Intoxicating substances used to go hand in hand with creative writing. Is it time for a change?

A few weeks into my creative writing MFA, a bunch of us new writers were sitting around a cramped table at one of New York City’s staple “writerly” bars. It was never one of my favorites to be honest—the prices are high, the seating limited or nonexistent and the waitstaff generally hostile toward the writers who overrun the place, with the exception of our favorite bartender who knew every writer in the program by name after only a day and often snuck us drinks on the house. I’m sure for years our loyalty helped keep the place in business.

Still I never felt that magnetic attachment to the place others did; it invariably made me anxious, most conversations (on my part) beginning, “Man, this place is really not conducive to conversation, huh.” Mere “conversation” was rarely the point, though.

“So …” said one girl, breaking the ice. “Favorite drug. Ready, go!”

“Opium.” “Ecstasy.” “Probably … blow.”

They kept rattling them off with ease.

“That would be my vibrator,” said one self-professed “Sober Sally.”

A couple writers, myself most likely included, seemed to scoff into their beers.

It’s no shocking revelation that for a long time writing, drinking and taking drugs have gone hand in hand. Often the very culture around writing seems more defined by this lifestyle than anything else. On more than one occasion throughout my MFA, events were attended simply for the open bar, others abandoned in favor of the closest bar. “Writing meetings” quickly devolved into 4 a.m. drinking competitions, and some classes were “drinking classes,” the professor occasionally most intoxicated of all. I have to admit, I didn’t always mind.

Every year, the creative writing community nationwide descends on one major U.S. city for the Association of Writers & Writing Programs (AWP) conference. While there is certainly valuable information to be gleaned at AWP and good networking to be done, there’s no denying that for many it’s an excuse to spend three days drunk in a hotel room with friends under the guise of literariness.

This year, however, with AWP rapidly approaching, something a little different is happening. This year there is Sober AWP, public, to my knowledge, for the very first time. “Anyone in recovery from anything is welcome,” notes the recurring, bare-bones event description on AWP’s events calendar.

As someone who has been enabled in the past, and done my fair share of enabling, I may have at some point laughed off Sober AWP (“that’s not the point!”) or at the very least overlooked it. Now, one year out of my MFA and much further along in life, I applaud it; I’m proud to see it exists.

More so, I’m impressed the event description does not play Sober AWP off as the “most amazing time ever.” It does not try to compete with all the other debauched festivities, but rather calls it what it is: daily meetings for sober writers.

The creative writing culture will never lose its emphasis on getting obliterated, and for many that’s just fine. While it can be extremely hard for sober people to merely coexist alongside those who are actively not sober, hopefully others in the national literary community will in some way follow suit in the future, and help carve out that place for sober writers that isn’t always behind closed doors.

Dr. Sanjay Bashki, a pain treatment specialist, said he looks for “red flags” to avoid addiction in his patients.

By David Gibbons

Pain management was pioneered by a Seattle anesthesiologist, Dr. John Bonica, in the 1970s, and its growth into an organized, accredited medical specialty was mostly shepherded by his colleagues in the field. So you would imagine these doctors to be masters of the numbing effects of various painkilling drugs. While this is true to some extent, it is also part of a popular misconception of that passive, white-coated figure who clamps on the knock-out mask and hovers over your inert corpus for hours while the “real doctors” perform their miracles.

As Sanjay Bakshi, M.D., a prominent pain doctor, pointed out, “Anesthesiologists are actually hands-on physicians who perform various procedures such as nerve blocks.” Bakshi started his pain management practice in 1996, and in 2003 founded Manhattan Spine & Pain Medicine, P.C., which now has five locations in the New York-New Jersey metro area. “I can tell you that even back then, in the 1990s, people didn’t know much about pain management.”

Over the past 20 years, it has rapidly evolved into a multidisciplinary, holistic approach wherein drug therapy supplements many other treatments, including physical therapy, acupuncture, meditation, Chinese herbal medicine, injections, implants and minimally invasive surgery. And the drug therapy itself has become much more multidimensional; Pharmacology of Pain, a 2010 book aimed at health professionals, emphasizes “multimodal analgesics,” the simultaneous use of more than one family of pain relievers. It also covers the issues of tolerance, dependency and addiction.

Bakshi figures that about 60 percent of his patients suffer from back pain. “The good news is most of them get better with some over-the-counter medications after a couple of weeks,” he said. “If the pain goes on beyond six weeks, we need to look at other options. We take a ‘step-wise’ approach.”

The least risky, least invasive procedures—and the simplest, safest medications—are tried first. If they don’t work, a decision is made to move on to more difficult, complicated treatments.

The most commonly prescribed medications for chronic pain are NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (e.g., Motrin, Advil) and naproxen (e.g., Aleve), many of which are also available over the counter. Muscle relaxers might also be prescribed, possibly steroids, and then, if necessary, opioids, so called because they act on the same receptors as opium. The term encompasses the naturally occurring alkaloids morphine and codeine, semi-synthetics such as hydrocodone and oxycodone and synthetics such as fentanyl. Antidepressants and anti-seizure drugs may also used to treat chronic pain.

With little hesitation, general practitioners have prescribed morphine to combat acute or chronic pain for more than a century. The luxury of benefiting from a specialist who knows and understands all the options—including opioids, aka narcotics—is relatively new. Still, there are concerns that these powerful analgesics can do worse than just knock you out.

“Opioids are effective in a large number of situations but at the expense of troublesome or even life-threatening side effects,” said Dr. Pierre Beaulieu, one of the editors of Pharmacology of Pain. “The complexity of pain targets is now obvious, and no one magic bullet will be able to address them all.”

A 1999 survey sponsored by the American Pain Society found that 82 percent of people taking so-called narcotics experienced side effects. Those included drowsiness (61 percent), dry mouth (51 percent), upset stomach (35 percent), nausea (31 percent), constipation (30 percent) and confusion (21 percent). According to government estimates, nearly 2 million people per year in the U.S. abuse prescription painkillers; accidental overdose of these drugs is now considered a significant cause of death among adults.

“I think opioids are a good treatment modality, but like any other class of medications, it has to be tailored to the patient,” said Bakshi. “For example, if you have an 80-year-old woman who has pain from spinal stenosis, you might prescribe a small dosage so she can avoid surgery and resume her normal activities. If you have a young patient and start by prescribing large doses, of course they could have problems.” Lower doses and long-acting medications are preferable.

“Addiction is certainly a problem,” he said, “and it’s not necessarily a function of the medication but of the patient. People become alcoholics because they have an inherent personality issue that makes them susceptible. The same is true for opioids.”

The bottom line with painkillers is that patients need to follow their prescriptions to the letter and communicate honestly with their doctor. Good, responsible doctors prescribe opioids in a cautious and conservative manner. Setting a trial period and/or starting with a smaller dosage, then adjusting as necessary, are two examples of this, as is clearly spelling out the possible side effects alongside the benefits.

At Manhattan Spine & Pain, Bakshi and his colleagues have a robust informed consent policy and follow the guidelines of the American Society for Interventional Pain Management in prescribing narcotics. Patients are required to sign a form indicating they understand all of the risks and have fully disclosed their medical history.

They also must agree to random monthly urine or blood tests. This helps weed out anyone who might be diverting their medications or “shopping around” for multiple prescriptions.

“There are certain red flags,” said Bakshi. “If there is a history of alcohol or drug addiction, I would not put a patient on long-term narcotics.” He added that doctors can now use confidential online services to double-check a patient’s medication history. Another red flag is a patient who ups his or her dosage unilaterally.

“In the pain management specialty, we have a lot of different tools available,” said Bakshi. “It’s not just medications. It’s a combination that includes physical therapy, injections and other procedures. You really have to tailor the treatment to the problem and find the most effective way to deal with it. That’s what we do.”

Pain-relief procedures that were once considered exotic or last-resort—implanting an electrical spinal cord stimulator is a good example—are becoming much more routine and indeed are pushing potentially worrisome drugs back into the category of final options.

Mayor, Council Deliver ‘On-Time, Balanced Budget’
Last week, Mayor Michael Bloomberg and the New York City Council passed a $68.5 billion budget for 2013 that will save some children’s programs and 20 fire companies.
“Working with our partners in the Council, we’ve again produced an on-time, balanced budget for our city that doesn’t raise taxes on New Yorkers and that preserves the essential services that keep our city strong,” Bloomberg said. “These actions…have allowed us avoid the severe service cuts that many other cities are facing.”
According to Bloomberg’s press release, the budget increase will allow the city to add about 1,000 teachers to the school system and about $150 million to after-school programs.
Funding for cultural institutions will be increased by roughly $50 million, slightly more than in 2012, with the city citing the institutions’ effect on tourism as a reason for the boost.
The city also expects to see $635 million in taxi medallion revenue in 2013.
“We face a significant challenge again next year, but given the effective and fiscally responsible partnership we’ve had with the Council, and the leadership we know we can rely on from Speaker Christine Quinn, I’m confident we’ll meet any challenges that arise,” Bloomberg added.

Bath Salts and Synthetic Marijuana Now Illegal
The U.S. Senate passed new legislation last Wednesday that will ban certain chemicals found in specific types of the drugs known as “bath salts” and synthetic marijuana. The ban will head to President Barack Obama for final consent.
The bill particularly targeted MDPV and mephedrone, two active ingredients found in bath salts. The salts aren’t your grandmother’s bath time treat, though—they are sold online, in smoke shops and convenience stores under brand names like Zoom, Red Dove, Legal Phunk and Vanilla Sky. When ingested, they cause hallucinations similar to the effects of cocaine or meth.
The bill will also ban 20 primary components that make up synthetic marijuana. The substance, also known as Spice, K2 or Blaze, is sold in smoke shops and delis under names like Killer Buzz and Aroma. Synthetic marijuana is essentially a mixture of plants and herbs like bay bean, blue lotus and red clover that are sprayed with chemicals. While the drug is reported to have similar effects to natural marijuana, it goes undetected on drug tests and has increased in popularity over the last two years.
Sen. Charles Schumer fought to ban these substances, citing a rash of recent crimes committed by people who were under their influence.
Earlier last month, a man in Texas under the influence of synthetic marijuana attacked his family members and the family dog. A teen in Iowa committed suicide after smoking K2, and a 17-year-old stabbed his schoolmate while high on the substance.
Recently, a 42-year-old man who had taken bath salts bit a chunk off another individual’s face in Louisiana.
“This bill closes loopholes that have allowed manufacturers to circumvent local and state bans and it ensures you can’t simply cross state lines to buy these deadly poisons,” said Schumer, who had previously expressed concern over differing state laws about the drugs. “We have seen bath salts involved in some of the most heinous crimes in recent months. With the president’s signature, we can eradicate these toxins once and for all.”

Julie Menin Leaves CB1
After a seven-year stint as chair of Community Board 1, Julie Menin left her post last Tuesday with plans to run for Manhattan borough president in 2013.
Catherine McVay Hughes, who is currently serving as vice chair, plans to fill Menin’s spot, running unopposed for the position. Hughes has lived a block away from the World Trade Center site for 24 years and has been a vocal supporter and advocate for WTC construction safety.
Highlights from Menin’s time as chair include helping raise $1 million to open Manhattan Youth’s Downtown Community Center. She also formed a housing committee to protect the existing stock of affordable housing in the downtown area.
According to the New York Times, Menin has already raised more than $450,000 to run for Manhattan borough president. Current Borough President Scott Stringer is focusing on a run for New York City mayor.

I used to turn down pot so I could someday run for Congress

By Alan S. Chartock

When I was a young man, I refused to smoke marijuana when offered the opportunity. I thought that it might interfere with my future career—at the time, I thought I might like to run for Congress and that if you were caught, you were disqualified.

Of course, we now know that weed is a rite of passage. Presidents and presidential candidates freely admit to drug use. We also know that white middle-class kids and their parents are exempt—it’s tough to get caught smoking dope when you are on the 15th floor of a Park Avenue apartment. On the other hand, if you are a black or Latino kid on the streetcorner, it is very easy to get stopped and frisked and sent off to jail.

Right now there is a great debate on whether to make marijuana possession legal or almost legal. I have a doctor friend, one of the top addiction specialists in the country, who tells me that marijuana is what we might call a “gateway drug.” She says that if you start with weed, you often graduate to something stronger. I have great respect for this doctor, who has to deal with people who have been sucked into drug use, and I find it difficult to dismiss her concerns. Yet the inequalities I mentioned above are also of great concern.

Let there be no mistake about it: Alcohol is every bit as dangerous as marijuana. In fact, judging from the number of automobile accidents every year caused by alcohol abuse, strong drink is much more dangerous than marijuana.

Now that the Rockefeller drug laws have been modified, things have gotten more sensible. Fewer kids are being put into the system, but there is still a glut of arrests among our most disadvantaged citizens. Some distinguished lawmakers have suggested it is time to legalize marijuana and other much more deadly and heavy drugs. Some have suggested that if we legalize cannabis, the same arguments that lead to its legalization will be used for other drugs.

Such a debate is really above my pay grade; I certainly can see all the arguments for and against it. As long as there is poverty and a lack of hope, there will be drug use in this country.

The idea of making marijuana possession a violation, like a speeding ticket, is a step in the right direction. Jail or prison time is just not an answer. The only people who make out in that scenario are those who run our gigantic prison industry. We know that there are just too many people behind bars. I certainly think that if we are going to spend the money, we should spend it on giving people an economic chance and some hope—I am sure that would go further than consigning them to a life of hell sending them to jail. Even a history of a violation may well hurt someone’s chances in life.
We know that cannabis has helped people who are terminal cancer patients. Our congressional and legislative hearings are replete with such testimony from some very high-ranking people in this country, including judges and doctors.

It is hard to believe that there isn’t a simple majority, even among the Republicans in the state Senate, who haven’t used marijuana. That makes it rank hypocrisy to criminalize its use. Otherwise, I suggest that all those sitting in the upper House should turn themselves in. I mean, wouldn’t that be the right thing to do?

Sometimes in life, choices have to be made. We know that when we tried to criminalize the use of alcohol, the result was catastrophic; a black market resulted and criminals got rich. The same thing is true with the distribution of marijuana. The time has come to do the right thing and use available money to help people who have developed serious drug problems. Makes a lot more sense than what we are doing.

Alan S. Chartock is president and CEO of WAMC/Northeast Public Radio and an executive publisher at The Legislative Gazette.

Q: What is acetaminophen and why do I see it listed on so many products in my medicine cabinet?

A: Acetaminophen is the most widely used pain-reliever and fever-reducer in the world. It is contained in more than 100 products. Tylenol is the best-known over-the-counter (OTC) acetaminophen product. The drug is also a component of well-known prescription drugs such as Darvocet and Percocet. Acetaminophen also is known as paracetamol and N-acetyl-p-aminophenol (APAP).

Acetaminophen is available without a prescription. Follow the directions on the package label carefully. If your doctor prescribes it for you, the prescription label will tell you how often to take it.

Taking too much acetaminophen can lead to liver damage. The risk for liver damage may be increased if you drink three or more alcoholic drinks while using medicines that contain acetaminophen.

The maximum daily dose of acetaminophen is 4 grams in adults. The toxic dose of acetaminophen after a single acute ingestion is about 7 grams in adults. The at-risk dose may be lower in some susceptible populations, such as alcohol abusers. When dosing recommendations are followed, the risk of liver toxicity is extremely small.

Acetaminophen is one of the most common pharmaceutical agents involved in overdose, as reported to the American Association of Poison Control Centers.

One of the problems with acetaminophen is its widespread use. You have to check your medicine cabinet to see what products contain acetaminophen. Then, if you’re taking more than one medication, be sure you don’t exceed the maximum daily dose.

Adults should not take acetaminophen for pain for more than 10 days without talking to a doctor. Acetaminophen should not be taken for high fever, for a fever lasting more than three days or for a recurrent fever without a doctor’s supervision.

There are basically two types of over-the-counter pain relievers. Some contain acetaminophen and others contain non-
steroidal anti-inflammatory drugs, often called NSAIDs. Examples of over-the-counter types of these drugs are aspirin, ibuprofen (Advil), naproxen sodium (Aleve) and ketoprofen (Orudis).

NSAIDs are associated with stomach distress. You should talk to your doctor before using NSAIDS if you are older than 60, taking prescription blood thinners or if you have stomach ulcers or other bleeding problems.

NSAIDs can also cause reversible damage to the kidneys. The risk of kidney damage may increase in people who are older than 60, have high blood pressure, heart disease or pre-existing kidney disease, and people who are taking a diuretic.

You should talk with your healthcare professional if you have questions about using an over-the-counter medicine before using it in combination with other medicines—either other over-the-counter drugs or prescription medicine. Combining these two types of medicines can lead to problematic drug interactions.

All older adults should consult their doctors before taking any over-the-counter medication or herbal supplement.

Often, older adults use many drugs at the same time, including prescription and over-the-counter drugs. They also process drugs differently than younger adults. This is why older adults need to be especially careful about drug-drug interactions.

If you’re a senior, talk with your doctor about all of the drugs and herbal health products you take. He or she can tell you whether you are at risk for having a bad reaction from taking an over-the-counter drug.

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