Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: New York Times

Middle-Aged White Women: Why Are We Dying?

Selfie of G. I'm 51, and I'm in the demographic that's dying fastest from painkiller addiction.

Selfie of G. I’m 51, and I’m in the demographic that’s dying fastest. I have six years in abstinence-based recovery from painkiller addiction.

The New York Times is all over the “narcotic epidemic” this week.

Probuphine

First we had a story about the recommendation for FDA approval of Probuphine, the implantable plastic matchsticks saturated with buprenorphine. The story was mostly about how sticking this drug inside our bodies would reduce overdose deaths from heroin, prevent us from selling buprenorphine (Suboxone) on the streets, and keep us compliant with taking our doses.

The trajectory of the story (“Let’s cure all addicts with this drug!!”) was saved by a CDC physician and a West Virginia University doctor, both of whom said we can’t just implant these sticks into people and send them on their merry way.

But you know what?—that’s exactly what will happen. Because that’s exactly what has been happening for two decades with SSRIs, which were approved for major depression, were never intended for lifetime use, and were recommended for use concurrent with psychiatric therapy. But the NYT has run stories about, gosh, therapy is so expensive! And to get SSRIs you no longer have to see a psychiatrist. You can go to your PCP, who most likely isn’t qualified to treat depression.

But you’re probably diagnosing yourself, so hey.

And you know what else?—the FDA will approve Probuphine for opioid addiction, but dollars to donuts it will be prescribed off-label for other stuff. Also, doctors will up the doses—off-label. Because that’s what happens with drugs. Doctors aren’t bound to prescribe only for approved uses. And they don’t. And doctors usually don’t know much about the drugs they prescribe. Most doctors who prescribe buprenorphine have no idea how strong it is.

I bet you a dollar that many people with opioid addiction who try Probuphine will wind up with permanent bupe implants.

Because doctors know how to get us on this stuff, but they never know how to get us off.

BIG News: Whites Are Dying Of Overdoses.

omg, AND!!: whites are now dying of overdoses faster than blacks. Which is HUGE news.

Because guess which race makes up the majority of the NYT’s audience—and that of the other major media outlets (except AlJazeera).

For the past five or six decades, black heroin addicts have been dying from overdoses (and ancillary illness and crime), and their communities have been bombed out by the war on drugs, but their deaths and mass incarcerations have not spurred the kind of critical, apparently sympathetic spotlight that the media is now turning on white overdose deaths.

The headline (“Drug Overdoses Propel Rise in Mortality Rates of Young Whites”) says young people are dying fastest, but when you get to the graphs, you can see that among women, the age group that’s dying fastest is 45-54—my age group.

Deaths from drug overdose. Source: NYT.

Deaths from drug overdose. Source: NYT.

Eileen Crimmins, a professor of gerontology at the University of Southern California, said:

For too many, and especially for too many women, they are not in stable relationships, they don’t have jobs, they have children they can’t feed and clothe, and they have no support network.

It seems weird that they spoke to a gerontologist for this story, but in fact among white women it’s the older ones of us who are dying fastest.

We have no support network. She says.

Recovery is all about building a support network. It’s also all about finding out how we can contribute to society, which is how we earn a living.

It’s strange that the Times didn’t put these two stories together. After all, the thinking in one (“painkillers are killing whites”) leads directly into the other (“Probuphine will save painkiller addicts’ lives—because everyone knows dopefiends can’t stay off drugs any other way”).

That is the way treatment is headed, by and large.

There is no reliable science to show that people addicted to opioids have a tougher time staying off their drugs than anyone else addicted to any other drug, as long as we have access to a support network. But the popular idea is that we painkiller addicts have wrecked our neurology for good.

And this is the line scientists will take because their research is funded by pharma. This is the line pharma will take because it will sell more drugs. This is the line physicians will take because prescribing drugs takes less time in the consultation room and helps them avoid the time-consuming work of actually getting to know patients. And this is the line journalists will take because they don’t bother to challenge their “expert” sources’ thinking.

So why are we dying?

Painkillers kill pain—physical and emotional. They numb the human being.

In a larger sense, to get at the real cause of why we’re dying, we could ask what we’re numbing out. What is the pain that we’re bombing out with drugs?

That’s a discussion I’d love to participate in, and that would not only keep people alive in a minimal, technical way but rather help them thrive and also cultivate people’s overall long-term quality of life.

Update, August 2016

You know how I talk above about Probuphine being used off-label? Well guess what—this blog is now getting hits from people searching for “Probuphine off-label.” In the words of Pete Seeger, When will they ever learn?

This site has always been add-free and fee-free. If this post helped you, please like and share.

New York Times Addiction Story—Is Addiction Really Like Diabetes?

Yesterday the New York Times ran a story called “Rethinking Addiction’s Roots, and Its Treatment,” about how medical schools are starting to establish accredited residencies in addiction medicine. This would allow med students who have completed such residencies to enter the field of addiction medicine right out of med school, rather than go through additional training.

So glad to see the NYT covering addiction issues. Something that needs to continue, in order to bring addiction into the national public health discourse. But:

Lots of complaints in the comments section about how problematic this story is.

Here are a few I found.

Problem 1: The Diabetes Analogy

Man, what a tired analogy. Let’s either get rid of it, or take it all the way. Right now, people only take it up to the point where diabetics inject insulin—implying “real” addiction treatment should be about drugs. Then they miss a critical part: most cases of diabetes these days are Type 2, which indeed has a genetic component but is largely influenced by poor “lifestyle” factors: smoking, drinking, and obesity. These problems are all related to addiction, and they all have underlying psychological drivers about alleviating stress.

Another critical part missed: in the vast majority of cases of diabetes, the pancreas never recovers its function, whereas in the vast majority of cases of opioid addiction, the opioid receptors do recover their normal functioning—if, at some point, when the recovering person is ready, they’re allowed to remain abstinent for a while.

Both addiction and Type 2 diabetes can be considered the result of unfortunate genetics and poor lifestyle choices. As for treatment: insulin doesn’t “cure” diabetes. While no drug or treatment could restore the function of the pancreas to normal, treating the cause of diabetes would address the underlying compulsions—the addictions—so people wouldn’t continue to smoke, drink, and eat compulsively.

The diabetes/insulin analogy drives the ending of the NYT story, where Suboxone comes in to save the day for a 53-year-old patient on bupe maintenance. This sets up Suboxone (and, implicitly, other future Miracle Drugs), as the magic bullet that can “cure” addiction simply by “blocking cravings.”

Hmmm.

Problem 2: Unexamined Conflicts of Interest

Is it really news that “the medical establishment is putting its weight behind the physical diagnosis”? The medical establishment, in the U.S. at least, is largely funded by Big Pharma—through government institutions such as NIDA. The most recent study on extended-release buprenorphine, the opioid drug in Suboxone and other preparations, was funded by NIDA to the tune of $7.6 million. The government did not hire the researchers of this study independently; the grant went to Titan Pharmaceuticals, the maker of the proprietary buprenorphine formulation being studied, who then turned around and picked the UCLA researchers—who were already being paid speakers’ fees and research funds from both Titan and Reckitt Benckiser, the makers of Suboxone.

Hmmm.

Problem 3: The Split Between Medicine and Psychology in Recovery

It’s important that med schools are starting addiction-medicine residencies—this helps to educate more doctors about addiction. Nora Volkow makes a good point when she says it’s a “very serious problem” that general practitioners lack knowledge about addiction—this is true, and leads to the corollary thought that it might actually be best to spend the money training primary-care physicians in addiction, rather than create more specialists. PCPs are on the front lines; they’re the ones prescribing, for example, the most Oxycontin and Vicodin. They could do with more education about addiction.

And it’s important to think of recovery from addiction as the management of a chronic problem, the way high blood pressure and diabetes are managed. (Addicts have been thinking of the problem this way for a long time. 🙂 )

But why should we automatically think about addiction as EITHER a medical OR a psychological problem? Why can’t its treatment involve both disciplines, as well as others? Most active and recovering addicts and alcoholics are able to articulate the experience that addiction involves not only their physical response to the substance or behavior, but also a psychological component—we use/drink/eat/gamble/have compulsive sex to alleviate “stress.”

“Bringing Respectability to Addiction Medicine”?

In the third graf the writer mentions a guy named David Withers from a rehab called Marworth (a physician? addiction specialist? the writer does not tell us… aha! quick Google search reveals he’s an M.D. and associate medical director at Marworth). Withers says that the establishment of residencies in addiction medicine is “the first step toward bringing . . . respectability and rigor to addiction medicine.” What a slap in the face for the many doctors in America already dedicating their practices to addiction medicine. Be interesting to hear what, for example, Dr. Drew thinks of this (as of this morning he hasn’t yet tweeted on it). I intend to call my local, renowned rehab and speak to the well-known medical director about this statement.

 

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