Random Life Things

Highlights From The President’s Commission on Combating Drug Addiction and the Opioid Crisis

Not everyone has time to read through a 138 page document produced by The President’s Commission on Combating Drug Addiction and the Opioid Crisis, but fortunately/unfortunately, I do.  The Commission gave 56 recommendations for what to do to help with the crisis, but the President just can’t seem to get a grip on any of them.  Instead of listening to his own Commission, he has decided to focus on enforcing opioid laws instead of providing opioid treatment.  Here’s a rundown of what the commission had to say.

Roster of Commissioners

Governor Chris Christie, Chairman
Governor Charlie Baker
Governor Roy Cooper
Congressman Patrick J. Kennedy
Professor Bertha Madras, Ph.D.
Florida Attorney General Pam Bondi

Introductory Letter

“Our people are dying.  More than 175 lives lost every day.  If a terrorist organization was killing 175 Americans a day on American soil, what would we do to stop them?  We would do anything and everything.  We must do the same to stop the dying caused from within.”

“Without comprehensive action, including your national public health emergency, the death count will continue to rise.”

“It is time we all say what we know is true: addiction is a disease.  However, we do not treat addiction in this country like we treat other diseases.  Neither government nor the private sector has committed the support necessary for research, prevention, and treatment like we do for other diseases.”

“The recommendations herein, and the interim recommendations submitted by the Commission in July, are designed to address this national priority.  These recommendations will help doctors, addiction treatment providers, parents, schools, patients, faith-based leaders, law enforcement, insurers, the medical industry, and researchers fight opioid abuse and misuse by reducing federal barriers and increasing support to effective programs and innovation.”

“We recommended that all law enforcement officers across the country be equipped with life saving naloxone.”

“We recommended full enforcement of the Mental Health Parity and Addiction Equity Act to ensure that health plans cannot provide less favorable benefits for mental health and substance use diagnoses than physical health ailments.”

“Today, only 10.6% of youth and adults who need treatment for a substance use disorder receive that treatment.  This is unacceptable.  Too many people who could be helped are falling through the cracks and losing their lives as a result.”

“One of the most important recommendations…is getting federal funding support more quickly and effectively to state governments, who are on the front lines of fighting this addiction battle every day.  Bureaucracy, departmental silos, and red tape must not be accepted as the norm when dealing with funding to combat this epidemic.  Saving time and resources, in this instance, will literally save lives.”

“Accordingly, we are urging Congress and the Administration to block grant federal funding for opioid-related and SUD-related activities to the states. . This was a request to the Commission by nearly every Governor, regardless of party, across the country.

“The Commission also identifies the need to focus on, deploy, and assess evidence-based programs that can be funded through these proposed block grants.”

“From its review of the federal budget aimed at addressing the opioid epidemic, the Commission identified a disturbing trend in federal health care reimbursement policies that incentivizes the wide-spread prescribing of opioids and limits access to other non-addictive treatments for pain, as well as addiction treatment and medication-assisted treatment.”

“The Department of Labor must be given the real authority to regulate the health insurance industry.  The health insurers are not following the federal law requiring parity in the reimbursement for mental health and addiction.  They must be held responsible.”

“We are recommending that a drug court be established in every one of the 93 federal district courts in America.  It is working in our states and can work in our federal system to help treat those who need it and lower the federal prison population.  For many people, being arrested and sent to a drug court is what saved their lives, allowed them to get treatment, and gave them a second chance.”

“Drug Courts are known to be significantly more effective than incarceration, but 44% of U.S. Counties do not have an adult drug court.”

“The Commission recommends enhanced penalties for trafficking of fentanyl and fentanyl analogues and calls for additional technologies and drug detections to expand efforts to intercept fentanyl before entering the country.”

“The time to wait is over.  The time for talk is passed. 175 deaths a day can no longer be tolerated.  We know that you will not stand by; we believe you will force action.”

What This Administration Has Already Done:

  • Announced the launch of a new policy to overcome a rule that prevents states from providing more access to care at treatment facilities with more than 16 beds.
  • Directed all federally employed prescribers to receive special training to fight this epidemic.
  • The DOJ has continued its efforts to stop the flow of illicit synthetic drugs into this country through the U.S. Postal Service
  • NIH DIrector Dr. Francis COllins has been partnering with pharmaceutical companies to develop non-addictive painkillers and new treatments for addiction and overdose.  THe Commission worked with Dr. Collins to convene a meeting with industry leadership to discuss innovative ways to combat the opioid crisis.

 

 

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Random Life Things

Privilege

If you identify as white and you are reading this, chances are it’s going to make you a little uncomfortable.  But discomfort isn’t always a bad thing.  Discomfort can be a place where learning and enlightenment happen.  It has been for me in the past and continues to be for me in the present.  Anyways, today I want to talk about white privilege.

Yesterday, I posted a graphic on Facebook.  It said:

dear white people

It got a few likes, but what really stood out was the person I have known for over eighteen years commenting on it and claiming that white privilege isn’t real but that people are racist against this person all the time for being white.  I tried to be patient.  I tried to be kind.  I tried to explain that white privilege doesn’t make you a bad person or mean that you don’t have difficulties or that no one is prejudiced against you, it just means that you started your life (and live your life) with several advantages over people of color.

I tried to explain that reverse racism isn’t real because we, as white people, have not been oppressed on an institutional level for hundreds and hundreds of years.  We have not been enslaved in the millions because of our skin color.  We didn’t have to suffer through the indignities of Jim Crow.  We haven’t been lynched because of our skin color in the thousands (though some white people have been lynched for siding with and helping people of color).  We are statistically less likely to be incarcerated.  We have representation in all forms of media that look like us.  It’s easy to go into a store and find a barbie or doll that looks like us.  Most of our favorite tv shows and movies have main characters that look just like us.  The vast vast majority of “heroes” are white.  We get to learn about many many people of our own race in school.

Our parents don’t have to give us “the talk” about police safety because we are less likely to be shot and killed by police officers.  According to Vox, “An analysis of the available FBI data by Vox’s Dara Lind found that US police kill black people at disproportionate rates: Black people accounted for 31 percent of police killing victims in 2012, even though they made up just 13 percent of the US population. Although the data is incomplete because it’s based on voluntary reports from police agencies around the country, it highlights the vast disparities in how police use force.”

Someone may have biases or prejudices against you because you are white, but that is not racism.  (Please see video #2 if you are having a hard time with this concept).  I tried to put it in simple terms that could be easily understood, but this person continued to argue with me, at which point I ran out of spoons and had to end the conversation.  I just didn’t have the energy to continue at that time.  I unfriended the person for a variety of reasons, but one of them is that we aren’t that close to begin with and I really have no desire to be friends with someone who won’t even entertain the idea that white privilege exists even though it has been explained and pointed out to them.  I wish that I hadn’t unfriended them.  I wish I had said, “this is emotionally exhausting work for me and I need to take a break and come back to it.”  But that isn’t what I did and, as a result, I had an even harder than usual time falling asleep last night, wondering if I had just been able to come up with the right sentence, if maybe I could have changed this person’s mind.

I know it’s possible, because I, too, once didn’t believe in white privilege and was very defensive the first time someone tried to explain it to me.  I know it’s hard to believe now, but I was actually in the College Republicans my freshman year at WCU and used to call Feminists “Feminazis.”  I’m not proud of the person I was, but I’m proud of the person that my college professors (Dr. Pete and Dr. Herzog), graduate school friends (Monica, Hanna, Jen, and Shyra), and graduate school professors (Lisen, Russ, Heather, Phyllis, Melody, and Valerie) helped shape me to be.  I care about others, I’m empathetic, and I understand that my ability to even type this up on a computer and post it to the internet with my name on it reeks of privilege.  I could tell you of so so many instances where white privilege has benefited me, but I find myself again running out of spoons.  Perhaps I’ll revisit this post later.  Just in case I don’t, please do me a favor and watch these three videos:

 

Adventure

River the Wonderdale

I realized recently that I’ve talked a lot about service dogs, service dog etiquette, and River being a service dog in general but that I’ve never actually acknowledged what specific tasks she does for me, which people may (or may not) be curious about.  Though I have Bipolar I, River’s tasks are all related to my Generalized Anxiety Disorder and Panic Attacks.

But first, a little background.  According to the ADA,  “a service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.   Tasks performed can include, among other things, pulling a wheelchair, retrieving dropped items, alerting a person to a sound, reminding a person to take medication, or pressing an elevator button.”  Providing comfort is not considered a task under the ADA.

“Emotional support animals, comfort animals, and therapy dogs are not service animals under Title II and Title III of the ADA. Other species of animals, whether wild or domestic, trained or untrained, are not considered service animals either. The work or tasks performed by a service animal must be directly related to the individual’s disability. It does not matter if a person has a note from a doctor that states that the person has a disability and needs to have the animal for emotional support. A doctor’s letter does not turn an animal into a service animal.”

In addition to being task trained, service dogs should also be completely potty trained, have a lot of public access practice hours logged, and have basic obedience down.  River is a full blown service dog (As opposed to a Service Dog in Training or SDiT), but she will always be in training as she will always continue to learn new things.  Although all online registries for service dogs are fraudulent and DO NOT make your dog a service dog, some states, including NC, have a voluntary registry.  Ours is through the Department of Vocational Rehabilitation and River has a special tag on her collar acknowledging her status as a trained service animal.  You may hang out with me a lot and never see her task or you may hang out with me a little and see her task a lot.  It really depends on how I am doing on a given day.  Here are some of the tasks River is currently trained to do:

DPT (Deep Pressure Therapy): When I am sitting or lying down and River senses me getting anxious OR when I say “Alert” to her, she climbs up and puts the front half of her body across my lap.  It’s like having a really heavy weighted blanket for anxiety and helps to calm me down.

Grounding: When I am standing up and River either senses me getting anxious or I give her the command “ground” she lays her body across my feet to provide grounding for anxiety.

Tactile Stimulation: When I become anxious or give the command “kisses”, River licks the tops of my feet or my hands (depending on what she can reach) to provide tactile stimulation and grounding.  When I have a panic attack, River will lick my face until it stops.

Blocking: When I am in a crowded area, River will lay down in front of, next to, or behind me to keep people from getting too close.  I am in the process of teaching her to lay down behind me every time I stop walking.

She has recently shown a few behaviors that I would like to shape into tasks, but she hasn’t been formally trained to do them yet.  For example, I’ve been struggling with depression for a few months now and this week there have been a few times when I did not want to get out of bed and she licked me until I finally got up.  She also got her leash off the ground and went to the front door and waited for me to take her out on a walk.  By themselves, these behaviors are not tasks, but they could be shaped to become tasks.

If you have questions, please feel free to comment or e-mail me at catherinecottamwrites@gmail.com .

mental health

Entitlement

I haven’t written in a long time.  I just haven’t felt like writing.  I’ve been a bit on the depressed side of things, which actually isn’t that terrible because it’s mild and at least it isn’t mania.

Yesterday I had an encounter that left me shaking and with my heart pounding.  Despite what everyone may think and in spite of how outspoken I am, I do not relish confrontation.

If you are reading this, you likely know that I have Bipolar Disorder, Generalized Anxiety Disorder, and panic attacks and you likely already know that I have a psychiatric service dog, River, who helps with my anxiety and panic attacks.  She goes pretty much everywhere with me and our partnership has been enormously helpful to my mental health.

Last night, we had dinner and went to a movie with a dear friend of mine.  While my friend was in line for concessions at the movie theater, I sat down on a bench to wait.  A woman with her two children walked past and said something along the lines of “Oh doggie, you’re so pretty!” at which point I said “Leave it, River” to get River to refocus back onto me.

The woman said “Oh.  Excuse me….is that a guard dog?”  I said “No, she is a service animal.”  She said, “Oh my friend has one of those, she takes her to the hospital to help people.”  I said “That actually sounds more like a therapy dog,” and she asked “What’s the difference?”  I replied “Well, a therapy dog goes to places like hospitals and nursing homes and serves many people.  A service dog serves one person who has a disability.”  Everything was fine up until this point.  I usually don’t mind answering questions about River, but the next question she asked and the way she reacted when I responded left me deeply uncomfortable.

Her: “What’s your disability?”

Me: “I’m sorry, but that’s actually pretty rude to ask.” (At this point, people usually say, “Oh I’m sorry, I didn’t realize” and I say “That’s okay.  Thank you for understanding.”)

Her: “No it isn’t.  I have a disability.  I had a brain tumor.”

Me: “I’m sorry but that’s still pretty rude.”

Her: “No, it’s rude of you to say that.”

Me: “It isn’t my responsibility to educate you and I don’t owe you an explanation about my health.”

Her: “Well it isn’t my responsibility to educate you on how to be polite!”

At which point I walked away.

Let me say this really loud for the people in the back: YOU ARE NOT ENTITLED TO SOMEONE ELSE’S PRIVATE HEALTH INFORMATION.  If they want to share it with you, that’s fine.  If they don’t, it’s really none of your business in the first place.  It is incredibly rude to ask someone “what’s your disability” as it implies that a)the person asking is entitled to know, b) you owe them some type of explanation, and c)your privacy doesn’t matter.  A business is only allowed to ask two questions about a service dog to the handler: 1) Is that a service dog required because of a disability? 2) What tasks does he/she perform?  Unfortunately, uneducated people everywhere think they are entitled to ask any question they want, regardless of how invasive or personal it is.

I’m usually very open about my mental illness.  If people ask things like “why do you have [River]” I usually respond “she’s a psychiatric service dog.”  If they ask what she does I sometimes will tell them “she helps with my anxiety” depending on how my anxiety is in that current moment and how my day is going.  Sometimes I will even explain how she does Deep Pressure Therapy, grounding, and blocking for me.  I’m fine with volunteering information when I feel safe doing so.  I am NOT fine with someone acting as though she is entitled to my private health information.

So here’s a Pro Tip:  Don’t ask questions like “what’s your disability?” , “why do you have a service dog?” , “what’s wrong with you?”, or say things like “I wish I could take my dog everywhere with me.”  The first three are just rude and the last one is incredibly insensitive.  I always want to say, “Really?  You wish that you were so disabled that medication and therapy weren’t enough and you had to take your dog everywhere with you just to function?”  So far I’ve never actually said that because I genuinely don’t want to be rude to people, but I think it every single time someone tells me they wish they had a service dog.

If you need a refresher on service dog etiquette, check out this article I wrote by clicking here.

When in doubt, be kind and don’t ask invasive questions.

mental health

World Mental Health Day 2017

In true Catherine fashion, this is possibly a bit too honest and probably uncomfortably personal for some people.

Yesterday, I sat in my OBGYN’s office and expressed that because of my Bipolar disorder and my clotting disorder, I probably don’t want to have biological children.   “More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component (National Institute of Mental Health).”  The clotting disorder, Factor V Leiden, is a genetic disorder, and would likely be passed down to any of my future potential offspring.  Though the clotting disorder is not a mental health disorder, it has direct effects on my mental health as it causes anxiety and panic attacks and even required the use of EMDR, a type of trauma therapy, as suggested by a therapist in my IOP because of my “PTSD like symptoms” surrounding my Pulmonary Embolism.

My doctor agreed that the clotting disorder would make any future pregnancy incredibly high risk but told me that since she loves me so much, she wouldn’t mind too much if I passed on the bipolar disorder.  I smiled and said thank you (and I was honestly somewhat flattered that my doctor thinks so highly of me), but what I wanted to say and perhaps should have said was, “spoken like someone who doesn’t have Bipolar Disorder.”  “Bipolar Disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year (National Institute of Mental Health).”  It, “results in 9.2 years reduction in expected life span, and as many as one in five patients with bipolar disorder completes suicide (National Institute of Mental Health).”  I wouldn’t wish it on an enemy, let alone an unsuspecting child.

Growing up, I always thought I would be a mother someday and there is the chance that I’ll eventually become someone’s step-mother or adoptive-mother, but I feel that it would be irresponsible, selfish, and somewhat cruel to insist on having my own children.  Population problems aside, how heartless would I have to be to knowingly put someone else through the hell that I have been through?  To subject them not only to a horribly debilitating mental illness that results in over 9 years reduced lifespan and possibly ends in suicide, but a genetic disease that can cause clots, Pulmonary Embolisms, Strokes, or even death.

The prospect of not having children of my own is a sad and difficult one, but it  seems like the right choice for me, given all of my health problems.  Today, on World Mental Health Day 2017, I urge you to think about the far reach mental illness has.  It not only affects how people function, but also important choices they must make about their lives and the lives of loved ones.  Mental illness is no joke and, honestly, I’m sick and tired of hearing it treated as one.  I’m tired of ableist language and of people referring to people or things as “crazy” when they really mean things like “unbelievable”, “surprising,” “angry”, “scary”, or “bad.”  I myself am guilty of using this type of language and am working on it, making an effort not to use it anymore.

If you think you or someone you know has Bipolar Disorder, I urge you to utilize the Mood Disorder Questionnaire and talk about it with your primary care physician or another health care professional.  You can find tests for Bipolar Disorder and other types of mental health disorders here.

If you are in crisis, please call 1-800-273-TALK (1-800-273-8255) or visit https://suicidepreventionlifeline.org/ .

Books

September 1, 2017

*Nineteen Years Later*

Today is Harry Potter Epilogue Day.  It’s the date, nineteen years from the Battle of Hogwarts, when Albus Severus will board the Hogwarts Express for the first time, stressing out about what house he will be placed in.  It’s the date that Ron and Harry see Scorpius Malfoy for the first time.  It’s the date we find out that Harry is happily married to Ginny with three children and Ron and Hermione are married with two children.  It’s the date we found out “All was well.”

In honor of epilogue day, I’m going to talk yet again about what Harry Potter has meant to me over the years.  It’s so much more than a book and movie series to me and many people don’t understand my passion for it.  I received the first three books as a gift from my parents on Christmas Day during my fifth grade year.  I accidentally picked up the second book first and was very confused, but figured out within the first few pages what I had done.  I read all three books in about two days and then I just had to keep re-reading them because the fourth book wouldn’t come out until July 8, 2000, the summer between fifth and sixth grade.

My friends and I would pretend to be Ron, Harry, and Hermione and run around with sticks for wands.  I received my copy of Goblet of Fire in the mail and couldn’t put it down, barely sleeping and taking it to summer camp with me during the day until I finished it.  I had to wait almost three years for the fifth book, which came out the summer after 8th grade.  I started suffering from depression in seventh grade, so the books got dark around the time my life did.

In high school, there were a couple of times when I was suicidal, but decided not to kill myself because I had to know how Harry Potter ended (and I couldn’t leave my family behind, but Harry Potter was a big factor, too).  J.K. Rowling quite literally saved my life with the books she wrote.  Aside from needing to know how the books would end, the books gave me hope.  More than being stories about magic, they are stories about love, hope, family, friendship, courage, loyalty and good conquering evil.  The characters may be fictional, but they are like old friends to me.  J

.K. Rowling taught me that Dementors don’t have to be the end and that  I can survive hard feelings.  She created the Dementors as an allegory for depression and I can’t think of a better one in any literature I’ve read.  They suck all of the happiness away and make you feel as though you’ll never be cheerful again, which is exactly what depression does to me.

When I find myself feeling sad or lonely, watching or reading Harry Potter always makes me feel better about my life, even if it’s just temporary.  So Happy Epilogue Day.  I hope the Harry Potter series can bring joy and peace to others the way it does for me.  I’m off to watch some Harry Potter!

mental health

Hospitalization #2

I don’t typically find it difficult to write, but over the past week I’ve struggled and struggled with how to write this post.  I try to be pretty open about my experiences with bipolar disorder in the hopes that it will help someone else with a mental illness to feel like it’s okay to talk about it or reach out for help.  For a refresher on Bipolar Disorder, please click here.

Days since last hospitalization: 6.

You may or may not know that I very recently spent quite a bit of time in the hospital.  11 days to be precise.  The time leading up to my hospitalization is a bit of a blur.  I’m not sure if I have things in the right order or not, but I’ll do my best.

I was depressed from October to the end of May.  My doctor and I were considering doing ECT, or electroconvulsive therapy (Shock Treatments) as we had tried most available medications and they didn’t seem to be helping.  In the end of May or beginning of June, the doctor put me on a medication called Vraylar that’s supposed to be particularly good for mixed episodes, which I have sometimes (Those are where you experience the symptoms of depression and mania at the same time and are considered the most dangerous time for people who have them because you may have suicidal thoughts AND the energy to carry out any plan you create).  He thought it may help with the depression and it did.  However, my spending started increasing and I mentioned to my doctor that I thought I was becoming manic.  I also expressed to him that I felt like the number of medications I was on was too much, particularly since they didn’t seem to be working.  He continued to add medications.  He said he didn’t want to start removing medications while I was manic.

I ended up in the ER on Monday, August 31st because I was rapid cycling between depression and mania and wasn’t sleeping well.  Really, some nights/days I was sleeping too well and some nights I was sleeping barely if at all.  I slept for most of three and a half days then was awake for 36 hours then slept for something like 16 or 18 hours then only slept for 2 hours the next few nights then sometimes wasn’t able to sleep at all then slept all night and all day again.  While I was awake I was talking to some of my friends a lot more and a lot more intensely than usual.  My spending was getting out of control.  Sometimes when I wasn’t able to sleep I would just lie awake in bed thinking about what a failure I felt like I was.  I was rapid cycling between depression and mania.

I had tried calling my doctor’s office for 45 minutes that Monday and no one answered.  I have given up on leaving messages there because they never return them.  I called my therapist and she suggested that I drive over to the psychiatrist’s office, explain to the receptionist what was happening, and ask to be seen.    The receptionist offered me an appointment on Wednesday when the doctor had a cancellation.  48 hours later was the earliest I could be seen.

At the ER, they asked me if I wanted to be admitted to the behavioral health unit.  I declined as I was still hoping things could be managed at home and since I wasn’t having any thoughts about hurting myself or anyone else.  They gave me a prescription for Lunesta and sent me home.  That first night, I took the Lunesta and fell right to sleep.  The second night, I took the Lunesta and still only slept for about two hours.  I think it was that day that I started packing for an inpatient stay.  I hallucinated on a couple of occasions, thinking that my Mom had called my name when she hadn’t and feeling like there were bugs crawling all over me.

On Friday, August 4, I ended up in the ER again.  This time, I was all packed and ready to be admitted.  I thankfully never ended up having thoughts of harming myself or anyone else, but all of the other symptoms had become too much to manage on my own.  I spent 11 days in the hospital trying to regulate my mood and my sleep.  While my mood is much more stable, I am a little on the depressed side now.  I also only got one good night of sleep the entire time I was in the hospital.  Since I’ve been home, I’ve gotten a few nights of good sleep but it’s still pretty hit or miss even with the new sleeping medications I am taking.  I just got out this past Monday.  The doctors took me off of about half of my psychiatric drugs, which I’m very very pleased about.  One of the medications I’m taking to help me sleep could potentially help with the depression but it may take a few weeks to work.  I feel clearer, more grounded, and generally better.  I will start an Intensive Outpatient Program (IOP) next Tuesday.  An IOP is where you go to group counseling three days a week for three hours or so.  I will probably do that for about six weeks.

I have to say, I’m really really grateful to Park Ridge Women’s Hope Unit and the amazing nurses and doctors there.  I don’t know where I would be without them.  This is twice they have helped me in times of desperate need and they are definitely my first choice of hospital to go to.  It’s an all women unit that only has eleven single rooms, the food is good, and the groups they have are meaningful and helpful.

Mom and Dad took excellent care of River for me while I was gone and she even got to come to the hospital and visit me with them every chance they got since she is a fully trained service dog.  It was tremendously tremendously helpful to see the three of them so often and to know that they were all taking good care of each other.  I cannot express the gratitude I feel for my parents for always loving me, supporting me, and helping me.  I have no idea what I would do if they weren’t kind enough to let me live with them.

Thank you so much to all of you for reading this and for your support.  I appreciate it more than you could possibly know.  ❤

 

 

If you or someone you know is having thoughts of self-harm or harming someone else, please call 911, go to the nearest Emergency Room, or call the National Suicide Prevention Lifeline at 1-800-273-8255.