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A massive heroin crisis is gripping the state of Vermont and the town of Rutland is Ground Zero. Many facilities are prescribing the drug Suboxone to mothers who are pregnant to wean them off Heroin given the addicting symptoms. However, it turns out that babies are getting horribly addicted to Suboxone as a result, like this one baby.

By her 20th birthday, Coleman was hooked on heroin, and she lived with the addiction for 10 years. She went into rehab five years ago and has been clean, but on Suboxone, ever since. Her firstborn, Cade, was born addicted to Suboxone and struggled with withdrawal. But nothing prepared her for Jax.

After the birth, Coleman and Jax were kept at Rutland’s hospital for four days, then sent home. But Jax continued to show severe withdrawal symptoms, and Coleman said she was uneasy. A few days after leaving the hospital, she was trying to settle her son, rocking him back and forth. She said she was exhausted taking care of her sick baby and didn’t know what to do. Then Jax went quiet. His lips turned blue.

Panicking, Coleman picked him up, shook him lightly and then blew in his face. Finally, he took a breath.

“It felt like forever,” she said. “It was probably a good 20, 25 seconds, you know, where he just was limp.”

Al Jazeera America has done documentaries on this crisis for the last two nights. What we are seeing is a warning that this sort of thing can strike anywhere, whether it is rural America or the inner cities. The problem is that too many legislators are not well versed enough in scientific literacy to understand that certain treatments are not simply a matter of the bottom line, but a matter of following best practices that have been tested and replicated by the scientific community. And too many states are following the punitive model of punishment, creating a stigma for drug use and a disincentive to seek medical treatment.

Last night, Al-Jazeera focused on some of the policy mistakes made by the state. The governor has been on a well-meaning crusade against Heroin use in the past year. However, he cut funding for Heroin stays that would be paid for by Medicaid from 28 days to 14 days.

As of July 2013, the state slashed the number of days of in-patient rehab it would fund with Medicaid, from 28 days to 14, unless a patient gets prior authorization. The directors of two residential treatment centers told America Tonight that since then, the number of patients requiring readmission at their facilities has doubled.

William Young, executive director of Maple Leaf Farm, said they looked at the number of people who called them for readmission since July 1 and compared the data to the same period in 2012. They found that the calls had more than doubled.

This makes perfect sense. Scientific evidence shows that it is frequently necessary to keep Heroin addicts in treatment for at least three months. In fact, the NIH says it is critical.
Remaining in treatment for an adequate period of time is critical.  The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.
This is borne out by a study from England.
Longer stays in treatment were predictive of better 1 year outcomes.
Al-Jazeera interviewed a drug rehab specialist last night who had this to say:
Dr. Deborah Richter is a family physician and one of Vermont’s leading addiction specialists. Asked whether two weeks was sufficient in-patient care for a recovering addict, Richter said, “Absolutely not!”

“It takes much longer in my experience,” she explained. “You need about 90 days for people to be able to reset their thermostat, so that they can have more resistance.”

To its credit, Vermont does understand the need for a rehabilitation-based approach. They are one of only 13 states in the country which has a "Good Samaritan" law, which means that if you check yourself into treatment or check a friend into treatment, you will not be prosecuted. But the problem with its model is that it is an out-patient model; the problem with that is that it is a lot more difficult to get patients to take the medications they need to get off Heroin addiction.

As early as 2006, the Bush Administration's NIH recognized the futility of a forced abstinence approach.

One old concept has been proven false, for we now know that "forced abstinence" from drug use during incarceration, if abstinence occurs, does NOT alleviate addiction. Research shows that effective treatment of addiction - a chronic, relapsing disease of the brain, characterized by compulsive behavior - requires addressing underlying issues and causes. Because drug addiction compromises the circuits involved in processing punishment and reward and in exerting control over one's actions, the addicted person will compulsively seek drugs despite the threat of severe punishment (e.g., incarceration, loss of child custody), at the expense of natural rewards, such as that from family and friends, and even when they consciously do not want to do it. Comprehensive drug abuse treatment therefore offers the best alternative for interrupting the vicious drug use - criminal justice cycle once a person gets caught up in it.

Why Treatment Should be Provided to Offenders with Drug Disorders:
For Public Health and Safety. We know that drug use increases the likelihood of criminal behavior. In fact, offender drug use is involved in more than half of all violent crimes, in 60-80 percent of child abuse and neglect cases, and, not surprising, in 75 percent of drug dealing and manufacturing cases. Moreover, illicit drug use costs this country about $180 billion a year in crime, productivity loss, health care, incarceration, and drug enforcement. Uninterrupted, the drug abuse-crime cycle jeopardizes public health and public safety and taxes an already over-burdened criminal justice system. It follows then that reducing drug use can reduce crime and improve not just the health, safety, and well-being of the individual, but of communities and society as a whole.

This was taken from testimony by Nora D. Volkow, M.D., Director, National Institute on Drug Abuse in 2006 to the  House Judiciary Subcommittee on Crime, Terrorism, and Homeland Security. Volkow also noted in her testimony that treatment-based approaches have been shown to significantly reduce both drug use and recidivism.

One possible solution to infant drug addiction is Buprenorphine instead of Suboxone.

A NIDA-supported clinical trial, the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, has found buprenorphine to be a safe and effective alternative to methadone for treating opioid dependence during pregnancy. Women who received either medication experienced similar rates of pregnancy complications and gave birth to infants who were comparable on key indicators of neonatal health and development. Moreover, the infants born to women who received buprenorphine had milder symptoms of neonatal opioid withdrawal than those born to women who received methadone.
However, as the NIH notes, treatment of any kind of drug addiction is complex with a lot of variables involved. Every individual case is different; the mother whose son nearly died from Suboxone withdrawal had another son who did not experience symptoms that were quite as severe. It becomes even more complicated when factors such as mental illness are involved.

The death of Philip Seymour Hoffman has led Valerie Vande Panne in the Daily Beast to call for the legalization of Heroin.

In the days since, there’s been all kinds of chatter about the evils of heroin or the need for better drug education. But there hasn’t been much talk about the painful, obvious, cold, hard truth: Heroin should be regulated—and not only because science says so, but because, (and again, let’s be honest) look around.

Drug prohibition didn’t keep us from this great cultural loss. In fact, drug prohibition causes thousands of unnamed human losses we suffer day after day, month after month, year after year in this country. Think of the person you know (or your friend who knows someone) who has died because of a heroin, or opiate, overdose. Say their name—because they deserve to be remembered, as much as Hoffman does. And because in a health-centered, rather than law enforcement-centered, world, they didn’t have to die.

The problem of Heroin addiction is not limited to Vermont.
According to the Center for Disease Control, “opioid analgesics, such as oxycodone, hydrocodone, and methadone, were involved in about 3 of every 4 pharmaceutical overdose deaths” and “38,329 people died from a drug overdose in the United States in 2010.” According to the Office of National Drug Control Policy, from 2006-2010, that was a 21% increase.

Death by heroin increased 45 percent during the same time frame.

Another reason to legalize -- in extreme hardcore cases, Heroin itself has been shown to work when conventional methods have failed. Time Magazine:
What’s the best way to treat the most serious heroin addiction? Giving addicts therapeutic doses of heroin itself may be cheaper and more effective than methadone, according to a new Canadian study.

Researchers divided a group of heroin addicts in two Canadian cities who had repeatedly not been helped by conventional treatment, into two therapy groups. One was provided heroin plus intensive social and medical support while the other received an equally enhanced methadone program as part of the clinical trial.

The new analysis showed that even though heroin treatment can be as much as ten times more expensive than methadone, lifetime social costs related to chronic addiction were cut by an average of $40,000 Canadian for each of these previously untreatable heroin patients. The research also suggested that addicted people given heroin under medical supervision would live a year longer on average than those in methadone treatment.

The site has posters debate on this and other topics. 59% of their users that participated say that Heroin should be legalized. Opponents say that it would only make the problem worse.

Comments from supporters of legalization:

The whole Heroine dilemma is the direct result of the drug being illegal and on the streets. Before Heroine was banned it was used as a remedy for countless of illnesses and discomforts.

Heroin itself is not toxic for the human Body. If Heroin could be used again as a remedy and NOT abused as a class A drug, we would all benefit from it. Police would concentrate on the REAL CRIMINALS, the prisons would be empty, street criminality would decrease, addicts could go their every day life and pursue a career without hustling for the drug the whole day. The drug would cost almost nothing and it would be 100 pure and could be taxed by the government ( like alcohol)

Its common sense in a free country we should be allowed to put what we want into our bodies. If we legalized drugs and taxed them it would save so much money and lives in the form of not incarcerating and breaking up families and inbound tax revenue a total win win. And those that need help because of a drug problem will have more access to addiction treatments and medicines without the stigma drug addiction has in this country today. In time there will be less drug users and youth in this country will no longer see it as the outlaw thing to do it would become uncool leading to less of the population doing drugs.
No, it kills too many people already.

Legalizing Heroin will also legitimize it, and that will be deadly for our young people. Keeping it illegal will make keeping children away from it easier. Heroin is addictive after only one or two uses. It cannot be compared to alcohol which is addictive only to a small part of the population.

Legalizing heroin will lead to widespread usage.

Legalizing heroin will cause an epidemic of addiction and adequate resources do not exist to support such an increase in the number of hard drug users from a medical or rehabilitation standpoint. Once becoming quickly addicted to heroin, new users would become a burden on society as they would not be employable or reliable as family members.

Jeff Deeney, himself a recovered Heroin addict, wrote last month in Atlantic that Heroin should be legalized.
Legal pot isn’t enough. For there to be an American version of Insite, Vancouver's celebrated, medically-supervised, legal injecting space, the U.S. would need to decriminalize entirely. If Philip Seymour Hoffman had taken his last bags to a legal injecting space, would he still be alive? Had he overdosed there, medical staff on call might have reversed it with Naloxone. Had he acquired an abscess or other skin infection, he could have sought nonjudgmental medical intervention. Perhaps injection site staff could have directed him back to treatment.

Safe injecting sites are an amazing, life saving, humanity restoring intervention we can’t have because our laws preclude them. Too frequently, heroin addicts instead utilize abandoned buildings and vacant lots to shoot up in order to evade arrest. The risk for assault, particularly sexual assault for women, in off-the-grid, hidden get-high places is incredible. Overdosed bodies are routinely pulled from such spaces in North Philadelphia.

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Comment Preferences

  •  Timely and well-written diary... (9+ / 0-)

    ...let's hope it doesn't get lost in the maelstrom of GBCW diaries and "those nasty republicans" diaries (not that there's anything wrong with the latter...)

    Drug abuse and addiction is a tough nut to crack. I've watched people with years of being clean and sober relapse.

    The more resources devoted to this, the better. For the cost of a military airplane or two, we could save thousands of lives, families and children from the mess of addiction.

    Great diary. The kind for which I come to DK.

    "Wealthy the Spirit which knows its own flight. Stealthy the Hunter who slays his own fright. Blessed is the Traveler who journeys the length of the Light."

    by CanisMaximus on Fri Mar 14, 2014 at 07:21:03 PM PDT

  •  I've been following on al jazeera, but I see (5+ / 0-)

    nothing about why Rutland is ground zero. Anyone?

    Dick Cheney 2/14/10: "I was a big supporter of waterboarding"

    by Bob Love on Fri Mar 14, 2014 at 07:42:44 PM PDT

    •  Because the use there is disproportionately high. (5+ / 0-)

      The New York Times did a whole feature article on it last month.

      Block by block, this city in central Vermont has been fighting a heroin epidemic so entrenched that it has confounded all efforts to combat it.

      On Cottage Street, the foot traffic is heavy in and out of No. 24 ½, a red two-story cottage set back from the street, where visitors stay less than a minute.

      “We know what they’re doing in there,” Victoria DeLong, a longtime neighbor, said of the house, which the police say is owned by an absentee landlord and is a haven for drug dealers. “It’s like shopping at the Grand Union,” Ms. DeLong said. “In and out, in and out.”

      It's all over the national news; Google it up and you'll find a bunch of other links.

      "The cost of liberty is less than the price of repression." - W.E.B. Du Bois Be informed. Fight the Police State.

      by Eternal Hope on Fri Mar 14, 2014 at 07:47:47 PM PDT

      [ Parent ]

      •  But why is use higher in Rutland than Burlington? (2+ / 0-)
        Recommended by:
        cotterperson, SeaTurtle

        That's my question.

        Dick Cheney 2/14/10: "I was a big supporter of waterboarding"

        by Bob Love on Fri Mar 14, 2014 at 07:53:21 PM PDT

        [ Parent ]

        •  I'm not 100% sure. (10+ / 0-)

          Vermont's use is high because it is equidistant from Montreal, Philadelphia, Boston, and New York. The second factor is market conditions; you can buy Heroin in those cities for $5 and sell it in Rutland for $30. But the best reason I can find is that Rutland was prescribed a disproportionate amount of Oxycondome.

          Gilbert says he was shocked by what he heard at a community forum last year in Rutland. "A pharmacist stood up and gave a statistic that made my jaw drop and not many things make my jaw drop and this did."

          The pharmacist talked about data gathered by the Vermont Prescription Monitoring System which showed over a million doses of Oxycodone were prescribed in Rutland County the previous year.  Oxycodone is the opiate-based painkiller found in drugs like: Tylox, Percocet and Oxycontin, says Gilbert. "Which figures out to 17 pills for every man woman and child in the county."

          Oxycondone is a gateway drug to Heroin. People would go all the way from MA to Florida to find doctors to prescribe Oxycondone-based drugs until 2011, when Governor Rick Scott finally signed off on legislaton to stop that; the President put in plans to stop it as well. So that would have contributed drastically to Rutland's spike in heroin usage when the flow dried up.

          "The cost of liberty is less than the price of repression." - W.E.B. Du Bois Be informed. Fight the Police State.

          by Eternal Hope on Fri Mar 14, 2014 at 08:08:35 PM PDT

          [ Parent ]

          •  I'm in the middle of it. (6+ / 0-)

            Vermont's use is high because the pills have gotten way too expensive in an increasingly rocky economy.

            We had always had the same pill problems as anywhere else where ya have rural folk in the US. Like an awful lot of places, our working class was prescribed a lot of painkillers to keep them, well, working...

            We're just like any other rural area- people are just shocked because they think vermont and they think foliage rides, maple sugar, hippies- which we have, sure, but also poverty, unemployment and drugs.

            Same junkies. Different junk.

            •  Gee...maybe you can fight the heroin epidemic... (0+ / 0-)

              ...with a third epidemic.

              "Wealthy the Spirit which knows its own flight. Stealthy the Hunter who slays his own fright. Blessed is the Traveler who journeys the length of the Light."

              by CanisMaximus on Fri Mar 14, 2014 at 09:02:07 PM PDT

              [ Parent ]

            •  If Rutland is the epicenter of a huge heroin binge (0+ / 0-)

              it's clearly not "just like any other rural area".

              Vermont's use is high because the pills have gotten way too expensive in an increasingly rocky economy.
              This doesn't explain why Rutland in particular is awash with heroin when so many other towns aren't.

              Dick Cheney 2/14/10: "I was a big supporter of waterboarding"

              by Bob Love on Sat Mar 15, 2014 at 08:25:34 AM PDT

              [ Parent ]

        •  Burlington Has the University of Vermont (1+ / 0-)
          Recommended by:
          Bob Love

          Which provides employment to a large percentage of households in town. I believe Rutland was traditionally more blue collar. While Burlington has quite a bit of New England charm, Rutland today gives the appearance of the eastern-most town in the Rust Belt.

          "I'll believe that corporations are people when I see Rick Perry execute one."

          by bink on Sat Mar 15, 2014 at 04:29:52 AM PDT

          [ Parent ]

  •  If there is one thing our governor has done (7+ / 0-)

    That pisses me off more than just about everything else, it's the hysteria over heroin in VT.

    The rate of opioid abuse has not changed. Users have switched from oxycontin to heroin, because manufacturers were forced to reformulate oxycontin to make it nearly impossible to abuse.

    Now that that's out of the way...

    Drug abuse can be much better addressed if it's not forced into hiding by draconian laws, and if treatment is evidence-based, not based on some paternalistic desire to punish the "offender." I don't care about public opinion pols regarding legalization - what matters is: what works? If legalization brings down addiction rates, then we should legalize. If legalization raises addiction rates, then it should not be legalized. Why is the topic being left to random people on the street, with no knowledge of what works?

    It sucks that any child anywhere is being born addicted, and it sounds like buprenorphine might hold promise. I hope it saves many children from the damage done by maternal addiction.

  •  I used to live in Rutland Town (7+ / 0-)

    and still live in the area. A decade ago Rutland was a heroin transhipment rest stop between Montreal and NYC. But now with all of these prescribed opiates flooding the market the drugs are everywhere. Pharmacies are being robbed repeatedly. Rutland is just where it's concentrated--all the small towns in central VT have addicts.

    Thank you for posting this.

    You can wake someone who is sleeping, but you cannot wake someone who is pretending to sleep.

    by gnothis on Fri Mar 14, 2014 at 07:48:45 PM PDT

  •  Thank you for the article (4+ / 0-)

    I read the Greenwald study a few years ago on the Portuguese model and providing safe use sites makes sense to reduce risk and provide opportunities to connect addicts to medical care.  

    It seems like decriminalization will do a lot of good in treating addiction as a medical problem, not a criminal justice problem.  

    I never thought I would see the war on (some) drugs start to end.

    I'm a 4 Freedoms Democrat.

    by DavidMS on Fri Mar 14, 2014 at 07:57:43 PM PDT

  •  Excellent diary (2+ / 0-)
    Recommended by:
    Eternal Hope, NancyK

    When there are serious problems, the more options that are available that allow people to find their OWN solutions, the better the chance there is that at least some people will find their way out of the problem.  Different things work for different people, and that's why people who do want to solve their problems need access to many different options, so they can find the one that works for them.  

    This is supposed to be a land "with liberty...for all".   Prohibition simply is not consistent with the concept of liberty.   What one person may call a "vice" may be another person's  "Pursuit of Happiness".   The only way that this nation will ever heal, is when it ceases to be at "War" with itself.   The "drug war" is a blight on our society.

    I am saying this because I want LESS people using drugs, and MORE people recovering when they get in trouble with drugs, and I truly believe that decriminilization or legalization is the best way to achieve that.  Just look at how many people switched from smoking cigarettes to vaporizers, when they were given a CHOICE - a legal, socially acceptable CHOICE.  People want control.  Control over their choices.  Control over their habits.   People want to be healthier, but they need encouragement and they need alternatives, and that means that alternatives have to be accessible, and help must be accessible.   When we bring the whole issue of drugs into the light of day, when people can be honest about their use of drugs, then they can also be honest about their desire to STOP using drugs, or to use less, and they can openly discuss their methods, like they do for losing weight or stopping smoking.  They no longer have to be afraid to ask for help.  The very first thing that an addict needs before anything else, when they are ready to recover, is respect.  The Drug War strips all respect from people who need it the most.

    And, the Drug War is just an excuse for police to harass, detain, search, arrest, assault, even kill just about anyone they feel like harassing -- but that's a whole other diary.  

    Legalization could bring some other benefits.  We could honestly, publicly, put some resources behind figuring out exactly what people are trying to achieve with some of these drugs, and find the safest ways to offer them that experience, WITHOUT some of the worst and deadliest side effects.  Or, we can continue to limit people's options so severely that they are driven to use what is available, despite the dangers.  It just breaks my heart when I hear of some teenager who died from using K2 because it was easier to get than pot.   It has been amply demonstrated, time and again, that we are delusional if we think we can stop near-adults from doing what many or most adults do.   That's what kids do -- train to be adults by DOING what adults do.  It's instinct.  You CANNOT STOP IT.  We could make better choices so that less teens  have to die using bizarre and horribly dangerous  alternatives, because we've been so obsessive about blocking their access to the safer alternatives that the adults that they are learning to be, use.

    One of the core problems is the delusion that we can achieve absolute control over our youthful population.   Teenagers have Free Will.  They have options and make choices regardless of how we try to legislate their choices.   If we are too restrictive of the safer choices, they will only make more dangerous ones.   The fantasy that we can control their choices is just that -- a fantasy.  A very dangerous one.  In essence, we are throwing out the baby with the bathwater.  Trading a live pot-smoking teen for a dead K2-smoking teen.   Smoking pot is unhealthy, yes, but is smoking pot really THAT bad, that we'd drive a kid to a deadly alternative?  What teenagers need is respect.    Treating them like criminals or toddlers who need safety locks on everything does not encourage in them mature behavior.

    Another of the core problems is this delusional belief in this society that we can legislate away undesirable behavior.  The truth is that when we have liberty, we express ourselves fully, and that includes the bad habits as well as the good.  But, when we try to legislate our bad habits away, what we are really doing is discarding our liberty -- and, still, it has been demonstrated over and over again, the bad habits DON'T go away.  They just hide in dark places, and multiply.   So, it's a lose-lose situation.  

    We have multiplied our bad habits in the dark until we have become overwhelmed by their vast numbers.   The only cure for this problem is to bring them into the light -- Stop The Drug War.

  •  Need to include alcohol (0+ / 0-)

    Philip Seymour Hoffman also had alcohol in his system when he died.  Alcohol is legal and cheap compared to illicit drugs and kills more people per year than opioids.  There is an overreliance on self-help groups like Alcoholics Anonymous.  They do good work but a volunteer organization simply doesn't work for many alcoholics.  Because alcohol is legal, it appears that there is less incentive to provide formal treatment.  It also seems to be a multigenerational disorder.  How much is genetic and how much is learned is hard to tease out.

    Don't look back, something may be gaining on you. - L. "Satchel" Paige

    by arlene on Sat Mar 15, 2014 at 05:59:08 AM PDT

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