Here’s a weekly question we pose to our resident advocacy professional, Joe Schrank. Joe’s been a social worker for 25 years, so he’s seen firsthand what is now popularly known as the “opioid crisis” building for quite some time. Joe’s helpful responses to some obvious questions begin right below this bold paragraph.
1. Is opioid addiction different than any other drug addiction?
Yes. One of the great lies or misunderstanding about addiction is that it’s all the same. Addiction is actually a range based on impairment, and the stakes with opioid addiction are very high. There is also a string pull from the withdrawal and craving. It’s also cultural. Opioids are often considered a vice of the unwashed, marginalized and disregarded populations.
2. Why is everyone so obsessed with it now, though?
Because of white people. People are obsessed with it now because the consequence has hemorrhaged into populations with a voice. Often dismissed as a problem of black people who did it to themselves, it was previously easy to ignore the opioid crisis. Now that it impacts people with a voice– white people– it’s harder for America to ignore.
3. What is fentanyl and why is it killing so many people?
Fentanyl is a super-concentrated high-powered opiate. If heroin is orange juice, fentanyl is the can of frozen orange juice before you dilute it with water.
It’s killing so many people because it’s incredibly strong and people never really know what they are injecting. It’s one of the big problems with criminalizing drug use: maybe they inject opioids, maybe it’s Splenda, maybe it’s fentanyl, but users have no way to check.
4. What can we do to help? Can we help?
We can all help, we are all culpable and we are all responsible. The first thing we can all do is talk about it. Talk about the experience and normalize the discussion. Until we could talk about HIV, we couldn’t manage it. As long as families said “They had a rare cancer” we couldn’t deal with the problem.
We can all carry Narcan. Narcan should be in every first aid kit, communities should be flooded with the stuff. We can demand solutions from Congress.
The truth is, we can manage this. We have the knowledge, values, and skills to do it. Most states haven’t raised taxes on alcohol in decades. A simple .05/100 tax on alcohol could fund treatment on demand. We can start talking about shifting the train of criminalizing drug use onto public health policy.
5. Is this epidemic worse than any other drug epidemic?
It’s close. America has always had a drug epidemic. Americans love to get drunk and high, we should all get with it. This is likely worse than the crack epidemic but the narrative is different. Crack was killing black people so it was framed as crime and urban decay. This is killing the kid who played Little League with your son, so people care more now.
6. Does Dr. Drew know about this?
Sure he does. He is a medical doctor and the truth is we’re not getting out of this without medical intervention. Will he make an impact putting porn stars in reality shows? Not much if any.
7. Is this just a white person problem?
Not in the least. Addiction may be the only truly egalitarian system in America. Opiate treatment is needed in all demographics. White people are more likely to have insurance that pays or ability to flow cash, so they seem to have made it their problem. Rehab is a $35 billion a year industry. Check out rehabs – they are lily-white, but that’s not a good indicator of need.
8. Is President Trump helping?
Trump isn’t helping, he’s actually hurting. Mostly he seems to take the opportunity to further his fear-mongering that brown people are bringing the drugs. He’s very invested in furthering the criminalization of drug use. I would love to blame Trump, but Obama didn’t help. Also G.W. didn’t help, Clinton was horrible, Bush The First was awful, Reagan was terrible.
The thinking on addiction in America is fundamentally flawed and misguided. The fact that the person who leads the drug policy is called “the drug czar” and has had a career in military or law enforcement says America thinks drug use is a crime. We say it’s a disease, but it isn’t handled like one.
Trump is absurd; he has tapped Kelly Ann Conway to lead the fight. I have no idea what she knows about addiction but there are smart accomplished people who could really make an impact. The fact that he appointed someone with no experience or knowledge demonstrates his genuine lack of concern but really, he’s just a duck in the stream of failure.
9. So how do you actually fight this “crisis?”
There are a few ways, none of which Americans like. The first way is by massive reform of drug policy. Stop the criminalization of drug use and retool the entire thing using the knowledge, values and skills of public health. Other countries in Europe have done that and reduced overdose deaths by 80%. Portugal for one. An overdose death in Portugal is actually pretty rare. The other is to medicalize the rehab industry. At the moment it’s steeped in AA indoctrination, prayer, behavioral modification. That has a 3-5% success rate. If addiction is a disease, the process needs to be led by doctors. It’s kind of like bariatric procedures, the doctor is in charge but there many other people involved. For that to be a success, it requires emotional support, nutrition, exercise training but the end result is still the same. We could yell at obese people and tell them to pray but we offer them medical intervention as well. Addiction goes nowhere without massive reform.
10. What is the wrong way to react?
The wrong way to react is with shock, horror, and surprise. Drug users use drugs. The question is will they use egregious lethal street drugs or something regulated and supervised that will help them. Moral posturing is a horrible idea. The night Whitney Houston died I got a frantic call from Fox News to come and comment. They said “don’t say it was drugs”. Of course I said “in my view, dying of addictive disease isn’t different from dying from cancer after a long fight. It’s sad and jarring, but not a surprise”. People were incensed “Whitney was beautiful. You don’t know it was drugs”. Beautiful people die of addictive disease all the time. Any application of logic, morality, or judgement and we are dead in the water.
