Recovery: One Place on Earth Knows How to Stop Teen Substance Abuse

It’s a little before three on a sunny Friday afternoon and Laugardalur Park, near central Reykjavik, looks practically deserted. There’s an occasional adult with a pushchair, but the park’s surrounded by apartment blocks and houses, and school’s out – so where are all the kids?

Walking with me are Gudberg Jónsson, a local psychologist, and Harvey Milkman, an American psychology professor who teaches for part of the year at Reykjavik University. Twenty years ago, says Gudberg, Icelandic teens were among the heaviest-drinking youths in Europe. “You couldn’t walk the streets in downtown Reykjavik on a Friday night because it felt unsafe,” adds Milkman. “There were hordes of teenagers getting in-your-face drunk.”

We approach a large building. “And here we have the indoor skating,” says Gudberg.

A couple of minutes ago, we passed two halls dedicated to badminton and ping pong. Here in the park, there’s also an athletics track, a geothermally heated swimming pool and – at last – some visible kids, excitedly playing football on an artificial pitch.

Young people aren’t hanging out in the park right now, Gudberg explains, because they’re in after-school classes in these facilities, or in clubs for music, dance or art. Or they might be on outings with their parents.

Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.

The way the country has achieved this turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense. “This is the most remarkably intense and profound study of stress in the lives of teenagers that I have ever seen,” says Milkman. “I’m just so impressed by how well it is working.”

iceland-5.jpg

The country has created new opportunities for kids of all ages to get involved with the community

If it was adopted in other countries, Milkman argues, the Icelandic model could benefit the general psychological and physical wellbeing of millions of kids, not to mention the coffers of healthcare agencies and broader society. It’s a big if.

“I was in the eye of the storm of the drug revolution,” Milkman explains over tea in his apartment in Reykjavik. In the early 1970s, when he was doing an internship at the Bellevue Psychiatric Hospital in New York City, “LSD was already in, and a lot of people were smoking marijuana. And there was a lot of interest in why people took certain drugs.”

Milkman’s doctoral dissertation concluded that people would choose either heroin or amphetamines depending on how they liked to deal with stress. Heroin users wanted to numb themselves; amphetamine users wanted to actively confront it. After this work was published, he was among a group of researchers drafted by the US National Institute on Drug Abuse to answer questions such as: why do people start using drugs? Why do they continue? When do they reach a threshold to abuse? When do they stop? And when do they relapse?

“Any college kid could say: why do they start? Well, there’s availability, they’re risk-takers, alienation, maybe some depression,” he says. “But why do they continue? So I got to the question about the threshold for abuse and the lights went on – that’s when I had my version of the “aha” experience: they could be on the threshold for abuse before they even took the drug, because it was their style of coping that they were abusing.”

At Metropolitan State College of Denver, Milkman was instrumental in developing the idea that people were getting addicted to changes in brain chemistry. Kids who were “active confronters” were after a rush – they’d get it by stealing hubcaps and radios and later cars, or through stimulant drugs. Alcohol also alters brain chemistry, of course. It’s a sedative but it sedates the brain’s control first, which can remove inhibitions and, in limited doses, reduce anxiety.

“People can get addicted to drink, cars, money, sex, calories, cocaine – whatever,” says Milkman. “The idea of behavioural addiction became our trademark.”

This idea spawned another: “Why not orchestrate a social movement around natural highs: around people getting high on their own brain chemistry – because it seems obvious to me that people want to change their consciousness – without the deleterious effects of drugs?”

By 1992, his team in Denver had won a $1.2m government grant to form Project Self-Discovery, which offered teenagers natural-high alternatives to drugs and crime. They got referrals from teachers, school nurses and counsellors, taking in kids from the age of 14 who didn’t see themselves as needing treatment but who had problems with drugs or petty crime.

“We didn’t say to them, you’re coming in for treatment. We said, we’ll teach you anything you want to learn: music, dance, hip hop, art, martial arts.” The idea was that these different classes could provide a variety of alterations in the kids’ brain chemistry, and give them what they needed to cope better with life: some might crave an experience that could help reduce anxiety, others may be after a rush.

At the same time, the recruits got life-skills training, which focused on improving their thoughts about themselves and their lives, and the way they interacted with other people. “The main principle was that drug education doesn’t work because nobody pays attention to it. What is needed are the life skills to act on that information,” Milkman says. Kids were told it was a three-month programme. Some stayed five years.

It’s less common to see children out on the streets in Iceland, as many are in after-school programs and participating in recreational activities

In 1991, Milkman was invited to Iceland to talk about this work, his findings and ideas. He became a consultant to the first residential drug treatment centre for adolescents in Iceland, in a town called Tindar. “It was designed around the idea of giving kids better things to do,” he explains. It was here that he met Gudberg, who was then a psychology undergraduate and a volunteer at Tindar. They have been close friends ever since.

Milkman started coming regularly to Iceland and giving talks. These talks, and Tindar, attracted the attention of a young researcher at the University of Iceland, called Inga Dóra Sigfúsdóttir. She wondered: what if you could use healthy alternatives to drugs and alcohol as part of a programme not to treat kids with problems, but to stop kids drinking or taking drugs in the first place?

Have you ever tried alcohol? If so, when did you last have a drink? Have you ever been drunk? Have you tried cigarettes? If so, how often do you smoke? How much time to you spend with your parents? Do you have a close relationship with your parents? What kind of activities do you take part in?

In 1992, 14-, 15- and 16-year-olds in every school in Iceland filled in a questionnaire with these kinds of questions. This process was then repeated in 1995 and 1997.

The results of these surveys were alarming. Nationally, almost 25 per cent were smoking every day, over 40 per cent had got drunk in the past month. But when the team drilled right down into the data, they could identify precisely which schools had the worst problems – and which had the least. Their analysis revealed clear differences between the lives of kids who took up drinking, smoking and other drugs, and those who didn’t. A few factors emerged as strongly protective: participation in organised activities – especially sport – three or four times a week, total time spent with parents during the week, feeling cared about at school, and not being outdoors in the late evenings.

“At that time, there had been all kinds of substance prevention efforts and programmes,” says Inga Dóra, who was a research assistant on the surveys. “Mostly they were built on education.” Kids were being warned about the dangers of drink and drugs, but, as Milkman had observed in the US, these programmes were not working. “We wanted to come up with a different approach.”

The mayor of Reykjavik, too, was interested in trying something new, and many parents felt the same, adds Jón Sigfússon, Inga Dóra’s colleague and brother. Jón had young daughters at the time and joined her new Icelandic Centre for Social Research and Analysis when it was set up in 1999. “The situation was bad,” he says. “It was obvious something had to be done.”

Using the survey data and insights from research including Milkman’s, a new national plan was gradually introduced. It was called Youth in Iceland.

Laws were changed. It became illegal to buy tobacco under the age of 18 and alcohol under the age of 20, and tobacco and alcohol advertising was banned. Links between parents and school were strengthened through parental organisations which by law had to be established in every school, along with school councils with parent representatives. Parents were encouraged to attend talks on the importance of spending a quantity of time with their children rather than occasional “quality time”, on talking to their kids about their lives, on knowing who their kids were friends with, and on keeping their children home in the evenings.

A law was also passed prohibiting children aged between 13 and 16 from being outside after 10pm in winter and midnight in summer. It’s still in effect today.

Home and School, the national umbrella body for parental organisations, introduced agreements for parents to sign. The content varies depending on the age group, and individual organisations can decide what they want to include. For kids aged 13 and up, parents can pledge to follow all the recommendations, and also, for example, not to allow their kids to have unsupervised parties, not to buy alcohol for minors, and to keep an eye on the wellbeing of other children.

These agreements educate parents but also help to strengthen their authority in the home, argues Hrefna Sigurjónsdóttir, director of Home and School. “Then it becomes harder to use the oldest excuse in the book: ‘But everybody else can!’”

State funding was increased for organised sport, music, art, dance and other clubs, to give kids alternative ways to feel part of a group, and to feel good, rather than through using alcohol and drugs, and kids from low-income families received help to take part. In Reykjavik, for instance, where more than a third of the country’s population lives, a Leisure Card gives families 35,000 krona (£250) per year per child to pay for recreational activities.

iceland-2.jpg

Children between the ages of 13 and 16 are prohibited from being outside after 10pm

Crucially, the surveys have continued. Each year, almost every child in Iceland completes one. This means up-to-date, reliable data is always available.

Between 1997 and 2012, the percentage of kids aged 15 and 16 who reported often or almost always spending time with their parents on weekdays doubled – from 23 per cent to 46 per cent – and the percentage who participated in organised sports at least four times a week increased from 24 per cent to 42 per cent. Meanwhile, cigarette smoking, drinking and cannabis use in this age group plummeted.

“Although this cannot be shown in the form of a causal relationship – which is a good example of why primary prevention methods are sometimes hard to sell to scientists – the trend is very clear,” notes Álfgeir Kristjánsson, who worked on the data and is now at the West Virginia University School of Public Health in the US. “Protective factors have gone up, risk factors down, and substance use has gone down – and more consistently in Iceland than in any other European country.”

Jón Sigfússon apologies for being just a couple of minutes late. “I was on a crisis call!” He prefers not to say precisely to where, but it was to one of the cities elsewhere in the world that has now adopted, in part, the Youth in Iceland ideas.

Youth in Europe, which Jón heads, began in 2006 after the already-remarkable Icelandic data was presented at a European Cities Against Drugs meeting and, he recalls, “People asked: what are you doing?”

Participation in Youth in Europe is at a municipal level rather than being led by national governments. In the first year, there were eight municipalities. To date, 35 have taken part, across 17 countries, varying from some areas where just a few schools take part to Tarragona in Spain, where 4,200 15-year-olds are involved. The method is always the same: Jón and his team talk to local officials and devise a questionnaire with the same core questions as those used in Iceland plus any locally tailored extras. For example, online gambling has recently emerged as a big problem in a few areas, and local officials want to know if it’s linked to other risky behaviour.

Just two months after the questionnaires are returned to Iceland, the team sends back an initial report with the results, plus information on how they compare with other participating regions. “We always say that, like vegetables, information has to be fresh,” says Jón. “If you bring these findings a year later, people would say, Oh, this was a long time ago and maybe things have changed…” As well as fresh, it has to be local so that schools, parents and officials can see exactly what problems exist in which areas.

The team has analysed 99,000 questionnaires from places as far afield as the Faroe Islands, Malta and Romania – as well as South Korea and, very recently, Nairobi and Guinea-Bissau. Broadly, the results show that when it comes to teen substance use, the same protective and risk factors identified in Iceland apply everywhere. There are some differences: in one location (in a country “on the Baltic Sea”), participation in organised sport actually emerged as a risk factor. Further investigation revealed that this was because young ex-military men who were keen on muscle-building drugs, drinking and smoking were running the clubs. Here, then, was a well-defined, immediate, local problem that could be addressed.

While Jón and his team offer advice and information on what has been found to work in Iceland, it’s up to individual communities to decide what to do in the light of their results. Occasionally, they do nothing. One predominantly Muslim country, which he prefers not to identify, rejected the data because it revealed an unpalatable level of alcohol consumption. In other cities – such as the origin of Jón’s “crisis call” – there is an openness to the data and there is money, but he has observed that it can be much more difficult to secure and maintain funding for health prevention strategies than for treatments.

No other country has made changes on the scale seen in Iceland. When asked if anyone has copied the laws to keep children indoors in the evening, Jón smiles. “Even Sweden laughs and calls it the child curfew!”

Across Europe, rates of teen alcohol and drug use have generally improved over the past 20 years, though nowhere as dramatically as in Iceland, and the reasons for improvements are not necessarily linked to strategies that foster teen wellbeing. In the UK, for example, the fact that teens are now spending more time at home interacting online rather than in person could be one of the major reasons for the drop in alcohol consumption.

But Kaunas, in Lithuania, is one example of what can happen through active intervention. Since 2006, the city has administered the questionnaires five times, and schools, parents, healthcare organisations, churches, the police and social services have come together to try to improve kids’ wellbeing and curb substance use. For instance, parents get eight or nine free parenting sessions each year, and a new programme provides extra funding for public institutions and NGOs working in mental health promotion and stress management. In 2015, the city started offering free sports activities on Mondays, Wednesdays and Fridays, and there are plans to introduce a free ride service for low-income families, to help kids who don’t live close to the facilities to attend.

Between 2006 and 2014, the number of 15- and 16-year-olds in Kaunas who reported getting drunk in the past 30 days fell by about a quarter, and daily smoking fell by more than 30 per cent.

At the moment, participation in Youth in Europe is a haphazard affair, and the team in Iceland is small. Jón would like to see a centralised body with its own dedicated funding to focus on the expansion of Youth in Europe. “Even though we have been doing this for ten years, it is not our full, main job. We would like somebody to copy this and maintain it all over Europe,” he says. “And why only Europe?”

After our walk through Laugardalur Park, Gudberg Jónsson invites us back to his home. Outside, in the garden, his two elder sons, Jón Konrád, who’s 21, and Birgir Ísar, who’s 15, talk to me about drinking and smoking. Jón does drink alcohol, but Birgir says he doesn’t know anyone at his school who smokes or drinks. We also talk about football training: Birgir trains five or six times a week; Jón, who is in his first year of a business degree at the University of Iceland, trains five times a week. They both started regular after-school training when they were six years old.

“We have all these instruments at home,” their father told me earlier. “We tried to get them into music. We used to have a horse. My wife is really into horse riding. But it didn’t happen. In the end, soccer was their selection.”

Did it ever feel like too much? Was there pressure to train when they’d rather have been doing something else? “No, we just had fun playing football,” says Birgir. Jón adds, “We tried it and got used to it, and so we kept on doing it.”

It’s not all they do. While Gudberg and his wife Thórunn don’t consciously plan for a certain number of hours each week with their three sons, they do try to take them regularly to the movies, the theatre, restaurants, hiking, fishing and, when Iceland’s sheep are brought down from the highlands each September, even on family sheep-herding outings.

Jón and Birgir may be exceptionally keen on football, and talented (Jón has been offered a soccer scholarship to the Metropolitan State University of Denver, and a few weeks after we meet, Birgir is selected to play for the under-17 national team). But could the significant rise in the percentage of kids who take part in organised sport four or more times a week be bringing benefits beyond raising healthier children?

Could it, for instance, have anything to do with Iceland’s crushing defeat of England in the Euro 2016 football championship? When asked, Inga Dóra Sigfúsdóttir, who was voted Woman of the Year in Iceland in 2016, smiles: “There is also the success in music, like Of Monsters and Men [an indie folk-pop group from Reykjavik]. These are young people who have been pushed into organised work. Some people have thanked me,” she says, with a wink.

Elsewhere, cities that have joined Youth in Europe are reporting other benefits. In Bucharest, for example, the rate of teen suicides is dropping alongside use of drink and drugs. In Kaunas, the number of children committing crimes dropped by a third between 2014 and 2015.

As Inga Dóra says: “We learned through the studies that we need to create circumstances in which kids can lead healthy lives, and they do not need to use substances, because life is fun, and they have plenty to do – and they are supported by parents who will spend time with them.”

When it comes down to it, the messages – if not necessarily the methods – are straightforward. And when he looks at the results, Harvey Milkman thinks of his own country, the US. Could the Youth in Iceland model work there, too?

Three hundred and twenty-five million people versus 330,000. Thirty-three thousand gangs versus virtually none. Around 1.3 million homeless young people versus a handful.

iceland-1.jpg

Iceland’s government has made a long-term commitment to supporting the national project

Clearly, the US has challenges that Iceland does not. But the data from other parts of Europe, including cities such as Bucharest with major social problems and relative poverty, shows that the Icelandic model can work in very different cultures, Milkman argues. And the need in the US is high: underage drinking accounts for about 11 per cent of all alcohol consumed nationwide, and excessive drinking causes more than 4,300 deaths among under-21 year olds every year.

A national programme along the lines of Youth in Iceland is unlikely to be introduced in the US, however. One major obstacle is that while in Iceland there is long-term commitment to the national project, community health programmes in the US are usually funded by short-term grants.

Milkman has learned the hard way that even widely applauded, gold-standard youth programmes aren’t always expanded, or even sustained. “With Project Self-Discovery, it seemed like we had the best programme in the world,” he says. “I was invited to the White House twice. It won national awards. I was thinking: this will be replicated in every town and village. But it wasn’t.”

He thinks that is because you can’t prescribe a generic model to every community because they don’t all have the same resources. Any move towards giving kids in the US the opportunities to participate in the kinds of activities now common in Iceland, and so helping them to stay away from alcohol and other drugs, will depend on building on what already exists. “You have to rely on the resources of the community,” he says.

His colleague Álfgeir Kristjánsson is introducing the Icelandic ideas to the state of West Virginia. Surveys are being given to kids at several middle and high schools in the state, and a community coordinator will help get the results out to parents and anyone else who could use them to help local kids. But it might be difficult to achieve the kinds of results seen in Iceland, he concedes.

​Short-termism also impedes effective prevention strategies in the UK, says Michael O’Toole, CEO of Mentor, a charity that works to reduce alcohol and drug misuse in children and young people. Here, too, there is no national coordinated alcohol and drug prevention programme. It’s generally left to local authorities or to schools, which can often mean kids are simply given information about the dangers of drugs and alcohol – a strategy that, he agrees, evidence shows does not work.

O’Toole fully endorses the Icelandic focus on parents, school and the community all coming together to help support kids, and on parents or carers being engaged in young people’s lives. Improving support for kids could help in so many ways, he stresses. Even when it comes just to alcohol and smoking, there is plenty of data to show that the older a child is when they have their first drink or cigarette, the healthier they will be over the course of their life.

But not all the strategies would be acceptable in the UK – the child curfews being one, parental walks around neighbourhoods to identify children breaking the rules perhaps another. And a trial run by Mentor in Brighton that involved inviting parents into schools for workshops found that it was difficult to get them engaged.

Public wariness and an unwillingness to engage will be challenges wherever the Icelandic methods are proposed, thinks Milkman, and go to the heart of the balance of responsibility between states and citizens. “How much control do you want the government to have over what happens with your kids? Is this too much of the government meddling in how people live their lives?”

In Iceland, the relationship between people and the state has allowed an effective national programme to cut the rates of teenagers smoking and drinking to excess – and, in the process, brought families closer and helped kids to become healthier in all kinds of ways. Will no other country decide that these benefits are worth the costs?

By Emma Young

This article was first published by Wellcome on Mosaic and is republished here under a Creative Commons licence

Opioid and Heroin Overdoses Have Reached ‘Crisis Level’ In Maryland

When Carin Miller’s son was about 19 years old, he began to abuse heroin by snorting pills, eventually moving on to shooting up. This went on for six years before he got help.

Lucas Miller’s history of drug use started in high school with smoking marijuana. When he moved out of his parents’ house, one of his housemates had access to between 750 to 1,500 pills at any given time between five houses located in Frederick, Maryland.

“My son was addicted to heroin, he’s in recovery by the grace of God since Thanksgiving 2014, I think that’s where we are at,” Miller said.

Opioid overdoses now rank with cancer, strokes and heart attacks among the top killers in Maryland.

State and federal lawmakers have passed legislation aimed at addressing the crisis, although they and public health experts agree the battle will be long.

On April 10, the Maryland General Assembly passed several bills to address this ongoing statewide crisis. The Start Talking Maryland Act, HB1082, and the HOPE Act, HB1329, were both passed.

The HOPE Act would increase access to naloxone, an overdose-reversal drug and would require hospitals to establish a new protocol when discharging patients treated for substance abuse disorders. It also introduced Keep the Door Open, a provision that provides three years of funding to reimburse community health providers. The act also requires the Behavioral Health Administration to establish a crisis treatment center before June 2018.

The Start Talking Maryland Act would require schools to have defined education programs on opioid addiction.

Other opioid related bills passed by the General Assembly were HB1432, which places a restriction on the number of opioid painkillers a doctor can prescribe to a patient per visit, and SB539, a bill that sets new penalties for distributing fentanyl.

The opioid-related legislation have been sent to Maryland Gov. Larry Hogan’s desk for his signature. The governor has until May 30 to either sign or veto the 900 bills passed by the General Assembly; otherwise they automatically become law.

On March 1, Hogan signed an executive order, declaring a state of emergency in response to the heroin, opioids and fentanyl crisis “ravaging communities in Maryland and across the country.”

“We need to treat this crisis the exact same way we would treat any other state emergency,” Hogan said in a statement. “This is about taking an all-hands-on-deck approach so that together we can save the lives of thousands of Marylanders.”

The final numbers for 2016 are expected to show that approximately 2,000 people died from heroin and other opioid overdoses in the state over the last year, about double the number of deaths in 2015.

Additionally, drug overdose deaths rose by 19.2 percent from 2013 to 2014 in Maryland, according to a press release from Sen. Ben Cardin, D-Md.

“There’s no question, no question there has been a spike in opioid overdoses,” Cardin said in an interview with Capital News Service. “Let me indicate the numbers in Maryland are shocking as we are seeing the doubling and tripling over the last couple of years, but the Maryland numbers are typical to what we see all over the country.”

Both Cardin and Sen. Chris Van Hollen backed passage of the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act of 2015 (CARA). Van Hollen was a cosponsor for the 21st Century Cures Act.

“The opioid addiction epidemic is having a devastating impact on communities in Maryland and across the country,” Van Hollen said in a statement for Capital News Service. “I fought to pass the 21st Century Cures Act, which helps states expand programs to treat those suffering from addiction, but we must do much more to prevent substance abuse and to get help to those who need it.”

The 21st Century Cures Act was signed by President Barack Obama in December. It will provide $1 billion over two years for state grants to support opioid abuse prevention and treatment activities. CARA, a bipartisan bill, was signed into law by Obama last July. CARA assists drug-dependent newborns and their parents.

The federal Department of Health and Human Services has just awarded Maryland a $10 million grant under the 21st Century Cures Act.

“These grants are a small but encouraging step toward addressing the opioid crisis,” Rep. John Sarbanes, D-Towson, said in a statement. He was among those who pressed for the funds in the law. “But to make real progress in our effort to combat the epidemic, it’s the responsibility of Congress to provide additional resources to programs, families and communities in Maryland and across America that are working day in and day out to end the crisis.”

Van Hollen said there is more to be done with the crisis, including “protecting the significant investments made by the Affordable Care Act, and ensuring institutions like the National Institute for Drug Abuse at NIH in Maryland and others across the country have the resources necessary to carry out their critical missions.”

On March 29, President Donald Trump signed an executive order creating a presidential commission designed to combat opioid addiction and the opioid crisis nationwide. New Jersey Gov. Chris Christie is leading the commission.

A main reason for the doubling of overdoses for Maryland has been a new street drug, fentanyl, a powerful synthetic opioid that dealers are increasingly blending into regular heroin and selling cheaply.

Fentanyl is coming to the United States from China, and that needs to be stopped, Cardin said. The senator added that there also is work to be done with Mexico to stop heroin from flowing from that country.

“We’ve seen an abuse of using these drugs for pain and an abuse of people selling these drugs on the street and getting people addicted,” Cardin said. “There are things we can do to dry up the supply and help people who have addiction and health issues.”

In response to the rise in drug-related deaths, Hogan announced on March 1 that he has budgeted an additional $10 million per year to combat overdoses over the next five years.

Miller said Hogan’s action would help, but more money is needed from the federal government.

Miller is no stranger to opioid abuse as well. She said her husband, Greg Miller, had been abusing opioids since the late 1990s after he was hit by a drunk driver and had an additional, separate accident at work.

It reached a point where her husband’s withdrawals were so terrible that he almost died after being denied narcotics prescriptions at Frederick Memorial Hospital six years ago, Miller said.

“I was trying to get my husband off the pills, never thinking that my own kids would go on them after they saw the hell that I was put through,” Miller said.

Three years ago, Miller co-founded Maryland Heroin Awareness Advocates (MHAA), a grassroots organization in Frederick. It was founded “out of necessity,” by a group of women from Frederick in order to save their children from the opioid and heroin epidemic, Miller said.

“We have all been affected in some way, a lot of my colleagues have lost their children to overdoses,” said Miller, who is the president of MHAA.

Miller noted that there is not enough education about these drugs in schools. While one of her colleagues is invited into middle and high schools in Carroll County to give presentations, MHAA is “just nipping the bud” at giving presentations in Frederick County, Miller said.

Frederick County is a 40,000-student district with 10 high schools.

“We really give the principals the autonomy to address any issue in their community,” said Mike Maroke, Frederick County Public Schools deputy superintendent. “They determine if this is something be address or not.”

If the Start Talking Maryland Act is signed by Hogan, it would require schools to have opioid education programs, possibly through presentations such as MHAA’s.

After one presentation at a school, Miller handed out index cards to the students, ranging from seventh to twelfth grades, and asked for their feedback. She recalled what happened next: “One little girl came up to me and handed me her card and it said ‘Thank you for coming out and telling us about drugs because I wouldn’t want to lose any friends because my dad died a couple of months ago from a heroin overdose.’”

 

by Jess Nocera

 

Profiles in Recovery: Vincent Douglas

It took Vincent Douglas a near-death experience to reevaluate his life and while that event would rock most of us into a self-assessment mode, for Douglas it required a life or death decision: did he want to die as a heroin addict or work toward a life of recovery.

The Spy caught up with the 28-year-old at the A.F. Whitsitt Center’s Recovery in Motion (RIM) 18 months after making his decision to live and talked with us about his pathway to a new life and his dedication as a peer counselor to carry a message of hope to others suffering from addiction.

Reflecting on his past, Douglas says, “I didn’t sign up for the lifestyle I lived. It happened and now I use that as a tool to help others. When I came here, I had nothing, I was nothing, so I had nothing to lose and everything to gain.”

As a peer counselor at RIM, his experience as an addict paired with his own recovery program opens the door for communicating with those suffering from the disease of addiction. Speaking a common language is the centerpiece of establishing trust in a peer recovery environment.

Recovery in Motion (RIM) “Offers a wide range of services that provide our community with the tools to increase their well-being.  Support includes  individual & group counseling, behavioral health education/prevention, peer support and care coordination to assist persons in recovery with behavior and addiction issues.”

 

This video is approximately 7 minutes in length.  More about A.F. Whitsitt Center in Kent County may be found here.

 

Recovery: Lindsey Newcomb on Talbot County’s Upcoming Conference on Opioid Epidemic

Did you know over the past three years that 272 Mid-Shore opioid overdoses were reported by Shore Regional Health-Memorial Hospital at Easton? That’s according to the Maryland Department of Health and Mental Hygiene.

That number has been on the mind of Lindsay Newcomb, the Parent Education Coordinator for Talbot County Department of Social Services as well as the challenge of educating kids and their parents that have not been impacted yet by the opioid epidemic in the region.

To help address the problem, she is helping to host a major free  conference on the subject  on April 8, “Opioid Use Across the Lifespan,” which will feature nationally-known guest speaker Tony Hoffman, Pro BMX Competitor and Recovering Addict. The day-long event will be held at the Talbot County Community Center, Easton, MD. Parents, teens, teachers, coaches, medical providers and anyone dealing with youth in our community are encouraged to attend. Some of the conference topics will include safe disposal of prescription drugs, drug abuse trends and prevention strategies, the use of NARCAN, available resources, and personal stories by local residents.

We sat down with Lindsey to talk more about the program and the importance of Tony Hoffman’s message to young people.

 “Opioid Use Across the Lifespan,” on April 8, 2017, from 10 a.m. to 3 p.m. at the Talbot Community Center. The conference is sponsored by the Talbot County Department of Social Services and is free to the public. Space is limited and pre-registration is required by March 24, 2017. Space is limited for the free conference and pre-registration is required by March 24, 2017. Call 410-770-5750 or email Lindsay.newcomb1@maryland.gov.

Recovery: When You Can’t Just Leave by Erin Hill

It’s a special kind of lonely hell when you love an addict.

Your relationship is teetering on disaster – you’re barely surviving – you’re in a hole so deep the sky looks like a pinhole – you’re ashamed of what you and your life has become. You are afraid that if you let go, the world as you know it will crumble around you. Those around you encourage you to leave. But they don’t understand that you can’t “Just Leave”.

It’s complicated. It’s messy. It hurts.

They don’t understand that just like an addict starts with their drug – we are addicted to our addict. We didn’t get into these relationships thinking “Gee, I think I’m going to spend the rest of my life trying to control someone else’s crap” – just like they didn’t wake up one day deciding to be an addict. It evolves.

The dark, sticky, snake-like fingers of the disease constricts every aspect of our lives.

The finances, the employment, the physical health and the mental well-being of everyone in the home is compromised. Before you know it – you’re so entwined in the madness that getting out feels like death. Because it would be. You had hopes and dreams of a happily ever after, and if you leave, that dies.
But just as addiction can wrap itself around your relationship, so too can recovery.

My husband and I have been together 12 years, married for 10 – and he recently celebrated 5 years clean and sober. It’s still not perfect – it’s like that illusive “normal” you hear about – or unicorns and leprechauns. But it’s definitely better than it was.

It takes both of you to work on it.

I thought for sure that if he just quit the drug, things would get better. That if he would just quit drinking. Or get a job. Or spend more time with me and the kids… that it would be OK. I didn’t have the problem – he did. I could run the household, raise the kids, go to work, AND deal with him and his crap –

I was superwoman – right?! Wrong.

I brought a few suitcases worth of my own crap to this party.

It wasn’t until I was willing to take a hard look at my part in our relationship that I was ready to get really honest with myself. I was attracted to him because I thought I could fix him. That if I fixed him, he’d owe me – and never leave. And most of all – because I thought that was the kind of man I deserved – I wasn’t going to do any better. It was disguised as a noble attempt at fixing his problems, saving him from himself, and making everything alright with the world. It was just a thin cloak over the ability to distract myself from my own problems.

When you start looking at your stuff – unpacking those suitcases of stuff from your own history, and tossing what you don’t use or love (The Art of Tidying Up style) and repacking in a loving way what you want to keep, you make room for the stuff you really want. Like recovery. For you.

They don’t have to get sober for you to be happy.

Once you start seeing what it is you want for your own life, you can detach and work on YOU. I found that in our relationship it comes in spurts. He’ll work on himself, then I’ll work on my stuff. It’s a partnership like it’s never been before.

As we know better, we do better.

Getting clean and sober was just the beginning for us. There’s been times that have been more difficult in the last 5 years in recovery that were harder than the drunken rages or nights of fear, tears and despair. It doesn’t get easier, but you get stronger. And just like any other muscle, the more you use it, the stronger you get.

Start small.

Go for a walk, sit in silence with your breath for a few moments every day. Journal, write, sing, speak, or scream. Do something that’s just for YOU. As you come back to yourself, you develop your sense of strength and hope. You know that regardless, you’re going to be OK. And OK is good enough. YOU are good enough.

A Beautiful Mess was created by Erin Hill to educate and inspire women to Care for themselves, Communicate their needs, and Connect with their tribe of women who “get it”. Erin is a coach for women and blogger about life. She lives in Cambridge Maryland with her husband and 3 children. More information can be found at www.beautifulmesslife.com

Recovery: Tony Hoffman, Pro BMX Competitor and Recovering Addict, on Opioids April 8

Did you know over the past 3 years that 272 Mid-Shore opioid overdoses were reported by Shore Regional Health-Memorial Hospital at Easton.

Mid-Shore communities are increasingly facing new risks from marijuana, heroin, and prescription drug abuse.  The report adds that prescription drugs have become established as significant substances of abuse, alongside illicit drugs among young adults, with prescription opioids being the second most commonly misused illegal drug after marijuana among persons aged 16 to 25 years old in Talbot County. Between 2010 and 2014 clients in Talbot County reported heroin as their drug of choice has grown 927%. Users cut across all income levels, but for Talbot County, most of the users are young.

Screen Shot 2017-02-20 at 9.31.50 AM

Pictured is Tony Hoffman, Pro BMX Competitor and Recovering Addict

On April 8, 2017, from 10 a.m. to 3 p.m., the Talbot County Department of Social Services will host a free conference, “Opioid Use Across the Lifespan,” featuring nationally-known guest speaker Tony Hoffman, Pro BMX Competitor and Recovering Addict. The day-long event will be held at the Talbot County Community Center, Easton, MD. Parents, teens, teachers, coaches, medical providers and anyone dealing with youth in our community are encouraged to attend.  Some of the conference topics will include safe disposal of prescription drugs, drug abuse trends and prevention strategies, the use of NARCAN, available resources, and personal stories by local residents.

Tony Hoffman’s story is full of redemption as he has seen some of the highest highs, and the lowest lows.  His BMX career started in high school, as he was a top-ranked BMX amateur with multiple endorsements. As a native of Clovis, CA, where he attended Clovis High School, Hoffman started drinking alcohol, smoking marijuana, and using prescription painkillers such as Vicodin and OxyContin by his senior year. His life took a turn for the worse as he became addicted at such a young age, losing everything. In 2004 he committed a home invasion armed robbery, and was ultimately sent to prison for two years in 2007.  Hoffman began rebuilding his life’s purpose while he spent two years in prison.

Hoffman has dedicated his life, to bringing awareness around the country, describing how dangerous prescription pill and heroin abuse are, as well as advocating a shift in thinking towards current addiction-recovery processes. He has been sober since May 17th, 2007 and is the Founder and Director of The Freewheel Project, a non-profit organization that mentors thousands of youth through action sports: BMX, skateboarding and after-school programs. The Freewheel Project focuses on teaching kids leadership skills, and making healthy life choices, including substance abuse prevention, each year. In 2016 he also began writing his first book, titled, “Coming Clean.” He is a Former BMX Elite Pro and is currently ranked #2 in Masters Pro class, coaching in the 2016 Rio Olympic Games with Women’s BMX PRO, Brooke Crain, in his lineup.

Space is limited for the free conference and pre-registration is required by March 24, 2017. Call 410-770-5750 or email Lindsay.newcomb1@maryland.gov.

Recovery: Hogan Announces new Measures to Address Opioid Addiction

Gov. Larry Hogan and Lt. Gov. Boyd Rutherford announced Tuesday they are rolling out new legislation that would counter Maryland’s growing opioid addiction crisis.
 
The Prescriber Limits Act would prevent doctors from prescribing more than seven days worth of opioid painkillers during a patient’s first visit or consultation. The law exempts patients going through cancer treatment and those diagnosed with a terminal illness. 
 
The Distribution of Opioids Resulting in Death Act would introduce a new felony charge carrying up to 30 years in prison for people convicted of illegally selling opioids or opioid analogues that result in the death of a user. Rutherford said the law would carry protections for people who were selling to support their addiction.
 
And the Overdose Prevention Act authorizes the collection of and review of non-fatal overdose data and would make it easier for people to fill prescriptions for naloxone, a drug that can counteract the effects of an opioid overdose. 
 
Hogan and Rutherford, whom the governor has directed to focus on opioid addiction, announced the legislation in a press conference at Anne Arundel Medical Center on Tuesday
 
Rutherford also announced that the governor would sign an executive order that will create an Opioid Operations Command Center — a “virtual” task force charged with organizing training and funding for local anti-addiction teams as well as collecting data on opioid use and abuse. 
 
Hogan said that he did not fully appreciate the scope of the opioid epidemic until he began crisscrossing Maryland during the early phases of his gubernatorial campaign. He said he asked people in different parts of the state what their community’s biggest problem was and that, regardless of whether they were from a rural, urban, wealthy, or poor community, “the answer was always the same: heroin.”
 
Both Hogan and Rutherford appeared optimistic but acknowledged that the problem of opioid addiction is worsening in Maryland. Anne Arundel County Executive Steve Schuh said that, at the start of his tenure a couple years ago, there was one overdose per day and one death per week from opioid abuse in his county. He said those figures have risen to two overdoses per day and two and a half deaths per week.
 
At the press conference, State’s Attorney Wes Adams, R-Anne Arundel, spoke about the recent death of his brother-in-law, who he said died of an opioid overdose.
 
Adams said his brother-in-law became addicted to opioids after being prescribed them following a surgery about eight years ago. He said he moved in and out of rehab centers and periodically became clean, only to relapse later. 
 
Adams lamented the obstacles from the medical and insurance industries that he and his family faced as they tried to keep his brother-in-law in treatment. 
 
He also expressed consternation over recently being prescribed a substantial supply of Oxycontin, an opioid pain-killer, following a medical procedure, despite telling his doctor that he was only experiencing moderate pain. 
 
He said angrily that the only major side-effect his pharmacist warned him of was constipation, despite the well-documented risk of addiction that use of the drug carries. 
By JACOB TAYLOR

State Analyst: Maryland Might Lose $1.4 billion under Health Care Repeal

A federal repeal of the national health care law could cost Maryland $1.4 billion in the 2018 fiscal year, state budget analysts said Tuesday.

Funds issued to Maryland through the Affordable Care Act include $1.2 billion of enhanced federal funding to cover Medicaid, David Romans, fiscal and policy analysis deputy director for the Maryland Department of Legislative Services, told the House of Delegates Ways and Means Committee.

“Roughly 312,000 people (in Maryland) will receive coverage in fiscal (year 2018) through that ACA expansion,” Romans said. Maryland’s Affordable Care Act expansion widens the range of income levels to help cover more adults.

Romans said if the Affordable Care Act is repealed, the state would need to decide to either drop the coverage or to make up the $1.2 billion for Medicaid and an additional $200 million for other related services.

The federal government now covers about 95 percent of funding for Medicaid, but if the federal health care law is repealed, it could be reduced to 50 percent, Romans said.

“There is a lot of unknowns around federal spending in Maryland,” he added.

“The 2018 (proposed) budget assumes 312,000 individuals enrolled under the ACA Medicaid expansion provision will receive full physical and behavioral health care coverage benefits at a total cost of care of $2.8 billion,” according to the Department of Legislative Services.

Included in the estimated $1.4 billion in cuts, the state could lose $200 million allocated for the Maryland Children’s Health Program, additional pharmacy rebates, and waivers for the all-payer rate-setting hospital system, which creates a consistent price for all insurers for specific procedures.

Romans told lawmakers that the repeal of the Affordable Care Act is the state’s “greatest vulnerability in terms of loss in federal dollars.”

The committee’s vice chair, Delegate Frank Turner, D-Howard, said he hopes Gov. Larry Hogan, a Republican, is looking carefully at the impact losing that amount of money would have on the state.

Hogan met with the state’s federal delegation Monday hoping to “put politics aside and find a solution to the (Affordable Care Act) issue,” according to Doug Mayer, a spokesman for the governor.

“We’re not going to speculate on what may happen,” Mayer said. Mayer specified there are aspects of the federal health care law the governor agrees with and aspects he doesn’t.

“Keep the good and get rid of the bad,” he said. The good including young adults being able to stay on their parents’ insurance plans longer and the bad including skyrocketing rates, according to Mayer.

Aside from the estimated $1.4 billion, Maryland’s Health Benefit Exchange, which covers about 60,000 households, could also lose funding if the Affordable Care Act is repealed, according to Romans. The Department of Legislative Services estimates program’s federal support to be about $225 million.

The state’s Supplemental Nutrition Assistance Program, also referred to as SNAP, which currently receives about $1 billion in federal dollars, is also at risk of losing funding if the health care law is repealed, according to Romans.

Warren Deschenaux, executive director of the Department of Legislative Services, told the University of Maryland’s Capital News Service that “the biggest concern (in the budget) is that it does very little to resolve the problems for the future.”

Deschenaux said he anticipates a $400 million to $500 million budget gap that will continue to increase in the future, despite the consideration of the Affordable Care Act repeal.

By Cara Newcomer

Recovery: Barriers discourage Doctors from providing Suboxone to Opioid Addicts

The Spy took note of a report a few days ago from Maine highlighting a number of state doctor groups having little effect in convincing physicians to become Suboxone providers.

“Boosting the low supply of doctors who prescribe Suboxone is a crucial piece of the puzzle that if solved would help to meet the treatment demand for the thousands of Mainers in the throes of an opioid addiction.

Those efforts haven’t worked yet. Among the barriers are cultural stigmas to treating patients with addictions, financial disincentives, bureaucratic red tape and doctors believing that opening their doors for drug treatment would overwhelm their practices”

http://www.pressherald.com/2017/01/08/hurdles-dissuade-doctors-from-providing-suboxone/

Maryland’s Heroin and Opioid Crisis Reaches an All-time High

Barbara Allen signs her emails with the names of her family members she has lost to addiction.

Jim’s mom, Bill’s sister, Amanda’s aunt.

Her son, Jim, died from a heroin and alcohol overdose in 2003 after battling substance abuse disorder for 22 years.

“What I found really annoyed me and made me angry was there was so little support, and in fact people didn’t have to continue to to die,” said Barbara, who lives in Howard County, Maryland.

In Maryland, heroin-related deaths tripled from 2011 to 2015, rising from 247 to 748, according to the Maryland Department of Health and Mental Hygiene.

The death rate from drug overdoses in the state is the fifth-worst in the country, and it’s only likely to get worse, experts say.

The rise of heroin and opioids

In the early 2000s, the popularity of heroin and opioids as illegal narcotics soared in Maryland around the same time as overdose deaths due to drugs or alcohol began to increase, according to the Centers for Disease Control and Prevention.

“If you go back to 2006 and 2007, it was most notable here where the conversation internally to the (sheriff’s department) really began because of overdose deaths from opiate painkillers,” said Tim Cameron, the sheriff in St. Mary’s County and a member of the Governor’s Heroin and Opioid Emergency Task Force in 2015.

When the epidemic first began, most of the people dying from overdoses were young, white and in the middle and upper classes, but that trend soon gave way to include almost all demographic and socioeconomic groups, Cameron said.

“It pretty much affects everyone,” said Sgt. Johnny Murray with the Hagerstown Police Department. “It’s just (a result of) the pill epidemic, when that was uncontrolled and people were being able to ‘doctor shop’ and go to 4 or 5 different doctors and get these powerful narcotics.”

Often after people get addicted to prescription opioid painkillers, they turn to heroin, which is cheaper and provides a similar high, said Murray.

In Washington County, Maryland, Delegate Brett Wilson, R-Hagerstown, who also served on the Governor’s Heroin and Opioid Emergency Task Force, said people in almost all demographic groups are dying from heroin and opioid overdoses.

“With our patients, they were often completely unaware that the heroin or sometimes even just the pills that they were using had fentanyl in it,” said Dr. Olsen, who is also medical director of an outpatient program in Baltimore.

Because of its potency, users require less of the drug to get the same effect as heroin, which makes people who inject fentanyl more susceptible to overdoses. Fentanyl-related deaths have doubled during the first six months of 2016 compared to the same period in 2015, according to the Maryland Department of Health and Mental Hygiene.

Race, gender changes

Arrest trends in Maryland have shown that for at least the last five years, at least 4,000 to 5,000 more people between the ages of 20 and 24 were arrested for drug abuse violations than those in the next oldest age group — people aged 25-29.

However, the vast majority of people who have been hospitalized for opioid-related disorders are between 45 and 64. According to a Capital News Service analysis, 14,843 people aged 50 to 54 were hospitalized from 2013 to the beginning of 2016 for opioid-related disorders in Maryland — more than any other age group during the same time period,

There is also data to suggest that drug use in middle and high school is declining, perhaps due to renewed drug education efforts, according to Harford County’s Office of Drug Control Policy.

There may also be a disparity between whites and blacks using heroin or opioids.

Between 2012 and 2014, 88,043 blacks were arrested for drug abuse violations while 53,125 whites were arrested for the same crimes during the same time period in Maryland, according to the Maryland State Police.

However, between 2013 and the beginning of 2016, 60,462 whites were hospitalized for opioid-related disorders in Maryland while just 41,918 blacks were hospitalized, according to a Capital News Service analysis of Maryland hospital data.

Even as opioid and heroin use and overdoses have increased across many demographics in Maryland, arrest rates have declined steadily since 2010. While 12,551 people were arrested in 2010 for possession of opium, cocaine or derivatives, just 9,618 people were arrested in 2014.

The Maryland State Police collect arrest data according to the National Uniform Crime Reporting Program guidelines, which consolidates opium, cocaine and like drugs into one category.

Though men are hospitalized more for opioid-related disorders in Maryland, there is evidence to suggest that women may be using heroin and opioids at a higher rate than other drugs.

Between 2012 and 2014, men were arrested at almost five times the rate for drug abuse violations than women.

However, hospitalizations for opioid-related disorders for men have increased 16 percent from 2013 to 2016, while those for women have increased by 15 percent.

“In looking at our numbers, we see that in some categories women are outpacing men related to this problem, and when it comes to (number of deaths), it’s even,” said Dan Aliato, the commander of vice narcotics for St. Mary’s County.

So far this year, the county has had 118 cases where someone was sent to the emergency room for a drug-related condition. Of those 118, 65 were women and 53 were men, said Aliato.

“It’s something that’s different and something that’s evolving,” he told the University of Maryland’s Capital News Service. “We’re not used to seeing those kinds of numbers and our jail is not used to seeing those numbers and not equipped to handle those numbers.”

Loss of Affordable Care Act

President-elect Donald Trump began discussing the issue about a month before Election Day.

“A wall will not only keep out dangerous cartels and criminals, but it will also keep out the drugs and heroin poisoning our youth,” he said during an Oct. 15 New Hampshire campaign stop.

In this speech, he detailed a three-pronged plan for combating the addiction epidemic, which included aggressively prosecuting illegal drug traffickers, closing shipping loopholes for drugs and encouraging the approval of drugs to fight addiction such as Suboxone and Narcan.

President Barack Obama signed the Comprehensive Addiction and Recovery Act — also known as CARA — into law July 2016. It is considered the most extensive effort taken thus far to address the opioid epidemic and covers prevention, treatment, recovery, law enforcement, criminal justice reform and overdose reversal.

“It would be really a major step backwards to something that would cost even more lives if the Trump administration did not continue and really build on and implement the pieces of both CARA and with the appropriate funding and other steps that will likely be needed to really address this epidemic,” said Olsen.

If Trump repeals the Affordable Care Act — which he promised to do while on the campaign trail — the coverage for many Americans in recovery and treatment who were previously uninsured could disappear, unless he institutes an alternative program.

Even so, Trump actually over-performed the most in counties with the highest drug mortality rates, according to a Pennsylvania State University study. He was even more successful than 2012 Republican presidential candidate Mitt Romney in 81.7 percent of these counties.

In rural Somerset County, Maryland, the number of people hospitalized for opioid-related disorders has increased by 91 percent from 2013 to 2016, according to Maryland hospital-patient data.

Trump won Somerset County with 57 percent of the vote, while Obama won the county with 50 percent of the vote in 2012.

The two Maryland counties with the highest increases in hospitalizations — Garrett County with 161 percent and Worcester with 128 percent over the past three years — also voted in the majority for Trump.

The ‘national emergency’

On Dec. 7, the United States Senate passed the 21st Century Cures Act, sending the bill to President Barack Obama, who signed it into law Tuesday.

The $1 billion bill includes $500 million a year to assist states in treating people addicted to opioids and preventing misuse of drugs.

Allen called the act a “huge step forward.”

“Every senator is being pressured because their constituents’ kids are dying, so I feel like we’ve begun to tip the balance of attention that we have this true epidemic,” said Allen, who founded the organization James’ Place to raise money for recovery services after her son’s death.

In Maryland, the Prescription Drug Monitoring Program was started in 2011, but it wasn’t widely adopted up until this year. Starting Oct. 1, doctors authorized to prescribe controlled substances had to register with the program, which analyzes the number of prescriptions coming from medical professionals.

“There’s a lot of value and accountability, to be quite honest, in counting the medication and doing that and sharing that information with others,” said Alioto.

Counties have also begun using state money to hire heroin coordinators within police departments to analyze data, which could help government officials develop a better response to the threat of heroin and opioid abuse, said Glenn Fueston, the executive director of the Governor’s Office on Crime Control and Prevention.

“What we hope to do is continue that process of looking at the data that’s available in the community, looking at ways we can share that data (and) analyze that data, while protecting the privacy and civil liberties of people that the data is involved with,” he said at the legislature’s Nov. 2 meeting of the Joint Committee on Behavioral Health and Opioid Use Disorders.

However, the government needs to do more to address the addiction epidemic, said Carin Miller, the founder of Maryland Heroin Awareness Advocates.

“It needs to be declared a national emergency,” said Miller, whose son is recovering from a heroin addiction and husband is battling an addiction to opioids.

If addiction was properly seen as a disease, Allen said, advocates would get their “fair share of those donor dollars.”

“I’m going to do this anyway,” she said. “I’m going to do this work no matter what, and we’ll do what we can because I don’t have any other choice.”

By Hannah Lang