January 18, 2022

A study conducted in two rural Massachusetts jails found that people with opioid use disorder who were incarcerated and received a medication approved to treat opioid use disorder, known as buprenorphine, were less likely to face rearrest and reconviction after release than those who did not receive the medication. After adjusting the data to account for baseline characteristics such as prior history with the criminal justice system, the study revealed a 32% reduction in rates of probation violations, reincarcerations, or court charges when the facility offered buprenorphine to people in jail compared to when it did not. The findings were published in Drug and Alcohol Dependence.

The study was conducted by the Justice Community Opioid Innovation Network (JCOIN), a program to increase high-quality care for people with opioid misuse and opioid use disorder in justice settings and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, through the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative.

“Studies like this provide much-needed evidence and momentum for jails and prisons to better enable the treatment, education, and support systems that individuals with an opioid use disorder need to help them recover and prevent reincarceration,” said Nora D. Volkow, M.D., NIDA Director. “Not offering treatment to people with opioid use disorder in jails and prisons can have devastating consequences, including a return to use and heightened risk of overdose and death after release.”

A growing body of evidence suggests that medications used to treat opioid use disorder, including buprenorphine, methadone, and naltrexone, hold great potential to improve outcomes among individuals after they’re released. However, offering these evidence-based treatments to people with opioid use disorder who pass through the justice system is not currently standard-of-care in U.S. jails and prisons, and most jails that do offer them are in large urban centers.

While previous studies have investigated the impact of buprenorphine provision on overdose rates, risk for infectious disease, and other health effects related to opioid use among people who are incarcerated, this study is one of the first to evaluate the impact specifically on recidivism, defined as additional probation violations, reincarcerations, or court charges. The researchers recognized an opportunity to assess this research gap when the Franklin County Sheriff’s Office and the Hampshire County House of Corrections, jails in two neighboring rural counties in Massachusetts, both began to offer buprenorphine to adults in jail, but at different times. Franklin County was one of the first rural jails in the nation to offer buprenorphine, in addition to naltrexone, beginning in February 2016. Hampshire County began providing buprenorphine in May 2019.

“There was sort of a ‘natural experiment’ where two rural county jails located within 23 miles of each other had very similar populations and different approaches to the same problem,” said study author Elizabeth Evans, Ph.D., of the University of Massachusetts-Amherst. “Most people convicted of crimes carry out short-term sentences in jail, not prisons, so it was important for us to study our research question in jails.”

The researchers observed the outcomes of 469 adults, 197 individuals in Franklin County and 272 in Hampshire County, who were incarcerated and had opioid use disorder, and who exited one of the two participating jails between Jan. 1, 2015 and April 30, 2019. During this time, Franklin County jail began offering buprenorphine while the Hampshire County facility did not. Most observed individuals were male, white, and around 34 to 35 years old.

Using statistical models to analyze data from each jail’s electronic booking system, the researchers found that 48% of individuals from the Franklin County jail recidivated, compared to 63% of individuals in Hampshire County. As well, 36% of the people who were incarcerated in Franklin County faced new criminal charges in court, compared to 47% of people in Hampshire County. The rate of re-incarceration in the Franklin County group was 21%, compared to 39% in the Hampshire County group.

Additional analysis showed that decreases in charges related to property crimes appeared to have fueled the 32% reduction in overall recidivism.

The Massachusetts JCOIN project, led by Dr. Evans and senior author Peter Friedmann, M.D., of Baystate Health, is performing further research on medications for opioid use disorder in both urban and rural jails across more diverse populations, including women and people of color. The investigators are examining the comparative effectiveness of the U.S. Food and Drug Administration-approved medications for opioid use disorder in jail populations, and the challenges jails face in implementing them.

“A lot of data already show that offering medications for opioid use disorder to people in jail can prevent overdoses, withdrawal, and other adverse health outcomes after the individual is released,” said Dr. Friedmann. “Though this study was done with a small sample, the results show convincingly that on top of these positive health effects, providing these medications in jail can break the repressive cycle of arrest, reconviction, and reincarceration that occurs in the absence of adequate help and resources. That’s huge.”

Far too often, shame and stigma fuel addiction and prevent treatment, argues Nora Volkow, MD, director of the National Institute on Drug Abuse. But replacing judgment with compassion can save lives.

When I was six years old, as I was having dinner with my mother and three sisters, my mother received a telegram. She broke down crying as she read it. Her father — my grandfather — had died. In her grief, she locked herself in her room and would not let me console her. The memory of my inability to relieve my mother’s suffering still haunts me.

My sisters and I were led to believe that our grandfather had died of a heart attack. It was only decades later, when I had already been an addiction researcher for several years and my mother was herself dying, that she revealed the truth: My grandfather had had an alcohol addiction. Unable to stop drinking, he had taken his own life in a final moment of futility and shame. 

Overwhelmed by this revelation, I asked my mother, “Why didn’t you tell me until now?” Her response was that she did not want me to lose respect for him or love him less. As a society, we still keep addiction in the shadows, regarding it as something shameful, reflecting lack of character, weakness of will, or even conscious wrongdoing, not a medical issue.

My mother knew that I had devoted my life to understanding the neurobiological effects of chronic substance use. She had seen me speak about addiction as a disease of the brain and not a character defect. Of all people, I was someone she should have been able to speak to openly about why and how her father died. Yet, for her, the stigma of addiction and suicide was more powerful than the scientific understanding I was trying to bring to medicine.

Things have not changed much since that day. As a society, we still keep addiction in the shadows, regarding it as something shameful, reflecting lack of character, weakness of will, or even conscious wrongdoing, not a medical issue warranting compassionate medical care. Unfortunately, many in the medical profession harbor this mindset.

In fact, stigma remains one of the biggest obstacles to confronting America’s current drug crisis.

Last year alone, more than 96,000 people in the United States died from overdoses — usually from opioids but also increasingly from stimulants — and the pandemic worsened an already dire public health crisis. If you have not lost a family member or friend to drug or alcohol addiction or its consequences, which include diseases like cancer, you likely know someone whose family has suffered such a loss. Additionally, untreated substance use exacerbates many other health conditions or interferes with their treatment.

The direct and indirect health effects of drug and alcohol addiction are so numerous and devastating that they are considered root causes of the declining life expectancy in our country.

What the Science Tells Us

Science has shed much light on addiction. We now understand that changes in brain networks needed for self-regulation cause substance use to become compulsive in some individuals — despite their best efforts to decrease or stop use. We are also gaining an understanding of the genetic, developmental, and environmental factors that cause susceptibility to drug experimentation and to the brain changes underlying addiction.

For instance, data from a large longitudinal study of adolescents funded by the National Institute on Drug Abuse in close partnership with other National Institutes of Health entities have provided insights into the adverse effects of poverty and adversity on the developing brain, including neurobiological changes that make drug use and addiction more likely.  

On the positive side, prevention research shows that providing targeted interventions to families with low incomes or lacking social supports can avert — or even reverse — these neurobiological changes. What’s more, decades of research on brain signaling systems have demonstrated that even once addiction takes hold, it is still reversible and recovery is achievable.

Unfortunately, stigma limits the impact of this knowledge and the reach of our tools.

The Role of Stigma

Stigma pervades medicine, policy, and communities.

Medical schools until recently offered little or no training in screening for or treating substance use disorders because, for many years, addiction was not seen as a medical problem. Even now, when medical systems offer treatment, it may be limited or inadequate. Among dedicated addiction treatment programs, fewer than half offer medications, which is tantamount to denial of appropriate medical care, according to a National Academies of Sciences, Engineering, and Medicine report.

Insurers are often reluctant to cover addiction treatment, including medications for opioid use disorder, and coverage is limited when it is provided. Inadequate coverage puts these life-saving treatments out of reach for many people who need them. Stigma also prevents the use of medications in most justice settings — even though at least half of incarcerated individuals in the United States have a substance use disorder, often an opioid use disorder. [Stigma] contributes to the tragic reality that fewer than 13% of people with an illicit drug use disorder received any treatment for their addiction in 2019.

What’s more, many communities fail to provide harm-reduction measures, such as syringe services programs and the overdose medication naloxone, out of a moralistic — as well as factually incorrect — belief that those measures encourage illegal drug use.

Even when treatments and other supports are available, people with addiction may not seek them, fearing the judgments of those around them and the discrimination they routinely experience in the health care system. Patients are often hesitant to disclose their substance use to their physicians.

This contributes to the tragic reality that fewer than 13% of people with an illicit drug use disorder received any treatment for their addiction in 2019 and just 18% of people with opioid use disorder received one of the three safe, effective, and potentially lifesaving medications that could facilitate their recovery. The proportion of people with alcohol addiction who received medications is even lower: 3%.

Government policies, including criminal justice measures, often reflect — and contribute to — stigma. When we penalize people who use drugs because of an addiction, we suggest that their use is a character flaw rather than a medical condition. And when we incarcerate addicted individuals, we decrease their access to treatment and exacerbate the personal and societal consequences of their substance use. What’s more, drug laws are disproportionately leveraged against Black people and Black communities, driving societal and health disparities.

The aura of illegality affects the treatment of people with addiction. For example, some treatment programs expel patients for positive urine samples, as if relapse were not simply a known symptom of the disorder and a clinical signal to adjust the treatment approach but instead actual wrongdoing.

Prescribers of addiction medications are themselves monitored and subjected to strong limitations that don’t apply to other medications — or even to the same medications in different circumstances, such as prescribing buprenorphine for pain. Such oversight tacitly signals that there is something suspect about these treatments and the people who receive them.

Help and Healing

Stigma’s damaging effects go well beyond impeding care and care-seeking. Painful social and emotional effects like rejection, isolation, and shame — internalized stigma — drive drug-taking to alleviate one’s suffering, leading to a vicious cycle. It was internalized stigma that led my grandfather to end his life. If we’re going to end the current addiction and overdose crisis, we must treat combating stigma as no less important than developing and implementing new prevention and treatment tools.

Research supports the lesson I learned firsthand in my own family — that stigma is not alleviated solely by educating people on the science of a disease. Partly, it requires facilitating contact between a stigmatized group and the wider community. If people with substance use disorders can share their experiences, then empathy and compassion can begin to replace judgment and fear.

For that to happen, addressing stigma must be a central prong of our public health efforts. If we’re going to end the current addiction and overdose crisis, we must treat combating stigma as no less important than developing and implementing new prevention and treatment tools.

We need a large-scale social intervention to change public attitudes toward addiction and people who have the disease. Besides ensuring proper training and the resources needed to help patients with substance use disorders, we need to seriously reconsider policies — not only laws but  regulations and practices in health care and other settings — that promote viewing substance use as wrongdoing. And we must make it safe for patients and families to discuss addiction and remove the shame that interferes with its treatment.

Methamphetamine is not the number one drug that is abused in most countries, but it is one of the most addictive and one of the most destructive. It’s important that parents and other family members are able to tell when someone they care about is abusing methamphetamine.

The appearance of Meth, and Methods of Use

Meth is most often a white to light brown crystalline powder. It may also be found in clear chunky crystals that resemble broken pieces of ice or shards of glass. Methamphetamine can be found in liquid form as well.

Methamphetamine can be swallowed, snorted, injected or smoked. If you are looking for traces of meth use, therefore, you may find small bags of white powder or crystals or syringes. Other items that could be left behind after meth abuse are small pieces of crumpled aluminum foil, soda cans with a hole in the side or the shafts of inexpensive ball-point pens that might be used to snort the drug.

Some meth users abuse the drug over and over, a form of binging known as a “run.” They may inject the drug every few hours until they run out of supplies or become too incapacitated to continue.

Meth Abusers:

• Do not sleep for long periods
• Lose his or her appetite
• Lose large amounts of weight
• May appear unusually active
• Can seem nervous and anxious

What Happens When People Abuse the Drug?

Methamphetamine is a very strong stimulant. With some methods of administration, there is a fast “rush” of euphoria followed by a long period of less intense euphoria. When meth is ingested, there is no rush but the high may last for as long as ten hours.

The user feels more energetic, does not sleep for long periods, usually several days, and loses his or her appetite. It is common for meth addicts to lose large amounts of weight and look gaunt, thin and undernourished. He or she will probably appear unusually active but may also act nervous and anxious.

The user is likely to get overheated and may appear sweaty without it being hot or his being involved in physical exertion. His pupils will be dilated. His blood pressure will also increase. He or she may become sexually excited.

Adverse Effects of Meth Use

In its manufacture, methamphetamine is processed using harsh, caustic chemicals. As a result, heavy use of this drug is very hard on the user. Additionally, the lifestyle of a methamphetamine user usually creates further damage. All in all, it is one of the most damaging drugs on the illicit market.

Repeated use can show up in an irregular heartbeat, rapid heartbeat, mood disturbances, violent, aggressive, paranoid behavior, confusion and insomnia. There may be a rapid deterioration of the person’s behavior or appearance if he or she is a heavy user.

Serious Results of Heavy Methamphetamine Use

Heavy users tend to experience hallucinations and delusions. Some users develop sores on their face or body when they have been picking at their skin, thinking that there are bugs crawling under their skin that they can’t see.

Because of the caustic nature of the chemicals and the fact that the drug dries up the flow of saliva, a meth addict’s teeth may get rotten and brown. This is referred to as “meth mouth.”

Meth users suffer from poor judgment and may engage in risky lifestyles and risky sex. When a person becomes a meth addict, getting the drug becomes far more important than taking care of the home, children or work. The children may go unfed. Animal feces around the home may not be cleaned up. Used diapers may be found all over the home. Drug paraphernalia and drugs may be within reach of children. If there are children in the home of confirmed meth users, families should take effective action as the children of meth users may come to harm due to neglect, abuse or worse.

An overdose of methamphetamine can cause overheating to the point of convulsions, cardiovascular collapse or death.

A period of heavy meth use is usually followed by a crash in which the person can’t control his sleepiness. He or she may sleep long hours or keep falling into a sleep. There will be heavy drug cravings during this time period that can lead to another binge.

If you see any of this pattern in someone you care about, you may be looking at the external signs of methamphetamine use. Meth is so addictive that some people may become addicted after just a few uses.

The Stigma of Substance Use Disorder

• Written By Granite Recovery Centers
• Clinically Reviewed By Cheryl Smith MS,MLADC
• November 23, 2021

People with substance use disorder face a stigma that is strong and nationwide. Others dismiss their very presence with sweeping, cruel generalizations, such as ‘junkies’ or ‘drunks’. This social stigma surrounding addiction needs to be seriously addressed, as it only contributes to the proliferation.

Alcoholism is the only disease you can get yelled at for having.
– Mitch Hedberg

Stigma is essentially disapproval based on characteristics. Alcoholics and drug addicts are met with disapproval of and/or thought to be less-than-equal on an everyday basis. Words like ‘junkie’, ‘drunk’, ‘stoner’, ‘tweaker’, or ‘crackhead’ all stem from the social stigma of addiction. Dismissal due to substance addiction is a stigma that countless addicted Americans face. Worse yet is the criminalization of addiction.

Statistics on the Stigma

Six years ago, the Johns Hopkins Bloomberg School of Public Health conducted a study on the stigma and discrimination that substance addicts face. The aim was to compare “current public attitudes about drug addiction with attitudes about mental illness.” It turns out most people “hold significantly more negative views toward persons with drug addiction compared to those with mental illness.”

Here are some significant findings of the study:

• 90% of respondents were unwilling to have a substance addict marry into their families, compared with 59% being unwilling to have someone with mental illness marry in.
• 22% of respondents were willing to work with a substance addict, compared to 62% regarding someone with mental illness.
• 54% of respondents agreed that landlords should be able to deny housing to a substance addict, compared to 15% regarding those with mental illness.
• 64% of respondents agreed that employment should be denied to substance addicts, compared to 25% regarding those with mental illness.
• 3 out of 10 respondents believed that recovery from substance addiction is impossible.

Perhaps the most interesting thing about this study is that substance addiction itself IS a mental illness. Addiction is a disease that, unfortunately, as Mr. Hedberg said, you can be ‘yelled at’ for having. Addicts aren’t just yelled at, though. Others dismiss, ignore, marginalize, and blame them for their behavior. That is the stigma, and it needs to go away.

What Addiction Stigma Leads To

Considering substance addiction a moral and/or criminal issue only makes the stigma worse. The individual American needs to begin viewing addiction as the mental illness it is, not as a crime or a lifestyle choice. Sure, perhaps choices led to the addiction, but once it takes hold, it’s as fierce a mental illness as any other.

The stigma of addiction also makes it more difficult for an addict seeking help. The fear of being dismissed or ignored or, well, stigmatized, often prevents addicts from speaking up and getting help.

This becomes a more major issue when one learns that approximately 1 in 10 addicts in America will ever seek professional treatment. In a country with tens of millions of addicts, that’s a whole lot of people who need help. Perhaps worse yet, about 60% of addicts in America that do realize they need help will never get it.

How to Erase the Stigma

Frankly, it starts with you. Erasing the stigma of addiction happens on a personal level. Realize that substance addicts are humans too, and that addiction itself is a fierce disease. Biases in the media don’t help at all; it often portrays addicts as addled misfits. This is rarely the case in real life. Public education is the most surefire way to end the stigma.

America needs more public service announcements, more blogs like this one, more word-of-mouth, and more open conversations about the disease of addiction. Instituting policy changes will help stop the criminalization of addiction and start treating it.

Percentage of adolescents reporting drug use decreased significantly in 2021 as the COVID-19 pandemic endured

December 15, 2021

The percentage of adolescents reporting substance use decreased significantly in 2021, according to the latest results from the Monitoring the Future survey of substance use behaviors and related attitudes among eighth, 10^th, and 12^th graders in the United States. In line with continued long-term declines in the use of many illicit substances among adolescents previously reported by the Monitoring the Future survey, these findings represent the largest one-year decrease in overall illicit drug use reported since the survey began in 1975. The Monitoring the Future survey is conducted by researchers at the University of Michigan, Ann Arbor, and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. Image

The 2021 survey reported significant decreases in use across many substances, including those most commonly used in adolescence – alcohol, marijuana, and vaped nicotine. The 2021 decrease in vaping for both marijuana and tobacco follows sharp increases in use between 2017 and 2019, which then leveled off in 2020. This year, the study surveyed students on their mental health during the COVID-19 pandemic. The study found that students across all age-groups reported moderate increases in feelings of boredom, anxiety, depression, loneliness, worry, difficulty sleeping, and other negative mental health indicators since the beginning of the pandemic.

“We have never seen such dramatic decreases in drug use among teens in just a one-year period. These data are unprecedented and highlight one unexpected potential consequence of the COVID-19 pandemic, which caused seismic shifts in the day-to-day lives of adolescents,” said Nora Volkow, M.D., NIDA director. “Moving forward, it will be crucial to identify the pivotal elements of this past year that contributed to decreased drug use – whether related to drug availability, family involvement, differences in peer pressure, or other factors – and harness them to inform future prevention efforts.”

The Monitoring the Future survey is given annually to students in eighth, 10^th, and 12^th grades who self-report their substance use behaviors over various time periods, such as past 30 days, past 12 months, and lifetime. The survey also documents students’ perception of harm, disapproval of use, and perceived availability of drugs. The survey results are released the same year the data are collected. From February through June 2021, the Monitoring the Future investigators collected 32,260 surveys from students enrolled across 319 public and private schools in the United States.

While the completed survey from 2021 represents about 75% of the sample size of a typical year’s data collection, the results were gathered from a broad geographic and representative sample, so the data were statistically weighted to provide national numbers. This year, 11.3% of the students who took the survey identified as African American, 16.7% as Hispanic, 5.0% as Asian, 0.9% as American Indian or Alaska Native, 13.8% as multiple, and 51.2% as white. All participating students took the survey via a web-based survey – either on tablets or on a computer – with 40% of respondents taking the survey in-person in school, and 60% taking the survey from home while they underwent virtual schooling.

This difference in location between survey respondents is a limitation of the survey, as students who took the survey at home may not have had the same privacy or may not have felt as comfortable truthfully reporting substance use as they would at school, when they are away from their parents. In addition, students with less engagement in school – a known risk factor for drug use – may have been less likely to participate in the survey, whether in-person or online. The Monitoring the Future investigators did see a slight drop in response rate across all age groups, indicating that a small segment of typical respondents may have been absent this year.

To address these limitations, the Monitoring the Future investigators conducted additional statistical analyses to confirm that the location differences for the survey, whether taken in-person in a classroom or at home, had little to no influence on the results.

“The Biden-Harris Administration is committed to using data and evidence to guide our prevention efforts so it is important to identify all the factors that may have led to this decrease in substance use to better inform prevention strategies moving forward,” said Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy. “The Administration is investing historic levels of funding for evidence-based prevention programs because delaying substance use until after adolescence significantly reduces the likelihood of developing a substance use disorder.”

The 2021 Monitoring the Future data tables

highlighting the survey results are available online from the University of Michigan. Reported declines in the use of substances among teens include:

• Alcohol: The percentage of students who reported using alcohol within the past year decreased significantly for 10^th and 12^th grade students and remained stable for eighth graders.
  • Eighth graders: 17.2% reported using alcohol in the past year in 2021, remaining steady compared to 20.5% in 2020 (not a statistically significant decrease)
  • 10^th graders: 28.5% reported using alcohol in the past year in 2021, a statistically significant decrease from 40.7% in 2020
  • 12^th graders: 46.5% reported using alcohol in the past year in 2021, a statistically significant decrease from 55.3% in 2020
• Marijuana: The percentage of students who reported using marijuana (in all forms, including smoking and vaping) within the past year decreased significantly for eighth, 10^th, and 12^th grade students.
  • Eighth graders: 7.1% reported using marijuana in the past year in 2021, compared to 11.4% in 2020
  • 10^th graders: 17.3% reported using marijuana in the past year in 2021, compared to 28.0% in 2020
  • 12^th graders: 30.5% reported using marijuana in the past year in 2021, compared to 35.2% in 2020
• Vaping nicotine: Vaping continues to be the predominant method of nicotine consumption among young people, though the percentage of students who reported vaping nicotine within the past year decreased significantly for eighth, 10^th, and 12^th grade students.
  • Eighth graders: 12.1% reported vaping nicotine in the past year in 2021, compared to 16.6% in 2020
  • 10^th graders: 19.5% reported vaping nicotine in the past year in 2021, compared to 30.7% in 2020
  • 12^th graders: 26.6% reported vaping nicotine in the past year in 2021, compared to 34.5% in 2020
• Any illicit drug, other than marijuana: The percentage of students who reported using any illicit drug (other than marijuana) within the past year decreased significantly for eighth, 10^th, and 12^th grade students.
  • Eighth graders: 4.6% reported using any illicit drug (other than marijuana) in the past year in 2021, compared to 7.7% in 2020
  • 10^th graders: 5.1% reported using any illicit drug (other than marijuana) in the past year in 2021, compared to 8.6% in 2020
  • 12^th graders: 7.2% reported using any illicit drug (other than marijuana) in the past year in 2021, compared to 11.4% in 2020
• Significant declines in use were also reported across a wide range of drugs for many of the age cohorts, including for cocaine, hallucinogens, and nonmedical use of amphetamines, tranquilizers, and prescription opioids.

“In addition to looking at these significant one-year declines in substance use among young people, the real benefit of the Monitoring the Future survey is our unique ability to track changes over time, and over the course of history,” said Richard A. Miech, Ph.D., lead author of the paper and team lead of the Monitoring the Future study at the University of Michigan. “We knew that this year’s data would illuminate how the COVID-19 pandemic may have impacted substance use among young people, and in the coming years, we will find out whether those impacts are long-lasting as we continue tracking the drug use patterns of these unique cohorts of adolescents.”

Earlier findings from a different NIDA-supported survey, conducted as part of the Adolescent Brain Cognitive Development (ABCD) Study, showed that the overall rate of drug use among a younger cohort of people ages 10-14 remained relatively stable before and during the first six months of the COVID-19 pandemic. However, researchers detected shifts in the drugs used, with alcohol use declining and use of nicotine products and misuse of prescription medications increasing. Adolescents who experienced pandemic-related severe stress, depression, or anxiety, or whose families experienced material hardship during the pandemic, or whose parents uses substances themselves were most likely to use them too.

In addition, a follow-up survey of 12^th graders who participated in the 2020 Monitoring the Future study found that adolescent marijuana use and binge drinking did not significantly change during the first six months of the COVID-19 pandemic, despite record decreases in the substances’ perceived availability. This survey was conducted between mid-July and mid-August 2020. It also found that nicotine vaping in high school seniors declined during the pandemic, along with declines in perceived availability of vaping devices at this time. These results challenge the idea that reducing adolescent use of drugs can be achieved solely by limiting their supply.

I speak of my son’s situation quite regularly in this blog. He is my reason for even beginning this. While his situation is not unique or even the worst across this country, it has led us to places the average rural American family never expects or wants to go. It is an uncomfortable situation. One with lingering grief, blame and pain as are many of the stories of people in our country, states and communities. This story is in my home. Maybe you have a story like this in your home.

If anyone has ever been involved in a federal case you know how important the PSI is. The infamous presentence investigation report. This is where they send a questionnaire that is about 40 pages long and ask about your family, work and school history, mental health history, look at your financial information. They want to know about every traffic ticket you’ve ever had, every damn detention you got in school and how many times you took a shit in the last 20 years. At least it seems that invasive.

No matter what that looks like, the government will object to your answers and tell you the fact that your sister was murdered when you were seventeen and a psychologist says you have recurring flashbacks and nightmares is irrelevant to your case. Having a severe stimulant use disorder on top of those PTSD symptoms and persecutory ideations didn’t have any impact on your actions.

PSI, aside and looking at someone with this diagnosis, this was simply one of the objections we had to the prosecutions insights on this report. When first arrested, my son was sent home with a GPS bracelet on his ankle. While this is invasive enough, they gave him a faulty mechanism. Exactly one week later on a Friday afternoon he is called at 12:30 p.m by his probation office from her Bangor, Maine office telling him that he needs to be in that office (3 hours away) before they close at 4. Considering he doesn’t own a vehicle that would make that trip at the time, I leave work and drive the 10 miles to his house to get him and head to Bangor, making it there barely in time, and he is outfitted with a new bracelet. Considering his curfew is 8 p.m. and none of us have eaten since morning, he is given permission to have dinner and arrive at home late.

This may have been inconvenient, but that wasn’t a problem as we are trying to do the best we can to keep him out of trouble. Having come out of the restaurant at 5:30 in the evening and preparing to make the return trip there are six missed calls from this woman in probation. The new bracelet isn’t working either. She will meet us at the local Irving gas station to look at it. While this is not ideal, we agree. I didn’t realize at that moment what a travesty this would be.

We are parked outside the local Irving and the probation officer pulls up in her huge black SUV with U.S. government plates and gets out with a gun attached to her hip. While Bangor is a town much larger than our rural community, people are still staring like some huge “bust” is going down. We sit like this for two hours while my son hangs his leg out the car door and she works on his bracelet. This is “uncomfortable” enough, but then she decides she needs to plug his leg into an electrical socket to see if it will work. He is taken inside the convenience store, not once, but twice to plug into the wall while customers mill about and she “packs her sidearm” like a sheriff in the old west.

Now imagine have PTSD and persecutory (people are out to get you) ideations. Imagine how “uncomfortable” this will be. Yet, here we have a supposed “professional” employee of the United States government subjecting my son to this. Having sat in this situation for nearly two hours before finally being directed to the local police station to go inside and get this bracelet working only to arrive home at 11 p.m that evening, I can tell you that this goes beyond uncomfortable. So much so that we insist it be put into the PSI.

The government’s response to this is that sometimes being on probation and a monitoring device can be uncomfortable. Yes, a monitoring device is uncomfortable. What it should not be is the subject of public humiliation. Imagine the impact to someone suffering mental illness such as this. It makes me curious about how much more incompetency are we subjected to?

My inclination is to take this information to a lawyer and try to make sure no other person is publicly humiliated at your local convenience store, but what would that really do? And then we wonder why someone with a severe stimulant disorder and a bevy of other mental health issues would want to get high after an instance such as this. Hell, I even wanted to get high and I’ve never done that in my life. Just adds to the ridiculousness of a federal drug response gone awry.

Dec. 2, 2021

By Spencer Bokat-Lindell

On Tuesday, New York became the first city in the United States to open officially authorized injection sites: medically supervised locations where drug users can find clean needles, naloxone — a medication that reverses overdoses — and options for addiction treatment. During the first day in operation, officials said, trained staff reversed two overdoses.

The intervention comes amid a staggering national surge in drug deaths: In the 12-month period that ended in April, as the pandemic enveloped the country, more than 100,000 Americans died of overdoses, surpassing the number of people who died from car crashes and guns combined. The figure marks not only a record high but also a nearly 30 percent increase from the same period last year.

“If we had talked a year ago, I would have told you deaths are skyrocketing,” Dr. Andrew Kolodny, medical director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School for Social Policy and Management, told The Times. “But I would not have guessed it would get to this.”

Why are so many Americans dying of overdoses, and what measures — in addition to or instead of those New York took this week — could help address the crisis? Here’s what people are saying.

‘The O.D. crisis is in a distinctly new place’

Even before last year’s increase, the United States had some of the highest drug overdose death rates among similarly wealthy nations, with rates more than tripling in the past two decades.

• Dig deeper into the moment.

That increase was fueled largely by the opioid epidemic, which started in the 1990s when pharmaceutical companies pushed to make prescription pills like OxyContin a cornerstone of pain treatment. But over the past decade, as those companies came under scrutiny for their role in the crisis, drugmakers and doctors tightened the supply — some argue too tightly — of prescription pills. But many who lost access to them were still addicted. The crackdown, as The Times’s Sarah Maslin Nir explains, opened a void on the black market for cheaper, more potent alternatives like heroin to fill.

More recently, the biggest driver of overdose deaths by far has been fentanyl, a fast-acting synthetic opioid that can be 50 times stronger than heroin. Because fentanyl is also much cheaper to produce than traditional plant-based opioids, it is increasingly added to other illegal street drugs to enhance their potency.

While some drug users actively seek out fentanyl, many die without knowing that a different drug they had consumed — cocaine, for example — was laced. “It’s not that fentanyl is attracting more users or creating new users,” Bryce Pardo, a drug policy researcher at the RAND Corporation, told The New Republic. “It’s just a very dangerous time to be a drug user and to be buying street drugs.”

Many experts say the pandemic played a leading role in last year’s surge. Public health resources were already stretched to the limits, so people working on the opioid crisis had to shift their attention to Covid treatment, Leana Wen, a former Baltimore health commissioner and medical analyst, told CNN. Many people struggling with addiction lost their health insurance and the ability to get treatment, as well as the jobs that paid for their housing and food.

And on top of that, Wen says, “we also can’t forget that addiction and mental health issues are diseases of despair, and this pandemic has worsened mental health for so many people.

How to reduce overdoses

In recent years, Americans across the political spectrum have turned their backs on the war on drugs. Polls suggest that most now consider imprisoning people for illegal drug use to be inappropriately punitive, but it is also ineffective: According to research from the Pew Charitable Trusts, there is no statistically significant relationship between state drug imprisonment rates and self-reported drug use, drug arrests and drug overdose deaths.

By contrast, treating addiction as a health problem rather than a crime has shown clear benefits, as The Times’s Austin Frakt wrote last year. Proponents of drug policy reform often point to Portugal as a successful case study: In 2001, the country decriminalized (but did not legalize) the use of all illicit drugs in small amounts. Overdose deaths plummeted, to the point where the country now has one of the lowest rates of drug death in Western Europe.

But Frakt noted that Portugal’s example is often misunderstood as a story mainly about decriminalization. In truth, decriminalization was just one prong of a broader strategy to encourage treatment. Portugal still penalizes people caught possessing or using illicit drugs by sending them to regional panels of social workers, medical professionals and drug experts, who can refer people to drug treatment programs, hand out fines or impose community service. Expanding treatment in this way, Frakt argued, “might bring the most tangible benefit to the United States.”

The $1.9 trillion relief bill that Congress passed in the spring did include $1.5 billion for prevention and treatment of substance use disorders, but critics say the response is inadequate to the magnitude of the crisis. Addiction treatment services can be sparse and extremely expensive in the United States, even with health insurance, putting them out of reach for many who need them. During his campaign, President Biden proposed a $125 billion investment to make prevention, treatment and recovery services available to all, but other issues, like infrastructure, have taken priority.

Experts say regulatory changes are also needed to make treatment more accessible. For example, physicians still need federal permission to prescribe buprenorphine, a first-line medication for opioid use disorder that has been shown to reduce overdose deaths and keep people in treatment longer. Because it’s a controlled substance, many pharmacies also fear running afoul of law enforcement by dispensing it.

For deaths to really come down, “you have to make it much easier for someone who is addicted to opioids to access treatment, particularly with buprenorphine,” Kolodny said. “It has to be easier to get treatment than to buy a bag of dope.”

For the first time, Congress also appropriated funds this year for harm reduction measures, the chief goal of which is not necessarily to help drug users achieve abstinence but to reduce their risk of dying or acquiring infections like H.I.V. and hepatitis C.

“It’s an enormous signal, recognizing that not everybody who uses drugs is ready for treatment,” explained Daliah Heller, director of drug use initiatives at Vital Strategies, a global public health organization. “Harm reduction programs say: ‘OK, you’re using drugs. How can we help you stay safe and healthy and alive first and foremost?’”

Some harm reduction proposals, like increasing the availability of naloxone, enjoy broad support. In New Jersey, naloxone is now widely available from community organizations and pharmacists without a prescription. Officials say the distribution effort is a major reason overdose deaths actually fell slightly in the state last year, bucking the national trend.

Other harm reduction measures, like rapid-test strips that detect whether illicit drugs have been laced with fentanyl and the kind of safe injection sites that debuted in New York this week, are more controversial. Critics say that safe injection sites, in particular, encourage drug use, end up littering neighborhoods or cause an increase in crime. Yet research on real-world injection site programs — mainly in Europe, Canada and Australia — has so far contradicted those assumptions.

Last, policymakers should try new ways of restricting the flow of highly lethal drugs into the country, Kathleen Frydl, a political historian, argues in Washington Monthly. Fentanyl, for its part, is primarily manufactured in China, which sends the drug or its raw ingredients on cargo ships to Mexico, where it is finished by cartels. Much of America’s heroin supply, too, derives from Mexico and South America.

Policymakers have tended to focus on the amount of such drugs seized at the border as a metric of success. But Frydl argues that border interdiction has proved to be a failed strategy, one that merely encourages suppliers to produce more drugs — and more potent ones — and fosters corruption.

Instead, Frydl argues that policymakers should use trade policy to control drug trafficking:

• Any trade talks with a source country, like Mexico or China, would include drug supply reduction goals, much like the emissions reduction goals that environmentalists argue trade deals should include.
• Failure to meet those goals would incur trade penalties, either in the form of additional tariffs on imports or withholding of exports.
• Success could be measured in the price and potency of drugs on the street, especially in places most affected by overdose deaths.

“Prior to World War II, during a more multilateral era when the U.S. was one power jostling with others, American drug policy relied on taxes and tariffs, not crime and punishment,” Frydl writes. “We used to stop the drug flow through trade negotiations. It can work again.”

Maine is on pace to lose more than 600 residents to overdose this year, which would shatter the record set just last year.

By Eric Russell Staff Writer

A decade ago, five years ago even, many Mainers struggling with substance use disorder could relapse with far less risk of suffering a fatal overdose.

Those odds have diminished significantly.

Fueled by the powerful synthetic opioid fentanyl, which is showing up in nearly every illegal drug being sold, overdose deaths in 2021 are on pace to shatter the annual record set just one year ago.

From January through September, there were 455 fatal overdoses tracked by the Maine Attorney General’s Office and the Office of Behavioral Health, an average of more than 50 every month. If that pace holds for the final three months of the year, there would be more than 600 deaths, easily eclipsing last year’s total of 502 that was attributed in part to increased isolation, challenges with accessing treatment and a disruption of illegal drug supply during the pandemic.

“I think the stress on people and the isolation from the pandemic are certainly factors, but I think the biggest factor is the lethality of the drugs,” said Leslie Clark, executive director of the Portland Recovery Community Center. “When we think about people who relapse or are at risk of relapse, the consequence is just so much greater. That experience didn’t use to be as likely to kill you.”

Nicole Proctor, who is program director for the recovery hub at the Portland center and in long-term recovery herself, said there is no question drugs are more deadly than ever.

“I’ve been grateful that I’m not living through the lethal drugs that are out on the street,” she said. “And it’s not just opioid users. Fentanyl is showing up in cocaine and methamphetamine, even marijuana. I don’t think there are necessarily more people using, I think there are just more people dying.”

In the last decade, the number of yearly overdose deaths has more than tripled, fueled overwhelmingly by opioids – largely diverted prescriptions like OxyContin at first, then heroin and now fentanyl.

Maine went over 200 deaths in a year for the first time in 2014. In 2017, the total was over 400. Now, eclipsing 600 four years after that seems all but certain.

Three of every four deaths this year have involved fentanyl or an analog. Cocaine and methamphetamine each show up in a quarter of all deaths, often in combination with fentanyl.

“We’re certainly not hiding it. The data is out there. But the reason you’re not hearing about it is because COVID is squeezing out everything else,” Gordon Smith, director of Maine’s opioid response, said in an interview.

Drug deaths outpaced COVID deaths last year, although that’s not likely to be the case this year. In 2020, there were 422 deaths attributed to COVID-19 and so far this year there already have been more than twice that many. More than three times as many people in Maine died by overdose last year as died in motor vehicle crashes.

Drug enforcement officials say drug cartels in Mexico are mass producing fentanyl and methamphetamine with chemicals imported from China. Fentanyl is profitable for drug dealers because it’s so potent that small amounts can be mixed with other substances.

Last week, more than 389 pounds of fentanyl – and 17,500 pounds of methamphetamine – were found hidden inside a tractor-trailer full of auto parts at a port in San Diego. The seizures were the largest for either drug in the U.S. for both 2020 and 2021, according to a statement from the U.S. Attorney’s Office.

Maine is by no means alone in the recent trend. The U.S. Centers for Disease Control and Prevention released estimates last week that more than 100,000 Americans died of drug overdoses from May 2020 to April 2021. That’s the highest 12-month period ever recorded, although it’s not yet an official count.

All but four states saw increases over the previous 12-month period. Nearby New Hampshire was among the states that saw overdose deaths decrease. Vermont, on the other hand, saw the largest increase, 70 percent, although that state started from a much smaller number than most.

Maine’s increase of 24 percent was slightly lower than the overall U.S. increase of 28.5 percent.

So far this year, overdose deaths have been reported in every Maine county, led by 82 deaths in Cumberland County. Of the 455 reported through September, 314 victims have been male (69 percent). Individuals between the ages of 40 and 59 account for just under half of all deaths.

As high as the total has been so far, it could have been higher still without the widespread availability of naloxone, a drug that can save lives by reversing the effects of an opioid overdose. Of the 6,892 overdoses reported from January through September, 7 percent have resulted in fatalities.

“It’s incredibly sad how many people are overdosing,” Smith said. “But it’s remarkable that we’re saving 15 people for every person who dies.”

Still, naloxone only works when it is administered shortly after an overdose. If it’s not on hand or if emergency medical providers can’t respond in time, it doesn’t do any good.

Oliver Bradeen, executive director of Milestone Recovery in Portland, said the increase in overdose deaths has come at a time when people have been desperate for access to limited resources. The detox unit at Milestone, for example, was forced to close for roughly three months this year because of staffing shortages. Another detox facility in Bangor also closed temporarily. That meant people who didn’t have private insurance had nowhere to go outside of a hospital emergency room.

“I think the thing we hear from folks, aside from the added level of isolation brought on by the pandemic, is that everything, when it comes to treatment, takes longer or takes more effort,” Bradeen said.

In recent weeks, members of the Alliance for Addiction and Mental Health Services of Maine have warned that the vaccine mandate for health care workers would exacerbate staffing shortages at agencies that provide crucial treatment, especially in rural areas.

“When I came into recovery, I lived in a rural area and had to move to Portland to find support and resources that I felt I needed,” Proctor said. “A lot of people may not have that option, but people can get resources away from Portland more easily than before and we continue to be more creative with how we deliver those services.”

In many ways, Maine has more tools now to fight substance use disorder, Smith said: Medicaid expansion and increased reimbursement rates for treatment; the introduction of medication-assisted treatment in jails and prisons; the widespread availability of naloxone.

But more work is clearly needed.

“With every overdose, there is something to be learned that might help us prevent them in the future,” he said. “For instance, how many people died while trying to get into treatment? If they aren’t trying, that’s one thing. You focus on harm reduction. But if there are barriers to treatment, that’s something else.”

Smith said he has a recurring nightmare about some college kid trying to buy one pill of Adderall – a prescription stimulant – to help him get through an all-night study session. The pill contains fentanyl, unbeknownst to the student.

“That kid isn’t going to wake up. He’s going to die,” he said.

The unprecedented number of overdose deaths, combined with the hundreds who have died from COVID-19, has been unnerving for behavioral health workers.

“The people dying from overdose, so many are in their 20s and 30s, so when you think of how much of their lives have been lost, it really brings it into perspective,” Bradeen said. “And many of them have kids, so that’s another generation that’s affected by this crisis, too.”

“The loss in our community, and the devastation to families, is just so continual,” added Clark. “But it does give us a stronger sense of purpose to keep doing this work. Because we also do see many people doing well and getting better.”

More than 100,000 Americans died from drug overdoses in the yearlong period ending in April, government researchers said

By Roni Caryn RabinNov. 17, 2021, 10:02 a.m. ET

Americans died of drug overdoses in record numbers as the pandemic spread across the country, federal researchers reported on Wednesday, the result of lost access to treatment, rising mental health problems and wider availability of dangerously potent new street drugs.

In the 12-month period that ended in April, more than 100,000 Americans died of overdoses, up almost 30 percent from the 78,000 deaths in the prior year, according to provisional figures from the National Center for Health Statistics. The figure marks the first time the number of overdose deaths in the United States has exceeded 100,000 a year, more than the toll of car accidents and guns combined. Overdose deaths have more than doubled since 2015.

Though recent figures through September suggest the rise in deaths may have slowed, the grim threshold nonetheless signals a public health crisis whose magnitude was both obscured by the Covid pandemic and accelerated by it, experts said.

“These are numbers we have never seen before,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, said of the tally. The fatalities have wide repercussions, since most of them occur among people aged 25 to 55, in the prime of life, she added.

“They leave behind friends, family and children, if they have children, so there are a lot of downstream consequences,” Dr. Volkow said. “This is a major challenge to our society.”

The rise in deaths — the vast majority caused by synthetic opioids — was fueled by widespread use of fentanyl, a fast-acting drug that is 100 times more powerful than morphine. Increasingly fentanyl is added surreptitiously to other illegally manufactured drugs to enhance their potency.

• Dig deeper into the moment.

Overdose deaths related to use of stimulants like methamphetamine, cocaine, and natural and semi-synthetic opioids, such as prescription pain medication, also increased during the 12-month period.

Fentanyl’s ubiquity, combined with the unique social conditions caused by the pandemic, have combined to create a perfect storm, experts said. While some drug users seek out fentanyl, Dr. Volkow said, others “may not have wanted to take it. But that is what is being sold, and the risk of overdose is very high.”

“Many people are dying without knowing what they are ingesting,” she added.

People struggling with addiction and those in recovery are prone to relapse. The initial pandemic lockdowns and subsequent fraying of social networks, along with the rise in mental health disorders like anxiety and depression, helped create a health maelstrom.

So, too, did the postponement of treatment for substance abuse disorders, as health care providers nationwide struggled to tend to huge numbers of coronavirus patients and postponed other services.

Dr. Joseph Lee, president and chief executive of the Hazelden Betty Ford Foundation, said that community and social support that was lost during the pandemic, along with the closing of schools, contributed to rising overdose deaths. “We’re seeing a lot of people who delayed getting help, and who seem to be more sick,” Dr. Lee said.

The vast majority of these deaths, about 70 percent, were among men between the ages of 25 and 54. And while the opioid crisis has been characterized as one primarily impacting white Americans, a growing number of Black Americans have been affected as well.

There were regional variations in the death counts, with the largest year-over-year increases — exceeding 50 percent — in California, Tennessee, Louisiana, Mississippi, West Virginia and Kentucky. Vermont’s toll was small, but increased by 85 percent during the reporting period.

Increases of about 40 percent or greater were seen in Washington State, Oregon, Nevada, Colorado, Minnesota, Alaska, Nebraska, Virginia and the Carolinas. Deaths actually dropped in New Hampshire, New Jersey and South Dakota.

“If we had talked a year ago, I would have told you, ‘Deaths are skyrocketing.’ But I would not have guessed it would get to this,” said Dr. Andrew Kolodny, medical director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School for Social Policy and Management.

Most of those who died probably already suffered from addiction, or were in recovery and relapsed, an ever-present risk exacerbated during times of stress and isolation, Dr. Kolodny said. And many of those with an addiction to synthetic opioids very likely became addicted after being given prescription opioids by medical providers.

“Teenagers are routinely being given opioids to this day when their wisdom teeth come out,” he said.

President Biden’s American Rescue Plan Act includes $1.5 billion for the prevention and treatment of substance use disorders, and $30 million to fund local services for people struggling with addiction, including syringe exchange programs.

Federal funds can also be used now to buy rapid fentanyl test strips that people can use to check whether drugs have been laced with fentanyl.

But critics say the response has been inadequate given the magnitude of the public health emergency. They have called for new funding streams to provide universal access to treatment, and for treatment centers in every county that offer same-day access to substance abuse treatment.

For example, physicians still need federal permission to prescribe buprenorphine, a first-line treatment for opioid use disorder, which limits the number of providers.

“If you really want to see deaths comes down, you have to make it much easier for someone who is addicted to opioids to access treatment, particularly with buprenorphine,” Dr. Kolodny said.

“It has to be easier to get treatment than to buy a bag of dope.”