Can We Get Real About Opioids?

The problem isn’t in Mexico or on our southern border. It’s here, and it’s us.

All my life I’ve been hearing about the drug problem, but mostly what I’ve heard are attempts to dodge responsibility. Those attempts have taken two main forms:

  • It’s not my problem. The middle-aged, middle-and-upper-class whites who run the country project the problem onto inner-city blacks or white-trash teens, who can be written off. In other words: I don’t need to do anything, they just need to shape up.
  • The solution is to punish somebody else. The problem isn’t the American demand for drugs, it’s the supply chain. If we just extend the death penalty to pushers, or seal the border, or launch para-military operations against drug cartels, or spray enough herbicide on the poppy fields of Afghanistan or the coca fields of Columbia, that’ll fix it.

In recent years, though, that first dodge has been breaking down. The opioid problem has started to climb up the national agenda not just because the overall number of deaths has increased, but because drug abuse has increasingly begun to affect whites, rural and suburban communities, and people who are both over 30 and above the poverty line. In cynical political terms: people who matter.

Let’s review a little: Drug overdoses killed 52,000 Americans in 2015. That’s more than car accidents (35K) or gun deaths (36K). The National Institute of Health estimated that in 2013, 1.9 million Americans were dependent on pain relievers, with another million or so dependent on heroin, sedatives, and tranquilizers.

That’s such a big deal that it’s pushing down the national life-expectancy-at-birth numbers, which in 2015 fell for the first time since 1993, from 78.9 to 78.8. (That’s the National Center for Health Statistics number. For cross-country comparisons, the World Health Organization figures slightly differently. It rates the U.S. at 79.3, well below Japan at 83.7 and culturally similar Canada at 82.2.)

But what makes this a politically serious problem is that it’s hitting white people: The 2015 national life expectancy decline might turn out to be a statistical anomaly, but white life expectancy has barely budged since 2010.

That doesn’t just change the importance of the problem, it changes the rhetoric. If drugs aren’t just a problem for “those people”, then we can’t solve it by telling them to shape up. The rhetoric has to soften, and lean more towards empathy than tough love. During the campaign, Trump said this about the opioid problem:

We’re going to take all of these kids — and people, not just kids — that are totally addicted and they can’t break it. We’re going to work with them, we’re going to spend the money, we’re gonna get that habit broken.

But so far that’s been a shaky promise. The for-now abandoned TrumpCare plan would have eliminated the ObamaCare mandate that insurance policies cover addiction treatment, not to mention the millions of people it would have left without insurance entirely. He claimed to increase funding for addiction prevention and treatment by $500 million, but apparently that was just him taking credit for the 21st Century Cures Act passed under Obama.

But Wednesday was opioid abuse day at the White House, so Trump appointed a commission that will issue a report in October. That’s some real action for you.

While he waits for that report Trump continues to use the second dodge: He’s spinning drugs as a border-protection issue that the Wall will solve. Wednesday, after listening to several people’s stories of addiction that began with prescription drugs, he said:

So it’s been really — it spiked over the last eight to ten years.  Would that have anything to do with the weakening of the borders? Because a lot of it comes from the southern border.

Like so many Trump statements, this presents a thicket of misperceptions that you have to hack your way through. First, the border hasn’t “weakened” in recent years. We’ve had more fences and border agents than ever, and fewer people crossing illegally.

And then we get to the reality of the drug problem: About a third of the 52,000 opioid overdose deaths in 2015 were from prescription drugs, and many of the illegal-drug ODs are simply the end of a story that began with legal drugs. Even if we could shut off all the heroin and fentanyl coming from overseas — it’s mostly from Mexico right now, but that doesn’t mean drug importers would give up if we capped that particular pipe — the problem wouldn’t be solved.

And then there’s the assumption that the Wall would stop Mexican drugs cold. Even granting the shaky assumption that Mexico lags behind in crucial ladder technology, bags of pills or powder are not that hard to throw. Fill a football with them, and any high school quarterback could complete the pass.

In short, the only real way to attack this problem is on the demand side, not the supply side. We have to prevent people getting addicted to prescription opioids, and help current addicts (to both legal and illegal drugs) quit. The Great Wall of Mexico won’t do that.

What would? Three things:

  • Finding ways to manage chronic pain without addictive drugs.
  • Reducing the overall level of despair among people that the 21st-century economy is leaving behind — over-50 folks in rural areas as well as non-white inner-city youth.
  • Funding effective rehab programs for everybody who wants to quit.

None of those is a just-do-it thing. We know how to build walls, but chronic pain and despair and effective rehab are much harder questions. The difference is: They’re the right questions, rather than just new ways to dodge the problem.

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  • barczablog  On April 3, 2017 at 11:13 am

    At the end of your piece you looked for solutions, “ways to manage chronic pain without addictive drugs”. There is one possibility that comes to mind, speaking as a Canadian where this solution is about to be implemented, namely legalizing cannabis. Whether we’re talking about medical or recreational marijuana the nature of the problem changes when people have other options for pain relief.

    • MAHA  On April 3, 2017 at 1:39 pm

      I’m Canadian too, but I don’t see that as a solution, unless the user is a non-driver.

      Deborah McP

      • Marty  On April 3, 2017 at 3:32 pm

        Because one thinks sooo much more clearly on opium than cannabis /s.

        Something tells me that, if the user is on addicting pain killers, then they aren’t supposed to drive.

    • janinmi  On April 4, 2017 at 1:28 pm

      In light of the scientifically established fact that chronic pain relief methods affect any two people differently, there is no single silver-bullet answer. Cannabis will work for some but not others. Same holds for prescription painkillers. It’s the individuality of response that throws a wrench into things.

      As for people taking addictive painkillers for chronic pain, those people and the causes for their pain are on a wide spectrum. How they react to painkillers is also variable. I am a chronic pain sufferer who takes an addictive painkiller when I need it. My doctor tells me I’m not addicted to it, which I believe after mentally reviewing when I take that med and for what pains. I don’t drive right after I take a pain med.

      Not all addictive painkillers, and not all people who need to take them for sound medical reasons, are the same. Some people may be more likely to become addicted to such chemicals, but again, that’s an individual response.

      • jh  On April 8, 2017 at 4:56 pm

        I remember watching an interview with a doctor (I think) who was studying addiction. There was one thing that I remember. During the vietnam war, the soldiers were using heroin. However, when they returned to the US, most of them quit. Why? Because most people don’t get instantly addicted. He went on to say that even crack wasn’t that addictive like the white morons were saying during the 80’s.

        However, if we are going to talk about things that impair drivers, we should talk about alcohol as well. But I get why we don’t. After all, too many white people drink and drive. We can’t target white people and put them in jail.

  • janinmi  On April 4, 2017 at 1:11 pm

    A minor note: unless the country has changed its name’s spelling, “the coca fields of Colombia” is the correct phrase.

  • Tom Davis  On April 5, 2017 at 10:17 am

    > > weeklysift posted: “The problem isn’t in Mexico or on our southern > border. It’s here, and it’s us. All my life I’ve been hearing about > the drug problem, but mostly what I’ve heard are attempts to dodge > responsibility. Those attempts have taken two main forms: I” >

  • Ealasaid Haas  On April 21, 2017 at 6:12 pm

    One huge issue is that the makers of OxyContin strongarm doctors into prescribing one every 12 hours even though the effects don’t last that long for a big chunk of patients. If you’re in the unlucky group, you’re basically prescribed an addiction.


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  • […] Can We Get Real About Opioids? and Opioids, My Mom’s Death, and Why People Trust Science Less […]

  • By Looking Behind the Tree | The Weekly Sift on October 30, 2017 at 11:46 am

    […] much has changed since I wrote about it in April, when Trump appointed the commission whose report is due Wednesday. Drug overdoses kill more people […]

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