“Once you’re into heroin, it’s almost like a relationship with a person you love. And letting go of that – the thought of never seeing someone I love again – I couldn’t imagine giving it up forever.” – A homeless user in San Francisco (Time Special Report: “The Opioid Diaries”)
Attempting to make sense of the worst crises and catastrophes to plague mankind, analysts often describe how “a perfect storm” of events and conditions have worked together to bring about some great evil.
Thus, the “unsinkable” Titanic, which dragged more than 1,500 souls down to the bottom of the North Atlantic in 1912, didn’t simply crash into an iceberg due to rotten luck. “The ship was ensnared by a perfect storm of circumstances that conspired her to her doom,” writes British scientist Richard Corfield. “Such a chain is familiar to those who study disasters – it is called an ‘event cascade.'”
The ship was traveling too fast. The steersman made a wrong turn. An uncontained coal-bunker fire raged below deck. The hull’s iron rivets were too weak. The weather was conducive to drawing icebergs into the ship’s path. Though specific iceberg warnings were received over the wireless, the Titanic’s captain wasn’t told because the message didn’t carry the required prefix. And binoculars that would have enabled lookouts to see the iceberg for themselves were locked up on-board ship – the key held by an officer cut from the crew just before departure. A perfect storm.
Today, like the Titanic disaster, America’s ever-growing opioid epidemic is the result of another perfect storm of cascading events and conditions. But instead of 1,500 dead, the opioid crisis has taken the lives of more than 500,000 Americans since 2000 – and some experts believe another 500,000 may die in the next decade if current trends persist. In 2016 and 2017, more Americans lost their lives each year to drug overdoses than died during the entire Vietnam War, driving Americans’ life expectancy as a whole downward.
And the epidemic is only worsening. According to new data released by the Centers for Disease Control and Prevention in March, opioid overdoses are dramatically spiking across America.
“We have an emergency on our hands,” CDC acting director Anne Schuchat told National Public Radio. “The fast-moving opioid overdose epidemic continues and is accelerating. We saw, sadly, that in every region, in every age group of adults, in both men and women, overdoses from opioids are increasing.” In the last year, hospitalizations for overdoses jumped 14 percent in the Southeast, 20.2 percent in the Southwest, 21.3 percent in the Northeast, 40.3 percent in the West, and a staggering 69.7 percent in the Midwest.
Moreover, officials say overdose and death rates are almost certainly higher than those reflected by statistics, since many victims never see the inside of an emergency room. Indeed, fueled especially by ultra-potent substances like fentanyl, drug overdoses are now the leading cause of accidental death for Americans under the age of 50, reports the CDC.
More ominous yet, it turns out many “accidental” overdose deaths may be intentional. Maria A. Oquendo, M.D., Ph.D., immediate past president of the American Psychiatric Association, recently said that based on the best available data, “it looks like it’s anywhere between 25 and 45 percent of deaths by overdose that may be actual suicides.”
What sort of “perfect storm” or “event cascade” could possibly be causing such a catastrophic meltdown of American civilization?
‘The 5th vital sign’
Historically, America has learned through hard experience that highly addictive drugs are best kept extremely hard to come by.
During the 19th century, opium, morphine and their derivatives were widely used with apparently few alarm bells ringing. “Doctors administered morphine liberally to their patients,” reports the New York Times, “while families used laudanum, an opium tincture, as a cure-all, including for pacifying colicky children.” Noting that doctors of that era “did not fully appreciate the risks these drugs posed,” the Times says many physicians “viewed morphine as a wonder drug for pain, diarrhea, nerves and alcoholism.”
Meanwhile, as millions in China were hooked on smoking opium, the Times reminds us of another shocking bit of history: “In the mid-1800s, the British went into battle twice – bombing forts and killing thousands of civilians and soldiers alike – to keep the Chinese market open to drug imports in what would become known as the Opium Wars.” That’s right: The British were, at that time, selling thousands of tons of opium to China every year. All the while, Americans, from Civil War veterans to housewives, were becoming addicted – including many doctors themselves.
Finally, in 1914, Congress passed the Harrison Narcotics Tax Act, prohibiting doctors from prescribing opiates for America’s many addicts.
“Americans had had it with heroin,” summarizes journalist Christopher Caldwell. “It took almost a century before drug companies could talk them back into using drugs like it.”
In his article “American Carnage: The new landscape of opioid addiction,” Caldwell notes that throughout most of the 20th century, “powerful opiates and opioids (an opioid is a synthetic drug that mimics opium) were largely taboo – confined to patients with serious cancers, and often to end-of-life care.”
But then – as always seems to happen – history more-or-less repeated itself. Caldwell sets the stage:
[T]wo decades ago, a combination of libertarian attitudes about drugs and a massive corporate marketing effort combined to instruct millions of vulnerable people about the blessed relief opioids could bring, if only mulish oldsters in the medical profession could get over their hang-ups and be convinced to prescribe them. One of the rhetorical tactics is now familiar from debates about Islam and terrorism: Industry advocates accused doctors reluctant to prescribe addictive medicines of suffering from ‘opiophobia.'”
Thus it was, throughout the 1990s, that a new medical culture came into being, one strongly advocating that doctors come as close as possible to completely eliminating pain. Organizations of all sorts, medical journals and government converged on the idea that relieving pain was not being given sufficient emphasis in treatment. That’s when all the smiley-faced, 0-to-10 pain scales started appearing in doctors’ offices everywhere.
It was while all this was happening, writes Sarah Kliff in Vox, that “James Campbell, a neurosurgeon at Johns Hopkins University, took the stage at the American Pain Society’s 1996 annual conference in Los Angeles.” In “The opioid crisis changed how doctors think about pain,” Kliff describes the momentous sea change then occurring.
Campbell, she writes, “was the society’s president, and he delivered the keynote address”:
Campbell argued for a major change in pain management. Doctors took vital signs seriously, he said. They measured your pulse and blood pressure at each visit, and got worried if the numbers were off.
It was time, he said, to elevate pain to the “fifth vital sign,” along with temperature, pulse, breathing rate, and blood pressure.
“If pain were assessed with the same zeal as other vital signs are, it would have a much better chance of being treated properly,” Campbell told the audience. “We need to train doctors and nurses to treat pain as a vital sign.”
The group went on to trademark the slogan: “Pain: The Fifth Vital Sign.” Campbell remembers that before his speech, hastily and at the last minute, somebody made up some buttons that said, “Check the sign.” Doctors at the conference pinned them to their lapels.
What most people didn’t know was that the American Pain Society at that time was funded largely by Purdue Pharmaceutical, manufacturer of OxyContin, an “extended release” version of oxycodone. So while this expansive pharma-funded public relations campaign was pushing hard for enhanced treatment of pain, OxyContin was introduced to America with huge marketplace success.
“The time-release formula meant companies could pack lots of oxycodone into one pill, with less risk of abuse, or so scientists claimed,” writes Caldwell, a senior editor at the Weekly Standard. “Purdue did not reckon with the ingenuity of addicts, who by smashing or chewing or dissolving the pills could release the whole narcotic load at once. That is the charitable account of what happened,” he says.
The darker reality is reflected in the fact that, in 2007, three of Purdue’s executives pleaded guilty and had to pay over $600 million in fines for misleading the public about OxyContin’s risk of addiction. Their company also agreed to pay $19.5 million to 26 states and Washington, D.C., to settle complaints it had encouraged physicians to overprescribe OxyContin.
“With its OxyContin, Purdue unleashed a highly abusable, addictive and potentially dangerous drug on an unsuspecting and unknowing public,” U.S. Attorney John Brownlee said in a news release. “For these misrepresentations and crimes, Purdue and its executives have been brought to justice.”
In 2010, notes Caldwell, “Purdue brought out a reformulated OxyContin that was harder to tamper with. Most of Purdue’s revenues still come from OxyContin. In 2015, the Sackler family, the company’s sole owners, suddenly appeared at number sixteen on Forbes magazine’s list of America’s richest families.”
The result: ‘433 pain pills for every man, woman and child’
In its Pulitzer Prize-winning series, the Charleston Gazette-Mail begins part one, headlined “Drug firms poured 780 million painkillers into West Virginia amid rise of overdoses,” with some truly staggering statistics:
Follow the pills and you’ll find the overdose deaths.
The trail of painkillers leads to West Virginia’s southern coalfields, to places like Kermit, population 392. There, out-of-state drug companies shipped nearly 9 million highly addictive – and potentially lethal – hydrocodone pills over two years to a single pharmacy in the Mingo County town.
Rural and poor, Mingo County has the fourth-highest prescription opioid death rate of any county in the United States.
The trail also weaves through Wyoming County, where shipments of OxyContin have doubled, and the county’s overdose death rate leads the nation. One mom-and-pop pharmacy in Oceana received 600 times as many oxycodone pills as the Rite Aid drugstore just eight blocks away.
In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians fatally overdosed on those two painkillers, a Sunday Gazette-Mail investigation found.
The unfettered shipments amount to 433 pain pills for every man, woman and child in West Virginia.
“These numbers will shake even the most cynical observer,” former Democratic Delegate Don Perdue, a retired pharmacist, told the Gazette-Mail. “Distributors have fed their greed on human frailties and to criminal effect. There is no excuse and should be no forgiveness.”
Taking a hard line against the prescribing doctors and pharmacists, but particularly the pharmaceutical companies and distributors, the Gazette-Mail’s exposé was scathing:
“As the fatalities mounted – hydrocodone and oxycodone overdose deaths increased 67 percent in West Virginia between 2007 and 2012 – the drug shippers’ CEOs collected salaries and bonuses in the tens of millions of dollars. Their companies made billions. [Hydrocodone distributor] McKesson has grown into the fifth-largest corporation in America. The drug distributor’s CEO was the nation’s highest-paid executive in 2012, according to Forbes.”
And yet, the story noted ironically, “In court cases, the companies have repeatedly denied they played any role in the nation’s pain-pill epidemic.”
If over-prescription has flooded the nation with highly addictive opioid pills, from its greatest cities to its tiniest towns, the drugs’ illegal counterparts have grown to comprise another – and arguably even bigger – part of the problem, at least in terms of overdose deaths. Two drugs in particular dominate here: heroin and fentanyl, which have evolved a bizarre and deadly relationship.
Americans are much more familiar with heroin, the ubiquitous, highly addictive, euphoria-inducing illegal narcotic derived from morphine. The federal Drug Enforcement Administration says most heroin entering the U.S. is crossing our southern border, with 50 percent coming from Mexico and another 43-45 percent from Colombia, via drug cartels.
But heroin has been largely overtaken by fentanyl in terms of numbers of overdose deaths, thus earning a reputation as a major drug villain. Yet legally manufactured fentanyl, about 50 times as strong as heroin, was used more widely in medicine than any other synthetic opioid in 2017. The same fentanyl patches so abused by addicts are listed on the World Health Organization’s “List of Essential Medicines” – the most effective and safe medicines needed in establishing a health system anywhere in the world.
Nevertheless, explains Caldwell, these days, “when we say heroin, we increasingly mean fentanyl,” especially the illegally manufactured kind:
China manufactures a good deal of the fentanyl that comes to the U.S., one of those unanticipated consequences of globalization. The dealers responsible for cutting it by a factor of fifty are unlikely to be trained pharmacists. The cutting lab may consist of one teenager flown up from the Dominican Republic alone in a room with a Cuisinart and a box of starch or paracetamol. It takes considerable skill to distribute the chemicals evenly throughout a package of drugs. Since a shot of heroin involves only the tiniest little pinch of the substance, you might tap into a part of the baggie that is all cutting agent, no drug – in which case you won’t get high. On the other hand, you could get a fentanyl-intensive pinch – in which case you will be found dead soon thereafter with the needle still sticking out of your arm. This is why fentanyl-linked deaths are, in some states, multiplying year on year.
In 2016, fentanyl alone (including its analogues) was implicated in 20,000 deaths in the United States. But make no mistake: Vastly over-prescribed opioid pain pills have been the “entry drug” for later heroin or fentanyl use (or the illegal use of pain pills), proven by the fact that 80 percent of heroin users started on pain pills. (Fortunately, only 4 percent of legal opioid users become addicts.)
To summarize: The storm of opioid overdose deaths has occurred in three distinct waves. The first was caused by the wild and wanton over-prescription of opioids during the 1990s; the second, starting in 2010, was characterized by a rapid upsurge in overdose deaths due to heroin; and the third, beginning in 2013, has seen huge increases in deaths involving synthetic opioids, especially what law enforcement calls IMF – illicitly manufactured fentanyl.
‘Deaths of despair’
One more major but seldom-acknowledged factor contributing to the current opioid epidemic needs mentioning.
As the fabric of American society continues to unravel, vital immunities that once protected its people are disappearing. For example, up until the 1970s, the divorce rate was much lower than today. People surely had the same weaknesses and couples encountered the same problems then as now, but their marriages were more protected by powerful societal, religious and legal sanctions against divorce. Today those protections are largely gone and divorce is rampant.
Likewise, mainlining heroin was simply unthinkable for vast swaths of American society during our grandparents’ era. Today, much that was once unthinkable – not just shooting heroin, but everything from aborting two babies per minute, to over-diagnosing millions of school children with ADHD (mostly boys) and drugging them, to enduring frequent mass shootings and terror attacks, to being forced to embrace dozens of brand-new genders, to seeing rampant immigration radically transform our nation’s social fabric, labor market and electorate – is not only thinkable, but our ever-present reality.
Underlying all of this is a nagging sense that somehow the very sacredness of human life itself – that which confers order, meaning, value, purpose and ultimate worthwhileness to our lives, and which alone can inspire nobility, selflessness and cheerful sacrifice – has been sucked out of our society. We perfume this poverty with terms like “post-Christian” and “secular,” but what we really mean is that our elite thought-leaders in academia, science, the arts, entertainment, the press and government no longer acknowledge God. And unfortunately, failing to live in the service of a higher power and greater values than ourselves makes life meaningless and painful, and the slow suicide of addiction seems almost logical.
In fact, a revealing NPR story headlined “How many opioid overdoses are suicides?” reports that Princeton economists Angus Deaton and Anne Case, in a 2015 paper, “tracked falling marriages rates, the loss of stable middle-class jobs and rising rates of self-reported pain.” Startlingly, the authors say,
opioid overdoses, suicides and diseases related to alcoholism are all often “deaths of despair.”
“We think of opioids as something that’s thrown petrol on the flames and made things infinitely worse,” Deaton says, “but the underlying deep malaise would be there even without the opioids.”
A ‘perversely clever copy of that transcendent peace of God’
“I had a career in sales in the automobile business. I was making a lot of money, upwards of $100,000 a year. Then I started up with the OxyContins. It’s an amazing feeling, that warm hug from Jesus. It started as a once-in-a-while thing. But I began telling myself, ‘Well, if I can feel this good on Friday and Saturday, why shouldn’t I feel this good on Tuesday and Wednesday?’ And then the price started going up, and all of a sudden they’re $80 a pill. At this point, I’ve got a six- or seven-pills-a-day habit. I wouldn’t get out of bed without one. I always knew about heroin, but it was a line I didn’t want to cross. But, you know, the ship had already sailed. An opiate’s an opiate’s an opiate.” – John, an active user in Massachusetts (Time Special Report: “The Opioid Diaries”)
So what’s the solution? How can America defeat the many-headed hydra of opioid addiction?
Understandably, the crisis generates much public discourse. President Trump declared it a national “public health emergency” and his administration is developing a multifaceted plan to address it. His surgeon general, Jerome Adams, has made the opioid epidemic one of his top two priorities, declaring that “addiction is a chronic disease, and not a moral failing.”
Except there is a problem with this popular and comforting sentiment.
“Calling addiction a disease,” observes Caldwell, “usefully describes certain measurable aspects of the problem – particularly tolerance and withdrawal.” However, he adds, “it fails to capture what is special and dangerous about the way drugs bind with people’s minds. Almost every known disease is something people wish to be rid of. Addiction is different. Addicts resist known cures – even to the point of death. If you do not reckon with why addicts go to such lengths to continue suffering, you are unlikely to figure out how to treat them.”
He expands this point by citing University of Denver philosophy professor Francis F. Seeburger’s insightful 1993 book, “Addiction and Responsibility,” which explores the thought processes of addicts:
A cliché among empathetic therapists, eager to describe addiction as a standard-issue disease, is that “no one ever decides to become an addict.” But that is not exactly true, Seeburger shows. “Something like an addiction to addiction plays a role in all addiction,” he writes. “Addiction itself … is tempting; it has many attractive features.” In an empty world, people have a need to need. Addiction supplies it. “Addiction involves the addict. It does not present itself as some externally imposed condition. Instead, it comes toward the addict as the addict’s very self.” Addiction plays on our strengths, not just our failings. It simplifies things. It relieves us of certain responsibilities. It gives life a meaning. It is a “perversely clever copy of that transcendent peace of God.”
Noting that the Christian founders of Alcoholics Anonymous “thought there was something satanic about addiction,” Caldwell says, “The mightiest sentence in the book of Alcoholics Anonymous is this: ‘Remember that we deal with alcohol – cunning, baffling, powerful!'”
Thus, he concludes, “the addict is, in his own, life-damaged way, rational. He’s too rational. He is a dedicated person – an oblate of sorts, as Seeburger puts it. He has commitments in another, nether world.”
There is indeed something otherworldly and quasi-religious about addiction. Maybe that’s why all the individual puzzle pieces don’t quite add up to the whole, why the “perfect storm,” with all its “cascading events,” somehow falls short of fully explaining the devilishly seductive plague now destroying so many Americans.
We humans, after all, don’t exist only in a natural sphere like animals, where a negative “event cascade” – say, drought, famine, predators and overpopulation of competing species – would predictably cause widespread death. The human race uniquely inhabits a special moral-spiritual dimension of good and evil, which means each person’s life is inevitably shaped by powerful “otherworld” influences, for better or worse, coming through his own mind – the same mind targeted by addictive drugs. Put more plainly, one could reasonably conclude that drug addiction opens people up to demonic influence – or as recovery experts and doctors commonly put it, addiction “hijacks the brain.”
Choose your terminology but consider the evidence, as dramatically demonstrated on A&E’s Emmy-winning “Intervention” TV series, which documents interventions staged on behalf of countless addicts, intended to get them into a recovery center.
Here is an entirely typical scene: A young addict, surrounded by her loved ones plus the interventionist, is told, in turn, by her mother, father, brother, sister, boyfriend, childhood best friend and beloved grandfather that they will all do everything possible to help, support and love her if she’ll just agree to let them escort her to a state-of-the-art recovery center to get her life back. It’s completely free of charge – the rehab centers absorb the cost in return for being featured on the show. Before she makes her decision, however, the addict is also informed of the downside – that should she refuse to go, so she can stay with her first love, heroin, she’ll literally lose everything. Thus, her mother tells her, tearfully, that her precious daughter would have to move out of her home. Her father says the addict’s infant-and-toddler children would be permanently taken away from her – and that she’ll also see no more money, or food, or help from her family or friends. Her best friend and boyfriend both say they’ll exit her life, and her siblings cry, sob and beg her to get help – the best available in the world, all for free – because her addiction is destroying not only her life, but their lives as well. If she agrees to go, she gains everything – if she refuses to take the help offered, she loses everything and everyone she has ever known and loved. Plus, she will also soon be dead from the inevitable overdose.
Does this sound like a really hard decision to make?
Believe it or not, often it’s extremely difficult, and sometimes the addict literally jumps up and runs out of the room, because the “addict mind” – the “hijacked mind,” the “possessed mind” – has completely taken over her thinking.
This is not your normal “disease.”
The truth is, recovery is difficult, because the addiction pattern remains deeply engrained, even after successful detox has ended all physical dependency. The “memory” of the addiction lives on in the brain’s neural pathways – or in moral-religious terms, as a sin pattern – and beckons in times of stress and weakness. Relapse is an ever-present danger.
If, as experts and addicts attest, addiction can amount to a sort of quasi-religious devotion, complete with single-minded suffering, sacrifice and renunciation of worldly pursuits for the sake of a certain “god” and the “peace” he gives (however infernal and destructive to both the addict and his loved ones), then it’s reasonable to conclude that the best – and perhaps only – path to salvation from dependence on this false god is becoming wholly dependent on the real God.
This is why the founders of Alcoholics Anonymous created their successful 12-step program, which has been widely adapted for all forms of addiction. The program represents an admirably sound guide to genuinely turning one’s broken life over to the Great Healer. Without this, the addict can go through the most modern chemical detox, become entirely free of heroin or other opioids within two weeks, be plugged into a support group and given every opportunity for success and every mode of encouragement and counseling available – and still relapse. It happens all the time.
It seems only one thing can truly fill the proverbial “God-shaped hole” in each one of us.
Epilogue
In his book “The Problem of Pain,” C.S. Lewis argues that pain is, in many respects, the very language God uses to get our attention and bring us to Him.
“God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: It is His megaphone to rouse a deaf world,” writes Lewis, widely regarded as the 20th century’s foremost Christian apologist. “No doubt pain as God’s megaphone is a terrible instrument; it may lead to final and unrepented rebellion. But it gives the only opportunity the bad man can have for amendment. It removes the veil; it plants the flag of truth within the fortress of the rebel soul.”
The preceding is the opening article in the June issue of WND’s acclaimed Whistleblower magazine, edited monthly by David Kupelian. The issue, which explores the opioid crisis in-depth, is titled “OPIOID NATION: Conquering America’s worst drug epidemic ever.”
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