Crawling Out of Health Care Hell

Our current health care mess is more a political debacle than a substantial challenge to the intellect when it comes to solvency.

Morally?

We can do better by providing excellent health care to all Americans while lowering the overall cost, though it may slightly burden the wealthy and middle-class folks in order to reach the prize of truly affordable health care for all.

U.S. Ranks Second to Last in Child Poverty

In the 90’s I taught at a local community college and one of my students – who was abused as a child and neither fully-supported nor fully-educated – struggled her entire life with health issues, racking up hundreds of thousands of tax-payer-swallowed medical bills over the course of her too-short life.

Multiply this situation by millions – many citizens are now hooked on opiates – and one can see how this particular demographic could force a single-payer Medicare expansion into near-future reality.

The benefits of a healthy society are astounding.

The elephant in the room:  personal responsibility.
But we’re a capitalistic society and the dollar reigns supreme.

Furthermore, the concept of personal responsibility never gets addressed.  That fact coupled with the current opioid epidemic begs the question:

Is the practice of medicine really about health?

Source

While I was researching this article, it was obvious that
the “facts” coming from sites linked – in one way or another – to private insurance companies were quite different from those emanating from neutral sources.

The insurance-linked information sites apprised the cost at $32 trillion while the neutral sites announced it would actually lower costs.  The truth often lies at the midpoint, a hefty sum indeed.  But our current direction, and the soon-to-be-announced Obamacare Lite  are simply untenable.

Limiting Congressional health-care benefits to their own
plan for the rest of us
would be a start. But don’t expect a sitting Congressman to write that bill. And now Republicans are replicating the major mistake Obama committed in his first term, which was to push a secret backroom inviable bill into law while briefly holding the majority and babbling they’d better pass it first so “you can see what’s in it” later.

Hello?

Fast forward to today and it turns out that the ACA is actually a step above what the current Trumpcare plan offers the truly needy, a plan that boils down to “the rich get richer”.

Imagine that.

An alternate path – leading away from the debacle of Obamacare/ Trumpcare – is fairly simple and workable: expand Medicare using a single payer plan while dropping Medicaid altogether.

Drew Richardson, a columnist for The News Leader explains the concept: 

“So what is single-payer health care? Essentially it involves expanding the present Medicare system to cover everyone and eliminating private insurance (with the claimed accompanying savings of hundreds of billions of dollars). 

"Additional features would include the absence of means testing, no concern for pre-existing conditions, the restoration of independent doctors and hospitals who negotiate with Medicare and would be chosen freely by consumers and one public agency processing and paying bills.

“Because it would be unneeded with this system in place, the present Medicaid program for the indigent and its associated administrative costs would be eliminated. Proponents suggest that costs could be contained and quality maintained through more efficient review by the single insurer. Costs would be financed through a progressive income tax.”

Sounds good, aye? Well, unless you’re a millionaire and break in to a cold sweat at the clause “costs would be financed through a progressive income tax”.

Like me, you’re probably reading between the lines here.  When “eliminating private insurance” pops out, one’s mind – if the slightest bit of pragmatism is embedded there – questions the odds of cash actually drying up in the UnitedHealth, Kaiser, Humana, Aetna, and Cigna Rivers.

That’s doubtful.  Why?

According to the non-partisan, independent, and non-profit Center for Responsive Politics:

“In the 2012 election cycle, the insurance industry contributed a record $58.7 million to federal parties and candidates as well as outside spending groups. Of the nearly $55 million that went to parties and candidates, 68 percent went to Republicans, who have long been the recipients of most of this category's giving.”

Imagine that.

Admittedly, private insurance companies may suffer at first with a single-payer plan, but people with cash would buy supplemental insurance beyond Medicare basics and sustain the industry;  jobs would shift to government positions aimed at administrating the new system and would therefore mitigate unemployment.

With the GOP in power, we’ll likely get Obamacare Light if they can scrape up the Senate votes, which fattens the coffers of the already-wealthy while neglecting the truly needy.

However, the worm may turn in 2018, and if a new Congress actually functions, we’ll be able to bring down costs and increase quality with a single-payer Medicare expansion while simultaneously closing the income gap.

Source

The average citizen thinks the U.S. should turn to Medicare expansion: 58% back the idea, as well as most physicians.

A moral victory, indeed, if we hang tough and remain vigilant a few months while champagne flows from above and the neglected search for cake in the green dumpster marked US HEALTHCARE.

Opioids in the News

Dear Readers,

Today I’m simply re-posting recent articles — written by others — directly related to the opioid epidemic, which is the subject of my recently published novel.

New readers are signing up almost daily to receive this blog, and many are medical students or political science majors interested in the topics and the accompanying research. Perhaps this will help.

Look for original pieces arriving in the next few days.

First, from the St. Louis Post-Dispatch 4/3/17:

Social change and economic disappointment create an epidemic of ‘deaths by despair’

st louis pd deaths per 100kScreen Shot 2017-04-11 at 2.34.51 PM.png

Two years ago, Princeton University economists Anne Case and Angus Deaton disclosed a shocking finding: Between 1999 and 2014, middle-aged (45-54) white Americans with a high school education or less died at a rate never before seen in a modern industrialized society.

Alone among every other demographic group they studied, this group’s life expectancy was shrinking. The group’s annual mortality rate jumped from 281 per 100,000 to 415 per 100,000 during the 15 years studied.

Big reasons: Striking increases in the number of suicides, drug overdoses and liver disease caused by alcohol poisoning. Case and Deaton called them “deaths by despair.”

Now the two scholars have returned to try to explain why this is happening. In a report published by the Brookings Institution, they suggest that while income inequality and wage stagnation may play a background role, a lifetime of “cumulative disadvantage” catches up with this demographic.

They are the slice of the population who hit the job market as low-skill jobs were being mechanized, computerized and globalized. They grew into adulthood as cohesion-building social institutions like marriage, family and churches became weaker. Often they didn’t have spouses, pastors, work buddies or kids to back them up.

They did have opioid painkillers, which Case and Deaton say “added fuel to the flames, making the epidemic much worse than it otherwise would have been.” They cite a study from the Boston Federal Reserve that found that among men not in the labor force, nearly half are taking pain medication, most often by prescription.

Case is a professor of economics and public affairs; Deaton, her husband, was the 2015 Nobel laureate in economics. They admit their research is not a “smoking gun,” but it has ominous implications:

“This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65.”

Obviously the same forces affecting low-income middle-aged whites also affect poor educated middle-aged blacks and Hispanics. But mortality rates are decreasing among those groups and they don’t suffer high rates of deaths by despair. The authors speculate that expectations may be higher among whites, leading to greater disappointment when things don’t work out.

Many of these folks put their faith in Republican promises of help, and the GOP owes them something. Addressing opioid addiction is a place to start. So is keeping the social safety net intact. GOP politicians can boast about bringing back jobs and passing right-to-work laws, but voters must hold them accountable if they make things worse for the people the corporate economy has left behind.

***

Dallas Morning News 4/6/17

At the heart of our opioid crisis: the doctors who overprescribe them

President Donald Trump held a “listening session” about opioids and drug abuse at the White House last week. The gathering included former addicts, parents of children who had overdosed, top federal officials and others. Trump vowed to make drug treatment more widely available — a worthwhile goal with bipartisan appeal. He also spoke of strengthening law enforcement and dismantling drug cartels.

But there is a cheaper, low-risk tactic for curbing some opioid misuse that was neglected: changing doctors’ prescribing habits and better educating patients. A recent study found that for every 48 patients who receive an opioid prescription in the emergency room, one will likely become a long-term user. A more cautious approach to prescribing could save lives.

Across the United States, health care professionals wrote 249 million prescriptions for opioid pain medicines in 2013. In 2015, about 22,000 Americans died after overdosing on some form of opioid drug, legal or illicit, according to the Centers for Disease Control and Prevention. Of those deaths, 15,000 were attributed to prescription opioid overdoses. In fiscal 2015, Texas pharmacies dispensed almost 7 million prescriptions for the opioid painkillers hydrocodone or oxycodone alone.

There is no medical explanation for the rise in opioid use. Sales of prescription opioids nearly quadrupled from 1999 to 2014, even though Americans don’t report having more pain now. Prescribing rates vary widely among states, even though health conditions don’t. Even among doctors working in the same emergency room, some prescribe opioids much more frequently than others.

some states have more opioid

The federal government — along with some states and professional associations — has produced extensive prescribing guidelines. Opioid medications are not the preferred option for managing chronic pain; doctors and patients should try other approaches first and carefully weigh risks before starting prescription opioids. For acute pain, such as after surgery, doctors should prescribe the lowest possible dose of opioid for the shortest duration. Prescribers must be especially careful with older adults because opioid painkillers can put seniors at higher risks of falls and fractures.

Pharmacists and patients have an important role. In Texas, lawmakers are considering a bill, SB 316, which tightens the state’s prescription drug monitoring program. The bill would make it easier for pharmacists and regulators to quickly spot patients who fill multiple prescriptions for addictive medications and doctors who prescribe inappropriately.

And the public can help, too. How do most people who misuse prescription pain medications get them? One large study showed that about half obtained them free from friends or relatives. So, if you have pain pills left over from surgery or dental work, drop them in the toilet. Really. These medications are so dangerous when misused that the FDA recommends flushing them down the sink or the toilet if you can’t find an official drug take-back event. That will keep everybody in your home — you and your friends, relatives, kids and pets — safe.

What you can do

April 29 is National Prescription Drug Take Back Day, which aims to provide a safe, convenient and responsible means of disposing of prescription drugs, while providing education about the potential for abuse and medications. To find a drop-off location near you or to learn more about the program, visit dea.gov or call 800-882-9539.

(Verify the original piece)

***

Associated Press 3-10-17:

Workers comp programs fight addiction among injured workers

This article is protected, but the link is worth reading!

***

Fourth, the Kingsport Times-News 7/3/16:

Endless prescription: Suboxone, Subutex plaguing region

Suboxone. Subutex.

For many, they mean nothing. But they are at the heart of a disturbing trend which has seen people move to the area just to obtain them, caused doctors to leave other jobs to prescribe them and left hundreds of drug addicts with an endless prescription.

It is a problem law enforcement has seen explode in the last five years.

“We routinely arrest people for drug offenses and find them in possession of both buprenorphine (Suboxone or Subutex) and some other powerful narcotic (heroin, opiate-based pain pills, etc.) that buprenorphine is supposed to be weaning them off of. This phenomenon directly contradicts their intended purpose,” said Kingsport Police Department Public Information Officer Tom Patton.

“In an ideal world, buprenorphine could arguably serve a legitimate purpose. But we do not live in an ideal world, and we are probably seeing more harm than good out of these drugs at this point.”

The intended use of buprenorphine, the main ingredient in Suboxone and Subutex, is to help people addicted to pain pills achieve sobriety by providing an alternative to their drug of choice. Counseling and therapy are supposed to be provided along with the prescription.

Over time, the dosage should be reduced gradually until the patient is completely drug free.

That is not happening.

“I started going to a doctor in 2006 or 2007, somewhere around there,” said a Suboxone patient who wished to remain anonymous. “The first time you take it and the second time you take it, it feels great. Then it just turns into maintenance.”

He said he is disappointed because he was told by a healthcare professional that a tapering off would occur, but never did.

The patient, who is currently homeless, said he spends $160 a week to visit a doctor and fill his prescription. He readily admits he could spend that money on an apartment if he were not on Suboxone.

It is a cash-only business because his doctor, like many buprenorphine prescribers, does not accept insurance.

And cash only not only applies to patients, but to everyone, including law enforcement agencies that buy the drug for use as health maintenance for prisoners.

“All clinics do cash only,” said Christy Frazier, the health administrator for the Sullivan County Jail. “The ones I worked with here only take cash, even from us.”

Frazier said in just one week, approximately 75 percent of those coming into the jail had abused Suboxone or Subutex. She said at least two inmates told her they moved to Northeast Tennessee for the express purpose of obtaining the drugs.

Sullivan County District Attorney General Barry Staubus said almost every single drug case before a recent grand jury involved the selling of Suboxone or Subutex.

“It’s a real danger to the community,” he said. “I attribute that to overprescribing.”

Patients are not the only ones getting in on the act. Doctors are reportedly leaving their current work to start prescribing buprenorphine.

“Greed is taking over,” said Dr. Randy Jessee, senior vice president of specialty services for Frontier Health. “We are hearing stories about doctors quitting their ER work, quitting their practice and going into the Suboxone business.”

According to the Department of Substance Abuse and Mental Health, there are 94 buprenorphine prescribers in the greater metro areas of Johnson City, Kingsport and Bristol. And that number could be an underestimate because prescribers decide whether they want to be listed in the DSAMH locator, according to the 2015 DSAMH “Medication-Assisted Treatment Substance Use Tool Guide.”

It would never be obvious to anyone driving around town that so many buprenorphine prescribers exist. There is a reason why.

Many of the clinics or prescribers do not advertise the prescribing of Suboxone or Subutex. They also have unassuming names, calling themselves a rehabilitation center or family treatment center. Many users find out by word of mouth.

The Suboxone patient who talked to the Times-News was handed a card directing him to a clinic by a friend nearly 10 years ago.

“My friend at work gave me a card that was $25 off the first visit,” he said. “At my first visit, he (the prescriber) gave us cards to give out. We were pretty much advertising for them.”

He said he’s gone from being able to see the doctor at any time to having to wait up to two hours for a visit. Suboxone and Subutex are being prescribed so much in the area that pharmacies are either running out or reaching their federal limit on buprenorphine.

The patient said he’s had to drive to every Walgreens to try to get his prescription filled, only to be declined. Many smaller pharmacies refuse to accept new patients who are being prescribed Suboxone.

Once someone is given a prescription for these drugs, it becomes very hard to stop using them without tapering off because the withdrawal symptoms are worse than with regular opioids.

The Suboxone patient is stressed out because he was robbed of some cash and his entire prescription four days ago. He has not had Suboxone in three days and is starting to feel the effects. He has experienced withdrawal before and is not looking forward to going through it again.

“I feel like I woke up with the flu,” he said. “For 11 or 12 days, I feel really, really bad. Then I won’t feel right for about 30 days.”

He said he is currently $35 short for his next doctor’s appointment, meaning he needs to find the money so he can get his prescription. That means borrowing money from someone, usually with the promise of giving a pill or two in return.

Subutex is more popular on the street than Suboxone because it does not contain the overdose drug Naloxone. Users can take Subutex and get higher than they could with Suboxone.

Suboxone is going for about $25 to $30 per dose on the street while Subutex is selling for between $40 and $70.

The Tennessee General Assembly passed a bill in 2015 that said only pregnant women and those allergic to Naloxone can get it. Frazier said this had led to women getting pregnant on purpose just to obtain Subutex.

Subutex and Suboxone use on the street has become a huge problem and many blame the prescribers. The patient interviewed by the Times-News called it legal drug dealing.

“We’re giving doctors the money instead of drug lords,” Frazier said.

(Verify the original piece)

***

And last, from ClarksvilleNow.com, December 2016, which pertains to the characters and situations in Jellybeaners:

Tennessee sets new record in drug overdose deaths in 2015

This page is protected, but the link and information will open eyes.

***

Thanks for subscribing to Gene Scott Books, and please forward any pertinent opioid information to [email protected] you feel may help our readers.

Lamar Alexander: Listening with a Robotic Ear

We all knew the Betsy DeVos nomination was a done deal before the excruciating hearings confirmed our fears and made it clear she held no real experience in the arena she’ll now control.

After all, she’s a member of the billionaire class who bought her ticket the same way many in the cabinet have elbowed past the better qualified.

Listen to that swamp drain … gurgle gurgle.

Here’s my personal story.

One of our US senators, Lamar Alexander, once ran for governor and won the hearts of Tennesseans by walking across the state — from Mountain City to Memphis, over a thousand miles — wearing a red and black flannel shirt and meeting with and listening to folks along the way.

Abe Lincoln, reborn.

But now after fourteen years in Congress he replies to personal letters with pre-programmed robot mail because the office in question — secretary of education — was pre-sold to the highest bidder.

A friend of mine wrote and asked me to pen a note begging LA to rethink the DeVos nomination. So I took several hours, researched a bit, and produced a letter.

For security, I cut and pasted the letter into his website, the current way he’s receiving public mail.  The paper letter never garnered a response.

And his team was smart enough to not send their robot letter back a nano second after my personal letter hit the server.

Their response drifted back the next day. Savvy. As if they’d read it.

Anyway, it’s interesting to follow the order of events. Here they are: the original letter, the robot response, and my follow up at the end. Let’s set this down for posterity, as Lamar Alexander’s legacy rides upon the way our government is behaving at the moment.

***

Dear Senator Lamar Alexander,

My favorite American, Ben Franklin, perhaps the most inventive and prescient of us all, made it clear that he trusted neither the elite, nor the rabble. [1]

You, sir, sit in control of present day American history. With your influence and pen, you may turn a pillar of America freedom – public education – into a pile of desecrated ash.

Or, you may preserve a way of life that has successfully blended the melting pot into the powerhouse of capitalism, prosperity, and equal opportunity known as America, a richly diverse mix of blood, religion, creed, and ambition – all imbued with a love for family and civic pride that sweeps the nation while transcending political parties and narrow ideology.

Ben Franklin Jr High 9th Grade 1955-1956

The egalitarian principle upon which we’ve built our culture – that all people are equal and deserve equal rights and equal opportunities – already cost us the inestimable blood-soaked trauma of the most horrific of all wars, a war where only Americans perished, a war that came to a head at a wall on Missionary Ridge.

And yet, we sit looking on while another wall is erected, a wall pitting the resources of the private education scheme against traditional melting-pot public schools in a land already seething with a discontent for the unending privileges of few at the expense of many.

Senator Alexander, Betsy DeVos is unqualified to serve as the Secretary of Education for three reasons. First, she is a member of the billionaire class who has never worked in a public school, has never earned a degree in education, and never saw her children attend a public school. Experience? Zero.

Second, Betsy DeVos advocates “school choice” privatization schemes. When schools become business-driven for-profit entities mainly rewarding stockholders, they’ll immediately drain resources from public schools, which will wither and become “alternative schools” or in other words, a well-oiled feeder system for the burgeoning for-profit prison system even more than the outrageous present – where 40% of our prison population is comprised of a single racial group equaling only 13% of the general population. [2]

Which rewards for-profit prison stockholders.

prison stock graph

The vicious cash-churning cycle may buy yachts and classy real estate for a few, but it certainly poisons millions of youth while darkening our moral landscape to the point where civil-rights-rebellions are glimpsed on the mall the day after inaugurations.

womens march npr
Read more

Lastly, Betsy DeVos is unqualified for the post because she threatens the loss of civil rights and opportunity for those who won’t be able to scale the elite-inspired walls erected by private for-profit schools.

And once schools are effectively re-segregated, the elite will be ensured a never-ending supply of government-created-Soylent-Green-cash in the form of education-deprived public school self-created “rabble” permanently excluded from the egalitarian dream of equal rights, equal opportunity.

There is precedent. [3]

Following the Civil War, lawmen in the South rounded up black “vagrants” and funneled them through the penal system and instantly regenerated the once-lost-now-found system of slavery-by-another-name. Incarceration.

So the choice is yours. Ben Franklin’s history is set. Yours is about to be written.

The future of the nation depends upon your decision. May God guide your hand in egalitarian Christian [4] love for those whose destiny will be determined by that act.

Respectfully yours,
Michael “Gene” Scott

____________________________

[1] Walter Isaacson, Benjamin Franklin, An American Life, (Simon and Schuster: 2003), p. 112.

[2] Breaking Down Mass Incarceration in the 2010 Census: State-by-State Incarceration Rates by Race/Ethnicity, https://www.prisonpolicy.org/reports/rates.html

[3] T.R. Fehrenbach, Lone Star: A History of Texas, And the Texans, p. 629.

[4] Christian egalitarianism (derived from the French word égal, meaning equal or level), also known as biblical equality, is a Christian form of egalitarianism. It holds that all human persons are created equally in God’s sight—equal in fundamental worth and moral status.

***

Senator Lamar Alexander’s Robot Letter Response

Dear Mr. Scott,

Thanks very much for getting in touch with me and letting me know what’s on your mind regarding President Trump’s selection of Betsy DeVos to become the next Secretary of Education.

Betsy DeVos is an excellent choice. The Senate’s education committee will move swiftly in January to consider her nomination. Betsy has worked for years to improve educational opportunities for all children. As Secretary, she will be able to implement the Every Student Succeeds Act, the new law fixing No Child Left Behind, just as Congress wrote it, reversing the trend to a national school board and restoring to states, governors, school boards, teachers, and parents greater responsibility for improving education in their local communities. Under the new law, the federal government may not mandate or incentivize states to adopt any particular standards, including Common Core.

I also look forward to working with her on the upcoming reauthorization of the Higher Education Act, giving us an opportunity to clear out the jungle of red tape that makes it more difficult for students to obtain financial aid and for administrators to manage America’s 6,000 colleges and universities.

Improving our schools has been one of my top priorities in public service, both as a U.S. Senator and during my earlier service as governor, president of the University of Tennessee, and U.S. Secretary of Education. Better schools mean better jobs, which is why I have worked to support states and school districts in improving education so that our students have the tools they need for success.

We are unleashing a new era of innovation and excellence in student achievement—one that recognizes that the path to higher standards, better teaching and real accountability is classroom by classroom, community by community, and state by state—and not through Washington, D.C. I appreciate your taking the time to let me know where you stand. I’ll be sure to keep your comments in mind as this issue is discussed and debated in Washington and in Tennessee.

Sincerely,

Lamar
LA/BM
***

Thanks, Lamar. You’ve effectively trampled American-forged melting pot education with your Almighty Buck boots while sporting an old flannel shirt turned inside out.

Your legacy is now set in cement for those future Americans who can afford to read it.

 

http://www.startribune.com/sack-cartoon-betsy-devos-confirmed/413094453/
Cartoon by Steve Stack


Opioids and Obituaries

The motivation behind Jellybeaners — to shine light upon the opioid epidemic taking Americans at the rate of fifty per day — remains front and center in the news, and burns painfully in our collective hearts.

 Logically, one should abstain from indulging in news the first thing in the morning.

Soaking up death, stabbings, arson, child neglect, fracking, meth-lab explosions, sex slavery, environmental disasters, racist cops, neglected infrastructure, enduring slave wages, endless CEO profit raking, idiotic politicians blubbering pie-in-the-sky promises with no intention of following through … mixing all those nauseous facts with prodigious amounts of caffeine … well.

That can’t be good for the psyche.

But the routine never varies.

Out of bed, slurp coffee, devour news, cautiously turn to the obituaries, brace for the blow.

This week?

A recent law-school grad with a long history of academic success, a loving family, and a promising future. Twenty-seven-years-old.  Here’s a brief paraphrase from the obit:

God protected him many times when his parents were unable.  His earthly life ended unexpectedly but his everlasting life has begun.

We’ve watched the font-size of our local print paper decrescendo for thirty years to the point where it’s barely readable.

After all, they have our subscription money, and we’ve read the news on our iPhones and  internet feeds, old print news takes up valuable paper and ink, so we’ll minimalize it, shrink it with a pissant font, and look for other revenue streams.

To balance the loss of readership and revenue to online outlets, our local newspaper doubled the size of its obituary text,  colorized large head shots of the recently-deceased, and unknowing created a daily parade of local folk now leaving eternal digitized images. 

If you plan ahead, love to scribble, and can afford to throw even more cash at a local newspaper publisher, up goes your twin column half page manifesto, a.k.a. bird-cage lining.

Follow the money.

We’ve known for decades that newspapers and other media leverage sex and death to sell products.

Obituaries sell local papers. Furthermore, the family of the deceased wanting to run an obituary is billed up to $600 — approximately five times an annual subscription price — to purchase the publication of their loved one’s death notice.

And newsprint corporations will continue to milk grieving readers until obituaries naturally migrate whole herd onto the “everlasting” cloud — which is subject to evaporation any second of any day.

***

So we slurp coffee, wipe crust from our eyes, and suffer the dark parade of endless young-people obituaries — two or three “mysterious passings” per week — digitized head shots projecting health, vitality, and promise … while the shocking dissconnect of truth and image confounds the thoughtful reader.

Cancer victims either declare outright the nature of their earthly battle, or direct donations toward eradicating the scourge, which indicates the cause of their passing.

But prescription or illegal opioid drug deaths — cloaked in self-painted societal shame — lie hidden between the lines of the family-or-funeral-home-produced death notice.

We’re talking perhaps 2-3 opioid-connected deaths per-week in a region supporting a newspaper circulation of 43,000.

National statistics suggest nearly fifty-two Americans perish every day from prescription opioid overdoses — eighty per day if you figure in heroin — so two-or-three deaths a week in such a tiny demographic seems outrageous.

Heroin deaths are linked to the pill trade because recently skyrocketing street-prices of prescription opioids allow cheap heroin to flourish across the land, hitting rural states and Appalachia especially hard due to decades of high unemployment and a culture slow to raise education standards, though the epidemic appears to cross all lines, racial, religious, geographic, and socio-economic.

Many of our locals succumb to fentanyl, fifty times more potent than typical street heroin. They go to a party, try a little, forget how much they’ve taken, dab a little more, and before the dawn appears …. the sun sets on their precious lives.

The alarming potency of fentanyl — and even more horrendous Chinese exports washing ashore — steals our best and brightest, the folks we’re staking our future upon.

Opioid availability first soared (in recent history) after 26 states and D.C. legalized weed in some form and jerked market out from under Mexico, who made up the loss by dumping cheap heroin and opioid-laden chemicals on an already addicted North America poised to dull the pain with ever increasing amounts of opioids, a class of drugs that has debilitated us since the Civil War.

***

One family, six months ago, actually came clean in the second paragraph of their boy’s obituary, saying that the deceased fell victim to prescription drugs after losing his father two years prior. The son couldn’t bear the loss.

That’s the only self-admission I’d seen in thirty years of obituary reading, though I must confess that for twenty-eight years I only skimmed obits for astounding stories of WWII vets who’d conquered the world and returned home to build new lives.

***

The truth remains:  we all wear a mask.

mask
The Coalition for Positive Energy

This concept came home to me thirty years ago when I taught Hawthorne’s The Minister’s Black Veil to a class of honors English students in a suburban Chicago high school.

A small village church must deal with their minister, Mr. Hooper, who takes a notion to don a black veil covering his upper face — much like a widow would wear at an old-fashioned funeral. Everything goes south when he chooses to leave it on.

Permanently.

He becomes a better minister after this decision, ironically, and though his fiancé breaks off their engagement, she watches his entire life and comes to be with him on his death bed, where he admits all of us wear a mask.  Upon his death, Mr. Hooper is buried with the veil in place.

Let’s look into the mirror.

 When we’re at Sunday school, we wear the Sunday school face. Job interviews conjure a competent strong obedient flexible yes-sir face. Thursday night dollar-draft-beer Raccoon Club meetings at the local sports bar requires a special façade.

And since random acts of unprovoked violence occur in this crazy world  — say the unexpected death of a child through accident or SIDs — well, that means perhaps even God wears a mask.

No one is immune from the natural instinct to project a happy face while masking reality through omission.

Facebook is simply a party-line on steroids, a party line with enough bandwidth so a billion users may share photos, text, videos, music, and fake news.

For whatever psychological reason, the vast majority of us prefer to keep the laundry in the closet and to project the shiniest image of ourselves and our loved ones, clean photo-shopped textually-tweaked  images of success and prosperity.

Under this unspoken societal code lies a message

Vitality, good luck, success, look-what-I’ve-done, look-where-I’ve-been, see-where-I’m-going … that’s what’s important.

Let’s face it, we’re all the billboard producers of our archived lives, turned digital and pulsing across the electronic social universe — Google Plus, LinkedIn, Twitter, Facebook, et al. — social media entwined through massive servers grown muscular through carrying an ever-increasing crescendo of porn to the sex-starved masses.  Thirst begets thirst.

Irony. Cleanliness afforded by dirt.

As a result, we can now Photoshop and video-edit our pimples and purple lives while projecting sanitized, filtered, smiling, I’m so happy, self-assured-selfies, eternal masks frozen in digital clouds of memories, gigabytes juggled in “perpetuity” for dollars a month.

Even when people freak out, breech social barriers, and reveal their dark sides on social media, it’s often ignored until the post mortems roll in.

dylan roof
Dylan Roof

When an individual’s mask slips down,  the tribe doesn’t WANT to look, or doesn’t want to acknowledge some of us actually DID look and failed to respond.

Which brings us back to the Double-O-Demons.

opioid deaths 2015
opioid deaths 2015

Jellybeaners is a topical novel about opiates and obituaries, and the fact that shame drives many of our decisions.

And until we supplant shame with grace and help people recover from addiction through counseling, financial incentives, and work opportunities, well.

Jellybeaners will remain topical in perpetuity.