Northwest Texas Healthcare System releases information about late 2021 breach which involved patients’ protected health information

Northwest Texas Healthcare System releases information about late 2021 breach which involved patients’ protected health information

AMARILLO, Texas (KAMR/KCIT) — Officers with the Northwest Texas Health care Procedure unveiled details about a breach in late 2021 that involved secured health and fitness data for the system’s patients.

According to a “vendor breach celebration notice” printed on Thursday, officers explained that Adelanto Healthcare Ventures LLC, a consulting firm that is effective for just one of the system’s small business associates and a company that supplies “transactional advisory support” for the system, became mindful of two email accounts staying accessed as a result of a “phishing incident” in November 2021.

Officials claimed originally, they did not believe that the incident concerned the Northwest Texas Healthcare System. In December 2021, AHCV contacted a previous employee of the system that guarded health and fitness information and facts was discovered in the impacted email accounts and “potentially available through the incident.” It was not right up until August 2022 that a company affiliate of the method discovered that sure information and facts could have been concerned in the phishing incident.

Just after studying of the incident, the affiliate, not determined by the Northwest Texas Health care Process, commenced an investigation. But the associate did not obtain “sufficient information” to conduct the investigation until finally late December 2022.

“There is no proof to date to advise that the PHS was copied or misused, but our business enterprise linked notified our Corporation of the incident on January 28, 2023,” the observe reads. “Once we acquired this observe, we labored with our business enterprise affiliate to get the ways necessary to deliver notification to persons.”

Officers explained the email messages concerned in the phishing incident possibly contained some or all of the subsequent info from the system’s sufferers, including:

  • Patient’s comprehensive title
  • Facility title
  • Medicaid assert ID
  • Medicaid customer ID
  • Care program name
  • Medicaid program
  • Gender
  • Day of delivery
  • Admission and discharge day
  • Professional medical and analysis info
  • Psychological overall health comorbidity (if any).

Officers stressed that the e-mail did not comprise social stability numbers, credit history card numbers, or other financial facts.

The procedure explained that notification letters bordering this detect started to be mailed on March 29. They also mentioned that AHCV is reportedly expanding its safety steps and assessing more education for its workforce. The unnamed organization associate has also reportedly “counseled its personal workforce on the incident and greatest procedures.”

“While we are unaware of any precise or tried misuse of PHI, we are supplying impacted people 12 months of world wide web surveillance and identity restoration solutions through Experian at no charge,” the discover read through. “Individuals can refer to their notification letter for enrollment guidance.”

The notice said that people with added inquiries are questioned to contact 800-910-4035, a dedicated line open from 8 a.m. to 10 p.m. Monday by means of Friday, and from 12 p.m. to 7 p.m. on Saturday and Sunday, excluding holidays. Officials reported the line will remain open up until finally July 31.

“If you did not get a letter, but would like to know if you had been afflicted, you should get in touch with our devoted assistance line,” the see examine.

For the hottest Amarillo information and regional updates, check out with MyHighPlains.com and tune in to KAMR Area 4 News at 5:00, 6:00, and 10:00 p.m. and Fox 14 Information at 9:00 p.m. CST.

Texas woman provides free journey to recovery for those dealing with drug addictions

Texas woman provides free journey to recovery for those dealing with drug addictions

We requested you to notify us about inspiring girls in your lifestyle. We went by hundreds of nominations in our Remarkable Girls contest. Now, we’re sharing our finalists’ stories.

MARBLE FALLS, Texas (KXAN) — In a quiet Marble Falls community just a few streets away from downtown, sits a small, nondescript household that has grow to be an epicenter of alter.

Paula Mays smiles with mate at occasion. (Courtesy: Paula Mays)

As wind chimes sway softly in the breeze, people quickly feel a perception of relaxed outdoors the dwelling surrounded by indications about appreciate, endurance and kindness. Identical messages of hope and reassurance are posted inside of the household, laying the basis for the tale of Open Door Restoration Home and its founder, Paula Mays. 

“If we would enjoy and persuade each individual other, stroll beside each and every other, and not decide or toss stones — this earth would be these kinds of a improved location,” Mays reported. 

That’s aspect of the mission at Open up Door, a faith-dependent, sober-living residence for women of all ages that opened in 2010. For 13 a long time, Mays has housed more than 250 ladies for up to a yr, at no cost, to aid them on their journey to restoration and sobriety. 

Paula Mays and close friends painting items for Open up Doorway Restoration Home. (Courtesy: Paula Mays)

To superior realize why Mays has devoted her everyday living to Open up Door and women and gentlemen having difficulties with drug addiction, you will have to initially realize her difficult personal journey. 

“I was in South Dakota, and within a few of a long time my mother married an abusive male, and my 1st memory was at 2 years old of remaining sexually assaulted. I was raped and crushed. I was locked in trunks of automobiles,” Mays stated. “It was horrifying. I was not as well sure about God, but I realized the satan and I felt like I lived with him.” 

By the time she obtained more mature, she believed existence would transform, but it didn’t. 

“In my 20s, I started off looking for other substances to transform the way I felt, just to be in a position to cope,” Mays said. 

In 1999, she identified herself in jail, seeking at a 99-calendar year prison phrase. She was married and divorced with 6 kids at that time. She mentioned by the grace of God, the federal costs she was experiencing, had been dropped. She had moved to Texas, which she states served independent her from drugs and alcohol. She started out likely to 12-Action restoration conferences, joined a church and she mentioned the kindness she professional was existence-modifying. 

“I was in a position to rebuild with God. It is all Him. It was definitely remarkable: His incredible grace, His ability and His appreciate,” Mays reported.

  • Marble Falls woman Paula Mays provides free journey to recovery for those dealing with drug addictions. Mays was named Central Texas' Remarkable Women winner. (KXAN Photo/Patrick Hoffacker)
  • Marble Falls woman Paula Mays provides free journey to recovery for those dealing with drug addictions. Mays was named Central Texas' Remarkable Women winner. (KXAN Photo/Patrick Hoffacker)
  • Marble Falls woman Paula Mays provides free journey to recovery for those dealing with drug addictions. Mays was named Central Texas' Remarkable Women winner. (KXAN Photo/Patrick Hoffacker)

She started off serving in soup kitchens and at prisons together with ladies in her identical restoration system. That is when she fulfilled 3 different females struggling to reach sobriety. She remembers that they did not have a place to remain or a aid system, that means dying or jail turned their only way out. 

“I assumed, ‘These ladies need a spot to go. They require a secure spot to be,’” Mays tearfully remembered. “Recovery is tricky adequate devoid of the external triggers and pressures and anticipations and struggles — and God introduced back again to my thoughts a runaway shelter again when I was a teen in the town I lived in.” 

Paula Mays serving food to individuals in need to have with the aid of volunteers. (Courtesy: Paula Mays)

That was her safe haven, and she preferred to produce a thing very similar for other gals. It was in that moment, reflecting on that runaway shelter, that she understood her goal: to carry the message of hope and restoration by starting off Open up Door. 

It commenced modest with conferences in a church and by 2013, a household was bought, a campaign paid out it off and the doorways have been open for women in the neighborhood. Through group grants and donations, Open up Door homes up to 8 women of all ages at a time, for free of charge, for up to a yr. Mays guides the girls from addictive existence to lives of sobriety, features and successful membership in culture, by using AA Major E book, Bible scientific studies and other packages. 

“We wander beside them. We motivate them in their battle. We walk with them by way of CPS, probation and parole,” Mays stated. 

The ladies have a structured plan that starts early in the early morning and contains weekly meetings and scientific studies to help regulate their recovery. The females also have to carry out 17 hrs of volunteering every single 7 days. Mays performs all her responsibilities with little paid support, only a section-time place of work supervisor and part-time assistant.   

A major affect

Alicia Defranco mentioned Open up Door changed the trajectory of her everyday living.  

Alicia Defranco poses with her two daughters. (Courtesy: Alicia Defranco)

“This is my residence. This is my foundation. This is in which I figured out how to be a human,” Defranco explained. “I begun working with when I was 10 years aged and by the time I was 17, I was a complete-blown opiate heroin addict.” 

Defranco was on the operate and by the time she moved to Texas, she lost custody of her young children. 

“I was so damaged. I was so damaged,” Defranco explained. 

She was in a correctional facility in Uvalde when anyone informed her about Open Doorway. She wrote a letter to Mays, asking to be a part of the plan. Mays picked Defranco up when she was introduced, took her out to consume and brought her to Open up Doorway. 

“It was a reduction simply because I understood I got to keep sober even lengthier,” Defranco remembers. “I was anticipating a rehab center and I walked in, and it was a household, and it was frustrating when she showed me my bed room, toilet and took me to get outfits.” 

 Defranco paid out for practically nothing during the time she put in at Open Doorway. 

“I never ever experienced a have to have not fulfilled in this article,” Defranco explained. 

Soon after months of inner healing at Open up Door, she grew to become sober and was able to get started a new journey with her spouse and children. 

“I could not photograph it — I absolutely could not picture it. I acquired my very first property a yr in the past this past December and I have fiscally supported my young ones and I for 5 decades,” Defranco stated. 

Alicia Defranco pictured with her two daughters. (Courtesy: Alicia Defranco)

“What a wonder she is. There are so lots of miracles out there — they just need another person to stroll beside them,” Mays said. “Don’t give up on your loved 1 who is struggling with habit.” 

Defranco says Mays is not just her hero, but a hero for so quite a few girls who are neglected and not supported by their people or their communities. 

“She’s my motivator. She’s my backbone. She is my foundation,” Defranco stated. 

“If you see glory in my tale, it is God. It is all Him. He does the weighty lifting,” Mays claimed. “I am so grateful that I survived since by all accounts I shouldn’t have.” 

In accordance to knowledge from Open up Doorway Restoration Household, for females who lived in the property this past application year (From September 2021 to September 2022), the non-recidivism price was a report high of 85{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}. The 12 months prior, it was 80{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}. Numerous previous people say she assisted them realize that they by yourself are accountable for their actions. They discovered applications to make far better and more healthy decisions. 

Paula Mays teaching the neighborhood about resources offered by Open up Doorway. (Courtesy: Paula Mays)

Mays also assists women of all ages get better their little ones from CPS and foster treatment. She is also a crucial member of the 33rd & 424th District Drug Court docket Team. She is frequently “on-call” 24/7. She picks up new girls from rehab services or jail from as considerably as Austin, Dallas-Fort Worth, San Antonio or Galveston. If women depart the software early, by breaking guidelines or just leaving, she will help them come across other help.  

Even though her work is solely funded by donations and grants, she hopes to broaden to enable additional women across the condition. 

How Well Do Large Language Models Support Clinician Information Needs?

How Well Do Large Language Models Support Clinician Information Needs?

A recent perspective in the New England Journal of Medicine by Lee et al outlined the benefits, limits, and risks of using GPT-4 in medicine. One of the example interactions discussed is that of a “curbside consultation” with GPT-4 to help physicians with patient care. While the examples and scenarios discussed appear promising, they do not offer a quantitative evaluation of the AI tool’s ability to truly augment the performance of healthcare professionals.

Previously, we discussed how foundation models, such as GPT-4, can advance AI in healthcare, and found that a growing list of FMs are evaluated via metrics that do not tell us much about how effective they are in meeting assumed value propositions in healthcare.

The GPT-3.5 and GPT-4 models, available via the chatGPT interface and APIs, have become the fastest growing consumer computing applications in history, growing over several weeks to a 100 million+ user base, and are now used in a variety of creative generative scenarios. Despite publicly documented concerns about bias, consistency, and non-deterministic behavior, the models are likely being used by healthcare professionals in myriad ways, spanning the examples described by Lee et al and beyond.

To analyze the safety and usefulness of this novel mode of AI-human collaboration, we examined these language models’ answers to clinical questions that arose as “information needs” during care delivery at Stanford Health Care. In preliminary results, soon to be submitted to ArXiv, we find that the first responses from these models were generally safe (91-93{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of the time) and agreed with the known answers 21-41{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of the time.

We drew 64 questions from a repository of ~150 clinical questions created as part of the Green Button project, which piloted an expert staffed consultation service to answer bedside information needs by analyzing aggregate patient data from the electronic medical record as described in the NEJM Catalyst. An example question is, “In patients at least 18 years old who are prescribed ibuprofen, is there any difference in peak blood glucose after treatment compared to patients prescribed acetaminophen?” We excluded questions such as “How many patients admitted to Stanford Health Care with a brain bleed had 2 or more imaging studies of the head during that inpatient stay?” Such questions were too specific to Stanford practice patterns to pose to a general large language model.

We employed simple prompt engineering – instructing GPT-4 that “You are a helpful assistant with medical expertise. You are assisting doctors with their questions” and GPT-3.5 to “Act as an AI doctor” – to obtain responses, and then we compared their responses with the original answers provided by the consultation report. 

Twelve clinicians across multiple specialties reviewed the responses to answer two questions: (1) “Are there elements of this answer that are so incorrect as to cause patient harm?” (Yes / No) and (2) “The response from GPT-X is similar to the informatics consult and would lead me to the same action” (Agree / Disagree / Unable to assess). We found that:

  • 91{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of GPT-3.5 and 93{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of GPT-4 responses are deemed safe and the complement were considered “harmful” primarily because of the inclusion of hallucinated citations.
  • 21{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of GPT-3.5 and 41{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of GPT-4 responses agreed with the known answer.
  • 27{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of GPT-3.5 and 29{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of GPT-4 responses were such that the clinicians were “unable to assess” agreement with the known answer.

In addition, we assessed the reliability of the language models by submitting the same question with the same prompt multiple times over multiple days. Using common metrics to assess similarity of textual documents – such as Jaccard and cosine similarity – we find low similarity and high variability in responses to the same question. 

Below, we show an illustrative example of a question submitted with the same prompt at different times to GPT-4 and two responses received. Over the 64 questions, the average Jaccard similarity was 0.27 for GPT-3.5 and 0.29 for GPT-4 and average cosine similarity was 0.36 for GPT-3.5 and 0.45 for GPT-4. Ideal values would be closer to 1 for both metrics.

In patients at least 18 years old, and prescribed ibuprofen, is there any difference in peak blood glucose after treatment compared to patients prescribed acetaminophen?

First response: There is no significant difference in peak blood glucose levels between patients prescribed ibuprofen and those prescribed acetaminophen. Both ibuprofen and acetaminophen are primarily used for pain relief and reducing fever, and their effects on blood glucose levels, in general, are not significantly differentiated. However, it is crucial to keep in mind that individuals may have varying responses to medications, and it is essential to consult with medical professionals to address specific patient needs. It is also worth noting that nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can potentially have adverse effects on kidney function, which may indirectly affect blood glucose levels in some patients, especially those with diabetes or kidney disease. Therefore, close monitoring and consultation with a healthcare professional are required when managing medications in patients with existing health complications.

Second response: There is limited evidence comparing the effects of ibuprofen and acetaminophen on blood glucose levels in adults. Some studies have suggested that NSAIDs, including ibuprofen, may have a modest impact on blood glucose levels, while acetaminophen may cause a slight increase in blood glucose. However, these effects are generally small and not clinically significant for most patients. It is worth noting that individual responses to medications may vary and the effects on blood glucose can depend on various factors, such as dosage, duration of treatment, and the presence of other medical conditions. As always, it is important for patients to closely monitor their blood glucose levels and consult with their healthcare provider when starting or adjusting any medication.

Our study is ongoing. We plan to analyze the nature of the harm that may result from hallucinated citations and other errors, the root causes of the inability to assess agreement between the generated answers and the answers from expert clinicians, the influence of further prompt engineering on the quality of answers, and change in perceived usefulness of the answers if calibrated uncertainty was provided along with the generations. 

Overall, our early results show the immense promise as well as the dangers of using the system without further refinement of the methods – such as providing uncertainty estimates for low-confidence answers. Given their great promise, we need to conduct rigorous evaluations before we can rely routinely on these new technologies.

Contributors: Dev Dash, Rahul Thapa, Akshay Swaminathan, Mehr Kashyap, Nikesh Kotecha, Morgan Cheatham, Juan Banda, Jonathan Chen, Saurabh Gombar, Lance Downing, Rachel Pedreira, Ethan Goh, Angel Arnaout, Garret Kenn Morris, Honor Magon, Matthew Lungren, Eric Horvitz, Nigam Shah

Stanford HAI’s mission is to advance AI research, education, policy and practice to improve the human condition. Learn more.

Marie Nyswander Changed the Landscape of Addiction. Here’s How Her Story Begins.

Marie Nyswander Changed the Landscape of Addiction. Here’s How Her Story Begins.

In 1946, Marie Nyswander, a recent medical school graduate, joined the U.S. Public Health Service looking for adventure abroad. Instead, they sent her to Lexington, Kentucky’s Narcotic Farm, a prison and rehabilitation facility for people with drug addiction, where therapies included milking cows and basket-making. It was at Lexington that Marie encountered addiction for the first time, and what she saw there disturbed her—and reset her life’s course.

[New to the Lost Women of Science? Listen to Episode One of our last season here.]

LISTEN TO THE PODCAST

EPISODE TRANSCRIPT

The Lost Women of Science podcast is made for the ear. We aim to make our transcripts as accurate as possible, but some errors may have occurred nonetheless. In addition, important aspects of speech, like tone and emphasis, may not be fully captured, so we recommend listening to episodes, rather than reading transcripts, when possible.

—-

CAROL SUTTON LEWIS: Before we start, just a quick note to let you know, this season of Lost Women of Science is about drugs and also, a little bit about sex. The content and the language are mainly for adults. Also, note that in the coming episodes, we’ll be including a lot of archival audio from the mid-20th century, so you’ll be hearing some outdated drug addiction language, as well as perspectives that don’t reflect our own.

FRED WEISGAL:  It is quite clear that the officials today who have been handling the narcotics problem have failed completely. 

KATIE HAFNER: In the 1960s, heroin use in the United States was rising at an alarming pace. And nothing seemed to help, as this lawyer told a TV reporter in Baltimore.

FRED WEISGAL: All that they have been able to do is send people to prisons, have these people come out, and they are still drug addicts.

[fades low]

KATIE HAFNER: But in 1965, a team of doctors at Rockefeller University announced what sounded like a miracle: they’d found a treatment for heroin addiction that actually worked.

They’d been running an experiment with a small group of patients for a couple of years—and the results, they were astonishing. Their patients, all men, aged 19 to 37, had been addicted to heroin for an average of nine years. Most hadn’t finished high school and had more than one arrest on their records. All had tried to quit heroin before and all had failed. But then, the doctors gave them something called methadone hydrochloride. 

CAROL SUTTON LEWIS: Methadone wasn’t a new drug. It was already being used to help patients detox – basically to ease the symptoms of withdrawal. The difference here was that the doctors at Rockefeller were giving doses much higher than those normally given—and it completely transformed the patients.

CAROL SUTTON LEWIS: One man started painting. Another one finished high school and got a scholarship to go to college. Most remarkably—the relentless cravings disappeared. They could stop thinking about heroin, stop dreaming about it at night. And it took just a day or two to start seeing the differences.

KATIE HAFNER: And yet, the Federal Bureau of Narcotics wanted all of this stopped! In fact, the Bureau had been monitoring one of these Rockefeller doctors for years: Marie Nyswander. She was the psychiatrist on the team. And she’d been working on addiction for more than a decade at this point. And the men at the Bureau were not fans of her work. Narcotics agents would show up at her office unannounced, and they’d come to her meetings. They thought her approach to addiction was completely wrongheaded and dangerous. But she wouldn’t stop, not then, and definitely not now that she was finally seeing results. In 1965, Dr. Marie Nyswander was a legend in the making and she was set to revolutionize the treatment of addiction.

[theme music starts]

KATIE HAFNER: This is Lost Women of Science. I’m Katie Hafner.

CAROL SUTTON LEWIS: And I’m Carol Sutton Lewis. And this season, The Doctor and the Fix: How Marie Nyswander changed the landscape of addiction.

KATIE HAFNER: Marie Nyswander was a Freudian psychoanalyst in New York City, who owned a private practice on Park Avenue  where she specialized in sex therapy. But she was a study in contrasts. When she wasn’t seeing private clients on the Upper East Side she was working in a bleak tenement building  in East Harlem, treating heroin addiction. 

CAROL SUTTON LEWIS: Marie Nyswander was one of the most intriguing figures in 20th century medicine, and the mark she left on addiction treatment, it’s indelible.

[theme music ends]

CAROL SUTTON LEWIS: So Katie, I imagine a lot of people listening to this are going to be pretty skeptical. I mean it’s 2023, and clearly we have not solved the problem of heroin addiction—or any kind of opiate addiction. There’s clearly more to this story.

KATIE HAFNER: Oh yes, there is. Methadone, their miracle drug, isn’t a cure for heroin addiction. In fact, methadone is an opioid. Heroin is too, but there are differences in how they’re made and how they make you feel. Heroin comes from the opium poppy, and methadone is synthetic. But they’re both hitting the same receptors in the brain and body,  So think about it—the idea that you would treat an opioid addiction with  another opioid, it isn’t just counterintuitive, it’s radical—at least for the U.S. in the early 60s. And it made Marie Nyswander some very high profile enemies.

CAROL SUTTON LEWIS: But we’re getting ahead of ourselves. So let’s back up, all the way up to the very beginning of Marie Nyswander, in 1919.

EMILY DUFTON: She was born in Reno, Nevada to a German father and an American mother.

CAROL SUTTON LEWIS: Emily Dufton is a drug historian and writer.

EMILY DUFTON: They divorced when she was two.  So she was raised almost entirely by her mother—Dorothy Bird Nyswander—who is just this really groundbreaking, amazing leader in public health,  global public health especially.

CAROL SUTTON LEWIS: Dorothy instilled in Marie the importance of being of service to others and also being tough as hell. There’s a great story about a time that she and her mom were camping when a grizzly bear showed up. Dorothy just clapped and told the bear to go away. And it did.

The two of them moved a few times during Marie’s childhood. They lived in California, then Utah, and then New York. When Marie was a little kid, her mom taught high school during the day, and worked on her Ph.D. from UC Berkeley at night.

EMILY DUFTON: So she raised Marie to be very cultured and very literary. They’d hang out with like Margaret Mead at night, um, really interested in anthropology and very independent.

CAROL SUTTON LEWIS: And Marie, she really was an independent thinker, even when she was young. Marie was actually born Mary Elizabeth Nyswander, but she decided there were just too many Marys out there, so she changed her name.  She told her mother that  “Marie” had more “character.” 

So she was independent, but she also really followed in her mother’s footsteps, and Marie decided to become a doctor. She went to Sarah Lawrence College, an artsy, progressive school just north of Manhattan, then enrolled at Cornell medical school, where she was one of just a handful of women in her class. 

EMILY DUFTON: She wanted to be a surgeon, right? She didn’t wanna just be a doctor. She wanted to be a surgeon. I think that speaks to her ambition. She really pushed herself to do a lot of, a lot of things that, I mean, you think about this woman in like ‘41, like who is pushing themselves to these lengths. Um, but she does it and it’s- it’s like you can’t imagine her doing anything else. 

CAROL SUTTON LEWIS: And at this point Marie wasn’t even thinking about addiction or its treatment. It wasn’t covered in any of her classes. But that all changed in 1946, when she did her medical residency with the United States Public Health Service.

EMILY DUFTON: Well, she joins the public health service actually because she wants to travel. And she kind of wants to go and have an international adventure for a while. So she joins the PHS with, with that as her goal. And where they send her instead is Kentucky. [laughs]

CAROL SUTTON LEWIS: Lexington, Kentucky, known for its rolling bluegrass hills and horses. It was also home to a massive federal drug rehabilitation facility and prison – known as “Narco” to locals. It was just outside of the city. And when Marie, this ambitious would-be surgeon, showed up there on assignment, she saw things that would completely alter her life’s course.

DAVID COURTWRIGHT (1981): Testing, 1, 2, 3, 4. Testing, 1, 2, 3, 4. 

MARIE NYSWANDER: I’m just sitting here comfortably. 

DAVID COURTWRIGHT: 1, 2, 3, 4. 

MARIE NYSWANDER: 1, 2, 3, 4. 

DAVID COURTWRIGHT: This is an oral history interview with Dr. Marie Nyswander. This is June 22nd, 1981.

KATIE HAFNER: A few years before Marie died, a young historian named David Courtwright visited her at her Rockefeller office in Manhattan. She was in her early 60s then, still working, and David had come to interview her about her life and career. But, the first thing he remembers noticing was the smell.

DAVID COURTWRIGHT: I could smell nicotine. And, uh, I knew from, from what others had told me that, um, she was a smoker. And I knew that that had led to some significant health problems, battles with cancer. And I was a little bit surprised actually, that I could still smell the, the nicotine on her.

KATIE HAFNER: Marie had smoked since she was a teenager, and despite her decades of addiction work, she hadn’t managed to quit. But the other thing David noticed was it felt like Marie was sizing him up.

DAVID COURTWRIGHT: I mean, I think uh, as a trained psychoanalyst, I mean, she’s obviously gonna be looking me over and judging me, and I supposed to some degree I felt that I was being judged.

KATIE HAFNER: I hear that in her voice. This cool appraising tone, and throughout the entire interview, when personal stuff comes up, she’s curt. She lets the silences kinda hang there. But then, David asks about Lexington.

DAVID COURTWRIGHT (1981): And what was your initial reaction?

MARIE NYSWANDER: To Lexington, Kentucky?

DAVID COURTWRIGHT: And that, that’s the moment I think when the interview really takes off. Uh, and (laughs) and there, there’s some kind of role reversal, you know, where the, the psychoanalyst is venting to the patient

MARIE NYSWANDER: Well, it was a hard year. It was the hardest year of my life. Prison is a terrible thing if you’re not experienced with it or if you, if you have any kind of a personality that cares about your fellow man.

DAVID COURTWRIGHT: Mm-hmm

MARIE NYSWANDER: A prison, working in a prison, will simply blow you up with rage and frustration.

KATIE HAFNER: So Carol, the way Marie describes it, I’m imagining this cold, hard prison environment right?

CAROL SUTTON LEWIS:  Ugh, yes, I mean you can just imagine what a place called “Narco” looks like.

KATIE HAFNER: But you know, when we started looking into Lexington, aka “Narco,” it’s not exactly what we found.

NANCY CAMPBELL: It opens in 1935, and it’s billed as “a new deal for the drug addict.”

KATIE HAFNER: Nancy Campbell is a professor at Rensselaer Polytechnic Institute and a historian of drugs and drug policy.

NANCY CAMPBELL: That was the language that they used. They used the language of public enlightenment, the idea that drug addicts would no longer be simply considered criminals. Now, what’s interesting is they were not considered criminals until 1914.

KATIE HAFNER: 1914 was the year the U.S. passed the Harrison Narcotic Act, the country’s first  federal anti-drug law, and soon, the prisons just started filling up. By the late 20s, a third of people in federal prisons were there for drug convictions, not to mention all the people there for alcohol offenses. This was also the time of Prohibition, after all.

NANCY CAMPBELL: At that point, the Federal Bureau of Prisons is realizing that prisons are overcrowded with people who suffer from what they consider a public health problem.

CAROL SUTTON LEWIS: But most doctors didn’t exactly know what to do either. Many were getting frustrated with these patients who came to get “cured,” but then went back to drugs and alcohol over and over. And it wasn’t even clear if addiction was a medical problem. Was it physiological? Was it psychological? Was it a disease or a personality disorder? Or was it just a bad habit? Whatever it was, we needed a better solution.

So in 1935, the Bureau of Prisons and the Public Health Service teamed up to open a first of its kind center in Lexington—a U.S. Narcotic Farm. Not just a prison, but a hospital too—about a third of patients came voluntarily.

ANNOUNCER: When the United States Public Health Service Hospital was established in Lexington, Kentucky, the problem of narcotic drug addiction was put under the banner of medicine. Until that time, this problem had been regarded almost solely as a correctional one. 

KATIE HAFNER: And wow, this place, in this promotional film from the Health Service, you can see it. It’s a sprawling art deco building, set on thousands of acres of farmland, dotted with big old trees.

ANNOUNCER: Activities include the operation of a modern dairy, the raising of hogs, and poultry, and intensive truck farming.

KATIE HAFNER: Now, there were locked corridors and bars on some windows, but there were also cows grazing in pastures, fresh food—everything from tomatoes to kale grown by patients on site—art therapy. 

CAROL SUTTON LEWIS: What?

KATIE HAFNER: A bowling alley, Yes! (Carol laughs) and tennis courts. And everyone who stayed there—whether they came voluntarily or not—was supposed to be called a “patient” not a “prisoner.” 

So Lexington, it quickly became the biggest and best-known destination for people with drug addiction in the country. 

CAROL SUTTON LEWIS: People would say they were going down there to get “the cure.” But, Lexington really wasn’t offering a cure for addiction because a cure for addiction didn’t exist.

NANCY CAMPBELL: It was essentially getting people away from drugs.  

CAROL SUTTON LEWIS: Nancy Campbell again.

NANCY CAMPBELL: And it was often referred to as “the geographic cure.” Get them away from their old neighborhoods and their old suppliers, and also the settings, the social cues that led them to relapse.

KATIE HAFNER: A new patient first had to stop using drugs. Medical staff would ease their withdrawal often with doses of morphine tapered over the course of a couple of weeks. Then, the patient would join the general population for the rest of their treatment. Fresh country air and honest work were always a big part of it.

ANNOUNCER: Supervised outdoor recreation is desirable and necessary for the health of the patients. It promotes good fellowship and normal human relationships.

CAROL SUTTON LEWIS: There was some therapy too – individual therapy, group therapy. But, the most important kind of therapy seemed to be keeping busy – busy with work, classes, and recreation.

NANCY CAMPBELL: Which included everything from basket making to bowling, and they would graph the number of hours of recreation that patients engaged in. And, of course, the most famous form of recreation that there was at Lexington …

CAROL SUTTON LEWIS: … was jazz. On weekends, patients would put on big concerts and the audience would get so excited,  and cheer so loudly you couldn’t even hear the music. Over the years, some of the biggest names in jazz passed through Lexington – Chet Baker, Sonny Rollins. 

KATIE HAFNER: And Carol, I’ve heard that some people actually wanted to go to Lexington just so they could practice with super famous jazz musicians.

And if you look at patient accounts of Lexington, some of the reviews were surprisingly good! 

BENNY GIM: What do you think of Lexington as a whole? What’s good about it and what is bad about it? 

CAROL SUTTON LEWIS: In 1951, New York State held a hearing about the problem of addiction. The hearing included a few testimonies, like this one, from an 18-year-old who’d just come back from treatment at Lexington.

BOY: The convalescing period over there is very good. They’ve got work, all sorts. You can work as a farmer, out in a farm. You can work in a dairy, you can work inside in a garment shop.

CAROL SUTTON LEWIS: Or do carpentry or auto repair

BENNY GIM: And, uh, how about the food? 

BOY: The food over there is the best. 

KATIE HAFNER: It wasn’t all rosy. Lexington was still a prison. People sometimes got sent there for minor drug offenses. Nancy says there were fewer riots than at other prisons, but there were some riots. Still, many people went there voluntarily for a reason.

CAROL SUTTON LEWIS: In the early 80s, David Courtwright and a couple of others started a massive oral history project all about addiction. That’s how we got to hear Marie’s voice earlier—as well as the voices of many patients. And for some of them, this rural escape, this pastoral temple of jazz, it seemed like it was actually working, at least for a time…

JOHN B: While I was in Lexington, uh, there was never any craving for drugs. 

CAROL SUTTON LEWIS: John—last initial—B was at Lexington several times in the 50s and 60s.

JOHN B:  I knew that I was an addict. But, uh, craving in the sense that people speak of cravings, uh, uh, desire, a subconscious desire for drugs, there was never that. I had never thought of it.

CAROL SUTTON LEWIS: So that’s “Narco,” huh? 

KATIE HAFNER: I know! It’s called “Narco,” and then it’s like this country club.

CAROL SUTTON LEWIS: Yeah. You know, it’s so interesting that Marie saw it so differently. 

KATIE HAFNER: Oh yeah. We’re gonna find out why, after the break.

=====AD BREAK=====

KATIE HAFNER: So far, Lexington has sounded much better than we imagined. And I have to say, some of the things we learned really made me question whether we can trust Marie’s account of the place, so we were trying to square the two versions. Here’s Emily Dufton again:

EMILY DUFTON: Lexington is an extremely disturbing environment for someone who was raised like Marie Nyswander, you know?

KATIE HAFNER: Marie was raised among liberal academics, and she spent many  formative years in California and New York.  She even dabbled in Marxism as a teenager. A lot of the staff, like the guards, they were locals, and this was the segregated south. So, Lexington was a major culture shock for her. 

Now, the doctors—the other doctors—at Lexington weren’t typically locals, but it turns out, she didn’t fit in that well with them either.

EMILY DUFTON: All of the other doctors are married and they have families and they’re raising children here in bucolic bluegrass of Lexington. and she’s like this young single woman. She’s totally weird. She’s a radical.

MARJORIE SENECHAL: I don’t remember much about her directly. My main memories are my mother gossiping about her all the time.

KATIE HAFNER: Marjorie Senechal actually grew up at Lexington. We called her up on Zoom a couple of months ago. 

MARJORIE SENECHAL: I was on the farm because my father was a doctor at the hospital there. They had built hospitals for the doctors, so there were places for people to live, and I lived there from age one to fifteen. 

KATIE HAFNER: Marjorie’s dad was Abraham Wikler, a big name in addiction research in those days. She told us the doctors who lived on the farm each had their own house, staffed by patients. And Carol, Marjorie said these patients would do all kinds of things for them – they’d cook, they’d garden, they’d even babysit the kids. 

CAROL SUTTON LEWIS: That’s a little weird to me. It’s like you’re supposed to be there to get better, and you’re taking care of the people’s kids?

KATIE HAFNER: Mm-hmm, and in fact, that is something Marie took issue with. But okay, remember that Marjorie was just a child for all this. And so she has very fond memories of running around the grounds, interacting with staff and patients alike. 

KATIE HAFNER: So anyway, Marjorie met Marie when she was six or seven, and she only remembers her vaguely.

MARJORIE SENECHAL: Uh, she was pretty, and she was, she was very nice to us.

KATIE HAFNER: But she does remember what her mom said about Marie. So it turns out, Marie ruffled a lot of feathers, especially among the doctors’ wives.

MARJORIE SENECHAL: Well, she did things that were out- outrageous. She wore slacks that was just, you don’t do that. And she did. And she had gone to Sarah Lawrence, which showed that she was a brave intellectual with no concern for conventions and things like that. And she flew an airplane, which was pretty brave.

KATIE HAFNER: And this daring, attractive woman in her 20s was working alongside their husbands, while the women were at home, hanging out with each other.

MARJORIE SENECHAL: And so altogether, she was, she scared them, all the mothers as being too advanced. And they were jealous. I think that was really basically it.

KATIE HAFNER: And so learning all this I started wondering if Marie’s own loneliness and misery were maybe coloring her impressions. Or maybe it was that she was hearing more of the conversations happening behind the scenes? Or maybe it was just that the patients had seen far worse than Lexington, and Marie was new to all this. But what Marie described to David Courtwright in their interview years later were nurses and guards who held their patients in total contempt.

DAVID COURTWRIGHT: Do you think that the- this prison mentality was related to the racial and class characteristics of these people?

MARIE NYSWANDER: No, it was against drug addicts. I, I think I could say that because we didn’t have an overwhelming number, the, um, minority ethnic ratio was about the same as in, as in society.

DAVID COURTWRIGHT: Mm-hmm.

CAROL SUTTON LEWIS: So in the late 40s, most patients were white. Even though Lexington was in the segregated south, it was a federal facility and desegregated. But, there was racism. Marie said she heard nurses calling Black patients the n-word. And Marjorie saw white guards bullying a Black guard.

CAROL SUTTON LEWIS: But what would eventually get Lexington into real trouble was the research lab. As we’ve heard, very little was understood about how addiction worked, and how to treat it. 

NANCY CAMPBELL: One of the reasons that a laboratory is set up on the grounds of the narcotic farm in Lexington, Kentucky is because the U.S. Congress says What we really want you to do is find a cure. We we want you to use the power of science to find a cure for drug addiction

CAROL SUTTON LEWIS: But at Lexington, they did research on human beings, on the patients.

In one experiment, researchers put patients who’d already detoxed back on drugs. They “re-addicted them,” and then made them go through withdrawal again. They were testing things out like how addictive various drugs were and they were looking for drugs that would help ease withdrawal symptoms. Although the research that eventually got them shut down was CIA-funded experiments with LSD in the 50s and 60s. 

KATIE HAFNER: Ok, but let’s wind back for a bit. The ethics around this kind of research—and research on prisoners—were definitely different then. Nancy Campbell, the historian we heard earlier, she says the director of the lab had a real commitment to informed consent, so that the subjects were all strictly volunteers who knew exactly what they were getting into. 

CAROL SUTTON LEWIS: Right, but you really have to ask how voluntary participation can be when you’re a patient with a powerful addiction living in a prison-hospital.

KATIE HAFNER: Right, yeah, really thorny ethical questions. Although when Marie criticized Lexington, she doesn’t really talk about the research, her problem really seems to be the whole vibe of the place. 

MARIE NYSWANDER: It was pretty rough, pretty rough for a little girl out of our internship. 

DAVID COURTWRIGHT: Mm-hmm

MARIE NYSWANDER: Uh, and who had no idea that people like this existed.

DAVID COURTWRIGHT: Especially an idealistic one.

MARIE NYSWANDER: Well, yeah, but one who was kind of naive and had had very little experience in life.  

KATIE HAFNER: And that might have been the end of any interest she might have had in addiction research, but there was something that drew her in: the patients.

EMILY DUFTON: She becomes friends with a lot of the patients who treat her very kindly. They play their jazz music for her like they give her private concerts. They make her feel human connection when she doesn’t feel any other human connection in the environment.

CAROL SUTTON LEWIS: Though before we get too carried away, it wasn’t all sunshine and kittens. Marie told a reporter she got mugged a few times at Lexington, and one time, a female patient roughed her up after Marie refused to give her the key to a drug cabinet. 

But the jazz, the patients that seemed to be looking out for her when she was feeling alone – those memories would stay with her for decades.

EMILY DUFTON: And so naturally she, I think, becomes very interested in who these individuals are who are battling this pathology of addiction like they make a real impression on her. And that, I think, is probably the biggest jumpstart to her career in psychiatry.

CAROL SUTTON LEWIS: By the time she left Lexington, she was done with surgery. Marie Nyswander was going to be probing the mind instead. 

So, Lexington is where Marie gets her start learning about addiction. But here’s the thing, for the most part, what they did there, just didn’t work. Remember John B, the one who said his cravings went away at Lexington? Well, he kept coming back multiple times over the 50s and 60s. At first, whenever he got released, he didn’t feel any cravings. Four, five, six months would go by and he’d be fine.

JOHN B: And then, uh, all of a sudden I’ll meet somebody and they’ll say, uh, let’s go and get a fix. And I’ll go and get a fix. Like I told you, if I could afford it, I’d use drugs the rest of my life.

DAVID COURTWRIGHT: You really enjoyed the heroin?

JOHN B: Yeah, yeah.

KATIE HAFNER: Marie testified about Lexington at the narcotics hearing we heard earlier, and she was asked about this—how many people who went to Lexington recovered?

MARIE NYSWANDER: I, I would just say 15{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}. And that may be very generous, uh, very generous indeed. 

CAROL SUTTON LEWIS: Oh wow, her voice sounds so different.

KATIE HAFNER: Yeah, Marie was just 32 when that hearing happened. She still had all those years ahead of her to grow jaded and world weary…..

MARIE NYSWANDER: You see, one of the things is you don’t see the ones who, who have been cured. They don’t come back. But when one gets a kind of feeling for it, I would say 15{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}. Now, I don’t know how that stocks up with official figures.

KATIE HAFNER: Lexington’s own figures at the time were higher, estimating that closer to 25{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of the patients had been cured—though as Marie said, it’s really hard to know. 

So that’s where we were at this point in time with addiction. These were the success rates for the best, most respected rehab program in the country. 

SIDNEY TARTIKOFF: Is it your opinion that the- the best estimates of the effectiveness of cure are not particularly encouraging?

MARIE NYSWANDER: Unfortunately. Um, I don’t like to admit to it because you know we always, we always feel that- uh we always have to look on the side that one must and can somewhere there is a cure. And um, but up to now, uh, with the- what we know so far or what’s been done so far, it’s a difficult problem, very.

SIDNEY TARTIKOFF: So that we understand this a little more clearly, doctor, this isn’t some disease that responds to an antibiotic or a penicillin?

MARIE NYSWANDER: No, I wish it were.

SIDNEY TARTIKOFF: Uh, this isn’t a disease which you can treat with some specific remedy?

MARIE NYSWANDER: Not that we know of now.

KATIE HAFNER: But something important was about to happen. Because right around the time Marie was at Lexington, the research lab there started experimenting with a powerful, synthetic painkiller. It had recently arrived from Germany, It had been developed by a Nazi-allied pharmaceutical company. 

The Germans called it “amidone” but it would soon be better known as “methadone.”

KATIE HAFNER: The Lost Women of Science podcast is hosted by me, Katie Hafner,

CAROL SUTTON LEWIS: And me, Carol Sutton Lewis. This episode was produced by Elah Feder, our senior producer, and Nora Mathison, with help from Zoe Kurland and Dominique Janee.

KATIE HAFNER: We had fact checking help from Danya AbdelHameid. All of our music is by Lizzy Younan. D Peterschmidt mixed and designed the sound for this episode. 

A big thank you to David Courtwright who shared his large oral history collection with us. It’s called Addicts Who Survived, and includes the interview you heard with Marie Nyswander and many personal stories of drug addiction.

CAROL SUTTON LEWIS: We also want to thank Dr. Melody Glenn, who wrote in suggesting we cover the story of Marie Nyswander. If you know of scientists you think we should cover, contact us through our website, lost women of science dot org.

KATIE HAFNER: I want to thank my co-executive producer at Lost Women of Science, Amy Scharf. We are funded in part by the Alfred P. Sloan Foundation, and Schmidt Futures.

Our podcast is distributed by PRX and published in partnership with Scientific American.

CAROL SUTTON LEWIS:  For show notes and more about the whole team that makes this show happen, visit lostwomenofscience.org. 

KATIE HAFNER: Finally, to make sure you don’t miss the next episode, subscribe to Lost Women of Science on your favorite podcast platform

CAROL SUTTON LEWIS: See you next week!

Machine learning expert: Health information revolution is underway

Machine learning expert: Health information revolution is underway

In medicine, notes Tingting Zhao, Ph.D., there is no this kind of matter as way too significantly info. “When it arrives to creating the finest selections for their people, health professionals always want to know extra,” she says. An assistant professor of Details Systems and Analytics and a college fellow with Bryant’s Heart of Overall health and Behavioral Sciences, Zhao is an emerging chief in health care informatics, a field that offers new insights into trying to keep us healthier and far better knowledgeable.

Zhao, an accomplished researcher, reports a assortment of subjects at the intersection of data, technological innovation, and professional medical expertise. That fusion, she says, is an important and enjoyable frontier with limitless likely. “By combining all a few of them, we can make better selections in phrases of community policy, disorder manage, and ailment prevention,” says Zhao, who will be teaching in Bryant’s new Health care Informatics graduate system this drop.

As engineering evolves, it produces far more information and facts than at any time before. Some estimates advise that the healthcare sector generates as substantially as 30 {35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of the world’s info, a variety that could increase to 36 {35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} by 2025, in accordance to RBC Cash Markets. Healthcare informatics, which integrates healthcare sciences, laptop science, details science, and cognitive science, can help practitioners figure out new methods to use facts to enhance shipping and delivery of care, improve affected individual training, and tell community health and fitness plan. 

It is now a lot more important than at any time that specialists have the expertise and know-how to recognize, use, and innovate with info, states Zhao, pointing to the increase of precision drugs, an rising tactic for ailment remedy and avoidance that requires into account personal variability in genes, surroundings, and way of life. It is a aggressive and exciting location, she claims — a person fueled by a desire to make new methods to handle clients. “We can develop a lot more effective devices to not just document that data but to use it to make knowledgeable selections as properly.”

“The whole world is acknowledging we should put a lot more resources into developing new technologies to assistance us present superior healthcare and greater have an understanding of what would make us unwell.”

Particular overall health units this sort of as Apple Watches and Fitbits are other examples of the wellness info revolution, states Zhao. “We are connecting with and acquiring new items of element engineering and new tactics that we can use as analytical equipment to assess individual behaviors,” she states.

The COVID-19 pandemic, Zhao states, considerably elevated awareness of the worth of the industry and led to a large inflow of funding for information-similar health care tasks on the national stage, having it from roughly $23 billion to almost $96 billion. “The full world is acknowledging we should set a lot more methods into building new technologies to assist us deliver much better health care and better realize what makes us ill,” she states.

An specialist in device learning, a branch of artificial intelligence and computer science that focuses on the use of facts and algorithms to imitate the way humans master, Zhao made her enthusiasm for combining data science with health care as a doctoral university student, when she found out the thrill of being aware of that some thing she labored on could 1 day enable authentic everyday living sufferers. “It was exciting to know this was the future,” she says.

Zhao has considering that contributed to a selection of initiatives, like a Nationwide Institutes of Health and fitness-funded collaboration with Harvard Medical College and Northeastern Group to develop algorithms that can identify Serious Obstructive Pulmonary Condition (COPD) and make predictions with regards to its progress. Her most the latest analysis examine, which concerned developing and honing algorithms to detect which genes reply to distinct perturbation stressors, which can provide a superior comprehension of the underlying mechanisms of disorder and progress the identification of new drug targets, was published in the prestigious journal Briefings in Bioinformatics.

“This is an opportunity to do meaningful get the job done that positive aspects the total community.”

College students in the university’s Health care Informatics graduate plan, Zhao suggests, will acquire exposure to study executed by their professors, which include prospects to sign up for them in scholarly work. “When pupils come here, they can learn what really goes on in the industry,” suggests Zhao, who cites operating with junior partners on study projects as one of her most loved elements of being a professor.

The program aligns perfectly with Bryant’s other new graduate systems in Details Science and Company Analytics, notes Zhao, who is teaching courses in both of those. This offers alternatives for concepts to cross-pollinate and direct to new insights and innovations. The healthcare informatics industry, especially, is suitable for curious individuals who want to investigate — and to find ways to use their skills and their education and learning to enable others. 

“This is an option to do meaningful function that added benefits the complete community,” claims Zhao.

Fentanyl addiction, homelessness haunt this New Mexico town

Fentanyl addiction, homelessness haunt this New Mexico town

The caretaker at the hillside cemetery braced against the cold and walked among the graves. Crosses cast shadows on bunched flowers. A strand of tinsel gleamed from a bare tree. He looked over the rows and shut the gate, his face red, his hands small and coarse.

“I’ve got to come back and pick up the garbage,” the caretaker said. “People leave it.”

He glanced at a visitor, anticipating the question.

“We had a few kids who overdosed,” he said, nodding toward the graves. “But none for a little while.”

He got into his truck and headed west into Española where a familiar scene unfolded.

A man under a blanket lights a pipe.

A man smokes fentanyl in Española, N.M., on March 8.

(Francine Orr / Los Angeles Times)

Shoppers and workers drove past addicts roaming Riverside Drive, the main drag in this town of 10,500. Kids played in trailer parks. Contractors loaded pickups. Cars came and went from a methadone clinic. Men wearing hoodies and expectant gazes drifted toward a house with barred windows. They rustled pockets for cash. Others headed toward the marshes on the city’s fringes, where, as the morning frost lifted, Cristian Madrid-Estrada, a bearded man of 23, sat with a gun holstered on his hip at the Española Pathways Shelter.

“You can’t believe it sometimes,” said Madrid-Estrada, the homeless shelter’s chief executive officer. “I was here last night when my fiancee called and told me someone was trying to break into our house. He was at the windows.”

Madrid-Estrada spends much of his time at the shelter, giving addicts beds and warmth on frigid nights. But like others in this city, he contends with burglaries, robberies and thefts carried out by fentanyl addicts desperate to fuel their next high. The state police and the county sheriff have been called in to help Española’s understaffed Police Department, which reported 224 burglary calls last year, up from from 155 in 2020.

Rallying voices are trying to fix this community under siege. But it’s unclear if the story of Española, where a quarter of the population is poor and the murals of the dead are painted on junction boxes, will be a narrative about how to save a town from addiction — or lose it. In a one-year period ending in June 2022, Rio Arriba County reported 50 fatal overdoses, giving it the highest rate in New Mexico. It was about four times the national rate of approximately 33 per 100,000.

Española is a troubling American tale. Its despair and suffering echo through cities large and small, from the pitched tents and open drug use in Los Angeles to the hamlets and hollows reeling from the opioid epidemic across Appalachia. The crisis is born from a decades-long misguided war on drugs, greed in the pharmaceutical industry, an ill-equipped prison system, failed treatment programs and a nation seemingly inured to the startling toll of addiction.

A man stands amid debris at a homeless camp

Española Pathways Shelter Chief Executive Officer Cristian Madrid-Estrada, 23, walks through a homeless encampment near his facility.

(Francine Orr / Los Angeles Times)

Espanola is located between Santa Fe and Taos, New Mexico on March 9, 2023,

Española sits between Santa Fe and Taos, amid tribal lands straddling the Rio Grande.

(Francine Orr / Los Angeles Times)

Sitting amid tribal lands straddling the Rio Grande, Española appears stranded between better known Santa Fe and Taos. More than a century ago, long before cartels trafficking fentanyl with nicknames like China White and Dance Fever crisscrossed New Mexico on Interstate 40 and Interstate 25, ranchers and farmers here loaded their wares on trains bound north and south in what was known as the Chili Line. That route ended decades ago; other small businesses and industries disappeared as well.

Drug addiction seeped into the Española Valley after the Vietnam War as heroin, cocaine and other drugs flowed in from Mexico. Heroin settled in hard for years, tearing through families, ravaging livelihoods and scattering lean-tos and broken men beneath bridges. But over the last two years, the market has been taken over by fentanyl, which is cut with other substances and at times is so potent that it can take at least two doses of Narcan to revive an overdose victim.

“I’ve had knives pointed at me. Pipes swung at me,” said Madrid-Estrada. “It’s insane how much has changed in the last year. It’s scary. We have generational drug use. Generational trauma. Half the kids I went to school with didn’t have parents. They were dead or in jail or gone.” But fentanyl, he added, “is a completely different animal. A whole new epidemic no one was prepared for.”

The town — which has drawn addicts and the homeless from other states — has too few detox and drug treatment centers. Grandparents are raising grandchildren, and a “baby box” has been built at the fire station to take in unwanted infants. Shoplifters haunt the aisles at Lowe’s and Walmart. Syringes for heroin that once littered sidewalks and riverbanks have often been replaced by glints of tin foil used for smoking fentanyl.

A person sits on the median of the roadway next to a suitcase

A person sits on a roadway median in Española with a sign asking for help.

(Francine Orr / Los Angeles Times)

“We don’t even really see heroin overdoses in New Mexico anymore,” said Miranda Lopez, the state’s public health analyst for the national Overdose Response Strategy. “Fentanyl has changed things in ways that are unimaginable. It’s evolving with so many novel substances coming into play. You’re constantly having to reevaluate.”

Chris Dewitt, a resident at Española Pathways Village, a converted motel the shelter has turned into transitional housing for recovering addicts, spoke of the disarray that had gripped him for years and led from heroin to meth to fentanyl: “I tried fentanyl. It made me sick. It hit different. Much stronger. I tried it again. I wanted to embrace the darkness,” he said.

“I was the monster. It took me a while to see myself as worth saving.”

Much of the addiction stems from family problems, including domestic violence and abuse, said Nicko Zamora, who used drugs for more than 40 years and now works to help addicts recover. “A lot of us got sick on our secrets,” he said. “Drugs were the Band-Aid. It goes with our heritage in a weird, crazy way. We’ve seen it happen to Great-Grandpa, Grandpa, Dad and all the uncles. Drug use became normal.”

Madrid-Estrada and Pathways co-founders Ralph Martinez and former state Rep. Roger Montoya are working to change things. Martinez and Montoya helped get a $1.8-million grant for the property that houses the shelter, a Goodwill, a wellness center and a food pantry. John Ramon Vigil, at 27 the youngest mayor in New Mexico, is proposing the state open a regional drug treatment center. And Jeramay Martinez, who sued OxyContin manufacturer Purdue Pharma, is raising the 4-year-old son of a fentanyl addict and plans to start an agency to help addicted mothers and children exposed to drugs in the womb.

 A man sits in an overturned shopping cart in a dry marsh amid little

Dylan Lujan, 34, rests in a dry marsh next to Española Pathways Shelter.

(Francine Orr / Los Angeles Times)

Madrid-Estrada often wonders, though, about the town’s fate. He estimates there are between 250 and 350 homeless people in the Española Valley, some wandering past scrap yards and cannabis shops, not far from the ancient cave dwellings of Native American spirit lands, emerging from the cold darkness and into the shelter’s dim porch light.

On a February night, with the temperature slipping below freezing, a row of men and women huddled beneath blankets like an army dispersed. They waited to check in at the shelter, where they would receive a bowl of chili, a shower and a bunk bed. They could watch “Blazing Saddles” or “The Karate Kid” or play Battleship or put together 1,000-piece jigsaw puzzles. In a common room, Roberta Walker, a 47-year-old mother of seven, wept, yelled and calmed, as if a sudden storm had swept through her.

“I did crack for six years, meth for two and then to opioids and now fentanyl. I’m actively using because that’s what I want to do,” she said. “I don’t know who I am sometimes. I’ve never been Black enough, Latina enough or white enough. I’m mixed. But I’ve got to find me. Who am I? I’m always fighting that anger. I’m a Christian. I’m an addict.”

Ralph Martinez was once a man under a bridge, sleeping on the dirt, shooting heroin into a neck vein, listening to men with liquor bottles murmuring around barrel fires in the night.

Ralph Martinez once lived under a bridge.

Ralph Martinez once lived under a bridge and had a heroin habit. “The deeper I got, the deeper I went,” said Martinez, 45, who now works as a government affairs specialist at Los Alamos National Laboratory.

(Francine Orr / Los Angeles Times)

He sat the other day in a hamburger joint on Riverside Drive, sipping a soda and planning events to raise money. His tattoos were the same — stars, a heart and daughters’ names scrolling up arms — but he was far from the man he was when he stole an Xbox from kids and jacked circular saws from Lowe’s to sell for drug money.

“The deeper I got, the deeper I went,” said Martinez, 45, who was homeless from 2006 to 2012, had five felony convictions and went through six rehabs before he got clean. “I lived under a hoodie and went months without changing underwear. I held people in my arms who OD’d and died. But fentanyl has made things different. The homeless population today is thicker, and no one cares about being seen in town. Before, you’d hide in the shadows of the night, take the back pathways. People had pride.”

He now works as a government affairs specialist at Los Alamos National Laboratory. He sits on community boards and drives around Española, trying to fix the blight, like the abandoned shopping carts left outside a boarded-up low-income apartment building. He said the city, which has a $12-million budget and not enough money coming in from a state that is one of the poorest in the country, needs to reduce the homeless and addicted populations by working more closely with churches and institutions like Pathways.

“The message our leaders want to put out to their constituents is that they have it under control,” he said. “They certainly don’t have it under control.”

Two men talk outdoors

Ralph Martinez, left, talks with Dante on March 9. Martinez, a formerly unhoused man who sits on community boards, drives around Española as he seeks solutions to blight.

(Francine Orr / Los Angeles Times)

He told a story about why homelessness appears intractable: The city manager asked for Martinez’s help in cleaning up an encampment behind an ice cream shop. Another enclave had been bulldozed and the city wanted to try a different approach. Martinez had attended elementary school with the “leader of the pack” at the encampment. The two met and worked out a system for trash collection and syringe retrieval. But the plan collapsed when the property owner — who had not stepped up earlier — demanded the city remove the encampment.

“The homeless are not going to just disappear,” said Martinez. “Where are they going to go?”

He drove over the bridge where he once lived. Parts of him, his past, the things he’d rather forget but doesn’t dare, appear like whispers, reminders. A young couple with tattered backpacks walked along the road, picking up half-smoked cigarettes in what homeless addicts call Easter egg hunts. The couple pressed on through the afternoon traffic as the sun shone on the snow of the distant Sangre de Cristo Mountains and winds blew across pueblo lands.

“You can’t go back in time and clean the generations that have already suffered,” he said. “But you can go in today and break that curse and stop it from infecting other generations. We have to figure out why addiction is prevalent here. If you don’t want any weeds in the ground, you have to pull them out by the roots.”

Mayor Vigil walked through Española’s historic downtown, a stretch of small businesses, abandoned buildings and murals of the Virgin Mary, low-rider cars and men planting fields. Vigil’s ancestors arrived in this valley 12 generations ago, and in 1939 his grandfather bought 2 acres and turned an old dance hall into a funeral business.

A man stands beneath a blue sky near a beige building

Española Mayor John Ramon Vigil, 27, is the youngest mayor in New Mexico.

(Francine Orr / Los Angeles Times)

“This street’s seen better days,” said Vigil, the third member of his family to be mayor. “There was once so much life here. I’m hoping for a revival. We have a rich culture. We are the access point to the north. It’s always been a hub. Santa Fe is too Disney-fied. We’re a blue-collar real McCoy.”

Dressed in a blue blazer and jeans, a trimmed mustache on his young face, Vigil strolled toward Riverside Drive. He went to college and came back to Española when a lot of his contemporaries moved away. He pointed to paintings in Plaza de Española that depicted a legacy of Spanish explorers who arrived here in 1598 with nine Franciscan priests, which led to immigration, churches and a pueblo revolt.

The surge in fentanyl addiction and homelessness is testing his town, whose economy is largely reliant on those commuting about 17 miles away to jobs at the Los Alamos lab. Farming work shrunk over the years — loosening family bonds to the land and leaving a questioned sense of identity — and most other jobs are in retail and government.

Murders are not common in Española, but last year three of the city’s five homicides, including one on tribal land, were drug-related. Neighborhoods are turning ragged. Businesses complain about vagrancy and theft. An addict recently stabbed a store security guard. From 2021 to last year, shoplifting calls increased 21{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} from 693 to 837. In the same period, disorderly conduct calls jumped from 170 to 325.

The city’s new police chief, Mizel A. Garcia, was previously in charge of undercover units in Albuquerque, where he worked with the U.S. Drug Enforcement Administration. But his Española department has only 26 of the 40 officers he says he needs. Its pay of $25 an hour for new officers can’t compete with higher wages in larger cities.

Three men sit outdoors sharing a blanket

From left, Nicolas Martinez, 30, Christopher Martinez, 32, and Cassy Montoya, 31, wait to get inside Española Pathways Shelter for the night.

(Francine Orr / Los Angeles Times)

“Every city in the country is experiencing a fentanyl and homeless problem,” said Vigil. “But we’re a smaller town. We don’t have the resources that other communities do. Our budget’s extremely limited. We have a hard time just providing basic services.”

The problem is compounded by the overlapping jurisdictions — and competing interests — within the city. Española has parts of two tribes and two counties within its borders. “There’s a disconnect,” he said. “It’s hard getting everyone on the same page.” An example, he noted, is the difficulty of removing homeless people from tribal land in the city. Such a task would fall to tribal authorities, but they need assistance from the city to deal with nontribal people.

Vigil said another pressing concern is convincing the state to invest in a large drug treatment center for northern New Mexico. The city is expected to receive about $900,000 from statewide opioid settlements with a number of pharmacies, including CVS and Walmart. The mayor said the money will go to rehab programs and the Police Department. Local authorities, meanwhile, are putting together a team of firefighters, police officers, social and treatment workers and others to counsel and aid drug users to prevent overdoses.

“We’re trying to be proactive so we can lower our number of calls,” said Assistant Fire Chief John Wickersham. “We go to the same people for overdoses over and over. We’ve set up a QR code so they can find resources.”

A woman pours fluid into a fire inside a large barrel as a man sits next to her

Jimmy Walker sits as Rachel Salazar tends to an illegal barrel fire, which prompted a visit by the Fire Department.

(Francine Orr / Los Angeles Times)

But ingrained ways are stubborn to change. The mayor, like many people here, spoke of the close family ties that enable users and prevent them from entering rehab. He said he’ll hear people say: “Not my son. I’m going to get him through it. I’m going to pray the addiction goes away.” He added, “Honestly, we have to be realistic. They need treatment services to get off their drugs.”

Family, faith and weathered crosses marking roadside fatalities are potent on these lands. When asked why he ran for office, Vigil said, “Since I was 6 or 7 years old I wanted to be mayor. … I prayed to God and I said, ‘God if this is what you want for me, please open the door and show me the way.’”

Jeramay Martinez drives the streets searching for the mother of the 4-year-old boy she is raising. His name is Domonic. His mother was addicted to heroin and other opioids. His father died of a blood infection from intravenous drug use. Martinez knows where to look, but it’s hard to find a nomad who meanders roadsides and through abandoned buildings.

“I want Domonic’s mom to get it together,” said Martinez, who is the boy’s legal guardian. “I want her to be part of his life. But I can’t let her sleep in my house. You never know. She goes MIA. I see her on the road and pull over. The last time it was snowing. I gave her the jacket I had on.”

A woman sits in a backseat as another woman drives

Jeramay Martinez drives her cousin Britney Valdez, left, and her dog, Jacks. Valdez is a fentanyl addict who was in court earlier in the day.

(Francine Orr / Los Angeles Times)

A woman holds a child while standing on a dirt path

Jeramay Martinez, 33, holds Domonic, the 4-year-old boy she is raising. His mother was addicted to opioids and his father died of an infection from intravenous drug use.

(Francine Orr / Los Angeles Times)

She paused and glimpsed the sky.

“I hate to answer the phone anymore,” she said. “It might be the call that she’s passed.”

She turned from the window and sipped her coffee. Martinez is 33. She wears fanned earrings, ripped jeans and boots. She moves with swift grace, and her eyes hold the fierceness of a woman who doesn’t abide small talk. She opened a file of court papers. She was a plaintiff in a suit on behalf of children born to opioid-addicted mothers against Purdue Pharma before the company filed for bankruptcy protection.

“We’re losing our families and our friends,” she said. “No one is listening. We have to talk about drugs, social issues, domestic violence. People I went to high school with have done oxy, heroin and fentanyl. They look 60. No teeth. Bodies deteriorating.”

Many families here keep an invisible map of addiction — lines leading to death, sometimes with sudden tragedy, other times with sad familiarity.

Martinez’s mother’s boyfriend was a heavy drinker. He was arrested for DUI, she said, and was going through withdrawal in jail when he got hooked on heroin. Two weeks after he finished serving his sentence, he OD’d in her mother’s house. Another line traces to Domonic’s grandmother, who couldn’t take him in because she already was caring for three of his father’s orphaned children. Two more lines lead to Martinez’s stepmother, who was prescribed OxyContin after a car accident and is now on fentanyl, and to her cousin, an addict who recently bore her second baby.

Two men stand in a litter-strewn area outdoors

Nicko Zamora, left, a behavior health coach, and Española Pathways Shelter CEO Cristian Madrid-Estrada visit a homeless campsite.

(Francine Orr / Los Angeles Times)

Troubled histories twist and turn in her telling. Domonic was exposed to drugs in utero and was diagnosed with neonatal abstinence syndrome. A report from New Mexico’s Children, Youth and Families Department shortly after his birth reads: “Son born positive for heroin. … will be discharged today; mom admitted to using heroin throughout pregnancy & was high when [she] went to hospital.”

Domonic has had massage, physical and speech therapy. He’s in preschool and doing well, but sometimes he gets agitated and hyperactive at night. “He has meltdowns.” Martinez reached for her phone. She scrolled the cracked screen and pulled up the website for Brigid’s Path, an organization in Kettering, Ohio, that helps drug-addicted mothers and their newborn babies.

“I want to do this here. We need more support groups,” she said. “I’m getting a license to become a certified foster parent. I’m working with caseworkers. I want to start a nonprofit. We have to take away the stigma from these moms. We can’t make them feel less.”

Cristian Madrid-Estrada walked out of the Pathways Shelter and through the parking lot. A casino run by the Santa Clara Pueblo rose in the short distance to his left. To his right, colors bloomed in the marshes, the tents of homeless people. He guessed there were dozens living amid the muck and reeds. No one wanders too far back there. A tree exploded into fire one night.

Madrid-Estrada was homeless for a spell when he was a child. He was 3 when his father, an addict at the time, kicked him, his mother and 4-year-old brother out of the house. They spent six months at a shelter for battered women: “That time is burned into my mind,” he said. “My mom was so strong, doing everything for us. That inspired me to do this kind of work.”

The Pathways Shelter — an old chiropractor’s office — sleeps about 30 people and last year served about 17,000 meals. Most of those who come are drug users. The shelter’s staff, some of whom are recovering addicts, is accustomed to reviving overdose victims with Narcan. The shelter forbids drug use inside, which means many fentanyl addicts, who need frequent fixes, will stay outside the shelter even in the snow rather than go through a night without using.

“Their behavior is aggressive and erratic,” said Madrid-Estrada. “You just don’t know.”

Horses graze in an open field

Horses graze in an open field in Española.

(Francine Orr / Los Angeles Times)

A man props his bare foot up as another man sits on a bed and another watches

Paul Vigil, who is unhoused, has his blistered feet treated at Española Pathways Shelter by Nicko Zamora as Nate Gay, a shelter manager, looks on.

(Francine Orr / Los Angeles Times)

Pathways follows a holistic approach: It does its own case management on clients and has begun a pilot project to access Medicaid through collaboration with other agencies. “We started with nothing,” he said. “We’re now in sprint mode.” The shelter is also attempting to raise $1.7 million to renovate an old motel into transitional housing for 24 people — a project that is vital to Madrid-Estrada and senior case manager Rob Vigil as a sign a community can heal and thrive if attention is paid.

“It does take a village,” Madrid-Estrada said. “Everyone is just trying to figure out how to handle it all. We’re the only shelter and transitional housing around.” But Española is likely to need a more intensified effort by government agencies, police, social and health services.

At 7:40 p.m. on a winter night, the homeless gathered at the shelter. They were let in one by one, stripping off coats, emptying pockets, giving names and telling stories. “This is my first time here,” said Sebastian, who drifted up from Santa Fe. “I want to be clean and get a job. … Is that chili? Can I get a shower?”

He sat next to a shelf that held a bottle of Hershey’s syrup, a can of Barbasol shaving cream and “The Way of the Cross” by Fulton J. Sheen.

Roberta Walker stepped in. She wore pajama pants, two coats and a knit yachting hat with the tag affixed. She was brash and broken. She’d been on the streets more than two years, since her stepfather died. The first of her seven children was born when she was 16. Walker was raised in foster homes. A boyfriend stabbed her. Her drug habit over the decades — her mother was a heroin addict — veered from Tylenol to crack to meth to fentanyl.

A woman covers herself in blankets

Carol Draper, 58, sits on a porch under layers of blankets as she waits to enter Española Pathways Shelter.

(Francine Orr / Los Angeles Times)

She opened a packet of crackers.

“I was a mom,” she said.

Her eyes filled with tears.

“They said I fell through the cracks,” she said, “but no one helped me when I was falling.”

She wiped her nose.

“I want to be alive,” she said. “I’ve seen so many people die. So many in one year. Fentanyl is like modern crack. If you don’t get the measurements just right, you go down like the volume on the radio.”

More people waited outside, wrapped in blankets, sitting against the wall, smoking, shivering, watching others come and go. One went to try his luck at the casino. A couple huddled near a battered car. A few headed toward the glow of tents in the cold stillness of the marshes.