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praying, rooting, empathy, support, compassion and respect

A friend shared this obituary with me today.

I don’t know anything about Maddie beyond what’s shared in her obituary, but it’s has to be the most beautifully written obituary I’ve ever seen.

Addiction afflicts beautiful, good people and it sounds like she was one of them.

It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction. To some, Maddie was just a junkie — when they saw her addiction, they stopped seeing her. And what a loss for them. Because Maddie was hilarious, and warm, and fearless, and resilient. She could and would talk to anyone, and when you were in her company you wanted to stay. In a system that seems to have hardened itself against addicts and is failing them every day, she befriended and delighted cops, social workers, public defenders and doctors, who advocated for and believed in her ’til the end. She was adored as a daughter, sister, niece, cousin, friend and mother, and being loved by Madelyn was a constantly astonishing gift.

Maddie loved her family and the world. But more than anyone else, she loved her son, Ayden, who was born in 2014. She transformed her life to mother him. Every afternoon in all kinds of weather, she would put him in a backpack and take him for a walk. She sang rather than spoke to him, filling his life with song. Like his mom, Ayden loves to swim; together they would spend hours in the lake or pool. And she so loved to snuggle him up, surrounding him with her love.

Thanks to Maddie’s family for sharing her story, she sounds like a lovely person.

Her family has a few important messages for readers.

If you yourself are struggling from addiction, know that every breath is a fresh start. Know that hundreds of thousands of families who have lost someone to this disease are praying and rooting for you. Know that we believe with all our hearts that you can and will make it. It is never too late.

If you are reading this with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness. And chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support.

If you work in one of the many institutions through which addicts often pass — rehabs, hospitals, jails, courts — and treat them with the compassion and respect they deserve, thank you. If instead you see a junkie or thief or liar in front of you rather than a human being in need of help, consider a new profession.

I hope for peace and comfort for all of Maddie’s loved ones.


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Sentences to ponder

Framing the national drug problem around opioids misses the bigger target. The future of the national drug problem is more drugs used by more drug users – not simply prescription misuse or even opioids but instead globally produced illegal synthetic drugs as is now common in Hong Kong and Southeast Asia. A focus exclusively on opioid use disorders might yield great progress in new treatment developments that are specific to opioids. But few people addicted to opioids do not also use many other drugs in other drug classes. The opioid treatments (for example, buprenorphine, methadone, naltrexone) are irrelevant to these other addictive and problem-generating drugs.

Mark Gold, MD & Robert DuPont, MD

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Sentences to ponder

“Vancouver is a city with a lot of harm-reduction tools in its tool box and, still, we’ve barely slowed the wave of overdoses,” Mr. Robertson said.

Mr. Robertson is Vancouver’s outgoing mayor. He reflected on his experience managing the city through the opioid crisis.

Number of times the article mentions recovery = 0

Number of times the article mentions treatment = 0

Here’s the thought they closed the article with.

“Vancouver’s lesson is that we need more harm reduction, not less.”

(This post, in no way, implies that the presence of harm reduction is the problem. However, the absence of treatment and recovery should trouble anyone who cares about the lives of addicts.)


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No matter how cynical you become . . .

No matter how cynical you become, it’s never enough to keep up.

—Lily Tomlin

From the Financial Times:

A billionaire pharmaceuticals executive who has been blamed for spurring the US opioid crisis stands to profit from the epidemic after he patented a new treatment for drug addicts.

Richard Sackler, whose family owns Purdue Pharma, the company behind the notorious painkiller OxyContin, was granted a patent earlier this year for a reformulation of a drug used to wean addicts off opioids.

The invention is a novel form of buprenorphine, a mild opiate that controls drug cravings, which is often given as a substitute to people hooked on heroin or opioid painkillers such as OxyContin.

This is like a conspiracy theory playing out in real life front of us. Oy.


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New study casts doubt about injection site effectiveness

UPDATE: looks like this study has been retracted. I’ll post more, when I know more about why.

UPDATE 2: German Lopez has an update here.

A new meta-analysis of research on supervised injection sites delivers some disappointing conclusions for advocates:

One of the aims of MSICs (Medically Supervised Injection Centres) is to reduce harms associated with injecting illicit drugs such as heroin under unhygienic conditions. The current research suggests that the extent to which these aims have been achieved are at best modest.

How can this be?

Here’s what the authors say:

How can these surprising and sometimes counter-intuitive results be explained? There are at least two potential explanations. First, MSICs have been found to attract the most problematic heroin users . . . Second, MSIC clients might remain part of local injecting subcultures. In other words, they might be obtaining the benefits of MSICs, while at the same time continuing to inject in public and semi-public environments. There is some evidence to support this assumption.

Why is this noteworthy?

Insite, North America’s first MSIC, was opened about 15 years ago.

Over that 15 years, the approach has enjoyed vigorous support from public health, harm reduction advocates, and drug policy experts. There’s been a steady stream of publications to support their effectiveness.

Observers who questioned their effectiveness or whether they were the best use of scarce resources were often met with dismissive responses about science, evidence, empiricism, compassion, and challenges to presumed moralizing impulses.

This reaction has only intensified, despite other potential explanations for reduced disease transmission rates, reasonable questions about whether other approaches might save more lives, acknowledged “slight” drops in mortality rates, the absence of a recovery orientation in the coverage, and increasing OD rates in the region. There’s also been little willingness to discuss their animating beliefs and assumptions.

Why the discrepancy with past studies?

Well, first off, maybe the rhetoric hasn’t matched the actual evidence. Their description of the evidence is more mixed and narrow than you’d expect from coverage:

The results of the current review have shown that MSICs tend to have either a small effect or no effect on outcomes. The findings of the three reviews and one meta-analysis reviewed in the introduction were also mixed. McNeil and Small (2014) concluded that MSICs were effective in minimising client exposure to risk environments. Potier et al. (2014) concluded that MSICs were effective in reducing harm and providing health benefits to clients. MacArthur et al. (2014) concluded that, at best, there was tentative evidence of MSICs reducing IRB, but little or no evidence of MSICs reducing HIV/HCV incidence. Finally, Milloy and Wood (2009) concluded that MSICs were effective in reducing syringe sharing.

German Lopez got reactions from various researchers and ended with this observation from Keith Humphreys:

“If you are an advocate, you could say correctly that if we assume these are effective, we do not have sufficient information to confidently overturn that presumption,” Humphreys said. “But it’s equally true if you took another view — just look at it as a cold, scientific question — you could say we also don’t have the evidence to overturn the presumption that these don’t make any difference.”


That word “advocate” is important. It’s worth stepping back and considering what they advocate for. They are advocating for a philosophy, an approach, and a program.

This gets lost in a lot of these discussions and they get framed as advocates for science, research, evidence, empiricism, and compassion. A problem is that this framing sets up questioners as opposed or indifferent to those things.

Turns out that hasn’t been fair.

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The treatment hustle behind the scenes

So, the other night I posted about cash-only buprenorphine practices.

The next morning I find this in my mail.

Consulting services to help establish turn-key buprenorphine clinics with cash revenue models that use toxicology services to generate revenue and provide aggressive risk management. (It’s worth noting that I also get emails about treatment valuation conferences/services several times a week. That’s not a typo. Treatment valuation, not evaluation.)

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Vaping draws strong support — from bots

Apparently, twitter-bots are targeting more than elections:

Social media accounts run by internet robots may be driving much of the discussion around the health threats posed by e-cigarettes, according to a study led by San Diego State University researchers, who also found most of the automated messages were positive toward vaping.

More than 70 percent of the tweets analyzed in the study appeared to have been put out by robots, also known as bots, whose use to influence public opinion and sell products while posing as real people is coming under increased scrutiny.

Who the heck cam up with the idea of researching robo-tweets about vaping? They stumbled upon it.

The discovery of the apparent bot promotion of vaping was unexpected. The team originally set out to use Twitter data to study the use and perceptions of e-cigarettes in the United States and to understand characteristics of users discussing e-cigarettes.

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