Compassionomics: The World is Broken

 

Compassionomics is a relatively new term mainly referring to the medical field to look at compassion as a value proposition.   Rising complaints within the medical professions of  “systemic inhumanity” within patient based medicine.   Leading those to believe that we are in a compassion crisis in healthcare.  Treating patients more kindly, they argue, improves health outcomes, reduces doctor burnout and lower costs.  In a MacLeans article, “The world is broken—and human kindness is the only solution”, author Ann Kingston writes, “It’s estimated that business will lose well over $200 billion secondary to anxiety and depression, which translate into decreased productivity decreased creativity, increased healthcare costs and increased human resources costs.”

The article begins with Kingston recounting an incident, “In February, Canadians received a rude wake-up call about the lack of compassion of some Ontarians. After a late-night Amber Alert chimed on cellphones signalling the abduction of 11-year-old Riya Rajkumar, some people turned to social media, not to express concern for a child in peril (Rajkumar was later found murdered), but to vent about having their sleep disturbed. Others called 911 to complain, jamming lines for people with real emergencies. The angry blow-back was swift. Yet an identical cycle was unleashed during another Amber Alert a few months later (happily, the three-year-old boy was found safe).

The selfish reaction to the alert was more proof of dwindling societal empathy, of “me-first” narcissism, and the further tattering of the social contract that citizens share. The reaction was telling, from reflexive judgment to mockery and name-calling. The entire dust-up serves as a microcosm of a far bigger conflict now playing out: the urgent call for compassion as the last-gasp remedy for systems on the brink—politics, healthcare, civil society, the planet itself.

The public hunger for compassion in politics registered in March with the rapturous praise heaped on New Zealand Prime Minister Jacinda Ardern for her empathetic response after the horrific attacks on Christchurch mosque that killed 51 and injured dozens. Ardern’s first words, “As-Salaam-Alaikum,” a Muslim greeting meaning “Peace be upon you,” were followed by a bid to unify: “We feel grief, we feel injustice, we feel anger, and we share that with you.” She offered more than “thoughts and prayers”: her government gave financial assistance to help families with burial expenses, then passed legislation to ban most semi-automatic weapons. A photograph of the PM embracing a Muslim woman went viral—reproduced by artist Loretta Lizzio as an 18-metre mural on a silo in Melbourne, and illuminated on a Dubai skyscraper.

Ardern, and her call for “kindness over fear,” as she put it in a United Nations address last fall, is viewed by many as a flower growing through concrete at a time of rising isolationism, tribalism, racism and authoritarianism. Cruelty is used to divide and win votes—Donald Trump mocking a disabled New York Times journalist, Boris Johnson, a front-runner for British PM, objectifying Muslim women.

The U.S. government has literally institutionalized cruelty, caging migrant children and arresting “Good Samaritans” helping ailing migrants at the Mexican border. Austerity programs, including those in Ontario, are targeting the vulnerable—the poor, children, those on the margins. The divisive, toxic political climate gave rise to the British group Compassion in Politics, founded last fall by activists and academics. “People look at British politics and see a lack of compassion in policy on refugees, immigration, housing, Brexit,” group co-founder Matt Hawkins tells Maclean’s. Forty years of neo-liberal, free-market policies created widening inequities, falling incomes and a sense of desperation, he says. “There’s frustration with a political system that puts party above universal progress, majorities in Parliament over collaboration.” Support has been overwhelmingly positive, Hawkins says, including from the moral philosopher Peter Singer and Noam Chomsky; there’s interest in Australia and they’re liaising with Ardern’s office. In May, a cross-party group of British MPs called for legislation to contain a “compassion threshold.”

The loudest cries for compassion, tellingly, are heard within systems literally created to care for people. Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference, by American physician-scientists Stephen Trzeciak and Anthony Mazzarelli, published in April, is the latest book to sound the alarm about systemic inhumanity within “patient-based” medicine. The authors identify a “compassion crisis” in U.S. health care; treating patients more kindly, they argue, improves health outcomes, reduces doctor burnout and lowers costs.

Canada is in similar straits, Toronto physician Brian Goldman, author of the 2018 bestseller The Power of Kindness: Why Empathy is Essential in Everyday Life, tells Maclean’s. “We’ve designed a system that edits out empathy, that makes it almost impossible.” Something has to crack, Goldman says: “We’ve reached the limit of the myth of the superman-superwoman [doctor] who can juggle 10 things at once.”

Like the Compassion­omics authors, Doty presents compassion as a value proposition: “It’s estimated that businesses lose well over $200 billion secondarily to anxiety and depression, which translates into decreased productivity, decreased creativity, increased health care costs and increased human resources costs,” he says. Work he and others are doing, he says, reveals the power of compassion and caring in myriad ways, beginning with self-empowerment. Promoting the return on investment of compassion is one way to get the attention of a selfish world. Now the question is: How do we foster compassion within systems designed to reward those who aren’t compassionate?

Kingston interviews James Doty, founder of Stanford University’s Center for Compassion and Altruism Research and Education, speaks in similarly urgent terms, who links a societal lack of compassion to a slew of ills, personal and political epidemics, levels of stress, anxiety and depression, bullying, crime, growing wealth and health inequality, more children growing up in poverty.  Neuroscience brain mapping fMRI scans revealed how compassion and empathy change us physically and mentally.  The discovery that mirrors neurons are triggered in our brain and when we see someone who sad, angry, or happy provided insight int empathetic responses and helped explain the back of “compassion begetting compassion”.

The quest for compassion and empathy was a micro-industry, a self help sub-genre. It’s credibility was linked to the mainstreaming of “mindfulness”, attentiveness to the present moment that’s clinically proven to alleviate chronic pain and stress and to improve performance.  As Canadians we were once known in the global community as humanitarians and peace keepers, we were often called upon and esteemed for our compassionate ability to provide aide in difficult and war torn times for those in need.  As such, our medicare health system became a matter of national identity reflecting our empathetic and compassionate qualities of “accessibility”, providing equal treatment for those in need, that is now enshrined in our Charter of Rights and Freedom as well as in our  Canadian Health Act (1984).

Another one of our five guiding principles of the Canadian Health Act is the concept of “universality“.  It reads:

Universality means that provincial health insurance programs must insure Canadians for all medically necessary hospital and physician care. The condition also means that Canadians do not have to pay an insurance premium in order to be covered through provincial health insurance. (meaning: equal access)

This guiding principle is based on Equality Rights,  Section 15 of the Canadian Charter of Rights and Freedom, where it reads:

15. (1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability. (meaning: equal treatment)

In compassionate terms, “universality” and “equality” basically requires giving the same treatment, attention and care to all those who need service, by providing “equal access” to products and services to patients that would enable them to recover, to provide solace from discomfort and to not only feel better but also heal from their illnesses.  In short; equal access and equal treatment.

“Albert Einstein said empathy can’t be taught: Empathy is patiently and sincerely seeing the world through the other person’s eyes. It is not learned in school; it is cultivated over a lifetime.”  ~ quoted by Ann Kingston, MacLean’s

The Mercantilism of Drug Costs

Promoting  equality, universality and compassion in the field of medicine begins with providing equal access to life saving drugs at an affordable cost that would be covered under a national pharma-care plan.   It is then up to the health care professionals of equally treating their patients by providing access to prescriptions that solves the health problem and not just treat the symptom because the professionals get a healthy kick back from the drug companies on return visits from patients (see: Nadine Burke Harris video below).  Then there’s compassion on the part of the drugs companies in terms of drug pricing  by keeping life saving drugs affordable and available.  For example: in the development of new drugs for illnesses in the developing world.  Few companies are interested in developing drugs for tuberculosis, black fever (leishmaniasis), and malaria nor is there a significant private investor interest even though its the world’s most prevalent maladies.  Why? Because the people who contract them almost have no money to pay for them and without financial incentive of a potentially lucrative market the private sector is not interested, despite these drugs are ready and waiting for an investor/investment.

We will be revisiting this subject in future writings, however to summarize, our drug prices shouldn’t be priced so high as it is today.  In fact, second to  the United States, Canada pays the highest prices for pharmaceutical drugs in the world.  Why so high?  The pharmaceutical companies claim that in order to bring a drug to market from concept to on the shelf – a process that takes anywhere between 10-12 years – the investments and risk is quite significantly high. The exclusivity on patents therefore becomes key to receive a return on their investments (ROI) before competition from bio-similar (generic) manufacturers begins.

These generic manufacturers of bio-similar drugs price their products significantly less than bio-logics which leaves the consumer preferring to purchases bio-similar at much cheaper costs.  “Biologics are pharmaceuticals derived from living organisms,” reports CBC “which means they’re generally far more complex than chemically-produced, small-molecule drugs. Unlike generic, chemically-produced drugs, biologic drugs can rarely be copied exactly due to their complexity, so a similar version of a biologic is called a biosimilar.”

What the pharmaceutical companies don’t tell you is that the taxpayer is footing the bill twice; once by supporting government funded research and again by paying astronomically high prices for prescription drugs.  Merrill Goozner, author of $800 Million Pill demonstrates that almost all the important life-saving research in the past-quarter century are at tax payer-funded universities and the National Institutes of Health.  Once the innovative work is over, the pharmaceutical industry often steps up to reap the profit.  Another concerning feature consumers and tax-payers should also be scrutinizing is our current unilateral trade deal with Mexico and the United States.  Under the new NAFTA which is now called USMCA , pharmaceutical companies are seeking to have exclusivity on patents for 10 years on new drugs before generics companies can move in to provide an inexpensive version of the drug.  Mexico provides manufacturers 5 year exclusivity on patents while Canada provides 8 year exclusivity on patents.  By raising the term to 10 years will allow pharmaceutical companies to monopolize the sector charging exorbitant fees on life saving drugs without any competition.  One might ask, why are the prices so high?  What goes into manufacturing these pills?  What  ingredients are they using ; flakes of gold and fairy dust?

Mining for Pharmaceuticals and Manufacturing

I’ve often made the joke and I’ve certainly heard others do the same about those commercials on TV that advertise a new pharmaceutical drug and at the end of the commercial they list all the side-affects it could cause and its a huge long laundry list; diarrhea, vomiting, blurred vision, insomnia, bloating,  farting, burping, irritable bowel, runny nose, rash, dry skin, sinus congestion etc. etc. in the end you’re too scared to take the prescription for fear of getting even further sick from the side affects.  Or you’re prescribed a drug to take  but you have to wait 7-10 days before it can take affect – when you need relief right away!  Again, it makes you wonder what the heck are they putting on those capsules?

The pharmaceutical industry uses minerals to make their products and a wide variety of them. These  minerals are widely used in the pharmaceutical industry as lubricants, desiccants, disintegrants, diluents, binders, pigments and opacifiers, as well as emulsifying, thickening, isotonic agents, and anti-caking agents, and flavor corrector and carriers of active ingredients. A variety of minerals are used as excipients in pharmaceutical preparations because they have certain desirable physical and physico-chemical properties, such as high adsorption capacity, specific surface area, swelling capacity, and reactivity to acids. Other important properties are water solubility and dispersivity, hygroscopicity, unctuosity, thixotropy, slightly alkaline reaction (pH), plasticity, opacity, and colour. Clearly such minerals must not be toxic to humans.

The following minerals are commonly used as excipients:

oxides (rutile, zincite, periclase, hematite, maghemite, magnetite), hydroxides (goethite), carbonates (calcite, magnesite), sulfates (gypsum, anhydrite), chlorides (halite, sylvite), phosphates (hydroxyapatite), and phyllosilicates (palygorskite, sepiolite, kaolinite, talc, montmorillonite, saponite and hectorite). More recently, some tectosilicates (zeolites) also feature in pharmaceutical preparations.

The candy like mixtures of pharmaceutical drugs certainly made an impact on me when I reluctantly watched a documentary of a fashion model who was deteriorating from HIV/AIDS.  She wanted her journey documented as her HIV progressively turned worse with all the doctor’s visits and the drugs she had to take, cost of drugs, how she found/made the money to pay for it.  One scene, I could never divorce from my mind, we watched her down this salad bowl mixture of all these shiny colors and different sizes of drugs; I’d say half of that mixture was to treat the side affects of the drugs she needed to take that actually treated her condition.  And then after she successfully swallows the pills and she’s already gagging and crying over the ordeal, she throws it all up in the toilet and has to start the whole process all over again!   It was just so sad – and I totally get it – I have a hard time swallow a gel caped Advil! And she had to do this three times a day!

There are 24 drug companies operating in Canada and most are producing generic drugs for the medical community.  Most raw materials used as compounds for the drugs are imported from the United States and various parts around the world.  Because Canada has to import the raw material for their products, it leaves them vulnerable to fluctuating prices on the stock market.  Prices for raw materials purchased by Canadian manufacturers, as measured by the Raw Materials Price Index (RMPI), rose 0.7%, primarily due to higher prices for crude energy products. While, “prices of products sold by Canadian manufacturers, as measured by the Industrial Product Price Index (IPPI), increased 0.5% in April, mainly due to higher prices for energy and petroleum products. Whether you’re dealing with the RMPI or the IPPI most likely both, one can look to these fluctuating prices for raw material as the cause for high and  fluctuating prices in pharmaceutical drug costs.  While it’s true the generic drugs will cost cheaper and for that, Canada has many generic companies in which to buy in bulk for our national depository, it doesn’t however account for the more expensive drugs that treat rare and unique conditions nor new and improved drugs appearing on the market.

It takes time, about 10-12 years, to produce a new drug from concept to shelf ready medicine, which requires a huge amount of investment and resources.  This also accounts for the high costs for certain drugs.  Risk, I’d say would be another reason for high costs.  A company would go through all the necessary steps and followed every regulatory protocol, but let’s face it, each and every one of our biological and genetic make up is different, therefore those who take a specific drug might react to it differently,  hence the long laundry list of “possible side-affects”.  But once every so often the companies get a “problem” drug where reactions and side-affects didn’t appear when they performed the tests on animals nor human subjects.  It doesn’t happen very often but if curious you can consult the Health Canada website to learn about any defect issues that might crop up.

In terms of expanding medicare….

Canada is also reviewing the possibility of expanding it’s medicare coverage to include dental, physio, emergency services and home care (etc.). For these sectors, minerals also enjoy the following medical/health applications:

a) contrast diagnostic techniques, b) production of dental cements and dental molds in odontology, c) immobilization of limbs and fractures or dental and craniofacial surgical procedures in traumatology, d) bone grafts or construction of orbital implants, and e) spas and aesthetic centers. Examples of such minerals are: oxides (zincite, magnetite and maghemite), sulphates (gypsum and barite), phosphates (hydroxyapatite) and phyllosilicates (clay minerals).

Needless to say the pharamceutical industry is always searching for ways to minimize their environmental footprint every step of the way.  For example, phosphate mining presents a unique challenge in that we mine phosphate for many products including phosphate pellets for animal feed and improving soil conditions.  A Globe and Mail article reports that, “Every living thing needs it [phosphate] at the cellular level. If farmers don’t have it, crops will be stunted. Without plentiful supplies, the wheels will come off modern agriculture, with its bountiful harvests and ability to feed a teeming planet. There are no substitutes for phosphate and there isn’t any practical way of recycling the compound. Farmers could maintain phosphate levels in soil if they have access to manure, but that isn’t practical for most growers without livestock, except perhaps for small-time operators on the organic fringe.”

Morroco is the main country for producing phosphates, other countries with major reserves are in North Africa and the Middle East, including Algeria, Syria, and Jordan, where most investors quite sensibly fear to tread.  And like any out resource rich area in the African continent the local villagers most often receive the bad end of the deal, not being able to feed their own families, being harassed to the point of them having to leave their hereditary resource  rich lands while the militias or commercial companies take over.  Thankfully in Canada we mine phosphates and potash in Saskatchewan and in Quebec.

We not only mine for minerals but also for chemicals that help in diagnostic procedures.  One such chemical is uranium used in isotopes for chemotherapy and diagnosing cancer.  Again, these are costly procedures to make from receiving the raw material to processing it ready for medical use yet it leaves a pretty large environmental footprint as we shall soon see by using nitrogen, rubidium, flourine, indium, iodine, krypton and other materials to make up the final compound, but for now let’s quickly review it’s terms and benefits:

• nuclear medicine – The branch of medicine that uses radioactive isotopes in the diagnosis and treatment of disease.
• radiopharmaceutical – Any radioactive substance used as a pharmaceutical.
• physiological– Of, or relating to, the science of the function of living systems.
• Nuclear medicine is a medical specialty that involves the application of radioactive substances to diagnose or treat disease.
• Nuclear medicine can be used for image physiological functions.
• In addition to imaging, radionuclide therapy can be used to treat conditions such as hyperthyroidism, thyroid cancer, and blood disorders.
• Common isotopes that are used in nuclear imaging include: fluorine-18, gallium-67, krypton-81m, rubidium-82, nitrogen-13, technetium-99m, indium-111, iodine-123, xenon-133, and thallium-201.

Nuclear medicine is a medical specialty that involves the application of radioactive substances in the diagnosis and treatment of a disease.  Nuclear medicine uses radioactive isotopes in a variety of ways. One of the more common uses is as a tracer in which a radioisotope, such as technetium-99m, is taken orally or is injected or is inhaled into the body. The radioisotope then circulates through the body or is taken up only by certain tissues. Its distribution can be tracked according to the radiation it gives off. The emitted radiation can be captured by various imaging techniques, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET), depending on the radioisotope used. Through such imaging, physicians are able to examine blood flow to specific organs and assess organ function or bone growth.

In nuclear medicine procedures, radionuclides are combined with other elements to form chemical compounds. These radio-pharmaceuticals, once administered to the patient, can localize to specific organs or cellular receptors. This property of radio-pharmaceuticals allows nuclear medicine the ability to image the extent of a disease process in the body. These images are based on cellular function and physiology, rather than on physical changes in the tissue anatomy. Therefore, with some diseases, nuclear medicine studies can identify medical problems at an earlier stage than other diagnostic tests.

Benefits

• “In addition to its role in patient care, nuclear medicine imaging has the potential to accelerate the drug development process and substantially reduce the time and expense of bringing a drug to market“
• use of nuclear medicine imaging during the drug development process could identify which drugs should advance from animal to human studies, validate the mechanism of drug localization, evaluate drug distribution to target tissue, establish the drug occupancy of receptor sites, assess the actions of new agents on specific molecular targets or pathways, and determine appropriate dose range and regimen (Eckelman 2003).
•  Based on these animal data, imaging bio-markers can be developed to monitor treatment effects and to determine optimal drug doses on a molecular level in clinical studies.
• The small imaging devices also offer a means for rapid screening of potential drug candidates (especially analying the hair on their head.  Your hair can contain remnants of what you body has absorbed.  Embed a series of digital nano devices that can be an ongoing monitor through rapid screening – excellent for prisoners, and ex convicts.)
• Another promising application of PET is the use of probes, such as fluorine-18-fluoromisonidazole, that detect tumor hypoxia, which can affect tumor response to radiation therapy (Rajendran et al. 2006).
• These emerging radiotracer approaches hold promise for further individualization of cancer treatment. They will allow for the imaging of biological processes that are characteristic of cancer cells

Shortage Isotopes?

There recently has been a shortage of Isotope production within North America and even perhaps around the world.  The uranium that mined is primarily for nuclear (candu) reactors at various stations placed around the globe, only a fraction of the mined material goes to the medical community.  Canada relied on their nuclear reactor in Chalk River (Bruce Ontario) to provide the medical substance which up until a few years ago was shut down.  As a result Canada had to seek outside of the country to purchase and import isotopes from other countries around the world.   That helped to provide short term relief until we found a better alternative.  Because of the radio activity and short shelf life of the product, it could take days to weeks in order to receive shipments and deploy them to  the necessary medical facilities. Thankfully we have, in the Darlington nuclear power plant just outside of Pickering, Ontario now producing medical isoptopes while providing energy to residents and businesses in Ontario.

By producing isoptopes out of the Darlington plant places us in a unique position to service all of North America and the UK who, thanks to BREXIT, may face a shortage of medical isotopes especially if they leave with a “no” deal.  This will have to be explored in another blog entry for further reading; if Canada become a trading partner or back up for the UK, given the isotopes short shelf life, will we have the capacity to ship medical isotopes to the UK in a timely manner in a way that best serves its medical community?  Are there other alternatives to explore, such as Canada providing long distance tele-medicine for cancer detection and providing chemo therapy treatment across the shores to the UK?  Although this opportunity  may have many positive uses we cannot be blind to the catastrophic destructive potential of storing the thousands of tonnes of nuclear waste underground for centuries to come causing irreversible damage and our extinction with one small mishap.

• Storage of nuclear wastes (Bruce county, Ontario), shelf life of nuclear waste material before returning to its natural state.
• 2 shipments / day from seven nuclear reactor site from neighboring provinces and will take 40 years to ship the current volume of nuclear material.
• Bruce County  and Huron-Kinloss are waiting to hear if it would be chosen as the host burial ground for more than five million spent fuel nuclear bundles
• The highly radioactive waste will come from the nuclear reactor sites at Darlington and Pickering, from Gentilly in Quebec, Point Lepreau in New Brunswick and, closest of all, the Bruce Nuclear Generating Station, which is practically right next door.
• All in, we’re talking about the toxic legacy of six decades of nuclear power generation, with decades more to come.

 

In addition to imaging, radionuclide therapy can be used to treat conditions such as hyperthyroidism, thyroid cancer, and blood disorders. The radiopharmaceuticals used in nuclear medicine therapy emit ionizing radiation that travels only a short distance. This thereby minimizes unwanted side effects and damage to noninvolved organs or nearby structures. For this type of therapy, yttrium-90 and iodine-131 are the most commonly used isotopes.

Caution:  In addition to environmental concerns about storing nuclear waste. Radioisotopes typically have short half-lives and typically decay before their emitted radioactivity can cause damage to the patient’s body.

Recommended Reading:  Advancing Nuclear Medicine Through Innovation

Mental Health In Canada (CAMH)

The terms “mental illness” and “addiction” refer to a wide range of disorders that affect mood, thinking and behavior.  Examples include depression, anxiety disorders and schizophrenia, as well as substance use disorders and problem gambling. Mental illness and addiction can be associated with distress and/or impairment of functioning. Symptoms vary from mild to severe.  And here’s where compassionomics fits in not only in the medical field but also with your support networks.  If we were a society that demonstrated more empathy and compassion towards each other in the first place would the mental illness numbers be so high or the number of those who take these “comfort” drugs be so high.

Who is affected?

• Mental illness indirectly affects all Canadians at some time through a family member, friend or colleague.
• In any given year, 1 in 5 people in Canada will personally experience a mental health problem or illness.
• Mental illness affects people of all ages, education, income levels, and cultures.
• Approximately 8% of adults will experience major depression at some time in their lives.
• About 1% of Canadians will experience bipolar disorder (or “manic depression”).

Yet there are times, and there are many, that you do need medical and professional help. To do nothing can be very costly.

Economic Costs: This following is the economic costs just for mental health and does not overall health including cancer and chronic illnesses.

• The economic cost of mental illnesses in Canada for the health care system was estimated to be at least $7.9 billion in 1998 – $4.7 billion in care, and $3.2 billion in disability and early death.
• An additional $6.3 billion was spent on uninsured mental health services and time off work for depression and distress that was not treated by the health care system.
• In 1999, 3.8% of all admissions in general hospitals (1.5 million hospital days) were due to anxiety disorders, bipolar disorders, schizophrenia, major depression, personality disorders, eating disorders and suicidal behavior.Sources: The Report on Mental Illness in Canada, October 2002. EBIC 1998 (Health Canada 2002), Stephens et al., 2001

***With appropriate treatment and support, most people will recover.***  

• The economic burden of mental illness in Canada is estimated at $51 billion per year. This includes health care costs, lost productivity, and reductions in health-related quality of life.^1,10
• Of Canadians aged 15 or older who report having a mental health care need in the past year, one third state that their needs were not fully met.⁴¹
• An estimated 75% of children with mental disorders do not access specialized treatment services.²⁶
• In Canada, only 1 out of 5 children who need mental health services receives them.

• In 2013-2014, 5% of ED visits and 18% of inpatient hospitalizations for children and youth age 5 to 24 in Canada were for a mental disorder.²⁷
• Mental illness is a leading cause of disability in Canada.^8,9,10
• Men have higher rates of addiction than women, while women have higher rates of mood and anxiety disorders.³
• Mental and physical health are linked. People with a long-term medical condition such as chronic pain are much more likely to also experience mood disorders. Conversely, people with a mood disorder are at much higher risk of developing a long-term medical condition.³⁶
• Similarly, people with substance use problems are up to 3 times more likely to have a mental illness. More than 15% of people with a substance use problem have a co-occurring mental illness.⁴
• Canadians in the lowest income group are 3 to 4 times more likely than those in the highest income group to report poor to fair mental health.⁶
• Studies in various Canadian cities indicate that between 23% and 67% of homeless people report having a mental illness.⁷
• In any given year, 1 in 5 Canadians experiences a mental illness or addiction problem.¹
• By the time Canadians reach 40 years of age, 1 in 2 have—or have had—a mental illness.¹
• Schizophrenia is youth’s greatest disabler as it strikes most often in the 16 to 30 year age group, affecting an estimated one person in 100.
• Surpassed only by injuries, mental disorders in youth are ranked as the second highest hospital care expenditure in Canada.

We want to do for mental illness what others have done for epilepsy, heart disease and cancer. We want to help people see mental health for what it really is—health. ~CAMH

“It’s a paradigm shift. We’re beginning to unlock opportunities to identify and respond to these illnesses based on their true underlying causes and to design precision treatments that account for the unique needs of individual patients. These new perspectives make it clearer than ever that mental health must be treated like every other health issue. It’s the only way we can continue the work necessary to give the one in three Canadians affected by brain disease or disorder—and by extension, their family, friends, colleagues and caregivers—the help, and the hope, they deserve.” ~ CAMH

I am posting Freud’s meme for a reason.  People can be cruel these days, very cruel and it could add to stress of your mental health.  To understand and treat the type of mental health issue you might be dealing with, it is important that you get the right diagnosis, from the right professional – a person who is certified (whose diagnosis can hold up in court) – give you their professional opinion.  Heresay can do a lot of damage not only to the individual suffering but to their family and friends as well.  Therefore it is important to get the right diagnosis from the right professional who is trained and certified to do so.  Mental illness is different from a stress related problem.  For example: a women reacting to the natural phase of menopause will act radically in different ways – she might act crazy but would you throw her into a mental institute?  No, she’s going through a natural process and this is her reacting.  A parent, a lover, a child dies.  You’re grieving and it brings all sorts of emotions out of you. Would you throw that person into a mental institute?  No, that person is grieving. It’s a natural process the body, mind and soul goes through when experiencing loss. People grieve in different ways it doesn’t mean they are schizophrenic, ADHD or what have you.  That’s why seeking a professional’s opinion is the best in these circumstances.

In my previous blog I began telling you a story about my operation to remove a lump caused by endometriosis from my body.  As suggested by the specialist, I saw a “therapist” for about three or four episodes, I thought to share a bit of our conversation with you because sometimes, what you are going through is something very different then what people think.  Your mental health is YOUR responsibility – don’t let anyone take that responsibility from you and label your experience for what it is not.  We are on the precipice of a spiritual revolution some people react differently when it’s time to call back your spirit from ‘unfinished business’ (see: Unction).  The symptomology of  “spiritual” crisis is different from a “psychological” crisis but they often look the same on the outside which is why many get misdiagnosed.  It’s a phase that Carolyn Myss author of Anatomy of the Spirit and Why People Don’t Heal and How they Can write’s about what happens when your seventh chakra is activated.   The difference between the two?  With a “psychological” crisis you’re breaking down, a “spiritual” crisis you’re breaking up or breaking open. A psychological crisis weakens you, a spiritual crisis (if handled correctly) strengthens you every step of the way as you rise to the challenge and answer what your spirit is telling you. Mind, body, spirit; this is what it means to look after all three and in the Western world we are so quick to throw chemicals, doctor prescribed or street drugs, at it because we are about instant gratification, instant relief instead of listening to what the pain is telling you.

Unconsciously, I guess i was preparing for this moment for quite sometime with years of reading spiritual and psychological books, taking art therapy courses and attending various lectures by Marion Woodman, therefore I somewhat knew how to handle myself when I began experiencing my challenges.  I shared challenges and experiences with my “therapist”, I told him about the books I have read, my writings, and I was particularly solace and strength through my paintings.  I’d get lost for hours painting with my fingers, then brush, the feeling of the paint on my fingers squishing the canvas, the deep and bright colors, and the content is what I was particularly enjoying the imagery that was oozing out of my imagination and how it related to my experience of healing and it’s storytelling.   Never interpret another person’s artwork.  The imagery an artist might use to express themselves have different meaning that’s unique only to the artist.  It’s like dream interpretation 101. If you dream about a fluffy bear, well your interpretation of that fluffy bear is different than another person who dreams about a fluffy bear.   It’s deep personal work.  Don’t let other people define your mental and spiritual status – go see a professional if you need to.   Second to artwork was school kept me occupied and focused.  I was really excited about the whole experience of university as it engaged, activated and deepened areas of intellectual thought and helped put certain things I was taught into perspective.  He curiously and patiently listened then after a few sessions concluded that I was  fine and well and capable of handling my stresses in an appropriate manner. He assured me that some of the things I was going through at the time were normal reactions, it’s a cyclical process that people often go through and the length of time to go through that process is different from person to person; and if I wanted to continue to see a therapist, talk to my medical doctor who will arrange to find some one for me.  I stayed with my art and my schooling.

Friendly Fire: Opiod, Fentanyl

Remember the psychedelics of the 60s and 70s?  It was a time of “Damn the War!” civil rights movements, “Power to the People!” peace, love and joy! Sex, drugs and Rock ‘n’ Roll! Dude!   Psychedelics often used were LSD, mushrooms (laced with LSD), marijuana, cocaine, acid, opium and a host of other stuff, I am sure – and that same time period gave us the ‘birth control pill!  It certainly was a magical time that brought breakthroughs in music and art in at time of social upheaval.  No doubt, or should say thanks to the use of these drugs that encouraged the feeling of unity among opposites, the breaking down of boundaries, and a heightening of political awareness finding [and using] your voice to question authority.  It certainly was a time for consciousness-raising.   But then as the years went by, it was time to time move on, grow up and as these folks got older, joined the corporate game, became part of the “system” they all fought in their youth, while some – granted – stayed  true to the “cause” even down to today.  What’s changed?  Not a whole lot, including the drugs!

The late 80s and 90s brought MDMA and ectacy.  MDMA was developed by Merck pharmaceutical company in 1912 and through time especially into the 80s it became a street drug called ectacy but for the most part hardly any MDMA was found in the pills. Moving into the year 2000 to today people’s choice of drug – and dealer – has changed yet the potency is getting more dangerous.  Who’s the dealer?  The friendly, local neighborhood family doctor and pharmacist, (it’s more socially “acceptable”) for a prescription of Opioids, specifically fentanyl that are used in a variety of ways.

Opioids, including and specifically fentanyl, have been occupying the nightly news almost daily.  This over-the-counter drug is legally prescribed by doctors yet in many cases used illegally, yet they can also be produced or obtained illegally.  Doctors may also sometimes prescribe them for other conditions, such as: acute (short-term) moderate to severe pain, chronic (long-term) pain, moderate to severe diarrhea, moderate to severe cough. According to Health Canada’s website, “Opioids are medications that relieve pain. When used properly, they can help. But problematic use can cause dependence, overdose and death.  Opioids can also induce euphoria (feeling high), which gives them the potential to be used improperly.”

Opioids can be prescribed medications: codeine, fentanyl, morphine, oxycodone, hydromorphone and medical heroin.

What makes fentanyl so dangerous?

Fentanyl is a very potent opioid pain reliever. It is generally used in a hospital setting, and can also be prescribed by a doctor to help control severe pain. Fentanyl is a dangerous drug because:

• it is 20 to 40 times more potent than heroin and 100 times more potent than morphine, which makes the risk of accidental overdose very high
• a very small amount (about the size of a few grains of salt) of pure fentanyl is enough to kill the average adult
• it is odourless and tasteless, so you may not even know you are taking it
• it can be mixed with other drugs such as heroin and cocaine, and is also being found in counterfeit pills that are made to look like prescription opioids

People in the compassion sector say that media can stroke fear. “Bad news sells newspapers, but it also create a very narrow version of the world that plays into the hands of the extreme right  – that makes people hostile to one another.” Doty cautions in the MacLean’s article, “People are wired to pay attention to threat, which triggers your fear.  Most things happening in the world are good; when you create negative narrative it often leads to other negative events.”   The opioid crisis certainly snuck up on us and now with report after report it seems that with each story the drug is getting deadlier and deadlier.  I am wondering, has this always been a problem and media has sensationalized the issue or with media attention this issue has become bigger than it was before?  CBS certainly has go it right in their investigative report that this scourge of opioid related incidences has miraculously seemed to pop up in 2017. I certainly haven’t heard about this prior to 2017. Regardless,  media owes it to the public not to sensationalize these types of public health stories with the fear-mongering.  Remember all the silly stories that circulated about SARS?  It almost put Toronto’s tourism and entertainment sectors out of business .

Who is at risk of having an opioid overdose?

Health Canada reports, anyone using prescribed or street opioids can have an overdose,  look what happened to the King of Pop, Michael Jackson and Prince who were both reported as taking the drug.  But there are some things that put you at higher risk, such as: taking prescription opioids more often or at higher doses than recommended.  Taking opioids with alcohol or sedatives, such as: sleeping pills, muscle relaxants, benzodiazepines, injecting drugs, taking an opioid your body isn’t used to, or switching to a stronger drug, taking higher doses than you are used to, using drugs of unknown purity or strength, other health conditions, like liver or kidney disease, or breathing problems.  An overdose can also happen if you misuse opioids. For example, extended-release opioid tablets are meant to be swallowed whole. If you crush or break these pills before taking them, it may cause an overdose because too much of the drug is released at once.

Prince died April 21, 2016 after taking what he thought was Vicodin but was actually reported as a counterfeit painkiller that was laced with fentanyl. Prince had been “experiencing significant pain” and had been taking pain medication for a number of years. The evidence suggested that because of the number of years he relied on the drug to relieve his pain, he became addicted to pain medications but also took  great efforts to protect his privacy.”

The  toxicology report showed that Prince had what experts called “exceedingly high” concentrations of fentanyl in his body. Fentanyl, by the way is a  synthetic opioid up to 50 times stronger than heroin.  Prince was also being treated by Dr. Michael Schulenberg, a Minneapolis geriatrician, for opioid withdrawal, anemia and fatigue.  Prince had no known Vicodin or fentanyl prescription, and that investigators found prescription medications throughout his home, many not in the original container provided by a pharmacy. But no foul play was suspected.

Canada’s illegal drug supply is being contaminated with illegal fentanyl and other fentanyl-like drugs (e.g. carfentanil). You can’t see, taste or smell fentanyl and a few grains can be enough to kill you. Fentanyl is a cheap way for drug dealers to make street drugs more powerful and it is causing high rates of overdoses and overdose deaths.  Illegal drugs may contain unknown amounts of fentanyl. Drug dealers who make fake pills may not know or control carefully how much fentanyl goes into each pill. As well, sometimes drugs may accidentally contain fentanyl when drug dealers use surfaces and equipment contaminated with fentanyl. [Worth repeating] “Canada’s Good Samaritan Drug Overdose Act can protect you and anyone else at the scene of an overdose from simple drug possession charges.”  Administer naloxone if you have it; which is a fast-acting drug used to temporarily reverse the effects of opioid overdoses.

The strength and type of opioids available on the street are unknown and can vary. This can increase the risk of overdose and death. Some opioids called fentanyl and carfentanil can be particularly dangerous because they: can be fatal even in very small amounts; are being mixed with, or disguised and sold as street drugs, such as: heroin, cocaine, counterfeit prescription drugs such as oxycodone.

Michael Jackson died of an overdose that was prescribed to him by his personal doctor.  He was known to take a deadly mix of pharmaceutical Opioid and fentyl based product.  What’s striking about his story was the amount of pharmaceutical drugs that were found in his body that he had been accustomed to taking over the years.   It was reported that they found the following in Jackson’s system the night he died;

Propofol is a fast-acting hospital sedative, administered intravenously and used before anesthetics. It was first used widely in the late 1980s.is made by the pharmaceutical company AstraZeneca and is also sold under the brand name Diprivan.  Other drugs known as benzodiazepines, which are also used as sleep aids. But when they did not work, he claimed Jackson demanded Propofol. the singer swallowed several pills of Lorazepam on the morning of his death, enough to put six people to sleep. It is widely used as a sedative and muscle relaxant. Also known as Ativan and Temesta, the drug is used short-term for insomnia, anxiety, seizures and for sedating aggressive patients.

Midazolam is used in a similar way to Lorazepam. It is widely used as a sedative and to treat seizures. Also know as Dormicum, Hypnovel and Versed, the drug is also used short-term to treat severe insomnia and anxiety. Jackson was given four milligrams of the drug on the morning of his death.  Diazepam is better known as Valium. It’s used as a relaxant for patients suffering from insomnia and anxiety as well as seizures.  Michael Jackson was given a 10 milligram tablet of Diazepam at 1.30am on the morning of his death because he couldn’t sleep.

Lidocaine is a local anaesthetic and is sometimes used to treat skin inflammations. It is used by dentists to anesthetize patients’ gums. Michael Jackson had a dose of Propofol diluted with Lidocaine at 10:40am on the day of his death. Ephedrine was also found in Michael Jackson’s body. It is primarily used as an appetite suppressant and stimulant. [Source: Michael Jackson]

Michael Jackson had a complicated life growing up in the public eye as a child straight into adulthood. The salad mixture of drugs found in his system, wouldn’t you say it suggests that he was fighting something; perhaps some inner demons or fighting to keep his reputation as King of Pop, it is apparent something was haunting him. Considering his legal battles and the gossip, the media fiasco and facing ageism as he was training hard  for a comeback tour that he was neither physically nor mentally fit to perform.  People take these drugs for all sorts of reason but mainly for escapism and that is why these drugs are big on the open and black market.  Same as the drugs of 60s and 70s, 80s and 90s. It made people feel good, for a time to forget their worries, a return to innocence, floating on clouds, feeling invincible, leaving every care in the world behind, they also felt powerful and empowered;  performed super human feats, got more creative and accessed areas of the mind they won’t dare to go or even find when not taking the drug.

But as the years progress into today, people take these drugs mainly because they are depressed, have anxiety, they hate themselves, their life and the world. Opioids and Fentyl and all these other drugs help physical pain and just like yester-years but today it’s not for; sex, drug and rock ‘n’ roll, and peace be with you – fal, lal-a-la,la, la.  NO! People take these things because they feel like crap, they’re sad, they’re irritable, they’re angry, they’re depressed and want to get away. It’s the “systemic inhumanity” we’ve been facing for decades of Me, Me, Me.

“Yet there’s a final paradox in politicians giving lip service to compassion at a time when so many see its systemic adoption as essential to human well-being. Doty puts it bluntly: “Compassion is what’s going to save our species.” The alternative to willful change, Doty suggests, could well be violent uprising: “We know that when wealth and equality get so far apart and people think they have nothing to lose, you have bloody revolutions,” he says. “But the reality is that for our species to survive, we have to recognize we are all one and everyone deserves the right to dignity, the right to food, the right to security, to shelter and to health care. And until we go on a path toward that world view, we are doomed.”