Where the Opiate Epidemic is Spreading and Why

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The market for black tar and powdered heroin

 

Opioids are cutting through the country, claiming an increasing number of deaths and, in some cities, taking more lives than traffic fatalities and murders combined.1 But the rapid increase in overdose deaths over the past ten years didn’t extend to all parts of the country. In some states in the western half of the U.S., data suggests deaths may have leveled off or even declined.2

 

Map of overdose deaths across America, age adjusted per 100,000. (Custom map, See Citation 6)

 

Looking at heroin smuggling in the U.S., we historically saw four different global regions involved. Heroin from Southeast Asia, once smuggled throughout the world, is now limited to Australia and Canada; and heroin originating from poppies grown in Afghanistan and refined in Southwest Asia is sold predominantly in Europe. Today, heroin in America is exclusively from Mexico and Colombia.3 The latest data from the US Drug Enforcement Agency finds that within the U.S., 58% of heroin is Colombian-sourced, 40% Mexican-sourced with Southeast and Southwest Asia heroin combined falling to a 2% share.4

However due to the physical qualities of heroin shipped from Mexico and Colombia, Mexican supply chains and cartels control the western half of the United States, and Colombia the eastern half. The “black tar” heroin of Mexico is heavier per gram than the lightweight and low volume powdered heroin of Colombia.3 This difference in weight and volume makes it harder and more expensive to ship black tar heroin abroad. The weight of Mexican heroin makes it too expensive to be air shipped. Instead, black tar heroin finds itself distributed directly across Mexico’s nearest border: the United States.

 

Why is this important?

As overdose deaths mainly rise in the eastern half of the United States but not the west, it can be attributed to the availability of the stronger and often more synthetic forms of heroin in the Colombian distribution. While there is little difference in heroin addiction or use in one half of the country over the other, there is a strong difference in the availability of different types of these opiates. High density powdered Colombian heroin brings with it lower prices per gram (along with access to synthetic forms such as fentanyl.) It is with the decrease in price per gram that the strongest correlation with overdose deaths is found. The number of overdose deaths is found to correlate to the decrease in price rather than an increase in purity.5 As prices for the powdered and synthetic forms of heroin continue to fall, overdose deaths are expected to continue to rise, unless further action is taken to end the epidemic.

  1. Baker, Al. “When Opioid Addicts Find an Ally in Blue.” The New York Times. The New York Times, 12 June 2017. Web. 19 July 2017.
  2. Katz, Josh. “Drug Deaths in America Are Rising Faster Than Ever.” The New York Times. The New York Times, 05 June 2017. Web. 19 July 2017.
  3. Ciccarone, Daniel. “Heroin in Brown, Black and White: Structural Factors and Medical Consequences in the US Heroin Market.” International Journal of Drug Policy 3 (2009): 277-82. Web.
  4. US Drug Enforcement Administration. News Release, For Immediate Release, June 21, 1995. Colombian Heroin a Major Threat. Almost One Third of Heroin Seized in the United States Originates in South America. 1995 [Retrieved July 31, 2007].
  5. Unick, George, Daniel Rosenblum, Sarah Mars, and Daniel Ciccarone. “The Relationship between US Heroin Market Dynamics and Heroin-related Overdose, 1992-2008.”Addiction 109.11 (2014): 1889-898. Web.
  6. Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.htmlon March 2, 2017.

Happy Birthday Baby

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Birthdays have never meant much to me. I grew up with a sister whose birthday was two days before mine. Ours was a childhood of shared birthday parties and identical cakes. Then when I got older they never seemed very special. Maybe that’s because I was born at the end of the January when the bills for Christmas presents have just started coming in. No matter the cause I always felt like celebrating a birthday was celebrating something I had nothing to do with.

Here in California they celebrate birthdays in the 12-step rooms. A 45-year old man blows out a cake with a fifteen on top of it. A woman in her sixties turns twenty. The room is filled with people of all ages, races and sexes. They sing, a little off key and sometimes out of sync, “Happy Birthday”. Then ask, also a little out of sync, “How’d you do it?” There are tears and laughter in the responses. They all have one thing in common. They have spent the year sober.

These are the birthdays that make sense to me. They are earned. The people celebrating fought for them. They showed up on the first day of at least 365. They sat down, shaky and sweating. They are depressed and anxious. More than anything they are scared. Everything is about to change. Everything.

Then they come back. Day after day. The sweats and shakes disappear. The depression and anxiety lessens. They know what to expect and are no longer scared to walk in the rooms. They begin to celebrate milestones. First comes 30 days, then 60, then 90, and 6 months. Finally a year.

With the passage of time the world gets less hazy. Emotions come back. Relationships begin to be repaired. I heard someone say in a meeting once “It’s called recovery because you are getting something you lost back, and that something is you.” I love that. To me it’s the core of the 12-step program.

The other thing I always hated about being “belly-button” birthdays is being the center of attention. I hated being singled out. Cards, flowers, balloons: No thank you. In the rooms celebrating birthdays isn’t about you, it’s about the other people. It’s about showing the person with less time it can be done. It’s hard but it can be done.

So next year on January 31st I turn 36. I don’t think I’m going to celebrate much. Then on April 30th I turn 1, god willing. That’s the birthday I will have earned.

Who Are We?

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What does it mean to be an addict or alcoholic? I’m not talking about the medical definition but at the core who are these people?

Here’s what I learned in my 10 years in and out of the rooms of a 12-step program.

Addicts and Alcoholics are resourceful. They’ve had to be. When your life revolves around obtaining a drug of choice, you have to be able to figure out how to get it no matter what. The last three words of that sentence almost becomes a motto.

They are smart. Both book smart and street smart. You want to learn something new, go to rehab. Most love to learn and are extremely teachable.

They are funny. Addicts and alcoholics have seen some stuff. They’ve had experiences, and they are a little twisted. They have a unique way of looking at the world. They can tell a story. I’ve never laughed harder and louder than I did in rehab.

Boredom, lack of sleep, hunger, being angry and being alone is really dangerous for alcoholics and addicts. Seriously, they talk about HALT (hungry, angry, lonely, tired) all the time in 12-step meetings. Those four things, plus boredom are some of the reason addicts started using in the first place. They are also the things that will bring them back to their DOC.

They take care of one another, fiercely. When someone is hurting or needs help they come together, often regardless of their personal feelings toward the person needing help. They are always good for a hug.

They’ve learned to pretend to be tough. They’ve learned how to pretend to be okay. They want you to think nothing is ever wrong. They wear a mask that hides the true person. A person who is sensitive. A person who loves and hates with their whole being.

They are forgiving and want to be forgiven. Such a huge part of getting sober is giving up the resentments, the hurts. To let go of the anger they have towards others, but mostly themselves. They also know that forgiving is not forgetting. They know about learning from mistakes.

Above all, they are survivors. They have been through hell and back and are still standing. They’ve cheated death. They’ve seen terrible things. They’ve had awful things happen to them, and done awful things to others. Yet, still they stand. Still they fight. They aren’t going anywhere.

Fighting Together

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It’s about 7 p.m. on a Wednesday night. It’s still over a hundred degrees outside in the desert. The air conditioning is blasting. You can hear laughter in the air.

In this nondescript building, in a nondescript neighborhood lives about 20 women. They come from all over the country. Some are older. Some still in their teens. They have a single thing in common. They are all fighting to stay sober.

The journey to get here hasn’t been easy for any of them. In the battle against drugs and alcohol these women were on the frontlines. Most are scarred, emotionally and physically. They lost friends and family to the disease. They are the survivors.

Surviving doesn’t mean winning. And these women want to see a victory. They want to see the scars fade, the hurt go away. That’s why they are here. But the thing about scars is you always know they are there, even after they disappear.

These women get up every morning. Brush their teeth and get dressed. Some head to therapy, some to work. It doesn’t matter, they are out of bed. They come in and out of each other’s lives all day every day. An absence never goes unnoticed. They fall asleep every night next to a fellow soldier.

There are injuries along the way, women who couldn’t take it anymore. But those women came back, more knowledgeable about the enemy and more determined to fight it than ever. They saw what happened if they gave up. There are also casualties. At least it feels that way. They leave a hole behind, even if they don’t mean to.

Others leave to resume the fight somewhere else. Back at home maybe. They are missed too, just in a different way. They call, say Hi. Check-in.

Strength comes in numbers and while about 20 doesn’t seem like a lot, for this group, it’s everything. For some of these women its more people then they interacted with in a month. There is always someone around to talk to, cry with, and laugh with.

It’s by no means perfect. No one wants to have a chore or a curfew at 30. That’s the tradeoff though. A few simple rules, in exchange for support in the fight. It’s better than the days of being hopelessly, helplessly alone.

In this nondescript building in a nondescript neighborhood sits a sober living. Inside sits some of the fiercest, funniest, smartest women fighting to save their lives.

Tell Me a Story

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What do you think when someone says tell me a story? Does it conjure up images of beasts and princesses? Maybe it’s a little more personal. A time when you laughed so hard you cried, or cried so hard you laughed. Chances are it’s a moment. Just a moment, that made an impression in your brain.
But what do you say when someone asks you to tell them your story. Where would you start? And how do you want it to end?
In 12-step programs you’ll hear people’s stories a lot. Where they were born, what their families were like, and most importantly about their addiction. How it started, where it took them, and the struggle to get and stay sober.
In the rooms nothing is taboo. All of the things you can’t tell anyone come out. Suicide attempts, child abuse, sex, and mental health. Nothing is off the table. No story is too dark, scary, or painful to tell. As they say, secrets make you sick.
I’ve heard a woman share the story of running over a child while drunk, a man who spent years in jail for a crime he can’t even remember committing, and multiple people sharing about living on the streets.
Sound bleak? It isn’t. Those stories all come with a message of hope. And often, believe it or not, laughter. The people telling them are no longer in deep, dark places. Recovery has helped them see a light. They keep talking about it and it just gets brighter. They keep telling their story.
It’s not easy. It gets easier. As cliché as it sounds telling your story just takes practice. It’s important. Words have power. Keep them inside and the words own you. Speak your truth and you get the power back. Again: YOU get the power back. Letting other people see that could change their life. It will change yours.
The nice thing about a recovery meeting is you get to start slow. No one is going to walk up to at your first meeting demanding to know everything, down to your social security number. They will ask your name and maybe where you’re from. After the meeting starts you may have to introduce yourself “Hi my name is and I’m an alcoholic.” That’s it.

Simple.

The start to a story.

The Drug We Should Be Talking About

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It’s been called a weaponized form of marijuana by the police commissioner of New York City. On the street it’s known as Spice, K2, or Black Mamba depending on where you are in the country. The headlines say “synthetic marijuana”. No matter its name it’s killing people across America, most of them young.

Just take a look at the numbers. According to the Centers of Disease Control in just the first four months of 2015, 15 people lost their lives because of this drug. While that might not sound like a lot, it’s 3 times the number who died during 2014. During the same period, calls to poison control centers around the United States went up 229%. The median age of people making those calls, 26 years-old.

On a Facebook page titled Fake Pot Horror Stories-The Dangers of Synthetic Marijuana you’ll find picture after picture of people, most who haven’t even seen 20, hooked to machines, fighting for their lives. Not all made it.

The Government has tried to step in and do what it could. When Spice first appeared it was legal. That changed in 2012 when five of the main compounds were reclassified to a more controlled drug class. The drug came off the shelves and hit the streets.

Synthetic marijuana was considered relatively harmless by its users, a natural drug because at least part of it was made from plants. Sold in drug stores, head shops, and over the Internet it was easy to get. Users experience some of the same effects of marijuana like relaxation, elevated mood, and altered perception. Others reported psychotic effects, extreme anxiety, paranoia and hallucinations. In some cases users said the effects were even stronger than regular marijuana.

Scientist say that makes sense because they know Spice products act on the same receptors as THC, found in marijuana. It’s what else that goes into the drug compound that concerns them. Because the chemical composition of many products is unknown it’s hard to tell what they will do to the brain. And it just hasn’t been around that long to know what the long term effects are.

If scientists don’t know exactly what the drug does to the brain they are learning more about the impact on the body. According to the National Institute on Drug Abuse spice users who have been taken to Poison Control Center have reported rapid heart rates, vomiting, agitation, confusion and hallucinations. The drug can also raise blood pressure, causes reduced blood supply to the heart, and has even been associated with heart attacks.

Besides the high, Spice has another big draw. It doesn’t show up on most drug tests. To test positive the sample has to be sent to a laboratory and that can be expensive. However as most people in recovery will tell you it is hard to hide an addiction for long.

Good Times at the Recovery Resources Workshop in Palm Springs

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This two-day workshop  was a great success and a lot of fun. It gave everyone the opportunity to reach out to fellow colleagues, to meet, dine and socialize with like-minded professionals, to learn from each other, and to grow our outreach.

For information on how to attend our next event, please see our training schedule here.

Group Shot of the Recovery Resources Workshop attendees.

Group Shot of the Recovery Resources Workshop attendees.

IMG_6911

Group shot of attendees during the panel .

Steven Henke, Marketing Manager of Desert Sun speaking to the group.

Steven Henke, Marketing Manager of Desert Sun speaking to the group.

The producer of the TV show "Intervention"  speaking, with Eric the CEO of Intervention911.

The producer of the TV show “Intervention” speaking, with Eric the CEO of Intervention911.

Workshop attendees having fun.

Workshop attendees having fun.

 

Deaths Related To Molly Continue To Increase

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Molly Deaths

The club drug Molly, which is a street name for a drug called MDMA, has been linked to an increasing number of deaths recently. This is very troubling for a number of reasons, not least of which is the fact that many of the deaths related to the designer drug are occurring within teens and young adults. These tragic instances have left many parents and concerned friends wondering exactly what Molly is and why it has risen to popularity as of late.

MDMA in the United States

Although MDMA has been used in the United States since the 1970’s, when some therapists thought that it may have some psychopharmaceutical benefits for disorders like Post Traumatic Stress Disorder, the drug rose to popularity as a recreational drug in the 1990’s with the arrival of rave culture, a social phenomenon borrowed from Europe.

As MDMA became popular at rave events, it often showed up in the form of a drug called ecstasy, which was generally a pressed pill that often combined MDMA and a wide variety of other drugs, which included methamphetamines, heroin, and hallucinogenic drugs like LSD. Perhaps because these pills varied quite a bit from one to another and often carried with them very severe side effects, they lost popularity and have now been replaced by Molly, which is a powdered version of MDMA that is often snorted or put into capsules.

The Safer Ecstasy?

As Molly became more and more popular, many people began to tout it as a safe alternative to Ecstasy. This dangerous misconception may be the reason that Molly grew in popularity and that a broader group of people began using the drug. In fact, Molly is no safer than any other form of this very toxic substance. It carries with it very severe health risks, and can be deadly.

The idea that Molly is safer because it is “pure” is misleading for a few reasons. Firstly, there is no way of knowing exactly what a street drug like Molly is comprised of. The powdered version of MDMA can be cut with a number of substances, including very strong stimulants like crystal meth or cocaine. Secondly, even if Molly is comprised of only MDMA, it still carries very serious risks. Using Molly can result in death or serious injury from seizure, stroke, overheating, and overdose.

Molly and Raves

Perhaps one of the reason that makes this dangerous drug so pernicious is the fact that it is generally used by people at electronic music festivals or raves. Both raves and MDMA entered the social conscious in the United States around the same time, and for many people, the two go hand in hand. The rise in deaths from this drug may very well be attributed to the rise in popularity of electronic music festivals. These festivals are a terrible place to take an already dangerous drug.

One of the ways that the drug can become fatal is by causing a person to overheat. This is a risk any time Molly is consumed, but this risk is certainly compounded by the environment at raves. Most raves are attended by very large groups of people who very often dance extremely close together in very confined spaces, even if the festival occurs in the middle of a very hot day in the summer in a region of the country that has humid summers, as was the case in the tragic deaths of two teens at the Electronic Zoo Festival in New York last summer. To make matters worse, many rave attendees dance for very long periods of time, which only heightens their risk for a deadly overheating episode.

Electronic Music Festival Cancelled Because Of Drug Deaths

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Electronic Zoo MDMA Deaths

One of the country’s top electronic music festivals, Electric Zoo, recently cancelled its third day of programming after two concert goers who attended the first two days of the concert died due to what appear to be drug related issues. Four other concert goers are also currently being hospitalized and are in serious condition after using drugs at the festival. The decision to cancel the last day of the festival was made by the event’s producer, Made Event, in conjunction with the New York City Parks Department. Festival passes, which carried a relatively hefty fee at $179.00 a day will be refunded to ticket holders who were intending on attending the last day of the festival.

MDMA

The drug that seems to be responsible for the deaths and injuries at the festival seems to be MDMA, which is often known by its street name Ecstasy. MDMA was developed in Europe at the turn of the century and was popularized in the United States in the 1970’s by experimental psychiatrists and therapists who initially used the drug in an attempt to help patients find answers about themselves and their relationships.

It was soon found, however, that MDMA was not in fact the constructive tool that therapists initially believed it to be. The drug was found to have serious risks associated with it, including dehydration, overheating, and heat stroke. Even attempts to avoid overheating and dehydration can be fatal when a person is under the influence of MDMA, as the drug can cause the body to retain water, and injuries caused by excessive water intake can be fatal.

Drugs and Electronic Music

The drug Ecstasy has long been associated with the electronic music scene. The Electric Zoo is not the site of the first MDMA related fatalities. Over the last decade, there have been a number of drug related deaths at electronic music parties, often referred to as raves. At an electronic music festival called the Electric Daisy concert in Las Vegas, Nevada in 2010, a fifteen year old girl died of an apparent overdose. The drug is popular among young people and electronic music concert goers in particular because it alters the way a person experiences music and may compel them to spend all night dancing.

Drugs can be particularly dangerous in the context of a large concert or festival because due to the nature of the event, it can be difficult to notice in a large crowd when someone is exhibiting signs of overdose or heat stroke. Young people are often unsupervised at these events, and extremely large crowds of people are difficult for security to monitor effectively. Most venues and producers do make an effort to curtail drug use at their events. Drugs are prohibited, and there is generally signage outside of events reminding concert goers of this. Security checks are also par for the course at most large venues.

What Can Be Done?

As Ecstasy deaths and injuries continue to occur in growing numbers, parents and government officials are searching for ways to stop the spread of this dangerous drug. Some cities have banned raves altogether, and there is currently legislation being drafted in California that would make raves illegal throughout the entire state. While this could potentially reduce MDMA related fatalities, laws like this may also be met with opposition, as many concert goers legitimately attend concerts for the music and do not abuse drugs.

The most effective way of reducing Ecstasy injuries may lie in parents educating their teens about the dangers of MDMA and in young adults to make wise decisions about the way in which they enjoy a concert.

MDMA Intervention

Lamar Odom Receives Third Drug Intervention

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Lamar Odom Intervention

Life in the public eye is not easy for many people: the pressure of fame, a demanding career, and the discomfort of being in the public eye can be incredibly waring. For a person who struggles with addiction, these pressures can be particularly stressful and dangerous. This seems to be the case for Lamar Odom, famed basketball player and husband of Khloe Kardashian. Recently, Odom went missing for several days after his friends and loved ones attempted a third intervention with him.

Long Time Friends Came Together For Support

Many of Odom’s childhood friends became extremely worried about him as he spiraled further and further into addiction. A number of them traveled from New York to talk to Lamar about his addiction. The friends, some of whom are much less affluent than Odom, apparently literally knocked on his door and begged him to come home and get clean. Odom was not receptive to their efforts and responded with anger to his old friends, telling them to go away. When his friends finally were able to see Lamar in person, they learned that the successful star was freebasing cocaine.

Khloe’s Attempts to Help

Odom’s wife, Khloe, has been publicly distraught as she’s attempted to help her husband get clean. Kardashian and her family successfully helped Lamar seek help for his oxycontin addiction last August. Lamar did stay in treatment for a few weeks but relapsed back into addiction shortly after leaving. In addition to trying to help him work through his substance abuse issues, Khloe has attempted several times to stop the affairs Lamar has been engaging in. The couple has spent time in therapy, where they’ve attempted to help strengthen their troubled relationship and identify some of the issues that are leading Odom to use and commit adultery.

Teammates Have Also Tried to Help

Odom’s former teammates on the Los Angeles Lakers and current teammates on the Los Angeles Clippers have also expressed concern for the talented player. Many of them banded together for an intervention with Lamar just around a month ago. Members from both teams talked to Lamar about, among other things, the way his addiction was impacting his career. The discussions went on for a few hours, until Odom apparently abruptly left the site of the intervention.

A Family History of Addiction

Like many addicts, Lamar is at a higher risk for addiction because his father, Joe Odom, is himself a recovering heroin addict. Lamar has had a rocky relationship with his father and has expressed several times that he has serious fears about becoming an addict like him.

Sources do report, however, that Odom has entered a rehab facility, and many people suspect that if he has made the decision to receive the treatment he needs, it may be because his father talked him into entering treatment. While the rich and powerful colleagues and married family he is surrounded with have all attempted to get through to Lamar, it is possible that his father, who knows first hand about struggling with addiction, and whose life story has had such a huge impact on Lamar may be the only person who can get through to him.

Hope For Lamar

It seems clear that Odom has a strong support system around him. His wife, in-laws, immediate family, and teammates are all trying to help him in the best way that they can. By entering treatment, Lamar has made an important step in working towards a much better life. He will certainly need love and support after he leaves treatment and uses the tools he used to stay clean, and hopefully he will be ready to accept that from those he loves.

Lamar Odom Crack Addiction