The Coming Crisis in Opioid Nation

This Thanksgiving, we’re replaying our episode on the issue of opioids. Their epidemic running rampant has a 30-year back story and a grisly punch-line for 2017: drug deaths this year alone are heading toward the US death toll in Vietnam over ten years. The damage has proportions of a plague, or a war that will stamp a generation: let it grow at this rate and in ten years it will be taking more American lives than AIDS at its peak; than breast cancer, than World War Two, than the US Civil War.  There’s a palpable near-panic at what can look like collective mass suicide.  There’s torpor, too, a post-war feeling, after the drugs won.  There’s dismay about a marketized industry in man-made drugs that manages somehow to kill its customers and keep growing.

Here’s a short list of what’s strange and different about this opioid epidemic.  The poisons of choice and convenience are cheaper, laced with synthetics like fentanyl, much more powerful and more available than poppy heroin ever was.  The problem is everywhere – rustic New Hampshire a spike on the national map.  And the devastation is almost out of control: deaths on the order of 50-thousand a year, drug dependency for 2-million Americans, 10 percent of them getting treatment.  An aggressive, expanding marketplace is choking on a 30-year promotion of pain meds, like Percocet, addiction warnings long muffled and unheard.  For most new users of illegal opioids, the gateway is an array of prescription painkillers like Oxycontin.  The racial profile and the enforcement culture around drug abuse are markedly changed: opioids can be blamed for a shocking turn down in life-expectancy for white males in the US; but the stigma and the racialized rage around drugs are much reduced. We speak of drug addiction more realistically now, more humanely perhaps, as a disease, no longer a crime.

And so our crash course begins this week, to feel the size and shape and hear the sound of a full-blown public health nightmare in a circle of purgatory or possibly hell, known as the opioid epidemic.

[see Max Blau’s STAT forecast to understand just how bad this crisis could become]
Dr. Jessie Gaeta is the medical doctor that addicts meet at the Boston Healthcare for the Homeless next to Boston Medical Center on Albany Street.  Her patients, she says, are the furthest “downstream” in the opioid crisis — literally collapsing from overdose — or in horrible fear of withdrawal.  They come back and back, needing a safe space or maybe emergency treatment, like oxygen and a drug called Nar-can, which revives people who are unconscious and at risk of death. Doctor Gaeta walked us around the block the main drag of the opioid crisis in Massachusetts. She calls it “Recovery Road”, but it’s better known as “Methadone Mile”.

Kathleen Frydl

Kathleen Frydl is a political historian at the University of California, Davis and author of the The Drug Wars in America, 1940-1973In conversation, she shares with us the genealogy of the opioid epidemic, chronicling how prescription painkillers became the gateway to what is now the gravest drug crisis in our history.

As Frydl has written for Dissent, our national politics may be the ideology that has hijacked our political system over the last 40 years.

Neoliberalism: government austerity, unrestrained free trade, and the deregulation of markets. All of these present dangers that have played a role in the opioid crisis, but none has been more pernicious than austerity, an obsession over government deficits and debt that favors the privatization of public assets and services—and one that has exacted steep costs from the institutional culture and operation of the nation’s drug safety watchdog, the Food and Drug Administration (FDA).

The writer Michael Clune was born in Ireland, raised in Chicago, with a yen for books. He was studying at Johns Hopkins in Baltimore for his Ph.D. in English when he met the high of heroin and then the black hole that he decided over and over was inescapable.  He got out 15 years ago with a qualified recognition of what heroin does.  He begins here from his book White Out.

Michael Patrick MacDonald has another narrative of addiction. He first told a version of it in his memoir, All Souls, which focused in on these crisis in South Boston in the 1980s: a proud old Irish-American community coming apart around poverty, crime, drugs, and then gentrification.  His line—developed as a witness over the last thirty years—is that addiction is almost always about one thing: trauma.

In my experience with the populations I’ve worked with, what I’ve seen over and over is that people who are struggling, especially people struggling with any kind of pain killing addiction, are coming from a life of trauma, basically post-traumatic stress … [South Boston] was sort of invisible for people wanting to work on those issues. 

Donna Murch

Finally, a primer on the opioid plague before it engulfs us.  How like, how unlike, the flood of crack cocaine that hit black America in the 1980s?  That epidemic accelerated the War on Drugs, the quasi-military transformation of policing, and 40 years of mass incarceration.  We asked Donna Murch — historian at Rutgers, a chronicler of Black Power and the Black Panther, as well as a critical observer of drugs, punishment, and the carceral state—to compare these two crises. She urges us to recognize that the drug war is still ongoing and we may need some version of a Truth & Reconciliation process to begin repairing the damage:

[By] using the racial contrast between the way these two different problems are being treated to really highlight the deep role of structural racism and to think about most urgently how to get people out of prison and make sure they’re not being put in prison. 

See a full transcript of this show on Medium.

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  • Potter

    I fell into this report on the methamphetamine epidemic WBUR/ Here and Now, on another crisis in the rural small town south, Arkansas. What a story! it’s not only opioids.