Saturday, December 7, 2013

Controlling Ohio’s opiate epidemic requires a different treatment approach

Action teams are combating the opiate epidemic, but they are missing the vital piece of promoting medication-assisted treatment

Four Ohioans die every day of opiate overdoses. Yet as daunting as the statistics are, the reality of treating the ravages of our opiate epidemic is even worse. Medication-assisted treatment has become essential.

In 2011, one in 20 Americans used prescription painkillers for nonmedicinal purposes. Hydrocodone, an opiate, is the most frequently prescribed medication in the United States. Between 2000 and 2009, the number of pregnant women who used opiates went up five times.

In the late 1990s, doctors were urged to consider pain as a vital sign. Powerful painkillers were developed and used effectively by competent physicians, but they also were diverted to “pill mills” that sprang up in Ohio and across the nation.

Some greedy or careless physicians prescribed opiates indiscriminately. Other doctors who suddenly realized the problem, or feared government regulation, summarily ended treatment with opiates. That forced many patients who had grown dependent on opiates to get their drugs on the street — or to switch to heroin.

Studies over the past decade have shown that opiate addiction is a chronic relapsing disease, like diabetes, hypertension, and asthma. Relapse rates for people who depend on opiates range from 40 percent to 60 percent — similar to the rates for these other chronic diseases.

Brain scans reveal structural and functional changes in the opiate-addicted brain. Blaming an opiate addict for relapsing is like scolding a diabetic for having high blood sugars.

Addiction crosses all boundaries of race, religion, ethnicity, education, profession, age, and wealth. I’ve seen a 65-year-old suburban professional who is addicted to oxycodone chat with a 25-year-old heroin addict, in a touching display of fraternity.

I have specialized in treating addiction for more than two decades. In that time, I often felt powerless as I recommended abstinence and counseling, only to see relapses and ruined lives.

Medication-assisted treatment changed that. Such drugs as methadone, buprenorphine, naltrexone, and Suboxone can be prescribed along with behavioral treatment, enabling patients to maintain sobriety and regain the ability to function fully.

Methadone is very effective for treating opiate dependence. But because of its potency and high risk of overdose death, it can be dispensed only in maintenance programs that require daily attendance and swallowing of liquid methadone in front of a witness.

Buprenorphine not only binds tightly to opiate receptors in the brain, it also can prevent stronger opioids, such as oxycodone and heroin, from doing so. Higher doses of the drug do not cause euphoria, lowering its potential for abuse.

In medication-assisted treatment, patients get a detailed evaluation, urine drug testing, counseling, assignment to a 12-step program, and a prescription for buprenorphine. Doctors who are not board-certified in addiction medicine can take an online course in buprenorphine and obtain a license to prescribe it.

A pregnant opiate addict should be cared for by an experienced addiction specialist. In that way, the buprenorphine dose is carefully adjusted, the pregnancy is protected, and the intensity of opiate withdrawal in the newborn baby — and the resulting hospital stay — are reduced.

Without treatment, pregnant addicts often use a potpourri of drugs. Such abuse sometimes kills their babies, or causes prolonged stays for newborns in an intensive care unit.

Toledo has its share of addiction specialists. But it also has Suboxone “cash-pay” clinics, where the only activity is the exchange of money for prescriptions. Just as painkiller pill mills created the opiate epidemic, Suboxone pill mills are implicated in overdose deaths.

Action teams convened by Gov. John Kasich and Ohio Attorney General Mike DeWine are doing great work in combating the opiate epidemic. But they are missing the vital piece of promoting medication-assisted treatment.

My family-medicine patients send me thank-you cards, but my opiate-addicted patients write thank-you booklets. One such patient was homeless and hopeless.

He dutifully followed a medication-assisted treatment program for a year. He now has a job, a new car, his own apartment, health insurance, and even a 401(k) retirement plan.

Our collective contempt for the disease of opiate addiction is based on ignorance and misinformation. Criminalizing addiction is inappropriate and ineffective; you can’t punish it out of patients.

Recognizing addiction as a disease, and getting more physicians certified to practice office-based opioid treatment in tandem with counseling and 12-step meetings, can quickly control Ohio’s opiate epidemic.

Mahjabeen Islam, M.D., practices in Perrysburg and specializes in addiction and family medicine.

Wednesday, August 21, 2013

US will pay a price for its hypocrisy on Egypt: Haroon Siddiqui in Toronto Star

Superb article in The Toronto Star by Haroon Siddiqui

Opinion / Commentary

U.S. will pay a price for its hypocrisy on Egypt: Siddiqui

The U.S. and its allies have been enablers of the grave crimes committed by the Egyptian military.

By: Haroon Siddiqui Columnist, Published on Thu Aug 15 2013

There has always been a hierarchy to the value of life. Kings mattered more than peasants. Killing continental European colonialists in Africa or the British in India brought the wrath of the empire down on the natives, who were strapped to the cannons and blown to bits by the hundreds. The contemporary era, with its spread of democracy, globalization and greater egalitarianism, raised hopes that all human beings would have equal value.

But the murder of 2,977 innocents on Sept. 11, 2001, led to the killing of at least 100,000 Muslim civilians in Afghanistan and Iraq and Pakistan. An Israeli life is deemed infinitely more valuable than that of a Palestinian. Our own government in Ottawa makes no bones about caring more about Christians in Egypt and Pakistan than Muslim victims of similar religious persecution there or in Myanmar. When the West does care about Muslims, it does so for the secular “good Muslim,” not the Islamist “bad Muslim.”

When Tayyip Erdogan, Turkey’s thrice-elected “Islamist” prime minister, ordered tear gas and water cannons on peaceful protesters in Istanbul, he was duly reviled. But the Egyptian army that has been firing live ammunition into peaceful “Islamist” protesters and killing them by the hundreds in the last month has only been told, politely, of our “concern.”

On July 11, Ottawa raised just such a pipsqueak “concern.” Stephen Harper’s government was more emphatic as it condemned the shooting death of a Coptic Christian priest near El Arish. “The targeting of religious leaders is unacceptable.” Following the second massacre, July 27, in which about 80 protesters were gunned down, Ottawa was “deeply concerned and appalled” — and fixated on its clarion call for respecting “religious minorities,” namely Coptic Christians.

Barack Obama was also mostly silent about the two massacres. So was David Cameron. So was much of Europe. They had refused to call the July 3 military coup a coup. In fact, John Kerry passed the perverse judgment that in toppling the elected president Mohammed Morsi, the Egyptian army was “restoring democracy.” American annual aid of $1.3 billion was to continue.

It’s only now after Wednesday’s bloody massacre of pro-Morsi protesters that Obama stirred himself to shed crocodile tears. The U.S. and its allies have been enablers of the grave crimes committed by the Egyptian military as well of the Goebbelsian lies it has been peddling.

After each official atrocity, the army has under-reported the deaths and blamed the victims, accusing them of “inciting violence,” “hoarding weapons,” “torturing people in public squares,” “fomenting terrorism” and being “a threat to national security.” It has hurled a slew of charges against Morsi — murder, treason, espionage, conspiring with Hamas, attacking and insulting state institutions, etc. It has held him incommunicado, along with several top Brotherhood leaders. It has shut down a dozen pro-Morsi TV stations, with a nary a peep from free speech advocates in the West.

The U.S., the E.U and others have also been doing the Egyptian army’s bidding by calling on “all sides” to refrain from violence when, in fact, the violence has been almost always one-sided. Western governments and media have also accused Morsi of having been unduly partisan when, in fact, he was far less so than most ruling political parties in democracies. Proportionately, he appointed far fewer dummies than, say, Harper to the Senate, or the Republicans or Democrats named friends and funders to key posts.

Morsi was inept in the extreme. But he did reach out to his opponents who simply refused to accept their repeated defeats at the polls.

It has now been credibly reported that the secular anti-Morsi forces formed an unholy alliance with Egypt’s Deep State (the army, the intelligence, the security forces, the police, the interior ministry and its paid thugs, the judiciary and the bureaucracy), along with the beneficiaries of the Hosni Mubarak era (crony capitalists and corrupt politicians) to undermine the Muslim Brotherhood government. They collaborated in mounting mass protests, in a blaze of hateful anti-Brotherhood propaganda by both the state and privately-owned media, which heralded the unproven and unprovable claims that 20 million people had taken to the streets and 22 million had signed anti-Morsi petitions. Post-coup, acute shortages of gas and electricity miraculously disappeared overnight. Law-and-order situations improved in selective neighbourhoods.

Reportedly in on the plot were the intelligence agencies of Saudi Arabia, the United Arab Emirates and other oil-rich Gulf states except Qatar. They hate the Brotherhood, not so much for its Islamic ideology but the democratic threat it poses to their monarchies. They rewarded the coup with $12 billion in aid.

The army conveniently claimed that the coup was only a response to the people’s will. In turn, it has been forgiven all its sins — including the virginity tests on women protesters, and the shooting of Coptic demonstrators and running them over with armoured vehicles.

What we’ve witnessed is “fascism under the false pretence of democracy and liberalism,” said Amr Hamzawy, an Egyptian political activist and former MP.

All this will not be lost on the Muslim masses in Egypt and elsewhere. There will be a price to pay — we don’t quite know when and where and how. But as American pollster Dalia Mogahed, who has surveyed Muslim societies worldwide, says, it is useful to remind ourselves that “Al Qaeda was conceived in the prisons of Egypt and, contrary to conventional wisdom, not the caves of Afghanistan.”

Haroon Siddiqui’s column appears on Thursday and Sunday.

Tuesday, April 23, 2013

CAIR Leadership Award Acceptance Speech

Assalamoalaikum and may the best of peace be on all of you!
The highest honor in my mind is to be appreciated by one’s own people. And for this I am deeply grateful to CAIR.
The Islamic Center of Greater Toledo’s construction began in 1982-the year that I moved to the United States. Mine was the first wedding that was held at the Islamic Center. I could not have imagined then that fast-forward 30 years, not only would I become its president, it would be at a time when a hate-filled, armed and drunk Randy Linn would torch its prayer hall.
Throughout my career in medicine I have been acutely aware of the power of my signature and how it can profoundly change lives. After I was elected president of the Islamic Center the added power to affect the lives of 500 Muslim families would weigh on my mind. I remember. When requests for zakat money or financial assistance came from the community, I would beseech God to sharpen my sense of justice and objectivity.
Muslim leaders should continually remember the triumvirate of accountability: the angel on the right, the angel on the left and God above. Our responsibility and accountability is greater and the Day of Judgment should be continually in our thoughts and impact on our decision making. In my mind the definition of leadership encompasses the four Cs: consensus building, conviction, courage, and consultation. With absolute integrity connecting all of them.
The concept of shoora or consultation is an excellent one. I feel shoora begins at home, where I live with my youngest daughter and mother. I run a very democratic household and in every important issue my daughters Atiya, Sairah, Faiza, and my mother and I vote. Thanks to technology my Atiya votes from Chapel Hill NC and my Sairah from Boston MA. Everyone gets an equal vote; my youngest daughter Faiza’s vote is equal to my mother’s or mine. Instituting shoora and equal representation in families, workplaces and organizations encourages team spirit and accomplishes a whole lot more than egocentric tyrants handing down unilateral decisions made behind closed doors, as it tends to happen in our mosques and Islamic schools.
Just before Ramadan 2012 at the Islamic Center of Greater Toledo, we received an eerie threat that said “stopped” in Arabic with a smiley face in grease on the same paper. It was very strange. The writing was in typed Arabic, with each letter disconnected, and rather than “stop” it said “stopped.” But it didn’t have to make sense for us to know that it was intended as a threat.
Our congregation had gotten very concerned after the Joplin City Missouri arson and suggested that we get added security at the Islamic Center. And here came consensus building: some Council members felt that security during Saturday iftar dinners and Friday prayer was not needed and just another expense.
We learned how it is important for leaders to integrate conflicting opinions and make the decision that is born of conviction and a commitment toward the community. We did have security during Ramadan and I am so grateful that we did; had Randy Linn decided to attack us during Ramadan with a full mosque, it would have been disastrous.
I just attended a conference in Toledo called “Abrahamic Visions of Peace” and they spoke of “internal pressures from the community” and I was reminded of the disagreement within our community regarding the disposition of Randy Linn’s case. To me, making it a federal rather than a county case seemed so logical and obvious; but it wasn’t so clear to others. And here courage is what was needed. Against a lot of pressure I pushed for it to be prosecuted at a federal level and it was. This was important because it wasn’t just about our case; this sets a precedent for future cases.
Only this past week Randy Linn was sentenced to 20 years for unlawfully entering a religious institution, carrying a weapon and arson. I want to acknowledge the diligence and determination of the US Attorney’s office especially the work of Bridgett Brennan and Ava Dustin. The tense hearing when Randy Linn tried to withdraw his guilty plea was handled with professionalism and the skill and convincing arguments of Bridgett Brennan.
Randy Linn was given an exemplary sentence which works to ensure that religious minorities are protected in our country. Judge Zouhary’s statement at Randy Linn’s sentencing was very instructive. He told Linn that what happened on Monday in the Boston bombings and what Linn had done were “an assault on the American psyche”. He also told Linn to study Islam while he’s in prison so that he could perhaps better understand the people that he had attacked.
I can trace the way I’ve been treated as a Pakistani Muslim immigrant for the 30 years that I’ve been in the US. When I first came here, people did not know where Pakistan was and I was treated with interest and courtesy. Post 9/11 things still weren’t too bad. But over the last 7 years or so, that courtesy and interest has changed to coldness and intimidation. There are times I feel that I have horns on my head! At others if looks could kill I’d be dead! My experience is backed up by polls that show that public opinion of American Muslims is worse today than immediately after 9/11.
People would have us believe that America belongs to the White Anglo-Saxon Protestant. The fact is that all its citizens, red, yellow, black, white and brown own America. Muslims do live in fear; we do feel that we are under siege. But cowering in the corner will not do us any good. Calling non-Muslims “Americans” and allowing us to be made into “the other” will not either.
It is for Muslim-Americans in general, and our leaders in particular, to promote the premise that sharing a religion with fanatics or crazies doesn’t make all Muslims extremists. That there’s the good, the bad and the ugly in every group, culture and religion.
We must follow the example of our beloved Prophet Muhammad (peace be upon him) about whom the Quran says in Surah Qalam “You O Muhammad stand in an exalted standard of character”. With courage and restraint, determination and flexibility, fearlessness mixed with wisdom, let us work for a day where differences do not mean inequality and we can walk in any neighborhood with skins of many hues and covered heads and not be marginalized, harassed, intimidated, injured or killed.

Sunday, January 6, 2013

Islamophobia, anti-Semitism and freedom of speech

Printed in The Toledo Blade January 6, 2012

Watching Randy Linn in court last month was unsettling. He pleaded guilty to defacing religious property, using fire to commit a felony, and carrying a firearm as he walked through the Islamic Center of Greater Toledo last Sept. 30. He accepted a binding plea agreement of 20 years in prison, without appeal or parole, for the arson.

His diatribe at the hearing was worse. He cited news media, especially Fox News, for inspiring his desire to avenge U.S. military deaths. He conceded he knew nothing about Muslims or Islam, other than that Muslims did not believe in Jesus Christ as savior.

America’s Constitution promises justice, liberty, and protection of citizens. Yet a wave of Islamophobia, reflected in incidents such as the Islamic Center arson, suggests that we are more intent on protecting freedom of speech than Americans’ lives and property.

In 2004, when he signed the Global Anti-Semitism Review Act, President George W. Bush said that “extending freedom also means disrupting the evil of anti-Semitism.” The law requires a specific federal agency to document acts of physical violence against Jews, their property, their cemeteries, and their places of worship. It also mandates monitoring of anti-Jewish propaganda and promotion of unbiased school curricula.

There is no similar law to respond to this country’s ferocious and well-funded Islamophobia industry, which relentlessly whips up anti-Muslim sentiment that can inspire disturbed people to destroy property, maim, and even kill.

Just weeks before the Islamic Center arson, the Muslim Public Affairs Council released a report on 25 supposed experts on Islam, who are frequently quoted by news media. The report concluded that just one of the 25 “experts,” Daniel Pipes, has had any kind of education about Islam.

Two so-called academic experts, Pamela Geller and Brigitte Gabriel, do not have college degrees, the report said. Yet not only do these pseudo-experts get frequent attention from mainstream media, some of them also train law enforcement officers and testify about their hate-filled agendas before Congress.

Several of these so-called experts were cited by Anders Breivik, who in July, 2012, planted a bomb in an Oslo government building that killed eight people, then went on a shooting spree that killed 68 people, mostly teenagers. Breivik subsequently told a Norwegian court that violence was necessary to save Europe from Marxism and “Muslimization.” In his manifesto, he repeatedly quoted anti-Muslim propagandists Robert Spencer, Pamela Geller, and Walid Shoebat.

Marc Sageman, a terrorism consultant and former CIA officer, notes that just as religious extremism “is the infrastructure from which al-Qaeda emerged,” the writings of anti-Muslim misinformation experts are “the infrastructure from which Breivik emerged.” Their rhetoric, he adds, “is not cost-free.”

At the opening last November of the Islamic Center of Murfreesboro, Tenn., which survived arson and zoning protests, Assistant U.S. Attorney General Thomas Perez asserted: “Without question, we are seeing real challenges to the civil rights of Muslim Americans, including arsons of mosques, assaults, and other hate crimes. We have a steady diet of these cases.”

Mr. Perez expressed deep concern about harassment of Muslim, Sikh, Arab, and South Asian students in schools. “I have often said that today’s bully is tomorrow’s hate crime defendant,” he said. “So we are vigilant to ensure that schools are taking bullying seriously, and are held accountable when they do not.”

He added: “We are doing everything in our power to stop this blight on our nation.” It is comforting to know that the Justice Department recognizes Islamophobia as “blight.”

The Islamophobia industry helped push Anders Breivik to commit a massacre. Fox News helped incite Randy Linn to burn our mosque. Muslims, mosques, and Islamic schools are attacked every week.

There is a federal law against anti-Semitism. But if I call for a similar law against Islamophobia, I am told that protecting freedom of speech is more important.

Hate speech is turning into hate crime. It starts with words, but it ends with mosque burnings — or deaths.

Dr. Mahjabeen Islam is past president of the Islamic Center of Greater Toledo.