Update 9/28/2016. FULL 911 Good Samaritan Legislation in Michigan

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Great news!!

Both 911 Good Samaritan Bills have made it to the governor’s desk and are expected to be signed.

Take a minute to let the Governor Snyder know this is important to you.

While you’re at it, thank Rep. Sam Singh and Rep. Al Pscholka for their efforts on this issue.

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(The rest of this post was originally posted 5/12/2016. It is provided here for background.)

Good news!!!

There are 2 bills in the Michigan House of Representatives Criminal Justice Committee that would would provide immunity from criminal charges for people all ages who are seeking emergency medical assistance for themselves or friends as a result of a drug overdose from any illicit drug.

Rep. Pscholka’s bill, House Bill 5649, provides immunity from possession penalties in certain circumstances.

Rep. Singh’s bill, House Bill 5650, provides immunity from use penalties in certain circumstances.

These bills expand upon last years House Bill 4843 by removing limitations based on age and type of drug.

The House Criminal Justice Committee will be taking up these bills on Tuesday, May 17, 2016 at 9:00 AM in Room 327, House Office Building, Lansing, MI.

Contact the House Criminal Justice Committee to let them know you support these bills.

Background

The Facts

Keep these facts in mind:

  • Overdose is now the leading cause of accidental death in the U.S. Most of these overdose deaths are due to opioids.
  • If help arrives in time, overdoses can be safely and quickly reversed with a squirt of naloxone up the patient’s nose.
  • More than half of all overdoses occur in the presence of other people, usually other drug users.
  • Too often, people do not call 911 in a timely manner due to fear of arrest for possession of drugs.

A First Step

At the urging of parents who have lost children to overdose, the Michigan legislature made some good first steps last year. They enacted laws that increased access to naloxone, the drug that reverses overdoses.

On October 13, 2014, Public Acts 311, 312, 313 and 314 of 2014 were signed into law.

These acts will:

  • Allow Narcan to be prescribed to friends and family of heroin addicts, so it’s readily available in the event of an overdose.
  • Protect a person administering Narcan in good faith to be immune from criminal prosecution or professional sanctions.
  • Require emergency medical personnel to carry the drug in their vehicles and be trained in how to administer it.
  • Require the state Department of Community Health to complete annual reports of opioid-related overdose deaths.

Another Step

Last summer, Michigan Rep. Al Pscholka (R-Stevensville) introduced House Bill 4843, a bipartisan measure, that would create Good Samaritan protections for individuals under the age of 21 who seek medical attention for themselves or another person believed to have overdosed. However, the Good Samaritan protections are limited to the illegal possession of prescription drugs (in quantities consistent with personal use) for people under the age of 21.

Last December the Governor signed the Good Samaritan Bill, House Bill 4843, into law.

911 Good Samaritan Laws

NARCAN-KITThe Drug Policy Alliance provides a really good summary of 911 Good Samaritan laws:

Accidental overdose deaths are now the leading cause of accidental death in the United States, exceeding even motor vehicle accidents among people ages 25 to 64. Many of these deaths are preventable if emergency medical assistance is summoned, but people using drugs or alcohol illegally often fear arrest if they call 911,  even in cases where they need emergency medical assistance for a friend or family member at the scene of a suspected overdose.The best way to encourage overdose witnesses to seek medical helpis to exempt them from arrest and prosecution for minor drug and alcohol law violations, an approach often referred to as Good Samaritan 911.

The chance of surviving an overdose, like that of surviving a heart attack, depends greatly on how fast one receives medical assistance. Witnesses to heart attacks rarely think twice about calling 911, but witnesses to an overdose often hesitate to call for help or, in many cases, simply don’t make the call. In fact, research confirms the most common reason people cite for not calling 911 is fear of police involvement.

It’s important to know that this is not a liberal vs. conservative or Republican vs. Democrat issue. Some of the reddest and the bluest states in the country have passed 911 Good Samaritan laws.

Twenty states and the District of Columbia have enacted policies to provide limited immunity from arrest or prosecution for minor drug law violations for people who summon help at the scene of an overdose. New Mexico was the first state to pass such a policy and has been joined in recent years by Alaska, California, ColoradoConnecticut, Delaware, Florida, Georgia, Illinois, LouisianaMaryland, Massachusetts, Minnesota, New Jersey, New York, North Carolina, Rhode Island, Vermont, Washington and Wisconsin.

Further, these laws don’t protect dangerous or predatory criminals.

Good Samaritan laws do not protect people from arrest for other offenses, such as selling or trafficking drugs, or driving while drugged. These policies protect only the caller and overdose victim from arrest and/or prosecution for simple drug possession, possession of paraphernalia, and/or being under the influence.

The Bad News

An overdose is a major medical crisis, right? It’s not unlike a heart attack.

Here’s what happens when someone has a heart attack41KSA2GA12L._SX300_

  1. A person has a heart attack at the grocery store and . . .
  2.  . . . thank goodness, the store has an automatic defibrillator.
  3. Someone has been trained to use the defibrillator and performs the rescue.
  4. Someone else calls 911 to make sure the patient gets all the care they need.
  5. The patient is taken to the emergency department and medically stabilized.
  6. Once stabilized, the patient gets transferred to care that will address the cause of the heart attack and/or care that will prevent future heart attacks.
  7. The patient’s treatment plan will generally include lifestyle changes. (Diet, exercise, etc.)
  8. Then, the patient gets follow-up care that might include:
    • follow up appointments with specialists,
    • periodic tests to monitor for indicators of a recurrence,
    • self-monitoring (blood pressure), and
    • monitoring by the patient’ primary care physician.
  9. If problems recur or there are indications of a potential recurrence, the care plan will be re-evaluated and the patient will get whatever care they need.

Here’s what happens when someone ODs and is rescuednarcan

  1. A person overdoses and . . .
  2.  . . . thank goodness, the someone has naloxone.
  3. The person has been trained to use naloxone and performs the rescue.

Maybe, if they are lucky, these steps happen.

  1. Someone else calls 911 to make sure the patient gets all the care they need.
  2. The patient is taken to the emergency department and medically stabilized.

Naloxone is not enough.

We’d never tolerate cardiac patients being sent home without the proper care. Why should people with an addiction be treated any differently?

The good news

The good news is that there are models that work.

The Gold Standard

A male doctor writes on a patients chart.The best example of what should happen is the the kind of care that opioid addicted doctors, nurses, pilots and lawyers get. They all have low relapse rates and return to work at very high rates.

Here’s what would happen if one of them overdosed at work (or if it was known to their employer):

First, the recovery planning begins with some important assumptions:

  • abstinence is the goal;
  • full recovery with a return to full functioning is the expectation;
  • addiction is a chronic illness and recovery requires long term treatment, support and monitoring; and
  • for recovery to be durable, the addict must be an active participant in treatment and recovery maintenance.

Signpost along the road to recovery.The recovery plan is likely to include the following:

  • Formal treatment. The first phase of formal addiction treatment for most of these professionals is residential care ranging from 30 to 90 days.
  • Supportive services. Supportive services used by these professionals includes AA or NA 12-step groups, aftercare groups from their formal treatment programs, and follow-up from case managers.
  • Long-term support and monitoring. After completion of initial formal addiction treatment, they develop a continuing care contract consisting of support, counseling, and monitoring for usually 2 to 5 years.
  • Drug testing. Regular testing for 2 to 5 years, usually with more frequent testing at the start and reduced testing following periods of stable negative drug test results.
  • Dealing with relapse. Relapses are usually addressed by a combination of increased intensity of care and monitoring and by immediately informing family and colleagues of the physician to enlist their support.

Other options

Buprenorphine (Suboxone) and methadone have been shown to reduce drug use, overdose risk, criminal activity and disease transmission.

Some people are able to stabilize and live normal lives on these medications but, at this point, there is no research demonstrating its effectiveness with quality of life indicators like employment.

Many people hope to use these drugs as an interim step toward abstinence. However, there is no established model for successfully transitioning buprenorphine and methadone patients to abstinence. A large federally-funded study attempting to do this reported, “near universal relapse.”

Another option is an injectable drug called Vivitrol. It is injected once per month and can protect against overdose. Unfortunately, it’s very expensive.

Which to choose?

Hope Traffic SignThe gold standard offers a path to full recovery, but it does demand a lot of structure, effort and lifestyle changes.

Many professionals prefer drug maintenance as a goal. It’s an easier plan to implement and many professionals are not confident that their patients are capable of drug-free recovery. (Look for professionals that are optimistic and believe in you ability to achieve full recovery.)

However, most patients and families, for a wide variety of reasons, prefer abstinence as a goal–the most common reason is that they want their life back the way it was before they became addicted.

Patients not sticking with the treatment plan is the biggest barrier to success with both approaches.

It’s harder than it should be

Getting the gold standard for yourself or a family member is likely to be very difficult. But, there are steps you can take to improve the odds.

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Free, special addiction education opportunity

george-vaillantI wanted to make sure all of you know what a special opportunity this week’s Dawn Farm Education Series presentation offers.

The presenter will be George Vaillant. Who is he?

Well, he’s the source of one of our favorite quotes: “If you want to treat an illness that has no easy cure, first of all treat them with hope.”

Here are a few more things he’s known for:

He established much of the knowledge we now take for granted. Some of the findings from Dr. Vaillant’s alcoholism studies included:

  • That alcoholism is as much a social as a medical condition. “Alcoholism can simultaneously reflect both a conditioned habit and a disease.”
  • Factors predicting alcoholism were related to ethnic culture, alcoholism in relatives, and a personality that is antisocial and extroverted. An unhappy childhood predicted mental illness but not alcoholism—unless the family problems were due to alcoholism.
  • That alcoholism was generally the cause of co-occurring depression, anxiety, and sociopathic (delinquent) behaviour, not the result.
  • That even though alcoholism is not solely a medical condition, it is therapeutically effective to explain it as a disease to patients. The disease concept encourages patients to take responsibility for their drinking, without debilitating guilt.
  • That for most alcoholics, attempts at controlled drinking in the long term end in either abstinence or a return to alcoholism.
  • That there is as yet no cure for alcoholism, and that medical treatment can only provide short-term crisis intervention.
  • Achieving long-term sobriety usually involves (1) a less harmful, substitute dependency; (2) new relationships; (3) sources of inspiration and hope; and (4) experiencing negative consequences of drinking.[3]

You have two chances to see him:<

  1. You can see him on Tuesday night at St. Joe’s – Reception at 6:30 and presentation at 7:30.
  2. You can see him Wednesday night at U of M – Reception at 6:30 and presentation at 7:30.

The presentations are different. So, see him twice!

The presentations are free, there is no registration and there will be free food at the receptions.

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Where’s the hope?

nihilism by Brett Jordan

nihilism by Brett Jordan

Hot off the presses, Obama Administration Announces Prescription Opioid and Heroin Epidemic Awareness Week.

1945 words and the word “recovery” appears 2 times. (No, there are no uses of any other variation of the word.)

Zero times in the brief section on treatment.

American drug policy may finally be backing away from the war on drugs, but it’s still deeply inadequate.

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Changes ahead for the vaping industry

box-closed-pen-02_grandeNew FDA oversight of vaporizers could have a big impact on the vaping industry:

. . .the entire landscape is about to change…and it will most likely favor Big Tobacco, in one way or another.

But why the shift?

In May 2016, the FDA finalized a rule (a very dense 134 page rule, to be exact) extending their regulatory power established by the Tobacco Control Act in 2007 to cover all tobacco products, which now includes e-cigarettes. That rule officially went into effect on August 8, 2016,starting the clock for the entire industry to disprove that their products are “not appropriate for the protection of public health.”

. . .

The FDA defines a new group of cigarette technology as Electronic Nicotine Delivery Systems (“ENDS”), which includes “vaporizers, vape pens, hookah pens, electronic cigarettes (E-Cigarettes), and e-pipes,” among others. Despite the term “nicotine” being included in the terminology, the FDA extends their regulation to any tobacco-related product, regardless of whether it contains nicotine. Further, the regulation extends to ENDS and any component of ENDS products, such as e-liquids, atomizers, batteries, cartridges, flavorings, and even software.

. . .

k300_flavors_fruitsCoupled with that broad definition of regulated products is a broad definition of the term “manufacturer,” which includes all companies that “make, modify, mix, manufacture, fabricate, assemble, process, label, repack, relabel, or import ENDS.” This language is so broad that it essentially includes any company directly or tangentially involved in the ENDS industry.

. . .

What does it take to be approved by the FDA for ENDS products? Every manufacturer must submit an application to market each of their new tobacco products, which may not actually be new or a tobacco product. The term “each” is accurate, as an application must be submitted for each separate SKU (stock keeping unit), and each application must include studies that support their assertion that their product is appropriate for the protection of the public health. Estimates for each application submission range from two million to thirty million dollars, and most manufacturers must submit the applications within twenty-four months of the effective date of August 8, 2016.

Read the rest at Points. The author predicts “the near extinction of the e-cigarette market.”

It’ll be interesting to see how this plays out. Some words from Bill White have been on my mind as I’ve watched the emergence and evolution of vaping. He said something like, “I can’t tell you what the major drugs of misuse of the future will be. But, I can tell you that they are already here and someone will find a new way to use them. Look at the way the invention of the syringe and ‘rocking’ cocaine transformed the relationship between the user and the drug.”

We’ve only seen the tip of the iceberg with vaporizers and we know that regulation is a very imperfect instrument. Will FDA regulation help or create black markets that are worse than our current trajectory?

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Food for thought on marijuana

Marijuana AdvertisingFirst, a post on American use of and beliefs about marijuana:

There has been a significant increase in the number of Americans using cannabis, rising from 21.9m in 2002 to 31.9m in 2014. The number of regular users doubled over the same period to 8.4m. This coincides with an increasingly liberal approach to cannabis regulation in several US states. The authors of a new study, published in The Lancet Psychiatry, also found that people perceived cannabis to be less harmful. This perception seems justified as problems related to cannabis use, such as dependency, remained stable during the study period.

These findings are not what you would expect when cannabis use becomes more popular and is thought to be increasingly potent. This study also contradicts another study, using data over the same period, which found that disorders associated with cannabis use have doubled. So which one should we believe?

Second, a post examining the complicated questions around marijuana taxation:

Can I let you in on a little secret? No one knows the best way to tax either medical or recreational cannabis. Every option has trade-offs.

What should the tax be based on? What should the rate be?

Consider a price-based tax such as 25 percent at the retail level. While it would be easy to implement, the effective tax per joint would decrease as the price declines — something expected to happen as competition, innovation and scale-economies push down costs.

Taxing by weight, say $2 per gram, would also be easy to implement, but it means low- and high-potency products face the same tax. This creates incentives for producers to sell more potent cannabis to minimize the tax per hour of intoxication. Some public health researchers worry that more potent cannabis is associated with more health problems, an issue that is the subject of serious debate.

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Who’s “we”?

many-and-few

This article is making the rounds and getting some attention. The post below addresses the issues raised. (originally posted on 10/31/2014)

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This article has been forwarded to me by several people. Its author has been writing a series of articles that seek to redefine addiction and recovery.

As Eve Tushnet recently observed, “There’s another narrative, though, which is emerging at sites like The Fix and Substance.com.” This sentence is representative of this alternative narative:

“The addiction field has struggled with defining recovery at least as long and as fiercely as it has with defining addiction: Since we can’t even agree on whether it’s a disease, a learning disorder or a criminal choice, it becomes even harder to figure out what it means when we say someone has overcome an addiction problem.”

But are “we” really unable to agree that addiction is a disease? Who’s “we”?

It’s not unlike suggestions that there’s wide disagreement on climate change.

“Since we can’t even agree on whether it’s a diseasea learning disorder or a criminal choice, it becomes even harder to figure out what it means when we say someone has overcome an addiction problem.” “. . . just so you know, the consensus has not been met among scientists on this issue. Or that CO2 actually plays a part in this global warming phenomenon as they’ve come up with somehow.”
Health organizations that call addiction a disease or illness:

  • American Society of Addiction Medicine
  • American Medical Association
  • American Psychiatric Association
  • American Hospital Association
  • American Public Health Association
  • National Association of Social Workers
  • American College of Physicians
  • National Institute of Health
  • National Alliance on Mental Illness
  • World Health Organization
Scientific organizations that recognize human caused climate change:

  • American Association for the Advancement of Science
  • American Astronomical Society
  • American Chemical Society
  • American Geophysical Union
  • American Institute of Physics
  • American Meteorological Society
  • American Physical Society
  • Federation of American Scientists
  • Geological Society of America
  • National Center for Atmospheric Research
  • National Oceanic and Atmospheric Administration
Health organizations that dispute the dispute the disease model:

  • I can’t find any. If you have some that are similar in stature to those above, send them to me.
Scientific organizations that dispute human caused climate change:

  • None, according to Wikipedia.

To be sure, there are people who don’t accept the disease model, some very smart people, but they represent a small minority of the experts. (The frequent casting as David vs. Goliath should be a clue.) And, if you look at their arguments, you’ll find other motives (I’m not suggesting nefarious motives) like protecting stigmatizationdefending free will from “attacks”, discrediting AA and advancing psychodynamic approaches, resisting stigma and emphasizing environmental factors.

Attending to some of their concerns makes the disease model and treatment stronger, not weaker. Lots of diseases have failed to do things like adequately acknowledge environmental factors. And, one takeaway from these critics is the importance of being careful about who we characterize as having a disease/disorder explicitly or implicitly (by characterizing them as being in recovery).

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Why Does Alcoholics Anonymous Work?

This video addresses two important questions:

  1. Can evidence be trusted if it’s not from a randomized controlled trial?
  2. Does Alcoholics Anonymous involvement really help alcoholics stay sober? Or, do AA attenders just stay sober because they are more motivated than non-attenders to stay sober?

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