Public health officials trace the current opioid epidemic to aggressive marketing by drug makers, over-prescribing by doctors, and a desire among patients to get a quick fix for their pain.
Journalist Sam Quinones would add another factor to that list: social isolation. He sees a nation divided politically and socially, and citizens who prefer to retreat into cable news channels and online chat groups that affirm their worldview rather than interact face to face with their own neighbors.
“We live in a time when we’re more connected than ever, but the connection is very, very flimsy and superficial,” says Quinones, who is author of “Dreamland: The True Tale of America’s Opiate Epidemic.”
“Heroin is almost like a poster drug for our time,” he says. “Heroin does the same thing: It brings people together who don’t want to have anything to do with anybody else who doesn’t know about where to buy dope.”
Quinones appeared on KET’s Connections to discuss the roots of the drug scourge and new approaches to respond to the crisis.
Factors Converge to Create a Crisis
The social isolation that Quinones says plagues the nation isn’t just the result of personal choices to stay within our own comfort zones.
“Hand in hand with that is the destruction of community,” he says. “Destruction through exporting jobs or just simply losing jobs but also not funding or destroying the community assets that bring people together.”
For Quinones, that trend is epitomized by the public swimming pool that’s memorialized in the title of his book. Dreamland was built in Portsmouth, Ohio, in 1929 and served generations of families in that blue-collar steel and manufacturing community.
But as industrial jobs slowly drained from the area in the 1970s and ‘80s, Portsmouth fell on hard times and so did the swimming pool. When Dreamland closed in 1993, Quinones says the heart of the town was destroyed.
Similar changes echoed across many communities around the nation, but especially in Appalachia. And they coincided with important changes in the health care industry.
“This was also a time when the pharmaceutical industry was seeing a new business model, which was, ‘you take your biggest drug and you hire huge numbers of sales reps,’” Quinones says. “It was a total revolution of the sales rep profession.”
Over a dozen years, the number of drug salespeople in this country quadrupled, according to Quinones. One of the new drugs this massive marketing force pushed was the painkiller oxycodone. Doctors had long sought better ways to treat pain, and opioid-based medicines sold under brand names like Oxycontin held great promise for doing so.
But it became all too easy for health care providers to prescribe these painkillers, Quinones says. Doctors, who felt pressured by managed care companies to see more patients, spent less and less time diagnosing individual cases. Patients wanted a quick fix for their discomfort. And pharmaceutical companies claimed their new opioid medicines were non-addictive.
“We got into this because we wanted easy answers to complicated problems,” Quinones says. “The complicated problem was the mystery of pain – how do we alleviate pain? …The problem is we used a one-size fits all magic bullet for everybody, which was narcotic painkillers.”
Quinones says doctors began to prescribe narcotics in enormous quantities and for conditions that didn’t warrant such powerful drugs. It’s a situation Quinones experienced firsthand in 2009. After a short hospital stay for an appendectomy, Quinones says he was sent home with a 30-day supply of Vicodin. He says the hospital staff never explained to him how addictive the drug could be.
The Crack Epidemic and the Opioid Crisis
The U.S. Centers for Disease Control and Prevention says overdose deaths involving prescription opioids have quadrupled since 1999. In 2015 alone, opioids including prescription opioids, heroin, and fentanyl killed more than 33,000 people. Last year, more than 1,400 Kentuckians died from drug overdoses.
Quinones says the opioid crisis has been growing for 20 years, and it will probably take at least as long to fix the problem. He says when he first started writing his book, few friends and family members of drug overdose victims would discuss the issue.
“Nobody wanted to talk about it, I think largely because the primary victims were white,” Quinones says, “and [their families] were aghast that their prized children were now on a McDonald’s bathroom toilet, slumped over, overdosing.”
But he says the shame and stigma is starting to lift. People are willing to acknowledge overdose as the cause of death in a loved one’s obituary, and they are speaking up in public meetings about the loss they experienced. Quinones says the criminal justice response to the crisis is also evolving because of the number of middle- and upper-class white families that are being affected.
“Now that their kids are getting addicted, they are now understanding some basic realities about addiction,” he says. “…the reality of how a felony record will mangle a kid’s life for the rest of his life.”
Some African American activists have questioned why law enforcement responded to the crack cocaine epidemic that swept many black communities in the 1980s and ‘90s with tougher laws and harsher sentences, while the opioid crisis is being met with a greater emphasis on treatment. Quinones says he doesn’t believe the differing approaches are rooted in racial disparities. He contends the massive amounts of public violence that accompanied the spread of crack helped drive the stricter criminal justice response.
“I don’t know if current focus on treating addiction as a disease would be at all acceptable had we the same level of violence associated with [opioids] that we had with crack,” he says.
Expanding Treatment Options
Whatever caused the shift in perspective, public officials are responding with more funding for treatment options, needle exchange programs, and overdose reversal kits. Another positive trend, says Quinones, is to make addiction treatment more widely available to jail and prison inmates. He says some two dozen Kentucky county jails now offer intensive treatment and counseling to inmates with substance abuse issues. Quinones says that’s a much better use of corrections funding than to simply imprison those with an addiction with more hardened criminals.
“This epidemic is showing us a lot of what we’ve not been doing very well in this country,” he says. “And one way, I think, is we need to rethink jail.”
Quinones also supports medication-assisted treatment for inmates that combines behavioral therapy and medications to treat substance use disorders. Having a medication in their system that deters future illicit opioid use is especially important when inmates are released back to their communities, according to Quinones.
“We cannot have the supply of illegal and legal dope out on the street and expect people to get out of treatment without any shield from that and live,” Quinones says.
Some researchers are exploring how medical marijuana might also be used to treat opioid addiction. That idea often gets wrapped in the larger questions about marijuana legalization, which Quinones says is a complicated issue. He contends that newer strains of cultivated marijuana are significantly more potent, and there hasn’t been enough research into how those higher concentrations of THC, the chemical compound in cannabis that generates the high, might affect the brains of young adults.
“I believe that there are probably very great medical benefits that we can gain from marijuana but there also are significant downsides,” Quinones says. “Just rushing headlong into [wider legalization] is, I think, a huge mistake.”
