“How To Stop Heroin Deaths”: Up To 85 Percent Of Users Overdose In The Presence Of Others
Philip Seymour Hoffman who died of an apparent heroin overdose on Sunday, was just one of hundreds of New Yorkers who fall victim to this drug each year. Heroin-related deaths increased 84 percent from 2010 to 2012 in New York City and occur at a higher rate — 52 percent — than overdose deaths involving any other substance.
I am an emergency physician at NYU Langone Medical Center and Bellevue Hospital, but I rarely see victims die of heroin overdose because most fatalities occur before patients get to the hospital. Overdoses often take place over one to three hours. People just slowly stop breathing; often they are assumed to be sleeping deeply, or they are alone.
The most frustrating part is that each of these deaths is preventable, because there is an antidote to heroin overdose that is nearly universally effective. Naloxone, an opioid antidote, is a simple compound that has been in clinical use for more than 30 years. It can be administered via needle or as a nasal spray, and it works by displacing heroin from its receptors in the brain and rapidly restoring the overdose victim to consciousness and normal breathing.
An analysis in the Annals of Internal Medicine last year suggested that up to 85 percent of users overdose in the presence of others. This provides an opportunity for friends, family and other non-health care providers to intervene. In New York State, it has been legal to distribute naloxone to ordinary citizens since 2006. But the distribution has to be done with medical supervision. Naloxone is purchased by the city and state health departments, which then distribute the antidote through hospitals, harm-reduction programs and other outlets at no cost to patients.
Some New York City hospitals are now distributing kits containing naloxone to users and their friends and families. For the past three years, the New York City Department of Homeless Services has administered naloxone in shelters. And a new pilot program on Staten Island — which has the highest rate of heroin overdose deaths in New York City — is supplying the antidote through the Police Department’s 120th Precinct there.
The city’s health department is conducting a large study following people who get naloxone to assess how frequently the antidote is used to reverse overdose. In 2012, the health department filed a public letter to the Food and Drug Administration recommending that the F.D.A. approve naloxone for over-the-counter use. The letter stated that more than 20,000 kits had been distributed in New York City. It also noted that more than 500 overdose reversals had been reported by civilians who had administered the antidote.
Some people might argue that the widespread distribution of a safe, effective and inexpensive antidote might actually encourage drug use. But that’s like suggesting that air bags and seatbelts encourage unsafe driving. Naloxone is a public-health method of intervening when a life is in the balance. Its distribution is endorsed by the American Medical Association.
A new bill that would make it easier for users to obtain naloxone was introduced in the New York State Legislature just last week, and on Tuesday it passed the State Senate Health Committee. It would increase access to the antidote by allowing doctors and nurses to write standing orders — prescriptions that can be used for anyone — and issue them to community-based drug treatment programs. The programs would then train people on the signs of overdose and provide them with the naloxone kits. This means that the programs would not have to have a doctor present to distribute the antidote, overcoming one major hurdle that impedes widespread distribution.
This bill empowers a community to protect itself and others. If the bill becomes law, it would be one step closer to making naloxone available over the counter — as it already is in Italy.
According to the Centers for Disease Control and Prevention, drug overdose is now the leading cause of injury-related fatalities in the United States, ahead of motor-vehicle collisions and firearms accidents. We make cars safer by having speed limits, seatbelts, crumple zones and D.W.I. laws. We make it harder to buy a firearm with background checks and waiting periods, and we teach gun safety and sometimes mandate trigger locks. We can make heroin safer, too, by supplying methadone or buprenorphine as medications to treat physical dependence, providing clean needles to help prevent the spread of hepatitis and H.I.V., and facilitating the wide availability of naloxone to counteract overdoses.
While Mr. Hoffman’s death was without a doubt a tragedy, it is also emblematic of a societal need to take action to prevent the hundreds of deaths that otherwise go largely unnoticed. We can’t control heroin — that’s the job of law enforcement — but we can make it safer.
By: Robert S, Hoffman, Emergency Physician, NYU Langone Medical Center and Bellevue Hospital; Director of the Division of Medical Toxicology at New York University School of Medicine, Op-Ed Contributor, The New York Times, February 6, 2014
“Republicans Lying To Themselves”: Washington Austerity At Its Most Self-Defeating
This morning, the Post has a nice report about methane leaks. A team of researchers toured DC and documented nearly 6,000 natural gas leaks in the city’s decrepit pipe system, including 12 spots where concentrations had built to potentially explosive levels.
What does this have to do with the current obsession with austerity in Washington? Quite a lot, it turns out.
You see, Republicans have been arguing that America needs savage fiscal austerity because we can’t afford to do otherwise. “Let’s be honest…we’re broke,” says John Boehner. This was and is preposterous then and now markets continue to snap up American debt, which is still at historically low interest rates. But this methane study shows the Republican budget-cutting fever at its worst and most self-contradictory. Not granting the money to repair this aging pipe system isn’t just dangerous, it costs us more money. Let me explain why.
The case is obvious when you think about it: shelling out for maintenance now is dramatically cheaper that it is to wait until after the system breaks (and blows the street apart, as the case may be). Put in beloved Republican household accounting terms: suppose a central support beam in your home has cracked, threatening the collapse of the roof. Does it make more sense to nip down to the bank for a quick loan to replace the beam now, or procrastinate and have to build a new house?
It’s even worse when we take the slack economy into account. Borrowing rates are super-low. Construction and raw material costs are cheaper than they will be later if and when the economy picks up. Every wasted day not investing in repairs and upgrades just means more expensive, catastrophic failures.
Make no mistake, this is a terrible problem. Aside from leaky methane in DC, there’s the fact that the average water pipe in this city was installed in 1935, leading to an average of about 450 water main breaks yearly. Here are sinkholes caused by blown water mains in Philly and New York City. Nationwide, for water systems alone there’s an unmet repair bill totaling in the hundreds of billions that is going up steadily, year after year, as our capital stock continues to decay.
What we should be doing is increasing federal infrastructure investments and increasing aid to states and cities, which would allow the country as a whole to start tackling its massive backlog of deferred maintenance needs. If we did this, we’d avoid the expensive emergency repairs that are now the norm for keeping American cities functioning.
That doesn’t even begin to address the need for new investments, like hugely expanded broadband networks, or new higher-speed rail lines, by the way.
In a way, this negligence on infrastructure is just dodgy accounting that would get you thrown out of any halfway decently-run business. A budget process that allows you to claim you’re “saving money” while your critical infrastructure is falling to pieces is just allowing you to lie to yourself.
By: Ryan Cooper, The Plum Line, The Washington Post, January 16, 2014
“A Diabolical Chicken-And-Egg Conundrum”: Fear Is Why Workers In Red States Vote Against Their Economic Self-Interest
Last week’s massive spill of the toxic chemical MCHM into West Virginia’s Elk River illustrates another benefit to the business class of high unemployment, economic insecurity, and a safety-net shot through with holes. Not only are employees eager to accept whatever job they can get. They are also also unwilling to demand healthy and safe environments.
The spill was the region’s third major chemical accident in five years, coming after two investigations by the federal Chemical Safety Board in the Kanawha Valley, also known as “Chemical Valley,” and repeated recommendations from federal regulators and environmental advocates that the state embrace tougher rules to better safeguard chemicals.
No action was ever taken. State and local officials turned a deaf ear. The storage tank that leaked, owned by Freedom Industries, hadn’t been inspected for decades.
But nobody complained.
Not even now, with the toxins moving down river toward Cincinnati, can the residents of Charleston and the surrounding area be sure their drinking water is safe — partly because the government’s calculation for safe levels is based on a single study by the manufacturer of the toxic chemical, which was never published, and partly because the West Virginia American Water Company, which supplies the drinking water, is a for-profit corporation that may not want to highlight any lingering danger.
So why wasn’t more done to prevent this, and why isn’t there more of any outcry even now?
The answer isn’t hard to find. As Maya Nye, president of People Concerned About Chemical Safety, a citizen’s group formed after a 2008 explosion and fire killed workers at West Virginia’s Bayer CropScience plant in the state, explained to the New York Times: “We are so desperate for jobs in West Virginia we don’t want to do anything that pushes industry out.”
Exactly.
I often heard the same refrain when I headed the U.S. Department of Labor. When we sought to impose a large fine on the Bridgestone-Firestone Tire Company for flagrantly disregarding workplace safety rules and causing workers at one of its plants in Oklahoma to be maimed and killed, for example, the community was solidly behind us — that is, until Bridgestone-Firestone threatened to close the plant if we didn’t back down.
The threat was enough to ignite a storm of opposition to the proposed penalty from the very workers and families we were trying to protect. (We didn’t back down and Bridgestone-Firestone didn’t carry out its threat, but the political fallout was intense.)
For years political scientists have wondered why so many working class and poor citizens of so-called “red” states vote against their economic self-interest. The usual explanation is that, for these voters, economic issues are trumped by social and cultural issues like guns, abortion, and race.
I’m not so sure. The wages of production workers have been dropping for thirty years, adjusted for inflation, and their economic security has disappeared. Companies can and do shut down, sometimes literally overnight. A smaller share of working-age Americans hold jobs today than at any time in more than three decades.
People are so desperate for jobs they don’t want to rock the boat. They don’t want rules and regulations enforced that might cost them their livelihoods. For them, a job is precious — sometimes even more precious than a safe workplace or safe drinking water.
This is especially true in poorer regions of the country like West Virginia and through much of the South and rural America — so-called “red” states where the old working class has been voting Republican. Guns, abortion, and race are part of the explanation. But don’t overlook economic anxieties that translate into a willingness to vote for whatever it is that industry wants.
This may explain why Republican officials who have been casting their votes against unions, against expanding Medicaid, against raising the minimum wage, against extended unemployment insurance, and against jobs bills that would put people to work, continue to be elected and re-elected. They obviously have the support of corporate patrons who want to keep unemployment high and workers insecure because a pliant working class helps their bottom lines. But they also, paradoxically, get the votes of many workers who are clinging so desperately to their jobs that they’re afraid of change and too cowed to make a ruckus.
The best bulwark against corporate irresponsibility is a strong and growing middle class. But in order to summon the political will to achieve it, we have to overcome the timidity that flows from economic desperation. It’s a diabolical chicken-and-egg conundrum at a the core of American politics today.
By: Robert Reich, The Robert Reich Blog, January 15, 2014
“A Culture Of Privatization And Deregulation”: West Virginia Spill, Where “Regulation” Is A Dirty Word, Shady Businesses Flourish
Asked about the spill of thousands of gallons of toxic chemicals into a West Virginia river – a disaster that shut down schools and businesses, sent hundreds of residents seeking medical treatment and left an estimated 300,000 Mountain Staters without potable water – Speaker John Boehner (R-OH) told reporters that he is “entirely confident that there are ample regulations already on the books to protect the health and safety of the American people.”
Others weren’t as sanguine. “We have a culture of deregulation – regulation has been turned into a dirty word down here,” says Russell Mokhiber, the West Virginia-based editor of the Corporate Crime Reporter. “Both the Democratic and Republican parties are complicit,” he told Moyers & Company.“The chemical and coal industries have a stranglehold on most institutions in the state. The political situation is locked up.”
Jennifer Sass, a lecturer in environmental health at George Washington University told The New York Times, “West Virginia has a pattern of resisting federal oversight and what they consider EPA interference, and that really puts workers and the population at risk.”
A 2009 investigation by the Times found that “hundreds of workplaces in West Virginia had violated pollution laws without paying fines.”
Current and former West Virginia Department of Environmental Protection employees said their enforcement efforts had been undermined by bureaucratic disorganization; a departmental preference to let polluters escape punishment if they promised to try harder; and a revolving door of regulators who left for higher-paying jobs at the companies they once policed.
But this isn’t just a story of anti-regulatory zeal – and the price hundreds of thousands of West Virginians paid for it. As new details emerge about Freedom Industries, the company responsible for the leak, it’s becoming clear that it’s also a tale of how shady businesses can prosper in an environment where regulatory capture by an industry is so deeply entrenched.
Even the history of Freedom Industries is murky. It was co-founded in 1992 by Carl Kennedy and Gary Southern — who during a Friday press conference sipped bottled water and told reporters that he’d had a really trying day. Southern had been president but the firm’s website now lists Dennis Farrell, a college friend of Kennedy’s (with whom he also opened a sports bar in 2002), as president instead. As Businessweek put it, “That clearly needs sorting out.” According to The Charleston Gazette, Southern is also the president of Enviromine, “which makes products to help remediate environmental problems from mining.”
Kennedy may or may not remain with the company; according to The Gazette, he’s still listed on documents the firm filed with the Secretary of State’s office, but a woman who answered the phone at the company said he was no longer with Freedom Industries.
That may be a distinction without a difference. Only weeks ago, the firm merged with several others: Etowah River Terminal, Poca Blending and Crete Technologies. According to The Gazette, in 2007, Kennedy claimed to have stakes in both Etowah River Terminal and Poca Blending. Prior to the merger, these companies already had complementary operations in the Kanawha Valley, known as “Chemical Valley.”
Carl Kennedy’s history reads like that of a character in an Elmore Leonard or Carl Hiaasen novel. In 1987, he pleaded guilty to selling between 10 and 12 ounces of cocaine in a case that would lead to the federal prosecution of then-Charleston Mayor Mike Roark, a former prosecutor himself who, according to The New York Times, “was once nicknamed ‘Mad Dog’ for his zeal in fighting drug abuse.” He was charged with 30 counts of cocaine possession.
The Gazette’s David Gutman reports that in the early 2000s, when Kennedy was the accountant for Freedom Industries, Poca Blending and New River Chemical Co., he pled guilty to withholding $1 million in taxes from employees’ paychecks and pocketing it rather than sending it to Uncle Sam. He also owed $200,000 in unpaid state taxes. Sentenced to three years in prison, Kennedy got his time cut in half “after he cooperated with authorities by making controlled cocaine buys and wearing a wire in conversations with a former business associate.”
In 2005, Etowah River Terminal lost its license for failing to file an annual report. It was resurrected in 2011, according to The Gazette.
Despite Kennedy’s reluctance to send tax dollars to Washington, in 2009 Freedom Industries was happy to accept stimulus funds which helped the company stay afloat. David Gutman recalled that “sand, silt and mud had built up in the river, making it difficult for barges to travel the 2.5 miles from the company’s river terminal to the Elk’s confluence with the Kanawha.”
The company was in deep trouble until the Army Corps of Engineers dredged the waterway, thanks to a $400,000 grant from the American Recovery and Reinvestment Act. “It could’ve put us out of business,” Dennis Farrell told the Charleston Daily Mail. “At some point we wouldn’t have been economically fit to run the facility. That’s our claim to fame: the barges.”
Questionable Response
Last week, Gary Southern told reporters that Freedom Industries’ employees had discovered the spill, but that claim was contradicted by reports that officials from the state’s Environmental Protection Agency found it independently after nearby residents complained of a suspicious odor.
According to the Daily Mail, a team of inspectors visited the facility this week, and issued five violations for poor maintenance and operations, insufficient employee training and reporting, and storing chemicals in an above-ground tank without a secondary containment wall.
As The New York Times noted, “lawmakers have yet to explain why the storage facility was allowed to sit on the river and so close to a water treatment plant that is the largest in the state.” The facility hasn’t been inspected since 1991 because, unlike other states, West Virginia requires it only of chemical manufacturers and emitters, not storage facilities.
According to The Gazette, in 2010, experts from the US Chemical Safety Board asked the state to create a new program to prevent accidents and releases in Chemical Valley. Those recommendations followed a 2008 fatal explosion at a Bayer Chemicals plant. They were ignored.
The chemical released last week, 4-methylcyclohexane methane, isn’t classified as a hazardous material, which under state law would have required the leak to be reported within 15 minutes. The Daily Mail reported that “a different legislative rule states a facility must give ‘immediate’ notice of a spill, but leaves it up to the head of the [state’s Department of Environmental Protection] to determine what ‘immediate’ means in each case.”
The chemical’s classification as non-hazardous may also explain why state officials didn’t have an emergency response plan in place, despite the facility’s close proximity to a major water supply.
That 4-methylcyclohexane methane isn’t considered hazardous doesn’t mean it’s safe. Richard Denison, a senior scientist at the Environmental Defense Fund, told Mother Jones that little is known about its potential effects in humans. According to Denison, studies have found the substance to be lethal in rats at high doses, but it’s impossible to extrapolate from those data how humans might respond to smaller quantities of the chemical.
Today, many West Virginia residents are angry that they had no idea of the hazards posed by the storage facility. Angie Rosser, executive director of the West Virginia Rivers Coalition, told The Huffington Post, “No one seemed to be aware or care that this dangerous chemical was upstream from our largest drinking water intake in the state. It was a recipe for disaster.” The same chemicals are stored in above ground tanks across the state, but it’s difficult for public health and environmental activists to know where.
That’s why Russell Mokhiber cautions against focusing too much on Freedom Industries itself. “It’s really not about an individual corporation,” he said. “It’s a question of why the state has allowed the chemical and coal industry to get away with this. Because however you slice it, you see privatization and deregulation at the heart of these kinds of cases.”
By: James Holland, Bill Moyer’s Blog, January 16, 2014
“Chris Christie Is Not The Victim”: The Governor Accepted Full Responsibility But Not An Ounce Of Blame
You know a politician is having a bad day when he has to stand before a news conference and plead, “I am who I am, but I am not a bully.”
Frankly, New Jersey Gov. Chris Christie was unconvincing on that score Thursday as he attempted to contain a widening abuse-of-power scandal. Moreover, Christie displayed a degree of egocentrism that can only be described as stunning. His apologies would have sounded more sincere if he hadn’t portrayed himself as the real victim.
A bit of background is needed: During his successful reelection campaign last fall, Christie — shown by polls to be a leading contender for the Republican presidential nomination in 2016, should he decide to seek it — tried to run up the score by winning endorsements from elected officials across the state, Democrats as well as Republicans.
The mayor of Fort Lee, the town on the New Jersey end of the George Washington Bridge to New York City, declined to give Christie his support. Shortly thereafter, Christie’s deputy chief of staff, Bridget Anne Kelly, sent an e-mail to an official at the Port Authority of New York and New Jersey — the agency that controls the bridge — that said: “Time for some traffic problems in Fort Lee.”
The e-mail went to David Wildstein, who was installed at the Port Authority by Christie and has known the governor since high school. He replied to Kelly: “Got it.”
Four weeks later, on Sept. 9, Wildstein ordered the closure of two traffic lanes approaching the bridge from Fort Lee, ostensibly to conduct a traffic study. This may sound like a minor inconvenience, but the George Washington Bridge is one of the most heavily traveled in the country. Closing the lanes caused hours-long traffic jams in Fort Lee for four straight days, snaring commuters in hopeless gridlock. In one widely reported incident, an elderly woman died of cardiac arrest after emergency responders were delayed by the snarl.
Further e-mail traffic involving Kelly, Wildstein and Christie’s campaign manager, Bill Stepien — mostly using their personal e-mail accounts, not their official ones — showed unalloyed glee at the mess Wildstein had created. Finally, a Port Authority higher-up discovered what Wildstein had done and reversed the order.
All along, Christie had ridiculed the suggestion that there was any political motivation in the lane closures. On Thursday, faced with proof to the contrary, he apologized and said he had been “betrayed” by staff members and associates he believed he could trust. “I am embarrassed and humiliated by the conduct of some of the people on my team,” he said.
Christie announced that he has fired Kelly — not because she helped create a maddening and dangerous situation for the people of Fort Lee but because she lied when Christie asked all the members of his senior staff whether they had any involvement in the affair.
That was the central message of Christie’s nearly two-hour performance before reporters: I was betrayed by people I trusted. I’m the victim here.
The whole episode “makes me ask . . . what did I do wrong to have these folks think it was okay to lie to me,” Christie said. He described his principal emotion as “sadness” at the betrayals by associates to whom he had shown loyalty — and from whom he expected loyalty in return.
The governor accepted full responsibility but not an ounce of blame. “Politics ain’t beanbag,” he said, but “that’s very, very different than saying that, you know, someone’s a bully.”
But is it really all that different? Christie maintained that he never sought the endorsement of Fort Lee Mayor Mark Sokolich — never even met him, actually — and therefore had no reason to want him punished. What, then, would make his deputy chief of staff and several of his closest political associates think otherwise?
If Christie is truly in the mood for soul-searching, asking how his aides could tell him such lies should be secondary. The more urgent question is what Christie might have said or done to make these loyal lieutenants conclude it would be appropriate — and a lot of fun — to torment the people of Fort Lee because of the mayor’s refusal to pledge fealty.
Federal prosecutors are reviewing the whole affair. One obvious question is whether other officials who declined to endorse Christie faced retribution of any kind.
If voters see Christie’s pugnacious, in-your-face political persona as refreshing, he has a big future. If they see it as thuggish, he doesn’t. In that sense, you’re right, Governor. This is all about you.
By: Eugene Robinson, Opinion Writer, The Washington Post, January 9, 2014
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