As editorial page editor of USA TODAY since 2015, I oversee the four main types of Opinion content: debates (“Our view” paired with an “Opposing view”), op-ed columns, reader feedback and political cartoons. The column I wrote about my son’s death from an overdose (“The opioid crisis hits home – mine”) triggered an outpouring of comments from readers who are dealing with this awful affliction. My wife and I have two other children, a daughter in New York and a son in Philadelphia.

I know the emotional and financial toll addiction can take on families, but I’m not qualified to dispense medical advice. So Dr. Fishman is joining me for this AMA. Dr. Fishman is a psychiatrist and a faculty member in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. He is the medical director of Maryland Treatment Centers and a national expert on adolescent addiction treatment and program development.


Edit: Thank you for all your questions. Unfortunately, that's all we have time for today. We will try to get to some of the unanswered questions later. USA TODAY created a Facebook group called 'I Survived It.' It's a supportive place for people to share their stories of surviving seemingly insurmountable challenges and for others to find hope in community. If you're interested, join us in this group:

Comments: 973 • Responses: 23  • Date: 

ZombieBoobies816 karma

My sister and father are addicts, heroin and oxy. I've already lost my mother, aunt, brother and friend to heroin.

Thank you for writing your article. It was good for to hear that hitting rock bottom isn't the answer. Sometimes I tell myself it is so I feel ok about the distance I have to take with those that I love, but I agree MAT is the direction to push them if they'll let me.

With all that said, as the mother of three teenagers, what can I do to help prevent or catch it in the beginning? We have open discussions and try not to let my family influence what's seen as normal and acceptable but like most parents I often feel like I don't know what I'm doing.

Any advice for parents to help see signs of use or concern in teenagers?

usatoday145 karma

Very sorry to hear about your losses.

So important as a parent to look for warning signs and act on them. Hope alone is not an adequate response, as things usually will not get better on their own. Important not to "explain away" early use as something that "all the kids are doing." When parents are concerned they should talk openly with their children and seek professional evaluation.

One of the most messages for the prevention of opioid addiction is to prevent initiation by addressing earlier forms of substance use problems, most commonly alcohol and cannabis.

--Marc Fishman

harleyjosh1999239 karma

Very sorry for your loss.

Although I agree there is a problem but, Do you think the blanket change is punishment for pain patients? Also, when people can’t get legal meds do you think it pushes them to street drugs which make the problem bigger?

Thank you very much for your time to tackle this issue

usatoday91 karma

Yes, this is trickiest part of the crisis. We don't want to deny legal meds to people who legitimately need them for pain. And without enough access to treatment, people who are addicted to pain pill are going to turn to street drugs that are easier to get, cheaper and give a better high. I'm not sure the system is capable of such a highly calibrated response.

-- B. Sternberg

Loreleigeller114 karma

I’m gutted for you, and all the other families this has happened to. It just seems like there is no end in sight to this, that it keeps getting worse. Tell me there’s a glimmer of hope, that the tide might be showing signs of at least slowing?

usatoday110 karma

Thank you. You're right, the overdose death data continues to get grimmer. If there's a glimmer of hope, it's on the prevention side, where prescriptions of opioid painkillers are falling rather dramatically. Also, the scope of the crisis -- nearly 200 people a day dying of drug overdoses -- has mobilized a public policy response.

-- B. Sternberg

thekeeper228111 karma

Does it bother you that the DEA doesn't use simple auditing techniques to identify and prosecute "pill mills"?

usatoday43 karma

Important question, but I'm not well informed on the techniques that the DEA and other law enforcement uses to identify sources of illicit opioids. II do know that many pill mills have been identified and shut down --- which I think is a good thing, but I don't know how they are identified.

--Marc Fishman

sn0r98 karma

I'm not American. We don't have an opioid crisis in our country. What has caused the massive acceptance of prescribing addictive substances?

usatoday197 karma

Stage one of the crisis is that drugmakers, distributors and doctors flooded the USA with prescription painkillers that turned out to be far more addictive than the manufacturers claimed. This hasn't happened to the same degree in other nations.

-- B. Sternberg

usatoday123 karma

We have seen a 2 decade process of concern about the under-treatment of pain, in which the medical community took the mis-direction of excessive use of opioid pain medications as a response. As it turns out there are the non obvious consequences of overuse of opioids. This is the problem that has been well-publicized of getting 60 pills and 3 refills for a wisdom tooth extraction. Further, it turns out that opioids don't really even work that well to relieve chronic non-cancer pain to begin with.

-- Marc Fishman

HistrionicSlut43 karma

After kicking withdrawal from opiates how long does it take the brain to ‘heal’ (for lack of a better word)? Are there any nonaddictive medications someone could take to help them through the process?

I recently took myself off of them and have been in a funk ever since (it’s been a bit over a month)

usatoday51 karma

We don't really know exactly, but our best estimate is at least months and in some cases years for the lingering chronic effects.

The question of how to help restoration of normal function is one of active research. Certainly vigorous active pursuit of alternative pleasurable activities and stress relief tool is critical. Some doctors recommend antidepressants, certainly for those that have significant depression or anxiety. Some researchers are wondering whether there might be medications that can help restore "normal" dopamine balance or restore healthy function of the opioid receptors, but these remain hypothetical and unproven.

-- Marc Fishman

tara_tara_tara18 karma

My brother is in treatment for fentanyl addiction and is on suboxone. His treatment plan is to keep him on suboxone forever. The idea is that detox, rehab, and other treatment have dismal track records and are are costly to hospitals, shelters, cities/towns - basically society.

What do you think of this approach?

usatoday33 karma

Buprenorphine (suboxone) is one of the effective relapse prevention medications for opioid addiction. Our best information is that although some people can be successful after discontinuing the medications, most people do better the longer they stay on them.

-- Marc Fishman

vosot16 karma

I am so sorry for your loss. Thank you for sharing your story. Hopefully others will learn from your tragedy. How did you learn your son was addicted to opioids?

usatoday29 karma

For pain pills, when we confronted him for stealing from us to support his habit.

For heroin, the track marks in his arm were a dead giveaway.

- B. Sternberg

seal_raider12 karma

Since the crisis came to the forefront have the numbers stabilized or are they trending in one direction or another? Or is it simply too early to tell?

Also, I am saddened over the loss of your son. As a Dad myself it guts me to think of my own little boy someday being lost.

usatoday15 karma

I appreciate the kind thoughts. Unfortunately, the trend lines are grim. Last year, according to preliminary numbers from the CDC, there were nearly 50,000 opioid-related deaths, up 16% from the year before. This is being driven by heroin and counterfeit pain pills being laced with powerful synthetic opioids known as fentanyls.

- B. Sternberg

djcrzy12 karma

Dr. Fishman, as a psychiatrist, how do you think mental health plays into opioid addiction and abuse?

usatoday29 karma

Concurrent mental health problems with addiction are the rule rather than the exception. We have clear evidence that treatment of co-morbid psychiatric illness improves addiction treatment outcomes.

--Marc Fishman

pattyfire12 karma

Why are opioids so addictive?

usatoday26 karma

It's the fundamental biology of opioids and their effect on the brain. We are hard-wired to be very reinforced by opioid, and most people find them pleasurable. What's worse is that after a time of steady use, stopping opioids becomes difficult because of the physiologic withdrawal that happens, and the effect in relieving stress.

- Marc Fishman

StinkFingerPete6 karma

how much of this was caused by drug companies lobbying doctors to prescribe their products?

why is there not legislation to curb such practices, as well as limit advertising prescription drugs on tv?

usatoday12 karma

Probably a significant amount. Doctors were told there was less than a 1% chance of addiction for prescription opioids. In reality, the number is probably between 10% and 25%. There has been some legislation to limit initial prescriptions to 3 or 5 or 7 days, which should help.

-- B. Sternberg

usatoday10 karma

I agree that drug companies were part of the problem. But there were other sources of influence as well. As doctors we are motivated to try to relieve suffering, but in our attempts at compassion we sometimes make mistakes. Organizations like the profession medical societies and the Joint Commission (that accredits health care providers) also pushed the agenda of better stronger paint treatment. We tend to swing to extremes in general. And now although we recognize we vastly overdid that agenda, I think we are swinging too far the other way, and some patients who really need opioid pain medications are being limited by the new restrictions.

JohnH5504 karma

Can you speak to the efficacy of Drug Courts in the US in curtailing narcotics use?

What should our legal policy be toward users?

usatoday4 karma

I've seen drug courts in action and think they can be very helpful in providing incentives and alternatives to incarceration for non-violent abusers.

-- B. Sternberg

kdeezey4 karma

What can family members do to help someone with an addiction even if they don’t want help?

usatoday13 karma

The key message is never give up, it's a marathon not a sprint. The idea is to keep engaging, trying to persuade a child (or any loved one) that they have changed for the worse and their own personal goals are being derailed. Use natural reinforcers for positive behaviors (like accessing treatment) and "active ignoring" for negative behaviors. You don't have to commit to a full course of treatment (like "rehab"), how about just starting with an evaluation --"let's see what the professional has to say..."

-- Marc Fishman

DataRapist-5 karma

Do you feel responsible for his death by enabling his lifestyle choices?

usatoday7 karma

As I wrote, the line between supportive and enabling isn't bright or clear. It can shift by the hour or by the day. But addiction is a chronic brain disorder, not a "lifestyle choice."

-- B. Sternberg

usatoday4 karma

When treatment providers talk to parents about "enabling" we are often heard as send a message that this is your fault as a parent. That is the WRONG message. We need to do a much better job communicating with parents and helping understand that they can't control everything but we can educate them and empower them to use their natural leverage over the long haul to make a difference in monitoring and supervision. But there are no easy answers, and no predicting the future.

-- Marc Fishman