Charles Atkins, MD

Not to judge, but why are smart people often so dumb? Last Wednesday I got my first COVID-19 shot. Yay! To schedule an appointment I had to go onto the CDC’s Vaccine Administration Monitoring System (VAMS). Here’s a link to their site so you can verify for yourself that what follows is not Trumpian BS (Please wait until after you’ve read this essay to clink the link. It’s a black hole and you might never return.)

I’m intrigued by things that promote wellness, longevity, and happiness. Many of them are baked in, though we often screw them up because we think we know better. Indeed, common sense tells us, and science supports, that we have a robust capacity to survive adversity — to heal and bounce back.

While the 2019 overdose numbers are not yet finalized (around 69,000 per the Centers for Disease Control), it appears that cumulative overdose deaths since 2010 have surpassed the half-million mark, and if we go back to 1999, when the opioid epidemic first accelerated, it’s over 900,000 preventable deaths. For perspective, that’s slightly less than the state population of Delaware. And as a recent lunch companion, who lost her fiancé to an overdose and years of her life to addiction commented, “It’s the perfect crime.”

I chair death reviews. It’s part of my job as a medical director for a mental health and substance abuse agency. In recent years the bulk of deaths have been from opioid overdoses, now mostly fentanyl. The most-common themes are people who just left rehab, a detox program, or were released from prison. What has become clear is that abstinence-only approaches and programs for opioids don’t work, yet we continue to promote, practice, and pay for models that are ineffective and deadly.

A couple weeks back I did a naloxone (Narcan™) training and distribution. I do a fair number of these and often ask two questions:
“How many of you have used Narcan to reverse an overdose?”
“Have you ever had it used on you?”
Because of my job as medical director for a mental health and substance abuse agency, I often give these trainings in high-drug-use settings and find that a third or more will answer yes to both questions.

I’m in line with my friend Liz to get a flu shot at the CVS pharmacy counter. The man in front of us is told that the prescription cream he needs is not covered by his insurer.

“Can I pay for it myself?”

“It’s very expensive.”

“How much?”

“$750.”

“For a tube of cream?”

“Yes.”

I’m no stranger to suicide. There are days I ask a dozen or more people:

“Do you have thoughts of killing yourself?”  
“Are these more than thoughts?”
“Do you have a plan?”

It’s a “suicide ladder,” a series of questions that lets someone discuss their thoughts, plans, and history of self-annihilation and how close they are to irrevocable action.

I’m not much of a host. But with the opioid epidemic getting worse, I knew we had to start doing overdose-kit distributions. The whys seem obvious. As a medical director for a large mental health and substance abuse non-profit agency —CMHA in New Britain— I see too much death. The toxicology reports from the state’s medical examiner increasingly come back positive for fentanyl, which is now present in over 50 percent of our fatal ODs. At 50 to several-thousand-times-more potent than morphine, fentanyls—yes, there are more than 20— from China have thrown gas onto the fire of America’s opioid epidemic.

When I was 18, I lived in a Chelsea flophouse. There was one bathroom per floor, and I had the deluxe with a tiny sink and two-burner stove for $46 per week. To my right was a guy with advanced alcoholism. He’d scream in the night, “Oh God, not again.” I tacked blankets to the wall to muffle his cries. It helped. On the other side was my best friend, Mark. I’d been crashing with him illegally when a room came free. As the prior occupant vacated, I raced down three flights to face the building’s owner, Mrs. S, whose office was at the front.

As I prep for a two-day psychopharmacology workshop, I confront my troubled relationship with the drug companies. It’s beyond love/hate and as egregious acts of greed are committed, such as price gouging life-saving EpiPens I realize we all play a part in this.