Tag Archives: suicide

“Too many kids show worrying signs of fragility from a very young age…”

Story by Kate Julian

Updated at 10:30 a.m. ET on April 17, 2020.

Imagine for a moment that the future is going to be even more stressful than the present. Maybe we don’t need to imagine this. You probably believe it. According to a survey from the Pew Research Center last year, 60 percent of American adults think that three decades from now, the U.S. will be less powerful than it is today. Almost two-thirds say it will be even more divided politically. Fifty-nine percent think the environment will be degraded. Nearly three-quarters say that the gap between the haves and have-nots will be wider. A plurality expect the average family’s standard of living to have declined. Most of us, presumably, have recently become acutely aware of the danger of global plagues.

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Suppose, too, that you are brave or crazy enough to have brought a child into this world, or rather this mess. If ever there were a moment for fortifying the psyche and girding the soul, surely this is it. But how do you prepare a child for life in an uncertain time—one far more psychologically taxing than the late-20th-century world into which you were born?

To protect children from physical harm, we buy car seats, we childproof, we teach them to swim, we hover. How, though, do you inoculate a child against future anguish? For that matter, what do you do if your child seems overwhelmed by life in the here and now?

You may already know that an increasing number of our kids are not all right. But to recap: After remaining more or less flat in the 1970s and ’80s, rates of adolescent depression declined slightly from the early ’90s through the mid-aughts. Shortly thereafter, though, they started climbing, and they haven’t stopped. Many studies, drawing on multiple data sources, confirm this; one of the more recent analyses, by Pew, shows that from 2007 to 2017, the percentage of 12-to-17-year-olds who had experienced a major depressive episode in the previous year shot up from 8 percent to 13 percent—meaning that, in the span of a decade, the number of severely depressed teenagers went from 2 million to 3.2 million. Among girls, the rate was even higher; in 2017, one in five reported experiencing major depression.

An even more wrenching manifestation of this trend can be seen in the suicide numbers. From 2007 to 2017, suicides among 10-to-24-year-olds rose 56 percent, overtaking homicide as the second leading cause of death in this age group (after accidents). The increase among preadolescents and younger teens is particularly startling. Suicides by children ages 5 to 11 have almost doubled in recent years. Children’s emergency-room visits for suicide attempts or suicidal ideation rose from 580,000 in 2007 to 1.1 million in 2015; 43 percent of those visits were by children younger than 11. Trying to understand why the sort of emotional distress that once started in adolescence now seems to be leaching into younger age groups, I called Laura Prager, a child psychiatrist at Massachusetts General Hospital and a co-author of Suicide by Security Blanket, and Other Stories From the Child Psychiatry Emergency Service. Could she explain what was going on? “There are many theories, but I don’t understand it fully,” she replied. “I don’t know that anyone does.”

From December 2015: Hanna Rosin on the Silicon Valley suicides

One possible contributing factor is that, in 2004, the FDA put a warning on antidepressants, noting a possible association between antidepressant use and suicidal thinking in some young people. Prescriptions of antidepressants to children fell off sharply—leading experts to debate whether the warning resulted in more deaths than it prevented. The opioid epidemic also appears to be playing a role: One study suggests that a sixth of the increase in teen suicides can be linked to parental opioid addiction. Some experts have suggested that rising distress among preteen and adolescent girls might be linked to the fact that girls are getting their period earlier and earlier (a trend that has itself been linked to various factors, including obesity and chemical exposure).

Even taken together, though, these explanations don’t totally account for what’s going on. Nor can they account for the fragility that now seems to accompany so many kids out of adolescence and into their young-adult years. The closest thing to a unified theory of the case—one put forth in The Atlantic three years ago by the psychologist Jean M. Twenge and in many other places by many other people—is that smartphones and social media are to blame. But that can’t explain the distress we see in kids too young to have phones. And the more the relationship between phones and mental health is studied, the less straightforward it seems. For one thing, kids the world over have smartphones, but most other countries aren’t experiencing similar rises in suicides. For another, meta-analyses of recent research have found that the overall associations between screen time and adolescent well-being range from relatively small to nonexistent. (Some studies have even found positive effects: When adolescents text more in a given day, for example, they report feeling less depressed and anxious, probably because they feel greater social connection and support.)

A stronger case can be made that social media is potentially hazardous for people who are already at risk of anxiety and depression. “What we are seeing now,” writes Candice Odgers, a professor at UC Irvine who has reviewed the literature closely, “might be the emergence of a new kind of digital divide, in which differences in online experiences are amplifying risks among [the] already-vulnerable.” For instance, kids who are anxious are more likely than other kids to be bullied—and kids who are cyberbullied are much more likely to consider suicide. And for young people who are already struggling, online distractions can make retreating from offline life all too tempting, which can lead to deepening isolation and depression.

This more or less brings us back to where we started: Some of the kids aren’t all right, and certain aspects of contemporary American life are making them less all right, at younger and younger ages. But none of this suggests much in the way of solutions. Taking phones away from miserable kids seems like a bad idea; as long as that’s where much of teenagers’ social lives are transacted, you’ll only isolate them. Do we campaign to take away the happy kids’ phones too? Wage a war on early puberty? What?


Video: Kids Feel Pandemic Anxiety Too

Ihave been thinking about these questions a lot lately, for journalistic reasons as well as personal ones. I am the mother of two children, 6 and 10, whose lineage includes more than its share of mental illness. Having lost one family member to suicide and watched another ravaged by addiction and psychiatric disability, I have no deeper wish for my kids than that they not be similarly afflicted. And yet, given the apparent direction of our country and our world, not to mention the ordeal that is late-stage meritocracy, I haven’t been feeling optimistic about the conditions for future sanity—theirs, mine, or anyone’s.

From September 2019: Daniel Markovits on how meritocracy harms everyone

To my surprise, as I began interviewing experts in children’s mental health—clinicians, neuroscientists doing cutting-edge research, parents who’d achieved this unofficial status as a result of their kids’ difficulties—an unusually unified chorus emerged. For all the brain’s mysteries, for everything we still don’t know about genetics and epigenetics, the people I spoke with emphasized what we do know about when emotional disorders start and how we might head more of them off at the pass. The when: childhood—very often early childhood. The how: treatment of anxiety, which was repeatedly described as a gateway to other mental disorders, or, in one mother’s vivid phrasing, “the road to hell.”

Actually, the focus on anxiety wasn’t so surprising. Of course anxiety. Anxiety is, in 2020, ubiquitous, inescapable, an ambient condition. Over the course of this century, the percentage of outpatient doctors’ visits in America involving a prescription for an anti-anxiety medication such as Xanax or Valium has doubled.* As for the kids: A study published in 2018, the most recent effort at such a tabulation, found that in just five years, anxiety-disorder diagnoses among young people had increased 17 percent. Anxiety is the topic of pop music (Ariana Grande’s “Breathin,” Julia Michaels and Selena Gomez’s “Anxiety”), the country’s best-selling graphic novel (Raina Telgemeier’s Guts), and a whole cohort’s sense of humor (see Generation Z’s seemingly bottomless appetite for anxiety memes). The New York Times has even published a roundup of anxiety-themed books for little ones. “Anxiety is on the rise in all age groups,” it explained, “and toddlers are not immune.”

How do you inoculate a child against future anguish? What do you do if your child already seems overwhelmed in the here and now?

The good news is that new forms of treatment for children’s anxiety disorders are emerging—and, as we’ll see, that treatment can forestall a host of later problems. Even so, there is a problem with much of the anxiety about children’s anxiety, and it brings us closer to the heart of the matter. Anxiety disorders are well worth preventing, but anxiety itself is not something to be warded off. It is a universal and necessary response to stress and uncertainty. I heard repeatedly from therapists and researchers while reporting this piece that anxiety is uncomfortable but, as with most discomfort, we can learn to tolerate it.

Yet we are doing the opposite: Far too often, we insulate our children from distress and discomfort entirely. And children who don’t learn to cope with distress face a rough path to adulthood. A growing number of middle- and high-school students appear to be avoiding school due to anxiety or depression; some have stopped attending entirely. As a symptom of deteriorating mental health, experts say, “school refusal” is the equivalent of a four-alarm fire, both because it signals profound distress and because it can lead to so-called failure to launch—seen in the rising share of young adults who don’t work or attend school and who are dependent on their parents.

Lynn Lyons, a therapist and co-author of Anxious Kids, Anxious Parents, told me that the childhood mental-health crisis risks becoming self-perpetuating: “The worse that the numbers get about our kids’ mental health—the more anxiety, depression, and suicide increase—the more fearful parents become. The more fearful parents become, the more they continue to do the things that are inadvertently contributing to these problems.”

Read: What the coronavirus will do to kids

This is the essence of our moment. The problem with kids today is also a crisis of parenting today, which is itself growing worse as parental stress rises, for a variety of reasons. And so we have a vicious cycle in which adult stress leads to child stress, which leads to more adult stress, which leads to an epidemic of anxiety at all ages.

I. The Seeds of Anxiety

Over the past two or three decades, epidemiologists have conducted large, nationally representative studies screening children for psychiatric disorders, then following those children into adulthood. As a result, we now know that anxiety disorders are by far the most common psychiatric condition in children, and are far more common than we thought 20 or 30 years ago. We know they affect nearly a third of adolescents ages 13 to 18, and that their median age of onset is 11, although some anxiety disorders start much earlier (the median age for a phobia to start is 7).

Many cases of childhood anxiety go away on their own—and if you don’t have an anxiety disorder in childhood, you’re unlikely to develop one as an adult. Less happily, the cases that don’t resolve tend to get more severe and to lead to further problems—first additional anxiety disorders, then mood and substance-abuse disorders. “Age 4 might be specific phobia. Age 7 is going to be separation anxiety plus the specific phobia,” says Anne Marie Albano, the director of the Columbia University Clinic for Anxiety and Related Disorders. “Age 12 is going to be separation anxiety, social anxiety, and the specific phobia. Anxiety picks its own friends up first before it branches into the other disorders.” And the earlier it starts, the more likely depression is to follow.

All of which means we can no longer assume that childhood distress is a phase to be grown out of. “The group of kids whose problems don’t go away account for most adults who have problems,” says the National Institute of Mental Health’s Daniel Pine, a leading authority on how anxiety develops in children. “People go on to develop a whole host of other problems that aren’t anxiety.” Ronald C. Kessler, a professor of health-care policy at Harvard, once made this point especially vividly: “Fear of dogs at age 5 or 10 is important not because fear of dogs impairs the quality of your life,” he said. “Fear of dogs is important because it makes you four times more likely to end up a 25-year-old, depressed, high-school-dropout single mother who is drug-dependent.”

Compounding this, the young kids with mental-health problems today may have worse long-term prospects than did similar kids in decades past. That is the conclusion drawn by Ruth Sellers, a University of Sussex research psychologist who examined three longitudinal studies of British youth. Sellers found that youth with mental-health problems at age 7 are more likely to be socially isolated and victimized by peers later in childhood, and to have mental-health and academic difficulties at age 16. Concerningly, despite decreased stigma and increases in mental-health-care spending, these associations have been growing stronger over time.

Big societal shifts such as the ones we’ve undergone in recent years can hit people with particular traits particularly hard. A recent example comes from China, where shy, quiet children used to be well liked and tended to thrive. Following rapid social and economic change in urban areas, values have changed, and these children now tend to be rejected by their peers—and, surely no coincidence, are more prone to depressive symptoms. I thought of this when I met recently with the leaders of a support group for parents of struggling young adults in the Washington, D.C., area, most of whom still live at home. Some of these grown children have psychiatric diagnoses; all have had difficulty with the hurdles and humiliations of life in a deeply competitive culture, one with a narrowing definition of success and a rising cost of living.

The hope of early treatment is that by getting to a child when she’s 7, we may be able to stop or at least slow the distressing trajectory charted by Sellers and other researchers. And cognitive behavioral therapy, the most empirically supported therapy for anxiety, is often sufficient to do just that. In the case of anxiety, CBT typically involves a combination of what’s known as “cognitive restructuring”—learning to spot maladaptive beliefs and challenge them—and exposure to the very things that cause you anxiety. The goal of exposure is to desensitize you to these things and also to give you practice riding out your anxious feelings, rather than avoiding them.

Most of the time, according to the largest and most authoritative study to date, CBT works: After a 12-week course, 60 percent of children with anxiety disorders were “very much improved” or “much improved.” But it isn’t a permanent cure—its results tend to fade over time, and people whose anxiety resurges may need follow-up courses.

Illustration: Oliver Munday; Marco Pasqualini / Getty

A bigger problem is that cognitive behavioral therapy can only work if the patient is motivated, and many anxious children have approximately zero interest in battling their fears. And CBT focuses on the child’s role in his or her anxiety disorder, while neglecting the parents’ responses to that anxiety. (Even when a parent participates in the therapy, the emphasis typically remains on what the child, not the parent, is doing.)

A highly promising new treatment out of Yale University’s Child Study Center called SPACE (Supportive Parenting for Anxious Childhood Emotions) takes a different approach. SPACE treats kids without directly treating kids, and by instead treating their parents. It is as effective as CBT, according to a widely noted study published in the Journal of the American Academy of Child & Adolescent Psychiatry earlier this year, and reaches even those kids who refuse help. Not surprisingly, it has provoked a tremendous amount of excitement in the children’s-mental-health world—so much so that when I began reporting this piece, I quickly lost track of the number of people who asked whether I’d read about it yet, or talked with Eli Lebowitz, the psychology professor who created it.

In working directly with parents, Lebowitz’s approach aims to provide not a temporary solution, but a foundation for a lifetime of successful coping. SPACE is also, I have come to believe, much more than a way of treating childhood anxiety—it is an important keyhole to the broken way American adults now approach parenting.

When lebowitz teaches other clinicians how to do SPACE, he starts by telling them, several times, that he’s not blaming parents for their kids’ pathologies.

“Because we represent a field with a very rich history of blaming parents for pretty much everything—autism, schizophrenia, eating disorders—this is a really important point,” he said one Sunday morning in January, as he and his collaborator Yaara Shimshoni kicked off a two-day training for therapists. A few dozen were in attendance, having traveled to Yale from across the country so that they might learn to help parents reduce what Lebowitz calls “accommodating” behaviors and what the rest of us may call “behaviors typical of a 21st-century parent.”

“There really isn’t evidence to demonstrate that parents cause children’s anxiety disorders in the vast majority of cases,” Lebowitz said. But—and this is a big but—there is research establishing a correlation between children’s anxiety and parents’ behavior. SPACE, he continued, is predicated on the simple idea that you can combat a kid’s anxiety disorder by reducing parental accommodation—basically, those things a parent does to alleviate a child’s anxious feelings. If a child is afraid of dogs, an accommodation might be walking her across the street so as to avoid one. If a child is scared of the dark, it might be letting him sleep in your bed.

Lebowitz borrowed the concept about a decade ago from the literature on how obsessive-compulsive disorder affects a patient’s family members and vice versa. (As he put it to me, family members end up living as though they, too, have OCD: “Everybody’s washing their hands. Everybody’s changing their clothes. Nobody’s saying this word or that word.”) In the years since, accommodation has become a focus of anxiety research. We now know that about 95 percent of parents of anxious children engage in accommodation. We also know that higher degrees of accommodation are associated with more severe anxiety symptoms, more severe impairment, and worse treatment outcomes. These findings have potential implications even for children who are not (yet) clinically anxious: The everyday efforts we make to prevent kids’ distress—minimizing things that worry them or scare them, assisting with difficult tasks rather than letting them struggle—may not help them manage it in the long term. When my daughter is in tears because she hasn’t finished a school project that’s due the next morning, I sometimes stop her crying by coaching her through the rest of it. But when I do, she doesn’t learn to handle deadline jitters. When she asks me whether anyone in our family will die of COVID-19, an unequivocal “No, don’t worry” may reassure her now, but a longer, harder conversation about life’s uncertainties might do more to help her in the future.

Despite more than a decade’s evidence that helicopter parenting is counterproductive, kids today are perhaps more overprotected, more leery of adulthood, more in need of therapy.

Parents know they aren’t helping their kids by accommodating their fears; they tell Lebowitz as much. But they also say they don’t know how to stop. They fear that day-to-day life will become unmanageable.

PLEASE CONTINUE READING AND TO VIDEO….

In An Apparent Murder-Suicide…

Unfortunately we will start seeing more of this.  Many people cannot cope with the scenario’s we may have to endure and they are afraid of facing them.

We all have to stick together and help one another during this difficult time. Although we should be careful of too much personal interaction that doesn’t mean that we can’t reach out to one another in times of need.

Call someone…

Seven family members fatally shot in North Carolina

March 16, 2020, 12:05 PM CDT

By Janelle Griffith

Seven members of a family were fatally shot over the weekend in North Carolina, the Chatham County Sheriff’s Office said Monday.

The suspect is among the dead, sheriff’s office spokeswoman Lt. Sara Pack told NBC News.

Pack said the incident is a suspected murder-suicide but authorities are still investigating a possible motive. It occurred in Moncure, about 30 miles southwest of Raleigh.

Those familiar with the area describe it as “a quiet, close-knit community where violence is out of the norm,” the sheriff’s office said.

Investigators were searching three homes on a single property in Moncure, N.C. on the morning of March 16, 2020 after the report of a murder-suicide.Investigators were searching three homes on a single property in Moncure, N.C. on the morning of March 16, 2020 after the report of a murder-suicide.WRAL

Sheriff’s deputies responded to a “shots fired” call shortly after 5:30 p.m. on Sunday. The seven people were found shot at multiple homes on the same property, Pack said.

The deceased, including the suspected shooter, have been identified as: Jeanie Ray, 67, Helen Mason, 93, Ellis Mansfield, 73, Lisa Mansfield, 54, John Paul Sanderford, 41, Nicole Sanderford, 39, and Larry Ray, 66.

“To lose any family member is devastating, but to lose several at once to unexpected violence is unimaginable,” Sheriff Mike Roberson said in a statement. “There are no words to describe the sense of loss we feel as a community in the wake of this terrible event.”

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.

SOURCE LINK

As the feds crack down on opioid prescriptions, patients are taking their own lives, doctors are losing their jobs and overdose rates continue unabated.

The Government’s Solution To The Opioid     Crisis Feels Like A War To Pain Patients

By Art Levine

Meredith Lawrence's late husband died by suicide after his opioid pain prescription was severely restricted.

Jay Lawrence, an energetic truck driver in his late 30s, was driving a semitrailer across a bridge when the brakes failed. To avoid plowing into the car in front of him, he swerved sideways and slammed the truck into a wall, fracturing his back. For more than 25 years, he struggled with the resulting pain. But for most of that time, he managed to avoid opioid painkillers.

In 2006, his legs suddenly collapsed beneath him, due to a complex web of neurological factors related to his spinal cord injury. He underwent multiple surgeries and tried many medications to alleviate his pain.

The next year, he began to experience some semblance of relief when his doctor prescribed morphine, one of a class of opioid drugs. By 2012, he was taking 120 milligrams per day.

But this isn’t a story about opioid addiction. Lawrence managed a relatively productive, happy life on the medication for the better part of 10 years.

“This isn’t the life I thought I’d have,” he told his wife, Meredith Lawrence, in December 2016. “But I’m all right.”

Living on disability payments, he could still walk around their two-bedroom trailer home using his cane, take a shower on his own and, on his good days, even help his wife make breakfast.

Then, in early 2017, the pain clinic where he was a patient adopted a strict new policy, part of a wide-ranging national effort to respond to the increase in opioid overdose deaths. 

Citing 2016 guidelines from the U.S. Centers for Disease Control and Prevention, her husband’s doctor abruptly cut his daily dose by roughly 25 percent to 90 mg, Meredith Lawrence said. That was the maximum dose the CDC recommends, though does not mandate, for first-time opioid patients. 

The doctor also told Jay Lawrence that the plan was to lower his dose to 45 mg over the next two months, a cutback of more than 60 percent from what he had been taking.

At the end of that traumatic visit, his wife said, Jay Lawrence’s doctor dismissed their concerns and shared his own fear about losing his license if he continued to prescribe high doses of opioids. (When HuffPost followed up, the doctor declined to comment on the case, citing patient privacy.)

For a month, Lawrence suffered on the 90 mg dose. At times, his pain was so bad that he needed help to get out of the recliner, and when his wife looked over, she sometimes saw tears streaming down his face.

He dreaded his next appointment when his dose would be slashed to 60 mg. In the weeks before that scheduled visit on March 2, 2017, Lawrence came up with a plan.

On the day of his appointment, on the same bench in the Hendersonville, Tennessee, park where the Lawrences had recently renewed their wedding vows, the 58-year-old man gripped his wife’s hand and killed himself with a gun.

Meredith Lawrence sits in the living room of the home in Gainesville, Georgia, that she bought after her husband's death

Dustin Chambers for HuffPost Meredith Lawrence sits in the living room of the home in Gainesville, Georgia, that she bought after her husband’s death.

There are at least nine million chronic pain patients in the United States who take opioid painkillers on a long-term basis. As law enforcement and medical regulatory bodies try to curb the explosion in opioid deaths and the rise in illegal opioid use, they have focused on reducing the overall opioid supply, whether or not the drugs are provided by prescription. 

There’s mounting evidence this won’t work ― that curbing patient access to legal prescription opioids does not stem the rate of overdoses caused primarily by illegal drugs ― and that patients are being denied desperately needed relief. There are also troubling indicators that cutting back on opioids increases the risk of suicide among those with chronic pain.

Some chronic pain patients and advocates have even begun compiling lists of individuals they know who have died by suicide after they were no longer able to treat their pain with opioid medication.

“There is no doubt in my mind that forcibly stopping opioids can destabilize some of the most vulnerable people in America,” said Dr. Stefan Kertesz, a professor of medicine and an addiction researcher at the University of Alabama at Birmingham. “And the outcomes for those folks include suicide, overdose and falling apart medically.”

I mean, people need to take some aspirin sometimes and tough it out a little. Attorney General Jeff Sessions

For a decade or so, government officials in the U.S. have sought to drive down the opioid supply through a range of tactics ― from increased seizures of diverted opioid medications to state crackdowns on “pill mills.” The Trump administration has embraced the hard-line approach.

In late January, Attorney General Jeff Sessions announced a “surge” in Drug Enforcement Administration activity targeting pharmacies and physicians that, in the agency’s view, oversupply opioids. In February, the Justice Department doubled down with the announcement of a new task force that would focus on manufacturers and distributors of opioids. In March, President Donald Trump unveiled a plan to lower opioid prescriptions by a third within three years. And in late June, the federal government arrested 600 people, including 165 medical professionals, for allegedly participating in $2 billion worth of fraud schemes involving opioids.

The Trump administration’s efforts are dramatic even within the context of the CDC’s opioid dose guidelines. The guidelines were originally intended to advise primary care physicians treating chronic pain patients and other pain sufferers. They were urged to exercise caution in prescribing opioids, to use alternatives whenever possible and to prescribe daily doses of no more than 90 morphine milligram equivalents (MME) for new opioid users.

For pain patients like Jay Lawrence who had already been on opioids for years, however, the guidelines simply recommended regularly assessing the harms and benefits of the dosage. They didn’t advise either mandatory cutoffs or any set limits. (The Tennessee Department of Health’s guidelines would also have allowed Lawrence to stay at 120 mg of morphine when prescribed by a pain specialist.)

But “the CDC guidelines have been weaponized,” said Kertesz. The ramped-up enforcement by the DEA and state regulators has led some doctors to choose caution and to overcorrect in their prescribing, lest they lose their ability to practice medicine at all. Kertesz decried these policies as “simplistic” in a definitive new article published last week in the journal Addiction.

In February, Sessions struck a particularly harsh tone by suggesting that the fate of chronic pain patients was not high on his list of concerns. “I am operating on the assumption that this country prescribes too many opioids,” the attorney general said. “I mean, people need to take some aspirin sometimes and tough it out a little.”

Attitudes like that are based on a series of mistaken assumptions about pain, according to Dr. Thomas Kline, a North Carolina-based family practitioner and former Harvard Medical School program administrator. Kline regularly updates a list of pain patients, published on Medium, who’ve killed themselves in the wake of draconian restrictions on pain medication.

“I ask people to imagine the very worst pain they’ve ever experienced in their lives,” Kline said. “And then that they’re denied relief by a doctor with the one medicine proven effective for pain control for 50 centuries.” (Historical records show that people in ancient Mesopotamia cultivated the poppy plant for medical use.)

The CDC guidelines have been weaponized. Dr. Stefan Kertesz

The government’s aggressive focus on doctors and patients is unlikely to address the very real menace of opioid-use disorders and sharply escalating overdose deaths. Fraud ― driven by pharmaceutical company policies ― and diversion ― the phenomenon of prescription medications being sold as street drugs ― initially spurred a wave of opioid abuse in the late 1990s, as some doctors turned their practices into pill mills. But new reports by the CDC and a drug data firm, the IQVIA Institute for Human Data Science, suggest that prescription drugs play a much smaller role in today’s crisis.

The reports show that total opioid prescriptions dropped 10 percent in 2017 ― the sharpest annual decline in such prescribing in 25 years. While opioid prescriptions peaked back in 2010, the studies found that growth rates in opioid-linked deaths, overwhelmingly due to illegal fentanyl and heroin, have skyrocketed in the last seven years.

Indeed, although two-thirds of the 64,000 overall drug overdose fatalities were linked to opioids in 2016 ― the most recent year for which there is data ― more than 80 percent of those opioid drug deaths came from illegal street drugs such as heroin and fentanyl. Prescription opioid drug deaths alone ― excluding methadone ― amounted to less than 15 percent of all drug overdose deaths, or about 9,500 fatalities.

Still, the CDC’s guidelines have triggered restrictive laws in at least 23 states that mandate ceilings on opioid dosage. (Oregon, in fact, is moving to taper dosages down to zero for all Medicaid chronic patients over a year.) That makes relief less attainable for pain patients and threatens the practices of doctors who treat them. These laws have been augmented by the growth of state prescription monitoring programs that use the software NarxCare, which is designed to flag addiction but can also rope in pain patients based on their prescription history and use of multiple doctors.

And in June, the House of Representatives passed over 50 bills that would establish dramatic new restrictions on opioid prescribing, eliciting alarm among patients and some disability rights groups.

The side effects of the current enforcement efforts are disturbing enough, from patients denied relief to drug shortages to suicides.

No health agency has kept track of all pain-related suicides that may be linked to doctors cutting back on prescriptions. But some preliminary findings from Department of Veterans Affairs researchers indicate that VA pain patients deprived of opioids were two to four times more likely to die by suicide in the first three months after they were cut off, compared to those who remained on their pain medications.

“To protect people, you have to take care of the patient, not the pill count,” said Kertesz, who worked on the VA’s April 2017 study but spoke to HuffPost only as an independent researcher. “The findings suggest that the discontinuation of opioids doesn’t necessarily assure a safer patient.”

Even terminally ill cancer patients are increasingly getting less relief, and there are growing shortages of injectable opioids at local hospitals and hospices, spurred in part by DEA-ordered reductions in opioid manufacturing quotas.

Leah Ilten, a 53-year-old physical therapist who lives in Kennewick, Washington, told HuffPost that as her 86-year-old father lay dying of pancreatic cancer in a hospice, the medical staff ignored her pleas to provide appropriate opioid pain relief, even cutting his dosage in half on the last day of his life. A few days earlier, when he was in the hospital, one nurse explained to her that opioids could lead to an overdose or could potentially cause the man, who lay moaning in pain, to “get addicted.”

“I was horrified,” Ilten said.

In mid-April, the DEA responded to the injectable opioid shortage by lifting production quotas. An agency spokesman told HuffPost that it was “a manufacturers’ problem, not the quotas,” while asserting that progress is being made.

There have been production issues, including Pfizer’s foul-ups with a plant in Kansas. But the DEA’s delay in taking action ― shortfalls were flagged in February in a letter from the American Society of Anesthesiologists and other health groups ― definitely contributed to the shortage, according to Dr. James Grant, president of the ASA. He told HuffPost that quotas were among the factors creating the crisis.

I’m not willing to go back to the state I was in before I started treatment. Anne Fuqua

Faced with the hardline national crackdown on opioid prescriptions, people with chronic pain are trying to raise awareness of the suffering caused by the loss of medications. Some are gathering the names of those patients who ended up taking their own lives, both as a memorial to those who died and as a protest against the health establishment that has seemingly abandoned them. Others are seeking comfort from each other on social media.

Lelena Peacock, who declined to name her southeastern city of residence for fear of retaliation from doctors, is struggling with how to treat the pain associated with fibromyalgia. The 45-year-old found that her social media posts drew other pain patients who turned to her for help.

By her own count, Peacock has thus far convinced more than 70 chronic pain patients to call 911 or suicide prevention hotlines instead of killing themselves.

For Anne Fuqua, a 37-year-old former nurse from Birmingham, Alabama, the motivation for compiling a list of chronic pain-related suicides is to track the damage done by what she sees as policies that have left people like her behind. 

“There’s so many people who have died,” she said. “We have to remember them.”

Fuqua has an incurable neurological illness known as primary generalized dystonia that causes Parkinson’s-like involuntary movements and painful muscle spasms. She started taking about 60 mg of Oxycontin a day in 2000. Her doctor began to limit her access to high doses of opioids in 2014, the same year she started chronicling those friends who had killed themselves or otherwise died after being denied pain medications. Her informal list is now up to roughly 150 people, augmented by lists that other pain patient advocates have compiled.

On July 9, Fuqua joined other chronic pain patients at a meeting at the Food and Drug Administration campus in Maryland to express their fears and outrage at the cutbacks. Sitting in the front row in her wheelchair, she told FDA officials about that list and declared, “I’m not willing to go back to the state I was in before I started treatment.”

Anne Fuqua needs exceptionally high doses to manage her pain because of opioid malabsorption.

Courtesy of Anne Fuqua Anne Fuqua needs exceptionally high doses to manage her pain because of opioid malabsorption.

Fuqua’s own difficulties are compounded by the fact that her body does not respond to even large doses of opioids the way others do ― she suffers from severe malabsorption that hampers her ability to benefit from everything from opioids to vitamin D. Since 2012, she has relied on a strikingly high daily regimen of 1,000 MME of opioids, including fentanyl patches, to manage her pain.

But her physician, Dr. Forrest Tennant, was driven to retire this year after a DEA raid and investigation. The Los Angeles-area physician mailed her a final series of prescriptions, which will run out at the end of July.

“It’s terrifying,” she said looking at her future. “If these were people who had asthma or diabetes and weren’t stigmatized because of opioids, this wouldn’t be allowed to happen.”

Another doctor has quietly stepped forward to continue treatment for Tennant’s remaining patients, Fuqua said, although there’s no assurance that this physician won’t also be investigated in the future.

If these were people who had asthma or diabetes and weren’t stigmatized because of opioids, this wouldn’t be allowed to happen. Anne Fuqua

The raid on Tennant’s home and office last November illustrates the hard-line regulatory and enforcement approach that critics say doesn’t distinguish between pill-mill doctors who deserve to be shut down and legitimate pain doctors who use high-dosage opioids. The wide-ranging search warrant served to Tennant essentially accused him of drug trafficking even though he’d earned a national reputation for deft treatment of ― and research about ― pain patients.

“He’s highly respected and prominent in pain management,” said Jeffrey Fudin, a clinical pharmacy specialist who heads the pain pharmacy program at the Albany Stratton VA Medical Center in Albany, New York, and serves as an associate professor at the Albany College of Pharmacy and Health Sciences. “Most of his patients had no other options, and they came from around the country to see him.”

Tennant was known for taking on difficult-to-treat patients, including those suffering from pain as a result of botched surgeries and other forms of malpractice. His research included innovations in the use of hormones to alleviate pain and lower opioid use up to 40 percent, as well as work on genetic testing for enzyme system defects that lead to opioid malabsorption.

“The DEA can trigger an investigation every time they misapply the CDC guidelines without paying attention to the population the physician treats or issues of medical necessity,” said Terri Lewis, a patient advocate and a Ph.D. clinical rehabilitation specialist with Southern Illinois University who trains clinicians on how to manage seriously ill patients with incurable pain.

Special Agent Timothy Massino, a spokesperson for the DEA’s Los Angeles division, declined to comment on the agency’s approach to Tennant. “It’s an ongoing investigation,” he noted.

Tennant’s isn’t alone. Physicians must now balance their prescribing obligations to their patients with legitimate fear for their livelihoods.

DEA enforcement actions against doctors have risen some 500 percent in recent years ― from 88 in 2011 to 449 last year, according to an analysis of the comprehensive National Practitioners Data Bank by Tony Yang, a professor of health policy at George Washington University. Even though that’s a relatively small number of arrests compared to the roughly one million physicians in the country, such arrests can have an outsized impact.

“They make big news, and they serve as a deterrent for physicians whose specialties require them to use a lot of pain medications,” Yang said. “It makes them think twice before prescribing opioids.”

Meredith Lawrence shows the tattoo she got after her husband'€™s death. The bluejay represents her husband, Jay; a cup of cof

Dustin Chambers for HuffPost Meredith Lawrence shows the tattoo she got after her husband’€™s death. The bluejay represents her husband, Jay; a cup of coffee is the way she loves to start her day; and the quote is “Sail away with me, what will be will be.”

Dr. Mark Ibsen of Helena, Montana, found himself in a five-year battle against the state licensing board that’s still not over ― even though a judge last month reversed the board’s decision to suspend his license because of due process violations. The court has remanded the case back to the licensing board for potential further investigation of his opioid prescriptions, but Ibsen has decided he won’t resume his medical practice.

That’s bad news for Montana, which has the highest rate of suicide in the country, according to the CDC. What’s more, chronic pain-related illnesses account for 35 percent of all the state’s suicides, as a recent state health department study found.

In the course of his fight with the medical board, the 63-year-old doctor said three of his former chronic pain patients have killed themselves after he and other doctors stopped prescribing opioids. The first of those patients died shortly after attending a hearing to show his support for Ibsen.

The deaths of pain patients haunt those who treated them and loved them. Meredith Lawrence, who sat with her husband to the very end, said, “It was as horrifying as anything you can imagine.”

“But I had the choice to help him or find him dead someday when I came home,” she added.

Lawrence was arrested and sentenced to a year’s probation for assisting a suicide. Now her goal is to fight restrictions on opioid prescriptions.

“If we don’t stand up, more people will die like my husband.”

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.

Art Levine is the author of Mental Health, Inc: How Corruption, Lax Oversight, and Failed Reforms Endanger Our Most Vulnerable Citizens.

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That study isn’t without flaws. Veterans die by suicide at higher rates than average ― currently accounting for 20 suicide deaths a day ― so they are not a nationally representative sample. And the VA study, which was released at a national opioid summit in early April, has not yet been submitted for peer review.

But another study, published last year in the peer-reviewed journal General Hospital Psychiatry, looked at nearly 600 veterans who in 2012 were cut off from dosages after long-term opioid use and found similar results. Twelve percent of the vets showed suicidal ideation or took violent action to harm themselves ― a rate nearly 300 percent higher than the overall veterans community.