A Q&A with public health leaders on the opioid epidemic: ‘Prescription opioid abuse is still raging out of control’
The statistics describing America’s prescription drug abuse epidemic are startling, to say the least. Here are just a few statistics from the Centers for Disease Control and Prevention: In 2009, prescription painkiller abuse was responsible for nearly half a million emergency department visits — a number that doubled in just five years. Of the more than 41,000 drug overdose deaths in the U.S. in 2012, more than half were related to pharmaceuticals. In 2012, U.S. health care providers wrote enough painkiller prescriptions — 259 million — to provide every, single American adult with their own bottle of pills. Prescription painkiller abuse cost the nation more than $55 billion in 2007 alone.
While pharmaceutical companies are making billions in painkiller profits, it’s the public sector that ends up bearing the burden and cost of the widespread fallout that accompanies skyrocketing sales of highly addictive prescription opioids. Law enforcement, criminal justice, health and behavioral health care systems, and state and local public health departments are now on the front lines of an addiction and overdose crisis that continues to spiral out of control. And in addition to the painkiller problem, many state and local officials are reporting spikes in the use of another, more notorious opioid: heroin.
A handful of those frontline responders came together for a congressional briefing on the opioid epidemic in September and called on federal policy-makers to take a more concerted and coordinated effort to address a problem that, on more than one occasion, has been described as a public health crisis. Organized and hosted by the Big Cities Health Coalition (BCHC), the Sept. 16 briefing — “The Opioid Epidemic: Reporting from the Front Lines of America’s Big Cities” — featured insights and remarks from Barbara Ferrer, who until recently served as executive director of the Boston Public Health Commission; Bechara Choucair, commissioner of the Chicago Department of Public Health; and Mary Travis Bassett, commissioner of the New York City Department of Health and Mental Hygiene.
All three described their city’s experience in grappling with the opioid epidemic — click here to watch a video of their remarks. Chicago, in particular, has taken direct action against the pharmaceutical companies that manufacture painkillers. In June, the city filed a claim against five drug companies seeking compensation for damages and for the companies to forfeit revenue stemming from fraudulent marketing claims that pharmaceutical opioids are rarely addictive.
During the briefing, the BCHC members called for three specific federal actions. The first is passage of federal Good Samaritan Law, which would among other measures, give legal protection to those who intervene in a drug overdose. The second is increasing access to naloxone, a drug that can effectively reverse the effects of an opioid overdose and can be easily administered by first responders as well as friends and families of those struggling with opioid addiction. The third action is the creation of a federal interagency task force to address insurance barriers to addiction treatment. (Increasing funding for addiction treatment services may be a particularly challenging goal. A recent study found that the public has significantly negative views of drug addiction, with 43 percent of adults in a nationally representative survey saying they oppose insurance parity for drug addiction.)
Below is a Pump Handle (PH) Q&A with two public health officials at the forefront of the opioid epidemic within America’s big cities: Choucair of the Chicago Department of Public Health and Hillary Kunins, assistant commissioner at the New York City Department of Health and Mental Hygiene.
PH: Opioid use and overdose has been at crisis levels for some time now. Why did the BCHC decide to host a congressional briefing now? Are we at a particularly critical point in the epidemic?
Choucair: Cities have been on the front lines of the opioid crisis for more than a decade. Despite our best efforts, prescription opioid abuse is still raging out of control. In Chicago, we work to help residents in recovery, but we are also looking upstream to help stop the problem before it starts. We know drug companies have engaged in deceptive practices and downplayed the risk of addiction when it comes to prescription opioids — leading many good, law-abiding people to become addicted to prescription drugs or turn to the streets to seek out heroin. This is why Mayor (Rahm) Emanuel and Chicago have filed suit against Big Pharma to require all companies to accurately represent the risks of these drugs and ensure doctors and patients can make informed choices about their care.
Even with these innovative steps, there is still a huge challenge ahead of us. Just (recently), the CDC reported 17,000 annual deaths from overdoses and a rise in heroin use, linking these numbers directly to prescription painkillers. Cities can’t fight this battle alone. We need all hands on deck if we are going to win, including increased leadership from the federal government.
PH: Is federal action to expand access to naloxone preferred to state and local action? Or do we need a combination of both? Are you concerned that federal action may prevent local health officials from designing and tailoring a naloxone program to fit their community’s needs?
Choucair: We need all hands on deck if we are going to win, with cities, states and the federal government working together. Expanding access to naloxone is a vital and life-saving step. In Chicago, fire fighters and emergency medical technicians are armed with naloxone, which has been proven to save lives. Action on the federal level can sidestep two barriers some municipalities face: cost and outdated attitudes towards addiction. The first, cost, reflects the sad reality that local health departments are more likely than state and national health agencies to be restricted to incredibly tight budgets that might not allow for the addition of naloxone purchases. The second, outdated attitudes towards addiction, results in municipal governments refusing to support the use of naloxone out of the mistaken belief that the existence of a lifesaving antidote will encourage abusive drug behavior. This theory has been thoroughly debunked by scientific research, and we hope that national action will erase gaps in medical coverage for both overdose and addiction treatment.
Kunins: Both federal and state action is needed to increase access to naloxone for those at high risk of witnessing an overdose. A federal law that allows laypersons to carry and use naloxone, as we have in New York state, would increase access to naloxone greatly. In addition, (a) Good Samaritan law, which we are fortunate to have in New York State and which protects individuals from drug-related prosecutions in the setting of a drug overdose, should be adopted nationally. Finally, over-the-counter access to naloxone would be another way to facilitate access to and availability of naloxone to reverse overdose. These federal policies would help, not hinder, local health officials to prevent overdose in their communities. Knowledge of the local context, including opioid overdose trends and stakeholders, could be used in a synergistic way to tailor naloxone programs to the community’s needs.
PH: Some communities that have successfully curbed the illicit flow of prescription painkillers have experienced an increase in heroin use. A few months ago, I interviewed a local health official who told me that after successfully restricting the flow of painkillers, there was a nearly 100 percent switch to heroin among clients at the local needle exchange. What does a story like this tell us about the importance of addressing the opioid epidemic in a comprehensive way instead of focusing on either painkillers or heroin separately?
Choucair: Addiction to prescription painkillers and addiction to heroin are one and the same — both in terms of the chemical effects and their ability to ruin lives, tear families apart and kill the individuals using them. We are very concerned about individuals moving from prescription painkillers to heroin in response to either the lower price or the reduced availability of prescription drugs, which is why both the Big Cities Health Coalition and the City of Chicago have made addiction treatment such a high priority. Unless our public health and health care agencies are able to successfully intervene and rehabilitate an individual misusing prescription drugs, we will be turning addicts out onto the street in search of other alternatives.
Kunins: Using a comprehensive strategy to address the public health crisis related to opioids is very important. In New York City, we have taken a multi-pronged, public health response, including developing an innovative drug surveillance system, promoting safe and judicious opioid prescribing, promoting overdose prevention with naloxone, improving access to addiction treatment and conducting public education media campaigns. Although we have seen an increase in heroin overdose deaths the past three years in New York City, our data do not suggest that initiatives to limit opioid analgesic prescribing caused this trend, given that heroin overdose deaths began to increase prior to implementing these prescribing initiatives. Additionally, we are conducting real-time qualitative studies in the community to better understand this problem and we are finding that several patterns of new heroin users exist (not only those who transition from opioid analgesics to heroin). This is a complex story that is unfolding. A comprehensive public health response will help to understand and reduce overdose deaths.
PH: In efforts to prevent the diversion of prescription painkillers and refine prescribing practices, how can we ensure that legitimate chronic pain patients don’t get caught in the middle? Are you concerned that fewer and fewer doctors will be willing to prescribe painkillers to those who need them?
Choucair: I am a family physician, and I will be the first to say that we do not want painkillers to be banned or made unavailable for those patients for whom it is appropriate. We have gone too far in one direction by making prescription painkillers the first, most common, and often only method of pain management. Prescription painkillers should be used to address temporary pain in conjunction with other treatments, like physical therapy. Prescription painkillers are not appropriate for long-term or chronic pain in individuals who are not terminally ill, and physicians need to be more rigorous in screening for abuse risk factors.
Kunins: It is important to address patients’ concern for pain in a comprehensive and safe way. Although there is still a role for opioid analgesics in certain painful conditions, they are not always the appropriate treatment. In fact, for chronic pain that is not related to cancer, there is insufficient evidence for pain relief or improved function from long-term opioid use; however, there is a substantial risk for addiction and overdose. Efforts to promote safe and judicious opioid prescribing should be evidence-based and should encourage prescribers to carefully weigh the serious risks of opioid analgesics against possible benefits to the patient. In New York City, we urge consideration of non-opioid therapies to treat pain, whenever possible. However, if after thorough consideration of the risks versus benefits, opioids are prescribed, they should be for evidence-based indications, shorter durations and lower doses. This approach limits unnecessary exposure to opioid analgesics on the population level, preventing addiction and overdose, yet supports safe and appropriate treatment of pain.
PH: Public health officials are on the forefront of addressing the opioid use and overdose epidemic, yet we seem to hear little from the medical community, which is a key player in this problem. Are you hearing from physicians in your community who want more education and resources to help them responsibly prescribe painkillers? Do physicians in your community seem eager to help solve the problem?
Choucair: I am a physician and I can tell you I am concerned. Furthermore, physicians from around the country have reached out to me and expressed support for our efforts in Chicago. If you haven’t heard much from medical institutions yet, I expect you will soon. Public health officials and physicians are partners in this effort, as are policy-makers and community leaders — at every level.
Kunins: In New York City, we conducted office-to-office educational visits with more than 1,000 health care providers in Staten Island, our hardest-hit county. During these visits, we promoted our guidelines for safe and judicious opioid prescribing, provided resources and tools to implement these guidelines and received feedback. Providers were enthusiastic about our educational guidelines and were motivated to learn strategies to help address this serious problem.
To learn more about the Big Cities Health Coalition and its efforts to address prescription drug abuse as well as to access video from the September congressional briefing, click here. To learn more about the nation’s opioid epidemic, visit the Centers for Disease Control and Prevention.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Exclusions, barriers, bans and hurdles describe many injured workers’ experiences with workers’ compensation. A system that was supposed to assist them and provide streamlined procedures to recoup medical costs and lost wages has become a nightmare for individuals who’ve been injured on-the-job. A new policy brief by the National Economic & Social Rights Initiative (NESRI) describes seven destructive trends in workers’ compensation laws which reflect the attitude of many in state legislatures who “see workers’ comp as an unnecessary cost for business rather than a critical health care and social insurance program.” NESRI’s list them as the following:
- More workers’ health conditions are excluded from coverage (e.g., some state laws explicitly disallow claims for hearing loss, repetitive motion injuries and back disease.)
- Increased procedural barriers to workers claims (i.e., originally designed to be a “no fault” system, most workers have to retain lawyers and their own medical experts to support their claims.)
- Reduced income support for disabled workers (e.g., a fixed number of weeks of pay for disabled workers, regardless of the individual’s condition or advice from a physician.)
- More employer control over workers’ medical treatment (e.g., workers are forced to use physicians selected by the employer or insurer who have a vested interest in saving money.)
- End to universal mandates that employers carry workers’ compensation insurance (e.g., in 2013, Oklahoma joined Texas in allowing employers to “opt out” of carrying work comp insurance.)
- Bans on workers suing insurers for dishonest and misleading practices by insurers.
- Reduced access to attorneys (e.g., cutting the fees that an attorney can charge for handling a worker’s case.)
None of this is new to public health researchers and organizations who’ve studied workers’ experiences with the workers’ compensation system (e.g., here, here, here, here, here, here.) As Les Boden, PhD wrote in a 2012 article in the American Journal of Industrial Medicine:
“The sorry and declining state of workers’ compensation in the U.S. is largely the consequence of the political power of employers and insurers, bolstered by their ability to frame the political debate. Employer costs per $100 of covered wages declined from $2.18 in 1989 to $1.33 in 2009, reflecting both legal restrictions on workers’ compensation and declining reported injury rates. Yet even today the debate in the states is about excessive employer costs and employers’ threats to move to states (or countries) with lower workers’ compensation costs. The simplest way to reduce costs is to reduce the amount of benefits paid to workers, through raising barriers to approval of claims or reducing the benefits in claims that are approved.”
The impact of the destructive trends described in NESRI’s brief are made real through the voices of injured workers. Robert Hudson, 61, was working for the school district in Addison, New York when he was exposed to muriatic acid while cleaning a swimming pool. He’d never cleaned a pool before and wasn’t trained on how to do it safely. “I was a company man and I wanted to get the job done,” explained Hudson.
Injuries to his respiratory system were severe. Hudson wanted to continue working, but could no longer climb ladders or the other physical work required by the job. His doctor says he is permanently disabled. He used his paid sick leave and personal leave for three months while waiting for the workers compensation system to make a decision about his case. It was seven months later when he received his first payment from work comp for lost wages. His weekly payment was $202.36 compared to the $400 he used to earn. In a report prepared by the New York Committee for Occupational Safety and Health (NYCOSH), Hudson describes his frustration with the workers’ comp system:
“They keep sending me to independent medical examiners to prove my condition is not what my doctors are saying it is. I am being badgered. The procedures are flawed. My life as it was is ended now. I can never work again. I am tired of being screwed by all these people. They don’t have to live with the constant worry, and coughing their brains out all night long…”
In 2009, the American Public Health Association (APHA) adopted a policy statement calling for reforms to the workers’ compensation system. Not the pro-business “reforms” that create hurdles for injured workers, but improvements to create a safety net for workers and their families. Among others, APHA proposes a national system with
- uniform coverage of health care and adequate loss-of-earnings benefits for all occupational injuries and illnesses;
- health care for injured workers provided by providers independent of employer involvement and insurance industry control;
- health care providers removed from the responsibility of determining eligibility for benefits;
- an emphasis on prevention of injury and illness, and rehabilitation of those unable to return to work, and
- mandatory root cause investigation requirements for all occupational injuries and illnesses.
The US workers’ compensation system—dating back to Wisconsin’s law in 1911—stems from a bargain between workers and employers. Workers who are injured or made ill from hazards at work would receive medical care and payment of lost wages while they recover. In exchange, employers could not be sued by workers for the harm the employer caused. The destructive trends profiled by NESRI, however, illustrate that decades of “reforms” make the bargain no longer a good deal for injured workers.
Land managers in the eastern U.S. and Canada have spent countless man-hours and millions of dollars trying to tame a pernicious, invasive reed known as Phragmites australis. Toxic herbicides, controlled burns, and even bulldozers have been the go-to solutions to the problem. But recent research out of Duke University suggests another, less aggressive fix: goats. The approach is finding practical applications, including in New York City, where officials deployed a herd of goats at Staten Island’s Freshkills Park.
In an amazing three-part investigation, Seattle Times reporters Christine Willmsen, Lewis Kamb and Justin Mayo bring to light an occupational hazard not often heard about: the risk of lead poisoning at the nation’s gun ranges. They write that thousands of people, many of them gun range employees, have been contaminated due to poor ventilation and contact with lead-coated surfaces. Legally, gun range owners are responsible for protecting employees, but the investigation found that officials do little to enforce regulations. The investigative series offers a “first-of-its-kind analysis of occupational lead-monitoring data,” finding “reckless shooting-range owners who’ve repeatedly violated workplace-safety laws with no regard for workers who became sick. Other owners and operators were ignorant of the dangers posed by lead.”
Throughout the series, the reporters interview the victims of lead poisoning, such as James Maddox, a former gun range manager in Kentucky. They write:
Like many shooting-range workers, Maddox knew little about lead and its damaging capabilities. Daily, he inhaled airborne lead while managing the range and gun shop. Nightly, he swept up casings from spent ammunition in the 12 firing lanes, pushing a broom and kicking up more lead dust. The toxin landed on his skin and sank into his pores. Every breath pushed the poison further into his lungs, blood and bones.
He complained to owner Winfield Underwood that catch bins at the end of shooting lanes were overflowing with spent lead bullets, the ventilation system didn’t work and workers needed protective gear. Inspectors later discovered the air vents didn’t even have filters.
“It was just circulating the lead air,” said Maddox, who earned $9 an hour.
After working at the Louisville range about six months, Maddox, a hefty 38-year-old man, dropped 180 pounds. He also lost sensation in his fingers and toes. His head throbbed, his thinking slowed and he couldn’t remember birthdays.
Unfortunately, OSHA’s track record on inspections and enforcement seems severely lacking. The article notes that OSHA can’t determine just how many gun ranges have been inspected because they can’t track all the ranges in the first place. Apparently, many ranges register under categories such as “amusement and recreational industries” — one gun range even claimed to be a locksmith. And even when OSHA does take action, it may not stick. The reporters write:
In 2012, OSHA touted a crackdown at Illinois Gun Works, a firing range in Elmwood Park, a Chicago suburb. After federal inspectors found air inside the range contaminated with lead at 12 times allowable levels, the agency cited the range with 27 serious violations and hit it with $111,000 in fines. OSHA then hyped its enforcement in a widely distributed news release.
But since then, Illinois Gun Works has neither paid a dime nor fixed a single violation. Range owner Don Mastrianni, 59, a retired Chicago garbage collector, said he opted against making costly corrections after he learned his landlord was planning to demolish the building that housed his range.
Instead, Mastrianni kept the range operating for months before it was torn down in 2013 to make way for a new McDonald’s restaurant. Salvagers took no special precautions when hauling off the lead-caked debris.
In addition to telling the stories of gun range workers, the series also chronicles the effect of lead exposure on the families of workers. In the second part of the series, which investigates the nation’s worst known case of lead exposure at a gun range at Wade’s Eastside Guns and Bellevue Indoor Range in Washington, the reporters tell the story of construction worker Manny Romo:
An invisible assailant had invaded the bodies of Romo and his two kids, attacking their bones, brains and nerves.
They were contaminated with lead. And it came from an unexpected place.
In fall 2012, Romo had inhaled lead while helping erect a second story on Wade’s Eastside Guns and Bellevue Indoor Range. He was never warned about lead hazards from spent ammunition at the worksite and unknowingly tracked the poison home to his children.
Shortly before Christmas 2012, the Romo family evacuated their Auburn home, fearing for their safety and leaving behind contaminated furniture and toys.
Romo was one of 46 people contaminated by lead during the Wade’s renovation — the worst known case of occupational lead exposure at an American shooting range, according to public-health officials.
In other news:
Buzzfeed: Reporter Chris Hamby chronicles the story of Steve Day, who worked in the coal mines of West Virginia for nearly 35 years. Even though half a dozen doctors diagnosed him with black lung disease, Day initially lost his case to gain the federal benefits guaranteed to him by law, thanks to the opinion of a unit of doctors at Johns Hopkins Medical Institutions. Unfortunately, Day died in July. Doctors who saw his autopsy report said he had one of the worst cases of black lung they’d ever seen. Hamby writes about Day’s life and story, the doctors who wrongly diagnosed him and countless other miners, and how Day’s willingness to speak out is helping others.
Wall Street Journal: Less than a day after the Centers for Disease Control and Prevention announced new safety procedures for workers treating Ebola patients, thousands of New York City health care workers participated in an exercise in the proper use of protective gear. Reporter Melanie Grayce West writes that the union-organized event was convened in response to worker concerns about inadequate training. West reports: “Patricia Kane, a 55-year-old nurse from Staten Island and leader of the New York Nurses Association, said that Tuesday’s ‘very informative’ training was a step in the right direction and encouraging. But, she added, repetitive training and lots of practice is needed, as is adequate staffing for patients.”
Salon: Cantare Davunt, a Wal-Mart employee from Apple Valley, Minnesota, writes about life making little more than minimum wage and explains why she joined fellow Wal-Mart workers in shutting down Manhattan’s Park Avenue while protesting in front of the luxury penthouse where Alice Walton, one of Wal-Mart’s owners, lives.
Forbes: The Huffington Post recently exposed a non-compete agreement that all Jimmy John’s workers are asked to sign, even those at the bottom of the wage ladder making sandwiches and deliveries. According to Huffington Post reporter Dave Jamieson, the “worker agrees not to work at one of the sandwich chain’s competitors for a period of two years following employment at Jimmy John’s. But the company’s definition of a ‘competitor’ goes far beyond the Subways and Potbellys of the world. It encompasses any business that’s near a Jimmy John’s location and that derives a mere 10 percent of its revenue from sandwiches.” Forbes writer Clare O’Connor asks if such an agreement has any legal legs to stand on. Fortunately, the legal expert she interviews doesn’t think any court would uphold it.
Buzzfeed: Imagine sending an email to your boss asking for a raise and copying 200,000 of your co-workers. That’s exactly what Wells Fargo employee Tyrel Oates did in an impressive email about income inequality.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
A few of the recent pieces I’ve liked:
Nancy Shute at NPR’s Shots blog: Nurses Want to Know How Safe is Safe Enough with Ebola
Maryn McKenna at Superbug: What Would Keep Ebola from Spreading in the US? Investing in Simple Research Years Ago. (Check out the last paragraph for links to other great recent pieces on the disease.)
Atul Gawande at Slate: No Risky Chances: The conversation that matters most
Catherine Rampell in the Washington Post: Is sex only for rich people?
Laurie Abraham in Elle: Abortion: Not easy, not sorry
Ta-Nehisi Coates at The Atlantic: To Raise, Love, and Lose a Black Child
At this point, it’s pretty clear that soda is bad for your health. But a new study has found that it may be even worse than we thought.
Published yesterday in the American Journal of Public Health, the study found that drinking sugar-sweetened beverages may be associated with cell aging. More specifically, researchers studied the effect that soda has on telomeres, which are the protective units of DNA that cap the ends of chromosomes inside human cells. Previously, the length of telomeres within white blood cells has been tied to shorter lifespans as well as the development of chronic diseases such as heart disease, diabetes and certain cancers. In this study, researchers found that telomeres within white blood cells were shorter among people who drank more soda.
“This is the first demonstration that soda is associated with telomere shortness,” said study lead author Elissa Epel, a professor of psychiatry at the University of California-San Francisco, in a news release. “This finding held regardless of age, race, income and education level. Telomere shortening starts long before disease onset. Further, although we only studied adults here, it is possible that soda consumption is associated with telomere shortening in children as well.”
To conduct the study, researchers studied the association between drinking sugar-sweetened beverages, fruit juice and diet soda with telomere length among about 5,300 adults with no history of diabetes or heart disease and who were participating in the National Health and Nutrition Examination Survey. They found that each daily eight-ounce serving of sugar-sweetened sodas was linearly associated with shorter telomeres, which would roughly equal about 1.9 additional years of biological aging. (The average daily sugar-sweetened soda consumption among the study participants was 16.8 ounces.) A daily 20-ounce soda, which is a typical serving size, would translate into about 4.6 additional years of biological aging. Study authors Epel, Cindy Leung, Barbara Laraia, Belinda Needham, David Rehkopf, Nancy Adler, Jue Lin and Elizabeth Blackburn write:
Our hypothesis that consumption of (sugar-sweetened beverages) were related to shorter telomeres was derived from the known effects of (sugar-sweetened beverages) consumption on impaired fasting glucose and insulin resistance. (Sugar-sweetened beverages) have been known to increase oxidative stress and systemic inflammation, which are both processes that can influence telomere attrition. Telomere shortening in response to, and perhaps contributing to, these disease processes was reported, reflecting the overall burden of cardiometabolic disease. Our results suggested that another link between sugar-sweetened soda consumption and metabolic disease might be through shortened telomere length, a biomarker and mechanism of cellular aging.
While sugary sodas did seem to have an effect on telomere length, the study found that drinking 100 percent fruit juice was slightly associated with longer telomeres and no association was observed between telomere length and the consumption of diet sodas or noncarbonated sugar-sweetened beverages. The study noted that soda’s effect on telomere length was comparable to the negative effect of smoking or the positive effect of physical activity on cellular aging.
“Regular consumption of sugar-sweetened sodas might influence disease development, not only by straining the body’s metabolic control of sugars, but also through accelerated cellular aging of tissues,” Epel said.
However, the study authors cautioned that more research is needed, noting that the current study only examined participants at one point in time and that association does not equal causation. Currently, a new study is in the works in which Epel and colleagues will follow a group of study participants over a longer period of time and examine the effects of soda on cellular aging.
To read a full copy of the study, visit the American Journal of Public Health.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Not an “accident”: John Dunnivant, 57, suffers fatal work-related injury at Kia Motors plant in West Point, Georgia
John Dunnivant, 57, suffered fatal traumatic injuries on Tuesday, October 7, while working at a Kia Motors manufacturing plant. The facility is located in West Point, Georgia, off of I-85 near the Alabama-state line. WTVM provides some initial information on the worker’s death:
- Police and fire were called to the plant at 11:10 am local time.
- Dunnivant worked in maintenance and was crushed by a stamping machine.
- Kia management cancelled the remaining workshifts the day of Dunnivant’s death, but production began again the next day.
Ben Wright of the Ledger-Enquirer reports:
- Dunnivant was found in the steel press section of the facility.
- The county coroner reports that Dunnivant “was moving something very heavy and it fell on him.”
- The Korean automaker employs about 3,000 people at the West Point operation. The plant builds the Kia Sorento, Hyundai Santa Fe, and Kia Optima.
- In January 2008 when this Kia Motors plant was being constructed, a worker employed by Superior Rigging & Erecting Co. was struck by a beam and suffered fatal injuries.
The Ledger-Enquirer’s Wright also provides information on Dunnivant’s memorial, including his family’s request:
“Instead of flowers, donations may go to Native American orphanages or schools in his memory.”
Each year, dozens of workers in Georgia are fatally injured on-the-job. The Bureau of Labor Statistics reports 70 work-related fatal injuries in Georgia during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.
The AFL-CIO’s annual Death on the Job report notes:
- Federal OSHA has 49 inspectors in Georgia to cover more than 214,000 workplaces.
- The average penalty for a serious OSHA violation in Georgia is $2,061.
Federal OSHA has until early April 2015 to issue any citations and penalties related to the incident that stole John Dunnivant’s life. It’s likely they’ll determine that Dunnivant’s death was preventable. It was no “accident.”
Earlier this month a federal judge upheld citations issued by OSHA to Murray’s Chicken. The company, located 100 miles north of New York City, was cited by OSHA in June 2012 for repeat and serious violations of worker safety regulations. Among others, Murray’s Chicken failed to provide information and train its workers on the hazardous chemicals used in the plant to disinfect the chicken carcasses. OSHA inspectors found that workers in the “kill, evisceration and other poultry processing areas” were routinely exposed to bleach and Perasafe, an antimicrobial agent containing peracetic acid, hydrogen peroxide and acetic acid. Some of the exposed workers were suffering from respiratory system ailments and skin rashes.
For this and other OSHA violations, the agency proposed a $67,600 penalty. Murray’s Chicken, which operates under the name MB Consultants Ltd., contested the citations. The judge didn’t buy Murray’s challenge of OSHA’s findings.
OSHA’s inspection came following the November 2011 death of Jose Navarro, 37. Navarro was a USDA poultry inspector who was assigned to work at Murray Chicken. As reported in April 2013 by the Washington Post’s Kimberly Kindy, Navarro was concerned that chemicals used in the chicken processing were adversely affecting his health and those of the poultry-processing workers. His widow Nicole told Kindy:
“Some themes that were constant were poor ventilation and overuse and mishandling of chemicals which constantly irritated his lungs. Sometimes he would hold his hand over his chest and talk about the chlorine reaching intolerable levels that day.”
After a week in the hospital, Navarro died from a pulmonary hemorrhage.
At Murray’s Chicken, it’s better to be a bird than a worker. Their website shows it’s all about the chickens. The company says its poultry tastes best because its birds have
“the best living conditions,” are raised in a “lush countryside,” with a “leisurely lifestyle,” and plenty of fresh air and sunlight where they can stretch their wings. The company says its chickens are “happy and healthy,” and boasts its processes are “certified humane.”
More than 150 stores in New York City alone carry Murray’s Chicken products. Their poultry may actually taste better because of the way the chickens are raised. I just wish though that more consumers thought about the workers in the plants, than the animals that end up on our plates.
When it comes to substance abuse disorders, public health and the public at-large are hardly on the same page — in fact, they’re not even reading the same book. And that’s a serious problem for sustaining and strengthening efforts to treat addiction and advancing effective public health policy.
“We already know quite a bit about public attitudes toward mental illness and we were interested in learning more — especially in the context of prescription (painkiller) drug abuse — about what the public thinks about issues related to drug addiction,” Colleen Barry, who recently co-authored a study on how the public views drug addiction versus mental illness, told me. “The attitudes of the public can be linked in important ways to broader support for policy action.”
In the study, which was recently published in the journal Psychiatric Services, Barry and colleagues surveyed a representative sample of more than 700 U.S. adults, asking a variety of questions about stigma, social distancing and the acceptability of discrimination. For example, researchers asked questions such as: Would you be willing to have a person with mental illness/drug addiction marry into your family? Would you be willing to have a person with mental illness/drug addiction start working closely with you on a job? Do you favor or oppose requiring insurance companies to offer benefits for the treatment of drug addiction/mental illness that are equivalent to benefits for other medical services? And do you agree that landlords should be able to deny housing to a person with drug addiction/mental illness? Overall, the study found that respondents held significantly more negative views of drug addiction than of mental illness.
Specifically, researchers found that 62 percent of respondents said they’d be willing to work with someone living with a mental illness, but only 22 percent would be willing to work with someone living with addiction. Twenty-five percent said employers should be able to deny employment to people with mental illness; 64 percent said the practice should be allowed regarding drug addiction. Twenty-one percent of respondents opposed offering insurance parity for mental illness, while 43 percent opposed such parity for patients with drug addiction. Fifty-four percent thought landlords should be allowed to refuse housing to people with drug addiction, while 15 percent had a similar view about people with mental illness. Overall, researchers found higher opposition to public policies aimed at helping people struggling with drug addiction when compared to policies in support of people with mental illness. However, respondents did seem to agree in one area: About one in three believe that recovery from either drug addiction or mental illness is impossible.
Study co-authors Barry, Emma McGinty, Bernice Pescosolido and Howard Goldman write:
Less sympathetic views may result at least in part from societal ambivalence about whether to regard substance abuse problems as medical conditions to be treated (similar to other chronic health conditions, such as diabetes or heart disease) or personal failings to be overcome. More so than mental illness, addiction is often viewed as a moral shortcoming, and the illegality of drug use reinforces this perspective. It is likely that socially unacceptable behavior accompanying drug addiction (for example, impaired driving and crime) heightens society’s condemnation.
“It was surprising to me how negative the attitudes were,” said Barry, an associate professor in the Departments of Healthy Policy Management and Mental Health at Johns Hopkins Bloomberg School of Public Health. “From a policy perspective, we tend to roll mental illness and addiction together…but the way the public thinks about them is very different — more different than I would have expected.”
In efforts to reduce societal stigmas around drug addiction, Barry called for better public information about the treatability of drug addiction and media coverage that more accurately portrays the face of addiction. For example, many people might automatically associate drug addiction with the image of a strung-out drug user living on the streets. But that image misconstrues the growing reality of drug addiction and the idea that drug addiction can happen to anyone and in all walks of life, Barry told me. In fact, such a stereotypical image of addiction could significantly impact public support for policy action at a time when public health practitioners are struggling to contain increases in prescription painkiller and heroin-related deaths and overdose. In addition, such societal attitudes often prevent those who need treatment for addiction from seeking help. Barry noted that currently, less than 10 percent of people with an addiction disorder seek any treatment at all.
“We have a whole new population that needs treatment that is not going to get into treatment in the context of broader social attitudes,” she said, referring to the prescription painkiller abuse epidemic. “So this is a huge issue. …Public support plays a major role in determining which public policies get advanced and which don’t. When we look at the state of the substance abuse treatment system, it’s terribly underfunded and part of that has to do with an underlying lack of support among the public.”
To address the problem, the study calls for “portraying addiction or mental illness as treatable.” In this realm, Barry noted that with advancements in mental health treatments, such as the availability of selective serotonin reuptake inhibitors (SSRIs) to treat depression and anxiety, people became more comfortable talking publicly about their struggles with mental illness and thus, stigmas around mental health begin to break down. Unfortunately, on the addiction side, we’re behind in both treatment and public acceptance, she noted.
However, the arrow between public opinion and policy change is bidirectional, Barry tells me. In other words, policy can help shift public attitudes as well. She’s talking about the Affordable Care Act, which now requires insurance companies participating in the new health insurance marketplace to cover mental health and substance abuse services as essential benefits. Such a high-profile policy change could go a long way in mainstreaming mental health and addiction treatment, Barry said. Still, public attitudes on drug addiction seem far from the public health perspective that considers addiction a chronic disease.
“We need to transform the stories of addiction in our country,” she said. “We need to be more involved in communicating a more true face of what addiction looks like in the U.S. and how treatment can benefit individuals, and that includes influencing how the news media covers these issues as well as how politicians talk about this issue. We need to change the narrative to one of a chronic disease that can benefit from ongoing, effective treatment.”
To read more about the study, visit the Johns Hopkins Bloomberg School of Public Health.