrease smoking rates, Monroe responded that education is a key component."I think raising youth awareness is one area where we can do more," she said.Another audience member cited Mr. Potato Head as an example of the strides made to decrease smoking's appeal to youngsters. The popular children's toy featured a pipe until 1987."Habits and attitudes, they do start early," Monroe said.A seventh-grader in the audience asked Monroe what she could do to help keep her peers from lighting up. The student said the topic had been covered in her health class and that "a lot of girls looked very upset" when the teacher showed cigarette ads that could appeal to young girls."Getting upset about it is a really healthy thing," Monroe said. "They're targeting you."Monroe encouraged the student to talk about the issues with friends, parents and teachers to find creative ways to promote a non-smoking lifestyle.While the forum is focused on women's health issues, Monroe knows the addiction affects everyone in the state. Smoking costs Indiana over $2 billion in total medical costs each year and results in over 9,800 deaths. For Monroe, who is also a family physician, the numbers behind the dollar signs demand action."As a physician, the quality of life is the one that always pulls at my heartstrings," she said.Elizabeth Auxier, the tobacco cessation program coordinator at KDH, first heard Monroe speak at a Shape Up Indiana event and knew the local community could benefit from her expertise."The message was so right," Auxier said. "We were just honored that she could make it down here."Help is available for Indiana residents who want to quit smoking by calling the Indiana Tobacco Quitline at 1-800-QUIT-NOW.
Babies born to drug dependent mothers doubles in four years - Lamb
The number of babies born to drug dependent mothers has almost doubled in the past four years, reaching 2000 a year, new figures uncovered by the Liberal Democrats have revealed. The figures also show that 100 babies a month were born addicted to drugs last year, a 15% increase.Commenting, Liberal Democrat Shadow Health Secretary, Norman Lamb said:"These babies have a tragically unfair start in life. They are being put at an enormous disadvantage by their mothers’ addiction to drugs."As well as the obvious damage to their health, they are more likely to need intervention from social services, as a drug-dependent parent will probably not be able to care for their child alone."Early intervention is vital. Medical and social services staff must have the resources and the ability to identify and treat any drug problems early in a pregnancy. The sooner exposure to drugs is stopped the better."This is a harsh wake up call showing the urgent need to tackle the devastating impact of drug addiction in this country."
Applicability: this item refers to the UK.
Applicability: this item refers to the UK.
FROM HAMBURG, GERMANY: SUCCESSFUL PREGNANCY OUTCOME WITH HEROIN-ASSISTED TREATMENT OF OPIATE DEPENDENCE:
A successful outcome has just been described in a 31 year old long-time addict who had failed to respond favorably to methadone maintenance. Eur Addict Res. 2008;14(2):113-4. Ultimately, therapeutic decisions require weighing of the alternatives, and whatever reservations one might have about clinical prescribing of heroin to pregnant women, for those whom methadone does not help and who reject other forms of care, the alternative is probably abandonment!
UseMethamphetamine In The Changes Of The Pregnancy That Learn The Ability Of The Offspring
The studies had suggested that the infants had displayed to methamphetamines when in womb they can suffer to the damages from brain irreversible, even so the accurate effect of these drugs during the pregnancy were hard to locate due to many other negative behaviors that occur frequent in users of meth.
Now, using a model of the pig of the guinea that can evaluate changes neural in the loaded offspring to the mothers given methamphetamine during a pregnancy in another normal way, the Dr. Sanika Samuel Chirwa supplies to the new evidence the damages cognitive of these drugs.
In preliminary studies, Chirwa and the colleagues had found that the younglings of dog of the loaded pig of the guinea to the mothers who had received 1 mg/day from methamphetamine during the exhibition of the pregnancy a damaged ability to distinguish objects from the novel of articles they had seen before. This lack of recognition correlated with the changes in the region of the brain, hippocampus, associated with the formation of the memory.
The article was adaptou today for Medical Notice of the release of the original press.
Source: Sarah GoodwinAmerican society for biochemistry and molecular biology
Now, using a model of the pig of the guinea that can evaluate changes neural in the loaded offspring to the mothers given methamphetamine during a pregnancy in another normal way, the Dr. Sanika Samuel Chirwa supplies to the new evidence the damages cognitive of these drugs.
In preliminary studies, Chirwa and the colleagues had found that the younglings of dog of the loaded pig of the guinea to the mothers who had received 1 mg/day from methamphetamine during the exhibition of the pregnancy a damaged ability to distinguish objects from the novel of articles they had seen before. This lack of recognition correlated with the changes in the region of the brain, hippocampus, associated with the formation of the memory.
The article was adaptou today for Medical Notice of the release of the original press.
Source: Sarah GoodwinAmerican society for biochemistry and molecular biology
Path Clinic, Honolulu
This Perinatal Addiction Treatment Clinic was formed in Hawaii after founder Tricia Wright became aware of the lack of resources for this population. Their premise is "that suffering from an addiction doesn't make someone less human."
This Perinatal Addiction Treatment Clinic was formed in Hawaii after founder Tricia Wright became aware of the lack of resources for this population. Their premise is "that suffering from an addiction doesn't make someone less human."
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