Waking Up to an Epidemic

prescription pills

To be an informed citizen is follow the news closely. These days, to follow the news closely is to be buffeted by the frenetic winds of the news-cycle.

Given such conditions, it is easy to miss what is going on beneath the surface, the events and processes that affect the lives and times of people in communities. For that, we have numbers to reorient us.

And those numbers are not encouraging.

In “Our Miserable 21st Century”, economist Nicholas Eberstadt describes in careful detail the slowing down of economic growth since the year 2000 and its products, including devastating economic insecurity for Americans in the lower income quartiles. Persistent joblessness, limited returns to educational achievement, declining standards of living and declining life expectancy have become consistent underlying features of American life in the last 20 years. Informed commentators on the Left and the Right have ably demonstrated how these trends have played out along racial and class lines.

Of all these problems, few better capture the insufficiency of our present political discourse than the lack of attention paid to the ongoing opioid addiction and overdose crisis, which claimed an estimated 72,000 lives in 2017. That estimate represents a more than hundred percent increase from a decade ago and reflects an accelerating trendline over the past few years. Deaths from opioid overdoses have exceeded deaths from both cars and guns.

Researchers have pointed to two primary causes for the present epidemic. First, a greater percentage of Americans have been prescribed opioid-based painkillers over the past two decades, largely out of a desire by doctors to manage chronic pain. While some doctors over-prescribed prescription opioids, the highly addictive nature of opioid-based painkillers prescribed even within the recommended boundaries has left millions addicted. When the prescription supply runs out, those struggling with addiction are forced to turn to more illicit sources.

This leads to the second leading cause for the uptick in overdoses: powerful chemicals like fentanyl have been mixed with traditional opioids like heroin, which can devastate users and precipitate deadly overdoses. As the legal supply constricts, those experiencing addiction have turned to sources with far lower quality controls on the product being distributed; the risk with any given dose varies widely. As law enforcement and public health agencies grapple with this spreading epidemic, the presence and ubiquity of synthetic opioids has exacerbated the present crisis.

While public investment in prevention and treatment has begun to increase at the state and federal level, most public health experts have cautioned that at this point only a modest downturn can be expected in the near future and, until treatment centers and other such infrastructure receive adequate funding and connect with patients, the primary response to the crisis will be in the hands of law enforcement, emergency responders, and the friends, families, and acquaintances of those who experience addiction.

Powerful, addictive, mind-altering substances like opioids are not easily integrated into our usual frameworks for dealing with similar substances and technologies. Our legal system still holds the user responsible for his or her actions regardless of impairment or impulse; a person cannot use drunkenness to mitigate responsibility. Similarly, theft in furtherance of assuaging an addiction cannot be explained away by appeals to ways in which addiction alters impulse control and behavior. Yet criminalization has not been effective in reducing drug addiction and dependency. Likewise, most of our moral philosophies poorly integrate all manner of technology, especially addictive chemicals and substances: the degrees of freedom, rationality, and self-possession ingredient in most ethical systems are barely factors in an epidemic of this nature.

Opioid addiction and opioid-use disorders shatter such categories to a greater degree than similar substances. They reduce human agency and obliterate the usual workings of the human will, re-ordering human desires around the single principle of servicing addiction. The usual priorities of freedom and rationality are subverted by addiction and to combat the effects and symptoms of addiction require us to de-emphasis those priorities. Considering the additional social stigma that is further attached to those experiencing opioid-use disorder, is it any wonder the responses have proven inadequate to dealing with the breadth and depth of this crisis?

Likewise, the spiritual responses to severe addiction struggles to hold. Grace supposes the cooperation of freedom. But how can one be disposed to grace amidst the relentless cycle of addiction, with its violent urges, withdrawals, highs, and crashes? Can one admit one is powerless, as the famous 12 Steps begins, in the midst of such a cycle? Could such an admission have any chance of standing? The answers are far from clear, let alone encouraging.

Despite the inadequacies of the resources available to us, we cannot let this crisis slip from our attention amidst the sturm und drang of news-cycles. Beyond the tragedy of thousands of deaths is that state of communities and families throughout the country being devastated by the loss of loved ones and the diminished human flourishing that results. Thousands are dead who ought to still be among us; thousands more are at risk.

The stakes are clear and high. We will not long endure as a moral people so long as we neglect those least among us, especially those who suffer grievously from addiction.

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This article is a continuation of TJP’s November ’18 midterm elections series focused on faithful and discerning citizenship.

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Cover image courtesy FlickrCC user Marco Verch, found here.

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