James P. Freeman:Tuesdays are big opioid-overdose days on the Cape

The news this past Aug. 22, a Tuesday, seemed promising. The Massachusetts Department of Public Health released its quarterly report showing a 5 percent decline in opioid-related deaths in the first half of 2017 compared with the like period last year (978 deaths, as opposed to 1,031 deaths; January to June). The statistics led The Boston Globe to conclude this was “the strongest indication to date that the state’s overdose crisis might have started to abate.”

But the news was a tantalizing chimera. The Barnstable police already knew. August was cruel.

With overwhelming preponderance and without overlooking prejudice, the opioid crisis still rages unabated in Massachusetts. Especially on Cape Cod.

Figures provided by the Barnstable Police Department, the largest police force on the Cape, reveal a massive spike in opioid overdoses this past August compared with August 2016 (41 overdoses this year as opposed to 8 overdoses last year). Through the end of September, opioid-related overdoses in Barnstable, which at about 45,000 people is the largest town on the Cape, stood at 148. During the like period last year that number was 82.

Overdoses for the combined two months of August and September (61) were the highest for back-to-back months since January and February 2015 (51), when the Barnstable police first began keeping opioid-specific records. That’s when things seemed really bad. In many ways, now they’re worse.

Except for May, every month this year in Barnstable has seen an increase in overdoses compared to corresponding months in 2016. Already, there have been more overdoses in just nine months of 2017 than during all of 2016. And if current trends continue — nothing suggests that they won’t — this year will see more overdoses than in 2015, the year many thought was the high-water mark.

The death rate on the Cape isn’t encouraging, either. It is rising, not declining. Barnstable police report that 19 people have died due to overdoses through Oct.  10 of this year. In the like period, just nine people died through the end of October 2016. It is nearly certain that, beginning with respective Januarys, more lives will be lost by the end of October 2017 than were lost by October 2015 and October 2016, combined. This is progress in reverse.

Officer Eric W. Drifmeyer oversees the Research and Analysis Unit of the Barnstable Police Department. He is a busy man. Before 2015, the department, like many Massachusetts law-enforcement agencies, did not have adequate reporting mechanisms to track and maintain useful information relating to opioid-specific activity. In the past, Drifmeyer says, any data collected were categorized as generic “medical events.” But as the opioid crisis escalated — it is estimated that 85 percent of crimes on Cape Cod are opiate-related — the need for more accurate crime data increased, too.

So Drifmeyer and his colleagues built their own database.

Data-driven information provides police with intelligence. With superior intelligence trends become apparent — such as populations at risk in an opioid crisis. Here, that means young adults who are prone to abusing opioids. In Barnstable — an area of 76 square miles comprising seven villages of affluence and affliction — overdoses in 2017 disproportionately affect white males ages 20-29 and 30-39, far more than any other demographic group. Barnstable police statistics show that men are overdosing at nearly twice the rate of women. And for females, white women ages 20-29 and 30-39 show the highest levels of overdose in 2017. These have been trend lines for years.

A superior database of historical information doesn’t just reveal trends. Consistent trends become accurate predictors of criminal activity. Drifmeyer notes that a spike in overdoses correlates directly with an immediate surge in crimes, such as shoplifting and car and house break-ins. Accordingly, proceeds from illicit sales of ill-gotten goods finance the next purchase of heroin and other opioids on the street. And the cycle repeats itself. From this learning curve emerges better policing — devising effective strategies, dispatching efficacious resources, and thwarting criminal behavior.

Every day on Cape Cod, in a sad ritual, somewhere, someone is rolling up a sleeve, readying an arm for a taut elastic rubber tourniquet, anticipating the needle chill about to puncture a warm vein for perhaps the last sensationally euphoric high.

Tap. Tap. Tap …

Naloxone, the powerful opioid antidote, popularly known as Narcan, reverses the effects of overdose. Its widespread and immediate administration by first responders on those suspected of overdosing is probably the reason that the death rate has declined slightly this year in Massachusetts. Police in Barnstable have revived many people. Of the 148 officially designated overdoses this year, police have administered Narcan 46 times individually and another 25 times with assistance from a third party, such as a firefighter-emergency medical technician. In the short term Narcan saves lives. But Narcan solves nothing.

Stunningly, many addicts today have Narcan present while they are using, says Drifmeyer. Employing what one detective said was a “buddy system,” Narcan is administered by the corresponding partner in the event of overdose by the user. It is a bizarre insurance policy against a bad batch of drugs in this high-stakes risk/reward game; much heroin is now laced with the powerful additive fentanyl (itself a synthetic opiate), 50-100 times more powerful than morphine and 30-50 times more powerful than heroin itself.

Today, Barnstable police cruisers are stocked with two 4-milligram doses of Narcan. Not long ago it was 2-milligram doses. Those lower doses were not effective at neutralizing higher concentrations of fentanyl increasingly found in heroin.

First responders are also at risk from exposure to just small quantities of fentanyl. It is so dangerous, in fact, that police and paramedics can effectively “accidently overdose” if they come into contact with only a bit of the drug. Today, Barnstable police dog units now carry Narcan because service dogs sometimes accidentally overdose, too, by inhaling fentanyl into their nasal passages or absorbing in into their paws while working a case. This unimaginable collateral damage is the newest alarming phenomenon in what PresidentTrump in August rightly called a “national emergency.”      

Last decade, the most covered story in The Cape Cod Times, the largest paper on the Cape, was the controversial off-shore wind farm proposed for Nantucket Sound known as “Cape Wind.” By the end of this decade, depressingly, the opioid matter will likely be the top story. Since 2000, nearly 400 people have died on the Cape and Islands due to some form of opioid overdose. With crashing regularity, stories appear on a near-daily basis, one falling into the other, like cascading dominoes.

Click. Click. Click …

In the last month, these stories received front-page treatment:  Oct. 7, “Construction Workers Hard Hit by Opioid Addiction”; Oct.  4, “Study at McLean Hospital Reveals Marijuana’s Benefits in Lowering Opioid Usage”; Sept. 22, “Judge:  Drug Dealing Merits Homicide-Level Bail”; Sept. 17, “Addiction Experts Warn of Detox Dangers”; and Sept. 12, “Drop-In Night New Option for Drug Users.”

Obituaries in the paper are sad narratives of dying youth. They are all too frequent. Last year, 82 people on the Cape and Islands died because of opioid overdose. (Barnstable County ranked third statewide for fatal overdose rates in 2015 and 2016.) And all too often these announcements contain no cause of death, wrongly stating the deceased died “peacefully” or “quietly.” One was named Arianna Sheedy. She was 23 and a mother of two when she fatally overdosed on Feb.  16, 2015, one of seven who died of similar causes on Cape Cod that month.

Sheedy was featured in the 2015 HBO film Heroin:  Cape Cod, USA. The documentary portrays the day-to-day lives of eight young addicts. It is equally haunting and horrifying and must-viewing for anyone — everyone! — intent on understanding the mindset of people completely consumed emotionally, psychologically, and physically by this kind of addiction. (The film will be rebroadcast on HBO2 on Wednesday, Oct. 18.)

There are many memorable vignettes but one stands out. Opioid nirvana, one participant said, “felt like Christmas morning every time I shot up. Who wants to give that up?” Sheedy and another addict, Marissa, died before filming was finished. The film is dedicated to their memory.

Among the intriguing statistics in the Barnstable police database are 2017 overdoses by day-of-the-week. Surprisingly, Tuesdays rank second-highest, only slightly below Fridays. As Drifmeyer dryly concedes, heroin “is not a recreational drug,” so weekdays are just as active as weekends. (Heroin is a retail business; perhaps even big deliveries slow on Sundays.) Still, why Tuesdays figure so prominently is puzzling to police. But as time and statistics accumulate, it is likely that mystery will be solved by their unsung and noble work.

Most of the heroin on Cape Cod arrives from Fall River and New Bedford, transported along the I-195 corridor, what is considered a local Heroin Highway. Every day, anonymous lives, hopes and dreams travel that lonesome road. Until something desperately changes, they are slowly passing …

Gone. Gone. Gone.  

James P. Freeman is a New England-based writer and former columnist with The Cape Cod Times.  This piece first ran in the New Boston Post. Besides that outlet and newenglanddiary.com, his work has also appeared in The Providence Journal and nationalreview.com.

Sarah Anderson: Past time to go after the opioid-epidemic profiteers

Via OtherWords.org

Travis Bornstein never told his friends about his son Tyler’s drug problem. He was too embarrassed.

Then, on September 28, 2014, Tyler’s body was found in a vacant lot in Akron, Ohio. The 23-year-old had become addicted to opioid pain killers after several sports-related injuries and surgeries. Unable to afford long-term treatment, he ultimately turned to a cheaper drug — the heroin that killed him.

“Now I have no choice but to speak out,” the elder Bornstein, president of Teamsters Local 24 in Akron, told a crowd of thousands at the union’s convention in 2016. As he shared the unvarnished tale of how a middle-class, star athlete wound up in that vacant lot, Bornstein lit a fire under the 1.4-million-member organization.

The Teamsters pledged $1.4 million for a nonprofit organization the Bornstein family set up to expand treatment for addicts in Ohio. They’re also going after the drug industry CEOs who’ve been profiting off a national opioid problem of epidemic proportions.

According to the Centers for Disease Control, the number of overdose deaths involving opioids (including prescription drugs and heroin) has quadrupled since 1999. In 2015, opioid deaths in the United States hit a record-breaking 33,000.

The labor union is targeting the three largest U.S. prescription-drug wholesalers — McKesson, Cardinal Health, and AmerisourceBergen — for flooding hard-hit areas with the highly addictive pills.

Between 2008 and 2012, for example, these companies shipped 780 million hydrocodone and oxycodone opioid doses to West Virginia — 433 for every man, woman, and child in the state. During that time period, 1,728 people in the state overdosed on the painkillers.

The companies deny any wrongdoing, pointing the finger instead at corrupt doctors and pharmacists who sell pills directly to addicts and dealers. But as West Virginia Governor Earl Ray Tomblin recently told the Charleston Gazette-Mail, “Obviously, they had to know, with a state this size, and that many pills coming in, that something wasn’t right.”

The Teamsters are using their clout as pension fund investors to demand that drug wholesalers take responsibility for their role in the epidemic, conduct full investigations of their distribution practices, and hold CEOs accountable.

At AmerisourceBergen, for example, CEO Steven Collis hasn’t coughed up a penny of the tens of millions of dollars he pocketed as the firm was reaping opioid windfalls — even though the company has paid $16 million to settle a West Virginia case over their negligence.

The Teamsters are demanding that some of the CEO’s pay be “clawed back,” in the same way that Wells Fargo executives involved in last year’s bogus account scandal had to forfeit some of their compensation.

They’ve made similar demands on McKesson, where CEO John Hammergren’s compensation has amounted to an astounding $368 million over the past five years.

Part of the problem with accountability at McKesson, according to the Teamsters, is the fact that Hammergren serves as both CEO and chairman of the company. The union is filing a shareholder resolution urging the board to appoint an independent chair.

Meanwhile, Travis Bornstein is continuing to speak out, telling his son Tyler’s tragic story to students, policymakers, and others as he works to expand the availability of drug treatment for communities ravaged by the opioid crisis.

Since Tyler’s death, he’s learned that opioid addiction isn’t a moral failure, but rather a disease, like cancer or diabetes. “Now my son is my hero for everything he was able to accomplish with such a gut-wrenching disease,” Bornstein said. “I was the fool.”

Sarah Anderson directs the Global Economy Project at the Institute for Policy Studies and co-edits Inequality.org. 

An island for opioid treament

Penikese Island from the southeast.

Excerpted from Robert Whitcomb's Dec. 1 Digital Diary column in GoLocal24.

Tiny Penikese Island, off  southwestern Cape Cod and part of the Elizabeth Islands, has been turned into a beautiful if austere retreat for the treatment of opioid addiction, a staggering problem all over America. You can blame the addiction epidemic, in part, on pharmaceutical companies and their salespeople asserting that such newish opiates as OxyContin were not dangerously addictive and were needed to address an alleged American “pain crisis."

In the past, Penikese has hosted a leper colony, a school for troubled boys and a bird sanctuary. Its latest use is admirable, though, it should be emphasized, the facility can only take a few clients at a time – at this point only young men.

There must be some other New England islands that would serve as places where addicts can confront and overcome their demons with the help of tough but compassionate therapists and without the temptation, followed all too often by quick relapse, they’d have on a mainland. It’s hard to avoid the mindfulness and perspective you gain in such a quiet, if windy place. Not that you’d want to spend the rest of your life there.

James P. Freeman: State representative a brilliant warrior against the opioid crisis

Massachusetts state Rep. Randy Hunt was casually flippant — but with an intentionally serious undertone — when he imagined the day when constituents would call him complaining that they “can’t find any heroin anymore.”

Given the still-raging opioid crisis in the Commonwealth, that call will take time arriving as four people die every day of overdose here. But Hunt (R.-Sandwich), who sits on the Joint Committee on Mental Health and Substance Abuse and recognized as one of the state’s top thinkers on this crisis, is still hopeful that that day will indeed arrive.

Today, every community in Massachusetts is fighting a two-front war involving illegal street heroin (the contents of which are largely unknown to both dealer and user), and legally prescribed — and highly addictive — medications (oxycodone, hydrocodone and methadone). Both fronts of chemical cousins have collided, forming a complicated battle line which is forcing elected officials to devise new means of productive combat.

Hunt realizes that this also is a public-policy crisis, involving addiction, criminal justice, immigration, a maze of public entities not normally known for successfully collaborating and patience (see Special Commission on Substance Addiction Treatment in the Criminal Justice System). In 2014, he was instrumental in passing ASSIST Act (creating a path for formulating long-term strategies). HisWeb site  is must-reading for those interested in information, not just data on the subject matter. Much of his public service is dedicated to seeking solutions to this man-made epidemic.

Sitting comfortably in his office and appropriately dressed for a typically humid August day, Hunt was stoically reflective on why he has taken such a zealous interest. He said that “the opiate epidemic was going to be one of the biggest problems we would be facing,” after reading the work done by the OxyContin and Heroin Commission, during the 2009-2010 legislative session, just before he was elected to the House of Representatives.

Shortly after joining the legislature, he determined that “very few of my colleagues had any appreciation of the scope of the problem.” Today they do. Awareness, seemingly, is no longer an issue. But action, what kind of action, and specifically, efficacious action, is another matter.

Last year, the governor — who consulted with Hunt about the crisis during the 2014 gubernatorial election — commissioned the Governor’s Opioid Working Group (GOWG). This past March, a landmark bill limiting certain prescriptions on opioids was signed into law. Progress was made for those seeking treatment for addiction, requiring weeks of treatment without pre-authorization, a recognition of the critical need for immediate assistance. Over the course of the last year, more than two-thirds of the 65 recommendations made by GOWG have been implemented. And work continues on prevention, education and early interdiction.

But the statistics are a staggering stampede of defiance.

The year Hunt was elected, in 2010, the Commonwealth reported just 526 opioid-related deaths. Last year, that figure rose to 1,531 deaths and, incredibly, 221 of the 351 towns and cities in the state reported at least one overdose death in 2015. Hunt had hoped that 2015 would have been the “high water mark” for these grim figures but already the deaths for the first half of 2016 are estimated to be higher than those for the first half of 2015. “Policy,” he reasons, “takes time to filter” through the system. And annual appropriations may be short-term fixes for a problem demanding long-term oversight. So he is looking for ways for the state to make commitments in 10-year blocs.

Hunt is as rare as a longhorn in a cranberry bog.

He hails from the dust of El-Paso, Texas, not the dunes of Cape Cod. He is an accountant by profession, not a lawyer or career politician. He is a three-term incumbent Republican in a House controlled 80 percent by Democrats, and yet he is running unopposed in this year’s general election. And his perfect voting record was interrupted this past session only because he served jury duty (having “dropped to 99.11 percent,” as only a CPA could describe it).

Best described as a low-key personality, Hunt nonetheless radiates analytics like a prairie fire, no doubt the burning residue from the exacting science of accountancy; since he applies an outcomes-based approach to solving problems, he is not interested in the vauntingly ambitious or the vaguely ambiguous. Therefore, his method at creating and shifting public policy is markedly different than those of most public officials.

He looks at the supply-demand equation of addiction, where he calls street heroin an “economic rescue,” as it sells far cheaper than pills, when addicts run out of resources and alternatives. But today’s heroin is often laced with an even more powerful additive, fentanyl (that combination was responsible for half of the deaths in 2015). Now, there are legitimate fears that heroin infused with carfentanil, known as an elephant tranquilizer (10,000 times more powerful than morphine), will soon be hitting Massachusetts streets, as it has already in other drug ravaged states.

He wonders if legalizing recreational marijuana is a “gateway behavior” rather than a “gateway drug.” And he is already preparing for the likelihood of the marijuana ballot measure passing this November. If so, does creating a state-chartered bank solve many secondary issues associated with its passage, such as accounting for these new “revenues”?

While Hunt appreciates the emotional and spiritual toll on addicts and their families, he is mindful that solutions will arrive based upon cold metrics — the process of measuring what works, identifying trends that may emerge from using the same tools that yield different results or directions. Accordingly, he is encouraged by the conclusions reached in a recent study of Falmouth High School students, the 2015 Communities That Care Youth Survey. Administered over an eight-year period, it charts a dramatic reduction in drug and alcohol use by students and suggests prevention methods are working.

This simple but powerful indicator gives Hunt hope that someday he will get that phone call about no more heroin.

James P. Freeman is a New England based political writer. This piece first ran in The New Boston Post.