What the overdose epidemic teaches us about our deepest needs…

…and how modern society fails to meet them.

Hi everyone. I hope your summer is going smoothly, safe from insects, droughts, forest fires, and other human-assisted calamities. I’m on vacation in France now, after a harrowing trip giving talks, first in Victoria, Canada, and then in Melbourne and Brisbane. Harrowing because I flew across 16 time zones, then back, in just a week. But it was a great trip, the highlight of which was hanging out with inmates, then giving a talk, at a beautiful prison on Vancouver Island. I know the phrase “beautiful prison” is rare, but this was a rare place. It included an area for First williamheadNations rituals (complete with sweat lodge!), a Buddhist meditation parkette, and wild deer running everywhere. The only problem for the prisoners was that they couldn’t leave. The place was a living contradiction, and of course most inmates had been through addiction. A few of them gave me lovely gifts when I left. They spent their time developing craftsmanship in wood and metal. (And yes, I was allowed to leave — but I felt a familiar anxiety at the exit post, left over from years ago.)

Now that the zillions of comments on April’s moving post have finally died down, here’s a “vacation post” — a shortened and revised version of an article I published in The Guardian about a month ago. I’ve been asked many times what I think about the opioid/overdose epidemic hitting the US and Canada in particular but also the UK and other regions. Here are my thoughts.

……….

Most drug-related deaths result from the use of opioids, the molecules that are marketed as painkillers by pharmaceutical companies and heroin by drug lords. Opioids comprise a large family of molecular cousins, some weak, some powerful, all united by their capacity to bond with the opioid receptors all over our bodies, particularly our brains. Those receptors evolved to protect us from panic, anxiety, and pain. But the gentle impact of natural opioids, produced by our own bodies, resembles a summer breeze compared to the hurricane of physiological disruption caused by drugs — opiates — designed to mimic their function. And as if heroin wasn’t enough of a bull in the China shop, most street opiates (including heroin) are now laced or replaced with deadfentanyl and its analogues, far more powerful than heroin and so cheap that drug-dealing profits are skyrocketing at about the same rate as overdose deaths. People don’t know what they’re getting and they take too much. Fentanyl is recognized as a primary driver of the overdose epidemic.

Society’s response has been understandably desperate but generally wrong-headed. We start by blaming addicts for their self-indulgence or weakness of will. We blame the pharmaceutical companies for helpfuldocdeveloping and marketing painkillers. We blame doctors, for overprescribing opiates, which pressures them to underprescribe them, which drives patients to street drugs — cheaper, home-delivery via the arrestinginternet, and zero quality control. We say we’re going to rekindle the war on drugs, recognized by experts as a colossal failure from the thirties onward. Dealers will always find their way to consumers if the price is right. We also continue to view addiction as a chronic brain disease, so the benefits of education, social support, and psychological intervention receive far too little attention. Black-and-white solutions are simply inadequate for a problem of such complexity.

There has been some progress: There are pockets of activity here and there where prescribed opiates — like methadone and buprenorphine (Suboxone) — are made more easily available to addicts. That’s a good thing, because increasing addicts’ desperation (e.g., methadone clinic line-ups on the far side of town) often drives naloxone savethem to the street, where they’re most likely to die. The availability of naloxone, an opiate neutralizer, is slowly wending its way through the drug policy jungle, providing a simple resource to combat overdose on the spot. But in most segments of most communities in the US and elsewhere, naloxone is still too difficult to obtain.

I think there are smarter answers at hand — but also smarter questions to be asked. The opioid overdose epidemic compels us to face one of the darkest corners of modern human experience head on, to stop wasting time blaming the players and start looking directly at the source of the problem. What does it feel like to be a human trying to make it in the early 21st century? Why are we so stressed out that our own (internal) supply of opioids isn’t enough to feel okay?

The overdose crisis obviously builds on people’s desire for opioids. But what do opioids actually do? The opioid system was designed by evolution to allow us to function, not panic or shut down, when we are under threat or in pain. Critically, support from other humans also helps us cope with stress, and that support is underpinned by huggingopioids too. Our attachment to others, whether in friendship, family, or romance, requires opioid metabolism so that we can feel the love. Opioids grant us a sense of warmth and safety when we connect with each other. You get opioids (from your own brain stem) when you get a hug. Breast milk is rich with opioids. Rodents play more when given mild doses of opioids.

isolationIn short, we need opioids to feel safe and to connect with each other. Then what does it say about our life-style if our natural supply isn’t sufficient? It says we are stressed and isolated. That’s a problem we need to resolve.

To confront the problem of addiction, many have proposed targeted education, community support, and interpersonal bonding through group activities. Johann Hari’s powerful book, Chasing the Scream, reviews how such initiatives have worked in diverse societies. An intriguing example is the compassionate, blame-free dialogue that has naturally evolved among high-school students in Portugal, highlighting the dangers of hard drugs and urging the most vulnerable to abstain — not because they’re going to get in trouble but because addiction is miserable and dangerous! The emergence of this dialogue has been particularly meaningful because it has paralleled the decriminalization of drug use. Portugal had an astoundingly high heroin addiction rate 17 years ago. It now boasts the second lowest overdose rate on the continent. Drug addiction has diminished significantly in Portugal because compassion and social inclusion actually work against addiction, while punishment only fuels it.

But let’s look beyond the challenge of addiction per se. The peculiar appeal of opioids tells us more about ourselves as a society, as a culture, than addiction statistics can reveal. Today’s young people come of age and carve out their adult lives in an environment of astronomical uncertainty. Corporations that used to pride themselves on fairness to their employees now strive only for profit. The echelons of management are as risk-infected as those of the lowest clerks. Massive layoffs rationalized by the eddies of globalization make long-term deliverycontracts antique. I ask the guys who come to the house to deliver packages or upgrade our TV box how they like their jobs. They can’t say. They get up to three six-month contracts in a row and then they get laid off so the company won’t have to pay them benefits. People pour out of colleges and universities with all manner of degrees, yet with skills that are rapidly becoming irrelevant. But people without those degrees are couchpotatoeven worse off. They find themselves virtually unemployable, because there are so many others in the same pool, and employers will hire whoever comes cheapest. (The absurdly low minimum wage figures in the US clearly exacerbate the situation.) As hope for steady employment fizzles, so does the opportunity to connect with family, friends, and society more broadly, and there is way too much time to kill. Opioids help reduce the despair.

The opportunity to settle into a viable niche in one’s family and one’s society, the bedrock of social and personal security, is being blown away by the winds of unregulated capitalism in a globalized world. As for the intimacy and trust we humans have always sought in each other, in friends, colleagues, and lovers, the bonds are shaky these days. Even if we have the opportunity to connect — if we are not resettling geographically to find employment or staying up late to retool through distance education or simply sitting on the sofa all day long collecting welfare — we’re still too stressed and depressed to get to know each other, to develop trust, to give and receive compassion.

(The links between under-employment, family dissolution, and addiction are beautifully reviewed by Sally Satel. And many of you may know of Bruce Alexander’s explanation of how globalization feeds addiction.)

The early 21st century offers less structure and stability through religion, and through extended family relationships, than we have experienced in thousands of years. And maybe that’s just the way it is. But we don’t have to throw away the basic currency of security and interconnectedness entirely. We can build social structures — governments, corporations, community organizations, and systems of education and care — that encourage stability, hope, and trust in our day-to-day lives. Like the high-school kids in Portugal, we can offer compassion and inclusion as an alternative to heroin. If we fail to do that, many of us will want to hook ourselves up to an opioid pump. Just to endure.

……..

I’m not entirely pessimistic, but that’s the way I see it. Regardless, let’s not give up hope, not even slightly. Let’s do a bit of meditation, enjoy the sunshine, and be good to each other. See you again in September.

 

 

21 thoughts on “What the overdose epidemic teaches us about our deepest needs…

  1. Kathi Murray August 12, 2017 at 6:29 am #

    I read that book “Chasing the Scream” and it really opened my eyes about just how unbelievably damaging the “war on drugs” has been. I never cried so much reading a book! Anslinger was a horrible man when you really think about it. But I think Portugal has the right idea. The illegality of drugs are part of the lure. If all were decriminalized and maybe eventually made legal, the number of users would drop significantly, I’m sure.

  2. Mark August 12, 2017 at 7:17 am #

    Marc, good to know there’s at least one prison on the planet built for … human BEING(s). What’s it called?

  3. Maia Szalavitz August 12, 2017 at 8:29 am #

    Definitely agree!!! But why do you use those horribly stigmatizing pictures of people with addiction, which have been shown to decrease exactly the kind of empathy we need to support recovery and have solidarity in the face of unfettered capitalism?

    • Will August 12, 2017 at 1:06 pm #

      Maya do you think we should be showing pictures of people happily shooting heroin saying life is just wonderful? I don’t think that is realistic either….

      • matt August 13, 2017 at 9:11 pm #

        How about not showing any pictures? That way nobody gets riled.

      • Marc August 15, 2017 at 3:51 am #

        I agree. The nastiness, misery, and mind-numbing boredom are facets of addiction. For some, not all. I don’t want to hide these features, but I don’t want to blame the victim either.

      • Marc August 15, 2017 at 4:03 am #

        I meant I agree with Will. Maia, don’t worry. We don’t have to walk on eggshells if our message is clear and consistent!

  4. Tim Greenwood August 12, 2017 at 8:31 am #

    Hi Marc:

    Beautiful and thoughtful piece. Plan to share it with others who work in the field and some others who work in the prisons as well.
    Totally agree that we need to build community and that is the best approach to the crisis but also the other ills. Have recently begun reading Zen and the Art of the Motorcycle Maintenance and love the idea of Chattaquas where the community comes together to celebrate together and talk and think about important issues. Shared this with an older friend and she told me that she read one of her grandparent’s diaries and found an entry where she spoke fondly about looking forward to upcoming Chattaquas – and this was in Depression era rural Saskatchewan. The thing is we can do these things. Instead of being social on social media we can bring together the community to talk and learn and share in events that are not about making money or promotions but just connection and celebration and discussion. I plan to try to organize such events in my community in Newmarket. Think it would be great to have Chattaquas on issues like addiction so we could come together as a community and listen to and hear all sides of the discussion. Keep up the great work and hope to see you in the GTA in October.
    Tim Greenwood

    • Marc August 15, 2017 at 4:06 am #

      Great idea, Tim. In fact we can do both: arrange Chautauquas and present our case in the media. More soon.

    • Cheryk August 15, 2017 at 9:49 am #

      Are you from NewMarket, TN? Wondered. I’m visiting family. I live in SW Florida. My visit only made possible by my brother and wife. I’m broke, pretty much unemployable due to felonies fro 7 years ago. Posession, resisting arrest. All due to drug addiction. I was a RN. Now, get denied for minimum wage jobs.

  5. William Abbott August 12, 2017 at 8:36 am #

    You fail to mention one of my ” favorites” the depersonalizing” effects and impact of the internet and supporting technologies such as texting, Twitter etc etc

    • Cheryk August 15, 2017 at 9:58 am #

      Absolutely! Technology taking the place of families and friends talking face to face.Its easier to text, FB , etc.

  6. Peter Sheath August 12, 2017 at 10:01 am #

    Hi Marc
    Yet another really good piece that captures some very complex issues. I’ve been talking about this and writing bits about it for the past few months. In the UK you can roughly break it down to two very different issues. One involvese people who have been in drug treatment for many years, often well over twenty, who haven’t made healthy life choices. They probably started using dependently in the late 80s/early nineties, were prescribed methadone but carried on using, maybe to a lesser degree, drinking hazardously, smoking and using other drugs like benzodiazepines. Now, in their late 40s or early 50s they are suffering from chronic seriously debilitating conditions like COPD, liver disease, diabetes and cardio vascular diseases usually associated with people in their 70s. Unfortunately there are lots of them and they’re dying in droves. Personally I’ve long ago lost count of the friends I’ve lost in this way. Politicians and public health bods have even come up with a descriptive phrase for them, “the train spotting generation”, after the film and book by Irving Welsh.
    The second, in the main are people who, for whatever reason, aren’t in treatment and therefore at almost daily risk of overdose. Throw fentanyl, or it’s anologues, in the mix and you’ve got people playing a daily game of Russian roulette with four or five bullets in the gun. A friend of mine, who researches these things, has a private inkling that a lot of these accidental overdoses are probably suicides, which throws yet another layer of complexity into an already very complex mix. Unfortunately, rather than responding to this by making treatment easily accessible, attractive and meaningful, the providers, commissioners and politicians seem intent on making it more and more difficult. I’ve always seen someone looking for help as being in a massive window of opportunity for, given the right set of circumstances, profound and lasting change to occur. This means that the service they go to should have a wide window of tolerance that enables them to walk through with a minimum of fuss. They should be met with flexibility, adaptability, cohesiveness, energy and stability, anything less makes the dealer seem more attractive and easier to access. Unfortunately it’s nothing like this and people are met with, more often than not, exactly the opposite so they don’t bother and instead they consult doctor fentanyl.

    • Marc August 13, 2017 at 6:32 pm #

      Peter! I havent been able to email you. New address? Trying to contact you. Please provide.

      • Peter Sheath August 14, 2017 at 11:48 am #

        Hi Marc
        Yeah my newish account is petersheath@outlook.com thought it was a bit strange not getting a reply.

    • matt August 14, 2017 at 2:03 am #

      Hey Peter!

      It’s good to hear you (this blog is like a meeting of sorts– a very special meeting!)

      I talk about “the window of opportunity” you mention when I speak to clinicians, programs, detoxes and the like. It does not stay open indefinitely. People do not sit around for days or weeks or months in a waiting room looking at their watch and “Bonanza” reruns. They go back out. And the best time to pull people through that window is while they’re in detox, because that is where most make the decision to quit. They are in shock, beaten down, vulnerable and desperate for a way out. Their situation is right in front of them, stark and salient. If someone doesn’t reach them at that point with a plausible opportunity to free themselves from the habit, their only option is stark and salient as well.

      From my own experience and talking to addicts, I’ve drawn a similar conclusion as your friend. But when police and emergency services start making noise about not responding to ODs because of the toxicity of the poison carfentanyl– rumored or not– we’re coming to a breaking point. Public outcry and misbehavior are born of rumor.

      • Peter Sheath August 14, 2017 at 11:56 am #

        Hi Matt
        Spot on but, unfortunately, not very well recognised by many. “I’ll make you an appointment in two weeks time” or “you’ll have to join this group or go to that programme to demonstrate your motivation and/or willingness.” Ain’t going to wash when I rock up in my brief and ever diminishing window of opportunity. I want help and I probably need it right now, I may be dead tomorrow while your waiting for my motivation to become even more evident than it does now!

        • John Fox August 15, 2017 at 12:49 pm #

          We work in a target driven environment underfunded, understaffed, undervalued.
          The Goverment in the UK has cut budgets even further, delivered what I think is a poor cop out of a drug Strategy.
          People are dying I agree with comments above an aging drug using population with poor health. Poor quality substances that now have been laced with an extremely potient killer to line the drug dealers pockets. No housing ,no prospects,no respect a benefit system thats killing people.
          The place is a mess
          People having to jump through hoops to gain OST treatment
          I am passionate substances misuse practitioner and agree you need to strike while the irons hot.
          I have a great number of successful outcomes driven by the client. I am but a guide helping the client to find the tools to live again.
          I work in Treatment in Bradford.
          Yorkshire and the Humberside at the moment has a huge overdose rate.

  7. Russ Maynard August 12, 2017 at 11:43 pm #

    Hi Marc,

    PHS now has housing and recovery programs in Victoria. If I’d known I would
    Have tried to meet for a dinner as I move back and forth between. An liver and. Ictoria almost weekly.

    All the best,

    Russ Maynard
    PHS

    • Marc August 14, 2017 at 6:58 am #

      Hi Russ. I should have contacted you. But the timing didnt allow much leeway. More later. Im tapping this on my phone.

  8. Joanna Free August 14, 2017 at 12:24 pm #

    Marc, thank you for this.

    I share the perspective expressed here and in Alexander’s work: “The project is to reshape society with enough force and imagination to enable people to find social integration and meaning in everyday life.”

    I have needed to be quite creative and persistent myself in reshaping the world inside and around me. Building and growing community, getting outside my comfort zone and sometimes (often) that of others.

    Like you, I enjoy asking pointed questions, being direct.

    One friend calls me a “fearless hugger” because he’s seen me approach and hug complete strangers (and some stranger than others:) Some even stranger than me.

    How else does anything change unless we insistently disrupt it? We can each do our little part and then tell about it.

Leave a Reply

Your email address will not be published. Required fields are marked *