Ithaca, Opioids, and Trump

Ithaca and Tompkins County are among the American localities severely affected by the opioid crisis, prompting intensified efforts by local officials. Overdoses are a common occurrence, and authorities report an average of 15 drug-related deaths a year since 2011. In 2016, the number skyrocketed to 21, compared to two deaths in 2007.

President Trump put a welcome spotlight on the opioid crisis this week, declaring it a “public health emergency” and describing it as a plague that has spared “no part of our society, not young or old, rich or poor, urban or rural.” At least 64,000 Americans died of overdoes in 2016, driven, Trump said, “by a massive increase in addiction to prescription painkillers, heroin, and other opioids.”

ithacavoice

Trump said he was “directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis,” but was short on specifics, mainly rattling off various steps that the federal government had previously taken.

Moreover, Trump’s diagnosis of the crisis and prescription for its cure seemed wide of the mark. His speech focused on blaming foreigners—Chinese and Mexicans—for sending illicit opioids into the country, and on criminal gangs for pushing them on America’s streets. (A key part of Trump’s future plan, he said, is a “massive advertising campaign to get people, especially children, not to want to take drugs in the first place.”)

Trump made no mention of two factors that experts increasingly see as fueling the addiction epidemic—pharmaceutical companies pushing legal opioids, and a national mental health crisis in which people desperately seeking relief from depression and anxiety find relief in opioids.

The Atlantic’s Alana Semuels reported in June:

“Ohio’s Attorney General Mike DeWine filed a lawsuit Wednesday against a handful of pharmaceutical companies, including Purdue Pharma, Teva Pharmaceuticals, and Johnson & Johnson. The lawsuit accuses the companies of spending millions on marketing campaigns that ‘trivialize the risks of opioids while overstating the benefits of using them for chronic pain.’ The companies, the lawsuit alleges, lobbied doctors to influence their opinions about the safety of opioids, ‘borrowing a page from Big Tobacco.’

“The lawsuit follows similar recent lawsuits in Illinois, Mississippi, four counties in New York, and Santa Clara and Orange Counties in California. Last month, the Cherokee Nation filed a lawsuit against distributors and pharmacies in tribal court over the opioid epidemic. In January, the city of Everett, Washington, filed a lawsuit against Purdue Pharma, the makers of OxyContin, alleging that the company knew the drug was being funneled into the black market but did nothing to stop it.”

Also in June, the Washington Post’s Lenny Bernstein reported on a study by researchers at the Dartmouth-Hitchcock Medical Center and the University of Michigan that linked greater opioid use and mental health disorders. The researchers concluded that 51.4 percent of 115 million opioid prescriptions written annually in the United States were given to people with anxiety and depression.

“Those patients may have some form of physical pain, said Brian Sites, a professor of anesthesiology and orthopedics at Dartmouth’s Geisel School of Medicine, who led the study team. But their mental condition may cause them to feel that pain more acutely or be less able to cope with it, leading to increased requests for something to dull it.

“Pain that ‘you may report as a two out of 10, someone with mental health disorders — depression, anxiety — may report as a 10 out of 10,’ Sites said in an interview. In addition, opioids may improve the symptoms of depression for a short while, he said, with patients who experience that then asking for continued refills.

“As a result, doctors trying to be empathetic to their patients’ complaints may tend to overprescribe opioid painkillers, he said. About half of all opioids are prescribed by primary-care physicians, who also manage most routine anxiety and depression.”

Trump’s declaration of a “public health emergency” did not involve the release of emergency federal funding, but the White House indicated that the president would soon ask Congress for additional funding to combat the opioid crisis. Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by Governor Chris Christie of New Jersey, will hand Trump its final report and recommendations next week.

The New York Times quoted experts saying that an effective policy to fight the crisis will cost billions of dollars:

“Andrew Kolodny, the co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, said that no emergency declaration would do much to alleviate the impact of opioids without a substantial commitment of federal money and a clear strategy for overhauling the way the country treats addiction.

“‘What we need is for the president to seek an appropriation from Congress, I believe in the billions, so that we can rapidly expand access for effective outpatient opioid addiction treatments,’ Dr. Kolodny said in an interview. ‘Until those treatments are easier to access than heroin or fentanyl, overdose deaths will remain at record-high levels.’”

Senator Joe Manchin of West Virginia, a state hard hit by the opioid crisis that Trump singled out in his remarks, called for pharmaceutical companies to pay. CNN reported:

“‘This is a business plan. They are liable,’ Manchin told CNN’s Jake Tapper on ‘The Lead’ when asked if he believes the pharmaceutical industry needs to be found legally liable in some cases for the prevalence of opioids in the United States.

“Manchin added that the companies that supply opioids should be charged fees for the drugs they produce and for having inundated the market with the highly addictive drugs.

“‘This is what’s caused it. Can’t we at least charge the pharmaceutical companies one penny per milligram for every opiate they produce?’ Manchin added.

“‘Every state’s been affected,’ he said of the crisis. ‘I’m ground zero, West Virginia, more deaths per capita, more people addicted per capita.’

“‘This is like fighting a war,’ Manchin said about the need for funding. ‘You’ve got your soldiers on the front line fighting … (but) your guys on the front line run out of bullets.’”

Chart: From the Ithaca Voice, October 13, 2017

Bravo “Dear Evan Hansen”

“Dear Evan Hansen” is a musical about teenagers in the age of social media dealing with anxiety, confusion, loneliness, hurt, and suicide. A brilliant, cathartic narrative for our times, it cries out for us to recognize human fragility and empathize with it.

 

 

That message spread far beyond Broadway on Sunday night when “Dear Evan Hansen” won six Tony Awards, including for best musical, best actor, and best score. The musical’s cast album, with songs like “You Will Be Found,” “Requiem,” and “Waving Through a Window,” debuted in the Billboard Top 10 earlier this year.

Best-actor winner Ben Platt, who is 23, reached out to vulnerable teenagers in his acceptance remarks during the nationally televised ceremony at Radio City Music Hall:

“To all young people watching at home, don’t waste any time trying to be like anybody but yourself, because the things that make you strange are the things that make you powerful.”

In the plot, anxiety-ridden teen Evan Hansen writes pep-talk letters to himself on the advice of his therapist. One of the letters ends up in the pocket of a social outcast named Connor, who then dies by suicide. The Connor connection takes Evan into a swirl of lies as he fabricates stories about a friendship with Connor and pursues the crush he has on Connor’s sister. Evan achieves temporary social media-fueled fame as a campaigner to aid other youth experiencing Connor’s mental health struggles. Evan’s charade collapses, but the ordeal brings him to a reconciliation with his single-parent mom and to healthier self-awareness.

“Dear Evan Hansen” has been praised for its sensitive handling of mental disorders and suicide. The production has openly associated itself with mental health and suicide prevention organizations like the Child Mind Institute, the Crisis Text Line, The Jed Foundation, and The Trevor Project.

The show’s songwriters, Benj Pasek and Justin Paul, who won the Tony Award for best original score, spoke to Variety about the care they took in writing about teen suicide. As Paul put it:

“We wanted to make sure the subject was treated thoughtfully and sensitively. There was vetting of the script and of the story with mental health professionals, to make sure what we were telling felt truthful and honest, and like we weren’t trying to sugarcoat things, but that also wasn’t trying to provoke anything. There’s a small change in the show that we made between Second Stage and Broadway, the addition of two little lines toward the very, very end of the show, that we added after some feedback that we’d gotten from families of teenagers or people who had taken their own lives.”

 

s

TIME’s Susanna Schrobsdorff captures the incredible impact “Dear Evan Hansen” is having on teenagers—and their parents:

Ask one of the many teenagers in the audience if the play seems authentic and they can barely get the words out. They say things like, “I’m in shock, it’s so good.” And often, right behind them, is a parent who’s also feeling undone. I lost it in the first act when the two stellar actors who play mothers of teens sing about feeling totally unqualified for the job of being a parent. “Does anybody have a map?” they cry. “Anybody maybe happen to know how the hell to do this?”

Emma Stone’s Story

Emma Stone, who won the 2016 Academy Award for Best Actress for her role in La La Land, has kicked off the Child Mind Institute’s #MyYoungerSelf video series for Mental Health Awareness Month. The 28-year-old Stone discusses her struggles with anxiety and panic disorder.

emma

Watch the video, and read the transcript:

Hi I’m Emma.

What I would tell kids that are going through anxiety, which I have and can relate to, is that you’re so normal it’s crazy. So many people—I mean, to say that “you’re so normal, it’s crazy” is a pretty funny thing to say—but, it is so normal.

Everyone experiences a version of anxiety or worry in their lives. And maybe we go through it in a different or more intense way for longer periods of time. But there’s nothing wrong with you.

To be a sensitive person, that cares a lot, that takes things in in a deep way, is actually part of what makes you amazing. And is one of the greatest gifts of life. You think a lot, and you feel a lot, and you feel deeply. And it’s the best. The trade off—I wouldn’t trade it for the world, even when there are really hard times. There are so many tools you can use to help yourself in those times.

It does gets better and easier as life goes on, and you start to get to know yourself more and what will trigger certain instances of anxiety and where you feel comfortable and safe.

So, I would just say, don’t ever feel like you are a weirdo for it. We are all weirdos!

#MyYoungerSelf is a series of honest stories from public figures about growing up with a mental health or learning disorder—what they would tell their younger selves about mental health. Click here to keep track of all the videos in the series throughout Mental Health Awareness Month in the United States.

#MyYoungerSelf is part of the institute’s annual public education campaign, Speak Up for Kids, which promotes awareness of children’s mental health issues and providing needed information to families, educators, the media, and policymakers. Speak Up for Kids aims to counter the stigma for the one in five children struggling with mental health or learning disorders.

The Child Mind Institute is an independent, national nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders. Its teams work “to deliver the highest standards of care, advance the science of the developing brain, and empower parents, professionals, and policymakers to support children when and where they need it most.”

Click here to read Refinery 29’s story about the Emma Stone video

Click here to read Vogue’s article on Emma Stone.

 

13 Reasons Why: Warning Label

The new Netflix series 13 Reasons Why is generating alarm among many mental health professionals and suicide prevention experts, who are concerned about the risks of glamorizing suicide and the possibility of contagion.

13reasonsposter

Netflix kicked up a controversy with the series released on March 31 about a high school junior named Hannah who takes her own life. The series received a 91 percent critics approval rating and an 88 percent audience rating on Rotten Tomatoes. Critics praised the cast’s performances and the “authentic,” “sensitive,” and “hard hitting” portrayal of teenager angst.

However, 13 Reasons Why needs a warning label. The National Association of School Psychologists cautions that the series should not be viewed by vulnerable young people who experience any degree of suicidal ideation. NASP warns:

“Its powerful storytelling may lead impressionable viewers to romanticize the choices made by the characters and/or develop revenge fantasies. They may easily identify with the experiences portrayed and recognize both the intentional and unintentional effects on the central character. Unfortunately, adult characters in the show, including the second school counselor who inadequately addresses Hannah’s pleas for help, do not inspire a sense of trust or ability to help.”

NASP has problems with the accuracy of how mental illness and suicide are portrayed in the series. For example, it is concerned that the series does not emphasize that common among most suicide deaths is the presence of treatable mental illnesses. And that suicide is not the simple consequence of stressors or coping challenges, but rather, it is most typically a combined result of treatable mental illnesses and overwhelming or intolerable stressors.

Despite the strong misgivings, some see the widespread publicity around 13 Reason Why as an opportunity at least to spread greater awareness about suicide and suicide prevention. NASP says that the controversy is an “opportunity to better understand young people’s experiences, thoughts, and feelings,” educate parents, teachers, and students alike about suicide risk warning signs, and reinforce the message that suicide is not a solution to problems.

NASP advises that school psychologists and other school-employed mental health professionals can assist stakeholders such as school administrators, parents, and teachers to engage in supportive conversations with students as well as provide resources and offer expertise in preventing harmful behaviors. NASP published “Considerations for Educators,” guidance on 13 Reasons Why. Download it here.

Experts say if you’re thinking about the safest and best way to lead a discussion with teens about 13 Reasons Why and suicide, read the tip sheet co-authored by Suicide Awareness Voices of Education (SAVE) and the JED Foundation. Click here to download the tip sheet.

Some recommended reading from experts on the subject of suicide contagion:

Preventing Suicide With A “Contagion Of Strength” (National Public Radio February 25, 2015)

The Science Behind Suicide Contagion (New York Times, August 14, 2014)

Teen suicide: Prevention is Contagious, Too (Christian Science Monitor, December 8, 2013)

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]

Prince Harry’s Story

“Once you start talking about it, you realize that actually you’re part of quite a big club.” So says Prince Harry, 32, who has opened up in a British newspaper podcast interview about his mental health struggles and how he is dealing with them.

Harry spent 10 years in the British Armed Forces, including two operational tours in Afghanistan where he commanded Apache helicopters, and achieved the rank of captain. None of his military training and experiences, however, prepared him for the severe emotional challenges he faced due to the tragic death of his mother Princess Diana in 1997 when he was just 12 years of age.

In an interview with Britain’s Daily Telegraph, Harry revealed that he sought professional counseling after two years of “total chaos” in his late twenties. He described how he only began to address his grief at age 28 after feeling “on the verge of punching someone” and experiencing anxiety during royal engagements. He says he is now in a “good place.” He credits his elder brother, Prince William, for being a “huge support.”

Excerpts from the interview with Bryony Gordan’s “Mad World” podcast this week:

“I can safely say that losing my mum at the age of 12, and therefore shutting down all of my emotions for the last 20 years, has had a quite serious effect on not only my personal life but my work as well.

“I have probably been very close to a complete breakdown on numerous occasions when all sorts of grief and sort of lies and misconceptions and everything are coming to you from every angle.

“The experience I have had is that once you start talking about it, you realize that actually you’re part of quite a big club.

“My way of dealing with it was sticking my head in the sand, refusing to ever think about my mum, because why would that help?

“[I thought] it’s only going to make you sad, it’s not going to bring her back.

“So from an emotional side, I was like ‘right, don’t ever let your emotions be part of anything.’

“So I was a typical 20, 25, 28-year-old running around going ‘life is great,’ or ‘life is fine’ and that was exactly it.

“And then [I] started to have a few conversations and actually all of a sudden, all of this grief that I have never processed started to come to the 
forefront and I was like, there is actually a lot of stuff here that I need to deal with.

“It’s all about timing. And for me personally, my brother, you know, bless him, he was a huge support to me. He kept saying this is not right, this is not normal, you need to talk to [someone] about stuff, it’s OK.

“The timing wasn’t right. You need to feel it in yourself, you need to find the right person to talk to as well.

“I can’t encourage people enough to just have that conversation because you will be surprised firstly, how much support you get and secondly, how many people literally are longing for you to come out.”

British mental health experts praised Harry for speaking up so openly about seeking professional help for his mental health struggles. Sir Simon Wessely, the president of the Royal College of Psychiatrists, went so far as to say that the prince had achieved more in communicating mental health issues in the 25-minute podcast than Wessely had in a 25-year career.

Since retiring from the armed forces in 2015, Harry devotes much of his time to charity work. He is involved with Heads Together, which brings together The Royal Foundation of The Duke and Duchess of Cambridge and Prince Harry in partnership with charities tackling stigma, raising awareness, and providing help for people with mental health challenges. He also focuses on the welfare of servicemen and women, championing developmental opportunities for hard to reach children, and African conservation. In 2014, Harry created the Invictus Games, an international adaptive sporting event for wounded, injured and sick servicemen and women.