Showing posts with label drugs. Show all posts
Showing posts with label drugs. Show all posts

10 December 2017

Good Drug, Bad Drug

by Mary Fernando

I would like to introduce my colleague: an Emergency Room doctor with a passion for crime novels. He is a father and an all around good guy who saves lives regularly. He is also a passionate fan of crime novels and has some interesting ideas about murder. I will call him Emergency doctor Extraordinaire or EE for short.

My interview with EE was wide-ranging, but one of the issues he discussed at length was fentanyl - a drug that we hear about daily as a killer of addicts. In EE’s hands, fentanyl is transformed into a character, a noble one that has fallen into disrepute, and finally becomes a murderer of one person at a time, or many in one fell swoop.

Let me tell you EE’s story of fentanyl: the good guy gone horribly wrong.

Although fentanyl has been in the news as a deadly street drug, it has far nobler origins. Since the 1960s, fentanyl has been used as a pain reliever when other opioids aren't strong enough. About 50 - 100 times more potent than morphine, fentanyl is used for cancer pain and thank goodness we have it. In the hands of a doctor who prescribes the right dosage, it is a safe and decent drug. I stress the word decent, because if you haven't seen a person screaming in pain, then you have no idea how relieving this pain is the height of decency and good medicine.

However, if the dose of fentanyl is too high it can cause death. Fentanyl binds with opioid receptors in the brain that give a sense of well being. The problem is that these same opioid receptors are found in the area of the brainstem that controls breathing. So, breathing - essential to living - can be shut down by this same sense of well being - everything is fine it says - no oxygen needed. A high dose of fentanyl gives people such a sense of well being that they forget to breathe.

That last sentence should give us all pause: smothering while surrounded by air. For those of us who write about murder, the focus is always justice - righting a wrong. The murderer is that vile, unsavoury creature to be chased down and brought to justice. However, not all methods of murder are equal and, I would argue, the method of murder is a character in itself. And you will find few viler methods of murder than fentanyl and smothering a victim in air.

So, back to my EE and his thoughts: ‘In a fentanyl naive patient, it can kill at much smaller doses, so a patch that is therapeutic for cancer patients, can kill someone who has never received fentanyl.’
As with all drugs, a tolerance develops. So, patches, clear and small, can be put on the skin of a victim who is fentalyn naive. EE thinks a nicotine patch or other patch could easily hide it and be removed after. Another intriguing method of delivery is a nasal spray - so perhaps a method of substituting that for Aunt Gertrude’s sinus irrigation? Would this come up on an autopsy? EE responds by saying, “At first glance it would look like someone had a heart attack and died.”

This also brings up the issue of getting fentanyl. Healthcare workers can pretend to give it and store it up. Even a couple of patches could kill an opioid naive victim. Or there is always the street market.
EE pointed out a very frightening and immensely writeable option: weaponizing of carfentanyl. This drug is 100X more potent than fentanyl, and as much as 10,000 times stronger than morphine. There is the frightening scenario of mass murder. Carfentanyl’s deadly potential comes as no surprise to the various countries that have experimented for decades with weaponizing this synthetic opioid.
Although never officially confirmed, it was reported that the Russian military pumped aerosolized carfentanyl into a theatre to incapacitate the armed Chechens who took more than 850 people hostage in 2002. In this event, more than 120 hostages died.

This has thriller written all over it. An aerosolized form can kill many - how about a chase to find the carfentanyl and those who plan to use it?

If a character can be a focus- so can the weapon of choice. There is something poignant about a noble drug, developed to ease the extreme suffering of patients, being turned into a killer. Worse, this killer can then massacre thousands. It is a noble character gone wrong. And the making of a crime novel. Or a thriller.

19 January 2017

An Addict's Life

by Eve Fisher

Divine in Heaven T-shirt.jpg
Divine
(Source)
I grew up in Southern California in the 60's, which explains a lot. (Thank-fully, there was no Facebook, and no cell phones that took pictures, so I can deny everything.)  As I've said before, it was an interesting time and place to be a teenager.  There's nothing like starting off in a place where there are people of every ethnicity and religion.  (I still love the good juicy mix of people that you can only find in a multi-cultural city.)  Where people still might not be officially out of the closet - although wearing great designer drag - but the euphemisms were very thin and nobody was fooling anyone. (I learned about Jim Nabors when I was ten, and it didn't bother me a bit.) Where cult-shops were on offer everywhere you looked (which is why I know a cult when I see one, even if it's called a church, a party, a membership, or a club).  Where you were never sure if what was going on was reality or someone shooting a movie/tv show (now that could get a little weird...).

And then there were drugs.  Everywhere, oceans of them, both on and off-label, as it were.  I remember when I went to junior high, and the girls' bathroom reeked of what I quickly found out was not just cigarettes (my parents smoked), but also marijuana.  Reds and whites (downers and uppers) were widely available. And other things.  And wide recreational use was helped by the fact that both my junior high and high school were outdoor campuses.  Literally.

Only the actual classrooms and the auditorium were indoors.  The lockers were under the equivalent of concrete carports; the cafeteria was a row of vending machines (they even had burritos, which we all somehow ate and survived...) under their own concrete carport, and there were metal tables (never enough) under their own sheds.  The idea was that we students would dine and relax and run playfully on the wide and spreading lawns.  And we did.  Just not the way they [officially] planned.

Now, my personal experience in life is that almost all children and teenagers, given half a chance to run amok, will.  And in Southern California, where the weather was good and the teachers were worn out...   So freedom, space, opportunity...  most of us took it.

There is a period, from say 12 to 25, where people will do as much drinking, drugging, etc. as they can.  Whether or not they really feel like it.  Those of you who have ever worked at a candy store or a pizza place and been told, "eat all you want" will know how after a while, you don't really feel like it anymore, but you keep doing it because it's free, man, and you're supposed to want this stuff... Most people, after a few weeks/months of gorging will stop.  They may never want the candy, etc. ever again.  But during that time of gorging, you'd be really hard pressed to figure out who's an addict/alcoholic and who isn't.  I know anyone who watched me from 14 to early 20s would have been sure I was headed to rehab.  I drank, I smoked, I did some prescription drugs (my parents had bottles of both booze and Darvon everywhere), and later, when I left home, I did everything I could get my hands on. Just about everyone I knew did the same.

And then, it got old.  I quit doing pretty much anything but pot, alcohol, and cigarettes when I turned 18.  I quit smoking dope a couple of years later, when I figured out that it did nothing for my writing but make me think it was better than it was.  And then there was the early morning (2:30 PM) after the last big New Years' party of my life, where I turned to my new husband and said, "There has got to be a better way to start a new year than this."  And from then on, I was a social drinker.  One glass of wine, two at the most, and I'm done, thanks.

So, if you want to figure out if your teenager is an addict or alcoholic, chances are you really should wait until they're in their 20's to make a final call.  (I know, I know, what if you can't wait that long? Go to Al-Anon.  I am dead serious.  It can save your sanity, and perhaps your life.  Check HERE for a meeting near you.)

So, everything worked out great for me, right?  Yes, it did.  Except that I had one addiction I could not shake:  cigarettes.

Marlboro - my brand for years
Now this didn't bother me for years.  I loved smoking.  I loved the taste of it, the feel of it, the style of it, watching the smoke curl up to the ceiling, the activity, the movement of my hands, and the knowledge that I always had something to do.  It warmed me when I was cold, cooled me off when I was hot, tamped down the hunger pangs, tasted sooo good after a meal, fit in perfectly with my reading addiction (see my blog of 1/5/17), and was somewhere between the best thing that ever happened to me and my pacifier.  Smoking was entwined in almost everything I did, in almost every moment of my day.  I didn't know and I didn't care whether or not I was addicted: smoking was GREAT.

Fast forward twenty, thirty years.  I'm in my 40s, and I'm starting to feel it.  Colds sink into my chest and stay there.  I kind of want to quit, although I don't actually say it.  I'm struggling to cut down, to keep it under a pack, which I manage, and then under half a pack.  If I only smoke half a pack, that's fine, right?  It's better than nothing, and I still can't imagine being without cigarettes.  How do people live without smoking? How did I?  I can't remember it?  I can't envision it - not without a panic attack.  I am hooked, although I'm still in denial...

In my 50s, and I want to quit, God do I want to quit.  I can't deny it anymore:  my lungs are foggy, I'm coughing too much, my wind is gone, this is not good.  My journals are all about my struggle with addiction:  I tried Chantix (didn't work); I tried tapering down even more; I tried to quit outright, and failed, because I kept being ravaged by desire for a cigarette...  and I couldn't not give in.  I kept doing that years.  Tapering off, cutting down, going back, quitting, going back, on and on and bloody on...  I couldn't live with out that damned cigarette.  And the next one after that.  And the one after that...

Image result for horehound drops
Not me, but close enough...
(Source)
When I did quit, it was a miracle, plain and simple. My husband had a heart attack, and was hospitalized for 3 days.  I spent those days in the heart hospital with him, and I knew that that meant the nicotine was physically out of my system.  So - now or never, baby! And, by the grace of God, along with a sack of horehound drops big enough to choke a small hippo and a stack of straws, I quit.

TIP OF THE DAY:  If you cut a straw in half, it is the exact size and shape of a cigarette, and not only can you can puff away on them, but it fills that space in your hands, and that hand-to-mouth action of smoking, that cigarettes held for years.

There were times I thought I would die.  I'd walk by someone smoking and smell that warm, wonderful smell and practically reach down their shirt pocket for a smoke.  Something stressful would happen, and I would walk around the house puffing madly on that damned straw and thinking "this is lame."  And there would be that time, late afternoon, work mostly done, sitting on the sofa with a cup of tea and my heart breaking because that had been the best cigarette of the day.  (That and the one after lunch, the one after dinner, the one after that, and...)  But, through the grace of God, I bulled through.  For one thing, I kept telling myself, "Fine, go ahead and have one.  But if you do, you'll just have to quit again."  And I knew I could never go through this again and make it...

Skull with a Burning
Cigarette -
Vincent Van Gogh
And now, I have over 6 years smoke free (after 40 years of smoking). God is great.  Huzzah!

Why am I telling you all this?  Because addiction is real.  Addiction is a disease.  I learned that the hard way.  There are still times when I want a cigarette.  There is a part of my mind that - against my will, I swear to God - likes to look back with nostalgia and regret for the good old days of smoking.  I've got my addiction, like a gorilla, bound up in a corner in my mind, but if I give it an inch, it will come roaring out and eat me alive again.  I know that.  And I'm terrified of that.

And at the same time, I'm so glad.  Because otherwise, how would I understand what it's like for alcoholics? drug addicts? addictive gamblers? other addicts? How could I relate to the guys at the pen, most of whom have been wrestling (and mostly losing) the battle with the gorilla for years?

It's not a matter of will power.  It's not a matter of moral fiber.  It's a mental/physical disease that takes a long, hard time to uproot.  That sometimes is never uprooted.  That is waiting, always, to lure you back again, into one more dance with the devil.  And the worst part of it is the mental, not the physical.  It's the mind - that devious, malicious, faux-nostalgic, faux-friendly, faux-helpful f***ing mind that still screws with me, and that I'll have to watch out for until my dying day.  And so will every other addict.

Image may contain: textMaybe someday our laws will reflect that.  As I've said before, mental illness has been pretty much made illegal in this country.  Rather than getting treatment, it's expected that the family will get their loved one the help they need -
(a brief intermission while all of us in Al-Anon or other family support groups have a long, hard, bitter laugh - again, HERE's the link to Al-Anon, and to NAMI
that the family will somehow get their loved one to the treatment they need, make sure they take their meds (if any exist), and keep them out of trouble.  It doesn't work.  (In fact, usually, it's the people closest to you that you can help the least.) Allow me to repeat that:  IT DOESN'T WORK.

Addiction, like any other mental illness, like any other illness, needs professional help from the get-go, not shame and secrets and expectations that do nothing but drive it further underground.  And then, when the addict finally does something that lands them in the hospital and/or prison and/or the morgue everyone acts so shocked!  How could that happen?

Because there isn't enough treatment.  Because there aren't enough facilities.  Because there aren't enough programs.  Because none of them, without really GOOD insurance, are affordable.  Because we don't believe, as a nation, that addiction is an illness, that mental illness is really an illness, and that treatment / medication / therapy really works.  Instead, we keep talking this BS about willpower, and then, when people's lives have crumbled, we say stupid things like, "I hope they get the help they need."

Maybe.  Someday.  In the meantime, I am so fortunate, and I know it.  


07 June 2015

Dread Pirate Roberts

by Leigh Lundin

Day in history, 1 October 2013: A half-cocked Texas Tea Party senator shut down the federal government for seventeen days. The resulting outcry in Washington, panic on Wall Street, and consternation in world markets eclipsed another important news story. Outside of crime and tech circles, the public barely took notice of the seizure of Silk Road, the largest, most far-reaching criminal enterprise in the world, and the arrest of its young founder, Ross Ulbricht, aka, Dread Pirate Roberts.

A few days ago, a judge sentenced Ulbricht to two life terms.

Joshuah Bearman and Tomer Hanuka of Wired Magazine have created a fascinating and comprehensive article. I recommend checking their story, part 1 and part 2. Their article reads like a crime novella… and a Greek tragedy.

Recap

The hallmark of a Greek tragedy is hubris, encapsulated in mythology because of human (and human-like) failing. The putative Greek hero ascends, attaining glory and fame, only to be brought low by his (or her) own weaknesses and arrogance.

Such happened to Ross Ulbricht, an entrepreneur, ardent libertarian, former Eagle Scout and non-violent idealist… until the day he wasn’t. He began what he called a libertarian experiment, an on-line drug bazaar, a better eBay than eBay. He named the enterprise Silk Road after the ancient Asian trade routes.

Silk Road didn’t sell only drugs, they sold collectibles, electronics, and other goods much like Craig’s List. The web site also featured Silk Road chat, Silk Road forums, Silk Road wiki, Silk Road exchange, Silk Road credit union, Silk Road market, Silk Road bookstore, and Silk Road libertarian musings by its founder.

Ulbricht promoted trust, partly through anonymity, and partly through BitCoin exchange, but also through efforts to see customers were treated right. He devised an on-line escrow (which eBay should have done years ago), provided reviews and customer support. Ulbricht is noted for writing in his journal “This is more than a business to me. It’s a revolution and is becoming my life’s work.”

Security and anonymity were provided by software originally created by the US Navy. TOR, an acronym for The Onion Router, offered encryption for web sites behind the curtain that hides both legal and illegal activities, as seen in this video Inside the Dark Web or the recent movie, The Deep Web.

Ulbricht used a clever pseudonym as suggested by his mentor, Variety Jones. That alias was Dread Pirate Roberts, from the novel and subsequent film, The Princess Bride. In the story, Dread Pirate Roberts isn’t merely one person but, like Lee Falk’s The Phantom, a series of leaders who hand off the reins and the DPR name to a chosen successor when they become rich enough to retire. In conjunction with Silk Road, the sobriquet obscured who DPR was. Indeed many people believed Roberts was multiple people.

Operation Onion Peeler

The FBI geeks who went after the leader of Silk Road faced an intriguing challenge from a guy who made few mistakes… but a couple of errors was all it took. The digital police didn’t use a battering ram to get their man, they used finesse– or, as one described it, a form of ballet.

There’s little question Ulbricht ran Silk Road nor doubt he deserved a prison sentence for his misdeeds. But two life terms? The judge succumbed to pleas from the prosecutor to “send a message.”

Not all of us are fans of judicial messaging and over-sentencing, but a few other issues need to be considered. One is conspiracy and intent to commit the murder of at least one person and possibly five others who had stolen from the enterprise. That certainly shatters the image of the gentle idealist who wanted freedom for everyone.

However, the murder charge is murky. A Silk Road employee named Curtis Green had supposedly stolen $350,000. Ulbricht lamented how to handle it, writing that he didn’t want to use violence if Green would simply return the money. But Variety Jones, his mentor, urged Ulbricht to kill Green and referred to Green as the ‘organ donor’.

But the plot sickens. It turns out the money was actually stolen by Secret Service agent Shaun Bridges and facilitated by DEA agent Carl Force, who are being charged with the theft as well as other crimes, including laundering another half million dollars in BitCoins.

In other words, two federal agents stole funds using Green’s account, implicating him in the eyes of Ulbricht and moving him to homicide. One wonders if this constitutes entrapment, tipping Ulbricht over the edge of using violence to protect his interests. The only good part was that Green was in custody and not in imminent danger.

Ulbricht’s attorney is appealing the verdict.