"Let’s say that you haven’t had anything to eat for three or four days. You are starving. Can you feel it? What it’s like to be really starving? What would you be thinking about? You would be thinking about food. You would be needing, craving food. This craving that you feel is the brain’s mechanism that drives you to survive. Its purpose is to make everything else fall away and to force you to focus solely on acquiring what you have to have to live."

Quote found here:  What it Feels Like to Have an Opioid Addiction

A problem that may not immediately seem obvious that overlaps with opioids is hunger.  Hunger in itself is a particularly grievous issue that affects everyone in the community. It leads to numerous growth and stunting issues, in terms of learning and physical growth, the body devouring itself, and so many other problems. To me, it's easily either in the top 5 or 3 global problems that should be solved.

Opiates attack on the front of hunger in two ways: The stimulation of the appetite (or lack thereof / bodily resistances) of hunger, and the lack of access to food due to homelessness.

Opioids have a proven affect on those who abuse them when it comes to appetite management.  The stronger / prolonged / length of abuse of the opioid(s) the person takes, the more they are susceptible to side affects such as vomiting and nausea, along with fatigue which lowers the rate at which we burn fuel in our bodies.  Even those who do not experience these side effects, users have reported that the euphoric feeling of opioids and eating results in greater relief, which also leads into overeating.  In certain cases, the effects of hunger come secondary due to the alteration of the mind.  It affects both the innate desire to workout, coerces a sense of helplessness, and a lack of nutrition due to not wanting to eat a balanced diet.

Certain studies even show between 30-70% of those who are addicted or abuse drugs do suffer from the stresses of malnutrition or lack of food.

How Opiates affect your eating habits and appetite: HERE
Oxycodone's Side Affects: HERE
Addiction and Hunger: Intertwined Crises: HERE
Scholarly article of Hunger and Addiction #1: HERE
Scholarly article of Hunger and Addiction #2: HERE

The coexisting effects that homelessness and food insecurity and how closely they are related to each other can almost speak for itself.  But to bring it to perspective of my community, the below interactive maps (links cited lower) of recent years state that:

Opioids are also shown to have linkage between people becoming homeless, due to the sheer neglect of responsibilities and prioritizing the fix over everything else, and those who are already homeless getting fixed on opioids as an escape avenue from the problems of the worlds.  Such contexts, in an intersectional angle, can be seen in veterans. They have survived the horrors of war and conflict, only to come back home with injuries and PTSD. It's almost blameless then to see an unfortunate increase in veterans, both and especially without homes, to see them turn to opioids as their way out of pain.

It'd be no wonder to think then that if one were constantly hungry, with no roof over our heads adding in the insurmountable amounts of stress that involves, they could get a drug that numbs and takes the pain away.  The actual starvation of the body would then go ignored, and catastrophic side effects could occur, including the very death of people just from not knowing they are starving. There would be no reason then too to self improve, to get out of poverty and homelessness.  A perfect two-pronged attack.

Mercy Housing: 7 Facts About Hunger and Homelessness: HERE
Maryland Alliance to End Homelessness: HERE
Move for Hunger: Interactive Map: HERE
Opioid Abuse and Homelessness: HERE
Veterans Experiencing Homelessness: HERE
Opioids and Homelessness in America: HERE

There are efforts to bridge these two issues consecutively. Homeless shelters, along with other organizations, faith based, government rooted, and other, are taking the leading role of educating their workers and caretakers into the awareness, training, and steps to intervene in the opioid crisis.  I couldn't agree more with this effort, and as someone who wishes only for the best for my local, and all communities across America, across the world, tackling these two otherwise unseemly unrelated issues will help so much more than just one issue at a time. Because by eliminating both the stresses of home and addiction, curbing the food insecurity of those affected people can only skyrocket, which will bring us all one step closer to ending hunger.

Link to Substance Abuse and Mental Health Services Administration on Homelessness and Addiction:  HERE

With the width of topics and information covered in my blogs about blogs and all the angles that I've covered so far, there will always be a missing gap or unexplained view point. It's not to say for lack for trying, but to analyze so much information through the multiple lens of humanity and all the nuances that can drastically change how we perceive, interact or consider things such as opioid additions would have to consider a lifetime dedication to research. Not just for the points of views that exist yesterdays past or today, but for the rest of our lifetimes as well.

To further hone into a particular issue and framing it within context, I'll explain what a 'lacunae public' are.  Explained in an article, researcher A. Krishna explains that: "Knowledge deficiency, or the absence of scientifically legitimized knowledge, is key to the conceptualization of lacuna individuals" (2017, p. 180).

In regards to a lacunae public, this means people who may have no awareness or knowledge of a particular subject, that either participate in said subject or not, and may have general negative perceptions of said subject.

A part of the public that's forgotten or missing from the discussion of opioids, if I had to guess from all the research I've done in my blogs, is if there is a significant impact, or noticeable phenomenon in the LGBT community. I think I ever only found one statistic out of 50+ sources that I've compiled of my semester's worth of research that mentioned LGBT, but it didn't talk about the overlaps, such a race or gender or even possibly religious backgrounds that may or may not play a part in someone's choices of taking/abusing/overdosing on opioids.  I would like to see more research being shined in this rather unknown area of opioids.

That's not to say all of the LGBT community itself are lacunae activists or part of a public, nor to say those fall outside of that community are either, but there is a certain level of knowledge gap, whether that be through not enough research has been conducted, the openness or willingness of the LGBT community to share what it generally understands about the overlapping issues of opioids, etc.

To address this missing gap, I've research through the angle of the LGBT community and opioids, and have came across this alarming quote:

"Compared to the approximately 9% of the overall population that engages in substance abuse, between 20% and 30% of the LGBTQ+ community abuse drugs or alcohol. Also, compared to 4.5% of the total population, LGBTQ rates of Opioid addiction are considerably higher. Among adults over 18 years-old who misused prescription Opioids (such as Hydrocodone or Vicodin®) in the past year, the LGBTQ+ community accounted for 10.4% (or 1 in 10). Moreover, they are nearly 3 times as likely to develop an Opioid addiction than heterosexual adults."

Access the article: HERE

However, evident in the article is also the fact that only 7.4% of treatment services have any specialized LGBT training to coincide with opioid assistance. This demonstrates an example of a lacunae public.

Additions sources can be found below.

Opioid addiction in the LGBTQ Community: HERE
Article on treatment in sexual minorities: HERE
Scope of Opioid Addiction in the LGBTQ Community: HERE
Addressing Opioid Use Disorder among LGBTQ Populations: HERE

If there was any more pressing topic to talk about opioids, it's about responsibility. As someone who has research extensively into the subject, there's almost no other angle to focus on opioids than the pharma companies, drug companies, and reckless doctors that have taken advantage of the legal systems, people's pain, and the hopelessness of the unfortunate.

There has been multiple instances in this blog that has pointed out that doctors have contributed to the crisis we face now, but we must dig deeper. Further, to the very roots of the issue: The drug and pharma corporations.  New and older evidence has revealed that powerful companies such as Abbot Laboratories and Purdue Pharma, have either directly suppressed or grossly mislead the addictive natures of opioids to organizations and the people consuming them, or had gotten doctors into their pockets so they only sell certain, more dangerously addictive opioids than other competitors.  This has created a perfect storm, one in which keeps people addicted to the opioids, for as long as they keep buying, the companies will keep producing, and will keep growing bigger and become more aggressive.  This is a serious health risk caused by corporatism that has manifested from the worst parts of humanity.

Article on what pharma used to draw their fake assumption of "low risk addiction": HERE
How Purdue Pharma is responsible: HERE
How Abbot Laboratories bought out one doctor: HERE
How Insys Therapeutics Inc. took brides and kickbacks to physicians: HERE
Cornerstone article on corporate responsibility: HERE

Victims of opioids, and those who are impacted by the pains or deaths of those who overdose on opioids have risen up in a display of an activist public.  An article by Heather M. Zoller explains the phenomenon of activism and the outreach it possesses:

Zoller, H.M. (2017). Health activism targeting corporations: A critical health communication perspective. Health Communication, 32, 219–229.

Access the article: HERE

Multiple testimonies have come out against companies such as Purdue Pharma of how many lives, families, and loved ones have been destroyed or seriously harmed due to their sheer negligence and arrogance on not respecting their due diligence to tell the people of the dangers, as well as falsifying and silencing the truth on their drugs.  In one instance, an art piece, a huge bent and twisted spoon, burned with the markings of drug usage sits outside as a symbol of protest.  Lawsuits have swamped these pharmaceutical giants as more people share their stories. The money, power and influence these companies have is near limitless, and they will go to any lengths to protect their status quo, just as other insidious companies have done before in the past, such as the cigarette and tobacco giants did before.

Sadly, there isn't even any corporations who are taking an activism approach to bring awareness to the problem. In fact, the further research so, the more names of companies are popping up that are being sued in some form of negligence.

The challenges the activism public faces is still an uphill war. It will take more pain and suffering before we are heard loud enough for the companies responsible to pay retribution for their conduct. While activism does have its criticisms, it can also bring those who have large audience followings, such as social media platforms and/or influencers to become vehicles to champion the cause.  The fight against opioids is more than just treated the already affected, it's about finding out who else is suffering that we've overlooked, providing fair treatment by equipping our care providers with the right education and practices to care for all those people affected, including the minorities, while taking those responsible to justice.  One day, if we try hard enough, we will free our loved ones from the addictions, and hold those who choose to harm those accountable.

Opioid Addiction is a corporate responsibility: HERE
Father pleads for help to fight epidemic after losing son: HERE
Activists Protest with a Giant Spoon: HERE
A study on how corporate activism can help, or hurt, the message: HERE

This blog's focus will be dedicated to looking at a particular angle when it comes to opioid abuse, harm and usage. The lens shall be viewed in which we focus on how women are affected, particularly those with breast cancer.

Breast cancer and its effects has been prevalent in my mother's life, coming up twice, one in each breast. It has robbed a lot from her, especially her overall health. It could have turned far more worse and serious had my mom, who had to endure the painful and grueling process of chemotherapy, decided to either abuse opioids, or fallen into the addiction of them.

But why is this specifically important, and how is it intersectional? According to American Addiction Centers, here is what is found about the difference in sexes, and how women, in certain contexts, have it worse:

                      Men are more likely than women to use the illicit opioid heroin during the past 30   days, however, women are more likely than men to use other opioids, such as prescription pain relievers. Women are also more likely than men to experience chronic pain and be prescribed prescription pain relievers. Women use prescription opioid pain medications for longer periods and are prescribed higher doses than men. ( Link to Source: HERE )

Cancer always had painful side effects, whenever while still with cancer, under current treatment, and post-treatment of said cancer. The processes in which can lead to muscular, nerve and ache pains, either constant or acute. This in turn had lead doctors to prescribe various medications, but more commonly opioids, and many kinds of them too. A list of just how extensive these opioids can be can be found just below:

( Link to the list: HERE )

Breast cancer, and women who take opioids also come at various ages. It shows that middle aged women, ages between 40-59, are much more likely to use/over-use opioids, bringing in the age angle into the intersectional issue as well.  They also switch and use opioids faster and use it for longer periods of time too. While research has been sparse into how opioids affect women in very specific situations, there was one research article about specifically breast cancer. While access to the article was closed to me, their conclusion said that the chances of a 'second' or re-occurrence of breast cancer emerging in a breast cancer survivor is, and I quote "nonsignificantly higher" is negligible when comparing women who chronically use opioids vs. nonchronically. ( Link to the article: HERE )

(  Myths and Facts Link: HERE )    ( Cancer.Gov Link: HERE )   ( Women and Opioid Link: HERE )

One of the organizations that is taking aim at the intersectionality of women and opioids is National Women's Health Network. They have a large networking operation that collects information on the patterns and ways women have been using and affected by opioids.  Another huge wealth of information, on the who, what, where, how and whys are also found in an article by Healthline. Another repository of information is found in my community of Maryland at Maryland Department of Health. Their focus is directed into how opioids can impact pregnancies.

However, while there appears to be a promise of wealth of information, there seems to be a couple of noticeable gaps. For one, no clear action or impact is stated as how any one organization has accomplished, or for that matter any extensive scientific research into women and opioids, let alone any of the complex issues that could arise in women with, and post breast cancer. There also seems to be a lack of information of racial demographics too.

( Link to the NWHN: HERE ) ( Link to the Healthline article: HERE )
( Link to community DoH: HERE )

In order to bring meaningful and hopefully lasting change to better women's health, I'll conclude with an article by Heather Zoller, who writes about social justice and women's health. Other than highlighting the difficulties that women have faced in the equity of health care, she also brings up the politics and lack thereof of specialized research into women's problems. Heather Zoller says the following:

 Unfortunately, major public health institutions fail to engage adequately with the social contexts of health and avoid controversial political issues, preferring to locate the prevention of illness with the individual. Dominant discourses attribute every health problem—cancer, heart disease, arthritis, you name it—to problems of individual choice-making... Although individual agency is critical to managing our health, feminist perspectives must make clear that individual choices cannot be separated from the social, political, and structural contexts that constrain or enable better health (pp. 75)

Citation: Zoller, H. (2010). Communicating Women’s Health Activism: A Social Justice Agenda. Women & Language, 33(2), 73–79.  

Perma-link: HERE

To hopefully address the growing concern for women and opioids, especially for those suffering with something as awful as breast cancer, I want to bring attention to Cancer and Opioid Awareness, my tentative title to the issue at hand. Yes, I wish to focus breast cancer, but I also feel it is just equally as important to also hone in on both the problems that cancer can bring, and the dangers that opioids have when misused or mishandled.

By including as many dynamics into challenging the opioids crisis can we as a society move forward into ending the crisis, for we cannot leave anyone else behind in the death wake of overdosing on opioids, and they especially shouldn't have to suffer more agony than they already are if they are going through cancer.

There are a decent amount of voices, big and small, that fight for the end of addictions and loss of life due to opioids.  One huge repository of information, and a collection of agencies, grassroots organizations, and methadone clinics can all be found under the website Maryland ROTA, or Rural Opioid Technical Assistance.  It observes and lists known organizations and such under a user-friendly UI, along with searching certain parts or all of Maryland, especially focusing on parts of the shore where my immediate community is located.

( Click the picture above to get sent to the search of organizations/clinics, etc. )

More specifically, testimonies from more grassroots groups such as the WoCos (Worcester County Warriors Against Opiate Addiction) were formed to help immediate members of the communities who couldn't afford the expensive treatments/rehabs, or who just didn't have the knowledge to not only fight addiction but to help out and spot those who are beginning the signs of addiction or are worsening.  Such one of these testimonies is from the co-founder of the WoCos Heidi McNeeley, who said the following:

“We wanted to help get the conversation started in Worcester County and dispel the stigma surrounding addiction,” McNeeley said. “As mothers of children with addiction, we wanted to make it apparent that addiction transcends everything. It has nothing to do with parenting or the environment in which they were raised. We wanted to normalize the conversation, so people could talk about it.”

Opioids aren't the only heath injustice that cases some form of scrutiny, resistance from the community, or had it's fair share of uphill battles. For instance, there was, and in certain instances, still is some social inequities in the quality of life that deaf people get, the community inequities in the health care of different racial and indigenous people, and those have high rates of crime and violence in their communities, such as inner-city neighborhoods.

To start off with, I'll be showing some examples and strong moments from a short film called The Silent Child. In a brief explanation, it's about a family, who's youngest is deaf, hires an interpreter or mentor to help her out. Unfortunately, most members of the family, especially the mother, makes consistent ignorant comments about their knowledge of deafness, and unfortunately ends with the nanny being fired and the child placed into a school with no special care for her disability.

 Watch below for context, and to follow along for specifically pointed out time-marks

( Just as a disclaimer, some of the criticisms that I've seen/heard were actually in some AA and NA meetings that I've attended as part of a class assignment in my community college, so I can anecdotally confirm some of the views that people without first-hand knowledge have)
Check out some of the sources below, especially the statistic quote on fatalities among opioid users

Criticisms of AAs ( HERE ) Journal on if addiction is a choice or disease ( HERE )
Site of quoted statistics of opioid fatalities ( HERE )

In a second example is a trailer to an upcoming documentary called The People's Retort. Here, it shows the optimism and desire to achieve something better in an otherwise hopeless cycle of suffering in the inner-city community of Delaware. As someone who was born and raised in Baltimore, I have real, first-handed experience of suffering in unfortunate circumstances that are mostly not really the people's fault, but the leaders that do nothing to help them.

The extremes of getting Opioids ( HERE ) Testimonies on the CDC's site ( HERE )

As my third and final example, I'll be highlight some key quotes from a video that focuses on several startling claims and inequities found in the healthcare system.

( Below is a short video of a testimony to a road of recovery ) ( Click picture for video )

New York Doctor kills 5 people with over-prescribing Opioids ( HERE )
Drugabuse.gov statistics on NAS/NOWS ( HERE )
Another negligence story and how easy it is ( HERE )
Withdraw - What you need to know ( HERE )

Here are ten resources, communities, organizations and other interest groups that have direct/indirect relationship to bettering the community over opioids, and other similar issues:

Here's an example of what my hypothetical organization could look like:

Name: Project PainFree
Mission: To free Americans from opioid addiction.
Vision: To see that over the course in years, not decades, that we amass the greatest database and call to action to stop opioid addiction and deaths once and for all.
Goal statement: To one day disband as we are a non-profit organization aiming to eliminate the choke hold of opioid addiction in all communities big and small, rich and poor, in every corner of America.

About: We are a non-profit organization striving to spread awareness of opioid addictions and how dangerous and destructive they are, through a vast collection of scholarly research, field researches in local communities, and an active stance against the crisis by bringing awareness to those responsible. Through establishing a network of community leaders and groups, of all walks of life, creeds, experiences and stories, our voices shall unite to bring addiction down so we may free our neighbors, our loved ones, our fellow Americans out from opioid addiction.

Stakeholders would be, of course, those who are addicted to such drugs, the NAs and other local healthcare organizations and grassroots origins who are also directly or indirectly involved in the same goal, the local and greater communities of America, and the researchers who put themselves on the front line to collect and establish a wealth of knowledge so that we can best exercise what are the best possible solutions for each community, not just a blanket 'resolution / one size fits all' fix.

In smaller communities, it all starts with accessing the family and hosting / co-partnering with popular events. If we develop good faith in communities small, word will spread that we support more than just resolving addiction, but also remaining addiction free for the rest of their lives. We will make sure to access all kinds of voices, church leaders, urban centers, and much more.

Initiatives: To outsource to NAs, and to establish a strong internet presence. This will involve getting big enough to outsource for additional manpower and the technology needed to support such an ambition, and also to gain the trust from those currently effected by opioids to tell their story, while keeping their anonymity should they desire to do so.

To advocate for health equity, we wish to first focus on the most vulnerable and susceptible communities and parts of the communities who are most at risk of addiction. Although the bar is set up, we will look into the other factors either contributing to the addiction, or what elements are impacting speed, quality, and access to recovery or recovery options.  One such example is by examining the vulnerability index of Worcester County, we can see that transportation and housing is the biggest vulnerability, which may lead people to having an increase difficult time in reaching the necessary healthcare places or other places critical to their recovery.  Through this, we aim to de-stigmatize the victims of opioid addictions so that the community can be more forward and willing to assistance those who most need it.

Here are some of the more local efforts and field researches and efforts in fighting opioids that I have loosely based my organization off on:

Opioids in the Workplace: Click here
The Rehabilitation Department & University of Maryland Eastern Shore Response to the Opioid Crisis: Click here

Taking into consideration of how information travels and at the break-neck speed in which it reaches us, there's always a question into just how reliable these pieces of information are, or the reasoning as to why certain information on certain stories are shown and others not. To emphasize several key examples of just how influential journalism and reporting has, or how the information can be interpreted by both consumers and the reporters, consider the following: ( Access the resource for all pointed noted below here: Link )

While the above points only scratch the surface of the good and service that journalism and the media has done to bring things to the public eye, it also barely touches the surface on the amount that the media doesn't tell you, either by omitting information, telling only half truths, or outright fabricating certain stories.  These lies, of course can be easily picked out from 'yellow newspaper' sources such as tabloids, trying to capitalize on the revenue earned through the clicks on their websites, or by those who buy their product at stores. What's however concerning is when much larger networks, those who were meant to produce the story and the truth, and not influence or cater to any particular leaning, has taken a much more aggressive and more noticeable hold on the media's agenda.  Here are just a few examples of just how tension can rise when both the journalists and media are responsible for their own actions, across the public and officials.

NYpost Article ( HERE )        Breibart Article ( HERE )    MSN Article ( HERE )

FoxBaltimore Article ( HERE )      ABL.com Article ( HERE )

Continuing my examples of tensions between journalism/media, I will now also include some issues surrounding the COVID-19 Pandemic.

CNN Article ( HERE ) NYPost Article ( HERE ) NYTimes Article ( HERE ) FoxNews Article ( HERE )

Worcester County Business COVID ( HERE ) Informing the public ( HERE )
Overall Maryland Outbreak Interactive Map ( HERE )
Worcester County Tracked Cases and Deaths ( HERE )  Free Testing ( HERE )
Ocean City Article on Vaccines ( HERE )

"As the COVID-19 pandemic continues, Smullen said it is just as important to address addiction. She noted intoxication fatalities in Worcester County had increased 55.6% from January to June of 2020, compared to the same time period the year prior. “COVID has made it worse because of the stress, isolation and depression. It’s made people more vulnerable to overdose,” she said. “It was a problem before, but it’s even more serious now.”" (Hooper, 2021).

 TheDispatch Article ( HERE ) WoCo Warriors Site ( HERE )
Death Toll Rising from Opioids due to COVID ( HERE )

If now with all these examples of how important the media is in delivering vital news is, and how critical it is that this information gets spread unbiased, untainted, and fully disclosed to the public, then it's easy to call into action for the upmost responsibility for journalists, and of course our official leaders, to upkeep only the highest standards of integrity and honesty. For should we risk this, it is more than just 'a simple misunderstanding' that's at risk here: People's very lives hang in the balance in telling the truth, and telling it soon.

Through the means of the media, including aspects of advertisements, increase PSAs, and an investment in non-electronic information booths in key locations, such as libraries, post offices, government buildings, clinics, and more to help those who cannot afford or have access to the internet, we can give more power to the people through knowledge.  While I do believe that the pandemic is already widely known and spread throughout the online scene, as well as mask requirements posted up on businesses, I want to reserve my own thoughts about the vaccine.  While I'm not anti-vaxx, there's something unappealing that I've heard from others who share the same sentiment as I do: The vaccine was rushed through many of the otherwise normal amount of checks that vaccines normally go through, just because it was COVID. I honestly do want people to get better, and to prevent the spread of COVID-19 all-together, I also need the confidence that the vaccine is in fact effective and without detrimental side-effects because of its rushed nature.  However, this can be to an advantage; if time passes by and the vaccine does indeed does as intended and research has more time to show that no harm befalls the receiver, then I'd advocate strongly for everyone, including maybe even a small payment, to take the vaccine.

Below is a brief brochure on how the vaccine is utilized, how it affects your body, and what kinds there are.  This I believe can be a boon for communities that do not have the means to immediately retrieve it via online sources.

To explain my due diligence in research, despite my own personal views, I wish to express the fullest so that everyone and anyone has a chance to obtain as much information as possible.

1) - Honesty.  By sharing my own thoughts and anecdotes, I reveal that while there are concerns, there is an active development by the science community to alleviate these worries, to vet the vaccine vigorously.

2) - No Bias.  Sharing the good and bad parts of journalism and the media, along with highlighting the national/local forums of discussion, sharing concerns and optimism, and by providing a lot of research material. Most articles aren't just from one source, or sources of one particular leaning.

3) - Extensive research. Wealth of links and resources to be found using scholarly and journalistic articles through credible reliability.

4) - A call to action. A clear voice for those who have difficulties accessing certain online resources by providing a handy and easy COVID-19 vaccine brochure.

5) - Places for Vaccines. Searched up local, well-known, and convenient places that are usually near communities to help those who need it, especially since transportation is a concern in my home county of Worcester.

6) - Relate to my topic Opioids. By converging this with opioids, I hoped to truly magnify the issue, along with so many more, that have been pushed back into the shadows due to COVID, and that we cannot forget that often times problems worsen when more stressors are added to our lives.

7) - Diversity and Inclusiveness. Tap into the local voices, such as the WoCo Warriors, local authorities sites, and the knowledge and mindset to benefit all communities, not just those who have more access to health opportunities over others.

8) - A way forward. Through all of these actions and more, I can only hope that the bar for journalism and the media's role into supplying the public is raised to a standard that achieves health equity in as many communities as possible. Perhaps by showing that we all work hard and are affected by COVID-19, those who go through substance abuse and concerns over environmental issues, we can achieve not just one goal, but many, in the great strive for social justice in health equality and equity.

While I will reserve most of my opinions of the topic such as climate change to myself, I will address some of the more real, tangible difficulties that the weather, land and pollution puts on our communities.  To my community, a particular rural community, it is ever so important that we need to make sure that hazards such as pollution do not seep into the soil in which we grow our plants and feed our livestock. The impact of these environmental challenges does come with health inequities due to directly harming our farmer's, and the local communities that live off their hard work. It affects those who work, our children's health, and the sensitive environments and wildlife that is here on the eastern shore.

For the purposes of this entry, I will be taking up the food and agriculture side of the topic, since it directly relates to my community. To me, climate vulnerability is a list of possible dangers a given community has when faced in a weather or pollution-styled crisis, and how damaging it'll be in the short and long term. Although I touched on some of the issues that can affect my community, there are much more to be stated. For example, there is a high risk of flooding in the Snow Hill area, due to it being right next to the Pocomoke river, which easily floods during heavy rain. These rains have destroyed bridges that have stranded sections of the communities off from emergency services and roads to groceries and other stores that carry essential survival supplies. There's also the risk of extreme hots and colds during the seasons of summer and winter that can prove a challenge for our farmers. As pointed out before in the blog, housing and transportation is the largest vulnerability in my community, and all of these adverse weather-induced issues can only embolden these problems by reducing what little options some people may have in means of traveling, or that their current housing is not adequate enough to protect and shelter them from the adversity.

 (The picture above represents one flooding that's happened in the Snow Hill area of Worcester County. Parts of the town are several inches or feet in water).

To combat this, we put forward a plan or goal to achieve climate resilience; a way for us to minimize and recover the damage done by environmental causes.  In this case, Snow Hill, along with the other surrounding communities, have made the natural wetlands and forestry forbidden to be destroyed, so that most of the water can be absorbed there. Although Snow Hill doesn't have the funds, there are flood barrier (collapsible walls) that people can set up around the banks of the river to prevent some of the water from entering more vulnerable areas susceptible to damage.  Some of the things that Snow Hill could improve on are more local shelters that people can evacuate to in case of extreme threats, and work towards equity in the housing/transportation index to help alleviate both environmental and social justice issues.

According to the following document: ( Link ), there are nearly hundreds of health impacts that environmental hazards and difficulties can inflict on any given community. One needs not anymore evidence of the sudden damage of a sudden change of the environment than the cold snap/winter storm that happened to Texas during February of 2020. So when a community such as Wicomico County is threatened by some constant disasters, it quickly becomes an uphill battle to keep everyone safe.  As I highlighted before, floods and rain storms are a frequent enough event that Snow Hill must be on alert at all times.  One after effect however is the water that gets trapped within the forestry, and isn't absorbed fast enough.  This still water becomes, as the document vividly describes: "proliferation of mosquitos, increasing the risk of vector-borne illnesses" (Health Impacts of Climate Change, pg 62).

The concerns of environmental issues and the impact it will have on our community's health can be drawn from this recent article found on the Salisbury Daily Times.  It has been reported by the news site that on February 18th, 2021, Snow Hill, there has been a massive waste dump that had been accidentally leaked into the Pocomoke River.  Half a million gallons of the pollution now runs it course, and officials have declared now that it is unsafe for bodily or fishing use. While the article draws the concerns to use, it ill informs of all the damage it'll cause to the river, the soil that will absorb the toxins, and the animals effected. Spillages such as this will directly cause more inequity in the food and agriculture side of our rural community, and, should there be another flood soon, Snow Hill could face a truly devastating catastrophe.
( Link to Snow Hill waste leak: Here )

In no particular order, here are some steps that we as a community can take to address some of the pressing concerns related to the environment:

One of the greatest challenges we face when we talk about the health issues that affect us, our neighbors and our fellow Americans is the fact that we can have fairness, or equity, in both treatment, quality, and opportunity to get the right treatments we need. While for some the current trends of health care and opportunity works for some, it leaves behind many in the wake of terrible costs and low opportunity to even prevent health issues before they arise.

Virginians, both in West Virginia and Virginia are experiencing an epidemic of obesity.  Claimed in an info-graphic (file below) in 2016, over 1/4 Virginians are classified as obese, and suffer many troubling issues and health concerns from it.

To fight this, both the CDC and local Virginian programs have taken up the challenge to combat this escalating problem, in both releasing information to raise awareness to it's community and embracing events and changes to start reducing the obesity numbers.

The CDC's impact is collecting and sharing a wealth of information that explains just how impactful certain health issues are, and what some of these causes are from, such as the use of tobacco products to the items served by schools.

( Source located here: Link )

In one example to achieve health equity, West Virginia implemented Try This, a repository of community challenges that any member, big or small can participate in.  Such achievements  of the Try This organization include, but are not limited to: "Workshops, social media and on-the-ground organizers to help local people plan projects, carry out long term planning, find resources and get training. Since 2016, Try This has sponsored ten regional meetings and has sparked the statewide Mindful West Virginia network." 

( Source located here: Link )

Health officials are regularly engaged with both the local and federal levels of how the systems of health care can change to help less privileged people, and even other systems that too will help balance the overall health inequity several communities face.  Director of the state Office of Maternal Child and Family Health Christina Mullins is in a constant fight on behalf of West Virginia, citing that "One in four West Virginia fifth-graders have high blood pressure, cholesterol and obesity, well above the national average."  She also goes on to say that the people there, both the community and local officials have a drive to change the trajectory that West Virginia is heading to.  One of West Virginia's accomplishments for fighting for the community is stated by Mullins that: "The state Bureau of Public Health and the state Department of Education are meeting regularly to plan for children, she said. DHHR gave the schools a half million for playgrounds... They want to let residents of communities with no gyms use school gyms after school." 

( Source located here: Link )

It's not just local officials getting active.  The Charleston Gazette reported that local stores, such as Walmart, have committed to push more healthier alternatives to consumer's shopping habits rather than junk food.  Instead of skittles and gum, fruits and toys such as jump ropes were put at displays, especially the check-out lines.  This has an enormous reach to all kinds of communities, and has the community optimistic that the work done by businesses and local officials will have the impact needed to not just slow the obesity epidemic, but reverse it.

( Check out the video below for how the local community has responded to such a change )

As evidenced by the CDC, the impact of the obesity epidemic, along with other health issues is devastating.

( CDC Source located here: Link )

However, West Virginian's health were in much better shape and health just a few decades ago. The transition of the culture from hard, labor workers, such as coal miners and foresters, have now become a massive consumer of fast food and sugary carbonated drinks.

The Shape We're In, a documented series on the Charlestown Gazette, has taken a step back in time to find out how, when and why West Virginians were escalating in health issues.  By observing the trends that the rest of America has followed, and the phasing out of hard physical labor, it wasn't long before a calamity struck almost every community.  From the subtle changes in the workforce culture, it has altered an entirely new one that has worsening health complications by the years, with no end in sight.  A quick look below, provided by the gazette, provides a bulleted list of what contributed to the shift.

( The picture is also a link to the source )

While compared to an entire state, Worcester County of Maryland has a somewhat similar breakdown of ethnic background make up. Our work culture remains rural and tends to be centered around agricultural purposes, with a high concentration on raising chickens.

A wealth of demographic information of Worcester County can be found here: Link

For more in-depth information on Worcester County's cultural make-up, consider the additional source found linked to the picture above.

For those interested in joining the cause to fight for various health inequities, including the focus of this blog opioids in the community of Maryland, and specifically around the eastern shore area, counties near and including Worcester County, consider reaching out to the following resources below. (Please note that some of these resources do not have a specific contact person, but any additional information will be provided below to compensate)

1.) Snow Hill Health Center (Worcester County)
6040 Public Landing Road
Snow Hill
MD
21863
Worcester.Health@maryland.gov
410-632-1100 (Phone Number)
410-632-0906 (Fax Number)
http://www.worcesterhealth.org  

2.)W.A.C.S. Health Center
Worcester Addictions Cooperative Service Center
11827 Ocean Gateway
Ocean City, Maryland 21842-9529
Phone 410-213-0202

3.)Berlin Health Center
9730 Healthway Drive
Berlin, Maryland 21811
Phone 410-629-0164

4.)Pocomoke Health Center 
400-A Walnut Street
Pocomoke, Maryland 21851
Phone: 410-957-2005

5.)Department of Development Review and Permitting (Worcester County)
Government Center
One West Street, Room 1201
Snow Hill Maryland 21863
Telephone: 410-632-1200
Fax: 410-632-3008
http://www.co.worcester.md.us/departments/drp

SPECIFIC CONTACT INFORMATION BELOW

Jo Ellen Bynum, Program Administrator
Phone: 410-632-1200 (ext. 1171)

6.) Recovery Resource Center
726 S. Salisbury Blvd. Suite E
Salisbury, MD 21801
410-749-9482

SPECIFIC CONTACT INFORMATION BELOW

Betty Hartman - Desk Manager / Volunteer Coordinator

While there remains a large amount of work, proof of conceptualizing, and project scoping to find real answers to real problems, I hope to spearhead at least the effort into establishing equity in the health of my community, especially when it comes to Maryland's opioid crisis.

Here is a small document of some of the plans that can be initiated to make a difference:

( Click on the picture above to be taken to an already active plan prepared by the health department )

One of the steps I have already taken is the possibility of opening up an Narcotics Anonymous in the immediate community of Snow Hill, my hometown.  While there are NA options in locations such as Pocomoke and Salisbury, there's a void in Snow Hill, which evidenced by my previous blogs, Worcester residents do face a common issue of transportation.  By opening an NA locally, those who are going through opioid abuse, as well as other substances, can get the community outreach, resources, and guides they need without being judged or ostracized by others. 

Often times churches are used to host these meetings.  Snow Hill Christian Church, located directly in the heart of the town, is an excellent and conveniently placed location that can serve the community a greater good by having such meetings there.  While it is no direct solution, everything requires diligence and an open mind to options, and if NA can help just a few people overcome their addictions, then to me it's all worth it.

Because of COVID however, I could not establish contact with the church, to see if the idea could be feasible, but I remain optimistic that Snow Hill, Worcester, and all of Maryland, through effort and a constant supply of genuine community support, we as neighbors, Americans, and as family, can achieve anything we put our minds to.

There are perhaps no greater concerns on the forefront of people's minds than making sure they are healthy (or at least it should). No one would ever want their child getting ill, or their older, more vulnerable loved ones catching a cold that can well threaten their lives.  However, another concern some people may not realize is the equal treatment and care they are given... or in some cases, not given.

Isabel Estrada-Portales' article Drylongso argues that even through our current strife of the COVID-19 pandemic, colored communities still receive unequal and lower quality treatment and care from health-care providers (2020). While we still are working towards true equal treatment of people in the social context, we must still remain vigilant and exercise equality in every dynamic of society, perhaps most especially our health-care system.  As the author points out, "Racism is not simply ignorance or not knowing, and we can’t fix it with acknowledgment and moral commitment alone" (2020). It requires that society must commit to the necessary achievement of equality by exercising practices and care that all people deserve and need in order to get well. If we cannot do that, the health risks not just escalate due to the mistreatment of the health problems, but so does the health risks that stem from racism and prejudice.
                                   ( Click the picture below to get taken to the article )

To establish the necessary communication tactics, I once again look into the suggestions of the author. In her recommendation, she suggests that: "Researchers, activists, individuals, community health workers, public affairs and health communications officers, and reporters should ask themselves and others different questions about how our world works, and how it can be transformed, at its core" (Estrada-Portales, 2020).  Per her suggestion, it's not about simply the awareness of the issue, but the dedication of driving the narrative that the issues at hand are real and affect many members of many communities.  We must continue to push it to the forefront, and challenge journalists, truth-seekers, researchers, and other people similar to not remain silent on their findings. We must task ourselves to be open and transparent to all patients and community members, on all social and physical platforms, about the dedication, promise, and commitment doctors, nurses, and other similar works of people will do to eliminate any bias and prejudice from practices to ensure true, genuine equal health care for all.

According to the CDC's Social Vulnerabiity Index, Worcester County is fairly low in its ranking, with a score of 0.2884. While the socioeconomic is the lowest vulnerability according to the data at a 2.557, Housing/Transportation is the largest vulnerability, at almost 5.0. To me, this issue strangles the community in terms of opportunities, especially those in lower/low-middle income households. Relating to my last blog post, this acknowledgement of a transportation issue shows that people who may be vulnerable, at-risk, or already are using opioids, may have a hard time getting to the places they need for the help they require.

The data map can be found here: Link

According to the excel sheet containing the data of SVI totals for Maryland, one of the numbers that sticks out that's alarming, in relations to all counties, their populations and the amount of people who live below-poverty are relatively high.  The document can be found just below this text:

Taking a step back to view the larger picture, even as America spends a significant amount of money on health care, we trail far behind other countries that spend far less than we do, per capita.

For an even thorough analysis, the following document highlights even more areas of America falling critically behind in comparisons, both domestically and internationally.  In one critical highlight, the document titled Unnatural Causes points out that kids who are born in overwhelming poor houses are at least several times more vulnerable to develop health conditions, and grow up to become poor themselves. More information to this can be found in the below file.

When it comes to piecing the puzzle together, the underlying health and social justice issues that Worcester Country faces is equivalent to a ticking time bomb. With a sizable population unemployed and the statistics to back up that children will be in ailing condition and financial stress, it creates a vicious cycle and explains why housing and/or transportation issues can arise in such circumstances. They can follow the advice given to health providers, but only if there is a large change in the systems that are in play that keep our children in poor conditions, and ill provides the community of Worcester County the necessary needs.

While we must highlight areas of the community in need of assessing of who receives more resources to satisfy the growing needs, we must also be considerate to how we ultimately treat the community by doing so. The article best to highlight this is titled Exploring the concept of vulnerability in health care' by Beth Clark and Nina Preto. When we blanket communities such as 'vulnerable', we might be giving it the much needed protection from those who are more well off, but we could also be putting a label of stigma and broaden control of said areas (Clark & Preto, 2018).  To best summarize, Worcester can be duly noted as a hard working, rural community that has its unique strengths, while also looking to help bolster said community with opportunities for housing and fairer public transportation.  By wording with positive words and not painting the negatives in flowery language, it treats the county and its residents fairly.

The article mentioned here can be accessed here:

Communication can play a huge impact on improving the housing and transportation issues Worcester County faces.  For one, I'd advocate for community leaders and groups to focus on being transparent about the issue to their local mayors and their branches. Only through express, sincere demonstration of highlighting these issues can action start to fix these problems. One big change that could happen is nominating someone, an already established community leader or well respected person of Worcester, to lead this charge to raise awareness to both the broader

For those who are more interested in some of the alarming statistics of Worcester County, compared to the rest of the U.S. and Maryland, check out the following fact sheet below:

One feasible, easy recommended action that could be possible for me to do would be to provide a petition to our local offices so they can see the amount of people who are in support for this. By doing this, this will communicate a clear need, a call to action, for those to not only voice their concerns, but to give those who were previously disadvantaged a chance to get the much needed help they need so they too can find equal social justice. This will have in the long run, a vision and path to overall health improvement to treat others more fairly, a road for us to right previous wrongs.  All in the hopes that the symbol, the Rod of Asclepius, is balanced for all, and not tilted for others.

Nationwide, the toll that Americans had to paid with their lives is in the hundreds of thousands.

 "Opioids, which include prescription drugs and illegal substances such as heroin and illicit fentanyl, have been linked to more than 470,000 deaths in the U.S. since 2000" (Salisbury Post, 2021) 
Link: https://www.salisburypost.com/2021/02/05/consulting-firm-to-pay-nearly-600-million-for-role-in-opioid-crisis/

Maryland specifically, the opioid crisis is one of the worst afflictions to happen to the state in terms of addictions and death by overdose.  According to drugabuse.gov, Maryland leads in second place to highest death counts.  To show just how much of a stranglehold the opioid epidemic has swept across the nation, and how much it has impacted Maryland, console the image below:

Link for the image, as well as chart data, can be found here: https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state

To hit closer to my college of Salisbury University, Wicomico county has suffered one of the worst three year periods of opioid crisis in the entirety of Maryland.  Between 2013, 2014 and 2015, the amount of deaths caused by homicides were less than that of the number of overdosing on opioids, the number of overdosing almost tripling between these years, and was only just under the amount of overdoses in Baltimore city which had an even greater number of deaths.  Link for the source material can be located here: https://salisburyindependent.net/wicomico-news/changing-face-of-opiates-seen-in-wicomico/

Those who do survive overdosing suffer agonizing side effects, ranging from vomiting, nausea, hallucinations, impaired judgment, severe constipation, damage to veins, liver damage, insomnia, and much more.  More can be found here: www.addictioncenter.com/opiates/symptoms-signs/

Opioids are drugs that, through proper use, are meant to treat chronic pain that are otherwise most often unmanageable. Because of how easy it is to get addicted to opioids, this has directly caused a huge issue for those who are already in such pain, in such a condition to be in poor health, those who are vulnerable to addictive substances, and those possibly disabled or are unable to handle the correct quality/quantity of such drugs.

Despite lawsuits taking place ( https://www.classaction.com/opioids/lawsuit/ ), the effects of aggressive marketing, ill research, and omitting key information from those who are desperate to alleviate their pains have now fallen victim to the addiction of opioid use.  The most dangerous form of opioid use is when it's often mixed with unknown or more powerful substances, especially.  As a result, those who are financially struggling to buy over-the-counter and have a preexisting health problem are a great risk to the dangers. The picture below is data collected from the official Governor's office of Maryland on the impact of the opioid crisis as of 2020:

More information can be found here (This information was taken specifically from the 2nd Quarterly report of 2020):bha.health.maryland.gov/OVERDOSE_PREVENTION/Pages/Data-and-Reports.aspx

 
According to the following article: (online.maryville.edu/online-masters-degrees/health-administration/understanding-the-opioid-epidemic-opioid-abuse-in-america), some of the most vulnerable populations that would be considered a larger threat to intersectionality justice and a threat to overall social justice are our youths and young adults, returning veterans, Native Americans, senior citizens, the LGBT community, and rural communities.  A staggering claim was found that just about 74% of farmers are affected by the opioid crisis, which hits a lot more closer to home here in the eastern shore of Maryland.

To give another look at the demographics of who is impacted, take a look at the following chart:

Source provided by: bha.health.maryland.gov/Documents/Annual_2018_Drug_Intox_Report.pdf

In 2017, Governor Larry Hogan declared a state of emergency due to the escalating issues of the crisis at hand. Shortly after, new and improved programs were available to the communities that were most vulnerable. These new declarations included, but not limited to, providing the necessary support to clinics and rehab centers, specially training first responders such as police with the knowledge to address these issues, and making naxolone, a drug that counters the effects of opioids, much more readily available, especially to said first responders by having it equipped.  However, there still persists an alarming fact that the majority of these victims are male, with some evidence showing no real decline, and a plateau or increase in deaths among blacks.

More can be found on Governor Hogan's Act here: bha.health.maryland.gov/OVERDOSE_PREVENTION/Pages/Index.aspx

Opioids continue to plague all communities across America, but especially now in these uncertain times there's been evidence that it has grown due to the additional stress of COVID-19. ( Source of claim here: www.wicomicohealth.org/news-releases/addressing-the-opioid-epidemic-during-a-global-pandemic/ )

We must continue to remain vigilant when it comes to these issues. Unfortunately, the safety measures that Hogan enacted haven't yet shown a solid elimination or curving of these death rates due to the chance being squandered by COVID-19.  I continue to advocate for what he started, but unfortunately some of the services have been relegated to phone operations such as council-ling, and that may not be enough for people, especially for those financially struggling to afford the necessary technology to use such services.

There should be a call to action, to increase the opportunities for people to attend facilities such as detox and rehabs even during COVID, safely, so that they may get the help they need to overcome this terrible addiction. The health and/or drug board must also acknowledge these serious issues that plague 'all' the communities of Maryland, and have resources readily available to use at locations that many can access. Though this will be daunting, I know that the transportation system can also help alleviate those who need it.

More funding may be required to accomplish a feat, which is no short order in the slightest considering the situation. I strongly advocate analyzing appropriate funds from all branches and programs that Maryland has, and make some accommodations and cut down on frivolous spending that helps neither Maryland or its great communities.

To emulate this, please check out this site.  More counties should adopt this, and additional sites that offer these services: www.freeopioidtreatment.com/li/wicomico_behavioral_health_21801

By accepting the challenges ahead, I can only hope that we can see an improvement.  We must protect all Americans, no one should have to suffer a horrible health risk such as addiction to opioids. We must be cognizant however to the most vulnerable communities as well: We must intervene somehow to stop the escalating death toll among black Americans, men, our young and old, our veterans, the LGBT communities, and native Americans, and we must continue to work hard to protect those who otherwise cannot afford, or are vulnerable to being preyed upon, for the pains they didn't ask for.