Drug Wars, Drug Addiction, and Social Justice Issues


I have been reading Johann Hari’s Chasing the scream: The first and last days of the war on drugs. 

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This book provides a very detailed account of how we came to be an anti-drug and pro-prohibition nation that lead the way toward making criminals out of people who struggle with use of substances and millionaires out of people/ cartels who sell drugs on the black market. I have found the book in some aspects hard to read because the political manipulation of our global population and the injustices that have arisen from this global movement. I get angry about what has happened as I read and I have to step away for awhile.

Some key points from this text for nurses to consider:

  • The dominant medical establishment (in particularly the AMA) was initially very against “drug” prohibition, but key vocal players were forced into silence by the government.
  • Overall, 90% of people use substances we call “illicit drugs” without having addiction issues, yet we continue to think that people need to be cautious with drug use. For instance, many (not all) soldiers used heroin in Vietnam to get through the hellish experiences, yet many (not all) had no issues with heroin addiction when they returned stateside.
  • There is a clear connection between lack of social support, childhood abuse, and adverse childhood experiences (ACEs: see the CDc website for more info on this) with addiction. We need to be compassionate toward those who are suffering, because these childhood experiences literally changed how their brains function, making them very vulnerable toward addiction. Adverse childhood events impact young people across the socio-economic spectrum, and many people who came from “good families” have also experienced a lot of childhood trauma.
  • When it comes to death and illness, our two leading “drug use issues” are likely nicotine and alcohol, both legal, and both toxic and deadly. Yet, we simply put warning labels on these drugs and let folks self-determine their fate. Why are these drugs okay, but others are not? Because they are socially acceptable? Because they are “cheap”?

When we think of the opiate crisis, one of the biggest issues of course is people not having safe and affordable access to opiate medications: when people are cut off from safe supplies (ie, their pain prescriptions which the medical establishment has endorsed and prescribed, with potentially some of the cost covered by their medical insurance ), they may turn toward heroin and other “street” opiate medications. These drugs are expensive, sometimes hard to find, and in many ways they force or perhaps support people to live a life of crime in order to maintain their habits, if people have gone that far they must get help. And people overdose because they have no idea what is in the products they are obtaining.

Maybe, we have created an addiction monster in our society.

However, Portugal has found a way out of the addiction monster’s clutches. In 2001, with a growing heroin addiction problem, Portugal decriminalized all drugs and began to consider addiction to be a public and personal health issue. Drug addiction was viewed for what it is:  a chronic, debilitating illness. People caught with a 10 day supply of any drug are referred to a sociologist who helps to determine their treatment options. And what Portugal has realized is that not only is this a more humane approach, it is also far less expensive to provide adequate medical care and treatment to addicts versus incarcerating them. Portugal has experienced a 75% drop in addicted persons from the 1990’s, and their addiction rates are 5 times lower than the rest of the EU. Meanwhile, drug related HIV infections have dropped by 95%, and the stigma around addiction has lessened dramatically.

http://www.npr.org/sections/parallels/2017/04/18/524380027/in-portugal-drug-use-is-treated-as-a-medical-issue-not-a-crime

As nurses, we are concerned about social justice issues and public health issues. I would posit that nurses and politically active nursing organizations should be taking action around the opiate crisis in several ways:

  • Calling for safe injection sites and distribution of clean needles (or needle exchange centers) and free condoms.
  • Looking at prevention and early identification of at risk persons (both ending early childhood trauma through supporting parents at risk for enacting trauma and assessing for early childhood trauma both across the lifespan and across all populations to determine risks for addiction).
  • Supporting harm reduction techniques.
  • Supporting a view of addiction as a public health issue, and a chronic disease issue.
  • Considering a call toward decriminalization of drugs and ending incarceration for addicts (the Portugal Model).
  • Acting compassionately toward all addicts (even the “drug seeking” ones).

If you are interested in this topic, I do recommend reading Chasing the scream. This text provides great historical insight into how we came to where we are at with the global  “war on drugs” and the escalating issue of for-profit prisons.

We have become the nation with the greatest number of incarcerated individuals (not %, but sheer number!): though we only have 5% of the world’s population, we incarcerate 25% of the world’s total prison population (this link looks at the complexity of these numbers and supports the idea of the truth that in the land of the free, we incarcerate a much higher percentage of people due to lack of alternative ways to provide help https://www.washingtonpost.com/news/fact-checker/wp/2015/07/07/yes-u-s-locks-people-up-at-a-higher-rate-than-any-other-country/?utm_term=.1ca70c3620af).

Columbia University’s CASA group has released multiple reports that link drug addiction issues to crime, incarceration, and repeat offenses. Sadly, while 65% of our prison population qualify for addiction treatment, only 11% actually receive treatment. Meanwhile, the majority of violent crimes are committed by those suffering from addiction. https://www.centeronaddiction.org/newsroom/press-releases/2010-behind-bars-II

Poverty, race, and income inequality also play a role in both addiction and incarceration, and as nurses, we are ethically obligated to advocate for change in healthcare and system wide policies that impact vulnerable populations. Raising awareness is a first step, but perhaps nursing organizations need to also start taking stances and lobbying for more humane treatment of those who struggle with addiction.

 

 

The Power of Ten!


Sigma Theta Tau has now published the 2nd Edition of the book “The Power of Ten,” a book of essays by nursing leaders that address ten top issues for nurses to rally around for the next few years.  These issues were identified prior to the results of the 2016 election, and now they are issues of increasing importance!  The essays provide ideas and inspiration for actions to strengthen nursing’s focus and activism.  The issues are:

  1. Educational Reform
  2. Academic Progression
  3. Diversity
  4. Interprofessional collaboration
  5. Systems thinking
  6. Voice of Nursing
  7. Global Stewardship
  8. Practice authority
  9. Delivery of care
  10. Professional handoff

This is an important resource for all nurses who are determined to act on the fundamental values of nursing.  The essays are a follow-up to the 2012 “Future of Nursing” report; the issues dovetail with the four recommendations of the report, and sine a light on the actions that nurses can take now to bring a culture of health to the center in shaping the future of nursing and healthcare.  The essays are short and to the point, and there are inspirational quotes from nursing leaders throughout that point the way forward.

Check it out! The book is available in several different formats directly from Sigma Theta Tau or from Amazon.  All proceeds from the book are being donated in equal parts to the American Red Cross nursing programs and the American Nurses Foundation.

The Call for Community, Art, and Artists in the Resistance Movement


This week, members of the Nurse Manifest Team gathered together by the warmth of our computer screens for engaging video conference. We took the time to welcome some new members and talk about the future of the movement. I have to say for me, being with like minded #NurseResisters was so energizing (even though I have been suffering through a bout of the flu this week!) and also very comforting.

It’s important for #NurseResisters to remember we are not alone and to gather those around us during these challenging times: when change seems to be happening at a rapid pace, when social media pages are filled with what resisters might find to be concerning or bad governmental news, when there are 10 things you would like to take action on, but you can’t be on the phone all day….it can become easy to become discouraged, overwhelmed, or burned out. This is where truly being with a like minded community can lift your spirits and buoy your endurance.

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And endurance is what we will need. I know right now it sometimes feel like a sprint…get out there and get things done now, get to this march, make your signs, write your emails and postcards, get on the phone….because the administration has been creating changes at a rapid pace, the media and social media have been bumping up our energy, and we feel drawn to create change now.

The thing is, this is not a sprint and it’s not a solo race…it’s more like a team based marathon or ultra-marathon, and it is going to take teams of like minded community members to both participate in and complete the race.

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Individual Sprint

Versus

Team Marathon

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We need to carry lights, march together through the dark night with our nightingale lamps, and strive toward unity. There is no clear finish line, and no medals for winners, second, and third place. There is a beautiful planet and population of people that need caring for and this endurance test is in part about not giving up that vision of a caring, compassionate, kind, peaceful, unified, and spirit filled world.

I suggest other #NurseResisters start gathering with your communities in real life or as we did last week, in real time via video or phone conferencing. Set aside thoughtful, meaningful time to be together, to discuss future actions, and also to just support one another, to laugh together, to share your stories. Communities can rejuvenate and recharge us, and they are a must for folks who plan to run the long race.

I also did want to share that part of our discussion last week focused on the use of humor, satire, parody, art, and music to support and gather people together. Saturday Night live is becoming a great example of the power of humor, parody, and satire to help us lighten our load, to help us rejuvenate, to connect us across time and space.

 

 

While there are many older political songs we can use (Carol King just re-released One Small Voice with free download!: https://soundcloud.com/user-844282824/one-small-voice), it remains imperative that we also create new art and new music that reflects our current siutation here, now in 2017. Until then, let’s be strong together:

“One small voice speaking out in honesty
Silenced, but not for long
One small voice speaking with the values
we were taught as children
Tell the truth
You can change the world
But you’d better be strong”

(Carole King/ copyright Rockingdale Records).

 

Guidelines for Resistance


It has been one week since we posted the Nurses Declaration of Solidarity and Resistance, and today we registered 833 signatories, and still counting!  But what matters is that nurses are not only signing this Declaration, but we are acting in our communities all over the world to put the values of this Declaration into action. We have heard from many nurses directly who have said “I have never taken this kind of action before, but now I am doing it.”

Of course not all nurses share the commitment that we have put forward, and we respect any challenge or difference of opinion.  The fact remains that there are hundreds of nurses who, like growing numbers of our colleagues and neighbors, continue to be alarmed by the actions of the new administration.  The book “Don’t Think of an Elephant” by George Lakoff has helped me to understand the perspectives that different people have concerning what is happening in our nation and the world. Recently a friend heard Professor Lakoff speak of central guidelines for resistance – ways to avoid inadvertently helping the new administration, ways to resist, and ways to promote the values that stand on the side of health and justice.  These guidelines can be applied not only to public action, but to our own language and thinking about the situation we are in:

1. Don’t use the name of the new President, and do not repeat his tweets.
2. Remember this is a regime and he’s not acting alone;
3. Do not argue with those who support him–it doesn’t work;
4. Focus on his policies, not his orange-ness and mental state;
5. Keep your message positive; they want the country to be angry and fearful because this is the soil from which their darkest policies will grow.
6. No more helpless/hopeless talk
7. Support artists and the arts
8. Be careful not to spread fake news. Check it.
9. Take care of yourselves; and
10. Resist!

If you have not found your way yet to a place and time to take specific political action.in your community, go to the Indivisible Guide website – and start by searching for groups in or near your zip code.  Read the guide, talk with your friends, explore existing groups or form one of your own.

When you get involved in a group, let everyone know that you are a nurse, and that you are speaking up based on the values that nurses hold dear! Together we can make a difference! And let us know here!  Add your comment to our blog any time to share what you are doing, because your action inspires all of us to act in our own ways and times!

Nurses Declaration of Solidarity and Resistance


The 2017 U.S. Executive Branch is taking steps that will have an effect on the health and well-being of all who reside within the borders of the United States, and of all people worldwide.  At this moment in history, we call upon nurses to stand together, act to resist that which harms health and well-being, protect those who are harmed, and build coalitions that move toward the ideals we seek.  We stand on a long legacy of political activism by nurses that arises from our moral imperative to actively promote public policy to assure social/health equity. Our actions are grounded in the premise that health and well-being depends on healthy environments and  just communities. We pledge to join with others to engage in determined action to protect health and justice for all, regardless of age, social/economic circumstance, religion, skin color, race, sexual orientation or gender identity.

1. We believe that health and well-being of mind, body and spirit is a fundamental human right.

As nurses, we are committed to provide care for all people – care that promotes and supports high level wellness, prevention and treatment of injury and disease, and restoration of health when it is compromised.  

2. We believe the integrity of our environment is integral to human health and well-being.

We oppose all actions that contribute to damage and erosion of the earth’s ecosystem and the physical structures which we inhabit. We will promote, protect, and support actions toward healthy and sustainable structural and natural environments for all the earth’s inhabitants.   

3. We believe that all people deserve access to affordable quality care.

As nurses, we are committed to caring for all patients and families, regardless of economic status, sexual orientation/gender Identities, current immigration status, age, ability to pay, or spiritual/religious beliefs/practices (or lack thereof).

4. We oppose all forms of oppression and discrimination.

We commit to protect and care for those whose safety and well-being is threatened based on gender, race, ethnicity, nationality, sexual identity, physical ability, economic status, or any other attribute seen as “difference.”  We will take public stands opposing any attempt to weaken public policies and programs designed to protect health and well-being of those who are disadvantaged. We will fight for policies and programs that assure equality and justice.

5. We oppose intimidation and violence in our homes and communities.

We will act to protect any who are victims of intimidation and violence, particularly those who are vulnerable because of skin color, race, sexual orientation, gender identity or religion.  As nurses, we nurture peaceful resolution of conflict and support those who step up to intervene peacefully in situations of threat and danger.

6. We believe that the health of women must be protected.

We will act to assure that all women receive the full range of care that assures their right to control their own reproductive choices as well as all women’s healthcare services needed to maintain their own health and the health of their families.

7. We trust scientific knowledge that supports a wholistic approach to nursing care

We examine all sources of evidence to inform the choices we make in caring for those we serve. We can assure the public that we practice from a firm foundation of sound and reliable scientific evidence. We will take all steps needed to inform the public of the science that supports our practices.

We invite all nurses, and our colleagues who support our values, to join us in declaring these  values and actions by signing this declaration. You can add your signature to this document here.  We invite you to use this declaration as you wish, and revise to suit your own purposes.  Let us know of your actions, follow #nursesresist, and join our Facebook group.

Contributing authors:

Carey S. Clark, PhD, RN, AHN-BC
Peggy Chinn, RN, PhD, FAAN
Elizabeth Berrey, PhD, RN
Lisa Sundean, RN, MS, PhD Candidate
Adeline Falk-Rafael, PhD, FAAN
Leslie Nicoll, PhD, PhD, MBA, RN, FAAN
Sue Hagedorn, RN, PhD, FAAN

Thank you to the Cambridge Health Alliance for inspiration!

If you would like to co-sign your name to this declaration, please provide your information using this formThe list of co-signatories will be updated as frequently as possible.

SEE THE DECLARATION AND LIST OF SIGNATORIES HERE