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Here, heroin spares no one, not even the sheriff’s wife

(CNN)Robert Leahy was sitting on his couch, watching TV, when his wife, Gretchen, walked through the front door.

It was about 10 p.m. She’d left for the grocery store hours earlier. Now, she “bumbled” about the room, Leahy says, incoherent and vacant. He’d seen her like this before.

“What the f**k are you doing?” he asked. “You’re high.”

After the initial shock wore off, Leahy was angry and embarrassed. He worried about his reputation and what his colleagues at the Clermont County Sheriff’s Office would think. He’d been a law enforcement officer for more than a decade, and now he was married to a heroin addict.

He needed to save himself and their young son. He had done all he could to save her.

Just weeks earlier, Gretchen had returned home to Madeira, Ohio, from Crossroads Centre Antigua, an addiction treatment facility founded by musician Eric Clapton. It was one of a handful of times she’d received treatment for opiate addiction in the past five years. Leahy says he spent more than $16,000 — nearly all of their life savings — to cover the cost.

And now she was high again.

On September 7, 2005, Leahy filed for porce and a temporary restraining order. At the time, the US opioid epidemic was in its early stages. Abuse of prescription painkillers was a growing, if hidden, problem, and heroin addiction had yet to ravage rural and suburban America. That would soon change. Nearly 15,000 Americans — 500 from Ohio alone — died of an opioid overdose in 2005. In 2015, those numbers soared to 33,000 and 2,700 deaths, respectively.

At first, Leahy could not understand why his wife had let herself become an addict, why she had made that choice. But as he watched her struggle for years to stay clean, his knowledge of addiction matured. He began to see it as a disease in need of treatment and compassion.

More than a decade later, as Ohio grapples with one of the deadliest drug epidemics in American history, the state’s criminal justice system has undergone a similar transformation. Local officers and judges know that they can no longer treat all addicts like criminals. To stop an epidemic, they have to think like medical professionals.

‘This is a mass fatality crisis’

On July 31, the White House’s Commission on Combating Drug Addiction and the Opioid Crisis released an interim report asking President Donald Trump to declare the opioid epidemic a national health emergency.

Ohio has been one of the states hit hardest by the crisis. Last year, 86% of overdose deaths in the state involved an opioid. In Montgomery County, the situation is particularly dire. Local officials say that more than 800 people will probably die from an opiate overdose there this year, more than double last year’s record of 349 opioid deaths.

Law enforcement officials say the county’s location has made it an ideal distribution hub for Mexican drug cartels. Interstates 70 and 75, two major arteries that crisscross the nation, intersect in the northeast corner of the region. Officials say the cartels ship their product directly to Dayton, less than a 10-minute drive from the intersection. Then, local dealers hop onto one of the “heroin highways” and circulate opioids throughout the country.

Most nights, the freezer in Montgomery County’s morgue is stacked floor-to-ceiling with bodies. Dr. Kent Harshbarger, the coroner whose office services more than 30 counties, estimates that 60% to 70% of these corpses are the result of an opioid overdose.

“What’s most challenging is seeing the same story repeated over and over again,” he said. “It seems, from my perspective, inevitable.”

Since last year, to deal with the surge in overdose deaths, Harshbarger has hired six part-time coroners, two autopsy technicians and three field investigators. He also extended some of the staff’s workday by three hours so they had time to perform more autopsies and remodeled the morgue freezer to fit more bodies.

Several times in 2015 and 2016, the office was overwhelmed, and he had to house some of the corpses in mobile morgues — trucks with refrigerated trailers. The state purchased the trucks in the mid-2000s with a grant from the Department of Homeland Security. They were intended to be used in the field to store bodies after a mass-casualty event like a plane crash or a terrorist attack. Harshbarger says the current crisis is not so different.

“Staff is overwhelmed,” he said. “This is a mass fatality crisis.”

What started as a heroin epidemic quickly turned even deadlier. Experts say the spike in overdose deaths in Montgomery, and in many places across the country, is largely due to heroin’s opiate cousins: fentanyl and its more potent analogues like carfentanil. Fentanyl is a synthetic opioid 50 to 100 times stronger than heroin. Carfentanil, originally designed as a large-animal tranquilizer, is 5,000 times more potent than heroin.

Montgomery County Sheriff Phil Plummer says that when addicts think they’re purchasing heroin, they’re more likely buying one of these synthetic opioids.

“We need to quit calling it a heroin epidemic; this is fentanyl.” he said. “It’s really not a heroin issue anymore.”

The numbers back him up. In 2016, 251 of the 349 opioid-related overdose deaths in the county involved only fentanyl or carfentanil, with no heroin present, and an additional 34 involved heroin laced with fentanyl.

To stem the tide of overdose deaths, the sheriff’s office is spearheading a new program called Get Recovery Options Working, or GROW. As part of the initiative, a sheriff’s deputy, a social worker, a medic and a member of the clergy visit a home where an overdose occurred within the past week. Together, they provide literature about Cornerstone Project, a local drug treatment facility, and talk to family members about how to best help their loved one, and if the inpidual is willing, the deputy will drive him or her to treatment that day.

“We just stop and tell them, ‘We love you and we care for you, we want to seek help for you,'” Sheriff Plummer said. “And we’re having tremendous success with that.”

Since the program started on January 1, GROW has reached out to 162 people who have overdosed, 57 of whom have entered treatment at Cornerstone Project, Plummer says. More than half of those who entered Cornerstone because of the initiative are still in treatment, says Cornerstone Project Community Outreach Manager Wendie Jackson.

A stopgap

By 2014, Leahy had climbed the ranks to chief deputy in the Clermont County Sheriff’s Office. That year, drug overdose deaths were also steadily climbing in the county, from 56 in 2013 to 68 by year’s end. It was the sixth year in a row the number of overdose deaths had risen.

Leahy recognized the trend and had an idea. He’d heard about law enforcement agencies in other parts of the country equipping their officers with a drug called naloxone, also known by the brand name Narcan. Administered as a nasal spray, the drug could reverse the effects of an opioid overdose and was easy to use. Leahy lobbied Sheriff A.J. “Tim” Rodenberg and volunteered to lead the initiative.

Rodenberg, Leahy says, was receptive but not convinced. He needed more information. The topic would be controversial, he told Leahy. Some in the community would, of course, think it’s a good idea, but others would consider it a waste of taxpayer money.

Leahy called other sheriff’s offices in the north of the state that were using Narcan and learned about the success they were having in saving lives.

He told Rodenberg what he’d heard and laid out the pros and cons of buying Narcan. Then, Leahy decided to speak from personal experience. He didn’t bring up Gretchen by name, but “I think he realized some of the decisions that I made, or the things I pushed along, were related to that.”

Leahy and Gretchen still shared custody of their son, but he says she was rarely around. She would stay clean for a few weeks — periods he calls “flashes of brilliance.” Each time, he hoped she’d turned a corner. But really, he was just waiting for her to relapse. If she overdosed, he would want the responding officer to have all the tools available to revive her, so she’d have the chance to fight another day.

“How can you get people into recovery if you can’t save their lives?” Leahy asked Rodenberg. Within months, the deputies were equipped with Narcan.

‘The challenge is to keep them alive’

In Montgomery County, the average opioid user is a 38-year-old white man, according to data collected by the sheriff’s office. But officials say the number of young addicts in the area has increased exponentially over the past five years.

County Juvenile Court Judge Anthony Capizzi estimates that nearly a quarter of the young defendants in his courtroom are addicted to either opiate painkillers or heroin.

“I have jurisdiction over children until they reach 21,” Capizzi said. “The challenge for me right now is to keep them alive that long.”

Capizzi presides over the county’s Juvenile Treatment Court. The young people in his courtroom have substance abuse issues and often, as a result, lengthy criminal histories. Capizzi puts the vast majority into some kind of treatment program; detention centers are the last resort.

Three and a half years ago, Rachel Chaffin walked into Capizzi’s courtroom. She was one of the first young defendants addicted to heroin that he’d seen in his 13 years behind the bench in Montgomery.

Chaffin was 15 years old. She had been captain of the JV cheerleading squad in high school and dreamed of one day cheering on the sidelines for the Dallas Cowboys. But growing up, her life was chaotic and unstable. Her family often teetered on the edge of homelessness. In December 2013, Chaffin got pregnant.

“I was 14. I was freaking out,” she said. “I ended up having a miscarriage.”

A drug dealer in her neighborhood later asked her whether she wanted to be a “tester” for his product and check the quality of the dope. She was scared but took the leap, fueled by a depression that consumed her after her miscarriage.

“Once I started doing it,” she said, “I didn’t want to stop.”

She landed in front of Capizzi after multiple felony and misdemeanor charges. Eventually, the judge removed her from her mother’s custody because she continued to use and put her in foster care. For the next three years, she bounced from group home to foster home, sometimes clean, sometimes not. She overdosed, and was revived by Narcan, three times.

Now 18, Chaffin eventually found a good foster home and graduated high school with a 4.0 GPA. She says she’s been clean since March, when she relapsed after another miscarriage. She says she struggles every day to stay clean, but when she feels weak, she remembers what a counselor told her during a recent stay in rehab.

“My counselor said, ‘I want you to picture your mom coming to the morgue to identify your body,'” she said. “That just broke me. I can’t picture putting my mom through so much.”

Before there’s no hopera

In 2013, the Clermont County Sheriff’s Office collaborated with local mental health officials to open the Community Alternative Sentencing Center inside the local jail. The voluntary program offers people who have been convicted of a misdemeanor and have a substance abuse issue the opportunity to serve their sentences in a wing of the jail that is separated from the general population. Nearly 40% of the participants at any given time were once addicted to opioids.

The center is operated by Greater Cincinnati Behavior Health Services. The participants — or “clients,” as staff refer to them — receive group therapy and drug rehabilitation treatment, such as participating in Narcotics Anonymous.

In 2016, the voters of Clermont County elected Leahy sheriff. He says he never had aspirations for the position, but in 2015, Rodenberg told Leahy he was retiring and wanted Leahy to be his successor. Leahy ran unopposed. Now, he was in charge of a program he’d help shepherd for years.

Alternative Sentencing Center clients technically are not inmates, and there are no correctional officers in that wing of the jail. The clients are on probation, and as part of that, they’ve agreed to complete their treatment. But if a client leaves the program early, he is in violation of his probation.

Leahy says these programs can help people before they’re burglarizing homes or robbing people to feed their habit — before they’re burdened with a rap sheet full of felonies. Once a person reaches that point, they often believe there’s no hope. Leahy saw Gretchen fall into a similar abyss, and it took her years to claw her way out.

“If you can catch people in the early stages, where their life is starting to go south but it’s not totally out of control,” he said, “there’s a chance for them.”

He doesn’t want people to mistake his compassion for weakness. Those who commit felonies, he says, deserve to be in jail. But most people with substance abuse issues are better served in treatment, he says.

So far, the program has helped men exclusively, but in the fall, Leahy and GCBHS will open a women’s version in another wing of the jail. The Clermont jail now houses between 90 and 100 female inmates, nearly double the number a decade ago, Leahy says. Virtually the entire increase in population, he says, can be attributed to the crisis. Opioid overdoses have increased 2000% in Clermont County since 2007.

Both the Narcan and Alternative Sentencing Center programs seem to be paying off. Overdose deaths in Clermont County decreased from 94 in 2015 to 83 in 2016.

“Is it too early to tell? Well, I think by the end of 2017, if we can get two or three years in a row with those numbers trending down,” Leahy said, “I think people will realize and say, ‘I think somebody’s doing something that’s working.’ “

Leahy says he speaks with Gretchen only occasionally now. There’s no ill will, but since their son has grown, there’s also no need. Gretchen says she’s been sober for three years, and Leahy gives her the benefit of the doubt. Not that he would ever ask. She doesn’t owe him any explanation, he says.

In some ways, he has a more clear-eyed view of her disease than even she does. Gretchen is still wracked with guilt from the years lost with their son and for driving her husband away.

“I think that was half of my issue. Every time I would get clean, I couldn’t let go of that guilt, shame,” she said. “And I still struggle with that to this day.”

But Leahy sees it differently. He says that the programs weren’t in place to save her, that law enforcement didn’t understand what they were dealing with yet. He’s learned that the addiction chose her, not the other way around.

“There is no rhyme or reason,” he says. “This is one of those deals, it’s kind of like fighting cancer. Your first heaviest, hardest hit is going to give you the best opportunity.”

Read more: http://www.cnn.com/2017/08/06/health/ohio-heroin-opioid-crisis-morgue-full/index.html

The Mediterranean diet doesn’t benefit everyone, study says

(CNN)The Mediterranean diet can reduce the risk of cardiovascular disease, yet only people with higher incomes or more education, or a combination of the two, experience this benefit, found a study published Monday in the International Journal of Epidemiology.

The Mediterranean diet emphasizes eating plant-based foods, including vegetables, nuts, fruits and whole grains, in addition to fish and poultry. The diet also recommends that you limit red meat, replace butter with olive oil, and exercise. Red wine in moderation is optional on the diet, which past scientific research proves to be heart-healthy.

Marialaura Bonaccio, lead author of the new study and a researcher at IRCCS Istituto Neurologico Mediterraneo Neuromed, an Italian Clinical Research Institute, said in an email that this same problem — in which people from different income levels get different results from the same diet — may also be true for other diets.

The reason? Diets “focus on quantity, rather than on quality” of the food, she said.

Diet data

Bonaccio and her co-authors randomly recruited over 18,000 people living in the Molise region of southern Italy between March 2005 and April 2010. “The Pfizer Foundation, which helped fund enrollment costs, did not influence the analysis or interpretation of results,” Bonaccio noted.

She and her team calculated total physical activity, body mass index (BMI), smoking status and health history, including cardiovascular disease, diabetes and cancer. The data available for each participant also included education, household income and marital status.

Using the Mediterranean Diet Score, Bonaccio and her colleagues assessed participants’ food intake, examining the variety of fruits and vegetables, meat and fish consumed. They scored participants’ cooking methods, detailing whether they’re using healthy methods such as boiling and stewing or less healthy methods such as frying, roasting and grilling. Vegetables were categorized as organic or not, bread as whole-grain or not.

Over an average followup period of about four years, participants experienced a total of 5,256 cardiovascular disease events, including incidents of heart failure, diagnoses of coronary heart disease (a buildup of plaque in the arteries) and strokes.

Analyzing the data, the researchers found that a Mediterranean diet effectively reduced cardiovascular disease risk, but only among a select group of participants: those with higher income or more education.

“We found heart advantages were limited to high socioeconomic status groups, even if groups showed the same adherence to the Mediterranean diet,” Bonaccio wrote. No benefits occurred for participants in the low income and low education group.

Differences in food quality

Surprised by this result, the researchers dug into the data more deeply and unearthed a possible reason for the difference: The same Mediterranean diet adherence score still included slight differences in food consumption.

“For example, as compared to less advantaged counterparts, people with high socioeconomic status tended to consume fish more frequently,” Bonaccio wrote. She added that, beyond diet adherence, participants in the most advantaged category reported a higher quality diet, which included higher consumption of organic products and whole grain foods.

“Let’s give that two persons follow the same diet, that is equal amounts of vegetables, fruits, fish, olive oil etc. every day so that they report the same adherence score to Mediterranean diet,” Bonaccio said. “It might be that, beyond quantity, differences in quality may exist. For example, in olive oil.”

She said it’s unlikely that a bottle of extra virgin olive oil with a price tag of 2 to 3 euros has the same nutritional properties as one costing 10 euros. Given that it is reasonable to assume higher-income participants are more likely to buy the 10-euro bottle compared with lower-income participants, “our hypothesis is that differences in the price may yield differences in healthy components and future health outcomes,” Bonaccio said.

How the food is cooked or prepared might also contribute to differences in results, according to Bonaccio, though she said the differences in cooking procedures — “a kind of marker of the numerous differences still persisting across socioeconomic groups” — probably did not “substantially account” for the disparities in cardiovascular risk.

Similar results in US?

Mercedes Sotos-Prieto, an assistant professor and visiting scientist at Harvard Chan School of Public Health, said evidence, including from her own research, shows that a Mediterranean diet is “one of the best choices to improve health.”

Sotos-Prieto, who was not involved in the new research, wrote in an email that the new study, which relied on self-reported data, does not prove that socioeconomic status caused the health benefits seen; it shows only a relationship between income and/or education and health outcomes.

“Previous studies have already showed a socioeconomic gradient regarding adherence to diet quality,” Sotos-Prieto wrote. Because of this, a similar difference in health results depending on socioeconomic status may also be occurring in the United States among those who follow a Mediterranean diet, she said.

Dr. Barbara Berkeley, who specializes in weight management and practices medicine in Beachwood, Ohio, said “one caveat in interpreting studies like this is that they are based on diet recall. It is generally very difficult for people to keep accurate food records and there is a tendency for participants to record their diets in the best possible light.”

Berkeley, who was not involved in this research, agreed with the hypothesis of the authors.

“A good diet is undoubtedly more than just a shopping list,” she said. “Quality, freshness, variety and purity of production may truly differentiate diets even when they appear to be the same.”

Berkeley noted that “food deserts” in lower-income areas means both quality and variety of fresh foods may be limited, while organic produce may be unavailable or too expensive.

“A healthy diet is likely not the sum of its parts but the quality of its elements,” Berkeley said.

Maria Korre, a research fellow at Harvard Chan School of Public Health, noted that “among the most important perceived barriers to healthy eating are the time and cost of shopping.” Korre, who did not contribute to the new study, added that “we need to work toward identifying ways … to overcome these barriers.”

“As a result of the worldwide epidemics of obesity and diabetes, we witness a strong and renewed interest in the traditional Mediterranean diet,” Korre said. Yet the appeal of this diet extends well beyond proven health benefits.

With its wide range of colorful foods, the diet provides “delicious meals” and “because of its emphasis on limited consumption, rather than abstention from red meat and sweets” plus its inclusion of moderate drinking of alcoholic beverages, “the Mediterranean diet represents a healthy yet indulgent and appealing lifestyle that can be sustained over long periods of time,” Korre said.

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According to the study authors, people of high socioeconomic status may actually be selecting foods that are higher in both polyphenols (plant-based micronutrients) and antioxidants (a nutrient found in fruits and vegetables that helps repair damage in our bodies). Such daily choices could result in health advantages unseen by those who make different selections.

“This hypothesis could be only tested by a direct measure of such natural compounds in biological samples, e.g., blood levels or urinary polyphenol excretion,” Bonaccio said. She said her groups’ future research and analysis will test this theory.

Read more: http://www.cnn.com/2017/07/31/health/mediterranean-diet-heart-benefits-socioeconomic-study/index.html

NFL Still Owes More Than Half Its Brain-Research Pledge

WASHINGTON The National Institutes of Health is ending its partnership with the NFL to study concussions and brain disease, with more than half of the $30 million the league pledged unpaid, according to ESPN.

The NIH decision to let the agreement expire follows a bitter dispute in 2015 in which the NFL backed out of a major study into chronic traumatic encephalopathy, or CTE, that was awarded to Dr. Robert Stern, a neuroscientist at Boston University School of Medicine with a history of criticizing the league, ESPN reported.

In 2012, the NFL described its $30 million contribution to NIH, the government’s primary biomedical research center, as unrestricted, and said it was the single-largest donation to any organization in the league’s 92-year history. NIH said the money came with no strings attached.

In reality, the league maintained veto power over how the money was spent, according to ESPN.

A May 2016 study by the House Committee on Energy and Commerce concluded that the league and its brain injury committee tried to steer the CTE study away from Stern and toward a doctor with NFL ties, The New York Times reported.

Our investigation has shown that while the NFL had been publicly proclaiming its role as funder and accelerator of important research, it was privately attempting to influence that research, the congressional study said. The NFL attempted to use its unrestricted gift as leverage to steer funding away from one of its critics. The League, its players, and the public have a vested interest in advancing our knowledge of the relationship between degenerative diseases and sports-related head trauma.

The research deal between the NFL and NIH is set to end Aug. 31, with $16 million more than half of the amount the league pledged unpaid.

“There are no current research plans for the funds remaining from the original $30 million NFL commitment,” NIH told ESPN in a statement. NIH is currently funding concussion research directly.

The statement continued: “If [the] NFL wishes to continue to support research at NIH, a simple donation to the NIH Gift Fund to support research on sports medicine would be favorably viewed, as long as the terms provided broad latitude in decisions about specific research programs.”

On Tuesday, researchers at Boston University School of Medicine and VA Boston Healthcare System reported finding CTE, a degenerative brain disease commonly found in athletes with a history of head trauma, in 110 of 111 deceased NFL players. Among college football players involved in the study, 91 percent were diagnosed with the disease.

A day later, Democratic members of the House Committee on Energy and Commerce sent a letter to NFL Commissioner Roger Goodell requesting information about how the league planned to spend the remainder of the NIH pledge, which it listed at $18 million.

“Since this research is critical to improving our understanding of the increased health risks that athletes face from their sport as well as ways to prevent and mitigate such risks for the future, we would hope that the NFL would follow through on its commitment to provide the balance of its $30 million donation,” the lawmakers wrote.

A league spokesperson said in a statement to The Washington Post that “the NFL is currently engaged in constructive discussions with the [Foundation for the National Institutes of Health] regarding potential new research projects and the remaining funds of our $30 million commitment.”

Rep. Frank Pallone Jr. (D-N.J.), ranking member of the House Energy and Commerce Committee and a co-author of the letter, told ESPN it’s disappointing that the NFLs inappropriate actions soured the relationship to the point where it appears that NIH couldnt see a path forward.

“However, at a time when there’s a desperate need for research dollars, I strongly encourage the NIH and NFL to work to use the remaining funding that the NFL committed to support critical research that could help protect current, former and future football players,” Pallone said.

A number of NFL players who committed suicide in recent years had subsequently been diagnosed with CTE. In March 2016, the NFL’s senior vice president for health and safety acknowledged a link between football and brain disease; a first in the league’s history.

Read more: http://www.huffingtonpost.com/entry/nfl-nih-cte_us_597ba1e6e4b0da64e8793819

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