The Opioid Issue: Part 4

Part Four: Taking It to the Streets

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The opioid epidemic doesn’t stay behind closed doors. It’s spilling into public life, spurring crime and homelessness.

The opioid crisis has hit hard in Macomb County, Michigan. Composed of 27 Detroit suburbs, the county has the state’s second-highest opioid-related overdose death rate, more than double the national average. District Court Judge Linda Davis has been on the bench 17 years. She sees the consequences pretty much every day. “When I look at the docket I handle, I’d say 70 percent is addiction-related,” she says, not counting low-level traffic offenses like driving on a suspended license. “We’ve definitely seen a rise in thefts with this opioid surge.”

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Although opioid addiction often starts out legally, recent years have seen a shift toward illegal opioids. It’s an all-to-familiar story: People get hooked on prescription painkillers, often moving on to heroin, which can be cheaper on the street. Since 2011, as prescription opioid overdose deaths leveled off, heroin overdoses started rising. Starting in 2014, illicit fentanyl deaths began spiking upward. Whatever the substance, the cost mounts up fast. So many users resort to theft. They’ll steal from family, friends, acquaintances or strangers. They’ll shoplift, commit fraud, rob pharmacies, break into homes or cars. Even commit armed robbery. And whether or not they’re committing those crimes themselves, their desperate dependency can feed some even worse ones.

Lethal Combination

In 2015, the nation’s homicide rate rose sharply (11 percent) after decades of decline. The uptrend continued in 2016, climbing another 8 percent. Some observers looked for racial reasons for it. There could be one, says Richard Rosenfeld, an emeritus professor of criminology and criminal justice at the University of Missouri-St. Louis. But he thinks there’s more to the story. When Rosenfeld looked into the data, he quickly saw homicides had jumped among several ethnicities—and it was very pronounced among whites.

“The increase is quite abrupt, quite recent and quite large, at levels we hadn’t seen since the early 1990s outside of 9/11,” Rosenfeld says. “The ‘Ferguson Effect’ doesn’t explain that. So what might explain it? The opioid epidemic, for one thing—which crosses racial lines, but is most concentrated among whites. Drug-related homicides rose more than 21 percent in 2015, a rate far higher than other common categories of homicide, which rose between 3 and 5 percent. Rosenfeld said it stands to reason that there’d be a connection between the spikes in opioid use and lethal violence.

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“It’s not opioid use per se that sparks violence, but the markets,” Rosenfeld says. “When disputes arise between sellers or buyers, they can’t be settled by police or courts or the Better Business Bureau. As the number of buyers expands, so does the number of disputes that turn deadly will also go up.”

Just how big a role do opioids play in driving the rise in homicides? That calls for more research, Rosenfeld says. But he sees ample evidence to sound the warning and to call for addressing the root causes. “Policymakers and law enforcement are framing this as a public-health crisis more than as a criminal-justice crisis, and I’m very much in favor of that,” he says. “The bottom line is: If we reduce demand, we reduce crime.”

“We Don’t Want Those People Here!”

Reducing demand for opioids would likely reduce other social pathologies too. Like homelessness. “For those of us who’ve been providing health care to people who are homeless, this is not a new problem,” says Barbara DiPietro, senior policy director for the National Health Care for the Homeless Council. “We’ve been seeing opioid addiction and overdoses for decades.

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“When people are in a spiral and aren’t getting the help they need, oftentimes they lose their jobs and their ability to pay rent. Before you know it, you cycle through family and friends, and you’re in a shelter or on the street.” Of course, not all people who are homeless have addiction issues, but those that do have a harder time getting into treatment once the stability of housing is gone. Living on the street could easily drive anyone to substance abuse. Maybe you started with alcohol, but once you were on the street, you found other things. It’s very hard to get well when you’re homeless.

Federally-qualified health centers provide care to 1.2 million people a year, and the Council provides technical assistance to help improve quality and access. DiPietro says homeless service providers often see clients who never expected to be in this situation. “We see a lot of clients who come from construction work or other hard-physical-labor jobs, who got hurt and got prescriptions for legitimate reasons,” she says. “We see a lot of people who’ve experienced trauma in their lives—child abuse, domestic violence, sexual assault. So they self-medicate to deal with the pain.” And on the street, their problems are much more visible than those of people who engage in their addictive behavior behind closed doors.

“They’re living their private lives in a public space,” DiPietro says. “They’re subject to public scrutiny, arrest and incarceration at a much higher rate. And once you have an incarceration history, it’s hard to get housing assistance or a job again.”

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While more medical facilities and first responders are being equipped with opioid-overdose medications like naloxone (Narcan), that’s just an emergency measure, not a solution. DiPietro says what people struggling with addiction and homelessness need most is stable housing where they can get effective treatment. Health care providers the Council works with can help, but not enough to meet the scale of the problem.

Right now, communities don’t have the capacity desperately needed to get people into treatment. Another big obstacle is the attitude known as NIMBY—Not in My Back Yard. “Everyone believes treatment is important, but no one wants the services near them,” DiPietro says. “When that’s proposed, they rise up in community meetings and say, “We don’t want those people here.”

We’ve simply got to get beyond that attitude.

A Parting Thought

I spent forty years in active addiction. It started simple enough: A case of beer and an ounce of Colombian Gold. Eighteen months later I was serving 3 to 10 in state prison. Drug and alcohol abuse continued throughout parole and into my thirties, forties and early fifties. My drug use ran the gamut, from weed to cocaine to crack to opiates. When I couldn’t get enough oxycodone through doctors, I began stealing it from friends and family. My addiction cost me plenty, yes, but it also cost my children, my two ex wives, my brothers, my sister, and my parents. I lost jobs, cars, apartments, friends and family. I blew every penny I made, bounced checks, embezzeled, fenced stolen goods. I was enslaved to addiction. Not only did my family disown me for nearly two years, my youngest son didn’t talk to me for five years.

It’s not only the family of addicts that can become fed up and turn their backs on their loved ones struggling with addiction; society has become rather fed up and impatient. One of our local television stations airs a nightly feature called “Talkback 16,” where viewers call to voice their grievances, pet peeves, and, yes, an occasional compliment. Several days after a news story aired about plans to build a drug and alcohol treatment center in the Pocono Mountains (Pennsylvania), a viewer called to complain about the plan, adding, “Not in my neighborhood. [Addicts and alcoholics] can’t be trusted. Besides, they did it to themselves.”

Truly, this attitude must change.

 

The Opioid Issue: Part 2

Part Two: Collateral Damage

As the nation grapples with opioid’s hold over millions, its smallest victims cry out to be heard, held, and healed. No Child Left Behind is a familiar battle cry. But to foster parents helping to care for children of parents addicted to drugs, those words have nothing to do with a political agenda or advertising campaign. One foster mom reported quietly watching another baby detox from opiates, its high-pitched wails unique with the sound of drug-induced anguish, and whispering, “A whole generation is being lost from the opioid epidemic. A whole generation.”

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That generation—with hundreds of thousands of America’s youngest feeling its physical, mental, and emotional impact, sometimes from the moment of conception—is staring down what doctors call Neonatal Abstinence Syndrome (NAS). The condition is not something that can be cured with a pill. There are so many children growing up without their parents that the long-term ramifications are still unforeseen. The United States has certainly faced its share of social and public health problems over the years, but when it comes to the opioid crisis, child advocates around the country warn, it’s a strange and scary new world.

Agony in the Womb

According to a study released by the University of Minnesota this spring, one baby struggling with NAS is born in America every 15 minutes. Furthermore, almost 90 percent of pregnancies among women struggling with opioid addiction are unintentional. When a woman takes opioids while pregnant—even exactly as a doctor might instruct, according to the March of Dimes—she runs the substantial risk of harming her unborn child.

One Baby Every Half Hour

Prescription painkillers like codeine, fentanyl, hydrocodone, morphine, and oxycodone (as well as the street drug heroin) are all classified as opioids and all negatively affect children in the womb. Common risks of opioid use during pregnancy, the March of Dimes says, include miscarriage, preterm labor, premature birth, birth defects, low birth weight (defined as weighing less than five pounds, eight ounces), and NAS. NAS is its own beast. The completely preventable condition can grip babies with tremors, fever, chills, weight loss, seizures, and even death. Dr. W. David Hager, member of Focus on the Family’s Physicians Resource Council (PRC), believes 55-94% of newborns delivered to women who used opioids in pregnancy suffer from NAS.

Clearly, it is nearly impossible for an unborn child to skate past the consequences of his or her mother’s opioid use, no matter how slight. Yet damage isn’t usually intentional. Instead, Hager says, addiction to opioids reaches far beyond the initial physical pleasure to something much deeper.

It All Adds Up

That’s a familiar story for J. Scott Moody and Wendy Warcholik, a married pair of economists. As the directors of Family Prosperity Institute (FPI), a New Hampshire-based think tank focused on measuring the health of the American family, Moody and Warcholik frequently hear about opioid-related crises—and have watched their own loved ones succumb to substance abuse along the way. Warcholik, for example, grew up in a family fragmented by her parents’ collective five divorces. Of all her siblings, she was the only one to have fully escaped the negative consequences. The others have experienced unemployment, substance abuse, government dependency, low educational attainment, unwed childbirth, and divorce.

FPI has created a family prosperity index—a formula-driven rankings list that measures the strength and prosperity of families and the nation by combining the most important economic and social data into a single number and then ranking those states based on which create the best environment for families to thrive. The index fills in the gaps around other measures like the gross domestic product, assembling all the pieces of the prosperity puzzle into a complete picture of the economy. No other measure takes into consideration both the economic and social choices of people in a state to create a holistic measure of human behavior in the States.

The latest FPI index ranked Utah first and New Mexico last. FPI’s formula calculates things like average welfare utilization, children in married households, religious attendance and infant mortality rate. That last category is most disconcerting because as opioid use has risen, so has infant mortality rate. (The U.S. Centers for Disease Control and Prevention defines that as the death of an infant before his or her first birthday), while the infant mortality rate is the number of infant deaths for every 1,000 live births.

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Between 2010 and 2015 twenty-one states saw an increase in their infant mortality rate. So many states, in fact, that while the national average dropped 16 percent between 2000 and 2015, the last five years only saw a decrease of 1.6 percent. Clearly, if trends continue, the country could see an increase in the infant mortality rate in the near future. Keep in mind that a rising infant mortality rate is typically only found in Third World countries. Besides the physical, emotional and mental cost to America’s children, opioid addiction doesn’t come fiscally cheap, either. For example, in 2015 Ohio paid more than $133 million to care for approximately 2,000 NAS babies born that year.

The True Cost

Interestingly, FPI’s research shows that devout beliefs and behaviors (consistent church attendance, daily prayer, Bible reading, etc.) reduce illicit drug use. The converse holds true as well. Moody says, “It is clear that people in despair who don’t turn to God for help will try to numb their pain some other way, whether it be with drugs or sex. Unfortunately, at least for the last decade, we’ve been seeing more and more people turning to drugs and sex than God. We have to reverse this trend.”

Ultimately, America truly has no idea what the long-term consequences of opioid addiction on our most innocent citizens will be. “We read horrifying stories in New England about parents shooting up their own children just to keep them quiet, or left in a freezing car with their parents passed out in the front seat,” Warcholik says. How far are we, as a society, willing to go in elevating adult desires over the health and well being of our children?

That is a question far beyond the scope of any research team—but one the Church must rise up to help answer.

 

 

Community: The Answer to the Opiate Epidemic

The following is taken directly from the Afterword of Sam Quinone’s bestselling book “Dreamland: The True Tale of America’s Opiate Epidemic.” You can purchase a copy of this vital publication here.

BY THE TIME I BEGAN research for this book in 2012, we had, I believe, spent decades destroying community in America, mocking and clawing at the girdings of government that provide the public assets and infrastructure that we took for granted and that make communal public life possible. Meanwhile, we exalted the private sector. We beat Communism and thus came to believe the free market was some infallible god. Accepting this economic dogma, we allowed, encouraged, even, jobs to go overseas. We lavishly rewarded our priests of finance for pushing those jobs offshore. We demanded perfection from government and forgave the private sector its trespasses.

Part of the private sector developed a sense of welfare entitlement. Certainly, in this opiate scourge, it is the private sector that has taken the profits; the costs of dealing with the vast collateral damage have fallen to the public sector. A couple months after this book’s publication, Forbes counted the Sackler family ¹, and Raymond Sackler, the last remaining of the brothers, as the richest newcomer to the magazine’s list of “America’s Richest Families” – with an estimated net worth of $14 billion. All of that was due to sales of OxyCotin, which the magazine estimated at $35 billion since the drug’s release in 1996.²

We seemed to fear the public sphere. Parents hovered over kids. Alarmed at some menace out in public, they accompanied their kids everywhere they went. In one case, a couple was actually charged with allowing their nine-year-old daughter and her sister to go to the park alone. The term “free-range parenting” was coined to describe the daring parents who let their kids out of their sight. No wonder so many kids – boys mostly – were diagnosed with ADHD and prescribed Adderall and other drugs. (I wish someone would study the incidence of opiate addiction [in] teens and young adults of people who as kids were diagnosed with ADHD and prescribed drugs like Adderall.) They spent their lives indoors, cooped up, bouncing off the walls. I can say this because I was one: Boys are like dogs; they need to run and run and run.

When I was a boy in suburban Southern California, we spent our entire free time outside playing – football, basketball, riding bikes, or just running around. We probably ran three or four miles a day every day. My knees were in an almost permanent state of being skinned, with scabs growing and being torn off by my roughhousing. My mother had a bell from her family’s farm in Iowa that she used to ring us home at dinnertime – because we were always running around out of the house. I’ve been back to the street where I grew up eight times in the last few years and have yet to see a human being outside. The park where I used to play is always empty.

Keeping kids cooped up seems to be connected to the idea that we can avoid pain, avoid danger. It doesn’t surprise me to hear that in universities, students, raised indoors on screens, apparently lived in some crystalline terror of any kind of emotional anguish. A 2015 story in the Atlantic called “The Coddling of the American Mind” reported on the phenomenon of college students – kids who grew up in the era of hyper-protection from physical pain – demanding to be protected as well from painful ideas. They were demanding professors provide “trigger warnings” in advance of ideas that might provoke a strong emotional content – for example, a novel that describes racial violence. This new campus ethos, the authors wrote, “presumes an extraordinary fragility of the collegiate psyche, and therefore elevates the goal of protecting students from psychological harm. The ultimate aim, it seems, is to turn campuses into ‘safe spaces’ where young adults are shielded from words and ideas that make some [people] uncomfortable.”

Psychology Today ran a story on “Declining Student Resilience” that [sic] noticed increased neediness in college students, that students had called campus police after seeing a mouse, blaming teachers for poor grades, and “increasingly seeking help for, and apparently having emotional crises over, problems of everyday life.” Professors, the authors continued, “described an increased tendency to see a poor grade as reason to complain rather than reason to study more, or more effectively. Much of the discussions had to do with the amount of hand-holding faculty should do versus the degree to which the response should be something like, “Buck up, this is college!” All of this seems the predictable result of the idea that we should be protected from pain at all costs.

As a country, meanwhile, we acted as if consumption and the accumulation of stuff was the path to happiness. We leave family Thanksgivings to go stand in line to buy products – Xboxes, tablets, and the like – that keep us isolated and that poison our kids, and we go do it as if we have no choice in the matter. We have built isolation into our suburbs and called it prosperity. Added to that mix is the expansion of technology that connects us to the world but separates us from our next-door neighbor. We wound up dangerously separate from each other – whether in poverty or in affluence.

Kids no longer play in the street. Parks are underused. Dreamland lies buried beneath a strip mall. Why then do we wonder that heroin is everywhere? In our isolation, heroin thrives; that’s it’s natural habitat. And our very search for painlessness led us to it. Heroin is, I believe, the final expression of values we have fostered for thirty-five years. It turns every addict into narcissistic, self-absorbed, solitary hyper-consumers. A life that finds opiates turns away from family and community and devotes itself entirely to self-gratification by buying and consuming one product – the drug that makes being alone not just all right, but preferable. [Emphasis added.]

I believe more strongly than ever that the antidote to heroin is community. If you want to keep kids off heroin, make sure people in your neighborhood do things together, in public, often. Form your own Dreamland and break down those barriers that keep people isolated. Don’t have play dates; just go out and play. Bring people out of their private rooms, whatever forms those rooms take. We might consider living more simply. Pursuit of stuff doesn’t equal happiness, as any heroin addict will tell you. People in some places I’ve been may emerge from this plague more compassionate, more grounded, willing to give children experience rather than things, and show them that pain is part of life and often endurable. The antidote to heroin may well be making your kids ride bikes outside, with their friends, and let them skin their knees.

Sam Quinones

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1 The richest newcomer to Forbes 2015 list of America’s Richest Families comes in at a stunning $14 billion. The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, flew under the radar when Forbes launched its initial list of wealthiest families in July 2014, but this year they crack the top-20, edging out storied families like the Busches, Mellons and Rockefellers. How did the Sacklers build the 16th-largest fortune in the country? The short answer: making the most popular and controversial opioid of the 21st century – OxyContin. Purdue, 100% owned by the Sacklers, has generated estimated sales of more than $35 billion since releasing its time-released, supposedly addiction-proof version of the painkiller oxycodone back in 1995. Its annual revenues are about $3 billion, still mostly from OxyContin. The Sacklers also own separate drug companies that sell to Asia, Latin America, Canada and Europe, together generating similar total sales as Purdue’s operation in the United States.

2 OxyContin is a dying business in America. Literally. With the nation in the grip of an opiate epidemic that has claimed more than 200,000 lives, the U.S. medical establishment is turning away from painkillers. Top health officials are discouraging primary care doctors from prescribing them for chronic pain, saying there is no proof they work long-term and substantial evidence they put patients at risk. Prescriptions are declining amid increased scrutiny over drug addiction, down 12% since 2012 according to data from healthcare information firm IMS Health. OxyContin saw prescriptions fall 17%.

The Worst Man-Made Epidemic in History

The following is comprised of excerpts from Sam Quinones’ Dreamland: The True Tale of America’s Opiate Epidemic. I want to praise Quinones for this seminal work. Personally, it has defined for me the very nightmare I, and countless others, have lived, each to his or her own level, after discovering the morphine molecule through seemingly acceptable pain medications like Vicodin, Percocet and OxyContin. You can purchase a copy of Dreamland here: Dreamland

AS HEROIN AND OXYCONTIN addiction consumed the children of America’s white middle class, parents hid the truth and fought alone. Quietly. Friends and neighbors who knew shunned them. “When your kid’s dying from a brain tumor or leukemia, the whole community shows up,” said a mother of two addicts. “They bring casseroles. They pray for you. They send you cards. When your kid’s on heroin, you don’t hear from anybody, until  they die. Then everybody comes and they don’t know what to say.”

These parents made avoidable mistakes, and when a son died or entered rehab for the fourth time, they again hid the truth, believing themselves alone, which they were as long as they kept silent. This pervasive lie was easily swallowed. It often lay buried beneath lush lawns, shiny SUVs, and the bedrooms of kids who lacked for nothing. It was easier to swallow, too, because some of these new addicts were high school athletes – the charismatic golden youth of these towns. Athletes opened the door for other students who figured that if cool jocks were using pills, how bad could it be?

One addict was Carter, from one of of California’s wealthiest communities, the son of a banker. Carter had been a high school star in football and baseball. With no break from sports during the year, he battled injuries that never healed. A doctor prescribed Vicodin for him, with no warning on what Vicodin contained, or suggestions for how it should be used. Sports were king in Carter’s town. It was a place of gleaming mansions, but he felt no sense that education was of value in providing choices in life, much less for the love of learning. These kids’ futures were assured. Sports were what mattered. Dads would brag to friends about their sons’ athletic exploits, then berate their boys for poor play, urging greater sacrifice. From the athletic director down to parents and teachers they heard, “You need grades so you can play. That was the vibe we got,” said Carter.

Many new athlete-addicts were not from poor towns where sports might be a ticket out for a lucky few. The places where opiate addiction settled hard were often middle- and upper-class. Parents were surgeons and developers and lawyers who provided their kids with everything. Yet sports were as much a narcotic for these communities as they were to any ghetto. Love of learning seemed absent, while their school weight rooms were palatial things, and in many of them pain pills were quietly commonplace. Just as opiates provided doctors with a solution to chronic-pain patients, Vicodin and Percocet provided coaches with the ultimate tool to get kids playing again.

Carter’s coach told him stories of players years before who were gulping down Vicodin before practices and games. “In my town, the stands were always filled. You wanted to be the hero. So you think, ‘I can’t look weak. I gotta push myself.’ I would get these small injuries. The coaches wouldn’t pay any attention. I taught myself to not pay attention to any injuries.” Most athletes on every team on which Carter played used pills, for injury or recreation. Soon Carter grew addicted to Vicodin, and then to OxyContin. From there, as a student athlete at a Division I university, he began using heroin.

Football players were seen as symbols of this American epidemic. Their elevated status on campus left some of them unaffected by consequences. Carter was caught selling pills and was told not to do it again. Above all, though, players were in constant pain and were expected to play with it. If opiates were now for chronic pain, well, football players endured more chronic pain than most. Necks, thighs, and ankles ached all season. Medicating injuries to get athletes playing through the pain was nothing new. But as oxycodone and hydrocodone became the go-to treatment for chronic pain, organized sports – and football in particular – opened as a virtual gateway to opiate addiction in many schools. Thus, with the epidemic emerged the figure of the heroin-addicted football player. Though, of course, few wanted to talk too much about that.

By 2008, when Jo Anna Krohn’s son died, these kinds of delusions had been accepted for almost a decade in places like Salt Lake, Albuquerque, Charlotte, Minneapolis, and other cities that had for that same decade been the drivers and beneficiaries of the greatest boom in the history of U.S. consumer spending. But it was in beat-down Portsmouth, Ohio, where one mother had the gumption to own the truth and say something about it.

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ACROSS PORTSMOUTH, AT THE Counseling Center, Ed Hughes thought silence was a huge part of the story. Opiates had exploded all those plans Hughes had in the mid-1990s to consolidate the Counseling Center’s operations and focus on improving its internal workings. The center opened years before in a small house. By 1992 it began residential treatment with 16 beds. This quickly increased to 150 beds, with a huge waiting list, and a staff of close to 200. It moved its outpatient center into an abandoned three-story school due entirely to the swarms of new opiate addicts.

“We’ve never seen anything move this fast,” said Hughes. A decade and a half in, Ed Hughes was still waiting for the arc of addicted clients to plateau and curve downward. Kids were coming to the center from across Ohio. Many, said Hughes, grew up coddled, bored, and unprepared for life’s hazards and difficulties. They’d grown up amid the consumerist boom that began in the mid 1990s. Hughes believed parenting was changing as well. “Spoiled rich kid” syndrome seeped into America’s middle class. Parents shielded their kids from complications and hardships, and praised them for minor accomplishments – all as they had less time for their kids.

“You only develop self-esteem one way, and that’s through accomplishment,” Hughes said. “You have a lot of kids who have everything and look good, but they don’t have any self-esteem. You see twenty-somethings: They have a nice car, money in their pocket, and they got a cell phone… a big-screen TV. I ask them, ‘Where the hell did all that stuff come from? You’re a student.’ ‘My mom and dad gave it to me.’ And you put opiate addiction in the middle of that?” Hughes added, “Then the third leg of the stool is the fifteen-year-old brain.”

Hughes saw this all the time: Adult drug users incapable of making mature choices. This happened because opiates stunted the part of their brain controlling rational action. ¹ “We’ve got twenty-five- to thirty-year-old, opiate-addicted people who are going on fifteen. Their behavior, the way their brain works, is like an adolescent,” said Hughes. “It’s like the drug came in there and overwhelmed that brain chemistry, and the front of the brain did not develop.” He added, “The front of the brain has to develop through mistakes. But the first reaction to the addicted person is to head back to the family: ‘Will you rescue me?’ Whatever the person’s rescued from, there’s no learning. There’s no experiences, no frontal brain development. They’re doing well and then some idea comes into their head and they’re off a cliff. It may not be a decision to use [drugs]. Most relapse comes not from the craving for the drug. It comes from this whole other level of unmanageability, putting myself in compromising situations, or being dishonest, being lazy – being a fifteen-year-old.”

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FIVE YEARS AFTER PORTSMOUTH found itself swept up in a national epidemic, the victims of America’s opiate scourge had emerged from the shadows and the silence. They were everywhere now. Heroin had traveled a long way from the back alleys of New York City and William Burrough’s Junky. The town of Simi Valley agonized over a spate of opiate overdose deaths – eleven in a single year. Simi Valley, conservative and religious, has long been an enclave for cops. Many LAPD officers live in the town. Simi’s vice mayor at the time was a Los Angeles police officer. So for years Simi was one of America’s safest towns. According to the crime statistics, it still is. But with pills everywhere and heroin sold in high schools, its kids were now also dying of dope. Simi youths clogged the methadone clinic. Nearby, Thousand Oaks, Moorpark, and Santa Clarita told similar stories. Low crime and high fatal overdoses was the new American paradigm.

Susan Klimuski, whose son Austin died from a heroin overdose, formed a coalition to fight back. It was called Not One More. It received support from city council and the town’s retail core. Yet these were times when heroin was still invisible, conveniently hidden away, at least to anyone who wasn’t a junkie, or a parent of one. Then, on Super Bowl Sunday 2014, America awoke to the news that one of its finest actors was dead. Philip Seymour Hoffman, forty-six, was found that morning in his Greenwich Village apartment, a syringe in his arm and powder heroin in packets branded with the Ace of Spades near his corpse. Blood tests showed he had heroin in his system, combined with cocaine, amphetamine, and benzodiazepine. The Oscar-winning actor – a father of three- had checked into rehab the previous May for ten days, and then, pronouncing himself sober again, left to resume a hectic film schedule. This death hit me right between the eyes. I was a die-hard fan of Hoffman’s acting. He had a heroin habit in college (twenty years ago), but managed to get clean. At least for two decades. Hoffman’s death awoke America to the opiate epidemic.

Within days of covering the story of Hoffman’s death, media outlets from coast to coast discovered that thousands of people were dying. Heroin abuse, the news reports insisted, was surging. Almost all the new heroin addicts were hooked first on prescription painkillers. It was not just the pain, however. This scourge was connected to the conflation of bigger forces: of economics, of aggressive prescription drug marketing, of poverty and prosperity. But this was tough to articulate in four-minute interviews, and a lot of it got lost in the media’s rush to discover and report the new plague. Attorney General Eric Holder described an “urgent and growing public health crisis,” and called on police and paramedics to carry naloxone, an effective antidote to opiate overdose. The problem also prompted Surgeon General Vivek H. Murthy, M.D., M.B.A. to issue a report in November 2016 on alcohol, drugs and health. This is the most comprehensive health crisis report issued by a surgeon general since cigarette smoking. You can read a PDF of the entire report here.

Two decades since the evolving pain revolution,² a consensus emerged that opiates are not helpful for some varieties of chronic pain, including back pain, migraines, and fibromyalgia. In fact, it was finally decided that opiate use is risky. Many clinics and physicians developed policies against using opiates for chronic non-cancer pain. One 2007 survey of studies of back pain and opiates found that “use disorders” were common among patients, and “aberrant” use behavior occurred in up to 24 percent of the cases. It was unclear whether opiates had a positive effect on back pain in the long term. Personally, I have found that opiates do nothing more than create a euphoria that tends to distract me from the pain for a few hours, only to ebb, thus requiring more opiates. By the end of the 2000s, it was already common for people to go from abusing opiate painkillers to a heroin habit. Purdue Pharma, the inventor of OxyContin (who paid a $635.5 million fine for falsely claiming their formulation of the drug oxycodone in time-released pills was far less addictive) recognized this, and in 2010 they reformulated OxyContin with an abuse deterrent, supposedly making the drug even harder to deconstruct and inject.

Unfortunately, by this time, heroin had spread to most corners of the country because the rising sea level of opiates flowed there first. “What started as an OxyContin and prescription drug addiction problem in Vermont as now grown into a full-blown heroin crisis,” said Governor Shumlin. What made New York City the dominant heroin market for much of the twentieth century – its vast number of addicts, and its immigrants from poppy-rich regions of the globe – was now true of most of America. Most of the country’s heroin was coming from Mexico, through the Southwest, trucked into New York. The entrepreneurial Xalisco brothers from Nayarit, Mexico, devised a system for selling heroin across the United States that resembles pizza delivery. An addict calls and places an order, and an operator directs him to an intersection or parking lot. The dealer carries balloons of heroin in his mouth. He simply spits out what the addict ordered. If the cops move on the dealer, he washes the balloons down his throat with a swig from a nearby bottle of water. No evidence, no arrest. The dealers have also been known to deliver to the door for “clients” that are home-bound due to illness or disability.

What started as a concern among physicians for a solution to chronic pain was hijacked by greedy Big Pharma, eventually morphing into nationwide heroin use and addiction resulting from the medical community and the government tightened the reins on prescriptions. Of course, whenever drugs are involved, there is always someone at the ready to provide a system of delivery to dope-sick addicts and chronic pain sufferers hankering for release.

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¹ Adolescence and young adulthood is a period of continued brain growth and change. The frontal lobes, key to executive functioning, such as planning, working memory, and impulse control, are among the last areas of the brain to mature. Age is a risk factor that is associated with the onset of drug use in adolescence and young adulthood. Adolescence is a developmental period associated with the highest risk for developing a substance use disorder.

² During the 1990s changes in attitudes and techniques in pain treatment were coming quickly. In 1996, the president of the American Pain Society, Dr. James Campbell, proposed that pain should be assessed in the same manner as other vital signs. They trademarked the slogan, “Pain: The Fifth Vital Sign.” This led to the 0-10 pain intensity scale now prevalent in every ER and doctor’s office in America. Essentially, doctors were finally given more power in prescribing opiates to patients suffering from chronic pain who were not cancer patients.

References

Quinones, Sam. (2015). Dreamland: The True Tale of America’s Opiate Epidemic. New York, NY: Bloomsbury Press

Winters, K. and Arria, K. (2011). “Adolescent Brain Development and Drugs.” The Prevention Researcher, 18(2), 21–24.