Resources on opioid addiction

This is a list of resources on opioid addiction that I am putting together for a talk to a community advocate group this Thursday.

The big picture:

CDC Grand Rounds: Prescription Drug Overdoses — a U.S. Epidemic, January 2012: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm

CDC 2018 (It’s not getting better yet.) https://www.cdc.gov/media/releases/2018/p0329-drug-overdose-deaths.html


Snohomish County:

Snohomish County:

http://mynorthwest.com/878895/snohomish-co-opioid-crisis/

https://drkottaway.com/2018/03/03/reducing-recidivism-snohomish-county-sheriffs-office-and-human-services-program/

http://www.heraldnet.com/news/state-house-backs-snohomish-county-opioid-help-center/

http://knkx.org/post/snohomish-county-jail-now-offering-medically-assisted-detox-inmates

Washington State Pain Law

https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/OpioidPrescribing

https://www.doh.wa.gov/YouandYourFamily/PoisoningandDrugOverdose/OpioidMisuseandOverdosePrevention


Is it genes that make people addicts?
(The short answer is genes are a minimal contribution. It is society and patterns learned in childhood and adulthood.)

Adverse Childhood Experiences (put people at way higher risk for addiction):
https://www.cdc.gov/violenceprevention/acestudy/index.html


Books that helped me understand addiction
(in my teens):

It will never happen to me by Claudia Black (about the patterns children take in addiction households to survive and cope with childhood)

Manchild in the Promised Land by Claude Brown (a black male writes about his childhood in Harlem when heroin hit the community. He was in a gang at age 6.)

Adverse Childhood Experiences 9: crisis wiring

I spoke to a patient recently about ACE scores. A veteran. Who has had trouble sleeping since childhood.

“What was your childhood like?” I say. “Was sleeping safe?”

“No, it wasn’t. We were in (one of the major cities) in a very bad part of town.”

“So not sleeping well may have been appropriate. To keep you safe. To survive.”

We both think this veteran has PTSD.

“I think I had PTSD as a child. And then the military made it worse.”

I show the veteran the CDC website and ACE pyramid: https://www.cdc.gov/violenceprevention/acestudy/about.html.

Adverse childhood experiences. Leading to disrupted neurodevelopment. Leading to a higher risk of mental health disorders, addiction, high risk behavior, medical disorders and early death.

Ugly, eh? Damaged children.

“But I don’t agree with it.” I say.

My veteran looks at me.

“Disrupted neurodevelopment.” I say. “I don’t agree with that. Different neurodevelopment. Crisis neurodevelopment. We have to have it as a species in order to survive. Think of the Syrian children escaping in boats, parents or sibling drowning. We have to have crisis wiring. It isn’t wrong, it’s different. The problem is really that our culture does not support this wiring.”

“You can say that again.”

“Our culture wants everyone to be raised by the Waltons. Or Leave it to Beaver. But the reality is that things can happen to any child. So we MUST have crisis wiring. Our culture needs to change to support and heal and not outcast those of us with high ACE Scores.”

My Veteran is quiet, thinking that over.

I say, “You may read more about ACE scores but you do not have to. And we can work more on the sleep. And we do believe more and more that the brain can heal and can rewire. But you were wired to survive your childhood and there is no shame in that.”

 

I took the picture in Wisconsin in August.

 

Influenza 2016

No influenza cases so far this year in my clinic.

I watch the flu map faithfully each week, as I try to get my stubborn patients to get their influenza vaccine. It takes up to two weeks to get them immune, if it works. It works most years about 80% f the time. When it doesn’t work, it’s because either their immune system didn’t respond or because the influenza virus has traded genes enough that the guess six months before on which way it will evolve, is wrong.

Here is the CDC weekly influenza update link: http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.

If you click on the FluView Weekly Influenza Surveillance Report, scroll down. My favorite to show patients are the Outpatient Illness Surveillance, which maps this year’s rise in influenza in the US each week, compared with past years. We are having a late year.

My other favorite is the next one down: ILIState Activity Indicator Map. It changes color each week by state as the influenza reports come in. Arizona turned red this year about a month ago, after Puerto Rico. Red is high activity level. The rest of the country was dark green, low, or light green, but has steadily been turning yellow green, yellow, orange…. Washington State is still green. But now only a few states are green and it’s still on the rise. If we continue to have unseasonably warm sunny days, like the last four days, we might avoid the influenza. But if it gets wet and cold again: boom. Like a sneeze, spreading. This is the first week we’ve had seven red states. I have been wearing a mask in clinic every time I see someone coughing. And I got a cold anyhow, but it is not influenza and I don’t think it’s strep A, thank goodness.

I said influenza is airborne but it isn’t. Or there is controversy. It is at least droplet spread, but sneezes count. Apparently influenza can get to people 6 feet away. Wear your space suit with the oxygen filter to the grocery store. http://www.cdc.gov/flu/about/disease/spread.htm — lots of information about the influenza virus. Is all of it 100% correct? Don’t be silly, this is science, not a religious text: science changes, just like the flu virus.

This year, a CDC alert was faxed to clinic on February 1: http://emergency.cdc.gov/han/han00387.asp. It is all very calm and clinical, with this sentence in the second paragraph: “CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported.” I called my son and said, “Get your flu shot now.” If you read the rest, it says ages 20-50 as the “young” and “middle-aged” adults. Not the group that we expect influenza to hit, but that is the group that got hit in the 1918-1919 influenza.

Get your flu shot… be careful out there.

 

I took the photograph two days ago with my phone: Boa was on my lap and I wrapped her in the shawl I’d knit, and she was so relaxed…. that’s how we need to take care of everyone with influenza.