***I drafted this post and let it sit for a few weeks. In the interim, a family friend traveled off to funerals for two brothers, both dead of overdoses within two weeks of each other. The boys’ parents are now childless.***
I am very interested in the opium crisis in America. Particularly, I am interested in the crisis’s effects on the American Way–our institutions and communities–felt most acutely in our nation’s small towns and suburban areas. My wife and I have both been touched by the crisis in the past few years as we’ve each had a twenty-something family friend overdose on heroin. Both of these young men had good parents, upper class upbringings. and intelligence. These kids had all the chances and love in the world going their way and still could not overcome their addictions. This has kept me thinking that opiate addiction must be intensely powerful. For this reason, my wife refuses painkillers, and I’ve adopted that position as my own.
In my thoughts about the opium crisis, I wonder if it could be that–instead of addiction causing many of society’s problem–opiate addiction is the effect of more widespread problems? I’ve been thinking it’s probably no surprise that heroin addiction increases as our culture’s belief in institutions and religion declines. As our uniquely American identities crumble, so to does our desire to live. But much of this decline in the American identity is also masked by modernity’s ease. Amazon can send you almost anything in less than 48 hours. Credit is easy to find–just a few clicks. Does modernity’s crushing of our former institutions make discontentment a sure thing?
My time in Afghanistan brought me face-to-face with poppy. I saw users there. And I saw the relatively ease with which Afghan farmers cultivated the heroin. Taliban fighters fronted the Afghans their seeds for the year and then recouped something like 90% of each family’s harvest if I remember correct. The families’ wealth was what remained: a heroin tar ball representing just 10% of their harvest. They bartered with the ball, buying things they needed to survive, only to have the Taliban return the next year with their seeds. In a different way, non-heroin using Afghans are just as addicted to heroin as America is. Author Andrew Sullivan recently tackled America’s heroin problem in his New York Magazine article. Here are some of the highlights, although I recommend you read the whole thing (my thoughts in bold):
The poppy’s power, in fact, is greater than ever. The molecules derived from it have effectively conquered contemporary America. Opium, heroin, morphine, and a universe of synthetic opioids, including the superpowerful painkiller fentanyl, are its proliferating offspring. More than 2 million Americans are now hooked on some kind of opioid, and drug overdoses — from heroin and fentanyl in particular — claimed more American lives last year than were lost in the entire Vietnam War. Overdose deaths are higher than in the peak year of AIDS and far higher than fatalities from car crashes. The poppy, through its many offshoots, has now been responsible for a decline in life spans in America for two years in a row, a decline that isn’t happening in any other developed nation. According to the best estimates, opioids will kill another 52,000 Americans this year alone — and up to half a million in the next decade.
[Higher number of fatalities than car crashes? That number really hit me, especially given that many states (like my neighboring Wisconsin) have up-to-date traffic fatality counters on their roads. These numbers often show numbers like 360, 380, or 410. This has always hit me hard. Having that many die on the roads seems like a “cost” for having freedom of movement and a bustling economy. But having that many overdose deaths? Unbelievable to me. FTNC]
Just as LSD helps explain the 1960s, cocaine the 1980s, and crack the 1990s, so opium defines this new era. I say era, because this trend will, in all probability, last a very long time. The scale and darkness of this phenomenon is a sign of a civilization in a more acute crisis than we knew, a nation overwhelmed by a warp-speed, postindustrial world, a culture yearning to give up, indifferent to life and death, enraptured by withdrawal and nothingness. America, having pioneered the modern way of life, is now in the midst of trying to escape it.
[This part really spoke to me. I can’t help but notice that–in a mega-merger, NAFTA, and post-pension era–the drug of choice is a downer. LSD speaks to the 60s. Cocaine speaks to the 80s. And, yes, opioids speak to the 20-teens. FTNC]
No other developed country is as devoted to the poppy as America. We consume 99 percent of the world’s hydrocodone and 81 percent of its oxycodone. We use an estimated 30 times more opioids than is medically necessary for a population our size.
. . .
In the mid-1990s, OxyContin emerged as the latest innovation: A slow timed release would prevent sudden highs or lows, which, researchers hoped, would remove craving and thereby addiction. Relying on a single study based on a mere 38 subjects, scientists concluded that the vast majority of hospital inpatients who underwent pain treatment with strong opioids did not go on to develop an addiction, spurring the drug to be administered more widely.
This reassuring research coincided with a social and cultural revolution in medicine: In the wake of the AIDS epidemic, patients were becoming much more assertive in managing their own treatment — and those suffering from debilitating pain began to demand the relief that the new opioids promised. The industry moved quickly to cash in on the opportunity: aggressively marketing the new drugs to doctors via sales reps, coupons, and countless luxurious conferences, while waging innovative video campaigns designed to be played in doctors’ waiting rooms. As Sam Quinones explains in his indispensable account of the epidemic, Dreamland, all this happened at the same time that doctors were being pressured to become much more efficient under the new regime of “managed care.” It was a fateful combination: Patients began to come into doctors’ offices demanding pain relief, and doctors needed to process patients faster. A “pain” diagnosis was often the most difficult and time-consuming to resolve, so it became far easier just to write a quick prescription to abolish the discomfort rather than attempt to isolate its cause. The more expensive and laborious methods for treating pain — physical and psychological therapy — were abandoned almost overnight in favor of the magic pills.
A huge new supply and a burgeoning demand thereby created a massive new population of opioid users. Getting your opioid fix no longer meant a visit to a terrifying shooting alley in a ravaged city; now it just required a legitimate prescription and a bottle of pills that looked as bland as a statin or an SSRI. But as time went on, doctors and scientists began to realize that they were indeed creating addicts.
. . .
Add to this the federal government’s move in the mid-1980s to replace welfare payments for the poor with disability benefits — which covered opioids for pain — and unscrupulous doctors, often in poorer areas, found a way to make a literal killing from shady pill mills. So did many patients. A Medicaid co-pay of $3 for a bottle of pills, as Quinones discovered, could yield $10,000 on the streets — an economic arbitrage that enticed countless middle-class Americans to become drug dealers.
. . .
The old stereotype of a heroin junkie — a dropout or a hippie or a Vietnam vet — disappeared in the younger generation, especially in high schools. Football players were given opioids to mask injuries and keep them on the field; they shared them with cheerleaders and other popular peers; and their elevated social status rebranded the addiction. Now opiates came wrapped in the bodies and minds of some of the most promising, physically fit, and capable young men and women of their generation. Courtesy of their doctors and coaches.
[Athletes and Marines I know are more prone to injuries and surgery. I cannot believe how easy painkillers can be to obtain. “Surgery? Here’s enough pills to kill two dinosaurs.” “Back pain? Here’s 30 pills to take the edge off.” And no matter who you are, the pull of the pill can be tough to fight. I’ve known some incredibly strong people who have had issues with pain pills. FTNC]
It’s hard to convey the sheer magnitude of what happened. Between 2007 and 2012, for example, 780 million hydrocodone and oxycodone pills were delivered to West Virginia, a state with a mere 1.8 million residents. In one town, population 2,900, more than 20 million opioid prescriptions were processed in the past decade. Nationwide, between 1999 and 2011, oxycodone prescriptions increased sixfold. National per capita consumption of oxycodone went from around 10 milligrams in 1995 to almost 250 milligrams by 2012.
[Anecdotally, I think there is a push back occurring right now. Just this past weekend I spoke to a dentist friend who informed me that her dental school offered a lot of training on prescribing painkillers. She described tactics she uses to weed out pill-seekers, saying that–while this is a stressful, unanticipated part of her job–it seems to be working. She and her cohort are prescribing less pills than previous dentists, but that’s only with great effort and training. FTNC]
[T]he cultural and political elites find it possible to ignore the scale of the crisis because it is so often invisible in their — our — own lives. The polarized nature of our society only makes this worse: A plague that is killing the other tribe is easier to look away from. Occasionally, members of the elite discover their own children with the disease, and it suddenly becomes more urgent
. . .
The dying gay men who joined ACT UP in the 1980s share one thing with the opioid-ridden communities who voted for Donald Trump in unexpected numbers: a desperate sense of powerlessness, of living through a plague that others are choosing not to see.
[Very interesting. Part of my belief is that people, until recently, grew up and lived in communities. Communities demanded certain things of a person: graduate high school, marriage, children, steady job, etc. While “mundane,” living up to these demands commanded respect for a young man. And–while the power of heroin addiction does not discriminate–respected young man are less likely to get hooked. Nowadays, true community does not exist. Without community, we are all drifting. Pills and heroin can be more enticing to some. FTNC]
Market capitalism and revolutionary technology in the past couple of decades have transformed our economic and cultural reality, most intensely for those without college degrees. The dignity that many working-class men retained by providing for their families through physical labor has been greatly reduced by automation. Stable family life has collapsed, and the number of children without two parents in the home has risen among the white working and middle classes. The internet has ravaged local retail stores, flattening the uniqueness of many communities. Smartphones have eviscerated those moments of oxytocin-friendly actual human interaction. Meaning — once effortlessly provided by a more unified and often religious culture shared, at least nominally, by others — is harder to find, and the proportion of Americans who identify as “nones,” with no religious affiliation, has risen to record levels. Even as we near peak employment and record-high median household income, a sense of permanent economic insecurity and spiritual emptiness has become widespread. Some of that emptiness was once assuaged by a constantly rising standard of living, generation to generation. But that has now evaporated for most Americans.
New Hampshire, Ohio, Kentucky, and Pennsylvania have overtaken the big cities in heroin use and abuse, and rural addiction has spread swiftly to the suburbs.
[Herein lies the problem, as I see it. I have been a free market capitalist for every moment of my life. I have never wavered from that belief. And now where has that brought us? I understand the benefits of Amazon (cheaper goods, more efficiencies, creative destruction more efficiently allocates otherwise inefficient labor and resources, etc.), but is it good? When it kills the small towns and social fabric of an entire nation, 48-hour delivery seems rather unimportant. FTNC]
It’s been several decades since Daniel Bell wrote The Cultural Contradictions of Capitalism, but his insights have proven prescient. Ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations, destroying what conservatives value the most. They create a less human world. They make us less happy. They generate pain.
This was always a worry about the American experiment in capitalist liberal democracy. The pace of change, the ethos of individualism, the relentless dehumanization that capitalism abets, the constant moving and disruption, combined with a relatively small government and the absence of official religion, risked the construction of an overly atomized society, where everyone has to create his or her own meaning, and everyone feels alone. The American project always left an empty center of collective meaning, but for a long time Americans filled it with their own extraordinary work ethic, an unprecedented web of associations and clubs and communal or ethnic ties far surpassing Europe’s, and such a plethora of religious options that almost no one was left without a purpose or some kind of easily available meaning to their lives. Tocqueville marveled at this American exceptionalism as the key to democratic success, but he worried that it might not endure forever.
And it hasn’t. What has happened in the past few decades is an accelerated waning of all these traditional American supports for a meaningful, collective life, and their replacement with various forms of cheap distraction. Addiction — to work, to food, to phones, to TV, to video games, to porn, to news, and to drugs — is all around us. The core habit of bourgeois life — deferred gratification — has lost its grip on the American soul.
[And here it is…without community and institutions, delayed gratification has destroyed lives of meaning. Are we better for it? FTNC]
To see this epidemic as simply a pharmaceutical or chemically addictive problem is to miss something: the despair that currently makes so many want to fly away. Opioids are just one of the ways Americans are trying to cope with an inhuman new world where everything is flat, where communication is virtual, and where those core elements of human happiness — faith, family, community — seem to elude so many. Until we resolve these deeper social, cultural, and psychological problems, until we discover a new meaning or reimagine our old religion or reinvent our way of life, the poppy will flourish.
[That last part–Opioids are just one of the ways Americans are trying to cope with an inhuman new world where everything is flat, where communication is virtual, and where those core elements of human happiness — faith, family, community — seem to elude so many. Until we resolve these deeper social, cultural, and psychological problems, until we discover a new meaning or reimagine our old religion or reinvent our way of life, the poppy will flourish–shakes me. For what are we to do? FTNC]
