To The Parents Who Have Lost a Child

This past Saturday, I spoke at the Vigil in Camden County, NJ. There were over 200 people in attendance, and many were there to remember one of the 274 individuals who died from an overdose whose names were read at the event. A number of people have asked for a copy of my speech; that’s quite a compliment, but alas, I only speak from an outline rather than a full script. I’ll cover some of the key points here, as well as list a few more resources that may be useful to the parent who has lost a child to an overdose (I’m not going to cover all of the current policy problems listed in my speech or review the positives from the last year or list my own policy goals, because I write about those issues here on a regular basis and it would also quadruple the length of this article).

I was going to be a Shakespeare professor, but then my friend died in late-2002 and I decided to work in an in-patient treatment program in Northern NJ. I engaged clients in individual counseling, group work, psychoeducation, family therapy and multi-family groups. I took them to 12-step meetings and on activities in order to teach them new ways to have fun. My work as a drug counselor led me to pay more attention to drug policy. One can’t look at drug policy without also looking at criminal justice policy. I am often exasperated with our state and country’s drug and criminal justice policies. I am angry with a number of different individuals, forces, companies and institutions.

I am angry at Big Pharma for pushing providers to expand diagnoses so they can increase their market share.

I am angry at Insurance Companies that refuse to pay for the appropriate level of care, or stop paying in the middle of treatment or decline to pay for any kind of treatment all together.

I am angry at those who tell me that it is “God’s will” that someone died.

I am angry about advertisements for drugs on TV and in print media.

I am angry at politicians who say they support forward thinking policies but then refuse to supply funding for said programs.

I am angry at people who write horrible things about those that have died from addiction and hide behind the anonymity of the internet.

I would like to yell and curse and mock and belittle and put-down and threaten and perhaps beat those that I am angry with. But not only are those behaviors ineffective, they are actually counter-productive. We must follow the example of Dr. King and win over those that stand against us with love, patience and the sharing of our personal experiences. In 2013, I spoke at the the NASW-NJ conference in Atlantic City. I talked about how Narcan can save lives by reversing overdoses, and how another social worker said something to the effect that we “should not encourage people to take drugs by having the safety net of Narcan.” Rather than yell and curse and belittle her, I showed her the picture of a mother and her son who died from an overdose and said, “I’d like to give her 3 more days with her son or even 4 more hours.” We need family members to show up at public events, speak at schools, talk before legislative committees and go to treatment programs and tell their stories. I encourage you to wear shirts with the pictures of your loved ones who passed from an overdose. Those shirts are devastating to look at and impossible to deny. You may find that people will say you were a poor parent, that your kid was a bad apple, that addiction is a choice, or that we need to clean up the gene pool. You will get angry. And I need you to respond with patience and tolerance. If I can do it, you can do it.

I have worked with people for a dozen years, and helped them through major life events like the death of a loved one, the end of a romantic relationship, job changes, money problems, moving, and health problems. I have suffered losses in my life as well: the deaths of family members, the aforementioned overdose of my friend Fraser, a divorce, and my sister’s battle with breast cancer (she is alive and well, but it was a doozy of a year for our family). During those stressful events, time slowed down and I would walk aimlessly around my house and stare at nothing in particular. I know other people do that too. At last year’s vigil, I met a woman who buried her daughter that morning. I wanted to comfort her and make everything better, but that is beyond my powers and abilities. But I do have some unsolicited advice for the parents who have lost a child:

1) Attend a meeting of GRASP or Parent-to-parent

2) See a professional grief counselor

3) Spend time with other family members

4) Engage in your hobbies, even if you take no joy in them

5) Get out of your house each day

6) Find a purpose. Last year, I wrote an article about what people can do to help (it’s a good starting point). Paul Ressler decided his purpose was to expand the use of Narcan. Others might want to talk to the parents of a young adult who is in the midst of her addiction. A few of you might want to become a therapist. The point is that there are many options, including work outside of the addiction and mental health fields.

This work often leaves me saddened, angry, cynical, skeptical and frustrated. But I continue to look for hope, help others, and work towards meaningful policy changes. Things are better than they were a year ago. They can get better still. Please join me.


The Next Step After Narcan

While Governor Christie continues to flirt with his no-shot bid at the GOP presidential nomination, dithers on meaningful policy, and blusters on about meager funding for treatment, local leaders in NJ are the ones making an actual difference in the Garden State.

Patty DiRenzo and the Camden County Addiction Awareness Task Force continue to lead the way on implementing innovative drug policies at the municipal and county levels. Ms. DiRenzo was one of the many vocal forces behind the passage of the 2013 Overdose Protection Act and then fought for Narcan expansion last year. Narcan is an anti-overdose drug that is “nonaddictive, nontoxic and easy to administer through nasal, intramuscular or intravenous application. It reverses the effects of an opioid overdose by essentially blocking the opioid receptors that are targeted by heroin and many prescription painkillers.” People that would otherwise die can be saved. Since its expansion in June of 2014, the application of Narcan has saved over 300 lives in Camden County alone. It is now available without a prescription at CVS in 12 states, including NJ.

I spoke about the advantages of Narcan at the 2013 NASW-NJ conference, and one audience member asked me if it was “a good idea to encourage people that we can bring them back from an overdose?” A few friends of mine were in attendance, and they half expected me to flip out. I wanted to (a brief aside here…I deal with idiocy, selfishness and figurative blindness at most public events that I attend or speak at, but I am wise enough to know that yelling, cursing, belittling or mocking are not the correct response).

I paused, looked at the woman and said, “I assure you the alternative is grim. I have met with hundreds of parents whose kids have died. If we could give them 1 more day, heck, 3 more hours with their kid, they would take that time and treasure it. The only time that it is too late to change the course of your life is when you are dead. We are social workers. We know this.”

Over the last two years, others have asked me more nuanced questions. The best ones sound something like, “So we save them with Narcan but then don’t help them get more services. That doesn’t make sense. Can’t we send them to treatment so that we aren’t just giving them Narcan and then releasing them back to the street?”  That is an excellent point, but it requires policy change, willing partners, treatment beds and funding.

On October 7th, Camden County announced Operation Sal, a local initiative that has $150,000 in funding to help people revived on Narcan go to detox and then attend treatment. All four hospitals in Camden County are participating, law enforcement has been alerted and is on board, and patients will be sent to Delaware Valley Medical. This is the ideal next step after Narcan. Kudos, Camden County, and thank you.

The Normalization of Opiates

This piece was written under emotional duress. The subject matter caused (and still causes) a mix of stunned disbelief and anger. Before we get to the subject matter at hand though, permit me to share a semi-vulgar anecdote that explains the process of normalization.

My friend Andrew had a dog named Steve. Steve was a very friendly, but untrained, yellow lab. Andrew had a lot of problems with Steve. He ate his socks, chewed on his shoes, ate three garden hoses, sniffed crotches, jumped on guests and even once ate a steak that Andrew was seasoning on the kitchen counter (Andrew turned away for a moment, turned back and it was gone). One winter night Andrew heard banshee-like howling coming from his yard. He had never heard that tone and level of shrieking out of anything and (he would later tell me) “it made my hair stand on edge.” He proceeded outside, where he saw Steve limping around, then hopping, then limping again, all while shrieking terribly. This was around 10 pm. Andrew tried to make out the cause of the problem. While he was scanning for a bear or a trap attached to a leg, he noticed that Steve appeared to have a second tail. He did a double take. As he got closer, he realized that Steve had half a tube sock sticking out of his butt.

Andrew walked over, whispered and petted Steve and then tried to pull the sock out. It was wet, a little frozen and quite stuck. Steve yelled. Andrew said, “Sorry about this Steve,” and gave a very strong pull. The sock came out. Steve howled worse than before. Then he quieted down, went in the house and lied down to sleep. Andrew said to himself, “That’ll teach him to eat my socks.” A few weeks later, Andrew was watching a football game and Steve walked in front of him. He had a second tail again. Andrew did a double take, and then he realized Steve was not howling. The sock coming halfway out of his butt had become somewhat normal. That is a pristine example of normalization.

There are others. I’ve had dozens of clients tell me that their first experience in jail would be their last, because it was so incredibly horrible (the food, the 24 hour light, the hard metal bed, the boredom, the fear). A number of them returned to jail or even prison, and the second time wasn’t nearly bad as the first. They had become accustomed to it. Normalization. We can do this exercise for getting bad grades, domestic violence, horrific hangovers (how many of you reading this swore off booze because of a tremendous headache), brutal romantic relationships or a host of other behaviors that cause us pain that we later just accept as normal. Normalization.

I’ve been treating people with heroin problems since 2004. I’ve been talking about the spread of prescription opiate painkillers since 2005. I started conducting trainings on the heroin epidemic in 2010, chaired a Task Force on opiates in 2012 and we released a report in 2014. I’ve written about opiates and opiate policies a number of times on this site. I am horrified to write this next paragraph.

I was watching a football game the other day and this ad appeared on TV. I did not pay attention to it at first, and then halfway through I thought it was a Saturday Night Live skit. When it came on again, I gave it my full attention. Movantik is advertised as a drug that helps people who take opioids deal with the side effect of constipation. The ad shows the woman talking to her doctor, sitting in the park (pictured below) and of course, walking into the pharmacy with her opioid pill. Everywhere she goes, her opioid is with her. There are advertisements on television that show a person with their opioid 24/7 and taking other drugs to deal with the side effects. This is normal now. Constipation is just an irritating side effect of chronic opioid use, and now it can be dealt with through more medication. At no point is a question raised like, “Should she be on opiates?” (I wrote this four times before I took the adverb-curse out of here). Opiate use has been normalized in this country. So much so that it has a cartoon-pill figure on television ads for mass audiences. I expect we’ll see more of these. Andrew’s dog got used to having a half eaten sock stick out of his ass. We will get used to seeing opiates in our lives all the time. I am aghast.