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Here’s how Northern Virginia is tackling the nationwide opioid crisis

Westlake Legal Group bottle-w-people-illustration Here’s how Northern Virginia is tackling the nationwide opioid crisis Public Health police overdoses overdose opioids national public health crisis medics medicine Medical Features february cover Drugs doctors doctor crisis cover story addiction
Illustration by James Boyle

Dr. Karla Lacayo remembers a 21-year-old who was brought in to the emergency room by an alert friend who said she was sleepy. As the triage nurses wheeled her in, she turned blue. With the hallmark symptoms of an opioid overdose—slowing respiratory rate, arousal difficulty, constricted pupils—they immediately gave her naloxone, a drug that reverses overdoses. But, resuscitated, she sat up, pulled out her IV—and walked right out the door, despite being counseled that she had just nearly died of an opioid overdose. “My heart was thinking, this girl will be back … and I hope not dead. Her addiction had taken over her. She didn’t want help. She wanted to use again,” recalls Lacayo, an emergency medicine physician with Novant UVA’s Prince William and Haymarket Emergency Departments and the medical director for the Haymarket Emergency Department.

The incident is alarming, but stories of opioid addiction coming to a head in emergency rooms across the nation—and right here in Northern Virginia—have become increasingly common as dependence on the drugs enters crisis territory.

Lacayo says she and her colleagues have seen “significant increases” in opiate overdoses in recent years, with opioids now the majority of drug overdoses being treated in the ER.

Her anecdotal observations mirror the national and local statistics. In 2017, the most recent year available for statistics from the Centers for Disease Control, more than 47,000 Americans died from an overdose of opioids, which include both legal and illegal forms of them: prescription painkillers, heroin and synthetic fentanyl (which is a powerful opioid similar to morphine but is 50 to 100 times more potent than heroin). That staggering number of deaths is on par with the number of Americans killed in the Vietnam War or from AIDS during its peak in 1995. In Virginia, 1,507 opioid deaths in 2017 put the drug as the leading cause of unnatural death in the state, ahead of firearms-related deaths (which saw 1,041 deaths that year).

Opioid addiction in Virginia, like the rest of the nation, is now considered a major public health emergency. But what is being done about it? Quite a bit in Northern Virginia. Interviews with local doctors, hospital administrators, health officials, nonprofit professionals, first responders and counselors reveal one common goal: to save lives. From new emergency room protocols to police officers trained to recognize overdoses to proactive hospital initiatives, this is a snapshot of the extensive work being done locally to combat the opioid epidemic.

Westlake Legal Group seasaw-with-opioids-drawing Here’s how Northern Virginia is tackling the nationwide opioid crisis Public Health police overdoses overdose opioids national public health crisis medics medicine Medical Features february cover Drugs doctors doctor crisis cover story addiction
Illustration by James Boyle

“I’m going to help as many people as I can.”

Nick Yacoub was 10 when his neighbor asked if he wanted to smoke marijuana. He heard, “Wanna be friends?” and said yes. By the time he reached high school, he was taking pills from other kids: Percocet, Vicodin, OxyContin. First arrested at 17, then arrested again by Fairfax PD at 19, his drug use had spiraled into heroin, cocaine, crystal meth. He was also dealing. “[I was] doing whatever it took to stay high … on drugs 24/7.” Drug-detoxed in jail, released and into rehab. He began drinking a fifth to a half-gallon of liquor a day post rehab stint. One night, drunk and swerving on the road, Loudoun County PD arrested him for a DUI. He went into alcohol withdrawal in jail, vomiting blood. “There was no medically assisted treatment, there was a trash can.” He went back into recovery, eventually got sober and, before long, he was leading the support groups. “It was the first selfless thing I’d done. That’s the most important part of my story,” says Yacoub. “Service to others helped me maintain my recovery. I’d taken a suggestion: When you’re feeling angry, sad, depressed, feeling like using, help out someone who’s worse than you.”

Yacoub, now 34, celebrates Nov. 22, 2007, as his recovery date. The Fairfax-Falls Church Community Service Board, support groups, treatment centers, a 104-day recovery program, followed by a sober living residence, all helped him dig out his “skeletons” he says. (He notes the youngest in recovery was 14; oldest, 77.)

Yacoub graduated from George Mason University in 2013 with a psychology degree, and is now working as a certified peer recovery specialist for Fairfax-Falls Church CSB, assigned to the year-old Striving to Achieve Recovery program at the Fairfax Adult Detention Center, where he helps inmates who want to recover from substance use disorder. “These men get a healthy sense of pride. They build support. We help them with release planning, employment and housing.”

“I care about the people in the unit,” says Yacoub, who hopes to expand the program. “We don’t want it to be 1% of the jail. Since 80% of people in jail have a problem with substances, we want to offer it to more people … We help people develop a better lifestyle.”

“The conversation has changed.”

Back when Yacoub was at the height of his addiction, there weren’t many opioid protocols in emergency rooms. But now, as the epidemic has intensified, emergency rooms are often the first line of defense, which is why many local hospitals have instituted programs to recognize symptoms, proactively help patients get treatment and to prevent addiction to a painkiller.

In Novant UVA’s emergency rooms, Lacayo says, to treat pain, the doctors try non-opioid medications, such as non-steroidal anti-inflammatories, acetaminophen (Tylenol) or muscle relaxants. Before stepping up to potentially addictive opioids, they have a number of protocols in place that include checking Virginia’s Prescription Monitoring Program (a statewide database that tracks patient prescriptions of controlled substances), analyzing patients’ past use, searching for emerging patterns (essentially looking at addiction risk) and whether or not the patient has been “medication shopping” at multiple hospitals.

“If they’ve had multiple visits to multiple providers prescribing narcotics, that’s a red flag and we don’t prescribe,” says Lacayo. Even if a patient doesn’t present an addiction risk, doctors will only write a narcotics script for three days.

The protocols are similar at Sentara Northern Virginia Medical Center (SNVMC) in Woodbridge. Dr. Debra Lee, director of the emergency department, says she’s conservative with prescription painkillers (and the hospital also instituted a three-day limit). If she prescribes a narcotic, she talks about the addictive properties, how “infrequent exposure can lead down a slippery slope. Even within a few days of opiate utilization there’s an increased risk.”

Getting addicted, she says, “is not a weakness. These are strong, serious medications.”

She admits, even with precautions in place, the risks are troubling to her. “You go into this profession because you want to help,” yet she worries people with excruciating pain, from a kidney stone or dislocated shoulder for example, may start down a path of addiction if prescribed a painkiller. Though she intervenes in addictions, treats overdoses and serves on a committee to prevent ER narcotics, “No doubt I’ve contributed to someone’s opiate addiction,” she says. “I can’t sleep at night because I want to get them help.”

Lacayo says, “I think there’s much more awareness among providers. We’re much more vigilant about how these meds are prescribed. The awareness of the public, that’s a great thing. I’ve tried to prescribe narcotics when someone’s absolutely needed it, and they’ll say they prefer not to take them. We didn’t see that five years ago. With awareness and resources, we’ll turn this around.”

Lee agrees conversations with patients are easier now. She says, “The conversation nationally has changed and progressed, when [we] give options to patients, they often say they want to avoid it.” She urges people to ask their doctors why certain meds are necessary; check underlying problems first.

Westlake Legal Group green-brain-illustration-with-pills Here’s how Northern Virginia is tackling the nationwide opioid crisis Public Health police overdoses overdose opioids national public health crisis medics medicine Medical Features february cover Drugs doctors doctor crisis cover story addiction
Illustration by James Boyle

“Nothing in the natural world can beat that.”

With so many headlines about the opioid crisis, one may ask: How does someone get addicted? Is taking an opioid for pain management really that dangerous? And is addiction really that quick? The answer, say doctors, is yes, it’s dangerous and dependency can be quick. And, like most addictive substances, it comes down to brain chemistry.

“Any individual given an opioid for an extended period of time will be dependent, and manifest withdrawal,” says Dr. Ash B. Diwan of Piedmont Family Practice in Warrenton. He’s board-certified in family practice, as well as addiction medicine, with 14 years experience treating opioid addictions. But not everyone dependent will get addicted, which is a behavior disorder, he says. Most people are OK for, say, a root canal, with a low-dose for two to three days. (And first line for pain is always anti-inflammatory, such as Advil, or an analgesic, like Tylenol, he says.)

Opioid addiction is physiological, Diwan explains. The brain’s outer core is decision making, morality, choices; the inner part, the limbic system, is survival, feeling good. When the dopamine rises 20 times, you feel good; it reinforces behaviors. Drugs bind to the same reward center, and opioids increase dopamine by 1,000. The inner system supersedes the conscious human outer core. Rewired, the brain is hijacked, changing circuitry. “Nothing in the natural world can beat that, but now you need higher doses to feel normal,” he says. “It takes years to go back to normal.”

Similar to what is happening in emergency rooms, Diwan advocates for a multi-pronged approach: awareness and screening, abolishing stigma, understanding treatment and increasing access to care.

But he also says those in the throes of addiction may also need the drug buprenorphine, which is essentially a low-dose opioid, to control the craving and “to wean the patient down and off” of the drug. Counseling, he says, is also a must.

“The goal is creating a connection.”

In addition to preventive measures, doctors are working to get those already addicted into treatment much sooner.

“Traditionally, at most hospitals, patients who came to the emergency department in need of addiction treatment were discharged with a list of local treatment centers they could try calling for an appointment,” says Dr. Darren Morris, director of clinical operations for emergency medicine, at Virginia Hospital Center in Arlington. “Now, if a patient comes to our emergency room in opioid withdrawal and is interested in treatment, we’ll start them on evidence-based medical treatment with buprenorphine immediately, right on the spot in the ER, and we partner with the VHC outpatient addiction treatment program, Arlington County and other local organizations to directly schedule a next-day appointment. Studies have shown starting this treatment in the emergency department doubles the likelihood of the patient starting and continuing treatment compared to just a referral.”

That’s Inova’s thinking too: Get the patient treatment, stat. The medical center’s Comprehensive Addiction Treatment Services offers inpatient detox and outpatient, a partial hospitalization program, dual-diagnosis programs, sober living and relapse prevention, along with medication-assisted therapies, such as buprenorphine and naltrexone (a similar drug for dependency weaning) injections.

Novant’s Prince William also has a detox unit and an intensive outpatient program for substance abuse and recovery. Virginia Hospital Center has inpatient and outpatient addiction treatment programs and Sentara works with local and statewide centers.

Of course, someone struggling with addiction must want help. That’s why two of Inova’s ERs, Alexandria and Mount Vernon, are running a HERO (Helping to Engage in Recovery Opportunity) pilot, launched last year, where peer recovery specialists talk with patients. “The goal is to create a connection,” says Maria Hadjiyane, senior director of behavioral health adult ambulatory services. “There’s somebody there to say, ‘This is my story, this is how I got help. This is how I got sober. I’d like to help you.’ We’ve had some success with that.”

Novant UVA Culpeper Medical Center also has an initiative where local community organizations provide peer recovery specialists or social workers to work with a patient facing addiction, leading them to treatment, therapy, groups and support.


A Bipartisan Effort

In Rep. Jennifer Wexton’s (D) 10th district, from NoVA to the Winchester area, she’s met with police, providers, advocates, a recovery center and hosted a roundtable on the epidemic. A member of the bipartisan Freshmen Working Group on Addiction, she’s introduced and passed the EFFORT Act in the House to expand research. If passed in the Senate, it would expand opioid research at the federal level. “This is an issue I’ve been working since my time in the state senate. I’ve continued to work across the aisle to find solutions here in Congress,” she said via her communications director. “The opioid crisis has impacted too many families in my district and across Virginia, leaving devastation and heartbreak in its wake.”

In September, President Trump announced $20 million for Virginia for the epidemic. Almost $2 billion in federal grant money is going to states and localities nationwide.


Westlake Legal Group pill-pulling-human-down-in-water Here’s how Northern Virginia is tackling the nationwide opioid crisis Public Health police overdoses overdose opioids national public health crisis medics medicine Medical Features february cover Drugs doctors doctor crisis cover story addiction
Illustration by James Boyle

“I was surprised at how quickly it worked.”

The front lines of the opioid crisis aren’t just in hospitals.

Police and other first responders have also found themselves faced with confronting the opioid crisis in a health care capacity. Case in point, they now carry naloxone—the fast-acting opioid overdose reversal drug—and train community members on how to use it.

When a call came over Alexandria PD radio about someone doing CPR on an unresponsive person near Mill Road, narcotics commander Lt. Michael Kochis was nearby. Finding no pulse or breathing, he thought it was too late. The person’s friends said they’d been at a party, so Kochis sprayed naloxone in the victim’s nostrils. The person gasped and coughed as medics arrived.

“I was surprised how quickly it worked,” Kochis says, touting the lack of liability and side effects of the drug if it’s not an opioid overdose. “Any officer would’ve done the same. Medics do this every day.” Virginia EMS workers reported 7,775 uses of naloxone in 2018.

Like Fairfax and Arlington counties, which also have opioid task forces run through the county government, the city of Alexandria’s opioid task force has undertaken a multitude of efforts. The police department created a “recovery bag” initiative in early 2019. When detectives interview a person at the hospital, they give them a bag with a burner phone, preprogrammed to the narcotics unit, treatment and resources. “If we can get these people help right after they almost died, they’re more willing to hear the message,” says Kochis.

Other state and local agencies are also referring people to treatment, forming community partnerships, meeting with treatment clinics and recovery programs, and substance abuse coalitions, to combat the problem.

“Our approach is to get people the help they need,” says Joshua Price, supervisory special agent with the Virginia State Police and coordinator of the Northwest Virginia Regional Drug and Task Force (Winchester and Front Royal area). “No one plans to be addicted.” When they interview those suffering from addiction, some people say they developed addiction from a prescription, some not. The police say they see a lot of heroin overdoses—which is cheaper than legal opioids and easier to get on the street.

The task force’s deadliest year, 2017, saw 40 opiate deaths and 190 injuries. In 2018, there was a reduction, which Price attributes to the increased use of naloxone. But in 42 toxicology results, 40 are fentanyl-related. They’ve had to purchase laser equipment to detect fentanyl (and other controlled substances) to prevent first responder deaths from exposure to fentanyl-laced narcotics.

“I knew something was terribly wrong.”

For the Atwood family, the awareness of naloxone came too late.

“If you knew him for 15 minutes, you’d never forget him,” says Mark Atwood, of his son, Chris, who died of a heroin overdose in 2013, after battling addiction for six years.

The son of an attorney and a personal trainer, Chris was bright, outgoing, popular (he was Reston’s South Lakes High School’s homecoming prince as a write-in in ninth grade). An empathetic listener, he even helped talk two friends out of suicide.

Things spiraled at 15. He’d admitted experimenting with drugs and smoking marijuana since 12. (With anxiety and ADD, he called his head “a never-ending hamster wheel.”) His family took him to rehab. He escaped. They tried a Pennsylvania treatment center and a Utah wilderness program that he liked, and AA and Narcotics Anonymous, but “most of the time we couldn’t tell if he was actively using,” says his dad. Recovering on buprenorphine, he didn’t want to rely on it. He tried to wean himself. In January of 2013, he overdosed and was revived. After another month in rehab, he planned for a sober house.

That’s when his sister, Ginny, drinking coffee at her desk at work, felt something wash over her. “A God moment,” she calls it. “I knew something was terribly wrong, so I went home … and found him.” Chris had a fatal overdose. She wishes she had the reversal drug naloxone, but their family didn’t know of it. “All those rehabs—no one had ever told us about it. A treatment center could’ve written the prescription.”

“Three days later, we knew we had a mission,” says Mark Atwood. “We started the foundation right away.” As executive director of The Chris Atwood Foundation, Ginny Atwood Lovitt says the organization has gotten three state laws—in as many years—passed to increase access. It has dispensed over 15,000 doses of naloxone, trained groups how to administer naloxone, given short-term housing grants—and saved 400 lives.

In 2015, it’s important to note, the Virginia Health commissioner issued a standing order that allows anyone to obtain a prescription for naloxone from a pharmacy without a prescription.

Westlake Legal Group humans-falling-out-of-pill Here’s how Northern Virginia is tackling the nationwide opioid crisis Public Health police overdoses overdose opioids national public health crisis medics medicine Medical Features february cover Drugs doctors doctor crisis cover story addiction
Illustration by James Boyle

“There’s a tremendous thirst for knowledge.”

For the Atwood family, that crucial element of knowing about the overdose drug was missing. A recent $16 million gift from the Russell Hitt Family for a new awareness program, Act on Addiction, at Inova hospitals is aiming to change that.

Over 1,000 people attended the first summit in October 2019. “There’s a tremendous thirst for knowledge and assistance, and a need for easier access to treatment,” says Dr. Michael Clark, chairman of Inova Health System’s Psychiatry and Behavioral Health and Opioid Task Force.

He notes the nature of the crisis is complicated and changing.

“While opioid prescribing itself has peaked and started to come down a bit, because of efforts on education and limiting prescribing, we’ve seen a rise in illicit heroin use and synthetic opioids like fentanyl,” Clark says.

As fatality headlines warn, heroin’s more highly potent cousin, fentanyl, can be lethal. On the street it might be laced into cocaine, marijuana or meth. Clark also warns about other mixtures, like benzodiazepines or alcohol mixed with narcotics pain relievers. (One SAMSHA report of treatment admissions showed it had increased 570%.)

The limits for prescribing will have “minimal impacts in terms of the total risk pool of patients” consuming substances, he says.

Echoes Diwan, the pain and addiction specialist in Warrenton, “Just because doctors aren’t giving [opioids] as much, it hasn’t slowed down the epidemic … Numbers are increasing with overdose, even though the numbers of prescriptions are coming down.” As police are seeing on the front lines, many are turning to illegal forms of it on the street.

“We can put a large dent and crush this epidemic, but we have to implement effective treatments. Medication is very useful and counseling is equally useful, and if it prevents overdose and death, we’ll keep them on [medication-assisted treatment] as long as required.”

Clark urges a greater need for identifying people, helping them into treatment, and better screening and referring to treatment for those with depression, anxiety and other psychiatric problems, which carry increased risks for substance use disorder. “If you can get [those] under remission, it makes it easier to treat substance use disorder.”


Legal Action

The state of Virginia, along with a number of Northern Virginia counties, are suing Purdue Pharma, owned by the billionaire Sackler family, the makers of prescription drugs like OxyContin. Similar to other states suing, the suit alleges Purdue convinced Virginia doctors to prescribe millions of opioid pills, downplaying addiction risks. The state is also suing Teva Pharmaceuticals and Cephalon, alleging similar claims about products that include fentanyl. While Purdue has reached a settlement with more than 20 states for billions of dollars, as of press time, the case with Virginia was still ongoing.


“We’re on the right track, but there’s a lot more we need to do.”

The stats on young people and opioids are particularly troubling. NICUs often treat babies born to addiction (In Virginia, eight babies per 1,000 births are born with neonatal abstinence syndrome.), while people ages 20 to 24 were seen in emergency departments for fentanyl/heroin overdoses more than any other age group. In 2016, 3.6% of adolescents ages 12 to 17 reported misusing opioids in a nationwide survey. In Fairfax County’s 2018 youth survey of eighth, 10th and 12th graders, 2.9% said they’d misused a prescription pain reliever in the last month, a decline from 4.4% in 2017.

“The bad news, 2.9% represents 900 students,” says Dr. Benjamin Schwartz, director of epidemiology and population health for the Fairfax County Health Department. “We asked in the survey why they’d used painkillers. More said to relieve pain than to get high.” With prescriptions in medicine cabinets, “This is a problem we can solve. It’s not like breaking up a drug cartel. We need people to not store in the location where it could be misused.”

Schwartz stresses all ages are at risk in all parts of Virginia; it’s not just in urban or rural areas. “Fairfax County, despite the wealth, is not spared the risk,” he says. He wants people to realize opioids take a greater toll than other causes of unnatural death here. “In the last five years, the number of deaths have taken off.”

With the highest total number of deaths in the state (thanks to a large population), Fairfax created an opioid task force in January 2018. The coordinator, Sarah Bolton White, shares five priorities: education; prevention and collaboration; early intervention and treatment; data and monitoring; and harm reduction.

“I’m humbled by the amount of damage this does to people’s lives. At focus groups at treatment facilities, I’ve heard stories of lives getting ruined, how incredibly difficult this is to beat. I have a ton of respect for people trying to beat this,” Bolton White says.

For people who have already lost someone, the concerted push by hospitals, county governments, organizations came too late, but it’s undeniable how much work is being done to save more lives, to prevent more tragedy, to find hope in the crisis. Chris Atwood’s sister says she’ll continue to work toward that goal. “Their lives have value,” says Lovitt of the people her brother’s foundation aims to help. The work, she says, helps to “keep Christopher alive. He knew intellectually heroin had ruined his life, and he hated it. But his brain was saying no. His brain had learned that opioids are necessary for survival.”


Westlake Legal Group dr-zhang-with-chem-bottle Here’s how Northern Virginia is tackling the nationwide opioid crisis Public Health police overdoses overdose opioids national public health crisis medics medicine Medical Features february cover Drugs doctors doctor crisis cover story addiction
Photo courtesy of Virginia Tech
Does this Virginia Tech researcher hold the key to a vaccine?

The National Institutes of Health’s National Institute on Drug Abuse recently awarded Dr. Mike Chenming Zhang, a professor of biological systems engineering at Virginia Tech, with a two-year, $3 million grant to develop a vaccine to counteract opioid addiction. NIH could add $5 million and three more years to the grant.

The vaccine is aimed at preventing the drug from getting to the brain. Working with a team of collaborators and grad students, the experiment involves injecting mice with the vaccine to see if they produce antibodies toward particular opioid molecules.

“We’d been studying the vaccine with nicotine. Nicotine molecules are small, like opioid molecules. Small molecules don’t illicit immune response in human bodies. But the more antibodies a vaccine can generate, the more small molecules can be prevented from entering the brain,” says Zhang.

At a recent NIH meeting, Zhang heard the testimony of a mother who lost her son. “As a researcher, you feel her pain. As a parent of two boys, I feel her pain as a loving pain. I cannot imagine the parent losing the child, nothing is more painful than that,” he says. When he received the grant, starting work in July 2019, “We were very thankful, happy we could potentially do something to help people with their loved ones, help the nation address the opioid crisis. If we can save a life, it’ll be rewarding.”

This is the cover story of our February 2020 print issue. To learn more about health-related topics affecting the NoVA region, subscribe to our newsletters.

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Watch: Virtue Signaling Swedes Say They’d Take Refugees Into Their Home Until Presented With One

Westlake Legal Group Untitled-1-1-620x343 Watch: Virtue Signaling Swedes Say They’d Take Refugees Into Their Home Until Presented With One virtue signaling Sweden refugees Rape Politics migrants International Affairs Front Page Stories Europe crisis crime Allow Media Exception

If there’s one thing I love about people who viture signal, it’s that when it comes time to practice what they preach, they suddenly have excuses as to why they don’t practice the virtues they’ve been preaching to you about.

Take, for instance, the good people of Sweden. The country leans so heavily left that it’s fallen over into the muck of its own making. It’s welcomed in refugees from the middle east, and as a result, has seen a spiking crime and rape epidemic that nabbed it the title of “rape capital of the west.”

Instead of helping the people of its country, the Swedish government went about covering up its rape statistics. What’s more, the Swedish people are seemingly proud of their newfound troubles and are outwardly welcoming to the refugees.

Outwardly being the keyword here.

Recently, a small group set out to get the reactions of Swedes when asked if they would be willing to take refugees in themselves. Every person in the video answered they would.

They were likely feeling pretty proud of themselves as they answered the question, but then the video makers suddenly put their convictions to the test as the Swedes were then presented with a migrant they could take in. A grown man named “Ali,” who needed a place to live.

Naturally, the people who were so welcoming just moments ago began desperately searching any excuse in the book to not have to take in the migrant and all their talk about helping those in need looked oh so foolish.

It makes you wonder what kind of society we’d be living in if people were just more honest with themselves and others about their beliefs. If Swedes would just stand up and say that they’re not into the idea of refugees living in their homes because of the fact that they know it may invite all sorts of troubles, then perhaps Sweden would be a country much lower in crime and rape.

But this simple video just unveiled the truth about virtue signaling. It’s many people creating problems for others that they themselves wouldn’t take on. This video may have taken part in Sweden, but it’s a principle that applies to everyone.

The post Watch: Virtue Signaling Swedes Say They’d Take Refugees Into Their Home Until Presented With One appeared first on RedState.

Westlake Legal Group Untitled-1-1-300x166 Watch: Virtue Signaling Swedes Say They’d Take Refugees Into Their Home Until Presented With One virtue signaling Sweden refugees Rape Politics migrants International Affairs Front Page Stories Europe crisis crime Allow Media Exception   Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com 

Gallup: Share who say immigration is America’s most important problem reaches highest level in modern history

Westlake Legal Group t-10 Gallup: Share who say immigration is America’s most important problem reaches highest level in modern history wall Trump The Blog Problem migrant immigration gallup crisis border

These results don’t tell us which side’s policies the public favors as a solution to the immigration crisis, merely that they recognize that there is a crisis.

But since one party’s presidential nominee wants to throw everything he’s got at closing the border, from a wall to asylum reform to new “safe third country” agreements with neighbors, and the other party’s leading voices seem to want to open the border to such an insane degree that even liberal pundits have begun scratching their heads, I’m guessing this boils down to “Advantage: Trump.”

For now. If the crisis were to persist another 15 months, good luck to POTUS arguing that he should get another four years to try to handle an emergency which he couldn’t handle in two.

Westlake Legal Group 2-4 Gallup: Share who say immigration is America’s most important problem reaches highest level in modern history wall Trump The Blog Problem migrant immigration gallup crisis border

The parties aren’t equal in their concern, with 42 percent of Republicans saying immigration is the country’s most important problem versus 20 percent each of Democrats and indies. But (a) immigration worries among Republicans are destined to bind some Trump-wary righties to him who might have otherwise considered voting Democrat next year and (b) getting 20 percent of the opposition to say this is the country’s top priority is no small thing, especially given the short shrift the issue has gotten in the Democratic presidential primaries relative to health care, taxing the rich, and, ah, busing.

Here’s the partisan difference in a nutshell. Trump this morning…

…versus Ilhan Omar last night:

Congrats to the congresswoman on somehow shoehorning open borders, universal health care, and abortion into the same tweet. I bet AOC could have worked climate change into it too, though.

NPR also polled recently on this issue, asking whether the public thinks various immigration positions which Dem candidates have endorsed are good ideas or bad ones. Decriminalizing border crossings pulled a 27/66 good/bad rating, with even Democratic adults underwater at 45/47. Instituting a national health insurance program to cover illegals polled better with Dems but not much better with Americans overall, landing at 33/62. That’s the good news for Trump, that most Americans agree that some of the left’s favorite ideas on immigration are bananas. The bad news is that various other Democratic proposals unrelated to immigration polled much better in NPR’s survey: From a public option for health insurance to a pathway to citizenship for illegals to, ugh, the Green New Deal, majorities are in favor of all — although NPR conveniently didn’t mention the price tag that each program would carry.

We might deduce from that that so long as the national conversation stays focused on immigration, Trump is more likely to win reelection. The more it strays from immigration, the less likely. Although…

Westlake Legal Group 4 Gallup: Share who say immigration is America’s most important problem reaches highest level in modern history wall Trump The Blog Problem migrant immigration gallup crisis border

And:

Westlake Legal Group 8 Gallup: Share who say immigration is America’s most important problem reaches highest level in modern history wall Trump The Blog Problem migrant immigration gallup crisis border

Again, how good does Trump look on immigration next year if the crisis continues and he’s proved himself seemingly powerless to stop it? Especially bearing in mind that the Dem nominee will likely tack towards the center on the issue next year.

The post Gallup: Share who say immigration is America’s most important problem reaches highest level in modern history appeared first on Hot Air.

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Mark Sanford presidential campaign ad(?): We have a fiscal crisis whether we want to admit it or not

Westlake Legal Group ms Mark Sanford presidential campaign ad(?): We have a fiscal crisis whether we want to admit it or not Trump The Blog south carolina Mark Sanford fiscal Deficit debt crisis

LOL at this guy trying to win righties over with something other than brute lib-triggering.

Although, even by the degraded modern Republican cardinal rule of “we’re for whatever the left is against,” you would think it’d be easier to maintain GOP interest in shrinking government. By one estimate the Green New Deal will cost $93 trillion, no typo. It’s no exaggeration to say that AOC and the Squad think the national debt should be waaaaaay bigger than it already is. They also think the problem of not being able to pay for federal programs can be solved by, ahem, simply printing more money. “Slash spending, reform entitlements” is the most obvious way to own the libs.

But it turns out the subject of debt and deficits is the one exception to the cardinal rule. Perfect.

Here’s Mark Sanford, who lost his congressional primary last year for the right-wing heresy of not thinking much of Trump, announcing that … actually, it’s not clear what he’s announcing. He’s considering a primary challenge to POTUS, but he’s also seriously considering passing on electoral politics and launching an “advocacy organization.” In fact, this is the first ad I’ve ever seen in which an apparent candidate for high office makes clear right in the ad that he may *not* end up running after all. He might go off and found “Nerds for Tax Cuts” or whatever instead.

Maybe wait a week until you’ve made up your mind before cutting the ad, eh, Mark?

I like him but he’s one weird dude. Always has been, and not just for his infamous “hiking of the Appalachian Trail.”

He was on “The View” today as well — another move typical of a presidential candidate, not a think-tank founder — and naturally was asked about the topic du jour. That clip is interesting because it shows Sanford grappling with his biggest challenge if he ends up primarying Trump: How does he resist getting sucked into talking about the daily Trump controversy and away from what he really wants to be talking about, spending? You can see an early example of that here, with the hosts pressuring him to call Trump’s tweets about the Squad racist and Sanford obliging them but also making a point of noting that they’re playing Trump’s game by focusing on it. America’s political class can’t go chasing every shiny object he tosses at them, he scolds. Uh, Mark, m’man, I have bad news. We can and we will.

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BREAKING: Trump Makes Major Change to Asylum Rules

The Trump administration has finally moved forward with making major changes to our asylum rules.

This is long overdue.

It makes no sense for any true asylum seeker to to be allowed to country shop on their journey. The point of asylum is protection from immediate danger. It is not to garner the most economically beneficial situation. If someone is truly physically threatened in Guatemala, there is no reason for them to travel almost 2,000 miles, paying off drug cartels and putting their children in mortal danger, to cross the U.S. border illegally.

We simply do not have the amount of facilities, immigration judges, nor welfare to continue to sustain the influx of migrants currently coming. Asylum is not something that should be abused and allowing so many to do so only makes it harder for legitimate claims to be adjudicated. Lax enforcement and asylum abuse only incentivize more to come, which leads to more abuse, more rapes, and more sick and dead children.

The United States is an incredibly charitable nation, but we simply can not absorb the entirety of the world’s poor. This change to asylum laws is common sense and should be allowed to go into effect.

With that said, you’ll be able to count the days on your hands before a liberal judge puts an injunction in place, stopping this rule change. We aren’t governed by elected officials anymore, only the whims of district judges.

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Logic Need Not Apply As California Passes Law Giving Free Healthcare to Illegal Immigrants

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California Gov. Gavin Newsom just signed into law a bill that will extend free healthcare coverage to illegal immigrants 0-25 years old (the coverage for minors had been previously passed).

On Tuesday, California Gov. Gavin Newsom signed into law State Bill 104, which now extends health care benefits to illegal immigrants between the ages of 19-25, in addition to the law that already had guaranteed coverage to illegal immigrants under the age of 19.

The Hill noted, “The bill, introduced earlier this year, is estimated to cover about 90,000 low-income residents overall and comes with a roughly $98 million price tag.”

This comes as California’s financial future gets even bleaker. While some are claiming a recent single year surplus means everything is all good, that ignores the unfunded liabilities and the fact that they have almost four times as much debt as cash on hand (and states can’t just print more money to cover shortfalls).

In fact, things are so bad that of the $5T in unfunded state and local liabilities in the United States, a full $1T of it resides in California, which only makes up 12% of the actual population in the country. California’s debt-to-GDP ratio is also approaching that of several eurozone countries that experienced economic collapses.

Worth noting is that cities like Los Angeles and San Francisco are dealing with an explosion of homelessness right now, many of which are mentally ill or drug addled. Instead of spending the proper resources to try to handle that issue, California is using its already finite, over-strapped resources to give free healthcare to illegal immigrants. Meanwhile, crime has spiked and feces litter the streets as homeless encampments spring up everywhere.

Keep in mind, there are plenty of poor Americans in the state not getting such coverage. It’s actually gotten to the point in California that it could be preferable to be in the country illegally.

Even past the financial considerations, giving free healthcare to illegal immigrants only incentivizes more illegal immigration. That means more money for the cartels, more women raped on the journey, more sick and dead children, and further strain on an already resource-starved Border Patrol. This also means that the “price-tag” for this program will balloon as more and more people show up, creating yet more liabilities for California they can’t pay.

It’s completely irresponsible and ignores all the unintended consequences that are ultimately produced by such a move. That’s a trademark of progressivism though. As long as it feels good, it’s worth doing. Who cares if it actually makes the situation worse, right?

As a moral imperative, I’d love to give everybody on this planet free healthcare. But I recognize that’s not only impossible, trying to do would could cause far more harm than good if it ends up bankrupting everyone in the end.

I’ll end by mentioning the other reason none of this is sustainable. Because of California’s ridiculous finical decisions and over-regulation, which has lead to high taxes and housing shortages, they are experiencing massive emigration to other states. Their tax base shrank to the tune of over 1M people between 2007-2016. Adding more and more debt as you continue to lose tax payers is a recipe for disaster.

But Gavin Newsom got to smile for the cameras and that’s what’s really important here.

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$300K anually for one bathroom for L.A.’s homeless?

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As has already been established, the homelessness problem in Los Angeles has long since reached epidemic levels. Officials estimate that there are currently more than 36,000 displaced individuals living on the streets of the City of Angels. So in addition to people dumping trash all over the streets, there are homeless people literally relieving themselves on the pavement, with growing deposits of excrement constantly needing to be cleaned up and fears of disease rising.

So what’s to be done? The obvious answer is toilets, right? More toilets open to the homeless population should tidy up the situation nicely. But that’s not going to happen any time soon because the City Council has been informed that it will cost more than $300K for each toilet – staffed with a couple of attendants – that they put out on the streets. (L.A. Times)

It seems like an obvious fix to the squalor and stench as homelessness surges on Los Angeles streets: more restrooms.

But L.A. has estimated that staffing and operating a mobile bathroom can cost more than $300,000 annually — a price tag that has galled some politicians. During budget talks this spring, city officials estimated that providing toilets and showers for every homeless encampment in need would cost more than $57 million a year.

“How many single-family homes could you build for that much money?” Councilman Paul Krekorian asked at a hearing at City Hall last month, saying that L.A. had to find a cheaper solution.

This is a real hammer and nails approach to a serious problem that would probably work pretty well if you had an unlimited budget. But the city is already pinching pennies and spending $57M annually on toilets and bathrooms for the homeless encampments is beyond their reach at the moment.

Consider all of the complications involved. Portable facilities need to be emptied on a daily basis and cleaned regularly to tamp down on the spread of disease. Considering where they will be placed and the problems with violence in those areas, each of the bathroom/shower stations have to be manned around the clock. And who are you going to hire to perform that tasty job, and how much would you have to pay someone to do it? It would have to be someone who can handle themselves in a potentially violent situation most likely someone who is armed. (At least with crowd control equipment if not actual firearms.)

You’re basically talking about an entirely new branch of city government devoted to nothing but toilets and showers for the homeless. And if you can figure out a way to manage a budget in the tens of millions to do all this work, not to mention the cost of city personnel to organize and manage the effort, perhaps there’s another way to deal with this. You won’t need to provide thousands of portable bathrooms and showers if you get rid of the homelessness problem driving the need for them.

No, I’m not talking about arresting or shipping out all of the homeless (except possibly the illegal aliens among them). This is Los Angeles we’re talking about here. It’s the home of Hollywood and one of the largest concentrations of wealth in the nation. And yet in the midst of all the luxury and capital, there is a literal army of people who are so destitute that they can’t put a roof over their own heads and they’re defecating in the streets. One of the City Councilmen, Paul Krekorian, asked: “how many single-family homes could you build for $57 million?” It’s a fair question. Given the price of real estate there, I’ll say maybe… two (?) in a lower cost of living part of the city.

But as I said, this is an area that’s home to a vast amount of wealth. How about establishing some larger scale homeless housing shelters, complete with security forces, bathrooms, and all the rest? And if the city can’t come up with the money, perhaps all of those compassionate liberal millionaires in the film industry could kick in to cover the cost. A small percentage of the profits from a couple of summer blockbusters per year could easily do the trick. Or does their money only go to the Democratic Party?

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AOC Flips Again, Goes Back to Saying We’ve Only Got 12 Years to Save the World

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Alexandria Ocasio-Cortez is talking about global warming again and she still can’t get her story straight.

After making several public appearances claiming that we only had 12 years to act on global war…excuse me…”climate change,” she suddenly reversed course a few weeks ago.

You see, she was just joking and if you believed her, well then it’s you that is the moron.

This never made any sense because in all the instances she made the claim, she was clearly not joking. But hey, she’s AOC, so making wild claims is kind of her thing. She also knows the media will rush to defend her, so she’s pretty comfortable with not being consistent.

Welp, AOC has decided that we all only have 12 years left to live on our current trajectory again.

Got whiplash yet?

What climate scientists is she even talking about? I’m curious if she’s ever actually cited a source for her crazy statements. I bet she hasn’t.

Also, notice that she mocks the idea of “communist cow farts,” ignoring the fact that it was her office the released a FAQ to the media asserting that cow farts were something needing to be eliminated. It was also those same FAQ which proposed paying people not to work. Is it really our fault for responding to her idiocy?

But again, she knows the media will play along and they certainly did when she suddenly claimed the FAQ was an “early draft,” because early drafts are typically pushed out as part of a full media campaign and then never updated with later drafts. It’s all so stupid.

There’s something perhaps a bit more insidious in her comments though.

As she goes back to claiming we’ve only got 12 years to live, you get the sense that there’s literally nothing she won’t justify to fight her made up crisis. This is the danger of politicians trying to use false urgency to push their power grabs. If the world is going to end, who needs freedom right? There’s no doubt in my mind that AOC thinks that way and we see it come out in her statements frequently.

But hey, maybe the media will actually call her out for her flip-flop-flip here?

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Pelosi: Nadler’s right, this is a constitutional crisis

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My hot take for today is that this cynical strategy of shouting “constitutional crisis!”, which is clearly aimed at appeasing pro-impeachment progressives, will backfire by stoking their desire for impeachment instead. Even friendly outlets like CNN have taken to asking Democratic guests why, if the White House’s refusal to comply with subpoenas is really a “constitutional crisis,” they don’t just impeach Trump already. Democrats seem to have no good answer except to mumble vaguely that “we’re not there yet” or that “there are other options.” Pelosi was asked about it in her presser today too. Quote: “Impeach or nothing — it’s not that. It’s a path that is producing results and gathering information.”

She’ll get back to you. In the meantime, please enjoy some complimentary heavy breathing about a “constitutional crisis” instead.

Are there other options besides impeachment if Democrats are serious about this? Here’s one, I guess:

Among the options they are considering is to bundle contempt citations for multiple Trump administration officials into one overarching package that could be referred to the Federal District Court here, in much the way Congress looked to the courts to compel President Richard M. Nixon to turn over tape recordings of his Oval Office conversations. Nixon’s refusal to do so prompted impeachment proceedings…

Mr. Cummings also said Democrats should consider “inherent contempt” — the congressional power, last used in the 1930s, to jail officials who defy subpoenas. Mr. Connolly, who leads an oversight subcommittee, agreed.

“We should be putting people in jail,” Mr. Connolly said.

Would throwing Bill Barr and Don McGahn in a dungeon be considered more or less draconian than impeachment by most of the public? We’ve reached a point of such relentless partisan rancor that I’m not sure impeachment would be viewed as that extraordinary a development; imprisoning cabinet officials definitely would. If nothing else, it’d be hard to reconcile the crocodile tears that were shed in 2016 over Trumpers chanting “Lock her up” about a political opponent with literally jailing the Attorney General of the United States for making the sort of executive privilege claim that every presidential administration eventually ends up making.

Keith Whittington, a Princeton professor who’s writing a book on constitutional crises, knows a stunt when he sees one:

[Nadler] feels the need to elevate a relatively routine dispute over the scope of executive privilege into the last gasp of democracy. Only if the House gains access to the last few sentences under redaction in the Mueller report can America be spared the collapse of the republic and the ascension of a “monarchy.” Only if Attorney General William Barr can be cross-examined by committee staff in a public hearing will we be able to avoid Donald Trump making “himself a king.” Someone has been watching too much Game of Thrones.

Politicians have become incentivized to declare constitutional crises because it enhances their own importance as saviors and demonizes their opponents as illegitimate. The rhetoric of constitutional crisis attempts to short-circuit routine constitutional processes and justify extraordinary and extraconstitutional responses. Donald Trump has played this game as well.

Andrew Napolitano is right, I think. It’s a real constitutional crisis once one branch or the other starts disobeying court orders. Until then it’s two co-equal branches asserting their constitutional prerogatives.

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Hell Freezes Over as The New York Times Says “Give Trump His Border Money”

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I had to double take at this headline.

The New York Times has endorsed giving Trump the $4.5B he requested in funds for the border. Not just a single writer either, it’s the whole editorial board.

The New York Times editorial board urged Congress to give President Trump the administration’s requested $4.5 billion in emergency funding for the crisis at the U.S.-Mexico border.

“President Trump is right: There is a crisis at the southern border,” the editorial board wrote Sunday in a piece titled, “Congress, Give Trump his Border Money.”

Crisis is the santizied word liberals like to use about the border because they are loathe to say “emergency” and possibly give Trump any credit. We all know what it is though. Over 100,000 people crossed illegally last month. The CPB don’t have the manpower or resources to handle the situation. Our asylum laws are being abused at a ridiculous level and Congress refuses to act.

If what’s going on at the border isn’t an emergency, then the word has lost all meaning.

While the Times manages to get the top line decision right, they still had to get their shots in.

“There is no pressing national security threat — no invasion of murderers, drug cartels or terrorists. No matter how often Mr. Trump delivers such warnings, they bear little resemblance to the truth,” it said.

They of course base that on absolutely nothing. When you have 100,000 un-vetted people crossing in a few weeks time, the idea that the drug cartels and gangs aren’t heavily taking advantage of that is nonsensical. They are out to make money, among other things. As the system is being overrun, it’s common sense that bad actors would work toward their own gain.  The Times assuming otherwise is pure gaslighting.

“None of the money would go toward Mr. Trump’s border wall,” it wrote. “Several hundred million dollars would, however, go toward shoring up border security operations, including increasing the number of detention beds overseen by Immigration and Customs Enforcement, or ICE. This, for Democrats, is a nonstarter.”

“But until better policies are in place, Democrats need to find a way to provide money for adequate shelter,” the board continued, encouraging both Democrats and the White House to be open to conditions from the other side of the aisle.

Perhaps the Times should examine why it’s acceptable for Democrats to reject increasing the number of beds instead of just passing over it as a legitimate position to hold. That never made any sense and always seemed inhumane at best, yet the media have done nothing to put pressure on Democrats for holding CPB hostage. Instead, they spend all their time gnashing their teeth over whether Trump is accurately describing every asylum seeker properly.

You can almost feel the torture in every word as you read the Times’ article endorsing Trump’s funding request. They really, really would have preferred not to write this. What we are seeing here is a decision driven by pure pragmatism, even as they long to push their political narrative in a different direction. I guess that’s better than nothing though. Perhaps the Democrat party should try the same thing?

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