CVS is selling Narcan in Rhode Island

NARCAN-KITHere’s an interesting development in access to Narcan:

CVS Pharmacy announced that it would offer the opiate antidote Narcan without a prescription at all of its 60 pharmacies in Rhode Island by the end of month.

Narcan, also known as naloxone, offers immediate help for anyone overdosing from an opiate such as heroin or a prescription painkiller such as OxyContin. If given in time, Narcan can reverse an overdose by restoring breathing.

“Over half of our pharmacies are now under a collaborative agreement that allows them to dispense Narcan without a prescription,” CVS spokesman Michael DeAngelis said Friday. “It’s part of our commitment to combat prescription drug abuse. We think it’s a great public service.”

Read the rest here.

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Young people’s experiences of 12 step groups

Students on Campus 6DJ Mac highlights a recent study of 302 18-24 year olds entering residential treatment and their opinions of 12 step groups. The study also included follow-up at 3, 6 and 9 months.

He pulls a few quotes from the paper and one, in particular, leapt out to me.

Clinicians can highlight that 12-step specific content was rarely cited as a reason for discontinuing 12-step attendance among young adults.

He also summarized their findings:

What was most helpful?
  • Removing a sense of isolation
  • Validating experiences
  • A sense of belonging, acceptance and validation
  • Installation of hope (being inspired/encouraged by another member who has a similar problem).
  • Altruism (members help and support each other).

12-step specific responses were rare leading the authors to conclude that ‘general group therapy factors were more important to these young adults in early recovery/post-treatment.’

What did they like least?
  • Meeting structure (length, repetition)
  • Having to motivate oneself to get there

Interestingly, less than 1% of young people found meetings unhelpful.

Why did they stop going?
  • Logistical barriers (e.g. lack of transport)
  • Low recovery motivation and interest
Why did some never attend?
  • Didn’t need treatment
  • Don’t have a problem

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contradictory, pointless, bearing very little relationship to reality

sad girl by .indigo

sad girl by .indigo

On the heels of Robin Williams’ death, some writers are sharing their experiences with depression.

The theme I find interesting are the themes around sufferer’s thoughts and beliefs. Therapists almost universally discuss cognitive distortions. I’ve been wondering if, in the case of very severe depression, framing these thoughts as distortions fails to capture the power of these thoughts and beliefs.

“Cognitive distortions” implies that a person is taking something real and selecting the negative, framing things in a negative light or intensifying the negative aspects/possibilities.

These are more like delusions that are firmly maintained with very little relationship to reality.

First, John Tabin:

To me a lot of the thinking in severe depression is more like a delusional system than distortions. They are not grounded in reality. When you’re that depressed, others seem blind and deluded–you’re the only one who sees things as they really are.

Depression is a skilled liar, using what you know is true as basis for a massive fraud. You know you’ll always be wrestling with your demons, and depression convinces you that you’ll always be in as much pain as you are right now. The kind of pain that’s so unbearable that you’d die to end it is not a permanent part of your life, no matter how much it feels that way.

Next, David Weigel:

If I’d imagined a dream job, it’d likely be the one I have now. But success doesn’t change the patterns of depression. These are the ways it hits me:

One: You earned none of what you have. You’re a fraud. People are going to find out. Everything your critics have said about you, from the guy who lobbed dodgeballs at your head to the hate-mailer who hated your Iowa story, is completely right.

Two: All that other stuff you feel, the negativity and the screw-ups? You definitely earned that, because you’re meant to fail. You’ve succeeded, and you still feel this way? Why, that’s proof that you won’t possibly feel better.

Three: Nobody truly likes you. They can desert you at any moment. They’re succeeding, and you’re not.

It’s contradictory, and pointless, and bears very little relationship to the reality of what you’re going through.

(hat tip: Elizabeth Nolan Brown)

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a beautiful life


Matt Schwartz. Kelley’s brother. My cousin. Great guy.

401962_10201206616432978_317921181_nAward winning author and editor (Also, a cousin of mine.) Kelley Clink shares an interesting insight about the effects of suicide on those left behind and on the victim’s legacy. [emphasis mine]

Here’s the thing about suicide: it can seep backward and stain an entire life. For years after my brother’s suicide, I could only think about him in terms of his death. Any moment of joy or happiness was called into question. He’d suffered so deeply for so long–had any of the pleasure in life he’d expressed been real?

It took a very, very long time for that stain to fade. For me to allow my brother’s life to be about more than his death. He, like Mr. Williams, made people laugh. He comforted. He celebrated. He loved.

But, she does offer hope.

Some people may be angry. Some people may judge. I think most people will just feel sadness, and hopefully compassion. Eventually the stain will fade, and we will be left with his beautiful life.

Kelley’s memoir will be published next May.


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High prevalence of opioid use by social security disability recipients

Proportion of the disabled Medicare beneficiaries under the age of 65 filling 6 or more opioid prescriptions by Hospital Referral Region. There are large regional variations. Credit: Image courtesy of Wolters Kluwer Health: Lippincott Williams and Wilkins

Proportion of the disabled Medicare beneficiaries under the age of 65 filling 6 or more opioid prescriptions by Hospital Referral Region. There are large regional variations.
Credit: Image courtesy of Wolters Kluwer Health: Lippincott Williams and Wilkins

A recent study finds that 43.7% of disability recipients are taking prescription opioids. Many are on very high doses.

The researchers analyzed trends in use of prescription opioids (morphine-related drugs) among disabled Medicare beneficiaries under age 65 between 2007 and 2011. Nearly all under-65 Medicare beneficiaries are SSDI recipients; patients who go on SSDI are eligible for Medicare after two years.

Consistent with reports of an “opioid epidemic” in the United States, the results showed high and rising prevalence of opioid use by SSDI recipients. The percentage of beneficiaries taking opioids increased from 2007 through 2010. In 2011, the most recent year with available data, prevalence dipped slightly to 43.7 percent.

The percentage of these beneficiaries with chronic opioid use rose steadily, from 21.4 percent in 2007 to 23.1 percent in 2011. Chronic opioid users received numerous opioid prescriptions — at least six and generally 13 per year — typically prescribed by multiple doctors. Women were at greater risk of becoming chronic opioid users than men.

Among chronic opioid users, the average “morphine equivalent dose” (MED) also dipped in 2011. Still, nearly 20 percent of chronic users were taking a dose of at least 100 milligrams MED, while ten percent were taking 200 milligrams. “Opioid use of this intensity has been associated with risk of overdose death in the general US population and more specifically in disabled workers,” Dr Morden and colleagues write.

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Recovery spaces and the adjacent possible

DJ Mac recently picked up on Bill White’s post on the need to create and protect recovery spaces, given current trends toward legalization.

He followed up by sharing another blogger’s reaction to Bill’s post.

White asserts that “any policy discussions of marijuana legalization should include the voices of people in recovery and should include a serious discussion about recovery space. Such space must be protected regardless of the future legal status of psychoactive drugs.” I have a great deal of respect for Bill White; but I disagree strongly with this line of reasoning. I submit that in an atmosphere of true destigmatization of addiction and recovery, the identification or designation of “recovery space” becomes unnecessary and, in fact, perpetuates the stigma that we are working so hard to shed.

. . .

The world will never be recovery-friendly; but to ask our communities and legislators to be sensitive to recovery space perpetuates the misconception that people in recovery are passive victims, hopelessly susceptible to environmental cues and in need of sheltering. In this context, people in recovery will never achieve full empowerment.

All of this seems like a bit of a straw man. I re-read Bill’s piece and I’m not picking up on any anti-drug or pro-prohibition message.

Look at alcohol.

  • We regulate advertising.
  • We control outlet density through limiting the number of liquor licenses.
  • We say it can’t be consumed in certain places–schools (except Ann Arbor Pioneer on U-M game days) and many parks, for example.
  • We have open container laws.
  • We impose some responsibilities on servers.
  • We have age limits on purchasing.
  • We have age restrictions on many events where it’s served. (All-ages shows can’t serve alcohol.)

We impose all of these regulations/restrictions (and more), and alcohol is still a celebrated and freely consumed drug.

I hear Bill saying that recovery is worth protecting in the same way that schools, churches, hospitals, community centers, etc, are worth protecting.

One can disagree with Bill on this, but I think we all could agree that some people live in recovery-hostile areas where there are no visible examples of recovery and that this inhibits people finding recovery. Isn’t in our community interest to address that? Isn’t in our public health interest to do something about that?

It’s not about creating a bubble.

How is hope to be kindled if there’s no visible living proof of recovery? This reminded me of another post from a couple of years back on “the adjacent possible”.

I discussed a guy who wrote a book and gave a TED talk on the topic.

During an interview he discussed the concept of the adjacent possible and it’s importance in forming new ideas. During the interview, he described it as the building blocks of new ideas. Without the right building blocks, any innovation is not possible. He described it another way in a WSJ article:

The adjacent possible is a kind of shadow future, hovering on the edges of the present state of things, a map of all the ways in which the present can reinvent itself.

The strange and beautiful truth about the adjacent possible is that its boundaries grow as you explore them. Each new combination opens up the possibility of other new combinations. Think of it as a house that magically expands with each door you open. You begin in a room with four doors, each leading to a new room that you haven’t visited yet. Once you open one of those doors and stroll into that room, three new doors appear, each leading to a brand-new room that you couldn’t have reached from your original starting point. Keep opening new doors and eventually you’ll have built a palace.

During the interview, he pointed out that it doesn’t matter how smart one is, it was not possible to invent a microwave in 1650, because the building blocks, the adjacent possible, just wasn’t there.

One factor is that the physical building blocks did not exist. The other factor is that the imaginative/inspiration building blocks did not exist.

This reminded me of a metaphor Bill has used when talking about hope-engendering relationships offering kindling for hope.

So, back to our critic. I admire his bootstrapping spirit, but, like I said earlier, he seemed to be arguing with a straw man and he seemed self-contradictory at times. In one paragraph, regulation is good,

. . . the legalization of marijuana is not about making it more accessible. Marijuana has always been more accessible to those under the legal drinking age than alcohol; which suggests that regulation will actually reduce its availability.

In another, regulation is bad,

Recovery space will not be achieved through restriction or regulation of those who can enjoy the recreational use of substances, legal or otherwise.

It seems that what he really wanted was a debate about legalization, which is a fine thing to debate. He just picked a piece that, rather than arguing against legalization, was suggesting that we be mindful enough to mitigate a potential pitfall of legalization.

UPDATE: The author of the original piece, Adam Sledd, sent the following comment directly to me because comments are now closed:

“Thanks for the thoughtful discussion. Sorry I am late, I just discovered this thread. Dirk Hanson has captured the spirit of my argument with his “hothouse flowers” analogy. I have a background in special education and disabilities, so I am sensitive to over-accomodation and its contribution to stigma. Of course there will be recovery space, and I am all for it. When this is mentioned in the context of marijuana legalization, I think we need to be mindful of the message we send in the name of recovery.”


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Suicide and aloneness

alone by Lst1984

alone by Lst1984

I’m not the type to get into speculation about the circumstances around Robin Williams’ suicide–his recovery, his mental health diagnosis, the care he received, etc. However, I read a few pieces that picked up on a theme of aloneness in suicide.

From the New Yorker [emphasis mine]:

Robin Williams’s suicide was not the self-indulgent act of someone without enough fortitude to fight back against his own demons; it was, rather, an act of despair committed by someone who KNEW, rightly or wrongly, that such a fight could never be won.

. . .

Suicide is a crime of loneliness, and adulated people can be frighteningly alone.


By now you’ve figured out what the three groups have in common; they are alone. It may not look that way to you, but that’s how it feels to them. It’s not the fault of their family or friends. It’s nothing that anyone is doing wrong.

From Jennifer Matesa, mulling over the coroner’s report:

And here’s the thing. He wasn’t found by his wife. He was found by his personal assistant. The employee knocked on the door at 11:45 a.m., more than 12 hours after Williams’s wife had last seen her husband, and couldn’t raise his boss. So the assistant went into the room, the assistant found the body.

I’m thinking about this report in this way because I think a lot these days about the commonalities of people who are suffering for various reasons. If Williams died in this supremely lonely way, then you can bet there are hundreds, thousands of others who have died this way

All of this brings to mind David Foster Wallace’s 2005 commencement speech from Kenyon College [emphasis mine]:

And I submit that this is what the real, no bullshit value of your liberal arts education is supposed to be about: how to keep from going through your comfortable, prosperous, respectable adult life dead, unconscious, a slave to your head and to your natural default setting of being uniquely, completely, imperially alone day in and day out.

. . .

And the so-called real world will not discourage you from operating on your default settings, because the so-called real world of men and money and power hums merrily along in a pool of fear and anger and frustration and craving and worship of self. Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom all to be lords of our tiny skull-sized kingdoms, alone at the center of all creation.

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