AIDS at 30

Boom. Heroin has gone viral, just as AIDS did back in the day when our complacency gave the virus a head start that will take us a full century to overcome.

How Long Island’s Opiate Crisis Threatens HIV Prevention Goals

It’s World AIDS Day again and this year’s theme is “Getting to Zero,” suggesting that the complete elimination of new HIV infections and AIDS-related deaths is within our grasp. After thirty years and 30 million AIDS deaths worldwide, that’s of course, great news. Echoing the theme, Secretary of State Hillary Rodham Clinton mused about an “AIDS-free generation” in a November 8th speech and Ambassador Dr. Eric Goosby, who serves as the U.S. Global AIDS Coordinator, recently opined on the Huffington Post that we are at a “tipping point” in the fight against the deadly disease.

President Obama, in the forward to his administration’s long-awaited National HIV/AIDS Strategy released in July of last year, noted that nearly 600,000 Americans have died of AIDS since the onset of the epidemic, 56,000 still become infected each year and an estimated 1.1 million are living with HIV, the virus that causes AIDS. Still, the document predicts that “the United States will become a place where new HIV infections are rare,” and lays out a goal to reduce HIV infections by 25% by 2015. Wait. Twenty-five percent? Is that really the best we can do?

That means that in 2015, 42,225 people will become infected with HIV, instead of the current 56,300 and that between now and then, best case scenario is another 150,000 Americans infected with an incurable, invariably-fatal virus that is 100% preventable. That’s what success looks like in Washington these days.  At that rate – a 25% reduction in new infections every five years – we’ll still have 24,000 new cases in 2025, 10,000 annual infections in 2040 and in 2060 – 50 years from now – we’ll still have 3,171 people each year that contract HIV. We won’t fall below 1,000 new cases until about 2081, which is exactly 100 years after the epidemic first appeared among a handful of gay men. Now anything can happen, but it sure looks like we’re going to take our time “getting to zero” and it’s safe to say that the “AIDS-free generation” probably won’t occur in our lifetimes. What’s worse is that given the current state of affairs, we probably won’t even hit those targets.

Obama’s director at the Office of National AIDS Policy – who helped write the report – resigned last month, the federal budget is a mess and HIV is the last thing on anyone’s mind. The failure of the Congressional “supercommittee” to come up with a workable fiscal plan means that essential programs for people living with, and at risk for HIV are threatened with deep cuts. Medicaid, Medicare, the Ryan White Program, public assistance, unemployment benefits and HIV prevention programs are all on the chopping block. State and county funding cuts have impacted local community-based programs and schools, which means fewer HIV-tests, less prevention education and ultimately, more infections.

While AIDS has historically been protected from funding reductions, both because of the severity of the epidemic and the grassroots activists that sprung into action at every whispered threat, those days are over. Everything is on the table, AIDS has morphed from a short-term acute crisis into a chronic, intractable problem and fighting the disease doesn’t appear to be on anyone’s list of priorities.

But there’s another variable that promises to set-back anti-HIV efforts in a big way and it didn’t even get a mention in the Administration’s report: our rapidly expanding heroin crisis among young people. We’ve seen it here on Long Island and communities – especially suburban centers – across the nation are experiencing the same thing.

A quarter of all new HIV infections nationwide occur in young people ages 15-29. Most don’t know that they are infected and as such, unwittingly pass the virus on to their peers either through unprotected sex or contaminated needles. Kids who are high on heroin – or anything else for that matter – have sex more frequently than their peers, and they do things they wouldn’t otherwise do when they are impaired or in search of the next fix.

Heroin has hit Long Island hard and the number of addicted young people continues to skyrocket. Most start with prescription pills and eventually move from $50 OxyContins to $10 bags of heroin. The longer you use, the more you need to use in order to achieve the same effect, so you become the go-to person who heads into Bushwick and brings back enough for your friends in order to finance your increasingly expensive habit. Boom. Heroin has gone viral, just as AIDS did back in the day when our complacency gave the virus a head start that will take us a full century to overcome.

Young people who two years ago were snorting heroin, are now injecting it. They’re sharing needles and they’re having unprotected sex, in part because they haven’t gotten the messages about HIV, Hepatitis C and sexually transmitted infections. Prevention materials – created in the 1990’s – tend to focus on the older drug user and many treatment programs still don’t do a great job teaching risk reduction, despite the well-established connection between addiction and communicable diseases, including HIV. This cohort of young people isn’t likely to call an AIDS hotline, attend an educational program or visit a health-related website because they don’t see themselves as being at risk.

Sure, they know about AIDS, but only as a distant threat and as a chronic manageable condition akin to diabetes. They were in diapers when President Clinton took on AIDS in a way his two predecessors wouldn’t and when MTV ran a steady stream of PSAs between music videos. They’ve never heard of Ryan White and probably don’t even know that Magic Johnson is HIV-positive. They didn’t see their friends tethered to IV poles and literally wasting away in what was then called the Nassau County Medical Center or Stony Brook Hospital for weeks at a time. They didn’t witness the discrimination – the worst of which often came from family, or attend the steady stream of funerals, and have never climbed the walls waiting for results of an HIV-test.

While we’ve made some strides in the last 30 years and AIDS is a different disease than it was back then, it’s still no party and if we don’t change course, we’ll have a brand new wave of HIV infections on our hands. Young people who find a path to recovery from addiction and begin rebuilding their lives will get slammed with a life-changing diagnosis and an AIDS-free generation will remain even further out of reach.

Our Addicted Island Hits Rock Bottom

The seeds of addiction have been sewn into the Long Island community and its roots have firmly taken hold. At a time when Long Island as a whole could use an intervention, funding for critical programs is being cut. LICADD Director Jeffrey Reynolds examines needed policy changes to put our Island on the road to recovery.

If four people being shot dead in a pharmacy isn’t hitting rock bottom, I don’t know what is. As the victims – Jaime Taccetta, Raymond Ferguson, Jennifer Mejia, and Bryon Sheffield – are laid to rest, they join Courtney Sipes and Rebecca Twain Wright and countless others who are also victims of Long Island’s drug crisis.

Sipes was run down on Main Street in Smithtown in November, 2009 by a driver allegedly high on heroin. Wright was gardening in her Hempstead front lawn when she was mowed down by Kayla Gerdes who was allegedly high on Xanax. Factor in all the others who each year, are killed by drunk or high drivers, in workplace accidents, assaults and other incidents and the collateral damage associated with unfettered and untreated addiction becomes absolutely stunning.

Indeed, addiction has always torn apart families, disrupted workplaces, ruined lives and given its progressive nature, often proves fatal to the one with the disease. But now it seems that the wreckage can’t be contained behind closed doors where families quietly and privately suffer the consequences – and is spilling out into the public domain, sweeping unsuspecting folks into its path.

How bad has Long Island’s addiction gotten when you can’t even pick up a prescription, cross a street or walk out your front door without being in danger? Or better yet, how bad does it need to get before we do something?

Pretty bad, it seems. After all, we’ve been talking about Long Island’s heroin crisis for years and the connection to prescription meds has been clear from day one. Addicts make the move to heroin from more expensive prescription meds once they figure out that 80mg of OxyContin costs $40-$50 on the street, while heroin runs just $10 per bag. Despite the media attention, school-sponsored parent workshops, legislative forums, educational campaigns and ambitious policy recommendations from blue ribbon panels like the Suffolk County Heroin and Opiate Task Force, not much has changed.

Arrests and overdoses continue to climb and the pain in our community is palpable, ironically due in large part to the misuse and diversion of prescription meds. That’s not to say that we should restrict access to medications that give chronic pain sufferers some relief and increased quality of life. As our population ages, we needn’t go back to dark ages, but we do need to get serious about a drug crisis that is claiming far too many lives. Here’s how:

  • Opiates are controlled substances. Control them. Prosecute the bad doctors that sell prescriptions and run pill mills. Convict them, take their licenses and sentence them like street drug dealers.
  • Educate, train and support the other 99.9% of doctors and physician assistants who try to do the right thing, but are often fooled by addicts who are charming, demanding and laser-focused on getting their fix.
  • Limit doctor shopping and pharmacy hopping by strengthening the prescription drug monitoring database to include real-time updates and give access to pharmacists. This database already exists, but is updated just monthly and only physicians – with limited time on their hands – have access to the information.
  • It’s time to reign-in the burgeoning pain management industry. The good guys will tell you that they can spot drug-seeking behavior a mile away, are willing to turn patients away, even if police intervention is required and they perform routine drug testing of patients. If you’ve been given a thirty-day supply of Vicodin and a quick urine test reveals that you’ve got none in your system or other drugs are present, then it’s time for a conversation.
  • National surveys suggest that 77% of those under the age of 25 get their first taste of prescription painkillers from their parents’ medicine cabinet, a friend or relative. How about we enforce state law requiring pharmacists to counsel patients picking-up prescriptions about the proper use and storage of medications? As consumers, we waive counseling when we sign that log at the pharmacy desk. A simple question from a pharmacist or pharmacy tech about whether there are teenagers in the home, along with a sentence or two about the addictive properties of opiate painkillers could go a long way.
  • OxyContin, Vicodin and other opioids are used to treat pain and are quickly replacing alcohol and marijuana as the drug of choice among adolescents. Being a teen has never been easy and kids have always done unsafe, unhealthy things, but we need to figure out why adolescence has become so damn difficult that our young people are turning to the strongest painkillers known to man to relieve the suffering. And by the way, how about we stop allowing pharmaceutical companies to promote expensive pills as a solution for everything from impotence to anxiety to difficulty urinating? 
  • Just as substance abuse is 100% preventable, addiction is treatable. Despite all the attention to heroin, drug treatment slots have not grown in recent years. In fact, they’re shrinking thanks to state budget cuts and an unprecedented demand for assistance. The Baldwin Council Against Drug Abuse, for example, is in the process of shutting down and two other drug treatment providers in Nassau will likely suffer the same fate before Summer’s end. Surviving agencies report long waiting lists and an unprecedented demand for help. We need to make treatment on demand a reality.

Without intervention and treatment, addiction is a progressive disease that often proves fatal. It gets worse as time goes on. It deepens and becomes more intractable. The risks to health, safety and well-being multiply and the consequences worsen. That’s where we are here on Long Island right now.

While accused Medford gunman David Laffer and his wife Melinda Brady have denied that they’re addicts, the storyline sounds far-fetched and may change at trial. Struggling with dependency, though, doesn’t earn them a free pass and if convicted they should be punished accordingly. The Medford murders do, however, remind us that our continued denial and collective failure to adequately address what has become Long Island’s top public health problem places each and every one of us at risk.

Charitable Choices

Dr. Jeffrey Reynolds gives tough love to colleagues in the nonprofit sector telling them, “Times are going to get tougher and there’s less money to go around. Some nonprofits will not survive the recession and perhaps they shouldn’t. We need to stop playing the victim and get into the game.”

Jeffrey Reynolds Jed Morey
AP Photo courtesy of the Long Island Press

The sky is falling. Again. The state budget deal approved last month contained significant budget cuts disproportionately aimed at education, health and human services, as did the recent federal budget deal that helped avert yet another government shutdown.  At the county level, youth organizations are fighting for their lives in Nassau where continued funding is being tied to red light camera revenues.  Suffolk County is facing a $127 million deficit that will only deepen as we head into the fall budget season.  And if you think this is bad, just know that by all accounts, 2012 is going to be even uglier.

For most of Long Island’s nonprofits, this is just the latest series of body blows. Foundations with declining major gifts and lower investment returns are naturally making fewer grants. Companies don’t make corporate contributions when their revenues are in the toilet and they’re laying-off staff; only LIPA does that. For the average Long Islander struggling to pay their bills, well, charity begins at home.  And at the same time, record numbers of volunteers and contributors are becoming clients looking for a helping hand from local charities instead of giving one. Requests for assistance have skyrocketed, creating the proverbial “perfect storm.”

Some charities are weathering the storm better than others, but it’s tough for even the best managed, well-established, resourceful and leanest organizations to meet the growing demand for services in this environment. That’s in part because there are more than 3,000 non-profits on Long Island. While some are quickly-incorporated non-functioning entities that never quite got up and running, at least half are going concerns whose biggest challenge these days is staying in business.

There are lots of nonprofit executive directors laying awake at night these days trying to figure out how to reduce client waiting lists, keep the lights on and make payroll. Business owners do that all the time; it goes with the territory. But there’s got to be a better way.

Nancy Lublin who runs, argued in the December 2010 issue of  Fast Company that charities – especially those that have achieved their missions – should have an expiration date.  “For-profits go out of business all the time, for reasons good and bad, from fierce competition to poor management to an inability to adapt. Lehman Brothers. Circuit City. Linens ‘n Things. All dead!” she writes, before issuing this challenge: “Now try to name a closed nonprofit.”

Of course, the work of many organizations isn’t done. We haven’t yet conquered poverty, homelessness, hunger, addiction, youth violence, sexual assault, AIDS, or cancer and the likelihood that we’ll eradicate these plagues anytime soon is pretty nil. Maybe that says something , too.

As an alternative to just closing up shop, the non-profit world and its funders have talked about “consolidation” and “mergers” for years, especially as times have gotten tougher. We all agree it needs to happen, but it hasn’t.  Merger discussions between regional nonprofits haven’t panned out for one reason or another – boards or management teams were incompatible, the programs weren’t a good mix or it “just didn’t feel right.”

Here’s the problem, though: Each of Long Island’s roughly 1,500 operational nonprofits has its own board of directors, an executive director or CEO, office rental costs and overhead expenses. Each one receives tax breaks, collects community contributions, enjoys the goodwill of volunteers and a fair amount get government grants.  Each one competes with the other for charitable dollars and at the end of the day we all have less money to spend on services. Our dream of actually achieving our agency mission, solving some problems and moving on becomes ever more elusive.

But faced with yet another round of budget cuts, we hold press conferences and rallies, wave placards, give fiery speeches, launch Facebook campaigns, and encourage our clients to call, write and hound our elected officials. We use words like “draconian” and “irresponsible” to characterize proposed reductions. We threaten to close programs, turn folks away and promise to send them en masse into the offices of elected officials. Nobody particularly wants a waiting room full of homeless, hungry, disabled or sick folks, so we often get our way and win at least partial funding restorations. Until now, this well-rehearsed strategy has worked pretty well, but all of us hate doing it and it’s simply not sustainable. It’s exhausting and the need to ratchet-up the rhetoric with each proposed round of cuts undermines our credibility.

Times are going to get tougher and there’s less money to go around. Some nonprofits will not survive the recession and perhaps they shouldn’t. Digging our heels in and desperately repeating our “no cuts” mantra leaves us out of some important conversations where our intelligence and experience could help reshape the non-profit sector in a way that preserves decades worth of investments. We need to stop playing the victim and get into the game. We know which nonprofits are high performers and which ones aren’t. We know which programs work and which ones don’t. So do our clients. Government – as the largest purchaser of health and services – is beginning to figure it out, too. 

The general public, though, doesn’t care. They want government to spend less so that they in turn, will pay fewer taxes and be able to support their families. They want it to happen now and they don’t care if the cuts are across-the-board, rather than strategic, surgical and well-considered. So far, most of the public pressure for change has been focused on school districts and the messages have been clear: Consolidate. Eliminate waste. Stop spending money we don’t have. Become more transparent, efficient and stop clinging to the outdated, implausible notion that any funding reductions will result in the end of civilization as we know it.  The message to nonprofits, though not yet as explicit, is exactly the same.

Quitting Charlie Sheen

Party Boy Sheen at Play

I promised myself I wouldn’t write about Charlie Sheen, so this article isn’t about him. It’s about us.

It’s about the millions of us who have tuned-in to watch Sheen’s rambling prime-time interviews, the 966,000 who “like” Charlie’s Facebook page and the thousands who have bought tickets to his multi-city “My Violent Torpedo of Truth/Defeat is Not An Option Show.” The allure is clear and age-old: A handsome, famous and ridiculously rich actor from a storied family goes on a coke-fueled bender with porn-star hookers, tells the corporate boss-man to stick-it, brands his two of his three ex-wives “bitches,” and proclaims himself a “high priest Vatican assassin warlock.” For voyeurs who love to see successful folks stumble, it doesn’t get any better than that.

Beyond the garden-variety “hero falls from grace,” storyline though, there’s another dynamic at work. We are fascinated by people who are drunk and/or stoned and behaving badly. Whether it’s Gary Busey on this season’s Apprentice or Janice Dickinson on Celebrity Rehab, we shake our heads, laugh nervously and lament the fact that we – even without all that money, fame, and power – aren’t THAT messed-up. The fascination with addicts goes beyond celebs considering the immense popularity of shows like A&E’s Intervention, Hoarders and the dozens of spin-offs in the making including Relapse, a show detailing treatment failures set to debut later this month.

Peel away the rich and famous veneer and Charlie Sheen is an extreme version of the guy at a party, who an hour into it is making inappropriate comments to female guests, slurring his words and dancing around with a lampshade on his head. We all laugh at that guy, egg him on a bit and feel a bit better about pouring our third Grey Goose. We’re entertained, he’s emboldened. Win-Win.

For those with an addicted family member (and who doesn’t have a few of those?), their drinking, toking or snorting invariably pales in the context of Charlie’s, Lindsay and the Hoff’s bizarre behavior. We no longer feel the same urgency to act, but we tune-in to Intervention for re-assurance and a few tips about how one day to best to trap our loved one in a hotel room before carting them off to rehab.

It doesn’t take a psychology degree to know that Charlie’s got some issues – issues that likely transcend coke and booze. After decades of education and awareness, we’re finally starting to get that making fun of mentally ill folks isn’t cool, which is perhaps why we’ve focused on Sheen as an addict, rather than a guy with a psychiatric condition. Addiction is still fair game, because we don’t view it as a brain disease, but as a series of bad choices, a lack of willpower and a moral failing.

Addiction, of course, is a brain disease. Would we laugh at an autistic child’s struggles? How about a senior suffering with Alzheimer’s? Probably not. We wouldn’t remix their desperate words over pop songs or peddle t-shirts with their confused slogans. We wouldn’t send them onto the stage before a packed house at Radio City and we wouldn’t forward their YouTube videos to all our friends.

The public attention paid to Sheen isn’t good for him, nor for anyone else. Young addicts look at Sheen and are able to say to themselves and others, “at least I’m not that f’ed up.” Sheen’s public potshots at Alcoholics Anonymous embolden treatment-resistant addicts’ beliefs that 12-step programs are thinly disguised cults, when in fact those groups have saved the lives of millions.

As much as Sheen’s rants delight, they also scare the hell out of some people.  His soliloquies reinforce the stigma associated with addiction and increase the barriers to care, compassion and recovery. LICADD – the nonprofit organization I run – has been looking for new office space in Nassau. About two-thirds of landlords have declined our offer to rent space once they figure out that our acronym stands for the “Long Island Council on Alcoholism and Drug Dependence.” Immediately, they conjure up an image of a hundred Charlie Sheens standing in their lobby ranting and raving as well-healed corporate types tiptoe by. Like it or not, Sheen has become the latest poster child for addiction.

That’s unfortunate because there are so many folks quietly struggling through the horrors and drugs and alcohol and an even greater number of those who have made it through to the other side. Profiling folks who have pulled their lives back together and are experiencing the miracle of recovery doesn’t make for good TV and just doesn’t titillate us in the same way.

During one of his rants, Sheen told the world, “I am on a drug – it’s called Charlie Sheen.” We all are Charlie. We all are.

Dr. Jeffrey Reynolds