Former drug dealer helps people in Salem battle addiction

Former drug dealer helps people in Salem battle addiction
Former drug dealer helps people in Salem battle addiction

Josh Lair, 44, bent down and rolled up his pant legs to reveal a tattoo spanning throughout both of those shins that browse “HOPE Vendor.”

“I applied to be a dope vendor, and I introduced demise and destruction into almost everything that I did,” claimed Lair. Now he tries to bring hope to everything and anyone, alternatively than destruction, he claimed.

Lair, of Salem, has been residing a material-cost-free existence for 12 a long time.

He will work as the group and legislation enforcement outreach supervisor for Ideal Solution, which has two outpatient clinics in Salem that help help material use problem recovery as a result of medicine-assisted procedure. Best Solution also connects people with community providers these kinds of as housing, treatment and transportation.

From Orgasms to Overdoses: How Marie Nyswander Went from Treating ‘Sexual Frigidity’ to Heroin Addiction

From Orgasms to Overdoses: How Marie Nyswander Went from Treating ‘Sexual Frigidity’ to Heroin Addiction

In the early 1950s Marie Nyswander was ready to move on from addiction. She set up a private practice and specialized in treating women afflicted with what she would call one of the “gravest problems of our time”: sexual frigidity. She and her adoring husband were living the good life, hanging out with rich art collectors and members of New York City’s literary scene. But when Nyswander started getting phone calls for help, she got pulled in a very different direction.

[New to this season of Lost Women of Science? Listen to Episode One here first.]

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.

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CAROL SUTTON LEWIS: This is the second episode of our series about Marie Nyswander. If you haven’t heard the first episode, stop now and go back and listen to that one. This episode will make much more sense if you do.

And a reminder that this season of Lost Women of Science is for adults. It will occasionally include adult language, and we’ll be talking about drugs and sex. Please, also note that some archival audio includes outdated language about drug addiction. Okay, I think we’re ready! 

CAROL SUTTON LEWIS: In 1912, the German pharmaceutical company Bayer ran an ad for cough syrup in a Spanish newspaper. The ad features a little girl sitting on a chair with a big bow in her hair. She smiles as a woman spoon feeds her medicine. The caption reads, “la tos desaparece” – “the cough disappears.”

The ad goes on to explain how this syrup will help with everything from bronchitis to laryngitis, even tuberculosis. And then, at the bottom, in big, bold letters, we see the name of the medicine: “Heroína.”

KATIE HAFNER: Just in case you missed that, the miracle cough syrup for kids is heroin. 

Bayer—yes, the same company that makes Aspirin—ran multiple ads like this in Spain: one features a boy grabbing at a heroin bottle in his mother’s hands, there’s another that depicts two kids in a standoff, both reaching for a vial of heroin on the table.

American ads were just as sweet, touting heroin’s many benefits, saying it was a non-addictive alternative to morphine. Some ads even suggested heroin for more vulnerable patients who couldn’t handle morphine.

CAROL SUTTON LEWIS: By the time these ads ran in 1912, Bayer might have had some inkling that heroin wasn’t actually so kid-friendly or adult friendly for that matter. It had been selling heroin for over a decade by then, and it was becoming very apparent just how addictive it was. Just one year after these ads ran, the company stopped making heroin for good.

But it was too late. And when Marie Nyswander arrived in New York half a century later, this “cough medicine” was wreaking havoc in the city, and around the world. And though Marie thought she was done with addiction, addiction was far from done with her.

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

CAROL SUTTON LEWIS: And I’m Carol Sutton Lewis, and this season is the story of Marie Nyswander. 

CAROL SUTTON LEWIS: In 1950, Marie was living in New York City, ready to start fresh. After her miserable year at the Narcotic Farm in Lexington, Kentucky, she’d spent a couple of years finishing up her residency at Bellevue Psychiatric Hospital in Manhattan, where she saw even more of the terrors of withdrawal  up close—diarrhea, vomiting, fevers, weight loss, pleas from patients that were so heartbreaking, it made the doctors keeping them away from drugs look like monsters. Marie was ready to move on.

CAROL SUTTON LEWIS: Fortunately, during those early years back in New York she’d also done some post-grad training at the New York Medical College, learning all about the hottest psychiatric method of the day: Freudian psychoanalysis.

DAVID COURTWRIGHT: Well, why psychoanalysis then? 

MARIE NYSWANDER: Oh, well, you have to remember, that’s again historical.

CAROL SUTTON LEWIS: Back in 1981, Marie told the historian, David Courtwright, it was just that most psychiatrists were into Freud back then.

MARIE NYSWANDER: And the Freudian explanation for behavior seemed to be the most dynamic and correct and true, and we took it just right down the line. It was like a bible. [laughs]

KATIE HAFNER: Marie soon started seeing private clients. And her specialty? What she would later call one of the “gravest problems of our times”? Carol, it was sexual frigidity, of course.

CAROL SUTTON LEWIS: Sexual frigidity? Can we even say that?

KATIE HAFNER: Uh, we said it a lot back then, at least Marie did. And here’s how Marie defined it.  Sexual frigidity is “the inability to enjoy physical love to the limits of its potentiality.” In lay person’s terms, the sexually frigid woman can’t orgasm. Or if she can it’s not very good.

So Marie, she was so taken with this particular subject that she later wrote an entire book about it. Are you ready for the title of the book? The Power of Sexual Surrender.  It is exactly what it sounds like, a treatise on female submission.  

Carol, I have to read you some quotes from this book. I couldn’t believe it was the same Marie Nyswander I had been reading about. I mean, here’s just one quote: “The biological role of woman is motherhood. If a woman cannot dare to accept this aspect of her destiny, she will be deeply defeated in her life.”

And she thought frigidity came from problems in childhood like having an absent father, or worse, a feminist mother.

CAROL SUTTON LEWIS: What?

KATIE HAFNER: Yeah, in this book, I mean, I was pretty surprised. Marie really goes after feminists for disrupting gender norms – claiming feminists make their daughters wanna live like men.

 And the book, it staunchly decries women who put their careers first, imagine that. A woman’s most important role, according to Marie, is in the home as a wife and mother.

KATIE HAFNER: So yeah, a very interesting read. Some real contradictions with the life Marie actually lived.

DAVID COURTWRIGHT: Marie was always a career woman. 

KATIE HAFNER: David Courtwright again, professor emeritus of history at the University of North Florida.

DAVID COURTWRIGHT: Um, she never had any children, and she was devoted to her patients, to her research, to her writing. 

So she’s off in Freud land now in the mid fifties. Okay, uh, and this is also when she meets and marries Leonard Robinson.  

CAROL SUTTON LEWIS: Leonard wasn’t her first husband. It turns out Marie actually had quite a bit of experience with marriage and its pitfalls. Because by the time she met Leonard, Marie had already been married and divorced twice. The first marriage, when she was just 16-years-old was to a man named Gordon Woodrow Raleigh, a pre-med student  at the University of Utah. We don’t have a lot of details on that, but we do know that marriage lasted no more than a year. And then, while Marie was at medical school at Cornell, she married Charles Miles Berry, an anatomy instructor at the school.  We actually asked Cornell whether he’d been her instructor, but they didn’t know. That marriage was short-lived too.

CAROL SUTTON LEWIS: But then, along came husband number three. 

KATIE HAFNER: Yes, Leonard Wallace Robinson, another guy who went by all three of his names.

And Carol, just in case anybody thinks we’re being judgmental here, we are definitely not. I mean, we are people—well, I am person—who has been married a few times herself. 

Anyway, Leonard was a writer and lecturer at Columbia University. And when Marie breezed into his life, Leonard fell hard, hard enough that he wrote a novel all about her and their relationship. The title is The Man Who Loved Beauty. 

KATIE HAFNER: In the book, Leonard – codename “Jonathan” –  recounts meeting Marie – codename Elizabeth – at a Columbia faculty party. He describes her blonde hair, her deep, textured voice, and their electric connection on the dance floor.

KATIE HAFNER: And Carol, I wanted you to hear this passage about that meeting on the dance floor. I actually got my husband Bob to read it for us. He was a little bit reluctant at first.

KATIE HAFNER: Okay, take it away

BOB: I wanna guarantee that you’re gonna use it. If I, if I do it, I need a guarantee you’re gonna use it.

KATIE HAFNER: He’s kidding. 

BOB: My, my union insists on it.  

KATIE HAFNER: Okay

BOB AS LEONARD: The feeling of her body against mine was simply not describable. It was different in kind from all that went before. And many (laugh) had gone before. I had not naiveté left. But with Elizabeth in my arms that night on the dance floor, the great complex mysterious and marvelous body of woman seemed to make itself known to me for the first time, with all its primal attributes streaming from it, passion and purity, and the heavy mystery waiting to be explored.

BOB AS LEONARD: Geez, you should have warned me.

KATIE HAFNER: So as far as Leonard was concerned, they had a fantastic marriage.   

CAROL SUTTON LEWIS: In the 50s, Marie is living the good life. She’s got her private practice, she’s married to Leonard, who is absolutely enthralled with her, and she starts hanging out with a fashionable group of art collectors. She even starts collecting art herself.

 It sounded like a comfortable life, and it seemed to suit her.  But then, she started getting these calls.

EMILY DUFTON: She started getting phone calls from an increasing number of people saying, you know, my son has this problem. My daughter has this problem, my husband has this problem. She was being sought out. 

The problem was heroin addiction. During the war, there’d been a temporary interruption in supplies, but in the 50s, heroin was back in full force, and New York City was its capital.

LOW: When I, when I, when I, when I was on dope, it seemed like everybody was on dope. 

CAROL SUTTON LEWIS: During an oral history interview decades later, a man named Low recalled how bad things were back in the 50s. Low had grown up in Spanish Harlem, and he remembered being afraid of heroin. He’d seen how it ruined people. They’d go from being well dressed to wearing rags. But then one day, in 1949, a guy at a bar offered Low a free sample. And for whatever reason, that day, he decided to take it.

LOW: And I started to vomit. I vomit so much I couldn’t…

Q: Was this the first time you…

LOW: The first time.  And then, when after the vomiting, you have, you, you, you feel a sensation. A sensation that no other high like marijuana or liquid could give you, you just sit down and you be, you’ll be asleep, but you’ll be hearing everything that’s going on.

CAROL SUTTON LEWIS: And that was it. Low kept using heroin until he ran out of money. So he got a second job, and used some more. He was addicted to heroin. And in the 50s and 60s, he had a lot of company. 

LOW: It was like an epidemic, like everybody was using it. You know, it seems to me that everybody in every street corner, 10, 25 guys. You know, pedaling, heroin. I said, gee, whiz, I mean, I thought, I thought, that the world would come to an end.

CAROL SUTTON LEWIS: Now, something else that’s happening at this point is the demographics of heroin use is shifting rapidly. That’s actually one of the things we’ve learned—that what an opiate user looks like is always changing. During the 19th century, opiates were actually a middle or upper class white woman’s drug. When Marie was at Lexington in the 40s, opiate users were mostly white men. And in the 50s, the people hardest hit were young, poor, Black and Puerto Rican men. 

COMMISSIONER STEVE CANADAY: Narcotics traffic is a dirty business. Its victims are the walking dead. (fade under)

CAROL SUTTON LEWIS: In this WNYC program from 1959, New York City’s police commissioner, Steve Canaday, sounded the alarm. All these drugs were coming into New York City from abroad; thousands were addicted. He urged anyone who had tips about illegal sales to call the narcotics hotline.

COMMISSIONER STEVE CANADAY:  Call the Narcotics Squad at DIGBY 4 9 4 3 0. That is DIGBY 4 9 4 3 0

CAROL SUTTON LEWIS: Phone lines were open 24/7.

COMMISSIONER STEVE CANADAY: Action will be immediate, and your identity will be kept in strictest confidence. Give us the leads. We’ll do the rest. Remember, someone you love may be the next victim.

CAROL SUTTON LEWIS: The way Canaday described it, drug addiction was spreading in New York City like a zombie apocalypse.

SAM K. ROBERTS: In the period between 1955 and 1965, the change is certainly dramatic. All the data I’ve seen indicates that it, it was not good. I will say that. It wasn’t Night of the Living Dead, but it wasn’t um, it was not a rare occurrence either.

CAROL SUTTON LEWIS: Samuel Kelton Roberts is an associate professor of history, sociomedical sciences, and African-American and African diaspora studies at Columbia University. And he explains that a lot of that heroin ended up in Harlem thanks to Italian organized crime.

SAM K. ROBERTS: Are you all Godfather fans? You know the film?

CAROL SUTTON LEWIS: Oh yes. Just thinking. Yes. If you know The Godfather, then you know that they could sit around the table with five families.

DON ZALUCHI: I want to control it as a business. To keep it respectable. I don’t want it near schools. I don’t want it sold to children. (table slam) That’s an infamia. In my city we would keep the traffic in the dark people, the colored. They’re animals anyway so let them lose their souls.

SAM K. ROBERTS: ​​That scene is based on reality

CAROL SUTTON LEWIS: After World War II, the sale of heroin in New York was dominated by Italian crime syndicates, with some help from Jewish organized crime. Italian gangsters were able to smuggle in a lot of heroin from their connections in Europe, especially Corsica. So that was the supply side. 

And according to Ralph Salerno, a New York City police detective in those days, when it came to distributing the heroin, it wasn’t so much about consciously targeting Black communities, as it was about protecting their own neighborhood. 

RALPH SALERNO: In the, in the lower part of Manhattan, the Italian gangster’s image was we keep the drug pushers out of the neighborhood. And they did. And they did. As long as they’re not selling it or allowing it to be sold in their community, whoever they might be selling it to, isn’t that we’re gonna sell it to blacks and therefore it’s, we will not allow it to be sold here.

CAROL SUTTON LEWIS: But the upshot was that soon, the streets of Harlem were flooded with heroin. In some parts, it was easier to get than cigarettes.

SAM K. ROBERTS: Circa 1965, in Harlem, if you had been living there for anything more than about three, four years, you probably knew somebody who had like negative impact of heroin. Not just using and here and there, but like you probably knew had been acquainted with somebody who had had problems. 

KATIE HAFNER: So in the 1950s, Marie Nyswander started getting these calls asking for help, as we mentioned before. And she’s kind of an odd choice. Remember, Marie was a Freudian psychoanalyst, spending a good deal of her time teaching women how to enjoy sex. So why were people coming to her about addiction?

CAROL SUTTON LEWIS: Yeah really?

KATIE HAFNER: Well, back when Marie was a resident at Bellevue, she wrote this paper. It was a how-to for drug withdrawal, based on what she saw at Lexington. And in this paper, she explained, for example, how much morphine to give people to ease their symptoms, and then how to slowly wean them off of it, and how to make sure they didn’t smuggle any drugs into the hospital. You know, like practical tips.

And that’s why people turned to Marie. There weren’t a lot of doctors treating  addiction in the 50s. In fact, medical schools weren’t even teaching about it.

SAMUEL K. ROBERTS: If you were a first year medical student, you know, at Columbia or Hopkins or Penn or wherever else, certainly during this period, if you raised your hand and said, professor, you know, how do you treat drug addicts? The answer likely would’ve been something to the effect of, you don’t.

KATIE HAFNER: Historian Sam Roberts again.

SAMUEL K. ROBERTS: What was more likely is that you would have social workers who would try to help, um, churches would be involved. You know, sometimes they, you know, depending on the church, you know, they’d help you pray away the demon of addiction. That usually doesn’t work.

KATIE HAFNER: So Marie stood out just by publishing this short paper.

MARIE: Far from being rid of the problem, more calls. How can you walk away when there’s a woman in the hospital on barbiturates? So the intern has cut off from all barbiturates and she’s starting to convulse. You cannot not treat that woman. And on it goes, you see, you’re kind of by default forced into these thing.

KATIE HAFNER: Okay, so Marie wants to help. But, how helpful could she really be? She didn’t have a lot of tools at her disposal, like almost none, and almost nothing was understood about addiction. 

And now, in the 50s, Marie was up to her ears in Freud, who actually didn’t have that much to say about addiction. Though, he thought maybe it had something to do with a substitute for masturbation in childhood?

CAROL SUTTON LEWIS: Oh, that Sigmund

KATIE HAFNER: Yes, very on brand for Freud. 

In any case,  miles away, in the great nation of Canada, a pair of neuroscientists made an accidental and important discovery. 

CAROL SUTTON LEWIS: In 1953, in Montreal, two researchers embarked on an experiment that wasn’t supposed to have anything to do with pleasure or addiction. But thanks to a rookie’s mistake, it would change our understanding of both for decades to come.

KENT BERRIDGE: Our understanding of the brain reward system really began with the experiments of Jim Olds and Peter Milner in Montreal at McGill University in the 1950s. 

CAROL SUTTON LEWIS:  Kent Berridge is a professor at the University of Michigan. His full title is actually the James Olds distinguished professor of psychology and neuroscience. Seventy years later, Jim Olds is still a very big deal.

KENT BERRIDGE: It was thought at the time that a lot of people’s motivation was driven by unpleasant states, like hunger, thirst, drug withdrawal, things you’d rather not be in.

CAROL SUTTON LEWIS: Jim Olds was a postdoc, and he was specifically interested in the arousal system of the brain. Not in the sense of sexual arousal, but arousal meaning kind of overstimulated or agitated.

Jim wanted to show that this kind of arousal is generally not a pleasant thing. So if you stimulate a rat’s arousal system, it will do its best to avoid that experience. That was his plan anyway.

KENT BERRIDGE: It turned out he wasn’t a very good surgeon to start off, and his electrode went to a wrong place.  And he turned it on, he expected the rat to want to avoid that stimulation, so he put the rat on a table top and he said to the rat, basically, if you go to one corner of the table, I’m gonna turn this electrode stimulation on. But if you don’t want it, all you have to do is avoid that corner of the table. So he let the rat wander around, explore the table, sometimes going to the corner and getting the stimulation. And to his surprise, the rat didn’t avoid that corner, and it went back to the corner and it ended up staying entirely in that corner so it could get the brain stimulation. And this was a total surprise.

CAROL SUTTON LEWIS: And sure enough, when Peter Milner took an x-ray of the rat, they saw Jim’s electrode had missed the mark by quite a bit. Instead of the brainstem, where Jim was aiming, his electrode ended up roughly in the septal area of the brain, likely in something called the nucleus accumbens.

And Jim and Peter found that rats would do just about anything to stimulate that part of the brain—not just sit on a corner of a table. They’d also press levers, run through mazes, and even endure strong electric shocks, just to get that hit. 

And at the time, the takeaway of these experiments was this: if these rats want this kind of stimulation, they must like it. We must have found the brain’s pleasure center.

And maybe that could explain something about addiction. The behavior of these rats at least looked a lot like addiction. So maybe addiction was also about seeking pleasure on a very basic neurological level.

It turned out a lot of this was probably wrong – and we’ll get to that. But this idea, that addiction could be something other than a moral failing or the product of a psychopathic mind, that it could actually come from a fundamental neurological issue – that was the promise of these kinds of discoveries. 

KATIE HAFNER: Back in New York, Marie decides she’s going to step up to the plate. So she rolls up her sleeves and gets to work in the neighborhood where she’s needed most, East Harlem. She teams up with the East Harlem Protestant Parish and sets up shop inside a storefront on the first floor of a bleak tenement building on East 103rd Street. 

And what she offered was unique. Unlike other addiction programs in the country, you didn’t need to be an inpatient to get treatment, and you didn’t have to quit drugs before she’d see you. That made no sense to her, if the whole point was to treat your drug addiction. Instead, Marie offered therapy to anyone who needed it.  Anyone could walk in, have some coffee, sit and talk with Marie. No appointment or payment needed. 

CAROL SUTTON LEWIS: It all sounds very noble. And Marie, in her interviews, often reminds us of just how noble it all is. So Katie, not to be horribly cynical, but I got a whiff of a savior complex from some of Marie’s interviews.

KATIE HAFNER: I didn’t get that sense. Well, which interview?

CAROL SUTTON LEWIS: Well, listen. Listen to her. 

MARIE NYSWANDER: I think if there had just been one other person in the city that would see addicts, I, I would probably have washed my hands. But there wasn’t anybody, and I just said, you can’t abandon them. At least the way I was raised, you simply can’t abandon someone when there’s nobody to give them a glass of water, you know.

CAROL SUTTON LEWIS: Ok, so when I hear that I hear her saying no one else got it. No one else cared. She was the only one who gave a damn.

SAM ROBERTS: That’s certainly not true. I mean, there were people who gave a damn when she came to  New York, um, I think in her social circle, she was the one who gave a damn. 

She’s a- a white professional woman. She’s from a middle class family. So I think in her social circles, shit, so probably was the only one who gave a damn.

CAROL SUTTON LEWIS: Heroin just wasn’t hitting the white people downtown the way it was hitting Harlem at this point. And yeah, it seemed like a lot of white people didn’t care, but Marie did. 

KATIE HAFNER: And in Harlem, people really appreciated her. 

EMILY DUFTON: Oh, man, they just love her. They just, like, eat her up with a spoon. Everyone’s just like this, she’s the greatest. 

KATIE HAFNER: What was it about her that made them fall in love with her? 

EMILY DUFTON: I think it’s because she really wasn’t pretentious, you know, like she, she was trying to understand the issues that, you know, it’s mostly men, like, mostly like young Black and Puerto Rican men are coming to see her at this storefront. And she’s really trying to understand what it is that’s driving them to these, you know,these harmful habits. And I think she leveled with them, you know. She really came to it with a lot of curiosity and compassion as opposed to like judgment and trying to demean them into better behavior. I think everybody fell in love with her because if she turned her sun beam on you, you’d feel good. 

KATIE HAFNER: One of the reasons we know this is thanks to the very long New Yorker article that came out in 1965, written by Nat Hentoff, who was a leading journalist at the time. In fact, one of the most famous jazz critics of the 20th century. And Hentoff got The New Yorker to devote a whole forty-five pages of print to Marie, and later Hentoff expanded those pages into a full biography. It was clear, he deeply admired Marie.  

And so did her patients. One man tells Hentoff that Marie was different from the other doctors. She “didn’t put us all in one box, she sorted us out, because she got inside. I could walk in next door and just blow my top if I want to; and believe me, she could blow her top too. I dig her because she swings. She’s really alive.” 

The bottom line was that Marie talked to her patients like people, and they loved her for it. And the results?

EMILY DUFTON: The results are terrible. 90{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} relapse rates.

CAROL SUTTON LEWIS: To Marie’s disappointment, her patients were relapsing at about the same rate as patients  at Lexington or Bellevue.

EMILY DUFTON: You’re gonna get about as good a relapse rate as, you know, hospital detoxification with no follow up care apparently, as you will with, you know, psychoanalysis about your mom

KATIE HAFNER: And doing this work, not seeing results she wanted, it was really getting to Marie, as she told David in 1981.

DAVID COURTWRIGHT: You had played about every card in your hand. 

MARIE NYSWANDER: Every card. Very frustrated. Very depressed, very. Nothing I could do. 

DAVID COURTWRIGHT: All, all the more impressed. Because you were really fond of these people. I mean, that’s, that’s-

MARIE NYSWANDER: I, I respected them, yes, I respected the, the courage to keep going. I would often say, my God, if I were in their shoes, it seems to me I would call Dr. Nyswander and ask her for money and procedure for drugs and in general, make your life miserable. And they never do. They, no matter how miserable they were, they. It made life difficult for me. I was around trying to help ’em. I couldn’t help them. They understood that. 

CAROL SUTTON LEWIS: But what if Marie was just using the wrong tools? What if addiction wasn’t a psychological problem at all? Remember those  rats being studied by the two researchers up in Canada? The way those rats acted looked a lot like addiction, but they didn’t have mother or father issues or prolonged adolescence, at least not that we knew of.

The problem was in their brain. What if the same thing was happening in people with addiction? If the problem was neurological or physiological, then talk therapy probably wasn’t going to fix it. 

And it seems like Marie would have known it wouldn’t all along. At that 1951 hearing in New York that we heard in the first episode, she’d been asked a final question:

SIDNEY TARTIKOFF: I know that you are a very fine practicing psychiatrist. Do you think that psychiatry in and of itself is the answer to the treatment and cure of addicts?

MARIE NYSWANDER: No, no. Far more complicated. 

SIDNEY TARTIKOFF: Far more than that? 

MARIE NYSWANDER: Far more, actually. 

ANOTHER VOICE: It’s just a partial element in the answer?

MARIE NYSWANDER: Oh, yes, yes. A very small part too, probably. 

SIDNEY TARTIKOFF: Thank you. Thank you so much, doctor.  The meeting stands adjourned. I mean, the hearing until tomorrow at one, thank you.

CAROL SUTTON LEWIS: Marie’s brand of psychiatry wasn’t enough, not on its own. But what was the alternative? If Marie knew about the rats in Canada or the studies that followed, it didn’t seem to shift her practice. And what could she do about a neurological problem anyway? She could only use the tools she had at the time. 

KATIE HAFNER: But it turns out another approach was just around the corner. Marie was about to get a call from one Vincent Dole, a researcher at Rockefeller:

VINCENT DOLE: I read as much as I could and I made a point of meeting everybody in the field that pretended any sort of expertise or had been recognized experts. And, uh, actually the only person that made sense to me just as a clinician was, uh, Marie Nyswander.

KATIE HAFNER: Together, Vincent Dole and Marie Nyswander made a discovery that would radically change how we treat addiction in this country. And much to her husband Leonard’s dismay, the Dole-Nyswander alliance would become a powerful one.

CAROL SUTTON LEWIS:  The Lost Women of Science podcast is hosted by me, Carol Sutton Lewis.

KATIE HAFNER: And me, Katie Hafner. This episode was produced by Zoe Kurland and Elah Feder, our senior producer, with help from Nora Mathison, Alexa Lim, Hilda Gitchell, and Dominique Janee.

CAROL SUTTON LEWIS: We had fact checking help from Danya AbdelHameid [UB-dell hah-MEED]. All of our music is by Lizzy Younan. D Peterschmidt mixed and designed the sound for this episode. 

KATIE HAFNER HAFNER: Amy Scharf is my co-executive producer at Lost Women of Science. 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 HAFNER: Finally, if you like what you’ve heard (or even if you hate it) tell your friends! I know people say that all the time, but seriously, it really helps the show. Text five people right now. Start a chain letter, with those ominous threats at the end that tell people if they don’t write five more people, their lives will be in shambles. Oh wait, no, don’t do that. But the texting is good. We’d really appreciate it.

CAROL SUTTON LEWIS: See you next week!

Opioid addiction treatment in EDs not a guarantee

Opioid addiction treatment in EDs not a guarantee
Illustration of a person holding their hand in their hands with buprenorphine's chemical structure, EKGs and abstracted pills.

Illustration: Shoshana Gordon/Axios

The overdose crisis is prompting extra hospitals to initiate opioid habit cure in crisis rooms — a improve welcomed by numerous behavioral health gurus.

Of course, but: It is resurfacing rigidity amongst companies over who’s seriously accountable for addressing the fundamental problem of opioid misuse.

Why it matters: Discharged individuals are customarily referred to substance use applications in communities. Habit industry experts say administering a drug to take care of dependence like buprenorphine in a healthcare facility can substantially cut down the odds of a patient relapsing and supply a critical intervention.

  • But it is however additional common for the burden to be positioned on people to “go and figure it out by themselves,” claimed Alister Martin, an crisis doctor and founder of Get Waivered, a campaign pushing for a lot more unexpected emergency departments to supply buprenorphine.
  • Considerably less than 10{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of practically 150,000 drug-linked unexpected emergency visits resulted in a buprenorphine prescription among August 2019 and April 2021, per a College of Michigan research.
  • In 2021 — practically 20 yrs after the Fda authorised buprenorphine — only 1 in 9 vendors were certified to prescribe it.

What is actually happening: The year-finish congressional spending deal eliminated a necessity that clinicians go through unique instruction and register to prescribe buprenorphine — a aspect physicians typically cited as a barrier to offering cure.

  • But some ER medical doctors “just never think about it portion of their position” and look at habit as a “moral failing” alternatively of a professional medical illness, claimed Eric Weintraub, a psychiatrist who prospects the University of Maryland’s Division of Dependancy Procedure and Research.
  • Some also will not want unexpected emergency departments — superior-volume enterprises with substantial preset charges — to be de facto compound use clinics treating a large number of uninsured or Medicaid sufferers.

State of engage in: The scope of the opioid disaster has prompted a lot more states to make addiction procedure in ERs an solution.

  • Massachusetts became the initial point out in 2018 to legislate that hospitals with EDs give opioid use condition remedy.
  • A Pennsylvania program has since employed condition funding to include dependancy treatment into emergency care for opioid use problem.
  • Emergency medical professionals launched CA Bridge, a nonprofit launched in 2018 to develop buprenorphine treatment in California’s EDs.
  • Indiana’s legislature introduced a bill this calendar year that would need crisis departments to assess their ability to initiate medication-assisted treatment method and connect sufferers to applications.

Zoom in: Starting up treatment in an ER tests a community’s continuum of treatment.

  • The problem for suppliers is, “What if I initiate this medicine but the affected individual doesn’t have any place to go and we don’t have means in our local community?” reported Marla Oros, president of the Mosaic Group, which has assisted additional than 70 hospitals integrate buprenorphine remedy education and protocols.

  • Scott Weiner, an ER doctor at Brigham and Women’s Medical center, explained to Axios that hospitals can coordinate with regional treatment centers or establish relationships with procedure suppliers to make referrals if they won’t be able to create their individual bridge clinic in-house like his facility.
  • People connections are not usually a given and referrals are only as good as the companies giving treatment method in the local community, Weiner mentioned.

Approximately 60{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of emergency health professionals stated addiction cure amenities exterior of the ER ended up “uncommon or never ever available,” in a 2017 survey from the American College of Unexpected emergency Doctors.

  • Edward Ratush, a New York psychiatrist specializing in habit drugs, informed Axios that he’s had pregnant sufferers with opioid use problem battle to find companies prepared to carry on their treatment method.
  • Drug distributors also often established quotas on buprenorphine due to the fact it is an opioid, which can limit the amounts that pharmacies stock even if ER doctors want to prescribe it, explained Jeffrey Davis, director of regulatory affairs at the American College or university of Crisis Physicians.

The bottom line: These aren’t good more than enough excuses to not do better, ER health practitioner Weiner reported.

  • “The crisis department is the basic safety net, and we have to action up simply because we are just dropping way too a lot of people today.”

Mothers Face Broken Addiction Treatment System

Mothers Face Broken Addiction Treatment System

This story was produced via a USC Annenberg Center for Health Journalism Data Fellowship.

Kayla Quinones began having contractions a few hours after midnight. Her baby, Jacarri, was on the way.

Quinones, 33, was homeless at the time and staying with a friend in upstate New York, and when she began to feel the undulating pains, spaced about 8 minutes apart, she called for help. Those pains, her friend told her, were contractions. They needed to get to a hospital.

Before staying with her friend, Quinones spent 6 years living on the streets of Sullivan County, about 2 hours north of New York City. She had been using heroin for 7 years, and cocaine for the last 4. She was homeless for the majority of her pregnancy. And using for all of it.

Doctors rushed Quinones to the delivery room, and the birth went smoothly. Jacarri was born healthy, but had developed neonatal abstinence syndrome. At the time of his birth, Jacarri had methadone and cocaine in his system, so doctors transferred him to the neonatal intensive care unit at a nearby hospital. The hospital where Quinones delivered him did not have one.

After Jacarri’s birth, Quinones was more motivated to get help for addiction than ever before. Jacarri’s father, Quinones’ longtime partner, died when Quinones was 4 months pregnant, and she was now learning that she’d lost custody of her baby. Jacarri would be going to stay with Quinones’ mother in Queens and would stay there until Quinones could get into a treatment program. She was again living on the street, searching for a program that would take her in.

It wasn’t the first time she had looked for help. She had been enrolled in a methadone program during her pregnancy, but continued to use heroin.

Now looking for a more comprehensive treatment program, Quinones ran into a new problem. Because she hadn’t received a postpartum check-up — which typically occurs between 4 and 6 weeks after delivery — many treatment centers wouldn’t take her, she said.

“They were denying me left and right,” Quinones told MedPage Today. “I was still running the streets, and miserable because they took my kid away. And I was worried that I wasn’t going to get into a program.”

In an underfunded, siloed mental healthcare system, pregnant and postpartum people with addiction face endless barriers to treatment. While patients typically come into contact with the medical system more frequently during pregnancy, those with addiction struggle to get adequate care, as insufficient numbers of behavioral health providers, logistical hurdles, and distrust of the medical system deter people from accessing treatment, according to providers, patients, and advocates.

“There is a presence of substance use that often gets overlooked and undertreated in pregnancy,” said Leah Habersham, MD, an addiction medicine specialist and ob/gyn at Mount Sinai Health System in New York.

Medication-assisted treatment (MAT), such as buprenorphine (Suboxone) and methadone, are the gold-standard treatment for pregnant patients with substance use disorder. These therapies manage cravings and prevent patients from going into withdrawal, which can result in preterm delivery or fetal growth issues.

But not all patients can access MAT, data show. Nationally, only half of pregnant patients with opioid-related substance use who received care at an addiction treatment center received methadone treatment in 2020, according to an analysis performed by MedPage Today.

Those who seek treatment in New York, where Quinones lives, receive it at a rate higher than the national average. In 2020, there were 635 episodes of treatment involving opioid use in pregnancy at New York addiction treatment centers. Of those treatment episodes, 75{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} received MAT at discharge.

The data, which come from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) treatment episodes database, is a compilation of addiction treatment center data reported by state agencies. Many of the treatment centers that report to SAMHSA receive state funds or federal block grants to provide drug or alcohol treatment services, the agency says.

Of the 6,200 times pregnant patients received opioid-related treatment nationwide in 2020, all received care at addiction treatment centers, such as methadone clinics or specialty behavioral health centers. However, providers say this is an underestimate of patients that receive care.

Many patients access treatment for substance use disorder outside of specialty care facilities, including from a family medicine provider, addiction specialist, or ob/gyn practitioner who prescribes buprenorphine — treatment that is not recorded in public databases.

Not knowing how many patients do or do not get treatment poses a host of issues, according to patients, providers, and advocates. Without an accurate count, it’s difficult to properly allocate resources to treat substance use disorder among the population of pregnant patients, they say.

“We don’t know how many people receive comprehensive services,” said Mishka Terplan, MD, MPH, a board-certified ob/gyn and addiction medicine specialist based in Maryland. “And that’s really kind of unknowable.”

image

Kayla Quinones, who lives with her son Jacarri at Greenhope Services for Women in East Harlem, New York, looked for treatment centers for a month before enrolling in the residential treatment program at Greenhope. Before having her baby, judgment and stigma from medical providers prevented her from seeking care, she says. Photo by Liam Quigley.

A Growing Problem

More than 1 million people have died of an overdose since the opioid epidemic began in the late 1990s. The crisis intensified during the COVID-19 pandemic, as isolation and interruptions to medical care led to skyrocketing overdose deaths.

Nationwide, there were an estimated 108,000 overdose deaths in 2021 — an all-time high, CDC data show. The majority of those deaths involved fentanyl, a synthetic opioid that’s 50 times more potent than heroin.

Opioid use disorder trends among pregnant patients are directly connected to patterns in the general population, Terplan said.

In total, 6,000 women had a maternal opioid-related diagnosis at delivery in 2017, the most recent year for which data are available, according to a study in JAMA. Self-reported data from the CDC suggest that 6.6{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of women used prescription opioids during pregnancy. One in five women who used prescription opioids reported misuse, the study showed.

“We all know that opioid use disorder is a rising problem, and it’s hitting the pregnant population as well,” said Wendy Wilcox, MD, chief women’s health services officer at NYC Health + Hospitals, New York City’s public hospital system.

The vast number of opioid-related deaths has left policymakers scrambling to solve a worsening addiction problem. Last October, the Biden administration released a plan to improve access to substance use disorder treatment for pregnant and postpartum people specifically.

The plan aimed to correct issues that were preventing patients from accessing MAT and looked to improve public reporting of access data.

Currently, there are no public databases that clearly show how many patients — pregnant or not — get medical treatment for substance use disorder. (Click here for more on the challenges of reporting data around substance use in pregnancy.)

Late last year, the federal government also deregulated buprenorphine to improve treatment access. Providers previously needed an X waiver — a special Drug Enforcement Administration (DEA) certification — to prescribe buprenorphine, which required an 8-hour training and restricted the number of patients a clinician could treat.

After years of rolling back restrictions, the federal government eliminated the X waiver entirely in December. The nixing of the rule allows any provider with a DEA license to administer buprenorphine, pending a one-time training.

Most ob/gyns are licensed by the DEA to prescribe controlled substances. But addiction medicine experts worry that though federal regulations on treatments for substance use disorder have begun to ease, there will remain a gap between the number of primary care providers and ob/gyns willing to prescribe buprenorphine and the number of patients who need it.

Should Ob/Gyns Provide More Addiction Care?

Medical organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Addiction Medicine (ASAM), have firmly said that they believe MAT is the gold-standard treatment for pregnant patients addicted to opioids.

Though there are three drug treatments available to all patients with opioid use disorder, methadone and buprenorphine are the most commonly prescribed treatments for pregnant patients. The opioid antagonist naltrexone (Vivitrol) is also safe to use in pregnancy, but is recommended less often because it requires patients to stop using opioids for about 2 weeks prior to initiating treatment.

Despite the recognition that MAT is widely believed to be the optimal treatment for opioid-addicted patients, providers who are not trained in addiction medicine still don’t feel comfortable administering it, said Daniel Rosa, MD, medical director of the Acacia Network, a human services organization in the Bronx that provides addiction treatment services.

“The problem has always been the buy-in from ob/gyns and primary care providers,” Rosa said. “It still falls on the very few people who happen to be board-certified in addiction medicine.”

Methadone can only be dispensed through a SAMHSA-authorized opioid treatment program. But now, most ob/gyns and nurse midwives can prescribe buprenorphine, as long as they have a DEA license.

Before buprenorphine was deregulated, ob/gyns did not get certified to prescribe it in large numbers. Less than 2{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of ob/gyns who treat patients on Medicaid had an X waiver as recently as 2019, according to a study in JAMA Network Open.

“That to me, is evidence that the workforce has failed,” Terplan said.

Addiction medicine is typically viewed as separate from reproductive healthcare, Terplan explained.

“Ob/gyns provide episodic care, and addiction is a chronic condition,” Terplan said. “That’s a clinical mismatch.”

Even then, asking ob/gyns to initiate care for patients with opioid use disorder puts the onus on the doctors to treat the highest acuity patients in a different specialty, Terplan added.

Take treating a patient with diabetes, Terplan said. “The first time you take care of somebody with diabetes is not the person who’s in a diabetic coma with a gangrenous foot in the emergency room. It’s somebody in the outpatient setting who’s on insulin, who brings their sugars, and you look at the sugars and you slightly adjust the insulin dose,” he said.

“Basically, we’ve been asking people for the last 20 years to take up a new domain of health and start with the sickest patient. And, there’s some DEA surveillance for the prescribing practices,” Terplan said. “I don’t think it’s a categorical surprise that uptake has not been what it could be.”

Until there is more training around the prescription of buprenorphine, experts are skeptical that the elimination of the X waiver alone will lead more ob/gyns and primary care providers to treat pregnant patients with opioid use disorder.

“I don’t think it’s going to be that … a ton more primary care doctors or ob/gyns are going to start prescribing,” said Amy Van Milligan, MD, an internist and pediatrician who provides MAT in Cincinnati.

Elimination of the X waiver takes away the mandatory 8-hour requirement, Van Milligan added, “but it’s not going to make people magically comfortable with substance use disorder.”

Why Treatment ‘Just Doesn’t Work’ for Pregnant People

Just as some ob/gyns and primary care providers may have difficulty treating pregnant patients with opioid use disorder, providers comfortable with treating patients with substance abuse may not feel comfortable treating pregnant patients. It all amounts to a siloed system that some say makes it difficult to connect patients with the various types of care they need.

“There’s still some confusion out there amongst MAT providers about how to care for pregnant people,” said Jaine Fairbairn, a wellness coordinator at the neonatal abstinence program at Margaretville Hospital in New York. “And trying to find an ob/gyn who is versed on the actual prescribing of MAT is very difficult.”

But once pregnant patients get linked to prenatal care and find an addiction treatment specialist, then the hard work begins: obtaining care.

Fairbairn works with around 10 pregnant patients at any given time. In addition to advocating for her clients in the exam room, Fairbairn connects her patients with resources like diapers or baby food, answers questions about what to expect at each stage of the baby’s development, and helps patients coordinate transportation to medical appointments, she said.

In Delaware County, where Fairbairn works, the sheer logistics of getting to and from doctor’s visits is one of the biggest challenges that patients face. The county is the size of the state of Rhode Island, but is home to around 45,000 people, she said.

“Here in the rural universe, methadone is almost impossible to maintain,” Fairbairn said. “These places are all an hour, an hour and a half, two hours from wherever you are.”

Medicaid transportation is available, but unreliable, Fairbairn added.

“Once a patient has been burned a couple of times, they just refuse,” she said.

Child care and other family responsibilities also pose barriers. “Addiction treatment isn’t easy if you have other kids at home,” Van Milligan said.

During pregnancy, patients are already overwhelmed with the number of appointments they need to make with their ob/gyn alone, she said. Factoring in a different provider that administers MAT, coordinating transportation, and figuring out who is going to watch the kids at home — it becomes nearly impossible for some patients to get treatment, she added.

“It’s not that they don’t want it, it just doesn’t work,” Van Milligan said.

In addition to the barriers to treatment posed by coordinating care, many pregnant patients with addiction may avoid treatment — both for prenatal and addiction care — because they don’t trust medical providers.

Quinones first went to an ob/gyn when she was about 8 weeks into her pregnancy.

“I was nervous at first, walking in and knowing that I was going to have to tell him that I was an IV user,” she said. On top of that, she used cocaine, had hepatitis C, and hadn’t been to a gynecologist in 5 years.

“The doctor basically told me I was a junkie and I had to stop using, otherwise I wasn’t going to be a good parent and my kid was going to come out just like me,” Quinones said. At one point during the appointment, her physician told her it was still early, and asked if she was certain she wanted to keep her baby, she told MedPage Today.

Quinones walked out of the healthcare facility before even putting on a hospital gown. She didn’t try to get prenatal care for the remainder of her pregnancy.

“I was disappointed, but already kind of knew that that was going to happen,” Quinones said. “Because I’ve been through it so many different times.”

While the stigma of addiction is enough to keep patients out of the doctor’s office, they also run the risk of losing custody of their child or children. (Click here for more on the relationship between access to treatment and the child welfare system.)

Fear of the medical system and child protective services (CPS) prevents patients from telling their providers the truth about their substance use, Habersham said. Fear and stigma not only impact a patient’s ability to get timely care — it affects the public health system’s ability to assess how many people may struggle with addiction in pregnancy.

Recently, Habersham saw a pregnant patient at Mount Sinai’s female-only methadone clinic in New York City. The patient became addicted to prescription opioids, and then heroin, and was now seeking addiction treatment before going to the ob/gyn for prenatal care.

Habersham encouraged the patient to come to a clinic she started at Mount Sinai last year called the Bridge Program, which provides integrated addiction and reproductive healthcare. She told the patient that she could get her an ultrasound and labs so that they could begin to assess her pregnancy and initiate prenatal care. But on the day of her appointment, the patient was a no-show.

“She ended up not coming,” Habersham said. Habersham reached out to the patient’s social worker, who told her that the patient was fearful that her children at home would be taken away from her.

“I think that as we change the narrative, as we decrease the stigma, and as we start linking patients with treatment instead of linking them with CPS, that we are going to see the true numbers,” Habersham said. “I don’t think that in the current climate, that we’re going to reach that point.”

image

Greenhope Services for Women in East Harlem, New York, which is an affiliate of the Acacia Network, provides residential recovery services to women and their children. Children up to age 5 are eligible to stay with their mothers in treatment. Photo by Liam Quigley.

The Push for Comprehensive Care

Habersham wishes there were more centers in New York for patients to receive a range of services at once — prenatal care, behavioral health counseling, addiction treatment, and more.

In 2016, David Garry, DO, a maternal-fetal medicine specialist at Stony Brook Medicine in New York, started the Maternal Opioid Management Support (MOMS) program. The outpatient clinic provides buprenorphine treatment, behavioral health counseling, social services, and prenatal care.

“I think medication alone is not the answer, and I think that counseling alone is not the answer,” Garry said. While medications can address the biochemical mechanisms in the brain that cause drug cravings, counseling helps patients work through mental trauma, he said.

Comprehensive care sites like the MOMS program exist throughout New York State, “but it’s tricky to get them paid for,” Terplan said.

Prenatal care is bundled, so it’s often reimbursed to providers as one lump sum per pregnancy. When an individual provider gets a bundled payment for prenatal services, it can be seen as double-dipping when they charge fee-for-service payments for addiction care on top of that, Terplan added.

“It makes this integrated care by the same provider really difficult to realize,” he said.

Some providers, like Garry, have gotten around that barrier. His program’s ability to provide prenatal and addiction treatment in one place is not only cost-effective for patients, but it also reduces the stigma of accessing addiction care.

“They are just like any other patient in the office,” he said.

Garry said that his clinic tries to follow up with patients 1 to 2 weeks after birth — the postpartum period is a time when many patients may fall back into drug use. More intervention during this period could reduce preventable deaths, he added.

Almost a month after Jacarri was born, Quinones found a treatment center that would take her in, despite the fact that she had not received a postpartum check-up. She became enrolled at Greenhope Services for Women, a residential, female-only addiction treatment center in East Harlem.

Greenhope, a part of the Acacia Network, allows children up to age 5 years to stay with their parents in treatment. A month after Quinones arrived at Greenhope, a judge granted her custody of her baby. Jacarri, now age 7 months, lives with Quinones full-time.

Quinones has access to primary, pediatric, and addiction care through Greenhope’s network of providers. She leaves the facility’s campus for methadone treatment, and is steadily decreasing her dose of the treatment until she can wean off of it entirely.

The death of Jacarri’s father, her fears for the future of her child, her unstable living situation — it all served as a pull into addiction, while simultaneously motivating her recovery.

“Every reason why I was using was pretty much a great choice for it,” she said. “But at the same time, everybody was also dying. I didn’t want Jacarri to grow up without his mom.”

But all the contradictions of addiction and every barrier to treatment were trumped by Jacarri, the boy who unknowingly provided the final push his mother needed to get care.

“He literally saved my life,” she said.

Why a criminology prof wants addiction clinics within 500m of major transit hubs

Why a criminology prof wants addiction clinics within 500m of major transit hubs

Day 610:12Fight violence on community transit with addiction centres at transit hubs, claims Calgary criminologist

Some towns in Canada are encountering a surge in acts of violence on public transportation and that’s prompted phone calls to place mental overall health and addiction therapy amenities in 500 metres of key transportation hubs.

“[Bringing] the providers all over the transit nodes will make so significantly feeling,” explained Kelly Sundberg, a professor in criminology at Mount Royal College in Calgary, in an interview with Day 6 host Brent Bambury.

Studies display that functions of violence from passengers on Toronto transit are up 46 per cent compared to 2021 and violent crime calls are up 53 for each cent in a yr in Edmonton. 

Sundberg suggests it can be being noticed in several metropolitan areas throughout the country.

“People who are challenged with housing or shelter, addiction, mental wellness, they have been employing these transit nodes, as perfectly as libraries and the other couple of community areas that remained open. They use these areas to stay warm, to continue to be dry, just to remain secure.” 

He claimed that a social friction has formulated although people today return to pre-COVID-19 lockdown habits like commuting or having transit for leisure, like movies and eating places — and additional supports are necessary. 

View | Emotional plea from mother of teenager killed at Toronto subway station:

Mother of teenager killed at Toronto subway station states ‘this has to stop’

Andrea Magalhaes has been in unimaginable suffering given that her 16-yr-aged son, Gabriel, was fatally stabbed at a Toronto subway station. She spoke to Adrienne Arsenault with the hope of supporting put an conclusion to the random violence that has plagued the TTC.

Bringing treatment near transit hubs

Sundberg thinks laws brought by B.C.’s minister of transport Rob Fleming that enables the province to obtain land in the vicinity of transit hubs for housing and community companies is a good move.

Fleming was unavailable for remark, but B.C.’s Ministry of Transportation and Infrastructure did verify in an e-mail that this could contain overall health services. B.C.’s Ministry of Psychological Health and Addictions provides that the province is investing $586 million for treatment method and recovery products and services.

Man in blue shirt standing in front of park
Kelly Sundberg, a professor in criminology at Mount Royal University, supports bringing providers for mental health and dependancy in the vicinity of transit. (Submitted by Kelly Sundberg)

Sundberg suggests he is been contacted about comparable initiatives about housing around transit in Ontario, but he endorses heading further more and supplying extensive sites providing social products and services for vulnerable communities around transit hubs. 

He was impressed by a presentation by Calgary-based landscape designer Erica Hansen at the 2021 Alberta Parks and Recreation Convention.

Hansen showed a design principle for a “centralized wellness hub” in the vicinity of Calgary’s Sunalta LRT (mild rail transit) stop at the web site of a previous Greyhound bus station.

“Homelessness and dependancy seems to be becoming a lot more noticeable in the metropolis. And why is that? It is mainly because individuals do not actually have any where else to go,” mentioned Hansen.

“I imagine that it is essential to have that transit connection, especially with like LRT transit. It really is just less difficult for folks to get about … if you want these centres to basically be applied.”

A rendering of a building near a park and railline.
Landscape designer Erica Hansen offered a strategy for a wellness local community hub around the Sunalta LRT station in Calgary at the 2021 Alberta Parks and Recreation Conference. (Erica Hansen)

Hansen suggests that there would be outside public spaces for unhoused folks to occupy, access to lockers and hand-washing amenities. This hub would be immediately linked to a building giving social services this kind of as mental overall health and habit therapy. 

Sundberg thinks it really is a good idea.

“Acquiring medical professionals and dentists, social employees, counselors, but other factors to give human dignity, having a spot so that men and women could get a haircut, that they can have a shower … use the washroom, get cleaned up since it is really just offering a shred of human dignity back again to these people today.”

U.S. research suggests rewards

Jeffrey Cohen, a professor at the University of Connecticut’s College of Organization, has been researching the advantages of bringing habit and psychological health and fitness cure facilities around public transit routes. His investigate undertaking ran amongst 2013 and 2018 is presently a performing paper below peer critique.

His crew looked at a swift bus transit line connecting four towns in Connecticut, which include the point out money of Hartford.

Man with glasses in front of grey background
Jeffrey Cohen, a professor at the College of Connecticut, has observed added benefits clinics and clients when facilities are near public transit routes. (College of Connecticut)

“What we’re locating is that you will find this major romantic relationship in between becoming near to these new transit get started ups … and costs, running costs are significantly less,” mentioned Cohen.

“The other matter that we’re locating is that you will find a connection between equity and entry to treatment.”

The exploration appeared at addiction and mental-well being clinics that ended up within just fifty percent-a-mile, or somewhere around 800 metres, of a new transit route. Cohen deemed that basically walking distance, and when compared effects with those people from clinics more afield.

“Possessing community transit is a single way that will help the vendors sort of not have to bear the direct prices of obtaining folks to and from remedy, as properly as obtaining a responsible stream of sufferers coming in the doorway, earning positive persons are on time for their appointments.”

The analysis uncovered a about two for each cent cost cost savings per individual for services around transit hubs, which Cohen says is statistically considerable, and adds up when you happen to be viewing hundreds of men and women.

Will need for wider, co-ordinated solutions

For Sundberg there’s a need to have for extra proof-based, considered-out options as opposed to ad-hoc responses like the Metropolis of Toronto introducing police officers to TTC routes and then getting rid of them. 

Toronto Police Chief Myron Demkiw did say in a assertion at the time that officers will keep on to be visible on transit and respond to emergencies. The elevated police existence considering the fact that late January resulted in 314 arrests and officers providing much more than 220 referrals to persons in need of social supports like shelter, food stuff and mental wellness providers.

Toronto has due to the fact included some outreach personnel from a community corporation to transit routes.

Cohen’s investigate brought alongside one another an advisory committee in Connecticut which include the state’s general public health, dependancy companies and transportation office. 

He credits departments having outside the house their silos for experiments with social staff and law enforcement officers at transit stations.

A streetcar approaches a stop at Yonge and Dundas on Jan. 26, 2023. Police will increase their presence on public transit after a surge of violent incidents on the TTC.
A streetcar ways a cease at Yonge and Dundas on Jan. 26, 2023. Law enforcement will raise their presence on public transit right after a surge of violent incidents on the TTC. (Evan Mitsui/CBC)

He states the advisory group led to discussions about regardless of whether bus routes really should be moved to end close to procedure clinics, which has been done in Prince Edward Island.

Sundberg thinks it truly is time to produce a national activity force in Canada to search at evidence-based mostly alternatives that tackle the desires of vulnerable individuals on general public transit, but also community areas completely.

“We need to consider a glimpse at broad, multifaceted remedies … I assume this is of important importance.” 


Radio phase made by Yamri Taddese, with data files from The Canadian Press.

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.

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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!