Category: blacklivesmatter

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blacklivesmatter

Police Violence & the Opiate Crisis: Public Health Emergencies

In San Francisco today, the district attorney announced charges finally on a 2017 police shooting of an unarmed black man in 2017. This coming mere DAYS before the statute of limitations would run out, according to this article on SFist. Racial justice continues to remain foremost in the minds of lawmakers and politicians and thank god–this country cannot keep going killing people. Police violence is a public health problem. I’ve said it before and I’ll keep saying it. But even more so, that leads us to a more basic point: RACISM IS A PUBLIC HEALTH PROBLEM. When black and brown people DIE merely because they are not white, this is not a coincidence. This is racism, and quite frankly, it is a national emergency.

Also in the news today, another public health problem created by white people: the opiate crisis. Purdue Pharma has finally pleaded guilty to several charges related to its role in starting–and maintaining–the opiate crisis in America. Bottom line, the company admitted to 3 basic things:

  1. The first relates to LIES told to the Drug Enforcement Agency (DEA). Purdue lied about having a program in place to prevent pills from getting to the black market. In fact, they really profited from oxycontin’s widespread sale by people buying it on the street. The company also lied to the DEA regarding false information provided to the agency that helped boost manufacturing
  2. The company paid someone to provide doctors with patient info (Hello! HIPPA?!?!) that encouraged them to write opiate prescriptions.
  3. Lastly, Purdue Pharma paid doctors to prescribe oxy. Boom.

Of course, there was a fancy explanation for “how” and why all these things were accomplished but the bottom line is Purdue wanted to make money. It did. The Sackler family is still filthy rich, in fact, from drug money earned by the deaths of over 200,000 Americans. The cost to the healthcare system might never be able to be estimated, as the full ramifications have not yet been felt. The East Coast still suffers from a heroin problem but has been hit hard by synthetic fentanyl in the past few years. Here on the West Coast, we’ve typically been more of a methamphetamine place, but synthetic fentanyl deaths are rising now too.

The last full book I read on the subject was Dopesick by Beth Macy. It is an incredibly detailed look at how the crisis began, details of the ways in Purdue Pharma changed not only the marketing of pain medicine but the very way we practice medicine itself. I highly recommend this book if you’d like to know more about this subject.

One of the most disturbing parts of Dopesick was reading about how during Purdue Pharma’s massive “educational” marketing seminars, it promoted PAIN IS THE FIFTH VITAL SIGN as a new concept. This really reinforced the idea that new & stronger pain medications were necessary for the average patient–medications like oxycontin. Surprise! But this mantra regarding pain became adopted by accreditation organizations such as the Joint Commission and the American Medical Association (AMA) itself. In nursing school, it was drilled into my head. Treat the pain, because your patient can’t HEAL if they are in pain.

But all of this helped contribute to our opiate problem as all doctors, including those taking care of hospital patients, felt the need to write more and more prescriptions for painkillers. Patients themselves also tended to not be satisfied that their pain was relieved no matter how much narcotic they received. I mean, we were telling them that they should have NO PAIN.

In 2016, the AMA went so far as declaring that pain is NOT the fifth vital sign, and that new non-pharmacologic measures and cooperative pain management techniques should be taken to manage patients.

As a nurse in the ICU, I have seen an attempt to reduce the use of opiate pain medication. Some of this seems silly given the circumstances–such as a patient on extracorporeal membranous oxygenation (ECMO) only getting IV acetaminophen. I mean–they do have garden hoses jabbing into each groin, plus more usually… But for surgical patients, I am fully on board. You are supposed to be able to feel your incision the day after surgery. And when you cough, it is definitely gonna hurt. While you’re coughing. And then it will stop. Magic!

My personal opinion is that the best treatment for pain and prevention of other post-operative complications is walking. Don’t take a bunch of opiates, get constipated, end up with an ileus and too weak to stand. Get out of bed, sit in a chair, take a walk. Do that over and over throughout the day. Rest in between. You’ll get better faster than your neighbor who takes oxy and complains that it hurts and refuses to get out of bed.

If you have recommendations for other articles or books on the opiate crisis, please leave a comment as I’d love to read more on this topic! Or any topic…

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blacklivesmatter

When police violence hits home

Within 20 miles of where I live, Vallejo, California suffers under the most violent police force in the state. According to this fantastic long form analysis by Shane Bauer in The New Yorker, “[s]ince 2010, members of the Vallejo Police Department have killed nineteen people—a higher rate than that of any of America’s hundred largest police forces except St. Louis’s.” In those 10 years, the city has paid almost $16 million in legal settlements, had their insurance raised significantly, and are currently still facing 24 use-of-force legal cases expected to cost upwards of $50 million dollars.

“It can’t be awful if it’s lawful.”

Joseph Iacono, Vallejo Police Lead Force Options Instructor

This is a small city where many black and brown families have moved, often being squeezed out of the historically minority-centered but now rapidly-gentrifying Oakland and Richmond. The police force is staffed mainly by white men who don’t live in Vallejo but get paid top wages, often leaving forces in places like Oakland to find a job where their violence is acceptable.

And you know my refrain… Who suffers when the white man is in power? Always the black & the brown & the women. Also the mentally ill, the senior citizens, the homeless, and any other disenfranchised and powerless groups. Vallejo has gone bankrupt trying to pay the police officer’s increasing wages and benefits, often eliminating funding for roads and senior centers entirely in the process.

This is a city with a public health problem, and that problem is POLICE VIOLENCE. Defunding the police–perhaps even disbanding and restarting from the beginning seems to be the only situation in Vallejo.

All I can ask from you is that you know what’s happening in your area. Are people suffering like this? Can you help? Stand with your fellow citizens!

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blacklivesmatter

We Need Mental Health Professionals Not Police

Again, I see an infuriating example of why defunding the police makes so much sense to me–or at least partially defunding. So many calls to 911 are for people causing a nuisance–in the wrong place (black man at a tennis court?), homeless, mentally ill, intoxicated in some way or just plain poor… And let’s be honest, someone is scared of something when they call 911 but these are people AND they are most likely suffering from a mental health issue, a substance use disorder, a severe medical condition, or ALL THREE. As a result, they may be lunging around “acting crazy” & not following commands. You know what happens when you don’t follow a police officer’s commands, right? Especially if you’re black, brown and/or a man? Well, quite simply, the chances that you’ll get arrested, thrown in jail or end up in the hospital (or worse, the morgue) go up astronomically.

“Law enforcement comes in and exerts a threatening posture,” Kimball says. “For most people, that causes them to be subdued. But if you’re experiencing a mental illness, that only escalates the situation.”

Angela Kimball, policy director of National Alliance on Mental Illness (NAMI) to Brett Sholtis, for NPR (link to article at end)

Police work and are trained mainly from a combat perspective. When you think about it, if they are fighting CRIME, they will most likely have to protect themselves. But here’s the kicker. Police are not always or even usually really fighting crime, per se. They’re fighting HOMELESSNESS, DRUG ABUSE, ALCOHOL ABUSE, POVERTY, DOMESTIC ABUSE. Do you think they need combat techniques to fight these things? Hell no. They need non-violent de-escalation training, communication training, training on substance use disorders, medical triage & first aid, mental health triage, psychology, racism, economics, etc etc etc. So basically, they need psychologists & social workers, homeless resources & outreach, domestic violence outreach & resources, food/shelter/medical treatment/basic human dignity.

We should take money from the police if we have to in order to fund these alternative programs, especially considering that developing these alternative services would lead to less need for police in general–and would also provide for less opportunities for fatal “accidents.”

During A Mental Health Crisis, A Family’s Call To 911 Turns Tragic

You know what I’d rather have than police on the streets? Nurses! Shit, we’d get so much shit done. We’re already really good at hassling “the man” until we get what we need for our patients. We’re organized, clean, know what the resources are already. We probably even get paid less too. I see a plan coming together.

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blacklivesmatter

Really, just now an east coast hospital proves that black people are discriminated against during the kidney transplant process?

I could just about die this very serious news article was so funny to me. I say with all sarcasm intended, if you can’t hear my tone. The general theory of article is there is a lab test that measures kidney failure correctly in white people (surprise) and is inaccurate for black people. It’s been causing black people to be overlooked for kidney transplants for years! So once the scientists did a little recalculating, we have a formula for both sets of people that reflects their kidney failure more accurately!

Wired: “How an Algorithm Blocked Kidney Transplants to Black Patients”

You wouldn’t think this would be so hard to figure out, except medicine has been a white man’s game since its inception. Most research on procedures and drugs, even today, is still done primarily on–you guessed it! Men!!! Of the white variety. But other things struck me funny (?) about the article as well. Let me run down my giggle list:

  1. Wired Magazine a quite prestigious news organization for science and technology (and I must admit, must I?, a former employer of mine) is covering this topic. This topic is not new or groundbreaking or pushing forward the field of medicine in any way. I find this interesting.
  2. I literally had no idea that other hospitals (geographic areas? States etc?) did not use the recalculated eGFR to determine the severity of black people’s kidney failure. We’ve been doing this at my facility for at least 10 years… I remember when it changed, but time flies when you’re wiping ass. Our chemistry reports show both values automatically, actually.
  3. Last but not least, I want to mention that getting selected and then listed for an organ transplant is a crazy process, one mainly shrouded in mystery to the average American. But it is not a joke. There are not nearly enough organs for people that need them. Surgeons that do these procedures are in competition to get the organs for their patients, to perform the surgeries at their hospitals. They often have quotas they have to hit to stay certified as a transplant center (both for the doctors and the nurses), and for some organs like livers and hearts and lungs, the patients may be in the hospital for months waiting… not even at home. Also, as this article notes, the process can be burdened by institutional racism. Sometimes it even looks a lot like real racism– for instance the young black men in our advanced heart failure service do not usually succeed in getting a heart transplant. They certainly qualify and are listed. But we had one (and he is a sort of amalgam if patients that serves as an example), we’ll call him Kevin. Kevin was so tall, like 6’4″ and he was like a brick house, weighed maybe almost 300 when he came in the hospital and last 50-60 pounds in the 3 months he stayed in. We waited and waited but we couldn’t find him a heart. There were (per the doctor) about 3 other guys if his size on the transplant list ahead of him. I used to joke that we would need a bus of NFL players to get into an accident for these guys. Typing that now, I realize that is some really dark stuff, but Kevin and I needed a laugh of any kind in those long days where he couldn’t sleep and was stuck in his 12 by 20 hospital room for weeks on end. In the end, he got an LVAD (left ventricular assist device) because it had enough power to help his heart–and it meant he could finally go home and live some life.

Some day I’ll write more about transplants, even though I worry that I’ll be breaking some secret code to just keep quiet.