Wednesday, July 26, 2017

There Is No Opioid Epidemic

Rachel Maddow has done solemn, suit-clad journalism
on the awfulness of opioid addiction
I'm sick of hearing about the "opioid epidemic." Repeating this claim has become a sure-fire way for media professionals to prove that they're serious about fixing the problems in American society today. Mainstream journalists like Dan Rather and Rachel Maddow have done somber think pieces about opioids, while humorists like John Oliver and Adam Conover approach the problem from a satirical, but still po-faced, angle.

There's just one problem. It's a bunch of crap.

Pause a moment and think about this: what do we call somebody who can't stop taking pain medication? Somebody who continues popping pills long after it's become measurably clear that their appetite for the medication drives a wedge between themselves and their family? Somebody who would rather pop pain medications than hold down a job, have a place in the community, or pursue constructive hobbies?

Modern medicine calls such people addicts. But I suggest another name altogether: patients. A person consuming pain medications with such dogged desperation, probably needs the pain to go away. Calling this person a moralistic name like "addict" implies the person has suffered a failure of ethical character, and we need to punish that person—an attitude which uses medicine and law to enforce moral values. Calling this person a "patient" lets us seek the root underlying pain.

We do need to distinguish here between addicts and recreational users. Some people take pain medication, mind-altering drugs, or prescription stimulants and steroids to enjoy the altered state of mind. Such people creep me out, but they aren't addicts; they just enjoy seeing the world from another perspective for a few hours, usually in the company of friends. As long as they harm nobody but themselves, stopping them feels pretty high-handed.

John Oliver plays the story for laughs, but
clearly has the same self-serious intent
But addicts have a completely different situation. They cannot stop taking whatever substance they're addicted to, because without it, they feel incomplete, pained... inhuman. Addicts don't want to feel good; they want to feel normal.

Consider what people become addicted to. Besides opioids, the most common addictive substances include alcohol, heroin, cocaine, and codeine. All of these are, or were at one time, prescription painkillers. Other addictive substances include nicotine, marijuana, and Valium, which all have anti-anxiety properties. Even lowly methamphetamine, the one drug I'd like to see permanently forbidden, began life as a prescription anti-anxiety medication, Benzedrene.

Besides substances, people can become addicted to behaviors. Psychologists have observed and treated people demonstrating addictions to gambling, sex, eating, work, and more. Each of these behaviors creates an internal reward system: the giddy rush of waiting for your pony to win, the sense of accomplishment from a job well done. They also give addicts something to think about other than the mundane, and possibly painful, circumstances of their day-to-day lives.

Opioid addiction, when considered in news or late-night comedy, seems inextricably entwined with two circumstances: medical trauma, or chronic unemployment. I've noticed a persistent trend of connecting opioids with West Virginia coal country, where declining revenues have forced many former miners, many suffering black lung and other work-related injuries, out of the workforce. The physical pain of illness, and the psychological pain of uselessness.

Journalist Nick Reding, author of Methland, correlates the most widespread consumption of methamphetamine with America's rural communities, where dwindling economic opportunities and declining wages make grasping at straws a necessity to get by. Addiction specialist Gabor Maté, based in Vancouver, British Columbia, notes how many of his destitute patients come from physically or sexually abusive backgrounds. Pain and addiction go hand-in-hand.

So God forbid we actually address the real problem.

The phrases "opioid addiction" and "coal country" keep coming up in the same news stories,
usually without any comment on the connection between addiction and despair

America's policy for dealing with addiction, largely unchanged since the days of Harry J. Anslinger, remains to jail offenders, regardless of their suffering. The isolation of prison, where prisoners lack social networks, meaningful work, or even sunlight, will only compound whatever pain got them addicted to begin with. Rather than helping addicts deal with their problems, our criminal justice outlook only doubles down on the underlying causes of addiction and other diysfunction.

Solemn, tedious think pieces about opioid addiction allow journalists to look engaged with America's diffuse suffering. But they exonerate a socioeconomic system that devalues humans and profits off their pain. Prescription pain meds cannot advertise on broadcast media, so blaming them doesn't hurt revenue. Media professionals thus excuse their own complicity in an economy that encourages resource hoarding, devalues labor, and treats humans as interchangeable parts.

And buying that crap lets us, the audience, off the hook for profiting from that system. Stripped of glitz, the problem is us.


  1. Great article. Mind if I share this on my blog?

    1. If you share, I have only two stipulations. First, share it as I have written it, without changes. And second, keep my name on it. If you do both, you may share.

  2. Pain clinics very much contributed to this problem when they started up in the nineties. Now physicians, internists and family physicians and surgeons refer their patients "out" to "specialty" pain clinics that are disrespectful to patients. Patients become frustrated and fall out from pain clinics. Yes, they drop out to do the inhumane treatment encouraged by CDC guidelines based on poor evidence. Pain clinics should shut down. Patients belong wit their family physicians.