Medication assisted treatment for opiate addiction saves lives and more

Related to another project I am working on, I was researching medication assisted treatment for opiate addiction today and came across some interesting points. Most importantly, I think, medication assisted treatment (MAT) for opiate addiction has been demonstrated to save lives, save money and positively impact society. The efficacy and effects of MAT beyond the individual patient have been studied extensively for 30 years.

This treatment is effective for opiates like heroin as well as prescription opiates like oxycontin and hydrocodone. The major problem seems to be that there is a limited supply of quality programs and so it has not reached its full potential.

All of the society benefits of MAT seem obvious when you look at them and there are studies to back up the observations (a nod to the American Association for the Treatment of Opioid Dependence). Participation in MAT is associated with a decrease in use of all illict drugs by that individual. MAT results in a dramatic decrease in crime committed by the individual in treatment. Fewer of the individuals in treatment become infected with HIV (yes, it is still out there, although we seldom hear about it anymore). The lives of the individuals in treatment improve, to their own benefit and to the benefit of society. Their family and other social relationships improve. In addition, their rate of successful employment increases. In addition to positive effects on the social fabric, all of these things demonstrate a great return on investment in MAT, if you want to boil it down to economics.

Most importantly, individual lives are saved by MAT and their quality of life (and the quality of society) improves. I have had some questions after our investigation aided the DEA and IL Dept. of Professional Regulation in stopping the practice of a few physicians, where could folks hooked by those practices get treatment. I, sadly, had to say I don’t know. The number of programs are limited (a local one has a 1 year waiting list), even into Chicago.

ID by Pacemaker

I went to speak at a local high school this morning. I was told that it would be a couple of 10 minute presentations with 30 minutes in between and only a small number of teens would attend. Well, it was a bit different. First, each discussion was about 40 minutes long. Second, about 80 kids filed into the room I was to speak in, it was a computer resource room and really not made for presentations like this. Apparently some of the science teachers heard I was going to speak and brought their classes. There were about 20 in the second group, a better fit for the room. An energetic bunch and while they had some distractions amongst themselves, they really got into my talk and it was a lot of fun as usual. I was able to discuss what we do as Coroner and I also got a few death prevention plugs in.

One of the things I discussed was a current case we are working on. Without discussing who, I told them about some skelatalized remains that were found last evening. They were found in a field not all that far from the office. One of the interesting facts about the case, and the part that I discussed with the students, was that we identified him by means of his pacemaker. We were able to get a serial number of the pacemaker and checking with the manufacturer we got his name. Several other things about the remains were consistent and so we were able to contact his family based on that information.

So many details contribute to death investigations to get straight and to keep straight; it can be quite the challenge (in a good way). That’s why we are called medicolegal death “investigators”. (His autopsy is going on now, but likely his was a natural death, without “foul-play”.)

Lack of Sleep Peaks Emotions

I certainly have noticed it in my kids and others, lack of sleep stirs the emotions. It is indeed as Matthew Walker is quoted as saying:

"It's almost as though, without sleep, the brain had reverted back to more primitive patterns of activity, in that it was unable to put emotional experiences into context and produce controlled, appropriate responses,"

They become bears.

When you consider that this would be added to the effects of lack of sleep I talked about a few days ago, it becomes a potentially deadly combination. Add anger and poor impulse control to the drunk-like effects and it is easy to imagine that lack of sleep can have a pervasive effect, probably a bigger effect than is usually really thought about.

Take driving while drowsy and throw in a little rage and consider the consequences. It isn’t much of a stretch to conjecture that impaired impulse control mixed with the poor judgment from drowsiness could contribute to violent action and escalation, as well.

Get good nights sleep and/or take a nap. It is good for you and good for the rest of us and your interactions with us.

Personal Livestock

I ran across an interesting posting about dust mites today (I am going home and clean and vacuum tonight). Did you know that there are 42,000 of them in every ounce of dust and that in addition to dead skin cells they feed upon “hair, pollen grains, fungal spores and bacteria, as well as cigarette ash and tobacco, clothing fibers, fingernail clippings and filings, food crumbs, glue, insect parts, paint chips, salt and sugar crystals and even graphite”. Just like when someone used to come into the ER complaining about scabies, just the thought of it makes you itch.

Even more itch inducing was a quote later in the post:

What was amazing was what happened to the Archbishop’s corpse, as described in Hans Zinsser’s 1935 epic book, "Rats, Lice and History", beginning with Zinsser’s description of the dead Archbishop’s robes of office. When he was murdered Becket was wearing, "...a large brown mantle; under it, a white surplice; below that, a lamb’s wool coat; then another woolen coat; and a third woolen coat below this; under this, there was the black, ...robe of the Benedictine Order; under this, a shirt; and next to the body, a curious hair-cloth, covered with linen." As Becket’s corpse grew cold the successive layers of robes also cooled, and all the little creatures that had been living within the folds and pleats started looking for a new home. Wave after wave of various fleas, ticks, spiders, pincher bugs, and other creatures flowed out from the corpse, "...like water in a simmering cauldron" producing in the hushed mourners gathered in the dim cathedral, "...alternate weeping and laughter...’".

Bugs you got to love them, particularly the personal livestock variety. We do run into this sort of livestock from time to time, never quite this graphically.

Thoughts on Teen Suicide Prevention Program

I was putting together some materials for our Lake County Suicide Prevention Task Force meeting tomorrow and thinking about 2 articles I read yesterday, they do relate (at least somewhat).

I had posted the goals of the Task Force back in March, 2006 on my blog so it was easy to cut and paste the goals to redistribute as a “hard copy” for discussion tomorrow. Two of the comments to that post mention the importance of peer-to-peer intervention (one directly and the other infers). That is where the articles come in.

While the articles are about impacting substance abuse, I have no doubt that they similarly would be true of suicide intervention. The first was about a recent study that looked at the utility of peer-led substance abuse programs (or another article on the study) and found them more effective at changing behavior than those led by adults. The second article referenced a study that demonstrated the effectiveness of teaching “competence skills” (refusal skills and decision making skills) in preventing future substance abuse.

Taken together I think this lays out a great framework for suicide prevention program for teens. It would begin first with training a cadre of teens to be educators. The education program would begin being presented to other teens in middle school and repeated throughout the remainder of school, possibly into college. It would be a peer-to-peer experience (with adult supervision and input) focusing on competence skills as they apply to suicide and life skills in general. Also the program should work to reduce the stigma of seeking or recommending that someone get help, as well as teaching how to recognize someone in trouble and how to “intervene” effectively. A last significant part would focus on where (and how) to send someone for help and/or where to get it yourself. After a conversation I had today, those already in treatment and/or with significant symptotology would only participate in the program with supervision of their (mental) healthcare provider.

Such a program would be easier said than done.

Drowsy Driving Kills

To steal a phrase from David Letterman; “I wouldn’t give my troubles to a monkey on a rock.” Busy craziness, anyway…

I recently joined a listserv pertaining to child death review. I have gotten interesting information on several topics and so it seems like it will be a good source of stuff (unlike some others I have joined and quit). The other day I got a notice about an upcoming “Drowsy Driving Prevention Week”, November 5-11.

According to studies, being awake for 17 hours impairs your judgment, coordination, and reaction time comparable to a blood alcohol of 0.05. Having seen some crashes and death related to driving drowsy, I can easily believe that that is the case. The National Highway Safety Administration reports that there are 1550 deaths and 71,000 injuries in crashes related to driving drowsy each year.

Drowsiness-related crashes are most common in teens and young adults who have the propensity to sleep too little and drive at night. So it is particularly important to get this information to them, let your teens know. Also keep it mind for yourself. You are only human. You can only push yourself so far.

Driving drowsy kills just as surely as does driving drunk.

Johnny Doe vidi-mentary

I got this link emailed to me today and thought I'd share it. It is a "vidi-mentary" on You-Tube about an unidentified toddler found dead in DuPage County. It is a nicely done piece.

It is worth watching, although the subject matter can certainly pull at the heart.

"Johnny Doe- Little Boy Blue"

TV, Salmonella, Violent Death, oh my

Posting has been a bit light lately, but it has to compete with everything else that is going on.

Last Friday I was whisked off by a limo to Chicago to do the Nancy Grace Show (about a recent homicide here in the county). There were 2 of us in a small studio in Chicago and it seemed like 10 others in various other places feeding into the story. It is somewhat strange doing these things. You sit in a room that is black walled and ceilinged (actually everything in the room is black except the stools and the wall behind us) and stare at a camera (the camera was robotic and moved at someone’s direction). You have to stare at the camera because you never know ahead of time when they might cut to you or catch you making some sort of face you don’t want on camera. I could listen to all of the conversation and interview, but couldn’t see what anyone looked like or their facial expressions. It is a bit strange talking with someone without that normal feedback. Our segment was about 20 minutes long, I got to answer 3 or 4 questions. I think it went pretty well.

Saturday was a good day, primarily because of what I didn’t do. I went shopping with my 9 year old and we picked up some food for lunch. I had actually picked up chicken pot pies to heat up, but put them back for other selections. Good thing or I might have had a serving of Salmonella I learned on the 10 o’clock news last night.

Monday, Columbus Day (although I have to agree with several folks’ comments that I don’t know why we still celebrate Columbus Day since we know he didn’t discover America and may have been a fairly unsavory character) I sent off a book proposal to an agent who agreed to look at it and consider representing me in that endeavor. We will see what develops.

Yesterday, I went to a meeting in Chicago, the Illinois Violent Death Reporting System Advisory Committee. I got fairly creative about my route down so the trip only took 2 hours each way. They are getting some interesting data from the first 3 counties participating (I will highlight some soon) and I look forward to our being able to join in the project after our county IT department gets the software loading and working here. If you want to see at least part of the data before I put more in the blog you can check out this link.

Next Generation of Blogging

I’ve been invited to serve on a small (3) panel of presenters/discussion leaders at a conference put on by the Metropolitan Chicago Healthcare Council. The panel discussion is entitled “News Media: The Next Generation of Blogging” (got the flyer today). I am honored and look forward to participating.

Apparently they see my blog as “next generation” in that its primary purpose is informational and authoritative (i.e. factual). I do think there are several things that blogs can be used for that may be “next generation”. I do support the expanded use of blogs to give out information and allow feedback (filtered to weed out the spam that comes in and the “naughty” words), opening discussion, expanding knowledge, relationally.

The conference is in a few weeks, I’ll let you know how it goes.

Sorry this is a bit short and only a few posts this week. It has been a busy week for a number of reasons and I am off soon to do the Nancy Grace Show.

Coroner Death Investigation

Why does your office do its own investigation of an individual’s death?

There are a number of reasons. First, since we are the agency that must make a decision as to the cause and manner of death, it just seems to make sense. We certainly work in tandem with and parallel to other law enforcement agencies. We use the information they gather and they use the information we gather. It is a synergy that just plain works. But our medicolegal investigations may take a bit of a different tack or have a slightly different focus so we can arrive at the conclusions that we must to make our ultimate decisions.

In addition, if an autopsy is done the forensic pathologist needs answers to a number of questions as she proceeds through the autopsy. If we have done our own investigation we get answers to those questions and have them available as we assist with the autopsy. Such things as exactly how was the decedent lying when found, whether they were lying against something that might have left a certain mark, all can make a difference to know as the post-mortem progresses.

Another reason is that often two sets of eyes are better than one. We may pick up a detail that another investigator glossed over inadvertently. Or we might think to document something that the other investigators don’t. Recently, for example, among the agencies investigating a death, ours was the only one that took photos of the crash scene in daylight and those photos became an important element in subsequent legal proceedings.

My deputies are all trained in death investigation, evidence tech work, and all the skills needed to do a “class” investigation. The number of cases we investigate is certainly sufficient to keep up their proficiency as well. We are proud to use our skills and talents to do the job necessary to arrive at the cause and manner of death in our cases. And as I said we use the investigations of others as part of our “tool set” in these investigations. Death investigation is a cooperative effort, with each of us doing our part. As is often the case, here too the whole is often more than just the sum of the parts.