Maddie died last fall after living for more than a decade with opioid-use disorder. When the obituary I wrote for her went viral, this newspaper, one of two my family paid to publish it, offered me a yearlong position writing about the opioid crisis in Vermont.
My regret has become more acute over the course of the past year, which I've spent researching and reporting on the disease my sister struggled with so mightily, learning things I wish I had known when she was alive. I have wanted a time machine like I have never wanted anything in my life.
Hooked On Your Love Mp3 Download
Download 🔥 https://urllie.com/2yGbBe 🔥
I believe in love the way some people believe in God or science. I believe in science, too, that both it and love have the power to transform and heal, but in the absence of the former I focused on the latter. I believed that if my family loved Maddie enough, we could keep her alive.
Every time I saw her I covered her face with kisses: I love you, I would say as I kissed her forehead, I love you as I kissed each eyebrow, I love you I love you I love you. Soon it was a ritual: Everywhere from my front door to the parking lot of inpatient rehab to the visiting room at Riker's Island, she would tilt her face to me as we said goodbye, and I would cover it with kisses.
When she died I thought I had been wrong about love. I thought heroin was stronger and fentanyl far more powerful. I thought endocarditis, the infection she contracted through injection drug use and ultimately died of, could defeat anything. But as I researched and reported the six stories in this series, as I talked to people across the state and learned of public health approaches being implemented around the world, I realized I wasn't wrong about love; I was unaware of the science and research, the evidence-based versions of love that actually could have saved my sister's life and the lives of hundreds of thousands of others who have died of this disease.
These are some of the what ifs that haunt my memories: What if I'd known how long it takes to achieve remission from opioid-use disorder? What if I'd understood how effective medication is in treating it? And the one I'm most ashamed never occurred to me while Maddie was alive: What if instead of focusing solely on helping her get sober, I had talked openly with her about how to protect herself when she was not?
It wasn't the decade spent watching my sister's disease rage and remit and recur that made me realize the woman was right; it was a statistic I came across while researching the first story in this series: It takes the average person with opioid-use disorder eight years and four to five attempts at treatment to achieve one year of remission from the disease.
Maddie's visits to rehab were usually followed by periods of sobriety that ranged from days to months to almost a year. But she invariably experienced a recurrence of her disease and a spiral into drug use that brought her to scarier and scarier places. According to various social workers and counselors, this was her fault: She wasn't getting honest with herself. She didn't take responsibility for her actions. She hadn't hit bottom.
When she lied to us or her doctor or probation officer or caseworker about relapsing, both the relapse and the lie were evidence of a character flaw, not a stage of her disease process or a failing of ours.
"As a society, we have a system that is so laden with stigma and shame and punitive measures that when somebody doesn't feel safe to talk to us about something that could put them in jail or take their child or make them lose their housing, then we shame them for lying," said Grace Keller, program coordinator at the Howard Center's Safe Recovery, Vermont's oldest syringe services program. "So many failures that are on the part of these systems we've placed instead on the person who is struggling."
There's a catchphrase that's popular among people who work in the field of substance use: "We need to meet people where they're at." But what if where people are at is actively using drugs? Most of our systems require, promote or reward abstinence. But if it takes almost a decade and multiple attempts at treatment to achieve one year of sobriety, there's a good chance that using drugs is where people are going to be at. And when I say people, I mean our sisters, sons, aunts and neighbors struggling with this disease.
So the question becomes: How do we keep our sisters and sons and aunts and neighbors safe when they are actively using drugs? How do we keep them connected to their families and their doctors and their communities when they are in the throes of their use and most need support? How do we keep them alive so that, if and when they're ready, they have a chance to recover?
These last two statistics don't include people like my sister, who died not of an overdose but an infection, or the millions who are struggling every day to survive their disease. Because that's what all those trips to rehab were: my sister's attempts to survive.
I hadn't even heard the term "harm reduction" before my sister died, though it's something I practice every time I get into a car: I put on a seat belt. Driving is dangerous, and some forms are more dangerous than others (think riding a motorcycle without a helmet versus driving a station wagon with airbags), but I reduce the potential harm by wearing my seat belt. I may still be involved in a crash, and I may still be hurt in that crash, but the seat belt reduces the chances that I will be harmed.
This same principle of harm reduction applies to opioid-use disorder. Harm reduction neither condones nor condemns illicit drug use, just acknowledges that it occurs and that there are ways of reducing the harm associated with it.
"When you strip away stigma and you look at this problem from a purely scientific and compassionate point of view, what you're left with is harm reduction," said Keller. "It's not a new thing; it's how we treat all other medical conditions. Doctors work with the patient on what they think will work for them and give them a menu of options."
But many of the services available to people with opioid-use disorder are abstinence-based, which Keller described as "all or nothing." She pointed out, "None of us live in an all-or-nothing model. If you're focused on abstinence and only abstinence, then you're missing a large part of the population, if not the majority of people, who use drugs."
As with driving, there are methods of illicit opioid use that are safer than others. Arguably the safest is taking a prescription opioid in the dosage prescribed by a physician; the most dangerous is injecting heroin, which could have been cut with substances that are far more potent. But as with driving, there are ways of mitigating the possibility of harm:
Don't use alone. Carry the overdose-reversing drug naloxone. Test your drugs with a strip that will detect fentanyl (which is 50 times stronger than heroin) and carfentanil (which is 5,000 times more potent) and adjust your use accordingly. Clean your skin before injecting to prevent the bacteria that naturally lives there from entering your bloodstream. Always use sterile syringes and other equipment.
All the supplies and information needed to take these steps are available at Safe Recovery in downtown Burlington, which also hosts legal and vaccination clinics, provides HIV and hepatitis C testing, and a year ago began providing rapid access to buprenorphine. Buprenorphine and another medication, methadone, are the standard of care for treating opioid-use disorder. They are also a form of harm reduction: Both medications reduce the mortality rate from opioid-use disorder by half or more.
But when she developed opioid-use disorder, I never, not once, talked to her about staying safe while she was using. The fact that my sister injected drugs was not a secret. I'd found syringes hidden in my house while she was staying with me; I'd seen the track marks and abscesses on her arms and feet and neck; I was with her at the hospital when she was diagnosed with hepatitis C.
But I didn't encourage her to visit Safe Recovery, which is located in the city where we grew up and she spent a great deal of her adult life, because I didn't know about Safe Recovery. Even if I had, I wonder now whether I would have thought then that encouraging her to go there was tacitly encouraging her addiction.
Which is the opposite of the truth. According to the Centers for Disease Control and Prevention, people who visit programs like Safe Recovery are five times more likely to enter treatment and three times more likely to stop using drugs than people who don't.
These programs are also associated with a 50 percent reduction in HIV and hepatitis C, and they reduce deaths by teaching people how to prevent and respond to overdoses when they occur. Since 2013, Safe Recovery has distributed more than 25,000 doses of naloxone.
There are similar data about safe consumption sites, places where people can inject their own drugs under medical supervision: They reduce drug use, incidence of HIV and hepatitis C, and overdose death, while increasing public safety, entry into treatment, and access to other medical and social services.
I had also never heard of safe consumption sites when my sister was alive, but the idea would have made me uncomfortable, because the idea of my sister injecting drugs made me uncomfortable. But my discomfort didn't stop it from happening.
"If people are going to do it anyway," said Patricia Fisher, a physician and chief medical officer at Central Vermont Medical Center, "you might as well teach them how to do it so that they're not creating bloodstream infections." Fisher was a member of a 2017 commission convened by Chittenden County State's Attorney Sarah George to study the potential impact of a safe consumption site in Vermont. Like me, Fisher was at first uncomfortable with the idea.
"I initially thought there's no way I could support ... a place where people come and use drugs," said Fisher. But after researching and reading the literature, "I was a convert," she said. "There is good data to support that this is really a good harm-reduction method." 152ee80cbc
offline farm games mod apk download