“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
“A Direct Correlation”: Stricter Gun Laws Mean Fewer Fatalities
A study released last week by JAMA (Journal of the American Medical Association): Internal Medicine shows a direct correlation between gun laws and gun-related fatalities. While the study is mainly based on the number of gun laws, not the type (it doesn’t, for example, specify which particular laws are the most effective), it confirms that generally speaking, stricter gun laws result in fewer deaths.
The report, entitled “Firearm Legislation and Firearm-Related Fatalities in the United States,” developed a method for rating states depending on the degree of the gun laws in place. How far state laws go to control gun trafficking, effectiveness of a background-check system, focus on child safety, restriction on military-style assault weapons, and whether state laws allow individuals to carry guns in public places were all considered when ranking each state.
The states that come in at the top of the list for strong gun laws are Massachusetts, California, New Jersey, Connecticut and New York. Aside from California, which is closer to the median, these states also have the lowest average of firearms deaths per year. The states on the other end of the list—those with the most lenient gun laws—include Alaska, Kentucky, Louisiana, Oklahoma and Utah, all of which have among the highest percentage of deaths per year.
The authors conclude from their data that just owning a gun puts individuals at risk, and the federal government should focus on limiting gun ownership entirely. “One way that firearm legislation may act to reduce firearm fatalities is through reducing firearm prevalence. Studies have shown a strong connection between gun ownership and firearm suicide and firearm homicide,” says the report. “A cross-sectional study of all 50 states from 2001 to 2003 found that higher rates of household firearm ownership were associated with significantly higher rates of homicide.”
The NRA’s Wayne LaPierre has stood adamantly against the implementation of new federal gun laws, citing these measures as an all-out attack on responsible gun owners with a view to taking away their guns, and a complete waste of time since the government fails to enforce laws already in place. LaPierre has completely ignored and opposed proposals that include universal background checks, banning military-style weapons, and outlawing high-capacity magazines. During an interview, the NRA CEO tried to shift blame for growing gun violence when he said, “Look, a gun is a tool. The problem is the criminal.”
At the 2011 Conservative Political Action Conference (CPAC), LaPierre said, “Across the board, violent crime in jurisdictions that recognize the right to carry is lower than in areas that prevent it.” During a January Senate Judiciary Committee hearing on gun violence, Senator Ted Cruz (R-TX) repeated this statement nearly verbatim. The problem with this logic is that there are far too many exceptions when piecing together a direct connection between any one lax gun law and a decrease in gun-related violence—other factors in society can trigger an increase or decrease.
The JAMA study focuses on gun-related fatalities, as opposed to gun-related violence. It also doesn’t delve into the specificity of each law, but instead measures the efficacy of all gun laws in each respective state by assigning one point for every law passed, all while taking into consideration the magnitude of the laws and the state’s demographic data.
Read the results of the study here.
A 2004 study by The National Academies Press called “Firearms and Violence: A Critical Review” shows that since the 1994 Federal Assault Weapons Ban (which expired in 2004) was passed, total murder rates and handgun murder rates have declined considerably.
In the 1990s, Congress voted to reduce funding for the Centers for Disease Control, a leading research source on gun control. Before the funding was cut, the CDC found that having a gun in the home put families at a far higher risk for suicide and homicide. President Obama signed an executive order that provides funding to the CDC for this type of research, which is telling of the president’s commitment to passing effective, sensible legislation.
LaPierre, Sen. Cruz, and other opponents of stricter gun laws can make claims that more lenient gun laws lead to a decrease in gun violence, but the data to support those claims is plainly non-existent. The JAMA study reiterates what a recent Quinnipiac University poll points out: A majority of Americans support stricter gun laws despite opposition from the NRA and NRA-funded Republicans—and it’s in the people’s best interests to do so.
By: Allison Brito, The National Memo, March 10, 2013
“Routine Securities Taken For Granted”: Essential Government Tasks Need Reliable Funding
Here’s hoping that Stewart Parnell goes to prison.
The former president of the now-bankrupt Peanut Corp. of America, Parnell ran a filthy Georgia processing plant contaminated with salmonella that injured more than 600 people in a 2008-2009 outbreak, killing nine. Last month, federal prosecutors charged Parnell and three others with criminal offenses, claiming the executives intentionally shipped out contaminated peanut products.
It’s about time that white-collar criminals whose actions result in death or horrible injuries have to do the perp walk, just like the leeches who sell narcotics to kids. Former workers and federal inspectors say the plant, located in the small southeast Georgia town of Blakely, was a breeding ground for bacteria — with a leaky roof, dirty floors, mold on the ceiling and walls, and rats and roaches everywhere.
Still, it’s not enough to know that Parnell is finally going before the bar of justice. I also want a vigorous and assertive government that will help ensure that plants like Parnell’s Blakely facility won’t be free to operate in the future.
With President Obama battling Republicans over government spending, it’s easy to forget the important functions that federal agencies carry on every day. The Washington commentariat has concluded the agreement — known as “sequestration” — that produced shortsighted budget cuts hasn’t caused any harm to the majority of Americans, an indication, in that view, that Obama oversold the consequences of the cuts.
Is that true? The fact is we may never know how much harm will be done by those cuts. We don’t know how many children will miss their vaccinations, how many Head Start teachers will be laid off, or how many food inspections will be skipped.
The line between cause and effect is especially hard to draw in the work of those federal agencies whose jobs are aimed at prevention. The inspectors at the Food and Drug Administration have done their jobs well when you don’t hear of a food-borne illness or a faulty medical product. That sort of work is essential, but its results are hard to measure. And it never attracts public attention of the sort that ensures big budgets.
After the Blakely fiasco, Congress passed laws beefing up the powers given to the FDA. The agency used that new authority to shut down a New Mexico peanut processing plant that was implicated in a 2012 salmonella outbreak.
That decision came after the FDA, the Centers for Disease Control and Prevention (another federally funded agency) and state and local health departments tracked the outbreak to that specific plant, run by Sunland Inc. That outbreak sickened dozens.
I don’t know — and neither do you — whether the CDC will continue to have all the resources it needs to track deadly diseases with the across-the-board spending cuts dictated by GOP intransigence. I don’t know whether the Consumer Protection Agency will be able to track down all the lead-tinged toys coming in from China. I don’t know whether the FDA will be able to shut down the next Sunland before hundreds are hurt.
But I do know this: When I fix my 4-year-old a peanut-butter-and-jelly sandwich, I should not have to worry about whether she’ll get food poisoning. When you buy peanut butter crackers from a convenience store to placate your growling tummy on a road trip, you shouldn’t fear that eating them will send you to an emergency room.
Those are routine securities that we take for granted because we live in an affluent, developed nation with government regulations for food safety. However, those protections cost money. They don’t come free.
I’ve eaten in countries where there were no pesky government regulations keeping the milk pasteurized and the water free of parasites and the cooked meat free of harmful bacteria. I’ll take more government — with its higher costs — any day.
By: Cynthia Tucker, The National Memo, March 9, 2013
When Food Kills: A Threat To Public Health
The deaths of 31 peoplein Europe from a little-known strain of E. coli have raised alarms worldwide, but we shouldn’t be surprised. Our food often betrays us.
Just a few days ago, a 2-year-old girl in Dryden, Va., died in a hospital after suffering bloody diarrhea linked to another strain of E. coli. Her brother was also hospitalized but survived.
Every year in the United States, 325,000 people are hospitalized because of food-borne illnesses and 5,000 die, according to the Centers for Disease Control and Prevention. That’s right: food kills one person every two hours.
Yet while the terrorist attacks of 2001 led us to transform the way we approach national security, the deaths of almost twice as many people annually have still not generated basic food-safety initiatives. We have an industrial farming system that is a marvel for producing cheap food, but its lobbyists block initiatives to make food safer.
Perhaps the most disgraceful aspect of our agricultural system — I say this as an Oregon farmboy who once raised sheep, cattle and hogs — is the way antibiotics are recklessly stuffed into healthy animals to make them grow faster.
The Food and Drug Administration reported recently that 80 percent of antibiotics in the United States go to livestock, not humans. And 90 percent of the livestock antibiotics are administered in their food or water, typically to healthy animals to keep them from getting sick when they are confined in squalid and crowded conditions.
The single state of North Carolina uses more antibiotics for livestock than the entire United States uses for humans.
This cavalier use of low-level antibiotics creates a perfect breeding ground for antibiotic-resistant pathogens. The upshot is that ailments can become pretty much untreatable.
The Infectious Diseases Society of America, a professional organization of doctors, cites the case of Josh Nahum, a 27-year-old skydiving instructor in Colorado. He developed a fever from bacteria that would not respond to medication. The infection spread and caused tremendous pressure in his skull.
Some of his brain was pushed into his spinal column, paralyzing him. He became a quadriplegic depending on a ventilator to breathe. Then, a couple of weeks later, he died.
There’s no reason to link Nahum’s case specifically to agricultural overuse, for antibiotic resistance has multiple causes that are difficult to unravel. Doctors overprescribe them. Patients misuse them. But looking at numbers, by far the biggest element of overuse is agriculture.
We would never think of trying to keep our children healthy by adding antibiotics to school water fountains, because we know this would breed antibiotic-resistant bacteria. It’s unconscionable that Big Ag does something similar for livestock.
Louise Slaughter, the only microbiologist in the United States House of Representatives, has been fighting a lonely battle to curb this practice — but industrial agricultural interests have always blocked her legislation.
“These statistics tell the tale of an industry that is rampantly misusing antibiotics in an attempt to cover up filthy, unsanitary living conditions among animals,” Slaughter said. “As they feed antibiotics to animals to keep them healthy, they are making our families sicker by spreading these deadly strains of bacteria.”
Vegetarians may think that they’re immune, but they’re not. E. coli originates in animals but can spill into water used to irrigate vegetables, contaminating them. The European E. coli outbreak apparently arose from bean sprouts grown on an organic farm in Germany.
One of the most common antibiotic-resistant pathogens is MRSA, which now kills more Americans annually than AIDS and adds hugely to America’s medical costs. MRSA has many variants, and one of the more benign forms now is widespread in hog barns and among people who deal with hogs. An article this year in a journal called Applied and Environmental Microbiology reported that MRSA was found in 70 percent of hogs on one farm.
Another scholarly journal reported that MRSA was found in 45 percent of employees working at hog farms. And the Centers for Disease Control reported this April that this strain of bacteria has now been found in a worker at a day care center in Iowa.
Other countries are moving to ban the feeding of antibiotics to livestock. But in the United States, the agribusiness lobby still has a hold on Congress.
The European outbreak should shake people up. “It points to the whole broken system,” notes Robert Martin of the Pew Environment Group.
We need more comprehensive inspections in the food system, more testing for additional strains of E. coli, and more public education (always wash your hands after touching raw meat, and don’t use the same cutting board for meat and vegetables). A great place to start reforms would be by banning the feeding of antibiotics to healthy livestock.
By: Nicholas D. Kristof, Op-Ed Columnist, The New York Times, June 11, 2011
United Nations Sharply Critical Of U.S. On Women’s Rights
The United Nations Rapporteur on violence against women, its causes and consequences, has issued a very critical report of the U.S. on its policies on women’s rights. The report is based on a trip of the Special Rapporteur to the US from 24 January to 7 February 2011. During that trip, Ms. Rashida Manjoo broadly examined issues of violence against women in different settings. Her recommendations should provide fruitful material for the U.S. to improve its policies towards women.
As indicated in the report, “Violence against women occurs along a continuum in which the various forms of violence are often both causes and consequences of violence.” Domestic violence or Intimate Partner Violence (IPV) is one of the most critical expressions of violence. According to the National Crime Victimization Survey (NCVS) 552,000 violent crimes by an intimate partner were committed against women in the U.S. in 2008.
Their husbands or intimate acquaintances are responsible for the majority of crimes against women. The Violence Policy Center states that the number of women shot and killed by their husbands or intimate acquaintances was four times higher than the total number of women murdered by male strangers using all weapons combined, according to an analysis of 2008 data.
Rape and sexual assault continue to be prevalent forms of violence against women in the country. According to the NCVS, 182,000 women were raped or sexually assaulted in the U.S. in 2008, i.e. approximately 500 women per day. In addition, there were 3.4 million persons who were victims of stalking, most of them women. 1 in 12 women and 1 in 45 men have been stalked in their lifetime in the U.S.
According to the U.S. Centers for Disease Control and Prevention statistics, the cost of intimate partner violence exceeds $5.8 billion each year. $4.1 billion of that amount is for direct medical and mental health services. Intimate partner violence incidents result in more than 18.5 million mental health care visits each year.
Children are also victims of violence carried out against their mothers. It has been shown that 30% to 60% of perpetrators of intimate partner violence also abuse children in the household. Witnessing violence between one’s parents or caretakers is the strongest risk factor for transmitting violent behavior among generations. In that regard, it has been shown that boys who witness domestic violence are twice as likely to abuse their own partners and children when they become adults.
Domestic violence offenses are one of the most chronically underreported crimes. It is estimated that only approximately one-quarter of all physical assaults, one-fifth of all rapes, and one-half of all stalkings carried out against females by intimate partners are reported to the police.
There are several reasons for these crimes not being reported. Among those reasons are: fear of retaliation from their abuser, the perception that the police will not respond adequately to the complaint or the belief that these are issues that should be privately addressed. According to a 2009 Department of Justice report, only 56% of intimate partner violence cases filed with the courts resulted in a conviction.
Women victims of domestic violence suffer a wide array of negative consequences, aside from the physical and psychological. Women victims of domestic violence face serious consequences in terms of economic instability, loss of employment and homelessness. In addition, violence against women is frequently seen among women in the military, women in detention, and among immigrant and undocumented women.
The extent of the phenomenon has made that violence against women is now recognized as an issue that belongs not only to the private sphere but that requires State intervention. According to the U.N. Rapporteur, the U.S. Government has taken positive legislative and policy initiatives to reduce the prevalence of violence against women.
Among those steps is the enactment and subsequent reauthorizations of the Violence against Women Act, as well as the establishment of dedicated offices on violence against women at the highest levels of government. However, according to the UN Rapporteur, more U.S. government actions are needed to curb a phenomenon that continues to cause tremendous harm to women’s health and quality of life.
By: Cesar Chelala, MD, PhD, CommonDreams.org, June 4, 2011
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