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Opioid Epidemic?…Not Exactly

Opioid Drug Epidemic


It seems every news broadcast is reporting on the latest American Armageddon, the Opioid crisis. Politicians and pundits are concerned about the epidemic of prescription pain medication indiscriminately killing our citizens. The truth is not quite so simple.

Nearly two decades ago, while working as a detective, I responded to a call for a sudden death. Upon arrival, we found a 22 year-old white male, lying supine on his bed. Rigor had already set in.

The tragic story involved a college student who had been partying with his friends, snorting brown heroin. He overdosed and his friends turned to an old wives tale method to revive him—they put him in a bathtub and turned on the shower with cold water. When he didn’t wake up, they moved him to his bed and left the apartment. Like Jimi Hendrix, he vomited, aspirated and died.

I made the notification to the family. Unfortunately, we didn’t determine whether his son’s path to heroin had begun with a legitimate prescription to pain medication. At the time, heroin overdoses were not on the national agenda.

We interviewed the young man’s friends, including the one’s he had been partying with. They were afraid to call 911 for fear of getting themselves, or the victim, in trouble.   There were no “‘Good Samaritan” statutes at the time, like there are now here in Missouri, that would have alleviated their fear of legal trouble when calling for help. We were able to identify the heroin dealer and notified our narcotics division who were able to extract some justice.

It was around this time, as a result of aggressive marketing by the pharmaceutical industry, opioid prescriptions skyrocketed. The marketing fostered a trend in the medical community to view opioid prescriptions as a viable and low risk method to manage patients with pain. The stigma of addiction and related adverse health conditions were glossed over by the advertising strategies of the pharmaceutical industry.

A historical construct of the Purdue Pharmaceutical marketing scheme for OxyContin that seems to have spawned the opioid problem, can be found in an October 2017 article in the New Yorker magazine:

“Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of malaises. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal.” [1]

The current crisis may have certainly begun with the over prescription of opioid painkillers; however, the increase in the number of overdose deaths that grab headlines are from synthetic opioids, such as Fentanyl.  [2]

Fentanyl can be 50-100 X more potent than morphine and may be added to heroin or used in the manufacture of fraudulent prescription pills sold illegally. A minute amount of this crystalline powder can kill the unsuspecting drug user.

A recent article in the American Journal of Public Health recommends a change to the Centers for Disease Control and Prevention (CDC) method used for quantifying prescription overdose deaths. They propose a method that removes deaths as a result of illicitly manufactured fentanyl (IMF).This change would improve data accuracy on reporting the number of overdose deaths directly related to a prescription opioid. [3]

These are clearly challenging times. Heroin prices are at an all-time low. The availability of IMF from China and Mexico is increasing while there is a call to reduce the number of opioid prescriptions written by providers. Restricting or denying access to opioids for legitimate chronic pain patients could force them to obtain relief with illicit drugs purchased from street drug dealers. The increase in the deaths from illicit drugs may be an unintended consequence of this restriction.

Solving the current opioid problem requires multi-factorial strategies. Educating providers in the appropriate use of opioid prescriptions is necessary, especially if they are managing chronic pain patients. Non-medical options including acupuncture, massage and chiropractic can offer relief for some patients.

Some commercial insurance companies have taken proactive approaches to address this issue. These include collaboration between the business units that manage their member’s pharmacy benefit, mental health professionals and the Special Investigations Unit charged with investigating health care fraud, waste and abuse.

They search claims data for members who appear at-risk for prescription fraud, such as patients who go to multiple doctors for pain medication prescriptions. They also identify providers who may be involved in aberrant prescriptive practices.

Strategies include limiting a member, suspected of prescription drug abuse, to a single pharmacy or prescribing doctor. Members may be referred to behavioral health staff where they can receive counseling and possibly medicated assisted treatment for addiction disorders.

Providers suspected of over-prescribing pain medication or other abusive or potentially criminal behavior undergo additional scrutiny by the SIU investigators which may result in notification to law enforcement and regulatory boards. These interventions are showing positive results in the reduction of opioid prescriptions and patients receiving behavioral health assistance.

Programs like this will not solve the opioid (IMF/Heroin) crisis, but they are steps in the right direction to avoid the unintended consequences of more overdose deaths.



[3] Puja Seth, Rose A. Rudd, Rita K. Noonan, Tamara M. Haegerich, “Quantifying the Epidemic of Prescription Opioid Overdose Deaths”, American Journal of Public Health 108, no. 4 (April 1, 2018): pp. 500-502.

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JOHNNY STRABLER (The Wild One) meet GEORGE BAILEY (It’s a Wonderful Life)

JOHNNY STRABLER (The Wild One) meet GEORGE BAILEY (It’s a Wonderful Life)

This story is about the exuberance, excitement and passion of youth. Johnny Strabler and George Bailey were clearly excitable boys. George Bailey was played by Jimmy Stewart. All George wanted to do was to get the hell out of his home town of Bedford Falls. He didn’t want to settle for a mundane life like the rest of his family. George wanted to travel to exotic places, do exciting things and make his mark on the world.

Shit happened and he ended up staying in Bedford Falls, working at the family business, marrying his high-school sweet heart, buying an old, drafty house and raising a slew of kids. He never traveled to exotic places, did exciting things or made his mark on the world (outside of Bedford Falls). By the end of the movie, he learned the same lesson Dorothy learned in the Wizard of Oz, “There’s no place like home.”

Most of us were dreamers like George. We wanted more, we wanted to travel to exotic places, do exciting things, make our mark on the world. And like George, shit happened, and we settled for a life less than what we had dreamed. With any luck, you had some moments of exhilaration that touched on those youthful dreams, as you changed diapers, mowed the yard and paid the bills.

Of late, the streets are filled with passionate and exuberant youths. It reminds me of lyrics from the classic 1960s protest song by Buffalo Springfield, “For What It’s Worth.”

“A thousand people in the street

Singing songs and carrying signs

Mostly say, hooray for our side

It’s s time we stop, hey, what’s that sound

Everybody look what’s going down…”

This tune, by Stephen Stills, reflected the angst in the streets of LA at the time. It was written about the closing of a rock club on the LA strip, but became a song for the times, as the fury against the Viet Nam war blossomed.

The kids on the streets today are equally passionate about the recent turn of events. Some of their disappointment and anger has a legitimate basis. Good for them…protesting, making your voice heard is a cornerstone upon which this country was founded.

Some of the protesting is based on emotion without a factual basis. And the violent protestors bring nothing to the table but response in kind. And unfortunately, some of the ‘song singers and sign carriers’ are professional, paid protestors. And finally, some are protesting in the same fashion as Marlon Brando’s character ‘Johnny Strabler’ in The Wild One. In it, Johnny was asked what he was rebelling against. He responded with, “What do you got?”

I’d like to remind the folks out on the street, that we have been here before. The country will survive, life will go on, things  may get worse, but they will eventually get better. I like to think that things may even be better than before.

Fifteen years from now that angry kid with a bandana masking his/her face, waving a “Not My President” or “Black Lives Matter” sign will likely be pushing a shopping cart with a kid or two in tow, looking for the best price on ground chuck. They will have become George Bailey. And there is nothing wrong with that.



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All In The Family
All In The Family Archie Bunker and Sammy Davis Jr.


The answer to why Trump won and can be found in two TV shows. All in the Family and King of Queens.  All in the Family was a 1970s sit-com featuring a middle-aged, blue collar, working stiff named Archie Bunker. Today, Archie would be classified as bigoted, racist, homophobic and misogynistic. He would be one of Hillary’s deplorable and irredeemable people. And yet, the show ran successfully for 9 seasons and touched on many of those controversial topics. Archie said ignorant, sometimes vulgar and hurtful things. But, the show demonstrated that in his heart, he was a good man that was loved by his family and friends, even the ones that were black, gay, women or hippies. And he was loved by America. Bravo named Archie Bunker, TV’s greatest character of all time. TV Guide ranked All in the Family as the fourth-greatest show of all time.

King of Queens was a more recent show airing into 2008. It was a family sit-com featuring a younger, blue collar, working stiff named Doug Heffernan. The show also ran for 9 seasons and earned high ratings from the TV industry. Doug was a parcel delivery truck driver. His co-worker and best friend on the show was a black guy named Deacon. Doug was not nearly as opinionated as Archie. Political correctness I suppose. In any event, they were just regular guys who loved their families, drank beer, bowled, played cards and worried about paying their bills.

Archie and Doug, and their families and friends were not deplorable, horrible people filled with hate. They were just regular people with whatever built in prejudices and opinions they learned from their upbringing. Clearly, some of those beliefs are wrong. Many of the episodes, especially in the All in the Family series, brought these controversial opinions to light and Archie changed.

Archie and Doug were typical working guys with typical working guy lives. Today’s working people are not much different. They worry about keeping their jobs, they are concerned about the safety of their families, the high cost of everything and what tomorrow will bring. The fact that some college student is over their head in student loan debt, needs a ‘safe place’ on campus or can’t find a comfortable place to urinate is not a priority.

These are the people who make up the bulk of America in what the politicians call fly-over country. These people are not racists and Nazis as the MSM would like you to believe. They are the people who work in factories that built your car, for construction companies that built your house, that drive the trucks that deliver your Amazon purchases, install your cable line or satellite dish so you can post your controversial opinions on Facebook, drill for the oil that makes the gas for the car you drive, operate the power companies that keep the grid working, cook your Big Mac or manage the Waffle House down the street.

These people watched as the economy sputtered, the middle class became invisible, the rich got richer, jobs were lost, wars were lost and terrorism increased on our shores. President Obama and Secretary Clinton both indicated that Hillary’s election would guarantee continuation of the Obama years. These folks are smart enough to know that “if you keep doing the same thing in the same way, you get the same result.” The same result was not acceptable.

These are the people, and their families who voted for Donald Trump. They were the regular people from fly-over country as well as the coastal cities. In fact, Archie and Doug lived in New York. Why did they vote for Trump? Because he connected with them. The Donald made ignorant jokes and statements that sounded a lot like something Archie Bunker may have made. But, Trump’s years of experience in dealing with people made this formerly liberal billionaire from New York City seem more like one of them than his opponent. They trusted him more than her. So they forgave him for saying stupid things and acting like an idiot.

Trump did not talk down to them or call them names. He didn’t bog them down with detailed specifics about complex world affairs, immigration and economic policies. “It will be tremendous. We will make America Great Again. Believe me,” he said. And they did, and they voted. No one knows how it will all turn out, but one thing we do know, the elitist liberal class took a spanking for not paying attention. Maybe they will listen now.



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Small minds on Facebook and Johnny Depp and Paul McCartney….Who Knew.

I recently had a run-in on the Facebook with a few fellows who didn’t like a comment of mine. It was a lively banter in which they called me names and threatened me. They live in STL, so I offered to meet them in person. As expected, it is so much easier to call someone out with a keyboard than in person. I suppose everyone has their comfort level and their’s is probably in their kitchen. Their childish antics reminded me of the Brad Paisley song about the guy living at home with his mom who, in reality is 5’5″ and chubby, but online is 6’5″ and a secret agent.  In any event, there is so much more interesting stuff out there than to engage on FB with small minds. I found some stuff that said Keith Richards is alive, Alien spaceship to be revealed if HRC is elected POTUS and that Stanley Kubrick’s movie “The Shining” was filled with clues about his filming of the moon landing. Just stumbled on this one. Johnny Depp is  a player of sorts. At least he keeps pretty good playing company.

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California Vice (Land) Part Two


California Vice (Land) Part Two

 Our travels took us to farming country in northern California. Weed farming. I had an idea of what we may find there because I watch the Viceland channel. Viceland is a cable channel that offers a wide variety of documentary and reality series style programming. Their focus is on the Millennial demographic, so you have a lot of weird stuff on it. One of my favorite shows is ‘Weediquette.’ In this series, the host, a guy named Krishna, (imagine that) explores different aspects of the marijuana culture. He basically gets stoned for a living. And a lot of that takes place in northern California, as well as Colorado and Oregon.

In California, the rules of growing weed legally were codified in the 2015 Medical Marijuana Regulatory and Safety Act which went into effect Jan. 1, 2016 and is called the Medical Cannabis Regulation Safety Act. The act contains plenty of legalese and has a two year goal to put together the various regulatory agencies. And, getting a license to grow weed is costly. It can be thousands of dollars to get through the process to be cleared and obtain a marijuana grow license. But essentially, if you follow the rules the state has specified, you can grow a lot of pot. As a former police officer, the experience of seeing legal marijuana farms was bizarre.

Marijuana farming in California is an industry, just like traditional farming. Whether you are growing Sour Diesel or Soy Beans, both require land, barns, utilities, fencing, water, irrigation, fertilizer, pest/predator control and a lot of hard work. Just like traditional farmers, the pot farmers we met were responsible stewards of the land. Their land and their crop is their livelihood and they take it seriously. To successfully grow good weed, you have to be part horticulturist, geneticist, environmentalist and laborer. None of them we met were stoners. It is apparently way too difficult to prepare a 400 gallon pod of growing medium, or put up a ¼ mile of fencing while baked out of your mind. We met some retirees with medical marijuana licenses who legally grew a few pot plants in their vegetable garden. They tell me smoking a joint in the evening is no different than having a glass of wine or taking a Xanax.

Sure, there are negative aspects to the expanding weed culture. Some growers don’t go the legal route. Those who don’t own a farm often trespass on public or private land and illegally set up their grow operation. These are the folks that may be armed, place booby traps around their plants and are otherwise engaged in criminal activities. Hopefully, California law enforcement will eliminate these outliers just like they do in states where growing is not legal.

Hindsight has shown us that alcohol prohibition didn’t work and that heavy handed, federal government enforcement of a product that is generally accepted by the public, was a mistake. It is difficult to justify how the legal Cali growers, who are responsible, law abiding, environmentally friendly and, in my humble opinion, nice people, would face arrest and significant jail time in other states. The cop in me says, “If you’re growing weed in a state where it is not allowed, it may not be right or fair or what you want, but it’s still the law.” Then again, maybe John Lennon was right. “You say you want a revolution…”