Time for a change.. MAT in corrections.. SAMHSA blog post

For persons with an opioid use disorder who are in the criminal justice system, the process of transitioning from jail or prison back to the community can be overwhelming. Within three months of release from custody, 75 percent of people who were in prison or jail with an opioid use disorder experience a relapse to opioid use. It is also alarming that incarcerated persons who are released to the community are between 10 and 40 times more likely to die of an opioid overdose than the general American population—especially within a few weeks after reentering society. As we observe March as National Criminal Justice Month, I’d like to call attention to SAMHSA resources and grant programs that are tackling this issue head-on.

As a society, we face the difficult challenge of preventing people with opioid use disorder reentering the community from relapsing and overdosing on opioids. However, it is possible through the use of medication-assisted treatment within the fabric of the criminal justice system. Medication-assisted treatment (MAT) is an evidence-based treatment for opioid use disorder that uses FDA-approved pharmacotherapy in combination with counseling and behavioral therapies to treat substance use disorders. Jails and prisons have been slow to offer this form of treatment, despite the overwhelming evidence of the effectiveness of MAT. However, in reaction to the current opioid epidemic, the criminal justice system is increasingly considering the use of MAT in drug courts, incarceration, reentry, and community corrections.  

For the past decade, SAMHSA has supported MAT and other forms of treatment for mental and substance use disorders, and trauma-related issues for people involved in the criminal justice system through discretionary grants, programs and resources. SAMHSA recently published two new guides, “Medication-Assisted Treatment in the Criminal Justice System: Brief Guidance to States” and “Principles of Community-based Behavioral Health Services for Justice-involved Individuals: A Research-based Guide.”

The SAMHSA brief, “Medication-Assisted Treatment in the Criminal Justice System: Brief Guidance to the States provides guidance to state governments on increasing the availability of MAT in criminal justice settings. By including the criminal justice system as a path to treatment, states may see an increase in access to and maintenance in treatment, and lower rates of overdoses, re-offending, and re-incarcerations. In this brief, states are provided an overview of the issue, the challenges to incorporating MAT, key considerations for establishing MAT in criminal justice settings, and existing standards and guidelines.

SAMHSA’s “Principles of Community-based Behavioral Health Services for Justice-involved Individuals:  A Research-based Guide” aims to assist community-based providers in their clinical and case management practice with the justice-involved population.  Intended for direct service providers, agency leaders and program developers, the principles articulated in this guide provide a foundation for achieving a quality, community-based behavioral health treatment system that is responsive to this population.  Eight key principles – reached by consensus – are described, followed by frequently asked questions, a table of evidence-based practices for substance use treatment for justice-involved individuals, and key resource materials. 

During fiscal year 2019, SAMHSA also funded 43 adult drug court grants, 12 family drug court grants and two reentry program grants and encouraged these programs to utilize MAT, as appropriate, with their program participants.  

It is always encouraging to hear personal success stories from SAMHSA grantees. Such an example was provided by a Project Director of a SAMHSA-funded drug court in Arizona. She recently shared the story of Patrick, one of her program graduates, who is now successfully working as a recovery support specialist for their MAT service provider. Patrick described his early struggles with anxiety and depression, becoming addicted to prescription drugs and later, heroin.  His addiction led him to several stays in jail and ultimately was sentenced to state prison. After release and new charges, Patrick was eligible for, entered and graduated from a drug court program. He offered that the source of his success was being able to participate in substance use treatment, and addressing his mental health issues through intensive counseling, job training, and receipt of MAT, which Patrick says “allowed the obsession for heroin to be lifted from the nooks-and crannies of my mind, heart, and soul.”

Treatment works and recovery from opioid use disorder is possible. If you or someone you know is looking for an opioid treatment program, visit

Purdue Pharma and other drug cartels..In Vermont

As a physician in the 1990’s in Vermont, I heard the sales pitch for Oxy Contin. I am an Ob/Gyn and didn’t think the medication applied to my patients. It seemed like a strong drug for patients dying of cancer. I never wrote a prescription for it.

I did note that many colleagues wrote for it, as well as, many other opioids.  I would hear of people going home with 40 oxycodone pills for a wisdom tooth extraction. A fellow Ob/Gyn, was chastised for crusading against over prescribing. People were given pain meds for headaches, menstrual cramps.  A local physician was known for just writing a script for the most minor complaints, mostly to poor patients who didn’t have access to yoga, massage or physical therapy.

I trained in an urban center, Buffalo, NY.  Many rotations were at the ECMC trauma center. Physicians there warned me of the risks of opioid pain medications. Oxycodone for back pain was just going to create a worse situation, it might be great for a few days but, in the long run the price was too high.. I often thought, we are creating use disorder for the patients being prescribed. What I never saw coming, was that the medicine cabinets in Vermont would be filled with these powerful dangerous drugs, often just kept on hand, just in case. That the victims, would actually be, the curious adolescents in the home.

My husband broke his ankle in 2010. It was pretty bad, he needed surgery. My husband was given three large prescriptions for a powerful opioid, #120 pills , three separate doctors wrote prescriptions. He took one tablet, and threw the rest away.

After all, our son struggled with substance use disorder and was fighting hard to stay sober at that time.  He ended up relapsing, not on any of the medication my husband was given (we kept it in a safe), just knowing the pills were in the house triggered him. He stole a bank card and ran away. he went missing for several weeks. We didn’t prosecute him, we offered treatment instead. It was one of the happiest days of my life, flying home from Minnesota, with Sean safely enrolled in a inpatient treatment program.

Sadly, most people I know with SUD have started with oral pain meds, prescribed sometimes, sometimes taken at a party.

The research by Sam Quninones for “Dreamland: The True Tale of America’s Opiate Epidemic” is an excellent resource for the absolute, reckless marketing of the new “pain vital sign” and ensuing campaign to coerce physicians into prescribing these dangerous drugs, all the while telling us they weren’t addictive.

I am grateful, I didn’t write for this medicine. I just wish my colleagues would have been more judicious. They wrote the scripts that are killing our kids. Most didn’t mean to create an epidemic. They just believed what they were told by the marketing campaign. Then, there are a few who knew darn well what they were doing and created the pill mills that added fuel to the fire.

There are complex issues at hand, reasons people become dependent, of course.  Many pharmaceutical companies do develop useful drugs for cancer, or heart disease. I just have to wonder how differently the situation might be if we didn’t have massive flooding of our communities by a pharmaceutical companies looking to make a buck, or a few billion

 

End of Summer

For our family, summer was a time of chaos and stress. In the beginning of cooler weather in Vermont, the quest for sobriety was real. No longer could nights be spent in a park or on the beach. the reality was homeless shelters, rehab or sometimes even jail.

Fall is a favorite time of year for me, maybe because I sought the stability that might come with it, the end to worry and frustration.  Oh, how I loved rehab, or a hospital stay. Not that I wished any frustration on my kid, I just wanted him to be safe, alive until he could figure it out.

I worked with German Lopez on a piece for Vox last month. As a followup, I was asked to do a podcast. Well, that was rough, revisiting the story, sharing voicemails and videos. I sure do miss my son’s beautiful voice. I always thought he would be great, sharing his poems in person, his voice resonating with all the emotion and feeling that sometimes words on a page cannot convey.

https://www.vox.com/policy-and-politics/2019/9/3/20750587/rehab-drug-addiction-treatment-sean-blake-opioid-epidemic

Speech by Michael Gaffney, Sean’s Best friend

This is the text of a memorial speech by Sean’s best friend, Mike. He gave a shortened version at the “OurStoriesMatter” event. I agree with his honesty and how we could have done better for Sean. I agree with his push for harm-reduction and medically proven therapy.

Introduction and spiritual well-being hopes.

As some of you know, Sean has been a close friend of mine for years, since Spanish at South Burlington High School. When I think of Sean, I am reminded in ways of St. Mark Ji Tianxing, both because of his patronage of opiate addicts and because of his complicated relationship with the Divine. St. Mark Ji Tianxing was unable to receive conventional Catholic salvation, due to an immature understanding of the nature of addiction on the part of his Confessor, but he pressed on towards Heaven, faithfully begging God daily for martyrdom, since he felt so ensnared by narcotics that freedom felt impossible but he knew that that death for Jesus would seal his fate for the good.

It is clear to me that God has been with Sean throughout his life. On the one occasion we broached the Eternal, attending Mass together, he promptly deposited the last dollar he had. Despite worrying before that he would “burst into flames” from having been far from the Church for so long, he was almost immediately rewarded with shelter and funds, bearing true the parables of Jesus in dramatic fashion. [Parable of the Widow who gave her last funds, amongst others] Of course, Sean had a much more convoluted walk than did St. Mark Ji Tianxing, but nonetheless the general direction of his path was clear to me. I thank the Lord that though Sean was unable to attain martyrdom as far as I know, and I’m uncertain even about his Last Rites, I was at least able to recite prayers in his presence which in our belief ought to hopefully help usher him to Paradise. Providence surely played a role at multiple levels. While his hobbies might’ve contributed to the early demise of his body, … compared to much of this town … , I worry little for the life of his soul. Ultimately, and fortunately, since my prayers have surely grown slack, he is now fully in the hands of the Most Merciful. We can be better, we must be better, and we will be better!

Memorializing and APPLAUSE Sean might best be remembered for his heroic sacrifices as a submariner. As anybody acquainted with the operations of a nuclear Navy is aware, a career path aboard submarines can easily lead to deployments on what constitutes a perpetual Schrodinger’s sentence of suicide. This is maddening for even the strongest of souls, and so in this light, the struggles of Sean can be seen as a continuing contribution to the defense of our very lives as Americans.

He made friends worldwide, one of the most remarkable things to me in the weeks after his death was the number of our friends I realized were impacted by his life, including individuals from countries a world apart. One of my fondest memories is eating at a Chilean restaurant in Midtown with two of our friends, along with the time we made a salad following Mongolian norms, off of Shelburne Road. He was of course known for his culinary capabilities. I’ll always remember his innovations—an egg in the Marinara. And a plate of quail wings he invented still makes my mouth water. His generosity extended to the table. I recall that during fatter times he provided me with enough healthy food to shed significant weight in a few months. His big heart extended to the many women in his life. While they sometimes fell head over heels, this was rarely reciprocated though they were always treated with respect, since Sean tried to keep his eyes fixed on greater things. I am reminded that at a point he perhaps managed to wed a beautiful lass though there were few accommodations made for the couple. I’m also reminded of St. Maximilian Kolbe, both because he is a patron of addicts, and because at Auschwitz [FACT-CHECK] he sacrificed his own life to save another’s. Somewhat similarly, Sean made known his organ donation wishes. And so shared the fire of life. Lamenting and accusing; sorrows section Of course, there were stressful times with Sean, and those must be discussed.

Let’s be truthful, we cannot blame beer or bud, we can’t even blame heroin, and while he can accuse himself, we certainly can’t blame Sean. We can, however, blame our collective inaction when it comes to the well-established covert Chinese chemical operations aimed at a disruption of our national vigor. And we can blame a need for action on one of the only proven solutions: potency-based sentencing, wherein the incentives of Chinese collaborators are aligned at least with the interest of honoring human life, by prosecuting in accordance with the potency and so the risk of fatality of seized narcotics. These same networks have been run by the Communists since the days of Korea and Vietnam, and as recent Congressional testimony has shown, they have continued at least in essence and adapted to turning Americans against our country by shipping synthetic opiates en masse to the desperate and the greedy and practically for free. It is necessary to stop or defang this flow, and in the interim, muzzle its public health bite.

We can also blame the “recovery” industry, in whose greedy modalities Sean was snared at times. While there are far more effective and scientifically proven treatments available, the 12-stepper’s promote a revolving door of recovery, rather than true improvement. That said, the programs are better than nothing, and are intended to provide a free sober socialization setting, which is a good and the hijacking of which for wanton profit is despicable. I bear much blame. Despite seeing one of my best friends forced to rely on drughouses and pushers for shelter because of the selfishness of his supposed loves ones, I was equally selfish, rarely offering him shelter in Vermont though I had every reason to trust him situationally. In New York, he was a reasonable houseguest, until our mutual poverties brought us to blows. Given an equitable economic distribution, he could’ve easily obtained employment and housing along with the many friends he earned each time, and even indulged his vices a bit—Lord knows some consume ten times the narcotics with a tenth the consequences. But most importantly, given each and every one of us having mercy on the addicts in our lives, we can ensure that our loved ones live.

I’m reminded of one time when Sean stormed out of a car with me and a few other men, bellowing “I just wanted my friend Mike,” and it was only much later, when I was leaving a bus and passed by someone I suspected might’ve been a distressed Sean, failing to offer him help, followed up by holding his dying body in a hospital bed, that I realized he was likely referring to myself. Adding to this accusation is the fact that I failed to send a letter intended for him during his imprisonment, despite being obligated by Conscience to do so, and I remain acutely aware that that letter could’ve perhaps saved his life. With Sean opening his eyes to these circumstances of neglect every single morning, his murder might’ve been mercy, and that horrifying conclusion must motivate us to change, to love, to actually care. And we must keep in mind that so many more are still suffering the same struggles, since Sean is both a statistic and a soul, so both symbolic and conclusive of the problem. Anything that would’ve worked for Sean we must offer to all those so afflicted, and anything that would’ve worked for anybody we have a duty to make available. STATISTICS Call for prosecutions, or explicit mention of mercy? We can be better, we must be better, and we will be better!

Call for action; anger/actualization We do need thoughts and prayers. Of course, we must do more. At a policy level, we want: A comprehensive evaluation of the factors and components of the drugs crisis, for example, housing policy. An ombudsman and office to serve as a voice for those suffering from the drugs crisis, e.g., in encounters with bureaucrats distributing thwacks and treats. Potency-based sentencing, with stiff penalties for negative outliers. The exploration of a short-term blanket amnesty (perhaps with reporting requirements) followed by a stark sharpening of penalties. At a philanthropic level, we want: • Memorial efforts • Hope for addicts, in the form of jobs, investment, and education. • Inclusive recreation and community centers; there’s a reason Vermont has among the highest rates of cannabis and alcohol use, and it’s shocking we have so few open community centers to alleviate this environmentally-induced ennui. And at a personal level, we must: Whatever you do, no money for the status quo, instead for things of relevance: musical library, lobbying, scuba, skiing, wildlife, etc. I promise you, had my friend been given a private bed, a spliff, and a sixer to go with his meals, so, a saner society, he would be speaking in my stead right now. We could’ve done better. We can be better, we must be better, and we will be better!

An Appendix: Props and Publications Sources: • Source for Chinese chemical warfare claims • Source for submarining claims • Source for VT drugs statistics. • Open with Ecclesiastes? Props: • Photo of quail wings

Our Stories Matter

ourstoriesmatter

Our Stories Matter   

 

Event to End Stigma for Mental Health Conditions and Substance Use Disorders

August 24th 5-7 pm

Oakledge Lower Pavilion, Burlington Vermont

 

Speakers share their personal stories,

Resource Fair,

Slideshow tribute to those lost,

Naloxone training,

Light refreshments

 

Presented by for-kindness.com

(Sean Blake’s family)

 

Have a family member you want to include in our slide show, send photo to blakestb@gmail.com

Mobilize Recovery

especially when you let it! Be kind to each other. (1).png

I recently returned from an amazing conference/training. The Voices Project is partnering with Facebook and several other recovery minded businesses.

It was inspiring and energizing. I felt drawn to doing more work in my own community to prevent substance use disorder and to help those who are afflicted with SUD and/or mental health issues.

Since returning home (via a short camp vacation) I got started planning an event to Stop Stigma regarding mental illness and substance use disorder. #OurStoriesMatter

It is still in the planning stages but, it will entail recovery speakers, book signing, Narcan training and a resource fair.

I have given an interview on costs of treatment to vox.com, and I have started attending a family action group in our state .I look forward to sharing some of the knowledge I gained over the last 10 years or so. I hope to be a resource for families and a recovery advocate.

More to follow…

 

Freefall

https://www.youtube.com/channel/UCVAv6b5_QFOux4TZGXfiddA

 

IMG-0890This movie was made by Riley, a high school student from Vermont. She made an award winning short version of the film and then transformed it into a longer more substantial piece.

As Sean’s Mom, I was asked to help with the film. Riley’s Dad was the ICU doctor who kept Sean alive the first night after his overdose. We weren’t sure of the extent of the brain damage but, we hoped he could get through the next 48 hours so a determination could be made.Unfortunately, the damage was severe. The transition to organ donation took place soon after it was determined that Sean have suffered brain death.

I really appreciated the compassion and care of the ICU team. So when asked I said of course I would help. I had no idea that the film would win awards or even be shown at a local cinema.

Of course, I wish I could have used some less stigmatizing language or paid more attention to my hair and make-up. However, it was filmed just a few months after he died and the emotions were pretty raw.

The real gift was I got to practice my story, or my version of Sean’s story. My husband and I presented Sean’s story a few weeks later to our city’s opioid task force. We have been able to testify at our local legislature. So much of this was possible because Riley,

took the time to encourage our story and perfect the message.  Sean was a beautiful person, afflicted by mental illness. A disease just like cancer or diabetes, unfortunately because the brain is affected, many choices are self sabotaging.

Riley is generously making the film available free and to the public.

Thank you!!

 

 

You’re Just A Marionette

Guest poet Halley Kunen

Halley and I met through Tumblr blogs, at the time I wrote an anonymous blog about parenting a child with substance use disorder. I had only a few followers..luckily Halley was one. I have appreciated her wit, wisdom and earnest posts, poems and messages.

You’re Just A Marionette

I saw something in those eyes
that sparked in me something different from the first time
blue pools of Persephone
a hidden fire
not sure what you used it for
but I’m tired of hurting
a magician uses the wand in a special way
with the key of timing
and that’s what you did
sleight of hand
all the better for clenching the secrets
you kept from everyone
what I could make of your smile
the edges sewn up like a marionette
encapsulating a life
in one dimension pacing in an abandoned cubicle
that was your trip home
while in the other world your space was full
or at least it temporarily felt that way.
I remember you used to write
you know how to use words
to mimick the touch on one’s abscessed spine
how do you cut to the core
when you don’t know yourself
and you don’t say what you mean
and I plead you do
but my expressions go right through you.
I’ve only seen your daughter
a few times it seemed like time slowed down
because I wanted to know her
to understand you
she looks more like her father
but the traces of you are in there

And when she speaks
she is just like you
I don’t know how to explain it
or to prove this
but

like her sudden spurts of energy
like when something brings her joy
I just hope she doesn’t use her grin the same way
I pray that she’s more free
I pray that your traits don’t rub on her
like how your mascara pours off when you fake cry
a waterfall
and your lashes fall into the street
composting the scraps of authenticity that fall to the wayside

And sometimes I think if I could meet your daughter
for more than a split second
I’d get the answers
but I know that isn’t true
other times I pray for amnesia
but I learned so much from you
even if it includes knives
to destroy myself.