The Coming Crisis in Opioid Nation

The opioid epidemic running rampant this summer 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, 1940-1973. In 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.


Guest List
Dr. Jessie Gaeta
chief medical officer of the Boston Health Care for the Homeless Program
Kathleen Frydl
historian, political consultant, and author of The GI Bill and The Drug Wars in America, 1940-1973 (2013)
Michael Clune
professor at Case Western Reserve University and author of White Out: The Secret Life of Heroin

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  • Judy

    Use marijuana products for pain already. They are non-addictive, non-habit forming, and don’t kill

    • corina

      And often do NOTHING for many kinds of pain.

      • Potter

        True enough. But does a lot and enough for some. I think this has been proven. Pain that is psychic or that moves from the physical to the psychic is another thing entirely. Often enough that is the case or so it seems.

        As well people need a way of getting high legitimately, or getting into another realm given the stresses modern life. Why is alcohol, which is addictive, okay? People fall into these addictive drugs and get hooked… include nicotine.

        • corina

          Thank you, Judy, for your thoughtful and even-handed response. I seem to have written in a moment of bitterness, and I’m sorry… I’ve just been personally so disappointed in what I’d hoped would be a solution to my life-wrecking pain. But I agree with everything you wrote, and I hope there will be, eventually, an end to the current insane prohibition of cannabis use for both medical and “recreational” use in every state, as well as federally….dream on, eh? So while I’m dreaming…. I’d also like to see our tax dollars spent on research into how this plant can help so many, many people who are suffering. (Even a fraction of our obscene military budget would be good for starters.) Of course you are right about alcohol….

          I feel deeply sorry and outraged for all those people – the vast majority of opioid users (I’m not one) who were able to have lives thanks to opioids, and are now suffering and struggling to go on with little or no relief. Of course, this is not a country that has any compassion for those suffering, and this issue is typical of its mean-spirited attitude.

          • Potter

            I also wrote meditation and yoga, learning stress reduction techniques, such as taught by mindfulness based stress reduction courses (MBSR) now given across the country and internationally which deal wth both kinds of pain. These give the tools to deal. Somehow I deleted this in my first post on the matter. This is what helped me so I am avid. I think we are talking about the effect/affect of trauma. Now I will listen to the show!!

        • corina

          Potter, I’m so sorry, I meant to direct my response to you (this is my brain on pain.)

  • Darryn Remillard

    Another excellent episode! I’d like to raise awareness about the next phase of the opiate crisis: the introduction of carfentanil. I’m a veteriarian and this is a narcotic used to tranquilize large animals (elephants and wildlife animals). When I read about carfentanil showing up in West Virginia last year I knew it’d only be a matter of time before it spread. We’re still trying to wrap our minds around fentanyl, but here’s where things get more grim with carfentanil: it’s an opiate like fentanyl, but 1000x more potent (so you can smuggle a much smaller amount). We’ve little to no pharmacology data for humans, and it’s unlikely that the reversal agent naloxone (“Narcan”) is going to save someone from carfentanil. All of the approaches that we’ve used to keep heroin users alive and not dying from fentanyl-laced heroin may prove woefully insufficient if carfentanil begins to displace fentanyl.

  • Cigarette smoking: 480,000 deaths annually (CDC)
    Obesity epidemic: 300,000 deaths per year (NIH)
    Alcohol-Related: 88,000 deaths per year (NSDUH)
    Opioid deaths: 33,000 (CDC)
    The CDC hasn’t reported 2016 numbers as far as I can find but the NYT is much better at producing a number cuz….

    I would say if you get rid of opioids tomorrow you could add a significant portion of those 33k deaths to alcohol and the rest maybe to obesity.
    My point: the problem isn’t the specific substance but the proclivity of people to self-destruct and the role of industry to make a buck thereon.
    If I were king, I’d turn DHS on the forces trying to kill us: pharmaceutical industry, fast food industry, chemical industry and alcohol & tobacco industry. (I would ask DHS to keep a close watch on the auto industry – vehicles are much safer since the 1970s although there was a 10% uptick in deaths last year.)
    And it’s not just the poor ravaged by addiction. Look at the faces of the TV pundits and see the gin blooms through the makeup. Sure they can afford the rehab, but there, is the evidence of an underlying pathology that pervades all of the carceral society.

    • Potter

      Gin blooms through the makeup? Treat people with dignity through education and work opportunities as well as cradle to grave decent healthcare, including for the mentally ill -and their families-(who should not be stigmatized).Treat those we send to war or military service with the close attention they deserve. Make America a country that cares about it’s people I.e. great.

      • Just finished Jarecki’s The House I Live In.
        Interesting factoids:
        Nixon’s war on drugs spent 2/3 of its budget on addiction – only later did they start incarcerating people to get votes.
        “There are more African Americans under correctional control, in prison or jail, on probation or parole, than were enslaved in 1850 a decade before the civil war began.”

        The richest nation on earth beating down the vulnerable…..not great.

  • Potter

    The guests were all well chosen, especially Ms. Frydl.
    People give up,they “lose it” as one woman interviewed said. No shame but can resilience be taught? Can the brain be retrained?also to deal with trauma? I think it can. But that is connected to getting help: caring with injections of hope and opportunity: a way to go forward..
    Can we identify early, addictive personalities?
    There are techniques to living with pain. People used to have to live with more pain before all the remedies.
    We never had drugs so advertised, so widely available,outrageously so pushed for drug company profit. and then doctors succumbing to patients.