Can We Do Anything to Stop the Opiod Epidemic?

Like most people, I would like to end the epidemic of heroin and drug over doses.


But there is an underlying assumption on the part of many well meaning people and politicians that if we only did more, spent more money, devoted more resources, employed more people, we could clean up this problem, as if it were like treating tuberculosis, smallpox or measles.

Clearly, drug abuse and drug deaths ought to be considered a public health problem, not a criminal problem.
Countries from the Netherlands to Portugal have in their own different ways decriminalized drug abuse and by many measures those countries have seen huge social and medical benefits.
In Portugal the rate of needle acquired HIV fell by 95% after drugs were legalized.  Similar declines in rates of Hepatitis C and Hepatitis B and subacute bacterial endocarditis will likely soon be documented.
All these illnesses place a burden on any national healthcare system--more in countries with national health care than in the United States, where we hope those afflicted drug addicts will simply die outside the hospital, but when they get sick enough, they almost always find their ways to the emergencies rooms, the wards and the intensive care units so the idea we can simply let them die and not have to pay for them is another tough guy fantasy.


The problem is, there is reason to believe little of what we do in rehabilitation programs actually succeeds in getting people off drugs and keeping them off drugs. The most thorough exploration of this issue I've ever seen is in the TV series, "The Wire," where the psychology, the culture and the intractability of drug use is explored thoroughly and at length.


With the use of naloxone to save people who have stopped breathing (respiratory arrest) the phenomenon of these patients waking up in the clinic and leaving, often with the IV still in the arm, in search of their next fix, is well known.

The rate of infections with and deaths from tuberculosis in England declined long before effective antibiotics were introduced.  The reasons for this are not really known, but the usual explanation was indoor heating and plumbing, better diet and overall better hygiene and nutrition may have made people simply more robust, healthier and less likely to be crowded together to transmit this communicable disease.


If we ever see a decline in IV drug use and deaths it may occur because we now have meaningful work, well paying jobs and a better life to offer those who wish to escape the lives they have in the tip of a needle.

Before: On Being and Nothingness

Have you ever awakened from deep general anesthesia?
I've had that experience three times and each time it was a profound experience.
I awoke with all my memories intact, quickly got my bearings and got oriented to being in the hospital, but for days after, it bothered me: Where had I been?
Before I emerged from that darkness, where was I?

There was no sensation, no sound, sight, sensation. It was very unlike sleeping or dreaming. It was just--nothingness.

Nothingness is a very big idea.

It was, presumably the same non experience or non place I came from before I was born. 
Nowhere.
The thought I might return to that after my death is not particularly frightening--it was not unpleasant, although it does put a certain pressure on life.
Life is much more fun and interesting than nothingness. At least here in America. If I lived in parts of Africa or India, I might prefer nothingness to that.

Is this  not a question which we should ponder?  Where were we BEFORE?
That is, before we were born.

I can deal with the idea of "after" much more easily. Religions almost all have some dogma about where we, as individuals  are heading, but few, as far as I know, spend much time on where we were before we were born.

Cultures have creation myths, but there isn't much about where you and I, as individuals came from before we came to consciousness here. And in normal life, we come to consciousness only gradually, imperceptibly. It's not like awakening from anesthesia having been nowhere and then--poof--you are fully conscious with memories and language and you can still read and write and you do not have to relearn everything.

Consciousness is a strange and essential thing--and unconsciousness even stranger.

There was a movie once, I think called "Flatliners" where medical students or someone use cardiac paddles to induce "death" a cardiac arrhythmia and then they resuscitate each other with the same paddles, just for the experience of "death," and resurrection.

But, of course, by definition, it was not death, because death is irreversible. That's the thing about death. It is no return city. But anesthesia, that is nowhere.

I suppose brain activity persists during general anesthesia and certainly heart and vital organs continue to function, but the "self" the "mind" that is gone, gone, gone.

Once  you awake you are left with only that blank space. You cannot look back over your shoulder like Orpheus. That void is behind you and gone. For a while at least.



What came before is an ultimately interesting question. As in: What came before the big bang? Must have been something , if it banged. You can't just have a bang from nothing. Had to be something.
And how can there be anything without a beginning?
A circle, of course, has no beginning and no end. But nothing in our existence, except for that construct of the circle, has no beginning.
How do you imagine no beginning, just "always was?"

This is the mind bending stuff of Stephen Hawking and Dark matter.  I never make it through those books about the "beginning" of time.

Anybody out there have any ideas?

All you blokes in Ukraine and France who apparently click on this blog regularly and say nothing: Now's your chance to offer some enlightenment, rather than just observing like some far off gods.

Alice and Martin Provensen

New Found Lake

Early Spring up here in New Hampshire is stick picking up time. Everywhere around town you see home owners walking around their yards picking up the branches which have snapped off the trees and scattered about the yards in the late winter storms. Some simply carry the twigs in their arms, others use wagons and others use tarps to collect the branches, but everyone, one way or another, does it. You cannot mow your lawn, when your lawn finally greens up enough to be mowed,  until you pick up all the twigs and branches.

I cannot recall a similar phenomenon in Maryland. 
Late March and April in Maryland,  it simply started pouring like a rain forest and then your lawn rose up and you got out the mower.  I lived in a forest, in Maryland, but I cannot remember clearing the yard of hundreds of branches and twigs, not  once in over two decades. 

One impediment to mowing we did have in Maryland we do not have in New Hampshire was deer poop.  Deer over ran our yards, in Maryland, ate our flower beds, our shrubs, stomped on our plantings. And deer are big. It's not like you can just shoo them away. Up here in New Hampshire we have wild turkeys who traipse across our yards, but they are much more polite, don't poop much and all you have to do is go out and stare at them, and they melt back into the woods.

I don't know where all the deer are in New Hampshire. It may have something to do with the gun laws up here. In New Hampshire it is legal to aim your gun at a deer across a road and shoot him. There are only 9 roads in New Hampshire it's illegal to shoot across, among them Interstates 95 and 93, which are eight lane divided highways. Otherwise, it's open season. That may have something to do with the attitude of deer up here. They must think: These people up here are truly crazy. No way I'm walking across their lawns.

 In New Hampshire, you can shoot your shot gun within 100 feet of a domicile. That's "domicile" --as in somebody's house. The deer are not crazy. They  avoid people in New Hampshire. 

After an hour of picking up sticks, this morning, I decided there must be a better way to spend an early Spring day in New Hampshire and I persuaded everyone in the house to join an expedition to New Found Lake. 

Pink Lake, Obadiah Youngblood

Many neighbors have said good things about New Found Lake. The water is still very clear, because there are few motor boats.  Lake Winnipesaukee used to be so clear you could see down thirty feet. That was 1957. I can remember that. When we first vacationed on Lake Winnipesaukee, there were no motor boats allowed--except for the cruise ship Mount Washington, which we could see from our cabin on the lake shore. But now Lake Winnipesaukee is hustling and bustling with jet skis and speed boats and there is an oily sheen on the surface. 

Within a few miles of Winnipesaukee are three lakes which are more serene, and New Found Lake is one of them.

I liked the name. New Found Lake. Where was it before they found it? Was it just wandering around New Hampshire?  

The lake  was still partially frozen this afternoon, and along the road which encircles it, dirty snow banks haven't yet melted.  It is clearly before season.  We stopped at a General Store in Hebron, which as far as I could see consists of a General Store, which shares a building with the post office, a church and one traffic signal, which must be for the summer traffic because there was not enough traffic today to justify a stop sign, much less a traffic signal.

Tugboat, Obadiah Youngblood

My neighbors were right. New Found Lake is unspoiled and much as what I remember Lake Winnipesaukee was like 60 years ago. The woman in the General Store who made our sandwiches looked just like the woman I remember from 1957, in the store near our cabin on Lake Winnipesaukee, plaid shirt, hair in a braided pigtail, chatting about the new bacon she'd just got in. It was like a scene out of the "Twilight Zone," except she wasn't spooky. 

So that's the report from Lake New Found, where all the women are strong, all the men are beautiful and all the children are above average.

Pas De Deux

Stop me if I've told you this story before.
As you get older, you have a repertoire of stories you like and you tell them over and over and refine them, but you forget who you've told them to.

This one is about my library frenemeny from college.

I studied in the stacks of the library in college. It was a very conducive place to study--you had a floor to ceiling window and along each of the four walls a different and lovely view of the campus, the streets, or along the South wall, a view of Providence, Rhode Island from College Hill, which was pretty spectacular.
From the floor vent, air  rushed out sighing with a white noise sound and on the facing wall, shelves for your books, a wood slab surface for a desk and on the non window side the stacks, containing books, often very exotic books, so if you got tired of organic chemistry you could read about the history of the California gold rush, or maybe Vienna at the time of Freud and Klimt,  or the life of Emily Dickinson, depending on which stack you happened to be sitting near.

Every day, I arrived at the library when it opened at 7:45 AM and set out my books and my models of molecules or whatever I needed and pasted my 3x 5 card with my daily schedule penciled in,  on the wall in front of me.  If I had an 8 o'clock class, I staked my claim and I was gone. 
As things progressed, I found my favorite study carrel on the third floor, convenient to the stairwell, the bathroom and with good light in the morning and no blinding light in the late afternoon.  The carrel was assigned to a graduate student who never used it, so it was, unofficially, mine.

Somewhere around October of my sophomore year, I noticed there was a guy who had apparently also staked a claim to a carrel, about twenty yards down the hall. He also arrived when the library opened, and he set out his stuff on his carrel much the way I did, but, mysteriously, I never saw him arriving. Just his stuff. He either got there just before or just after me and while I was in the bathroom, or busy setting up my stuff, he simply materialized.

During the day, we both had classes, so we were not always in place, but after dinner, we were both took our places in the trenches. 
The library closed at 11 PM, but I always left at 10 PM, wanting to be in bed by 10:30 PM, so I could be up at 6 the next morning.  It took me two months to notice, but I realized he was always there when I left at 10PM.

Except for two weeks in January--"reading period" before final exams--there wasn't any real competition for the carrels in the stacks. During those two weeks, a big crowd formed in front of the glass doors to the library and when they opened, a mad rush to the stairwells to the carrels, like those scenes of homesteaders claiming their stakes. But the rest of the year, there were only a scattering of other people in the stacks, maybe a dozen regulars on our floor.

After  I settled in after 5 PM, I made two trips to the bathroom, one at 7 PM and one at 9PM and one night, I realized I had forgotten my watch on my desk and returned to get it and noticed my carrel mate was gone from his station.

For some reason, I decided to sit down and wait and sure enough, about 5 minutes later, he returned. My bathroom breaks were 10 minutes. I had them scheduled on my 3x5 card.  He had left and returned in 5 minutes.

It occurred to me it was possible, he was timing his breaks to mine, but he was determined to be in his chair when I returned, so it appeared he never left.

I tested this out by shortening my next break to 3 minutes, returning at 7:03, and sure enough, when he returned 5 minutes later, he glanced down toward me and an unmistakable frown crossed his brow. I had not taken my full 10 minutes and was back in place early. He had expected me to be gone until 7:10 and he had expected  to be back in place by 7:05 so I would never know he had left his chair. As I thought about it, once he arrived after 5 PM, it appeared he never budged from that chair, even for bathroom breaks. Now I saw how he did that.

I started reducing my breaks bit by bit, from 10 to 7 to 5 and ultimately down to 2.5 minutes. And each time I reduced my time, he reduced his, so he was always back before me.

One night, I decided to raise the stakes.  Instead of packing up at 10 PM, I stayed put, reading genetics until 10:30.  I noticed him checking me out of the corners of his eyes, but I would not budge. Finally, at 10:30, I scooped up all my books and hauled out.

But I just stayed in the stairwell for three minutes and then went back to my carrel. It was 10:33. He was gone.

Over ensuing months, I did a few reconnaissance missions when he had gone off to class during the day. I checked out his books. He was clearly in engineering, and  judging from the courses, he was a freshman, in the class a year behind me. I never touched his books, although I was tempted to lift a cover, to see his name on the inside cover; I never did. I never knew his name.

All I knew about him was he was studying engineering, and he was Asian. For some reason, I decided Japanese.

Our silent relationship, our mutual stalking, our mental macho struggle continued until my senior year, until I got my first acceptance letter to medical school at the end of first semester.  
Second semester, I spent far less time in the library. Sometimes, I would study on a different floor altogether. Sometimes I would study in my usual spot and take long breaks, sometimes an hour. It was Spring in Providence, and I'd walk outside and meet my girlfriend (acquired after my acceptance letter)  for a break. When I got back, he was still there, but  I could see, at a glance, for him the thrill was gone.

I was no longer in the game.

That next Fall, I studied in my medical school dorm room, in New York City, alone. Sometimes, I'd think about that guy, probably still studying in his carrel, looking down the hallway and not seeing me. Had he found someone new to defeat, to scurry back to his carrel for?
Did he wonder how I had dealt with defeat?  Did he think I had committed Hari Kiri?

For all I know, he's still there.

Proof There Is A God

At the risk of venturing into metaphysics, I would like to call attention to sloths.
Once a week, my assistant and I watch the scene from "Zootopia" on youtube, set in the Department of Motor vehicles, where all the workers are sloths.

We do this to assess whether we are still alive; we know that when we stop laughing at this scene we are not alive. Anyone who watches this scene, if he is alive, will laugh. If he does not laugh, there is considerable doubt.

But back to God.

My older son, was appropriately horrified, watching the David Attenborough Planet Earth episode about spider wasps who plant a little spider wasp larva inside a spider and as the wasp grows, it eats the spider literally from inside out, leaving only a pathetic husk of what was once a perfectly healthy, happy, vigorous spider behind, flying off to find another spider to impregnate with a new larval spider wasp. Having sat through this whole sequence with his brother and me and a few friends, we were all struck silent, apart from a few agonized groans and "Oh, my God" expostulations.

"This proves there is no God," my son said.

We all looked at him and chewed on that and went back to David Attenborough.

Later my younger son said, "It proves there is no benevolent, kindly God who watches out for all innocent, good things, like spiders. But it does not prove there is no God."


Watching the video I found on line next to Zootopia, I learned about sloths. Sloths poop only once a week. And when they do, they climb down from their trees and poop on the ground at the base of a tree. Then they slowly climb back up.  The tree has thus been fertilized.  Sloths swim in streams and they move much more sprightly in the water, although they are still very slow.  They eat only leaves. They are home to a particular kind of moth which likes to live in their fur. Moss also grows on their fur.

They have very winning smiles.

You cannot look at a sloth and not believe there is a God.
Ditto for sea otters.

Unless, you are my older son, who says the fact these animals are so adorable and get eaten is more proof there is no God.


I think he misses the point.

Immortality for the Rich; The Room Where It Happens

And all your money can't another minute buy.
--"Dust in the Wind" Kansas 

In many cultures there is the story of the man who wishes for eternal life rather than eternal youth, Merlin, some Greek guy, they get an eternity of suffering as they age.

Aging certainly looks like a disease, as elasticity, strength, vigor, all the senses decay. The wisdom of age is hardly a compensation. Most of us really get no wiser, still crazy after all these years.

Ross Douthat, in today's NY Times column about how President Trump needs some one with a functioning brain to advise him, threw in an allusion to the New Yorker article about the ultra rich, often on the West Coast,  who are enjoying life so much, they are beginning to dread the inevitable end to their joy ride, and want to believe scientists can rescue them from the ultimate fate, the great leveler, which brings us all to the same place--well, unless you believe in Heaven and Hell.

Personally, I'm more inclined to believe in recycling souls. Everything in our universe seems to be cyclical--so dying Bill Gates rich and waking up, born in some impoverished village in Bangladesh or Africa would make sense to me.  Or Adolph Hitler born to a despised Jewish family or Strom Thurmond being born to a life as a 400 pound Black woman. I don't know why. All that just sounds right to me.

On the same page as Douthat's article was another about Trump voters in Oklahoma who had benefited from federal government programs he is now trying to destroy. They, of course, are still fans. 

Listening to them, I tried to assume a Christian attitude: "They know not what they do." But I failed. All I could think was: Good, rot in your own terrestrial version of Hell until such time as you are willing to say, "Lord, what was I thinking? Get this guy out of office!" 
Or words to that effect.
But they never will. 
You will have to, figuratively speaking, pry that idea, like their guns, from their cold, dead fingers before they will ever admit to themselves or anyone else they might have been fools.

This morning, I watched "Master and Commander" with Russell Crowe. This is such a masterpiece on so many levels, but one of the many issues which it explores is the nature of a society in which the mass of men are ignorant but not entirely unintelligent.  
"What they need, what they want, is a leader who will be strong," Captain Jack Aubrey tells his friend, the ship's surgeon.  He's referring to his crew, a collection of swabs and superstitious, ignorant but brave men.
"That's been the excuse for every tyrant from Caesar to Napoleon," replies the doctor.

Captain Aubrey is a man of his age. Handed a model of a double hulled wooden warship, he turns it about in his hands, admiringly, and says, delightedly, "Behold the new! What an age we live in! The modern age."

And, of course, the modern audience, watching him, is thinking, "You ain't seen nothing yet."  He could not possibly conceive of a metal warship, propelled not by wind but by coal, or oil or nuclear energy, to say nothing of ships which sail under the surface.

Watching him teach his ensigns to use a sextant before the advent of radar, not to mention global positioning satellites, is sheer joy. He is so consumed with repairing his wooden ship after a near disastrous engagement with the double hulled dreadnought, he cannot take time to dream of revolutionary changes, imaginings beyond a second wooden hull. He would not believe that,  just decades later, his country will be building a fleet of steel ships. 
There were only 69 years between Custer's last stand and the dropping of the atomic bomb on Hiroshima.  Custer, killed by a stone age weapon could hardly have  imagined the bomb which destroyed an entire city, nor the airplane, flown in the air from miles away.

The dreamers of the eternal youth efforts and the immortality projects will spend their money and tell us they are not fools to dream big, because if you don't dream of an airplane or a global positioning satellite, you cannot build it. 

But, what happens if your Captain is not simply preoccupied with rebuilding his wooden boat, but incapable of listening to advice from those in the room who might help him, and save his current wooden boat?

Throughout "Master and Commander" the Captain receives and rejects advice from his friends and subordinates. He makes bad choices but his general strategy is aggressiveness, intelligent, masterful aggressiveness, and that guides him to success.

Douthat suggests Bannon and Preibus will not be enough to save Trump. Douthat lists some of the dozens of conservative think tanks which might provide people who can help Trump think through the implications of policy decisions, but you know none of these people will be in the room.

The room where it happens, as they say in "Hamilton."

For those Silicon Valley billionaires the rooms they are in are where the discussions of immortalization of cells are happening. They hope what is said in those rooms will affect everyone outside the rooms. 

That's a thought. Trump sitting in a room making decisions which affect everyone--EVERYONE--outside that room.

Fortunately, outside of launching a nuclear strike, there are precious few decisions like that  he can make. Unless of course, he starts to believe in science.