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Dealers Gotta Protect Their Turf

English: Vicodin tablets Italiano: Pillole di ...

English: Vicodin tablets Italiano: Pillole di Vicodin. (Photo credit: Wikipedia)

In New Hampshire, more people die of prescription drug overdoses than car accidents. CDC statistics report that prescription drugs are involved in 75% of all drug-related deaths in the United States. In 2011, the Centers for Disease Control estimated 14,800 deaths related to opioids (opioids or opiates defined as morphine, heroin, oxycodone, codeine, methadone, hydrocodone and hydromorphone.)  Note that with the exception of heroin, all drugs of abuse are available from your friendly healthcare provider.

Whether drug sales are illegal enterprises selling vials on the corner or a transaction that takes place in an exam room, it’s all about numbers and turf. Getting people hooked and keeping them coming back are the keys to a thriving business. For people with insurance, getting narcotics (opiates) from their local doctor or Emergency Room is easier and less expensive than going to the corner drug dealer, particularly since drug dealers don’t settle for a co-pay. Just as dealers rename their products to generate interest,  Big Pharma continues to feed the appetite of addicts with new medications and new formulations of old medications.

Narcotic painkillers have been combined with over the counter meds because of  the belief that the two medications together provide better pain relief than either of the medications taken alone. Unfortunately when people take two Vicodin (hydrocodone and acetaminophen) every 4 hours for pain round the clock (12 pills daily), they run the risk of liver damage because of the amount of acetaminophen bundled in the pill.  The makers of Tylenol (brand name acetaminophen) are so concerned about acetaminophen overdoses that they have decreased the recommended maximum daily dose from 8 pills daily (4000 mg)  to 6 pills daily (3000 mg). This change forces the makers of Vicodin to lower their recommended maximum dose to stay within the new guidelines and will result in Vicodin users having their daily dose decreased.  Sad that in the face of increasing numbers of overdose deaths due to prescription narcotics and the increasing number of prescription drug addicts,  the push to change labeling is due to the potential for a Tylenol overdose resulting in liver damage, rather than concern about overdose or addiction.

Of course the makers of Vicodin don’t want to see their business cut in half. They want to keep on selling the same number or more pills every year. Faced with the very real possibility that providers will decide to switch patients on Vicodin to a drug without any pesky daily maximums, the makers attempted the business affirming move of  trying to get approval for a pure hydrocodone pill. Luckily the FDA panel on pain relief voted against it.

The panelists agreed the higher dose of hydrocodone would be an effective pain reliever, but they felt uneasy providing another formulation of a drug in a class that is already widely abused. According to the Drug Enforcement Agency (DEA), hydrocodone is on the top of the list of most abused drugs in the United States. Sounds like a no-brainer.

Hopefully the FDA will agree with the panel and prevent a new dangerous drug from flooding America’s streets, school yards, and homes. In the war on drugs, our government has gone after the dealers of meth, pot, heroin, and crack. Somehow the legal dealers, Big Pharma, are allowed to thrive while they destroy lives.

opioid prescriptionsDo some people need narcotic painkillers to control their pain? Of course.  In the face of increasing narcotic use, do we need to add more potential drugs of abuse to the marketplace? I think not.  Big Pharma seems to be doing pretty well with what they have.

chart courtesy of the National Institute on Drug Abuse.

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Mother Knows Best

Scratching

Scratching (Photo credit: ☺ Lee J Haywood)

 

My mother has always been a blunt, no-holds-barred giver of advice.  Her circle of friends is small, her capacity to remember slights limitless. To say she’s a little on the suspicious side is an understatement. She believes there’s two kinds of friends, friendship and friendshit. Her favorite saying concerning friendshit is,  “If you lie down with dogs, you get fleas.”

 

When you grow up with a cop for a mother, there’s not a lot of sympathy for stupidity.

Since I’m not psychic, I can’t tell at the start of a relationship where it will end up. Like courtship,  the beginning phase of a friendship is all about showing off our good sides and covering up our imperfections.  There’s that unquenchable hope that this time someone finally gets me.  The passage of time, though, can wear down the patina of initial niceness.  A cheap person can only buy a round of drinks so many times before they stop offering. A dishonest person can only fulfill their obligations as long as they can stave off their basic impulse to lie. A self-centered person will try to act like it’s not all about them, but in the end, they’ll insist it is.  That’s the point when you realize you’ve been lying with a dog and the itching you feel isn’t your new hand soap or poison ivy, it’s fleas.

 

Most of my life, I’ve followed my mother’s advice and steered clear of unsavory or people liable to get me arrested. Unfortunately those around me have not. One contractor friend of my husband’s has proven to be a persistent little puppy. During the initial phase of the friendship, he installed outside stairs, remodeled our bathroom, roofed our house, and installed replacement windows.  His rates were reasonable. We knew him. My husband counted him a friend. You’d think that would guarantee a job well done. Wrong.

 

Yes, we knew the contractor’s past jobs included  a string of small claims cases and customer complaints.  Yes, I balked at how he always wanted half down to start the job (which basically consisted of his taking the money and parking some equipment at our house) and seemed to be running a Ponzi scheme to pay for supplies and help. Yes, his initial job (a stairway) didn’t meet code and his second job (replacing a roof) started a year-long saga to find the leak we didn’t have until the new roof was in place. And even though he didn’t have a clue as to how to install a corner shower, it didn’t stop him from doing it. No amount of caulk has stopped the leaking in the subsequent two years.

 

Did I mention it takes superhuman strength to close and lock the replacement windows because they don’t quite line up? It doesn’t take skill to do a shoddy job, but it takes a special kind of incompetence to create new problems. Small wonder that when I finally took charge of hiring contractors, his name didn’t make the list.

 

Bad Carpentry!

Bad Carpentry! (Photo credit: Yuba College Public Space)

I still do a slow burn every time I enter the bathroom and realize I’ll eventually need to hire someone to pull out the shower and start again. I get a little hot under the collar when I watch part of the roof lift up and vibrate during windstorms. I curse loudly every time I have to hang on the lower window while pushing the upper window up to try to latch them for the winter. Giving him multiple opportunities to do something right became the punishment that keeps on delivering. If I’d heeded my mother’s warnings, after the first job I would have moved away from him as far and as fast as humanly possible.

Instead, I let myself become lulled by excuses and didn’t take appropriate action when I identified him as friendshit. If I had washed my hands of him early on, I wouldn’t have to walk around my house now and see the equivalent of toilet paper on my shoe everywhere.

But, just like you can’t blame fleas for biting you, you can’t blame shady people for taking advantage. Even if you think they’re friends. Which leads me to another lesson from my mother: Screw me once, shame on you. Screw me twice, shame on me.

Ignore my mother’s advice at your peril.

 

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Barstool Thoughts

A perfect pour

A perfect pour

Sometimes you read a line in a book or hear a piece of dialogue in a movie or play that speaks to you. It hits your brain and then rattles around like a bullet, careening off memories, bouncing off preconceived notions, and generally making a mess of your thoughts. For me, the sources of these are varied. I’ve spent months, years even, pondering the magic behind words from movies that went straight to DVD and books that no one has ever heard of. They don’t resonate in my brain because the words are elegantly strung together. They resonate because they hit me where I live, wherever that is at the moment I hear them.

Last summer I read Gillian Flynn‘s “Gone Girl.” Two lines have stuck with me and continue to plague me on a regular basis. Protagonist Nick Dunne, bar owner and adult child of an alcoholic father says “There’s no app for a bourbon buzz on a warm day in a cool, dark bar. The world will always want a drink.”

In some ways, I feel like I’m one of the last generations to enjoy alcohol before societal pressure and Mothers Against Drunk Driving made the idea of demon rum reality. Home movies of my mother during her pregnancies show her drinking cocktails.  When I was pregnant, it was suggested pregnant woman should minimize alcohol. Now a pregnant woman drinking alcohol faces public scorn and possible child abuse charges if the fetus-is-a-person-with-rights movement gets its way.

Driving drunk used to be against the law, but in small towns the cops would have you park your car and then drive you home rather than take you to jail and book you.  Groups didn’t apear at bars with a designated or sober driver. Whoever was the least drunk at the end of the night took the keys.

Bars used to be serve people until they fell off their bar stools or passed out. Now they cut you off if you slur a word or stumble over someone’s foot. When’s the last time a bar had 2 for 1 specials? I remember bars where beers were 4 for a 1 and they’d put a case on ice on the table to keep the drinks flowing.

Giving babies brandy, wine, even whiskey for teething used to be an acceptable parental decision.  As children aged, parent sponsored alcohol use  included purchasing kegs for  end of season football parties or graduation. The host parents made sure everyone hung around and slept it off.  Now any drinking at a house party, whether the parent provides it knowingly or not, results in criminal charges against the parents.

And don’t get me wrong. I don’t bring up the past to make excuses for what used to be acceptable behavior.  It’s just that was the way it was and it will never be that way again.

Are we better off now than we were then? Statistics and government agencies say we are. But if you’ve never spent a quiet afternoon in a dim bar where the television volume is low and the bartender asks if you want another drink with gestures rather than words, I think you’re missing something.

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Five Things Not to Do This Holiday Season

The holiday season is a time of reflection, as well as a time of overspending, overeating, overdrinking and overdecorating. Here’s five things not to do this holiday season.

 

1.) Candles are beautiful and romantic, but unattended may burn the house down, a holiday tradition you don’t want to start. A smoke detector and fire extinguisher are always thoughtful gifts.

 

A Danish Christmas tree illuminated with burni...

A Danish Christmas tree illuminated with burning candles, adorned with homemade Christmas decorations such as red hearts, white paper snowflakes, a golden star at the top, and gifts stacked underneath. (Photo credit: Wikipedia)

2.) Who doesn’t want to have the best lit home on the block?  There’s a price to pay if your light ambition is greater than your climbing expertise. Approximately 1300 people are seen in the ER each year for light decorating related injuries. Falling from the roof or ladders hurts in real life, no matter what you’ve seen on The Santa Clause.

Happy Holidays

Happy Holidays (Photo credit: Wysz)

3.) Holiday cheer in the form of liquid alcoholic refreshments can be a way to relieve stress and join in the festivities. Unfortunately overindulgence can lead to vomiting, alcohol poisoning, black outs, or a holiday arrest for driving while intoxicated. Even in the face of massive post holiday credit card payments, one should exercise moderation.

Drunk Pumpkin

Drunk Pumpkin (Photo credit: Wikipedia)

4.) Holiday potlucks are a fun and inexpensive way for groups to keep costs down. All those savings, though, will be washed away if the potluck ends in food poisoning. Just because things are left out for hours doesn’t mean they’re safe to eat. If perishable food has been out for more than two hours, throw it out. Don’t give the gift of food poisoning.

Deviled Eggs shot during the Inaugural Portabl...

Deviled Eggs shot during the Inaugural Portable Potluck Project on March 23, 2008. (Photo credit: Wikipedia)

 

5.) Those once a year holiday treats often involve rarely used kitchen appliances. Be extra careful with sharps, including food processors, electric knives, and blenders. All the work of a beautiful dish can be undone in the seconds after a serious, bleeding injury.

A knife and its victim

A knife and its victim (Photo credit: athomson)

Happy Holidays and don’t make the local Emergency Room an unanticipated stop on your holiday rounds.

 

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Tales of Black Friday

crowd

crowd (Photo credit: mia.gant)

I will be honest with you. I did not venture forth this Black Friday. I did not salivate over ads, print and internet. I did not check store opening times, available items in store, or mapquest to ensure I was taking the quickest route. I did not synchronize my watch with anyone or anything.

Other things I did not do today:

I did not see Wal-Mart employees lined up in riot gear shooting blu-ray DVD’s like frisbees into a screaming mob that threatened to rip their heads off and crap down their windpipes.

I did not witness Target employees in the electronics department drawing straws to see who would be locked under the display cases for protection and who would face the enraged customers and tell them the last discount tablet had been sold.

I have no firsthand knowledge of a group of smartly dressed young saleswomen at Kay Jewelers, armed with only stilettos and hairpins, beating back the mob that threatened to collapse the jewelry counter.

I totally missed the college student who snagged the last sale laptop at Best Buy, turned with a jubilant whoop, and was taken down by an elderly lady with a walker.

I did not sight a family of trolls using their sharp elbows to crawl through a crowd of shoppers massed outside K-Mart nor did I hear their howls as they were trampled when the doors opened.

I missed the mothers using strollers, with children still inside, as battering rams to get into Toys R Us.

I definitely didn’t glimpse the archangel Gabriel blowing his trumpet to herald the opening of Macy’s.

I stayed home on Black Friday and was thankful I didn’t work in retail.

Happy Holidays.

The Line at Best Buy

The Line at Best Buy (Photo credit: Dalboz17)

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Beauty Contests and Cancer

Miss America contestant plans double mastectomy after competition

The above headline hit me hard. To see a beautiful woman, fearful of cancer, planning a double mastectomy AFTER the competition only reinforced my healthy distrust of beauty contests. The take away message seemed that having a double mastectomy would ruin your chances of winning a beauty contest.  Of course they couldn’t discriminate against someone with breast cancer genes, but perhaps there was some obscure rule about reconstructed breasts via “natural” breasts or a prohibition against prosthetic breasts.  I didn’t know for sure,  but in my quick view of her world, this young lady didn’t dare get a mastectomy until after she had been judged with her breasts intact. My prejudice against these contests demanded that I find the facts.

I surfed the Miss America site to get some insight into what was, and wasn’t considered beautiful by pageant officials. At first glance, their requirements looked fairly innocuous:

To compete you must

  • Be between the ages of 17 and 24.
  • Be a United States citizen.
  • Meet residency requirements for competing in a certain town or state.
  • Meet character criteria as set forth by the Miss America Organization.
  • Be in reasonably good health to meet the job requirements.
  • Be able to meet the time commitment and job responsibilities as set forth by the local program in which you compete. (source)

So perhaps putting off the mastectomy was driven more by the need to be “in reasonably good health to meet job requirements” than needing breasts to compete. Certainly surgery, a hospitalization, and recovery would impact the contestant’s availability.  My suspicion that there was more to the pageant requirements was driven by the lack of a weight and height requirement in the rules.  Since the armed forces and other positions, such as smoke jumpers, must meet  height and weight requirements, I thought  Miss American might.  I dug a little further, went to the New Hampshire web page, and found more requirements for contestants:

(Q) A contestant must be and always have been a female.

(R) Contestants must not now be and never have been married.

(S) Contestants are not now pregnant, and have never been pregnant. She is not the adoptive parent of any child.

(T) Contestants must be of good moral character and never been involved at any time in any act of moral turpitude.

(U) Other than minor or petty offenses, contestants must never have been convicted of any criminal offense and there are no criminal charges presently pending against the contestant.

(V) Contestants must never have performed any act or engaged in any activity or employment that is or could reasonably be characterized as dishonest, immoral, or indecent.

(W) Contestants must be in good health, and can, to best of their knowledge, participate fully and without limitation in any Program activities. Contestants must not use or consume any illegal controlled dangerous substances or abuse the use of alcohol or other dangerous substances.  (source)

Whoa! We’ve all heard of contestants being stripped of their titles due to moral turpitude clauses, legal violations, and drug and alcohol abuse.  I can understand those, but to ask contestants to certify that they “are not now pregnant and have never been pregnant”?  Obviously the pageant is against abortion, adoption, and single parenthood (because they’ve nixed marriage, too).  Is this to impart an air of virginity and chastity to the contestants or to preclude unsightly stretch marks?  Why not disqualify them if they’ve had a sexually transmitted disease as it is as much an indicator of sexual activity as pregnancy.

Still, no clause stating a contestant can’t have plastic surgery. Miss Universe/Miss USA rules come right out and say they don’t prohibit plastic surgery because of the difficulty in enforcing the rule.  Though I suppose they could require contestants to sign a blanket medical release and go trolling through their medical records and health insurance bills looking for surgery. You know, if it’s that important to the pageant.

And then I started thinking of how important the pageant must be to women willing to sign off on the requirements because if  the Miss America pageant was  a job interview, the questions on marital status and pregnancy would be against the law. To the women who enter these, putting aside marriage, children, and college parties to be a contestant is likely considered a reasonable trade off. I don’t understand their desire to participate in a beauty pageant, but it’s a decision I don’t get to make. It’s theirs, as is either having or delaying cancer risk reduction surgery to pursue a dream.

When all is said and done, I wish Miss America contestant Allyn Rose  the best of luck in the pageant and in her decisions regarding her genetic risk of cancer. I’ll never be a fan of pageants, but as long as women enter and people watch, they’ll go on.

Colonel Russell Frasz, 89th Airlift Wing vice ...

Colonel Russell Frasz, 89th Airlift Wing vice commander, poses with the 51 Miss America 2004 contestants and Miss America 2003 on the Andrews flight line as part of their tour of Andrews AFB, Md. (Photo credit: Wikipedia)