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Wednesday, October 1, 2014

Silence Is Not Sexual Consent: The California Contract

* One in 4 college-aged women report experiences that meet the legal definitions of rape or attempted rape. 

* One in 5 college women are raped during their college years. 

* One in 12 college men admitted to committing acts that met the legal definition of rape.

* More than one in 5 men report “becoming so sexually aroused that they could not stop themselves from having sex,” even though the woman did not consent.

(National Statistics. New York University Student Health Center. 2010)

Gov. Jerry Brown has signed a bill into law that makes California the first in the nation to have a clear definition of when people agree to sex. The law goes further than the common "no means no" standard, which has been blamed for bringing ambiguity into investigations of sexual assault cases.
The "Yes Means Yes" bill, officially known as  California SB 967, seeks to create more institutional protections for college students who may be sexually assaulted by their peers. Authored by state senators Kevin de Leon and Hannah-Beth Jackson, SB 967 sets the standard for consent to sex a bit higher than some colleges have in the past. And that standard is "affirmative consent."

The consent of affirmative consent is best understood by the bill's slogan: "yes means yes." The old "no means no" doesn't create a very high burden on would be sexual assaulters to ascertain whether their partners' silence, intoxicated state, or lack of resistance is really tantamount to a "yes." And with the very serious charge of rape being a possibility for sex without consent, this is not a situation to trifle with. With only a "yes" (or each partner affirmatively consenting), can many of their sexual assault fears be silenced.

The new law seeks both to improve how universities handle rape and sexual assault accusations and to clarify the standards, requiring an "affirmative consent" and stating that consent can't be given if someone is asleep or incapacitated by drugs or alcohol.

"Lack of protest or resistance does not mean consent," the law states, "nor does silence mean consent. Affirmative consent must be ongoing throughout a sexual activity and can be revoked at any time."

The "affirmative consent" standard also would not allow accused rapists to claim that an intoxicated victim consented or that the accused was too intoxicated to confirm consent. For college students, this may mean a sobering new reality about drunken sex.

(Brett Snider, Esq. "Calif. 'Yes Means Yes' Sexual Assault Bill Awaits Gov.'s Signature."
 Law and Daily Life. August 30, 2014")

The bill applies to all California post-secondary schools, public and private, that receive state money for student financial aid. The California State University and University of California systems supported the legislation after adopting similar consent standards this year.

Before the legislation was approved, the National Coalition for Men, a non-profit group based in San Diego, posted on its website an article urging Brown to veto the legislation.
"It is tragically clear that this campus rape crusade bill presumes the veracity of accusers (a.k.a. 'survivors') and likewise presumes the guilt of accused (virtually all men). This is nice for the accusers – both false accusers as well as true accusers — but what about the due process rights of the accused?'' wrote Gordon Finley, an adviser to the group and professor emeritus of psychology at Florida International University.

(William M. Welch. "California Adopts 'Yes Means Yes' Law."  
USA Today. September 29, 2014)

Here is the language of the law:


 (a) In order to receive state funds for student financial assistance, the governing board of each community college district, the Trustees of the California State University, the Regents of the University of California, and the governing boards of independent postsecondary institutions shall adopt a policy concerning sexual assault, domestic violence, dating violence, and stalking, as defined in the federal Higher Education Act of 1965 (20 U.S.C. Sec. 1092(f)) involving a student, both on and off campus. The policy shall include all of the following:
(1) An affirmative consent standard in the determination of whether consent was given by both parties to sexual activity. “Affirmative consent” means affirmative, conscious, and voluntary agreement to engage in sexual activity. It is the responsibility of each person involved in the sexual activity to ensure that he or she has the affirmative consent of the other or others to engage in the sexual activity. Lack of protest or resistance does not mean consent, nor does silence mean consent. Affirmative consent must be ongoing throughout a sexual activity and can be revoked at any time. The existence of a dating relationship between the persons involved, or the fact of past sexual relations between them, should never by itself be assumed to be an indicator of consent.
(2) A policy that, in the evaluation of complaints in any disciplinary process, it shall not be a valid excuse to alleged lack of affirmative consent that the accused believed that the complainant consented to the sexual activity under either of the following circumstances:
(A) The accused’s belief in affirmative consent arose from the intoxication or recklessness of the accused.
(B) The accused did not take reasonable steps, in the circumstances known to the accused at the time, to ascertain whether the complainant affirmatively consented.
(3) A policy that the standard used in determining whether the elements of the complaint against the accused have been demonstrated is the preponderance of the evidence.
(4) A policy that, in the evaluation of complaints in the disciplinary process, it shall not be a valid excuse that the accused believed that the complainant affirmatively consented to the sexual activity if the accused knew or reasonably should have known that the complainant was unable to consent to the sexual activity under any of the following circumstances:
(A) The complainant was asleep or unconscious.
(B) The complainant was incapacitated due to the influence of drugs, alcohol, or medication, so that the complainant could not understand the fact, nature, or extent of the sexual activity.
(C) The complainant was unable to communicate due to a mental or physical condition.

I understand the terrible problem of sexual assault on campus. And the intent of this law is good. It will hopefully change how states and universities handle rape allegations. The legislation should begin a needed paradigm shift in how college campuses in California prevent and investigate sexual assaults.
However, I think some fuzziness is apparent ...

What levels of intoxication and/or recklessness apply? Is anyone the least bit under the influence subject to strict interpretation of drunkenness? And, reckless is a hallmark of college-age social situations. The Animal House mentality is a reality that must be tackled.
Does this law apply to all "sexual activity"? And, if so, what is defined as such? Quite a wide range does exist from oral sex to copulation.

In the heat of the moment what does “affirmative consent” actually require as "affirmative, conscious, and voluntary agreement to engage in sexual activity"? Is physical response itself "affirmative consent," or does the consent have to be verbal? Although lawmakers say consent can be nonverbal, and universities with similar policies have outlined examples of such consent as a nod of the head or moving in closer to the person, what applies to actual legal consent remains vague.

If the "fact of a dating relationship between the persons involved, or the fact of past sexual relations between persons is never assumed to be an element of consent," does each new sexual encounter require new consent? Does this also apply to married couples and those who engage in different, aggressive foreplay and/or fantasy?

Does each level of sexual advancement require a response in order for the sexual engagement to continue? The law says "it can be revoked at any time." So, does that mean lingering and being aware of each stage of the process? You know, like the aggressor getting the OK to go on to "second base," on to "third base," and finally to "home"?

I also assume this law applies to unwanted mutual gay sexual activity. This type of contact may prove more difficult as to defining the roles of aggressor and complainant. I can't imagine how one may determine fault in many of these sexual intrusions.

Considering the law, here is a loud and clear message I believe people should understand: taking any kind of chance that puts you in the role of a sexually aggressive partner is risky. That said, now a partner does not have to say "no" to sexual advances. The responsibility to have sex requires a "yes" between both parties involved, not just an intuitive notion of consent but a clear and direct response. Considering the statistics above, this is a step forward. Thorny? Of course, but the aim is true.

This legal contract of love does seems rather unromantic in many ways. Shakespeare may be turning over in his grave. 

"Love is a smoke raised with the fume of sighs,
Being purged, a fire sparkling in lovers' eyes,
Being vexed, a sea nourished with lovers' tears.
What is it else? A madness most discreet,
A choking gall and a preserving sweet."

-- William Shakespeare, "Romeo and Juliet | Act 1, Scene 1"

Love is a smoke raised with the fume of sighs,
Being purged, a fire sparkling in lovers' eyes,
Being vexed, a sea nourished with lovers' tears.
What is it else? A madness most discreet,
A choking gall and a preserving sweet.
-- William Shakespeare, "Romeo and Juliet | Act 1, Scene 1" - See more at:

Tuesday, September 30, 2014

Beautiful Young People In Heroin Love Affairs

People love to argue about addiction. The uniformed and the inexperienced claim heroin addiction is a problem of the lower social class and confined to the stereotypical "scum of the earth" -- unemployed, victims of bad upbringings, high school dropouts, and prostitutes.

Heroin addiction was considered the scourge of the urban poor. That is simply not true, and now studies and statistics prove that heroin addiction is prevalent in youth of all economic levels, even the kids of modern suburbia.

In America, suburban teens are turning to heroin in greater number than ever before, after first getting their habit going with prescription painkillers. These people are young, privileged and seem "to have everything to live for," yet they fall into heroin addiction after developing a dependence on prescription opiates.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), heroin use in America is up 79 percent between 2007 and 2012. SAMHSA reports initiations to heroin have increased 80 percent among 12- to 17-year-olds since 2002. The National Survey on Drug Use and Health (NSDUH) found teenagers have reasonably easy access to heroin. 29.7 percent of 12th graders say that it is easy to obtain. Even 8th graders (12.6 percent) say that they can obtain heroin. Of course these statistics are shocking to older generations that considered heroin hardcore and a drug used only by the criminal element. Looking at the NSDUH information, it is estimated that in the last year, about 91,000 persons over the age of 12 used heroin for the first time.

But, it's no wonder that a generation weaned on prescription opiates would soon turn to heroin. The cost ratio is stark. According to, a user-contributed site that collates “the latest street prices for prescription drugs,” the standard black market cost of Oxycodone is approximately one dollar per milligram. By contrast, heroin is sold either as individual doses, usually in $10 "bags" or by weight. It can go for as low as $50 dollars a bundle (approximately one gram).

Generally, the following holds true about the cost of street heroin:

The average cost of a single dose of heroin (purchased on the street) is approximately $10 – $20.
The approximate average cost for a half gram is generally about $40 - $60.
The approximate average cost for one gram is generally about $60 - $100.

A heroin dependent individual who uses regularly and continually may pay $150 – $200 per day in order to support his or her habit.

A young brain is not yet fully developed. As a result, the brains of young people may be more susceptible to drug abuse and addiction than adult brains.

One of the major deficits in the thinking of teenagers, particularly in early adolescence, is in evaluating the probabilities of a risk - luck vs. reality. Beatrix A. Hamburg, a child psychiatrist at Mount Sinai Hospital in New York City, says ...

''By age 10 or so, children enter a risky period when they do lots of exploring at a time when their cognitive development has not yet reached the point where they can make judgments that will keep them out of trouble. They cannot really comprehend laws of probability. And they also have ideas of invulnerablity that persuade them that they can safely take a known risk...

''Often, if a teenager does something several times - like not breaking his neck when he does something stupid, or not getting pregnant after sex without contraceptives - he will assume it becomes less risky each time, not more so."

(Daniel Goleman, "Teen-Age Risk-Taking: Rise In Deaths Prompts New Research Effort,"  
The New York Times, November 24 1987)
 Tom Dietzler, an addiction counselor at Caron Pennsylvania Young Adult Program, stresses that addiction is a powerful disease -- one that can cause good kids from loving families to make horrible decisions.

"They have no fear of death," Dietzler says of heroin addicts. "They will do anything they can to get their drug. They become vicious as they progress into their addiction."

Heroin gives users a euphoric high, followed by an intense physical withdrawal that addicts describe as 10 times worse than the flu. To avoid the pain of withdrawal, the heroin addict structures life around getting the next dose.

Abbie Hoff, also a counselor at Caron, says that the addict's life quickly begins to revolve around the same, never-ending questions: "'When am I going to get the drug again?' 'How am I going to get the drug again?' 'What do I need to do to get the drug again?' The obsession begins and all they want is the drug."

 (Andrew Sullivan. "Hooked On Heroin: Young People Battle Addiction." 
ABC News. October 28, 2010)

Many adults think heroin (opiate) rehab is a relatively short process. It is unrealistic of parents of a heroin addict to think that the patient can begin a healing process in 30 days. To complicate matters, addicts themselves often feel that they are cured after a few weeks of sobriety, but quickly relapse once they leave treatment. It's one reason that 78 percent of heroin addicts in treatment have been through rehab before, often multiple times, according to the Substance Abuse and Mental Health Services Administration. 

For those lucky enough to find and to afford treatment, how much is enough? Experts say there is no universal timeline: every patient is different.

"We treat people individually here," says Hoff. "Some people take two to three months just for the brain to start healing, before they can even look at their core issues."

And, successful treatment for a young addict usually involves the entire family. In cases in which a patient fails in treatment, it's often because the family doesn't get involved, or the family doesn't want to take a look at their own issues they might have.

 The Bottom Line

A survey of 9,000 patients at treatment centers around the country found that 90 percent of heroin users were white men and women. Most were relatively young — their average age was 23. And three-quarters said they first started not with heroin but with prescription opioids like OxyContin.

Here is a brief bio of Emmanuel Donato, a 33-year-old former heroin addict, one-time narcotics dealer, and ex-convict who served two years for felony drug sale and possession and who managed to survive from an overdose and being robbed at gunpoint while he sold heroin to fuel a habit that had spiraled out of control. The following is taken from Paul Grondahl's "Surviving Heroin Addiction and Rebuilding a Young Life" in the Albany on September 8, 2014.

Unlike the other drugs Donato had abused to get high since middle school — alcohol, marijuana, cocaine, Oxycodone and other prescription opioid pills — heroin felt like swallowing a ball of fire.

"As soon as you touch that pin, within a millisecond you get the rush," he said. "It starts as a warm, tingling sensation at your feet and then moves to your head and it's like fire pouring through you and then you're floating on top of the world. It's just warm and you're feeling no pain."

His drug addiction was hiding right in plain sight.

He lived with his parents in a semi-rural rustic farmhouse and managed to hide it from them. He used heroin while he worked and kept it a secret from employers. He did not share his clandestine life as a heroin dealer and an addict with his friends who were not in the drug scene.

He blended in with other twentysomethings: Tanned and well-muscled, clean-shaven, close-cropped sandy hair, Aeropostale baseball cap, tight Aero t-shirt, designer jeans and white Nike sneakers.

Injecting heroin for Donato, who attended Guilderland public schools, was as much an everyday fixture of the suburban landscape where he lived as were ubiquitous fast-food drive-throughs, multiplex cinemas, strip malls and a car culture.

He shot up in his car in the parking lot of Crossgates Mall, or in the stall of a public restroom in Dunkin' Donuts or Taco Bell or Price Chopper.

His drug kit did not attract attention. He carried a bottle of water and heroin in tiny clear plastic bags the size of a thumbnail. He poured two bags of the whitish powder into the bottle cap. He snapped off the cotton end of a Q-tip and with the bare end mixed the equivalent of half a sugar packet with a few drops of water and stirred it into a milky, watery slurry.

He pulled from his jeans pocket a syringe and needle he bought in bulk at CVS, used the snapped-off cotton to filter out impurities and drew the liquid narcotic into the syringe.

He clenched his right fist and found a prominent vein on the fleshy inside crook of his elbow. Toned and athletic, his veins stood out. He never needed a tourniquet.

While the fiery rush only lasted about five minutes, the pain-free, floating high stretched out languidly for three hours or more when Donato first started using heroin.

But it's an addiction of diminishing returns. Soon, the rush got shorter and less intense for him. The fire did not burn as hot. The high did not last as long. It took more heroin — one bag fairly quickly ramped up to two and three and four bags — for Donato to reach that euphoric level of carefree buoyancy.

"You just keep chasing and chasing that rush and after awhile, you never get there," Donato said.

Donato was locked in a vicious cycle of addiction. Within a matter of months, he increased the amount and frequency of his drug use, not so much to achieve a high but to manage the horrible side effects of withdrawal.

"Imagine the worst flu you've ever had and multiply that by 10," Donato said.

Even when he managed to avoid hellish stomach pains and a plague of fever and chills, he said he felt "heavy and slow" when he came down. As the high faded, he showed an unwanted junkie's profile, "the nodding off and drooling and not caring."

His heroin addiction grew costly, too, and he was spending $500 a week and more chasing the rush. But the cash he made from sporadic, low-paying jobs as a construction laborer could not keep pace and he was sliding into the horrible sickness of withdrawal more often, always jonesing for another fix.

Read the rest of Emmanuel Donato's story here. It is a must read for parents and their young children alike: Click here:
If you think your child is experiencing opioid dependency or addiction, he or she probably is. Get treatment immediately and don't ignore the symptoms you find. Nothing is as destructive as this disease, and once the addiction occurs, the nightmares begin. Recovery requires strong wills and family support.

Above all, never think a child is "above" heroin addiction. "Straight-A" students, talented athletes, beautiful and loving young people of every kind are at risk. As author Oliver Marcus says, "And it doesn't matter if you're a good or a bad person, once you become addicted to drugs. What happens next is inevitable. It's a natural process that happens in everyone's brain, once the drugs take over. So don't ever fool yourself into thinking that only weak or bad people get addicted."

"But there’s a million of these
towns that are like factories,
breeding hate and fear that only
the fortunate will never meet

"And these zoomed up
kids die like saints, for
someone else’s

--Volatalistic Phil, White Wedding Lies, and Discontent: An American Love Story

A heroin addict? Yes, For someone else's dollar.

Monday, September 29, 2014

A Suboxone Primer: What Everyone Should Know

Basic Suboxone Information

Here is some general information about Suboxone from the Food and Drug Administration.

Subutex and Suboxone are medications approved for the treatment of opiate dependence. Both medicines contain the active ingredient, buprenorphine hydrochloride, which works to reduce the symptoms of opiate dependence.

The FDA approved two medications. Subutex contains only buprenorphine hydrochloride. This formulation was developed as the initial product. The second medication, Suboxone contains an additional ingredient called naloxone to guard against misuse. Subutex is given during the first few days of treatment, while Suboxone is used during the maintenance phase of treatment.

Suboxone is the formulation used in the majority of patients.

Currently opiate dependence treatments like methadone can be dispensed only in a limited number of clinics that specialize in addiction treatment. There are not enough addiction treatment centers to help all patients seeking treatment. Subutex and Suboxone are the first narcotic drugs available under the Drug Abuse Treatment Act (DATA) of 2000 for the treatment of opiate dependence that can be prescribed in a doctor’s office. This change provides more patients the opportunity to access treatment.

Subutex and Suboxone are less tightly controlled than methadone because they have a lower potential for abuse and are less dangerous in an overdose. As patients progress on therapy, their doctor may write a prescription for a take-home supply of the medication.

Only qualified doctors with the necessary DEA (Drug Enforcement Agency) identification number are able to start in-office treatment and provide prescriptions for ongoing medication. CSAT (Center for Substance Abuse Treatment) will maintain a database to help patients locate qualified doctors.

Both medications come in 2 mg and 8 mg strengths as sublingual (placed under the tongue to dissolve) tablets.

These medications will be available in most commercial pharmacies. Qualified doctors with the necessary DEA identification numbers will be encouraged to help patients locate pharmacies that can fill prescriptions for Subutex and Suboxone.

FDA has worked with the manufacturer, Reckitt-Benckiser, and other agencies to develop an in-depth risk-management plan. FDA will receive quarterly reports from the comprehensive surveillance program. This should permit early detection of any problems. Regulations can be enacted for tighter control of buprenorphine treatment if it is clear that it is being widely diverted and misused.

The main components of the risk-management plan are preventive measures and surveillance.
Preventive Measures include:
  • education
  • tailored distribution
  • Schedule III control under the Controlled Substances Act (CSA)
  • child resistant packaging
  • supervised dose induction
The risk management plan uses many different surveillance approaches. Some active methods include plans to:
  • Conduct interviews with drug abusers entering treatment programs.
  • Monitor local drug markets and drug using network areas where these medicines are most likely to be used and possibly abused.
  • Examine web sites.
Additionally data collection sources can indicate whether Subutex and/or Suboxone are implicated in abuse or fatalities. These include:
  • DAWN—The Drug Abuse Warning Network. This is run by the Substance Abuse and Mental Health Services Administration (SAMHSA) which publishes a collection of data on emergency department episodes related to the use of illegal drugs or non-medical use of a legal drug.
  • CEWG—Community Epidemiology Working Group. This working group has agreed to monitor buprenorphine use.
  • NIDA—National Institute of Drug Abuse. NIDA will send a letter to their doctors telling them to be aware of the potential for abuse and to report it if necessary.
Research From the National Institute of Health

The NIH announced results from first large scale study on treatment of prescription opioid addiction in 2011.

("Painkiller Abuse Treated by Sustained Buprenorphine/Naloxone. NIH. November 8, 2011)

People addicted to prescription painkillers reduce their opioid abuse when given sustained treatment with the medication buprenorphine plus naloxone (Suboxone), according to research published in the Archives of General Psychiatry and conducted by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

The study, which was the first randomized large scale clinical trial using a medication for the treatment of prescription opioid abuse, also showed that the addition of intensive opioid dependence counseling provided no added benefit.

"The study suggests that patients addicted to prescription opioid painkillers can be effectively treated in primary care settings using Suboxone," said NIDA Director Nora D. Volkow, M.D. "However, once the medication was discontinued, patients had a high rate of relapse — so, more research is needed to determine how to sustain recovery among patients addicted to opioid medications."

Pain medications are beneficial when used as prescribed, but they have significant abuse liability, especially when taken for non-medical reasons. This study examined whether the FDA-approved medication Suboxone could help combat this growing problem.

Suboxone is a combination of buprenorphine to reduce opioid craving plus naloxone, which causes withdrawal symptoms in someone addicted to opioids if Suboxone were taken by a route other than orally, as prescribed. This combination was specifically designed to prevent abuse and diversion of buprenorphine and was one of the first to be eligible for prescribing under the Drug Addiction Treatment Act, which permits specially trained physicians to prescribe certain FDA approved medications for the treatment of opioid addiction.

According to the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health, an estimated 1.9 million people in the United States meet abuse or dependence criteria for prescription pain relievers. In addition, the Centers for Disease Control and Prevention report that annually, more people die from prescription painkiller overdoses than from heroin and cocaine combined.

Suboxone just prevents withdrawal symptoms. It does nothing to help a person stop craving the high of opiate abuse, or desiring the oblivion of the opiate euphoria. The only way to stop the desire to abuse drugs is with honest and effective drug rehabilitation.

According to market research firm Wolters Kluwer, in 2011, sales of Suboxone in the U.S. exceeded $1.3 billion dollars and continues to steadily grow.

Dangers of Using Suboxone

There is no major risk of overdose for people who take Suboxone for medium-to-long-term maintenance, as long as the drug is used as prescribed. The problem with treating an opiate addiction with an opiate is that patients must then be weaned from the replacement drug.

Research continues into the use, effectiveness and dangers associated with Suboxone as deaths have been reported in patients using the drug. These deaths are generally the result of improper or illegal use of the drug. But, the risk of severe negative effects, including overdose, is higher if the patient does not receive enough buprenorphine and continues to take other drugs.

Suboxone overdose can be fatal, particularly if the patient injects this drug while also taking sedatives, tranquilizers or alcohol. Unconsciousness, severe respiratory depression and death can occur. Life-threatening overdose also can result from taking excessive amounts of Suboxone orally or combining oral Suboxone with alcohol, sedatives, tranquilizers, certain antidepressants and other opioid medications.

Opponents argue that it should have been more controlled and blame the FDA and the NIDA for allowing it to emerge on the streets. The system is imperfect, however, and any drug, no matter the control, can still get into the wrong hands and be used improperly.

 Suboxone Abuse

The editors of CESAR FAX, a weekly update on substance abuse research, wrote, "While research indicates that buprenorphine is an effective drug for treating opioid dependence, we feel that the potential for its nonmedical use and related unintended consequences may be going unnoticed."

As buprenorphine is more widely prescribed, there may be increasing problems with diversion and misuse.

In the study, researchers at Brown University analyzed patterns of buprenorphine abuse by intravenous (IV) and non-IV opioid users in Providence, Rhode Island.  They found that about three-fourths of these opioid users were obtaining buprenorphine-containing medications illicitly.

(Wolters Kluwer. Journal of Addiction Medicine.2012)
Suboxone is particularly attractive to recreational abusers because there is a built-in safety factor with pharmaceutical grade prescription drugs when compared to street drugs. Prescription drugs are manufactured in sterile environments with highly calibrated instruments that measure each dose to a finite amount and guarantee potency. Potency will not be less than stated, ensuring that abuser will not get “ripped-off”, and likewise, potency will not be greater than stated, thereby “mitigating” the risk of overdose. Such finite measurements also facilitate crushing and mixing of pills of different classes to enhance euphoric effects.

The euphoric effects of Suboxone are attractive to these adolescents who lack the developed tolerance for opiates which the experienced veteran abuser has. Suboxone is about 20-30 times more potent than morphine as an analgesic; and like morphine it produces dose-related euphoria, drug-liking, papillary constriction, respiratory depression and sedation. As noted above, it is also addictive.

Adolescent non-drug addicts can quite easily get “high” from a single Suboxone pill (the euphoric effect can be further enhanced by crushing and snorting the pill). In this group, experts predict a future generation of addiction-challenged individuals as their tolerance and experiences increase and their needs are met by increased intake or by combining with different classes of drugs or alcohol.

Doctors are permitted to prescribe as many as 30 take-home pills per visit, so federal regulators now acknowledge that some users seem to be injecting the crushed tablets to get high, that there exists a thriving street market for the drug and that certain doctors seem to be prescribing the drugs outside of the bounds of good medical practices.

Dr. Charles R. Schuster, former director of NIDA, explains that, "A small minority of doctors are not practicing good medicine." He contends that although it may be legal for a doctor to prescribe a full 30 day supply after a first visit, it is neither expedient nor good care, and contends that doctors should get to know patients prior to prescribing full dosage quantities.

("Getting High on Suboxone? The FDA Says It's Happening - Ex NIDA Director Blames Doctors." February 24, 2008)

Nationally, at least 1,350 of 12,780 buprenorphine doctors have been sanctioned for offenses that include excessive narcotics prescribing, insurance fraud, sexual misconduct and practicing medicine while impaired. Some have been suspended or arrested, leaving patients in the lurch.

In Ohio, 449 doctors were authorized to prescribe buprenorphine (2013), and around 16% had been disciplined.

The New York Times says the addiction drug was a “primary suspect” in 420 deaths in the United States reported to the Food and Drug Administration since it reached the market in 2003, according to a Times analysis of federal data. 

But buprenorphine is not being monitored systematically enough to gauge the full scope of its misuse, some experts say. The Centers for Disease Control and Prevention does not track buprenorphine deaths, most medical examiners do not routinely test for it, and neither do most emergency rooms, prisons, jails and drug courts. 

Still, Dr. John Mendelson of San Francisco, a consultant for the company that manufactures Suboxone (Reckitt Benckiser), said it could be proud of its management of a difficult product. “Their biggest success so far,” he said, “is that the whole system has not imploded, that enough doctors have prescribed the drug appropriately that there has been no move to withdraw it from the market.”

(Deborah Sontag. "Addiction Treatment With a Dark Side." The New York Times. November 16, 2013)

The general consensus, however, is that even with a certain level of abuse, Suboxone therapy remains one of the most promising treatments for opiate addiction.

An estimated 2.5 million Americans were dependent on or abused opioids in 2012, mostly painkillers, although heroin dependence has skyrocketed, with the number of addicts doubling over a decade to 467,000, government data indicate. In 2010, the last year studied, 19,154 people died of opioid overdoses.

“Had buprenorphine never been released and all we had was methadone, that number would be much higher,” said Dr. Andrew Kolodny, the president of Physicians for Responsible Opioid Prescribing. 


Sunday, September 28, 2014

Enforcement and the Poor -- Equality Should Be Our American Birthright

When you are a poor person without all the window dressings of others living "the good life," you cling to your basic beliefs with desperate tenacity because they are the tenets of your existence. Two of those important views are your trust in equality and your belief in justice. Your faith holds that these qualities are your birthright and a lifelong inheritance from your ancestors.

Along with your classmates from all economic and social levels, you are taught that the guiding first principle of the American founding, according to the Declaration of Independence, is that "all men are created equal." You read that Abraham Lincoln confirmed this in his Gettysburg Address, proclaiming nearly a century after the Declaration that America was still "dedicated to the proposition that all men are created equal."

Yet, based on experience, many less fortunate soon find that the rich and the politically connected receive special favor. One example of that favor is the privilege afforded to police and the apparent disregard some enforcement officers have for the rights of others. The detrimental aspects of police misconduct cannot be overstated.

In terms of public trust for law enforcement, a Gallup Poll shows that only 56 percent of people rated the police as having a high or very high ethical standard as compared with 84 percent for nurses.

("Nurses Shine, Bankers Slump in Ethics Ratings." Gallup Poll News. November 24, 2008)

In enforcement, Virtue ethics emphasizes the role of an officer's character and the virtues that the person's character embodies for determining or evaluating ethical behavior. It relies on dispositional qualities, such as personality traits, values, or attitudes, to explain deviant behavior.

For example, if officers fabricate evidence to obtain search warrants, their actions reflect their dishonest character. According to this view, character predisposes officers to act certain ways, regardless of the situation. 

Findings from the fifth round of the European Social Survey (ESS) confirm that unsatisfactory police contact damages trust and erodes legitimacy. Those who regard the police as lacking in legitimacy also express less consent to the rule of law, less willingness to co-operate with the justice system, and more likelihood to break laws.

The ESS findings support the idea that fair and respectful treatment by the police generates trust and bolsters police legitimacy. Legitimacy finds practical expression in people's sense that they are under a moral obligation to defer to police officers and to comply with the law. When the justice system enjoys legitimacy, people believe that they should comply with the law and that it is unacceptable to use violence to achieve their own social or political goals.

 (Mike Hough, Jonathan Jackson, and Ben Bradford. "Reading the Riots."
The Guardian. December 12, 2011)

Professor Mike Hough, co-director of the Institute for Criminal Policy Research at the University of London, explains ...

"Our research lends support to the Danish adage that trust arrives on foot and leaves on horseback. The negative effect of one poorly handled stop-and-search may have implications far beyond an immediate sense of annoyance. Once police have lost the trust of the policed, it can be very hard to regain it."

The poor victims of unsatisfactory police contact lose all precious hope that justice reigns supreme.
These common folk, especially those without any political connections, find they are just second-class citizens who are often manipulated by a ruling class that dictates what is "appropriate" police action.

To them, equality and justice become nothing but inky symbols on paper. As they realize their superiors, at best, merely tolerate their existence, they understand although they are supposed to be "endowed by their Creator with certain unalienable rights," they face unfair treatment in their pursuit of life, liberty, and happiness.

In fact, the poor become the scapegoats for crime in a system that favors inequality. Critical criminologists warn: “Greater investment in criminal justice is consistent with a political economy devoted to increasing capital for the wealthy while subjecting the lower classes to coercive measures of social control.”
(Michael Welch. Punishment in America. 1999)

In his book The Rich Get Richer and the Poor Get Prison, author Jeffrey Reiman illustrates the injustices experienced by lower classes at each level of the criminal justice system: definitions of crimes, policing, arrest procedures, court proceedings and representation, and finally sentencing.

Reiman acknowledges there has been increased prosecution and punishment of white collar crime, but he emphasizes the rich are not caught, processed, prosecuted, and sentenced as severely or as often as the poor. The poor and indigent fall through the cracks.

During the past twenty years, the gap has widened between the rich and the poor; therefore, “the rich get richer and the poor get prison.” Reiman compares the American criminal justice system to a mirror, “in which a whole society can see the darker outlines of its face…what is justice and what is evil.” His book claims the systems does not attempt to “eliminate crime or to achieve justice,” rather it reinforces the image that the “threat of crime” is a “threat from the poor.” 

(Liza Lugo, J.D. "Prison for the Poor, Riches for the Rich." 2012 and 
Jeffrey H. Reiman. The Rich Get Richer and the Poor Get Prison. 2000)

The confidence of the American people in the system of criminal justice likely depends upon their standing on the economic ladder. Without equality, is it any wonder the poor feel neglected and deprived of their rights? The political influence of the well-to-do is not something new: it is a continuation of practices used to maintain controls that have been perpetrated upon the masses for centuries.

The justification of the holding of power by enforcement is created when we believe that justice institutions have a set of moral values that align with our own. This is known as moral alignment, in which normative justifiability of power creates political obligations through a sense of shared goals.  

Perhaps the biggest question is "Do the majority of American citizens sense their values are aligned with the values of the justice system?"

I think Reiman was correct when he wrote ...

"The American criminal justice has failed to reduce crime and has failed to protect society’s most vulnerable citizens, the poor. Therefore, in line with the Declaration of Independence, 'whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it.' Thus the criminal justice system will have to change in order to protect society, maintain order, and preserve justice."

"To say we trust you means we believe you have the right intentions toward us and that you are competent to do what we trust you to do." 

--R. Hardin

Friday, September 26, 2014

Suboxone Abuse: Tales and Truths

Suboxone is a drug that was developed by Reckitt Benckiser, a British pharmaceutical company, for treatment of addiction to drugs like heroin, hydrocodone, OxyContin, morphine, codeine, fentanyl and others. It was approved by The Food and Drug Administration in 2002 for such use.

Suboxone prevents withdrawal when someone stops taking opioids by producing effects similar to those drugs. Therefore, it is considered a "partial agonist," binding to opioid receptors in the brain and producing endorphins, the so-called "happy hormones," but not as many as full agonists such as morphine or methadone. Doctors say this makes it more difficult to abuse.

Sadly, almost as soon as it was approved, Suboxone began to be abused by some individuals. Here is a report from the Louisville Courier-Journal about three people who did just that:

1. Kenny

Kenny Stearns III first took Suboxone to help him kick OxyContin after an overdose. At first, Stearns melted Suboxone tablets under his tongue. But it wasn't long before he began dissolving Suboxone strips in water and shooting the mixture into his veins.

His life spiraled so far out of control that he was kicked out of a homeless shelter for drug use. "The first few times I used it, I could get really high from it. Then I just felt normal ... I wasn't high, but I wasn't sick either," said the 25-year-old from New Castle, Indiana. "To me, it's just trading one addiction for another."

Looking back, Stearns said he went to the wrong doctor — one who did nothing but prescribe Suboxone, accepted only cash and never offered counseling.

Stearns said he stayed off other drugs for a little while but soon returned to meth, using Suboxone as a "backup."

2. Nicholas

Nicholas Merola, of southeastern Ohio, said he also first got Suboxone from a cash-only doctor. He recalled being prescribed a month's worth of tablets, taking half a tablet a day and selling the rest. Over the next four years, he said, he did the same with prescriptions from 10 other doctors.

"If I would've took it as prescribed, I'd probably be pretty doped up. Taking half a day, it made me feel not sick," Merola said. "There are two reasons people take it: to get off drugs, and as a crutch to keep from getting dope-sick."

3. Evan

Evan Blessett of Jeffersonville, Ind., said some Suboxone users simply use the drug to get high. That's why he tried it at 17, buying it from a friend with a prescription.

"I liked it," said Blessett, 27, who previously had abused alcohol, marijuana and pain pills. "It was very similar to OxyContin, a heavy, sedative feeling."

Like Stearns and Merola, Blessett got hooked. He began selling his Suboxone for $20 to $30 apiece, using the money to fuel his habit.

All three men are now in recovery, Stearns and Blessett at The Healing Place and Merola at Chad's Hope Teen Challenge in Manchester, Kentucky. None is a fan of Suboxone.

(Laura Ungar. "Addiction Medicine Suboxone Now Being Abused." The Louisville Courier-Journal. 5, 2014)

The drug Suboxone seem safe, since it comes from a doctor, and it might also be cheap to purchase. The problem is that no one can deny Suboxone is increasing being abused. It is sold on the streets and inappropriately prescribed.

In a recent report published in the Journal of Addictive Diseases, the Center for Substance Abuse Research at the University of Maryland warned “there may be an epidemic of buprenorphine misuse emerging across the U.S.” because Suboxone was being so widely prescribed to treat addicts.

Researchers said addicts were smuggling buprenorphine into jails and the drug’s street value was growing because it doesn’t show up in drug tests.

(Meredith Y. Smith PhD. "Abuse of Buprenorphine in the United States: 2003-2005." Journal of Addictive Diseases, Volume 26. 2007)

People who choose to abuse Suboxone are likely to have abused opiates over a long period of time. They may simply abuse Suboxone as a way of preventing withdrawal symptoms from heroin or other opiate addiction, or they may wish to get high or simply be curious about the effect of the drug.

Prescribers who choose to abuse Suboxone usually have a troubled past and questionable practices. They find the Suboxone trade lucrative. To effectively treat addicts with Suboxone, physicians need only eight hours of required training. Many Suboxone clinics are cash-only establishments. Unless they are caring professionals who closely monitor patients and ensure they receive counseling or similar support, their carelessness causes abuse.

The U.S. Drug Enforcement Administration reports that 9.3 million prescriptions for buprenorphine (the mixed agonist-antagonist opioid receptor modulator in Suboxone) were filled in the United States in 2012.

Laura Ungar reports that prescriptions for Suboxone and its generic equivalent rose 63 percent in Kentucky between the first quarter of 2012 and the first quarter of this year, to 113,713 from 69,640.

Statistics like this suggest that medications like Suboxone are just readily available, and it might be all too easy for curious people to seek out the drug as a reasonable substitute for heroin or prescription painkillers.

"Suboxone abuse is huge," says Karyn Hascal, president of The Healing Place, a Louisville recovery facility. "For some, it's their primary drug of addiction. They're choosing it over other drugs."

We all know drugs thrive in troubled regions. The markets for Suboxone --  legitimate and illegitimate -- reflect this activity in regions with rampant prescription abuse and heroin abuse. And, of course, such hotbeds of activity have limited drug-treatment options.

The Bottom Line

I agree with Kentucky Attorney General Jack Conway, who said. "Some people desperately need Suboxone. (But) I view it as a treatment of last resort ... not a magic pill for addiction." Suboxone can be a lifesaving treatment when prescribed correctly, monitored closely and coupled with therapy or a support group.

"This is a double-edged sword. We want as many people as possible to get help, but we don't want the abuse," says Van Ingram, executive director of the Kentucky Office of Drug Control Policy. He continued: "Here's the deal: If you take it as prescribed, it can help you."

A 2008 study in the Journal of the American Medical Association showed that addicted youths who took Suboxone for 12 weeks were less likely to use opioids, cocaine or marijuana, or to drop out of treatment, than those who received only short-term detox and counseling.

Officials agreed that Suboxone can help some addicts kick drugs. That is why they don't want to cut off access for legitimate patients.

But, to me, nothing is slimier than a treatment facility that abuses. The control of a substance like Suboxone is crucial. The old line against the use of the drug is "You're merely trading one addiction for another." And, even if that holds some truth, a person who needs Suboxone to survive is a most worthy candidate for receiving continued medication. Yet, a medical clinic dedicated to saving lives that, instead, breaks the law and contributes to abuse is evil. It is the worst of licensed killers.

Nothing will convince me that any minuscule illegal prescribing or any intentional misstep involving drug trafficking, money laundering, or insurance fraud by a treatment facility should be tolerated. If illegal activity in Suboxone clinics occurs, the people involved are operators of pill mills. They know better and still choose to get their greedy hands on the object of their supreme affection -- big money.

"Let me share my story a little with you. I was a heroin addict. 2 years ago I went on methadone until I thought I was ready to taper last summer. I went to a medical detox for a week and left with a script of suboxone. I came off 90 mgs of methadone and went on 2 mgs of subx. I stayed n subx for about 4 months until I ran out. I thought I was ready to do this on my own. It just seemed like the best choice. I stopped subx and within a week I was driving into the city to cop heroin just to ease the withdrawal of subx. Made sense at the time.

"Withing a month I had a dope habit. Then last December I went back to a good subx Dr and went back on about 2 mgs. It's been 7 months and i am in no hurry to get off. My life hasn't been this good since before I started using heroin.

"I'm not saying this will happen to you, just be very careful because the opiate, she works in mysterious ways."

Thursday, September 25, 2014

Raid on Drug Treatment Facilities of Paul Vernier

I admit I am stupidly gullible and even more distrustful of so-called treatment facilities in Scioto County. The news today has made me wonder about the good intentions of drug abuse facilities. There are credible, wonderful rehabs and treatment services, but my experience with pill mills makes me wonder about who is making illegal money and how they handle shady operations.

I posted this in the Facebook group "Missing -- Help Find Megan Lancaster" on September 15, 2014:

"Wonderful people are helping renew the efforts to find Megan Lancaster. Paul and Sherry Vernier own Community Counseling and Treatment Services as well as Hand of Hope in Ashland, Kentucky. 

"These gracious folks are offering a reward of $5,000.00 for the return of Megan or evidence of her whereabouts. They pledged this money a year or so ago, but we need to remind people again of the reward. They hope these efforts lead to information that solves Megan's disappearance. God bless these wonderful people."

I am so regretful of my comments about the generosity of the Verniers. I apologize for my lack of knowledge. I feel terrible.

You see, three drug treatment facilities and the owner's home became the target of a raid Thursday, September 25, 2014.

According to Kristen Schneider and Dan Griffin of WSAZ news, local and federal officials executed search warrants at Community Counseling Treatment Services Center in Ironton, Ohio, as well as  two facilities in Portsmouth and the owner's home -- the accused is Paul Vernier.

Investigators searched the clinics in Portsmouth and Ironton, all owned by the same man, Paul Vernier, 52. Federal and state investigators are looking into the clinic's practices at locations in Scioto and Lawrence counties in Ohio.

They're looking for evidence in a drug trafficking and money laundering case they said has been in the works for more than a year. "It's what happens in a facility like this," said one employee, who wouldn't tell his name. 

The authorities said the owner of all the clinics, Vernier, and his staff took part in illegal activity including drug trafficking, money laundering, insurance fraud and forging prescriptions.

For now, investigators said Vernier hasn't been charged or arrested. 

"I think when money gets involved, you start not following the laws and rules and it catches up with you and I believe that's the situation we have here," said Lawrence County Sheriff Jeff Lawless.

Neighbors said they weren't surprised by the raid. "This place is killing our kids and grandkids, and when I saw that on the news, I was so happy, I said thank you Lord Jesus, for stopping people like this," said Sandy Cooper, a neighbor.

"I lost a son ten years ago on drugs, I've got two grandsons that's on drugs, and I'll do anything in this world to stop it," Cooper said.

 (Kristen Schneider and Dan Griffin. "Drug Treatment Facilities Raided in Lawrence, Scioto Counties." WSAZ News. September 25, 2014)

According to a prior news report in 2012, Vernier admitted he had been addicted for 25 years and said he wanted to open these facilities to help others.

A law passed in Ohio to help crack down on pill mills has helped fight distribution abuse, but investigators said it does not give them the teeth they need to fight illegal drug activity at places like treatment facilities.

House Bill 93 created stricter reporting requirements by doctors who prescribe drugs, it cleared up the definition of pain clinic and limits the amount of prescription drug doctors can dispense.

"House bill 93 prohibits employees of a pain clinic from being a convicted felon, Mr. Vernier is a convicted felon," said Scioto County Sheriff Marty Donini.

What House Bill 93 does not do: define who can work at these drug treatment facilities. That is why Vernier is able to legally own three of these "counseling" locations.

Damn It All!

So much controversy about opening any type of clinic or drug treatment facility erupted as these "counseling" locations opened. The fight against the pill mills was long, hard, and extremely complicate.

To me, the bottom line was that if lives were saved through their operation, the new facilities were  needed. That was then; this is now. Oh, no ... why in the hell do I trust people? Greed and the love of money have once again raised their ugly heads in the illegal drug game. It seems the risk is worth the fortune for a never-ending line of corrupt owners, doctors, pharmacists, and health workers.

I know Paul Vernier is innocent until proven guilty. Yet, unless a lot of investigators have wasted tons of time and effort on nothing but speculation, Mr. Vernier is no better than the evil pill mill criminals of the past. I don't mind controversy over substances used to help real, honest recovery, but the bastards who abuse their practices are the worst of the worst. They gorge on riches dependent on maintaining other people's misery and pain.

I was in the Statehouse and witnessed the unanimous vote that passed House Bill 93. I hoped it would be the beginning of the end of prescription drug abuse in Scioto County and in Ohio. Those days I had faith that a majority of the populace would rise up and continue the struggle to rid our neighborhoods of a deadly health epidemic. I should have known greed and the corruption of the drug trade have no end.

Now, with heroin and crooked drug treatment centers taking the place of opioids and pill mills, the crisis in Scioto County continues. The fix of love for money and the fix of artificial euphoria are sure to keep business going strong. It is the law of supply and demand, and now even the most noble of professions routinely deal in dark corners.

I feel betrayed and strangely justified. I don't give a damn for any of those who use this whole mess for profit or for pleasure. I do not want one innocent person to die because of drug abuse, but I hope those who are involved in illegal distribution and dealing are prosecuted to the fullest extent of the law. I hate the fortune schemers and the dream killers. I believe they put their souls in the balance as they reap their blood money.

Now, Mr. Vernier, I fully understand how you could be so generous offering a huge reward for the return of Megan Lancaster. I have been a foolish man, but I have a clean conscience.

**NOTE: I am amending this initial blog entry to apologize to Mr. Vernier for judging him before he is arrested. I have been very harsh here because my hatred for abuse is very strong. I don't personally know if Paul Vernier is guilty of abuse. I pray he is not. I know we cannot judge something without evidence. I am sorry for jumping the gun, Mr. Vernier. 

Many tell me Vernier has been "framed" and that he is a good man. I take back my attack on him personally. If he has been the victim of law enforcement, I hope he vindicates himself. I promise to help him with such efforts.

“The point is, there is no feasible excuse for what are, for what 
we have made of ourselves. We have chosen to put profits 
before people, money before morality, dividends before decency, fanaticism before fairness, and our own trivial comforts before 
the unspeakable agonies of others.” 

 --Iain Banks, Scottish author

Chronic Drinkers and Smokers Are Costly Junkies

If we really, really want to face the problem of drug abuse as it relates to the financial woes of America, we have to consider substances many consider less harmful than illicit drugs. We must take a long look at the damage inflicted by tobacco and alcohol. These substances drain money from our economy just as much, or more than illegal substances.

Abuse of tobacco, alcohol, and illicit drugs is costly to our Nation, exacting over $600 billion annually in costs related to crime, lost work productivity and health care.

Health Care Overall
Tobacco $96 billion $193 billion
Alcohol $30 billion $235 billion
Illicit Drugs $11 billion $193 billion

("National Threat Assessment." Centers for Disease Control and Prevention
and the National Drug Intelligence Center. 2010)

Much less stigma is associated with people who abuse tobacco and alcohol than with those who abuse illicit drugs.

In many ways, this is understandable considering the great risks with consuming illicit substances such as overdose and criminal behavior; however, research by the National Institute on Alcohol Abuse and Alcoholism found that approximately 46 million adults used both alcohol and tobacco in the past year, and approximately 6.2 million adults reported both an AUD (co-occurring tobacco and alcohol use disorder) and dependence on nicotine.

(D.E. Falk,  Hsiao-ye Yi, and S. Hiller-Sturmhöfel, S. "An Epidemiologic Analysis of Co-ocurring Alcohol and Tobacco Use Disorders." Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health  29. 2007)

Alcohol and tobacco are among the top causes of preventable deaths in the United States. Multiple cancers, lung disease, and heart disease (cardiovascular disease) are major killers resulting from alcohol and tobacco abuse.

(A.H. Mokdad, J.S. Marks, D.F. Stroup, and J.L. Gerberding. "Actual Causes of Death in the United States." JAMA: Journal of the American Medical Association 291:1238–1245, 2004.) 

Moreover, a substantial body of research over many years has shown these substances often are used together. Studies have found that people who smoke are much more likely to drink, and people who drink are much more likely to smoke.

(J.K. Bobo and C. Husten, C. "Sociocultural Influences on Smoking and Drinking."  
Alcohol Research & Health 24. 2000)

Dependence on alcohol and tobacco also is correlated: People who are dependent on alcohol are three times more likely than those in the general population to be smokers, and people who are dependent on tobacco are four times more likely than the general population to be dependent on alcohol.

(B.F. Grant, D.S. Hasin, S.P. Chou,et al. "Nicotine Dependence and Psychiatric Disorders in the United States." Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 6. 2004)

Teach Your Children Well

The 14th annual survey conducted by the National Center on Addiction and Substance Abuse (CASA) at Columbia University examined the impact of parental attitudes on certain teen behaviors. The resulting statistics and figures quantify the behaviors of teens based upon the example and attitudes of their parents.

* Just over half of the 17-year-olds surveyed have witnessed one or both of their parents drunk, and about a third of 12- to 17-year-olds have witnessed one or both of their parents drunk.

* Compared to young people who have not seen their parents drunk, teenagers who have are more than twice as likely to get drunk themselves in a typical month.

* Those teens who get drunk regularly are three times more likely to use cannabis (marijuana) and smoke cigarettes.

* The use of marijuana and alcohol often leads to even more risky behavior involving alcohol, drugs and sex, and associating with others who are involved in harmful behavior.

* The drinking teens were 18 times more likely to have tried marijuana, three times more likely to have friends who use marijuana and four times more likely to be able to get marijuana in an hour.

* Over a quarter of teens say marijuana is easier to find than beer, cigarettes or prescription drugs.

* These teens are nearly four times more likely to know peers who abuse prescription drugs and more than twice as likely to know peers who use illegal drugs such as cocaine, methamphetamines, heroin, ecstasy or LSD.

("Parents Influence Teens' Attitudes Toward Drinking and Smoking." October 26, 2009)

This study makes an association between parents and their children very clear: teens' behavior is strongly associated with their parents' behavior and expectations, so parents who expect their children to drink and use drugs will have children who drink and use drugs.

Bottom Line

Oh, I can hear the arguments against this proposition already.

Let's see. Social drinkers and discrete smokers will deny that anything in moderation can possibly cause such ill effects.

Then, those who preach "Do as I say, not as I do" will chime in about the difference between adults making risky personal decisions and raising their children not to make the same "mistakes."

Then, of course, the Constitutional evangelists will wave Old Glory and scream about their rights of expression while citing the colorful American history of tobacco, alcohol, and liberty. (In the background, strains of Steve Earl's "Copperhead Road" will be heard.)

Yet, after all the hubbub about the acceptance of smoking and drinking finally recedes, there remains stark reality and a bitter pill for all of us to ingest. Nothing is good about the vices of smoking and drinking. Nothing.

The only difference between legal and illegal consumption of unhealthy drugs that cost us immeasurable money, misery, and death is a questionable governmental judgment that we are better off without illicit substances yet strangely tolerable of similar, popular sources of equal corruption.

Hell, I don't like the facts either. But, if we truly want to improve our standards of health and stop wasting money dealing with those who abuse drugs, we have to face highly prevalent alcohol and tobacco abuse.

Does it bother you to say that the war of drugs must include controlling these two substances? It bothers me: my father was a cigarette salesman long ago, and I enjoy drinking beer. But I know the truth sometimes is very painful, hard on our held beliefs and hard on our clouded perception.

It must be said: If you are a chronic smoker or drinker, you may be negatively influencing the lives of your children. God forbid you are recklessly wielding the hammer that drives their last coffin nails. If you both smoke and drink with abandon, your dependency likely doubles that chance.

Read this and weep:

Cigarette smoking causes about one of every five deaths in the United States each year. Cigarette smoking is estimated to cause the following:
  • More than 480,000 deaths annually (including deaths from secondhand smoke)
  • 278,544 deaths annually among men (including deaths from secondhand smoke)
  • 201,773 deaths annually among women (including deaths from secondhand smoke)
(Centers For Disease Control and Prevention. 2014)

Excessive alcohol use led to approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) each year in the United States from 2006 – 2010, shortening the lives of those who died by an average of 30 years.

(Centers for Disease Control and Prevention. 2014)

Alcohol-Attributable Deaths Due to Excessive Alcohol Use
Average for Ohio 2006-2010
  • All Ages

Harmful Effects Summary

Chronic Causes1,455997458
Acute Causes1,8331,284549
Total for All Causes3,2882,2811,007

Harmful Effects
Chronic CausesOverallMalesFemales
Acute pancreatitis321814
Alcohol abuse604713
Alcohol cardiomyopathy23194
Alcohol dependence syndrome816417
Alcohol polyneuropathy000
Alcohol-induced chronic pancreatitis220
Alcoholic gastritis000
Alcoholic liver disease503370133
Alcoholic psychosis19145
Breast cancer (females only)19019
Chronic hepatitis< 1< 1< 1
Chronic pancreatitis835
Degeneration of nervous system due to alcohol660
Esophageal cancer29263
Esophageal varices22< 1
Gastroesophageal hemorrhage< 10< 1
Ischemic heart disease402911
Laryngeal cancer14122
Liver cancer423210
Liver cirrhosis, unspecified312172141
Low birth weight, prematurity, IUGR, death*963
Oropharyngeal cancer19163
Portal hypertension< 1< 10
Prostate cancer (males only)10100
Spontaneous abortion (females only)000
Stroke, hemorrhagic816714
Stroke, ischemic22165
Superventricular cardiac dysrthymia1578
Acute CausesOverallMalesFemales
Air-space transport220
Alcohol poisoning413110
Child maltreatment743
Excessive blood alcohol level000
Fall injuries324163161
Fire injuries432518
Firearm injuries330
Motor-vehicle nontraffic crashes862
Motor-vehicle traffic crashes38529986
Occupational and machine injuries550
Other road vehicle crashes651
Poisoning (not alcohol)401260141
Suicide by and exposure to alcohol110
Water transport110

(Centers for Disease Control and Prevention. 2014)

The Toll of Tobacco in Ohio

High school students who smoke 15.1% (95,000)
Male high school students who use smokeless or spit tobacco 15.1% (females use much lower)
Kids (under 18) who become new daily smokers each year 11,900
Packs of cigarettes bought or smoked by kids each year 28.0 million
Adults in Ohio who smoke 23.3% (2,069,100)

Deaths in Ohio from Smoking

Adults who die each year from their own smoking 17,700
Kids now under 18 and alive in Ohio who will ultimately die prematurely from smoking 259,000

Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined — and thousands more die from other tobacco-related causes — such as fires caused by smoking (more than 1,000 deaths/year nationwide) and smokeless tobacco use.

(Campaign For Tobacco-Free Kids. 2014)