15Jul/16

Why CARA Is a Failure and How Recovery Advocates Were Duped

On Wednesday, the Comprehensive Addiction and Recovery Act (CARA) passed the Senate 92-2 and was sent to President Obama’s desk. Advocacy groups lit up social media with praise for the bi-partisan legislation which expands Naloxone training for first responders, provides more funding for buprenorphine for people with opiate disorders, and grants some meager funds to find alternatives to incarceration.

While the bill offers up a few good solutions, it’s far more of a failure than a success.

1) The Senate version of the bill called for a mandated prescription drug monitoring program (PMP). The House rejected it after doctors and pharmacists lobbied that it would be burdensome. The final language just suggests that doctors and pharmacists use it. “Suggests” has not worked when it comes to public policy and addiction treatment issues.

2) Case in point. CARA calls for over $900 million to go towards expanded buprenorphine for individuals with opiate misuse disorders. It does not address the key flaw regarding buprenorphine, which I have been writing about for years. Buprenorphine has proven to be effective when combined with weekly therapy sessions and weekly drug screening. The Drug Abuse Treatment Act of 2000 introduced buprenorphine to America and despite the trials and evidence, merely suggested it be accompanied with therapy and drug screens rather than required it. As a result, buprenorphine has been less effective in America than in other countries and has gotten a bad reputation in some treatment programs and 12-step rooms because it is viewed as swapping one drug for another. Without a requirement for drug screens and counseling, it isn’t medication assisted therapy. It’s just medication.

3) The $1.1 billion bill has little funding. This is a political trick. Pass the bill. Get applauded by people in recovery, family members and advocates. Congress will now go on break for the next seven weeks and everyone’s attention will turn elsewhere for the rest of the summer. Advocates will calm down. Then Congress will return after Labor Day. At that point, schools will be back in session, the NFL will be on TV, and the Presidential election will be in full swing. Voting on funding for CARA will most likely be buried. Even if CARA does not get funding, 92 Senators in June and 400 House members in March voted in favor of it. One third of those Senators and all of the House members are up for reelection this fall. Even without funding the bill, they can all claim that they voted for CARA and that they really, truly, deeply care about addiction.

Maybe (hopefully) I’m wrong about the third point and Congress will somehow find the $1.1 billion to make it work. Even so, it would still fail on points one and two.

 

09Jul/16

In Defense of Teachers, Muslims and Cops

I try to limit my writing to subjects that I have an obvious expertise in (addiction, recovery, military, education, criminal justice, public policy) or intense interest (comics, baseball). I’m concerned enough about the current public discourse regarding teachers, Muslims, and cops that I’m going to write about them, but only within a very limited framework. I do not know what the fixes are for these problems; rather, I am just offering up a few of my viewpoints and experiences. A quick background on me: politically, I’m a centrist. I’m a registered independent voter. Family members, friends and students of mine that are conservative view me as a liberal while liberals often express a frustration with some of my conservative viewpoints.

Teachers

I taught high school English from 2006 to 2009. My mother was a high school English teacher for 31 years. My grandmother taught English in the 1930s and my great grandmother taught every subject in a K-12 school house in a small farming community about 50 miles outside of Minneapolis, Minnesota. Teaching is not only in my blood and a way of life, but a deep, enduring passion. I have tried to encourage a number of my high school and college students over the years to pursue a career in teaching, and I’m thrilled when I hear them talk about their students when they “got” the lesson or hear a story about how a kid made them laugh.

Over the last dozen years, I have read (at least what seems to be) at least one story a week on NJ.com about teachers who are accused or convicted of having sex with their students. I did a quick google search, and it appears that teachers make the news more for having sex with their students than anything else. It’s distressing, and I have had more than a few people in my personal life ask me about the “teacher-student sex problem.” While I am always distressed to hear about these stories, I think it is neither an epidemic nor endemic of the teaching profession. There is a tiny percentage of teachers that do this, but because of the “if it bleeds it leads” mindset, this is what we hear about. On top of this, Governor Christie has continually demonized teachers (along with police officers and other public workers) since he took office. Attacking the teachers’ union made for popular soundbites and youtube vidoes, both of which increased Christie’s popularity during his first term. Partly (I’m quite sure but can’t prove) because of the negative publicity and Christie’s attacks, the number of young people who report wanting to become a teacher has gone down.

Muslims

Each time there has been a mass shooting the last couple of years and before we find out who pulled the trigger, an old friend of mine asks me if I think it is either a “rural white Christian who feels economically and culturally left behind or a radical Muslim with foreign ties.” It’s an awful question, but it seems to me that liberals hope it’s the white Christian while conservatives want it to be the radical Muslim (the whole business of hoping it’s someone from (or not from) a particular group is ugly, and each side ultimately tends to use it as a talking point to push their world view or limited political agenda). Again, I don’t know what the fixes are for addressing the grievances of either group, but it seems to me that Muslims in America are constantly asked to answer for the heinous crimes of a tiny percentage of 1% of American Muslims.

I have served in the military with Muslims; just like members of every other religion or race, a couple were great soldiers, some were good, most were ok and a few were sub-par. I’ve had dozens of Muslim students over the years (both at Essex County College and Rutgers), and I found them to almost always be polite, studious, punctual and usually a bit quieter than my other students. Unless they discussed a particular issue involving their faith, I could not tell that they were Muslim through their writing. A former colleague of mine at the Rutgers Newark Counseling Center is Muslim, and he is a prime example of a wonderful American: calm, smart, wise, kind, humorous and hardworking. He is also a Cowboy fan, which caused me to ask him when we met, “Wait…you are a Cowboy fan? How do you reconcile that with being a psychologist, a Muslim and a teacher of young people?”  He grew up with many of the same cultural experiences I did (trading lunch items in school, cartoons on weekday afternoons). He invited me to observe services in a mosque, and I took a number of my recovery students there on a few separate occasions. I felt welcome and safe there every time (just as I have felt when I have gone to Catholic, Protestant,  Baptist, or Jewish services with friends). Rany Jazayerli is a dermatologist from middle America who is a life-long Kansas City Royals fan. I have been reading his work with Rob Neyer, at Baseball Prospectus, at Grantland, at Five Thirty Eight, and on his own site for almost 20 years. He is a married father of three and a Muslim.

Not every Muslim I know has been an ideal American citizen though. I have also worked with Muslims in jails and rehabs. Some of them drove drunk, sold drugs, stole from family members and engaged in a variety of other drug related crimes. Like people of every other race, religion, and class in America. (When I was working in Thailand, Muslim leaders despairingly talked to me about the drug use among their young people and how it was devastating their families. They expressed the same sadness, fear and powerlessness that I’ve heard from Americans the last dozen years)

Cops, State Troopers, and Other Law Enforcement Officers

I started writing this piece before Alton Sterling and Philoton Castillo were shot this week. In their immediate aftermath, I wrote this: “The number of cops that engage in excessive violence (and in even fewer instances, murder) are a tiny percentage of law enforcement overall. My fear is the legitimate grievance regarding the higher statistical likelihood of black people being searched, arrested, beaten or shot will continue to be used to ascribe all law enforcement with racism and evil. The sadness and anger felt by Americans will be fueled by the echo chamber in which it seems that most of us live and end up motivating some deranged individuals to attack police officers, which in turn will further drive a wedge in society. And it will probably be captured on camera.” I wrote that a few hours before the five police officers were killed in Dallas on July 7th.

I have two friends that are cops. One is a guy I served with in the Army from 1997 to 2001. His father was a State Trooper and from everything I heard from other troopers in the NJ Army National Guard, a wonderful man with great sense of humor. My buddy is a married father of three and an easy going sergeant. Over the years, he changed his views on drug arrests. When he was younger, he was quick to arrest and charge people with simple possession. As he aged, he realized that it was a numbers game and that it was detrimental to the people he was arresting and not a good use of his time (that said, he takes a very strong stance on driving while under the influence of any substance). I met my other friend in college in 1996. We went to Rutgers together. He was a Maryland State Trooper for a few years before transferring to a municipal force in NJ. He has been in law enforcement since 2004. He joined to protect people and catch bad guys. On the morning of July 8th, he left home to go to work. His wife cried and begged him to be safe and make it home. His two children watched this interaction. Because we are so close, we’ve talked about drug problems and drug arrests for years. Long before the Good Samaritan Law was passed in NJ, he understood that drug users do better with treatment than incarceration, and at lower costs to society. He has taken people to the hospital and referred them to treatment for years. And it has gone completely unnoticed and unreported.

In April, I watched one of my former students from Elizabeth High School graduate from the Maryland State Trooper Academy. The Colonel of the Troopers was there, and in his speech to the graduates he said everything that one would want to hear. I’m going to quote him from memory as best I can:

We are a paramilitary force with specialized training. You must remember that we are not a military force. We are not going out there to engage the enemy, but rather be part of the community and protect society. If you use excessive force, we will get rid of you very quickly. Please watch your words and actions at all times – do not be one of those troopers who give all of us a bad name. Do not be discouraged by what a few bad officers do that causes a media frenzy.

My former student is a young man (25) of color. He has been assigned to a barracks in Baltimore. Unlike my buddies from the Army and college, I worry about my student. I’m not just concerned about the usual work, but I’m afraid that someone will take a shot at him because he’s in law enforcement. He has been on my mind throughout much of the last few days.

At the start of June, I gave a keynote speech at the NJ Juvenile Justice Officer Convention. I talked about a variety of illegal and prescription drugs, as well as criminal justice reform and other public policy issues. I also talked about the failure of D.A.R.E., and how not only does it not work, but kids that go through D.A.R.E programs are more likely to use and abuse drugs. Afterwards, I spoke with dozens of cops, both in person and via email. Some of them were D.A.R.E officers. They asked me to see that data on their ineffectual programs and then for advice on what they could do better. Many of them expressed frustrations within their units, schools or communities. It seemed that all of them cared a great deal about the work they do.

I have been hired by other law enforcement groups for trainings or to engage in group or individual counseling sessions. I always ask why they become cops. Usual answers include “it’s the family business” and “good benefits” and sometimes “a cop saved my life.” By far though, the most common answer is this: “I want to catch bad guys.” I then ask them if they joined for any of these reasons:

Possibility of getting killed. Lots of paperwork. Long shifts. Nights, weekend and holiday work. Dealing with the worst people. Working with old and broken equipment. Bosses who are out of touch. Pressure to make arrests. Investigating sex crimes.

Of course no one entered law enforcement to deal with those problems, but they are part of the job. It’s a rhetorical question and one of my bonding and teaching strategies. Add to these problems the shift in public perception about cops – many feel unappreciated, blamed and attacked. Morale is low. The data on cops and troopers is pretty clear. They have more sleep problems, higher rates of first marriage divorce, higher rates of alcohol abuse, higher rates of stress, a high likelihood of PTSD, higher suicide rates, and shorter life expectancy. I tell them that their job might be killing them (much like how military jobs and child welfare workers jobs cause them to have all kinds of personal and health problems). This is a point that I must emphasize strongly – there are some jobs that we ask people to do that are detrimental to their physical and mental health, as well as the well-being of their families. Again, the data on this is clear.

One unit I work with focuses on sex crimes. What they deal with and see is beyond horrible. Someone will work in that unit for at least 3 years, but many work in it 10 or more. They see thousands of horrendous pictures of sexual acts committed against 6 month olds, toddlers and small children. And it’s not a bad day at work. They see this every day. For years. It does a number on them. It effects their families. These officers often don’t take sick days or vacations, because time is of the essence and any time off to them means “bad guys are doing bad things.” And they are haunted by the images of those bad things. I am thankful for the work they do and feel a sense of desperation to help them.

When military members came home from Vietnam, they not only had to deal with physical injuries and psychic wounds, but a hostile public that sometimes spat at them and called them baby killers. The burnt out and disillusioned Vietnam Veteran was so common that he became an American archtype, and we can all think of books and movies and TV shows where they are represented. The perception of the military and veterans changed after Gulf War I concluded in 1991, and soldiers (and marines and airmen and sailors) came home to yellow ribbons, parades and thanks. This respect for servicemembers and veterans has continued through 2016. I don’t know how it flipped (nor can I find a reasonable theory on it), but law enforcement needs and deserves a similar public perception change.

From what I’ve learned about the Dallas Chief of Police, he seems to be the ideal type of individual to help address the problems of modern policing and current perception in America. Even before the recent and well publicized problems between the black community and police blew up on the American radar (one might argue that it entered the national dialogue with Ferguson in 2014), Chief Brown had been working on engaging the community and training his officers to use restraint. A veteran of over 30 years, his son killed a police officer and was then killed by another cop shortly after Mr. Brown became the Chief in 2011. He’s also black, which is particularly significant and potentially impactful because of the level of distrust between many members of the black community and law enforcement.

The Importance of Language and How We Say Things

All of this written, I don’t have policy proposals to deal with teacher-student sex, Muslims who shoot people in America or the rampant fear that other Americans have towards Muslims, how to fix the disparity of arrests and violence against black Americans by law enforcement, nor how to improve the perception of the vast number of cops who try so hard to do the right thing all the time. What is obvious and painful to behold is that teachers, Muslims and cops are all being maligned for the actions of a few deranged individuals that share a profession or religion with them.

I’m an Orwellian. That means that precise language is extremely important to me and that I try to avoid understatement, exaggeration, hyperbole, and inflammatory language. I am so disappointed and frustrated by the words I hear people use to argue their positions. People threaten, curse, yell, exaggerate statistics, and misstate facts to make their points. People on both the right and left, conservatives and liberals, Republicans and Democrats, are guilty of this. We surround ourselves with people that think and speak like us and choose to read media that reinforces our opinions. We get fired up on social media by the latest outrage and unfriend those that have a different viewpoint.

President Obama spoke at the Rutgers graduation this year, and he criticized the administration, faculty and student body for pressuring Secretary Rice to not speak at the 2014 graduation.

I don’t think that’s how democracy works best, when we’re not even willing to listen to each other. If you disagree with somebody, bring them in and ask them tough questions. Hold their feet to the fire, make them defend their positions. … Don’t be scared to take somebody on. Don’t feel like you got to shut your ears off because you’re too fragile and somebody might offend your sensibilities. Go at them if they’re not making any sense.

A number of liberal writers said he was wrong, and that Rutgers community was justified in denying Secretary Rice a chance to speak. I strenuously agree with the words of President Obama. We need to be able to talk to and more importantly, listen to each other. If you are a conservative, ask yourself if you have any liberal friends or liberal views. If you are a liberal, do you have any conservative friends or conservative views. Do you talk in specifics or generalizations? Are you in a constant state of rage and agitation? Can you have a conversation without getting nasty or raising your voice? These are points I implore you to consider and questions to ask yourselves.

22Jun/16

The Recovery Coach Problem

Two weeks ago, I received a notice from the NJ Addictions Professionals Certification Board that they have created a credential called the Certified Peer Recovery Specialist. This replaces the terrible Recovery Mentor credential, and is just the latest term for a Recovery Coach. Two years ago, I wrote about Recovery Coaches and it has been of the most read articles on my site.

My biggest concerns about Recovery Coaches are that they are uneducated, untrained, unlicensed and unsupervised people that are collecting a fee for services to a very volatile and vulnerable population. The people who act as a Recovery Coach are usually in recovery themselves and often well meaning, but neither is a proper sole qualification to engage in this work (more on the Life Coach disaster below*). Many of the Recovery Coaches that I have come across cut their teeth in 12-Step programs and cite God as a profound force in their ability to recover. This is problematic at best, even moreso than typical “this way worked for me so therefore you should follow” it strategies. One should not infer that I don’t like 12-Step programs – I do – but I don’t want to see people use their AA or NA experience to give people advice on medications, family dynamics, suicidal thoughts or educational guidance. Another problem is that Recovery Coaches are, more often than not, against Medication Assisted Therapies and I know some proclaim that if you take Suboxone that “you are still getting high.”

All that written, having a certification that requires training, limits scope of work and requires supervision is a good start to fixing the Recovery Coach problem. The Certification Board described the credential as such:

This credential is available to Peers seeking to learn Peer Support skills in order to foster the recovery of others affected by addiction and co-occurring problems.The CPRS is not a private practice credential, as they are only licensed by the NJ State Division of Law and Public Safety, Division of Consumer Affairs.The CPRS will replace the Recovery Mentor. Please note that this is not a counseling certification (italics are mine), but rather a Peer Recovery credential that allows the holder to perform the following domains:

1) Advocacy

2) Ethical Responsibility

3) Mentoring and Education

4) Recovery/Wellness planning, within a supervised professional agency.

As of now, the training has only been approved to be provided by CARES in MorrisCounty. Their website states that the credential was inspired by the “Peer Specialists (that were placed) in hospital emergency rooms anytime someone is saved from an opioid overdose with Naloxone. The Peer Specialists meet with the patients in the ER with the goal of getting them into treatment and hopefully long term recovery.”

As long as the peer specialists (or recovery coaches or recovery mentors) are limited to this role and are not speaking out against medication** to those with addiction issues, this is a positive development. Like so many other programs and public policies though, it’s a good first step. There is more work to be done on this, and I still urge people to get a licensed therapist over a recovery coach.

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* Life Coaches are another group that seek to circumvent education, training, licensing, supervision and experience in order to collect a fee and act as therapists. The counseling professions are a bit of a disaster (far less than 20% are competent, in my wide experience), but that still should not open the door to anyone who can get someone to listen to them to become a pseudo-therapist. One wouldn’t hire a legal coach, medical coach, financial coach (well…I’m not sure why anyone would get a financial advisor that wasn’t a fiduciary, but I digress), or marriage coach, but for some reason life coaches caught on. From the dawn of civilization until present day, there have always been charlatans, hucksters, carnival barkers and snake oil salesman. Then as now, they are best to be avoided.

** In reading this and other articles by me, one might assume that I am wildly pro-medication. I am not. I believe that medication can be effective to help people with severe addiction issues, as well as people with depression, PTSD, anxiety, bi-polar disorder and a variety of other medical problems (heart disease, diabetes, HIV). I just don’t believe in medication first, but rather after a series of behavioral changes (proper sleep, proper diet, regular exercise, quitting smoking) have been legitimately attempted. I am quite wary of Big Pharma, and have written about the problems of over or improper medication extensively.

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6/23/2016 Correction: An earlier version of this piece stated that the NJ Division of Mental Health and Addiction Services (DMHAS) had been involved with the creation and approval of this certification. After communicating with officials at DHMAS this morning, I was informed that they were not involved in the process at all and that the Certification Board erred in its statement (please note that CARES has not made this false claim).

22Jun/16

Governor Christie’s Heroin Failure

Last week, Governor Cuomo and a number of legislative leaders announced a series of bills and initiatives to counter the heroin crisis in New York state.  This bi-partisan legislation was announced at a big press conference in Albany on June 14, 2016. The highlights of their work (which I’m quite impressed with) include:

1) the first time opioid drugs are prescribed, they can only be a 7 day supply (this means that Oxycotin, Percocet, Percodan, and Vicodin can no longer be handed out in 60 and 90 pill quantities to first time patients)

2) it mandates all prescribers (MDs and Advanced Nurse Practitioners) get training on pain management

3) increased the number of funded inpatient treatment beds by the state by 270

4) increased the number of funded outpatient slots by the state by 2,335

5) it ends prior authorization by insurance companies for inpatient or outpatient treatment. The first review by the insurance companies can only take place after 14 days of treatment (previously, reviews would happen after 2 or 3 days – think about that…someone from an insurance company would ask the treatment provider if the treatment has been working and how the client is doing after 2 days…and also think about how much time these treatment providers have to spend on the phone with the insurance companies, every few days)

6) it addresses insurance coverage and how insurance companies are not paying for treatment, despite the legal requirement to do so as dictated by the 2008 Mental Health and Addiction Parity Act and the 2010 Affordable Care Act.

7) it mandates that insurance plans pay for Naloxone (the anti-overdose drug)

All seven are good, but 1, 5 and 6 are incredible. What is particularly impressive is that Governor Cuomo was able to work with the NY legislature, whose leadership has continually been in trouble for years (click here, here or here for the horrid and sordid details).

Governor Christie’s failures in dealing with the heroin and opioid epidemic are lengthy. He delayed the Task Force report by 18 months and then did not take any action on the recommendations. He has failed to mandate the PMP in NJ. He vetoed the creation of more recovery high schools. He got a standing ovation at the Statehouse in January when he announced a $100 million for addiction prevention and treatment, but he never put the money aside (so there are no programs – but he still got his ovation and media attention).

The successes that have happened while he has been Governor happened in spite of him, rather than because of him. Advocates like Linda Surks, Patty DiRenzo, Paul Ressler; politicians like Senators Vitale and Lesniak, and the members of the Camden County Freeholders; former Deputy Attorney General Calcagni and hundreds of other hard workers have been the driving forces behind the Good Samaritan Law, Narcan Expansion, the Recovery High School, prescription drug drop off boxes, and the stunning fact that law enforcement officers carry Narcan and look at addiction as more of a public health issue than a criminal one.

NJ Assemblyman Joseph A. Lagana of District 38 introduced a number of bills last week that seeks to combat the heroin epidemic in NJ (none of them are as forward thinking as the aforementioned NY laws). His four bills (I’m taking all of this from an email he sent out last week):

The first bill would establish a process that would allow an individual to petition the courts for the involuntary commitment of another individual for treatment for substance use disorder.

Specifically, the bill would provide for a “petitioner” who is the spouse, civil union partner, relative, friend, or guardian of an individual to submit to the court a petition for the involuntary commitment of the individual to treatment for a substance use disorder. The petition must be accompanied by a guarantee obligating the spouse, civil union partner, relative, friend, or guardian of the individual to pay all costs for treatment of the individual that is ordered by the court.

“Many drug users want help, but are rendered helpless by their addiction,” said Lagana. “Addiction not only hurts the people using, but those close to them. People who have the best interest of these individuals at heart should have the option to get them treatment.”

The second bill would require that every prescription for a controlled dangerous substance, prescription legend drug, or other prescription item be transmitted electronically using an electric health records system. This requirement would take effect one year after the date of enactment.

The third bill would add naloxone hydrochloride, and other opioid antidotes, to the list of prescription drugs that are to be monitored as part of the state’s Prescription Monitoring Program. While the PMP focuses on monitoring the dispensation of controlled dangerous substances in the state, and although opioid antidotes are not considered to be controlled dangerous substances, the sponsor noted that information related to the dispensation of opioid antidotes is nonetheless relevant to determinations regarding the prescription and dispensation of controlled dangerous substances.

The bill, called “John Wagner’s Law, is named after the son of former Assemblywoman Connie Wagner who lost his battle with opioid addiction. Lagana holds the seat vacated by Wagner. Lagana said the bill came about after hearing from local law enforcement and addiction specialists that they needed naloxone deployment data to help with their prevention efforts.

The fourth bill would require certain health care professionals to meet continuing education requirements on topics related to prescription opioid drugs as a condition of renewal of a professional license, certification or registration. Under the bill, health care professionals with the authority to prescribe opioid medications, including physicians, physician assistants, and dentists would be required to complete one continuing education credit on topics that include responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction and diversion. Health care professionals without prescribing authority would be required to complete one continuing education credit on alternatives, risks and signs of abuse. The credits required under this bill would be part of a professional’s regular continuing education credits and would not increase the total number of continuing education credits required. (this is my favorite of the four)

When I spoke with the Assemblyman at a panel discussion last week, he admitted that it was an uphill battle and that many of these would not pass the legislature or if they did, that Christie would almost certainly veto them. And that gets to the heart of the problem here in NJ – while Governor Cuomo passes meaningful legislation in NY by working with a historically crime-infested legislature, Governor Christie shuts down bridges, goes to Cowboy games, and campaigns for Trump. While he dithers, people die.

06Jun/16

How Big Pharma Gets Doctors to Push Its Drugs

This piece on Continuing Medical Education Units was written by Anthony Gallo, a student of mine last year at the Rutgers School of Social Work. Anthony graduated with his BASW last month. He is now enrolled in the Rutgers MSW program and is interning this year for the NASW-NJ.

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Continuing Medical Education (CME) units are the professional educational requirements for renewing a doctor’s medical license. The requirements differ from state to state: Arkansas requires 20 CMEs in a 2-year cycle while Washington requires 200 (to search your state’s requirements, click here). According to the Accreditation Council for Continuing Medical Education (ACCME) they are intended to help physicians by improving “their practice and delivering high-quality, safe, effective patient care.” They are generally designed to influence physicians’ practices in positive ways, but this is not always the case.

CMEs can cost several hundred dollars for a six hour class, so keeping up with them could potentially cost a thousand to upwards of ten thousand dollars every two years. Conflicting motives arise when CMEs are paid for by companies who can introduce intentional or unintentionally bias. The late Arthur Sackler, co-owner of Purdue Pharma and founder of modern pharmaceutical marketing, was one of the originators of the concept of commercially sponsored CME units. He rightly believed that by influencing medical education he could increase sales of his pharmaceuticals to doctors. This strategy was showcased in the American prescription pain pill boom in the 1990s.

Purdue flew doctors to resorts and conferences where they would hear lectures from corporate sponsored experts on the benefits of prescribing opiates for pain. These speakers would deliver messages that downplayed the risks of these medications and portrayed Purdue’s opiate drug, OxyContin, as a wonder drug that was “virtually non-addictive.” An unnamed CME organizer quoted in Sam Quinones’ book Dreamland described the effectiveness of one of Purdue’s paid speakers, Russel Portenoy:

All you need is one guy to say what he was saying. The other guys who are   sounding a warning about these drugs don’t get funded. They get a journal article, not a megaphone.

In this way CMEs were used to reassure the medical community that opiate painkillers were safe and effective when they were actually overstating the benefits and understating the side effects (including addiction).

In all, the U.S. General Accounting Office reported that Purdue Pharma helped to fund over 20,000 educational programs and their efforts proved wildly successful. Pain pill prescriptions rose from 670,000 in 1997 to 6.2 million in 2002, in part due to their CME programs. This was also before strict regulations governed commercial influence in CMEs.  Many of Purdue Pharma’s statements were false. Several executives eventually faced criminal charges for misrepresenting the dangers of their drug, and Purdue Pharma continues to pay fines to this day. America’s current heroin epidemic was partially created and compounded by the misuse of pharmaceutical marketing and education.

Regulations have been since tightened, limiting the commercial influence on CMEs. CME providers are now required by the Accreditation Council for Continuing Medical Education to be independently structured from “any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.” There are also strict reporting requirements for financial contributions and prohibitions on direct or indirect influence of course material.

The potential for abuse is still real, however, and in the first quarter of 2009 the pharmaceutical company Eli Lilly paid out roughly $44.5 million in speaking fees to company approved experts. One of their highest paid was Dr. Manoj V. Waikar, who received $74,850 for speaking at 51 events for the company. These speeches are generally scripts written by the company.

In 2014 the ACCME reported that 41.4% of CME providers received commercial financial support.  Eleven CME providers received in excess of $10 million from commercial companies. Dr. Michael Steinman, an associate professor of medicine at the San Francisco V.A. Medical Center described the conflict perfectly by stating, “The course providers have a subtle and probably unconscious incentive to put on courses that are favorable to industry because they know where their bread is buttered.”

CME programs are receiving more scrutiny than before. Recent tightening of accreditation standards for CME programs and shifting public opinions have lowered commercial influence. Doctors receiving reimbursements for CME credits dropped from 26% to 12.7% between 2004 and 2009. Doctor’s receiving payments for speaking on behalf of companies dropped from 16% to 8.6% in the same timeframe.

Major universities have taken steps to prevent commercial bias. Stanford recently expanded its ban on faculty involvement in commercially sponsored speaking activities to include adjunct professors as well. Harvard also has strict regulations regarding commercial involvement.

The move away from commercial funding will be difficult and expensive, likely requiring more doctors to pay for their CMEs. Despite the challenges, this change will likely be vital for the unbiased advancement of the medical sciences. The industry has made progress since the early days of OxyContin, but Big Pharma continues to get into trouble for using CMEs to push medications on doctors (you really should click on that). We’ve seen some of the dangers of commercial influence and we must push ahead in fixing the CME funding system.

01Jun/16

Two Great Drug Policy Bills

State Senator Joe Vitale, the Chair of the Senate Health, Human Services and Senior Citizens Committee

On June 6, the NJ Senate Health Human Services and Senior Citizens Committee will meet on in the State House Annex in Trenton at 1 pm to discuss seven new bills. Two of them are excellent attempts to address the opioid epidemic.

S-1266Vitale Establishes permanent sterile syringe access program; appropriates $95,000.

When I was working on my Masters in Social Work, I wrote a long research paper on the international history of needle exchange programs. I was dismayed to find out that NJ was one of the states that did not have a widespread program – it was blocked by then (and current) State Senator Ron Rice, a Democrat from Newark. One of the reasons for his opposition to the needle exchange programs was that he believed it encouraged drug use (the other was that he was unhappy that inner city treatment programs are underfunded, which was and is a legitimate gripe).  Research from around the globe and US unequivocally shows that needle exchange programs greatly reduce new HIV and Hepatitis C infections while not causing new people to pick up drugs (“hey free needles, I should use drugs now”).

NJ has had pilot programs in a few cities, but Senator Vitale’s bill would create a permanent and broader reaching program. The meager funding for it is farcical, but passing this is the first step. Increasing the funding can be broached later.

S-2035Turner Restricts initial prescriptions for opioid drugs to seven day supply.

Senator Turner’s bill will probably not pass the State Legislature, but even if it did Governor Christie would surely reject it. This is an excellent idea to help address the overprescribing by doctors and forcing MDs to do a better job of monitoring how the painkillers they prescribe are being used and how they are effecting their patients. Patient advocates argue that this causes an undue burden by requiring additional visits that they can’t afford, and doctors cry that they should not be regulated and told how to practice medicine. One only needs to look at these charts to see how opioid overdoses are continuing to increase to see that additional regulations are needed. This not burdensome.

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I urge anyone who is interested in these issues to write a letter to one or more of the committee members. If your state senator is on the committee, then consider calling him/her on top of submitting a letter. To see a list of the members of the committee, click here.

11May/16

The Church of Baseball: Part Two

The Church of Baseball: Part One can be read here.

In 1999 playoffs, the Yankees dispatched the Sox in five games and went on to sweep the Braves in the World Series. I engaged in some behavior that was funny then and is embarrassing now. I randomly called Boston numbers and asked if they were Sox fans. When they inevitably said yes, I told them this is what it sounds like to win the World Series and yelled “woooooo!”

That fall, I started dating April. We met at Rutgers and one of our first dates was a 12-inning game between the Mets and Braves at Shea about a week after my Atlanta trip. She recognized that she would need to learn about baseball in order to make the relationship work. She became a Yankee fan and actually bought a season ticket plan in 2001 (thus getting us to the World Series that year). She became interested in attending stadiums as well, and eventually helped me get to some of the farther reaching ones (Tampa, Miami, Kansas City, Houston, Arizona). We got married in 2010 and our introduction song was “Enter Sandman” in honor of the great Rivera.

Food_Poutine_Closeup

Poutine. It’s amazing.

In April of 2000, I took a road trip with Tuffer Benbow and Eric Castro to Toronto and Montreal. All three of us fell in love with Montreal – the coffee, Cuban cigars, croissants, poutine…the sheer style of it. We saw a game at Olympic Stadium, ate amazing smoked meat sandwiches and marveled at Vladimir Guerrero. Since that trip, I have traveled to Montreal about once a year and taken in a dozen Expos games (I was at one of the last ones in 2004 during Tuffer’s bachelor party) and a few Canadians games as well (by far, Toronto v Montreal was my best NHL experience).

Steve and I journeyed to the Midwest in August of 2000. We took in a Brewers game at County Stadium – I felt like we had been thrown back in time. I bought brats for $2 each (or something like that) and 10 year olds sat in front of me wearing Brewers, Reds and Cubs hats while talking about baseball, Star Wars and sleep overs. The next night, we traveled 90 miles South to Comiskey (along with the Great American Ballpark in Cincinnati, it is my least favorite park). Steve bought a beer from a walking vendor and said, “Didn’t I buy a beer from you last night in Milwaukee?” The man answered yes.

I completed my military service in 2002 and unsure of what to do next, I decided to live overseas. I picked Japan because of its relationship with America, its complete foreignness and for the fact that they loved baseball. I taught English to students as young as 10 and old as 80. For most of 2003, I lived just outside of Tokyo, but I chose to root for the Hanshin Tigers (the Red Sox of Japan) instead of the Giants ipydznvguz989lh8v2yi(the Japanese Yankees). Hideki Irabu had returned to Japan to play for the Tigers. At the same time, Hideki Matsui had left Japan for the Yankees (my students would ask me what I thought about Matsui, and I told them that all I knew was that we passed each other in the sky over the Pacific). April visited me and we attended a Yakult Swallows game – she liked that they sang songs and waved umbrellas whenever the team hit a homerun (years later, Steve and I went to a baseball game in Cuba and were equally impressed by the passion and cheering there).

Starting in 2004, I watched less baseball because I began a grueling full-time work/full-time school schedule that lasted for two years. It eventually gave way to a period of 10 years where I worked/studied 60 to 80 hours a week. I grabbed games when I could, but spent more time listening to them on the radio or reading about what happened late at night. I added a five stadiums between 2004 and 2008, but Tampa was the only one that took a lot of effort to get to.

Sept 18, 2008

Sept 18, 2008 – You can really see how we’ve aged.

George Steinbrenner and the Yankees convinced Mayor Rudy Giuliani to build a new stadium with public dollars (despite being a huge sports fan, I detest this form of corporate welfare and terrible use of public funds – here is a ’98 article on it and a biting commentary from John Oliver in ’15).  The New Yankee Stadium was built on the grounds of an old park at a cost of over $1 billion (money that should have gone to schools, roads, hospitals, cops). I was doubly irritated, because Yankee Stadium was a great venue for an event. Boston had figured out how to keep Fenway and Chicago treasured Wrigley. A friend stated that if this were Europe, they wouldn’t have torn down the House that Ruth Built. The Yankees would close out their old stadium in the fall of 2008. Having attended a few hundred games there, I wanted to say goodbye. I went with Steve, Jason Suppo and Nat Purcell. We visited Monument Park, ate Italian sausage, sang Take Me Out to the Ballgame, shared old stories and watched Bobby Abreu have a monster game in helping Mike Mussina win his 18th of 20 games that year.

Me and DB Sweeney

Me and DB Sweeney

In 2009, April and I hiked the Grand Canyon and took in a Diamondbacks game in Phoenix. We had great seats, and I recognized John McCain immediately when he sat down pretty close to us. He has a bit grumpy but posed for a photo. After the game, I saw a booth outside where DB Sweeney was advocating for veterans’ services. I went over to him and told him that I adored him as Dish Boggett in Lonesome Dove (my pick for best western) but that The Cutting Edge was not that cool (he looked at me, smiled and said, “It’s a chick flick. I know. It also was a paycheck man.”)

Burger in Iowa City at Short’s

After my marriage ended, I drove around the mid-West in June of 2014 taking in the top BBQ spots, minor Civil War sights, Mark Twain’s hometown (Hannibal, MO), the Field of Dreams and two more stadiums. Just after I entered Wisconsin, I was pulled over by a State Trooper. He asked me if I knew how fast I was going and I said I did. He took my license and said “New Joisey.” I told him that is not how you say it. He peered at my over his sunglasses and said, “You know you are in my hands for the next few minutes, right?” I told him that I was well aware of that but that I wanted other people to pronounce the state correctly, that I spoke the Queen’s English, and that most of the bad accents were people from Staten Island that just wanted to be from New Jersey.

Right field line in Miller Park.

Right field line in Miller Park.

He stared at me for ten seconds and then said, “I like that. Why are you in Wisconsin? Family?” I told him that I was on a Civil War-BBQ-baseball road trip and that I wanted to get to Milwaukee early enough to take pictures before the game. He said, “You are a traveling son of a gun.” He walked back to his cruiser with my information. A few minutes later, he reappeared at my window and said, “Here’s the deal. Writing you a ticket for this speed is too much trouble. If you can tell me when the last time a Wisconsin baseball team beat a NY team in the playoffs, I’ll let you go.” I told him that I had been waiting for a quiz like this my entire life, and that the answer was 1957 when the Braves beat the Yankees in the World Series behind Lew Burdette’s three wins. “You are free to go young man…enjoy Wisconsin.”

DSC_0097

The Ball Park at Arlington.

There were only two stadiums I had not been in by the time the 2015 season opened: Safeco in Seattle and The Ballpark in Arlington, Texas. I traveled to Seattle in May and enjoyed the food and scenery at Pike’s Place before the game. In August, I was stationed at Ft. Sam Houston in San Antonio. I had weekends off, so I rented a car and drove 300 miles to the outskirts of Dallas so I could hit stadium number 41. It was 97 degrees in the shade where I sat. The Rangers hosted the Rays, and neither team sparked much interest. I looked around the stadium and stared a lot at the right field stands, which were modeled after Tigers Stadium. I thought about all the games and all of the people that I’ve sat in stadiums with.

The Perfect Games

On May 17, 1998 I had just left for Yankee Stadium when I heard that it was Beanie-Baby Day. I decided I didn’t want to deal with the kids or the crowds, so I turned around and watched from my Dad’s house. David Wells threw the 15th perfect game in MLB history that day. A year later, a friend’s father gave me two tickets to the June 18th game at Yankee Stadium. I had military service that day, so I gave the tickets away. David Cone pitched a perfect game against the Expos, and I caught the last few innings on television because I was (surprise) let go early from the Army that morning. On September 28, 2013, April and I attended a game at the Marlins new stadium in Miami. We had plans to attend the next day as well, but she wanted to hit the beach and go paddle boarding, so I acquiesced. Of course, Henderson Alvarez threw a no-hitter. I’ve missed six other no-hitters by a day, but those three sting. They help me laugh at myself, and when I talk to baseball fans I receive the sympathetic groans that I so much deserve.

Me and Baseball Today

I’ve been to over 350 games. In addition to missing those perfect games, I’ve never caught a foul ball (or homerun). If I did, I would not give it to a kid. I feel pretty strongly about this. You might argue that it would mean more to a kid, but I would vehemently disagree with you. I would put it on display and cherish the ball until I died, whereas a kid would be excited for 20 minutes and then eventually lose it a few weeks later.

I’m no longer a Yankee fan. It happened over time. When the Yankees won in 2009, I was happy but it wasn’t like 1996 (it felt like we had bought it by adding CC, Burnett and Teixiera). Pettitte and Rivera kept me interested and attached until they retired after the 2013 season, but by then I had been watching more Dodgers, Giants and A’s games because 10 pm games worked better with my crazy work schedule. While I admired Jeter, I had argued with Yankee fans for years that they were overrating him, especially his defense. Other Yankee fans annoyed me, I didn’t like the no-beard policy, the corporate culture, and especially how the Yankees routinely charged so much more money than everyone else. So I left them. Some friends give me grief, but I tell them that players and coaches change teams all the time. People leave their hometowns, jobs, political parties and marriages, so changing baseball teams just isn’t that big a deal (particularly if you don’t have a family member to share the team with).

More than football, baseball is the game that both reflects and predicts American history and progress. Jackie Robinson crossed the color line in 1947, a year before President Truman integrated the military and seven years before the Brown v. Board of Education ruling (Robinson also refused to move to the back of a bus ten years before Rosa Parks did it). With an ethic make-up of white, Hispanic, black and Asian players, baseball looks more like America than any other major sport.

I’m a fan of the game and especially great starting pitchers, but whgrant1en push comes to shove I’m a Dodgers fan. It started with Jackie Robinson, who I have admired since the Ken Burns Baseball documentary in the 1994. The inning on the 40s and its focus on Robinson was stunning, and the way John Thorn described Robinson as “the loneliest man” was haunting.  When MLB.TV came out (which along with the IPOD, seems to have been invented for me), I was able to start watching games of all the teams, not just the Mets/Yankees/Cubs/Braves and the Sunday night ESPN games. I eventually found my way to Vin Scully and the Dodgers. Mr. Scully has announced Dodgers games since 1950, and I find him to be, by far, the best announcer to listen to. He will retire at the end of the 2016 season, so I urge you to try and hear him call a game (I felt the same way during Johnny Carson’s last year – I marveled at him and sensed the impending loss of someone who was the best at his craft). Strangely, I also catch a lot of Giants games and root for them almost as hard. Buster Posey is everything that Yankee fans claimed Jeter was. But with both teams, I don’t live and die with wins and losses like I did when I was little. I enjoy the effort and the moments, and I constantly think about US Grant. After suffering heavy losses at the first day of Shiloh, General Sherman found Grant smoking a cigar under a tree and lamented about the situation. Grant responded, “Lick ’em tomorrow.”

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Number of MLB stadiums I’ve attended: 41

Best player of all time: Babe Ruth

Most important player of all time: Jackie Robinson

Best player I saw: Barry Bonds

Best pitcher I saw: Pedro Martinez

Best team I saw: 1998 Yankees

Favorite old ball parks: Fenway Park and Wrigley Field

Favorite new ball parks: PNC in Pittsburgh and AT&T in San Francisco

Favorite current players: Clayton Kershaw, Buster Posey, Madison Bumgarner and Zach Greinke.

Favorite piece of baseball writing: Bart Giamatti’s “Green Fields of the Mind

Professional I most want to see win a World Series: Billy Beane

Best stadium food: The half smoke in Washington

 

01May/16

The Church of Baseball: Part One

“The only church that truly feeds the soul, day in, day out, is the Church of Baseball.”  — Annie Savoy, Bull Durham 1988

It began in childhood.

nicolletMy father grew up in Minneapolis. In the 1950s, the Minneapolis Millers were the farm club of the New York Giants. My Dad saw a number of Giant greats (including Willie Mays and Orlando Cepeda) play while they were still minor leaguers, so naturally, he became a Giants fan. His father was also from Minnesota, but became a Yankee fan in the 1920s because of the prowess of Babe Ruth.  When the Washington Senators moved to Minnesota and became the Twins before the 1961 season, my father’s allegiance became a bit divided. I was born in 1976, and for the first 11 years of my life, my father worked a lot and neither of his baseball teams were local nor any good, so I don’t recall him watching games.

We lived next door to my grandparent’s farm. Gram was a Yankee fan, but she watched the Mets too. I remember her cheering when the Mets beat the Astros in extra innings in clinch the NLCS in six games (thus avoiding the dreaded, beastly Mike Scott, who almost surely would have shut out the 108-win Mets in the winner-take-all game seven). My grandfather did not follow either of the local teams. For years, he had been a Yankee fan but grew disgusted with the team in the 60s and 70s when players like Reggie Jackson talked about how great they were. Pop switched teams and began to follow the underdog Phillies. He particularly liked the humble, work-man like Mike Schmidt.

gary-carterjpg-1a6377f820cca38bThe first baseball game I remember watching with my father was Game Six of the 1986 World Series. We had spent the day at the Hunt Meet, a series of horse races that were held in Somerset County each fall. He had a few friends over, and they talked about how they had to see Boston finally win the World Series. When I asked him why it was a big deal, he said that the last time the Red Sox won was when his father was younger than I was. When the Red Sox lost, one of my Dad’s friends expressed frustration and I said, “They can still win in Game Seven.” He looked at me and muttered that the series was over. The day after the Mets won, a number of kids in my school were celebrating too much and in too annoying a fashion. I decided I did not like the Mets, regardless that they won 108 games in the regular season, had exciting young players, were a dynasty in the making and had just beaten the Red Sox in the World Series.

In 1987, I cheered along with my Dad as the Twins upset a strong Detroit team in the playoffs and went on to beat Ozzie Smith and the Cardinals in the World Series in seven games. The next spring, I convinced my friend Damon that we should play little league, despite that we had never played baseball before and that at age 12 and almost 12 (my birthday is in May), we were starting quite late. Damon could hit and hit for power. I hit .200 and couldn’t field, but loved taking walks (12 year-olds have shit for command) and I stole bases every time I made it to first. At that point, I had just started watching baseball, had chosen the Yankees, and my favorite player was Rickey Henderson (which is both cool and embarrassing). The Yankees were good but not great, couldn’t win the division and were in the shadow of the Mets and their annoying fans. I learned about the Yankees history and clung to their past era of greatness as a promise of future returns. That spring, our little league coach organized a trip to see the Phillies host the Cardinals at Veterans Stadium. I was told to watch the Cardinals shortstop. The men seemed so small from our seats, but it was fun to be at such a big event with all of those people. My father and Pop had come along. That was my first baseball game.

My first Yankee game was in the summer of 1991 (a dark time for the empire). I went with my Mom, Dad and Pop. It was surreal finally seeing something in person that I had watched on television for years. I was stunned at the size of the stadium, and found the other people there fascinating. The Yankees lost, which was disappointing, but the overall experience was wonderful. In 1992, I attended a game on my 16th birthday with my father, Pop and my friend Brad Henry. Robin Yount and Paul Molitor homered for the Brewers, Don Mattingly homered for the Yankees, and the Brewers won in 10 innings. There was a middle aged man (50s) who cheered when the Brewers went ahead in the 10th, thus angering others in our section, but I admired how he was willing to oppose everyone around him.

I celebrated other birthdays at a variety of stadiums. In 1999, I took the Denver Greenagel clan to see the Rockies win a 7-6 game in the bottom of the ninth at Coors Field. In 2001, April, my college girlfriend and eventual ex-wife, celebrated my 25th birthday by watching Andy Pettitte outduel David Cone in an emotional game for me. In 2004, my friends and family joined me at Shea as Tom Glavine almost pitched the first no-hitter in Mets history. In 2014, April and I went to Philadelphia to see Clayton Kershaw dominate for the Dodgers.

Sports_Illustrated_711060_19940418-001-775As a teenager I partied a lot, and things got out of hand for a few years. In August of 1995, Mickey Mantle and Jerry Garcia died within a few days of each other. Mantle had gotten sober a year and half earlier but died from decades of alcohol abuse. Garcia overdosed in a hotel room at the age of 53. Both of them weighed heavily on me, and their early ends factored into a decision to turn my life around a few months later.

In 1996, I decided to join the United States Army as a tanker. Before I left for Ft. Knox, I visited my friend Geoff at Boston College in April and bought tickets for all four games of a September Yankee-Red Sox series. I was at Roger Clemens last game as a member of the Red Sox and one of Nomar’s first games. I had a number of great conversations with Sox fans that series, and would eventually return to Fenway for over a dozen games the next several years (I attended a 15 inning game in 1997 where I saw a couple get into a horrific drunken fight in the 8th inning and then continue in the 12th where they then agreed to get divorced).

The Yankee dynasty of the late 90s and early 2000s synced perfectly with my college years and my entrance into capable young adulthood. During the six years that followed basic training, I attended community college and then Rutgers. I either listened, watched or attended almost every Yankee game (I also watched the Braves on TBS, the Cubs on WGN and the Mets). There were times that I missed one because of military service or some event, and this being the era before cell phones, I had to go to extraordinary measures to get updated on scores. I attended over 150 home games during those years, was a season ticket holder in 1998 (and took my Dad to the first game of the World Series that year), and was there when President Bush threw a strike before the start of the third game of the 2001 World Series. My Yankees were Paul O’Neill (hardworking and passionate), Bernie Williams (quiet competence and grace), Andy Pettitte (a homegrown lefty who radiated decency), Mariano Rivera (the all-time great who managed to be truly humble), Joe Torre (who managed the Boss and the media with deft aplomb) and Don Zimmer (the baseball lifer who was funny, grandfatherly and wise).

Taken the last day of the 1998 season. It was Joe DiMaggio Day and Bernie Williams won the batting title.

Taken the last day of the 1998 season. It was Joe DiMaggio Day and Bernie Williams won the batting title.

In the late 90s, I started reading the work of Rob Neyer at ESPN. He was a disciple of Bill James, and he steered me onto rigorous baseball analysis and towards better writers. In 1999, he turned me onto Baseball Prospectus, where I started learning from Joe Sheehan, Gary Huckabay, Christina Kahrl, Kevin Goldman, Jay Jaffe and Nate Silver, who would eventually go on to become one of the most accurate political analysts. Their writings on baseball not only caused me to look at the game differently, but think differently too. I have adopted new approaches towards counseling, education and policy as a result of how those writers measured success and transformed my mind through their writing.

I’ve read over 70 baseball books, including amazing biographies (Sandy Koufax, Joe DiMaggio, Casey Stengel, Mickey Mantle), fantastic first person seasonal stories (Ball Four and the Bronx Zoo) and wonderful tales of interesting teams: the 29 A’s, 34 Cardinals, Halberstam’s 49 and 64, 97 Marlins, 03 Cardinals, 04 Red Sox, and 2010s Dodgers. I developed an appreciation for other players, managers and franchises. Michael Lewis’s Moneyball was published in 2003 and detailed how Billy Beane was able to turn the cash-strapped Oakland A’s into a franchise that routinely outshined its larger-market rivals. I was pleased with the 2011 movie of the same name, and happy that Mr. Beane has become more celebrated. But until he wins a World Series title, his genius will continue to be underappreciated (the key problem with measuring success by the results of the postseason instead of the regular season is that randomness and luck play a much greater part in three short playoff series than in a 162 game season). Genius and talent that goes unrecognized or unrewarded bothers me – it’s a reason that I ache for Vincent van Gogh’s life and am thrilled at Sixto Rodriguez’s late success.

Steve Castro, a college buddy from Rutgers, and I drove to Toronto to see the Blue Jays play the Red Sox and Indians over Labor Day in 1998. We stopped at the Anchor Bar in Buffalo to try the first hot wings ever made and then journeyed to Niagra Falls before ending up in Canada. Toronto has the CN Tower, the hockey hall of fame, clean streets, friendly people and good food. I bought a Maple Leafs t-shirt and led fans in chants against the Red Sox on Sunday and then the Indians on Monday (Steve commented that the Boston fans must have been stunned to run into such an aggressive Canadian). We enjoyed the trip so much that we decided that we needed to visit more stadiums.

I attended several spring training games in 1999 with my friend Mike Neilan while on a raucous and driving intensive college spring break trip to Florida. We saw Greg Zaun (a favorite of mine because of his role in the 1997 Marlins book) hit a homerun against the Pirates and I caught a glimpse of Yankee superprospects Nick Johnson and Alfonso Soriano at Legends Field. In Tampa, I talked to four hardcore middle aged Tigers fans whom had been coming to spring training for 20+ years – I admired their passion, friendship and longevity.

In late August of ’99, Steve and I drove to Detroit to see Tiger Stadium before it closed. While waiting in line, I talked to a woman who had been attending games since the 1940s. She expressed a love for the city of Detroit, Hal Newhouser and Kirk Gibson. She showed me dozens of pins on her cap and bade me to enjoy my time at “one of the last real ballparks.” From there, we drove to Cincinnati where we saw the Braves crush the Reds. We sat in the far upper deck and ended up talking to a man from Houston who was 15 years older than us. We told him that we were driving to St. Louis after the game and that maybe we would head to Texas after. He slapped his knee and said that sounded awesome, expressed some jealousy and told us to continue to enjoy our youth. After the game, we drove to St. Louis. We went up the Arch, bowled at the bowling hall of fame and watched the Cardinal fans gape and yell during every Mark McGwire at-bat. My Mom’s second husband had been recently diagnosed with cancer, so we headed home (by way of Baltimore) rather than continue to Houston.

A few hours before Chipper Jones ripped out my friends' hearts.

A few hours before Chipper Jones ripped out my friends’ hearts.

In late September, the Mets had surprised everyone by staying in close contention with the Atlanta Braves. Steve, Mike, our friend Jimmy (all three are Mets fans) left New Brunswick at midnight on 9/21/99 and drove 18 hours to see the first of their three game showdown. Chipper Jones hit a homerun against Rick Reed in the 1st inning for a 1-0 lead and then hit another homerun (from the other side of the plate) off of Cook in the later innings to seal a 2-1 victory. Chipper won the 1999 MVP that year and is probably the player who killed one team more than anyone else. After the loss, we drove home. Mike and Steve were physically exhausted and emotionally devastated. A few hours into the ride home, I tried to console them by saying that they could get them tomorrow. Steve looked at me and said, “The game was a killer. We aren’t winning the division.”

We drove on through the night and the next morning, and found ourselves in a horrible traffic jam on route 78 East in Pennsylvania. We drove off the road and cut through a field and took back roads into New Jersey. The Mets played well enough the rest of the season to tie the Reds for the wild card. After beating them in a one game playoff behind Al Leiter, the Mets went on to defeat the Diamondbacks and set up a showdown with, of course, the Braves. Atlanta buzz sawed through the first three games and went up 3-0. The Mets won games four and five and I got Steve and his older brother to agree that we would drive to Atlanta for game seven if the Mets were able to eke out game 6. The Mets lost a heartbreaker in the bottom of the 11th inning on a based loaded, walk-off walk by Kenny Rogers.

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Click here for Part Two

20Apr/16

Insults that people have said to me when they don’t like my positions

On my Greenagel Counseling Services Facebook Page today I wrote about the recent Saturday Night Live fake ad about Heroin AM (click here to see the video):

There was a fake commercial for “Heroin A.M.” on Saturday Night Live this past weekend and all kinds of people are freaking out over it. I think satire is an important part of communication, education and advocacy. Ford Vox wrote a nice piece on it.

“”Heroin A.M.” did a great job elevating awareness that many seemingly “normal” and high-functioning people are abusing opioids. This skit is savvy satire that portrays the medicalization and commercialization of a “street drug,” and that seemingly absurd scenario speaks to the underlying truth that a haywire medical system ruled by corporate greed, bad regulations and complacent doctors actually generated this problem in the first place.” (to read Mr. Vox’s CNN article, click here)

One woman disagreed with me and voiced her displeasure thus: “First you drank the Kool-Aid from Partnership for Drug Free Kids and now you talk about “satire” and a heroin epidemic. I hope to God your following is as small as it should be. Oh and I do understand satire and irony. I also understand the word “dangerous” and your posts are exactly that.”

This got me thinking about other insults and diatribes against me over the years.

When I wrote “The Suboxone Problem That No One is Talking About” for Hazelden-Betty Ford, I received the following emails:

a) I hope you die a fiery death

b) You have no understanding of addiction or recovery

c) You are in the pockets of the pharmaceutical industry

d) You’re a fucking asshole

After “Why Colleges and Universities Need Naloxone,” I received a message that colleges would be better served “if they just let the junkies die” and another one that said “why should we worry about saving scum bags when there are so many good kids on campus that have real needs?”

After several deaths and negative incidents in the fall of 2014, I wrote two articles on why colleges should shut down fraternities and sororities on their campuses. I received dozens of missives, including:

a) You don’t know how to have fun

b) You have no understanding of college

c) Your an asshole!!! (their grammar, not mine)

d) You better not ever come to Alabama

Back in 2012 when we held the NJ Opiate Task Force Hearings, I was called some nasty things by other professionals and advocates in the field of addiction/recovery that disagreed with me. I could go on and on and make this a 10,000 word article, but you get the idea. Don’t feel bad for me and certainly don’t get defensive – I am both used to it and have thick skin. One of the key lessons that I work on with my students at the Rutgers School of Social Work is to not demonize those that you disagree with and try to find common ground. I explain that you not only fail to win people over that you are arguing with, but you may lose those that might have otherwise been sympathetic towards your cause (I have seen Michael Moore do this for much of his career). Part of the alarming aspect of American society and our political discourse is the nasty language and hyperbolic rhetoric that so many use. Regardless of what side of the political aisle you sit, you might recognize that members of your party accuse the other side of either “trying to fundamentally destroy America” or “not caring about the people.” Those who utter statements like that are both wrong. More often than not, both sides care and want good things but are coming from different perspectives and have a variety of view points.

I’ll conclude with my favorite insult I’ve ever received, and it was sent to me this past February by a recovery advocate after I criticized a program for not having enough training or supervision:

I’m glad the Vikings lost. You are both losers.

11Apr/16

My Spring and Summer Speaking Tour

This is a list rather than an article. I get a number of emails and messages each week asking about upcoming speeches, conferences, panel discussions, webinars, and other events, so I put this together as a tool for those individuals.I’m a huge music fan, and have recently purchased summer tickets for the Dandy Warhols, Grateful Dead (w/John Meyer but no Phil Lesh), Lumineers, and the star studded show of Cheap Trick-Heart-Joan Jett, so I was inspired to label this my tour (private speeches and trainings that are not open to the general public are not included here).

April 20: Life After Incarceration for NAADAC. Free Webinar. This webinar is aimed at professionals working with clients either currently or formerly involved in the criminal justice system. This includes prison, jail, parole, probation, intensive supervised probation (ISP), and drug court. This session will cover the current state of our national criminal justice system, including statistics that show that America is the number one jailer in the world. The costs of maintaining county, state and federal jails/prisons will also be covered. We will review current reforms in a few forward thinking states. Participants will discuss the top three ways to avoid recidivism: education, treatment and employment. Participants will receive a toolkit of concepts, topics and strategies that they can engage in with their clients. Recommended readings will be offered to help participants gain a strong foundation in the American criminal justice system. Statistics will also be provided regarding the number of people, crimes and costs. The need for reform will be presented, including discussion of problems and inequities within the system that need to be addressed, such as the impact that heroin and prescription drugs have had on the criminal justice system. The webinar will also cover soft and hard skills that we need to teach our clients in order for them to lessen their chances of recidivating, along with examples of success. Participants who have clients in the criminal justice system will leave the webinar with a plan for work with clients and an understanding of the clinician’s role in the work of criminal justice clients. To register, go here.

April 28: What is the Responsible Marijuana Policy for Our Veterans? at SAM/NJPN. Conference in Atlantic City, NJ. I’m going to lay out the evidence that details the damage that marijuana causes service members and veterans and detail the lack of data on how marijuana helps vets (whenever you read or hear about this, it’s just anecdotes). All day registration (10 to 4, plus lunch) costs $100. To register, go here.

May 3: Substance Abuse Keynote Panel and Life After Incarceration for NASW-NJ. Conference in Atlantic City, NJ. I am facilitating a panel discussion on addiction and recovery that will cover prevention, treatment, recovery support services, policies and medication assistance. The panelists include Dr. Louis Baxter, Jass Pelland and Patty DiRenzo (I handpicked them). This will go from 9 to 11 am. I will present on the criminal justice system in the afternoon. To register, go here.

May 25: College Recovery’s 1st Client Graduation Ceremony. New Brunswick, NJ. Back in 2014, I helped a few concerned individuals create a new treatment program for young adults in order to combat the opiate epidemic and provide newly sober individuals with supportive housing and an entree into higher education. I stepped away from full time work with them in 2015, but I have continued to run the family program there, which is work that is very near and dear to my heart. Sometime this June, they will be having a graduation ceremony for the first half dozen clients that have completed a year of treatment (among other successes). This is free and open to interested individuals. To learn more about College Recovery, go here.

June 15: NJTV Roundtable Discussion on Opiates. Busch Campus, Rutgers in Piscataway, NJ. Healthy NJ: New Jersey’s Drug Addiction Crisis is a new year-long, multi-platform community engagement initiative designed to raise awareness about the state’s drug problems and solution. The community forum will focus on prevention and education strategies in the fight against drug addiction.The forum will include interactive presentation and informational tables from prevention and education facilities, treatment providers and other experts in the field of drug addiction. We’re expecting close to 150 individuals who would like to recognize, deter and prevent substance abuse from a loved one or colleague to attend the event. The event will be livestreamed on NJTV’s njdrugcrisis.org website.

July 10: The Opiate Epidemic and the Medical Industrial Complex for the Rutgers Center of Alcohol Studies. Keynote in New Brunswick, NJ. I’m going to talk about the history of opium, heroin and opioids. I’ll discuss how Big Pharma, doctors, insurance companies, marketers, the FDA, the government and consumers are each responsible for the current epidemic. They are all guilty, though some moreso than others. I’ll also mention policies that are still causing problems and I’ll conclude with policies and programs that are working and should be copied or expanded. To register, click here

July 11 – 15: 21st Century Drugs and Working with the Military and Veterans at the Rutgers Center of Alcohol Studies. Conference in New Brunswick. These are 10 hour classes that I’m teaching over five days. They count for initial CADC/LCADC education or CEUs for a variety of health care professions. To learn more about 21st Century Drugs, go here. To learn more about Working with the Military, click here.

August 18: The History of Marijuana Policy at the National Conference on Addiction Disorders. Conference in Denver, CO. This session provides a detailed history of US drug laws, especially as they pertain to marijuana. We will cover the mid-17th century to the present. A strong focus on state laws will be provided from the 1990s to the present, with a particular examination of California, Massachusetts, Colorado and Washington. The push and pull between the federal government and the states will also be discussed. While the main thrust of this session is on history and policy, interventions at the individual and group level with clients will be discussed. (I may have military duty at this time or another obligation, so I’m only 50/50 for actually making this). To register, go here.