U.S. Drug Epidemic: The Time is Out of Joint
By Angela Vullo
March 4, 2018–When parents and grandparents are attending nonstop funerals for their children and grandchildren, something in our society has gone awry. As Shakespeare put it, “The time is out of joint.” It reflects some major dislocation in our country, and it’s time we got to the bottom of it.
Author and journalist Sam Quinones is uniquely qualified to help us in this endeavor. As a reporter who has spent decades studying Mexican gang culture on both sides of the border, he has seen the criminal and personal side of the drug problem. In 2016 Quinones authored the book Dreamland on the opioid crisis that is now ravaging the nation, and has become a sought-after expert on that topic. While this blog covered his January 9th testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions in brief, we think much fuller coverage is necessary.
In over two hours of testimony, the author laid out the problem and the solution. On both counts, Quinones nailed it. He addressed the obvious problem of oversupply of opioids, that has increased over two decades, but he addressed the problem from a longer perspective. He identified the economic and cultural paradigm shift over the last fifty years, which he equated with free trade and globalization, and sees as resulting in the growing despair that has overtaken the country. He further attributed the problem as a turn away from the general welfare to isolationism, where it’s every man for himself and no longer a sense of community. As the only antidote he called for a national mission orientation, led by the federal government for a massive economic recovery program. He identified this with a type of post WW 11 Marshall Plan, or the kind of inspiring science driver of the Kennedy space program.
During the Q&A he addressed the multi-faceted aspects of dealing with addiction, and the need to keep people alive in the short term, but his main concern is on a long-term solution. “I would caution, however, against believing in short-term responses,” he said. “Everything I’ve learned about this issue has taught me the importance of long-term, community responses.”
In this article, I will deal mainly with the broad perspective Quinones laid out in his opening remarks. Let’s look first at his crucial analysis on how we arrived at this dire moment.
The No-Pain Society
Although Quinones characterizes the opioid crisis as severe, he also sees it as an opportunity to pull the nation together, or as he calls it, “a second chance”. On this note, he made his case to the nation’s lawmakers.
He minced no words:
This is the deadliest drug scourge we’ve known. [It’s] hitting areas of the country that had never seen this kind of drug problem.
It is the first in modern America to be spread not by mafias and street dealers, but by doctors over-prescribing pain pills, convinced they were doing right by their patients. Urged on by the pharmaceutical industry, by the medical establishment, and, indeed, urged on by us, by American health consumers, who too often wanted a quick fix and easy end to pain.
Supply has ignited all this. We did not have this demand, this widespread addiction, until we unleashed a large supply of powerful legal narcotic painkillers on the public for the last two decades.
Quinones does not specifically identify the 2001 report issued by The Joint Commission on Accreditation of Healthcare Organizations, but that document certainly backs up his argument. According to the Journal of Change, published by Independence Blue Cross Foundation, this report gets to the source of the oversupply problem of opioids. The Joint Commission is the entity that “accredits health care organizations, published standards for pain assessment and treatment that required accredited hospitals to assess and manage pain.”
The Journal of Change puts it this way: “In the wake of these standards, and with the prevailing belief that opioids were not addicting when used to treat pain, physicians willingly prescribed opioids to control pain and pharmaceutical companies developed progressively stronger synthetic opioids in response to demand.”
“In the ensuring decade the number of prescriptions doubled. They were increasingly prescribed in excess to manage pain after dental surgery for minor procedures and to treat otherwise healthy athletes following injuries.”)
In his testimony Quinones characterized this flood of opioids as no different than a foreign attack. “ISIS could not have dreamed of inciting the kind of torment and death that we have visited upon ourselves through this overuse of opiates.”
Then he launched into how the oversupply hit an already vulnerable population.
“For over four decades we have exalted the private sector, the individual, while we ridiculed government as inefficient, incompetent and wasteful. We admired wealthy businesspeople, regardless of whether the way they made their money produced anything of value for our country and our communities. We wrought a second Gilded Age.”
He correctly throws the blame on government and the shift from the government’s role in productivity into an economy run by a private sector obsessed with making a profit, rather than benefitting the nation. He believes that everyone must participate in government, that it be all inclusive, and that no one should drop out, or be discarded by society as a proverbial useless eater.
He insightfully proclaimed to the Senators: “I believe this scourge is about issues far deeper than drug addiction. It’s about the effects of this cultural shift. It’s about isolation in areas rich and poor, about the hollowing out of small town America and the middle class, and of the silo-ization of our society. And it’s about a culture that acts as if buying stuff is the path to happiness.”
Quinones recognizes that the country has increasingly lacked a mission since the 1960s, and that every individual has been left to fend for himself. He testified: “I believe we got into this because we believed problems could be attacked in isolation, with one magical Silver Bullet.” At the same time, he attacked the absurdity of trying to solve the problem with “A pill for all our pain. A jail cell for every addict.”
He demanded: “This epidemic is calling on us to reverse these decades of isolation and come together.”
A Wall is Not the Solution
Quinones attacked the idea of building a wall between the U.S. and Mexico. He called for the collaboration of both countries for the benefit of the other.
I have to say I think it’s delusional to spend time and money on yet another wall along the U.S.-Mexico border hoping that this will staunch the supply of heroin and fentanyl. These drugs are coming in through areas without walls.
I believe a wall will corrode the only thing that will truly help stop these drugs from flowing into our country: a deep, respectful, but also forthright and honest, relationship with Mexico that will lead to it finally become the kind of neighbor and partner we can work with effectively.
Another wall seems to me, is just like heroin: feels good for a moment, but will leave us in a worse place in the long run. Another Silver Bullet for a complicated adult problem.
However, he also made the point that the proximity of drugs from Mexico, in particular, has exacerbated the problem. “By the early 1990’s, most of our heroin no longer came from the Far East (Turkey, Burma, Afghanistan, but from Latin America – from Columbia, and today especially, from Mexico. From so close by, this heroin gets here cheaper and more potent then the Far East stuff. In other words, the Latin American heroin out-competed the heroin from the Far East.”
The Deeper Sickness
Turning to what actions must be taken, Quinones said that treatment must be preemptive and preventative, “Education is so important, but we should recognize that it doesn’t have much effect on an addict once she’s enslaved to the morphine molecule.”
We may not be able ‘to arrest our way out of this’, but it’s not clear to me that we can treat our way out of this, especially if the supply of highly potent and now cheap opiates in various forms remains so prevalent.
I believe more strongly than ever that the antidote to heroin is not naloxone. It is community. People coming together and working in small and local ways, toward solution. No one saving the world alone.
He regards the drug addiction as a metaphor for the greater sickness of the country, despair, and that despair ignited the crisis, supply addressed the despair.
Although he believes that communities must work together in small ways, he ultimately gets to the bigger role of government. “As politicians, your natural response to a crisis like this is to look about for things you can do quickly to show constituents you’re taking action,“ he said. But that won’t work.
History Is Key
Quinones then looked back to history for the solution. He enlightened the Senators: “American history offers two templates for action from which you might take guidance and inspiration”–“The Marshall Plan to rebuild Europe after World War 11,” and “our space program.” He then elaborated as to why:
Each involved government and the private sector, acting in concert over many years—bringing money, brains, energy, and long term focus to bear.
Each achieved an unalloyed good for our country—though they were doing things that seemed, on first blush, far beyond our own short-term interest.
The Marshall Plan was about building up ravaged regions to allow them to function independently, while containing the viral spread of Soviet communism. It allowed reborn countries to prosper and contribute to the world again.
A Marshall Plan for American Recovery might focus on rebuilding those regions that have been caught in dependence on dope and raged by economic devastation to contain the viral spread of addiction.
Through our space program, we were inspired to spend years and dollars, bringing together smart people—all to achieve something no previous generation thought possible. We ended up far beyond the moon.
The spillover in economic benefit, increase in knowledge, and in simple human inspiration is beyond calculation.
Seems like we might profitably apply these examples—the Marshall Plan and the space program—to the regions of forgotten Americans where this problem began. Let’s do it not because it is easy, but as JFK said, “because it is hard. Because that’s what Americans have always done at their greatest.
Quinones then implored the Senators: “I’m urging you to see this not only as the catastrophe that it is, but also as the gift that it can be.… It offers an opportunity to reinvest in areas that need it most. A chance to inspire us as Americans to be something great again.”
What Made America Great?
If America is to be great again, we need to redefine what initially made it great. That requires understanding history that is increasingly being buried and forgotten, a history that involves the American System of Economics.
While the Marshall Plan and Kennedy space program to rebuild America are excellent examples of a positive American economic approach, the best example is the depression-era New Deal. Franklin Roosevelt’s New Deal happened at a time of similar conditions of economic and cultural despair in the country. It was a government-financed economic recovery program that pulled the country together during its darkest days. It not only addressed immediate needs, but implemented a science-driver concept by creating jobs and infrastructure with a long-term perspective. In this new mission orientation FDR brought together all segments of the population and made it possible for everyone to participate–scientists, engineers, teachers, artists, etc.
The New Deal as a whole resulted in not only pulling the United States out of the depths of despair, but inspired a nation to become the greatest industrial power in the world, with the most powerful middle class. This defined a new American identity, both domestically and abroad. This is what we urgently need today to create a new direction for our country and to generate the hope and optimism for the future. No greater antidote can be applied.
Prescription for a Long-Term Recovery
As Quinones described in his testimony, “While some are dropping out, new blood is coming in.” He pleaded with the lawmakers to reach out to the population and include them in their solution.
I’d like to add that all across America are families who are suffering due to the addiction of a loved one, or the loss of that loved, one. I believe they are a raw material to be marshaled, harnessed in this fight. Many now want to be involved, need to be involved to help salve the lacerating wounds that will last a lifetime. I believe you as senators can help, this, by recruiting them, recognizing them, giving them platforms from which to tell their stories. Maybe it’s because I’m a reporter, but I believe that through their stories the awful stigma of addiction will be reduced.
I want to urge you to view this as an opportunity, … an opportunity to revive those regions hammered by globalization and free trade.
He then laid out his vision of how people should work together in a new Marshall Plan for America.
A Marshall Plan for American Recovery would fund new drug treatment capacity, vastly increase research into addiction and pain treatment, expand law enforcement efforts, especially of the Internet, give incentives to counties transforming jails into recovery units, expand the use of medically assisted treatment, and provide for coroners in small country.
It would also focus just as much on reviving those regions that have been caught in dependence on dope and ravaged by economic devastation. It might include a large and sustained federal investment in infrastructure. These are Rust Belt areas, Appalachia. But also of parts of Maine and Vermont. Of the Central Valley of California, and the Rio Grande Valley of Texas. They are parts of Mississippi and Alabama, the inner cities of Baltimore and Chicago, but also rural areas of New Mexico, Kansas and Oklahoma.
I suspect, by the way, that increased investment in addiction and pain research has the chance to transform some of these areas and be a detonator of economic development over many years.
One such area is the Ohio River Valley, including the states of Ohio, Kentucky, and West Virginia.
This region could be a world center for the study of addiction – one of humankind’s most persistent torments. Boston is the center of study of cancer and blood – to the great benefit of that area, and the world. Addiction, in all its form, afflicts far more people than does cancer.
Regional cooperation is key. One state alone, one sub-region alone, probably couldn’t achieve the synergies and the political pull needed. State and local government would have to work together toward this future. Folks at those medical centers would have to get to know each other, cooperate on studies and leverage their research abilities.
This is the kind of vision we need. It is time for us to be true Americans. Let’s not cower from the challenge out of fear.
In the words of Hamlet, “Let us go in together. And still your fingers on your lips, I pray. The time is out of joint—O cursed spite. That ever I was born to set it right! Nay, come, let’s go together.”