Updated 08.10.17 4:32 EDT: Within an hour of posting this, the president declared the opioid crisis a national emergency. This is progress, however the rhetoric continues to focus on the idea of “Just Say No” and increasing law enforcement and incarceration rather than treatment, which is unfortunate at best.
“So if we can keep them from going on—and maybe by talking to youth and telling them: ‘No good, really bad for you in every way.’ But if they don’t start, it will never be a problem.” — Donald J. Trump, August 8, 2017.
As far was the public knows, this constitutes the entire White House strategy for addressing the Opioid Crisis in America.
Even if one ignores our President’s inability to speak in complete sentences, these words are those of a fool. But the fool didn’t stop there. He went on to say, “Strong law enforcement is absolutely vital to having a drug-free society. I’m confident that by working with our health-care and law-enforcement experts we will fight this deadly epidemic and the United States will win.”
Lets be honest with ourselves, “Just Say No” failed completely and utterly. During the peak of the “Just Say No” years our nation witnessed the crack epidemic, which devastated our cities.
There are so many reasons why these naive polices have failed. First and foremost is that the “Just Say No” camp fails to understand the effect of peer pressure on teens. According to this article, “psychologists used functional magnetic resonance imaging scans on 40 teenagers and adults to determine if there are differences in brain activity when adolescents are alone versus with their friends. The findings suggest that teenage peer pressure has a distinct effect on brain signals involving risk and reward [my emphasis], helping to explain why young people are more likely to misbehave and take risks when their friends are watching.”
Now, it’s well researched and documented that drugs and alcohol affect our brain’s reward center. Specifically, drugs and alcohol increase our brain’s production of dopamine. It’s thought that the reason that people need more and more of a substance as they become addicted to it is because their dopamine receptors become accustomed to the high levels of dopamine that are produced when we partake in a drug or alcoholic drink.
So, lets put these two things together. Kids have an increased level of risk taking when in the presence of friends, as a result of heightened activity in the reward centers of the adolescent brain induced by the mere presence of peers. This leaves them susceptible to trying the drink or drug in the first place. Then when they do try it, they experience the rush of dopamine that further heightens the activity of the rewards center of the brain.
Add to this that many teens who try drugs or booze are doing so in order to escape from some form of trauma whether they know it or not. I certainly was. When I first started experimenting with booze and marijuana, I was about 16 years old. I turned 16 in 1988. Between January of 1988 and the middle of 1989, I had 5 relatives die. One Uncle, 3 Grandparents, 1 Great Uncle, and my Great Grandmother. I don’t remember anything from from my Junior year of high school. It’s blackness.
Now, I’m no psychologist. I’m not a neuroscientist. But I am a recovering alcoholic and I can tell you in no uncertain terms, that the rush of the first drink was pure pleasure every damn time. And when I was in that fog of death after death after death, the promise of a short escape, the promise of relief was not only tempting, it was awesome. There was no fucking way I was going to say, “No” when I was first introduced to booze and marijuana by a friend.
I was well educated on the topic of drugs and alcohol. I’d watched my alcoholic grandfather throughout my childhood. I also knew that several of the deaths were the direct result of smoking and booze. Nonetheless, I desperately wanted the relief that came with a bit of escapist experimentation — especially because my friends were doing it.
That’s why telling kids “Just say no,” or “No good, really bad for you in every way” isn’t going to do shit to address the opioid epidemic.
So lets look at the second part of Mr. Trump’s asinine strategy: Enforcement and Incarceration.
It turns out that this hasn’t worked either and it’s well documented.
Even conservative business magazines like Fortune get this:
“Despite the logic of limiting the availability of drugs and threatening and punishing those who are involved in the drug trade and using drugs, the report card for this tough method of enforcement is bleak. We have invested more than $1 trillion during [Fortune’s link not mine] the past 45 years in the war on drugs. Yet there is essentially no evidence in support of the success of that effort.”
Why has this failed?
Because addiction is a medical problem, not a moral problem. Even in the 1930s the medical profession knew this. Dr. Silkworth who contributed to the chapter “The Doctor’s Opinion” in the book Alcoholic’s Anonymous knew that it was a medical problem not a moral problem when he wrote, “We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy”1
And because addiction and trauma are closely linked there are often other mental health concerns at play as well.
“To complicate the landscape, approximately 40% of opioid-dependent individuals have depression, anxiety, or bipolar disorder, and some have other co-occurring psychiatric disorders. Post-traumatic stress disorder and personality disorders are also present, though less frequently. Punishment is not only ineffective; it often exacerbates these mental health problems.”2
Punishment does not address the fundamental issues that an addict faces. It does not address depression, anxiety, bipolar disorder or PTSD. And neither do our incarceration centers.
When I was freshly sober, a friend on Twitter asked for sober people to write letters to one of his friends who was in a detention center after a DUI. I offered to write to this person and told my story in the letter. I fully expected that I might never hear back on the letter, but to my surprise I got an email one day and one sentence in particular struck me:
“Thank you for taking your time to write to me, I have read your letter over and over and have continued to read it daily. The support meant so much to me while I was in jail, especially since there were no meetings or AA literature to read.”
I was dumbstruck. I simply could not believe that there were no meetings or even literature made available to a person who was being held as the result of a DUI. It turns out, sadly, that this is not uncommon. According to a 2014 article in the Washington Post, while 65% of our prison population met the medical requirements for substance abuse disorder, only 11% of our prisoners were offered treatment. That’s a travesty. It is no wonder that the recidivism rate for people with substance abuse disorders exceeds 80%.
Now, the crack epidemic of the 1980s, it didn’t register on the radar of most of America, for a lot of reasons, but primarily because it never became a drug of choice across socio-economic boundaries. But today, things are different. Today, we are witnessing an opioid epidemic that affects all socio-economic classes of our society — rich, middle class, and the poor. It also touches nearly all of the other classifications we use to identify people: black, white, brown, gay, straight, trans-gender, and cis.
Not that the crack epidemic of the Reagan years wasn’t horrendous, but the opioid epidemic is even bigger. And its destroying our society.
It turns out that our “No good, really bad for you in every way” President, actually has very own bipartisan panel investigating the opioid crisis and their report makes the recommendation that he declare a national emergency.
“With approximately 142 Americans dying every day, America is enduring a death toll equal to Sept. 11 every three weeks,” the commission members wrote, referring to the 9/11 terrorist attacks. “Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the executive branch even further to deal with this loss of life.”3
In addition to this recommendation the report makes several smart recommendations including:
- Rapidly increasing treatment capacity.
- Mandating prescriber education initiatives.
- Immediately establishing and funding a federal incentive to enhance access to Medication-Assisted Treatment.
- Providing model legislation for states to allow naloxone dispensing via standing orders.
- Requiring the prescribing of naloxone with high-risk opioid prescriptions
- Equiping all law enforcement in the US with naloxone to save lives
- Enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses.
These are good recommendations. These are recommendations that make sense and would have an immediate impact on the opioid epidemic. But president Trump hasn’t declared a national emergency and his comments aren’t about expanding treatment. Why not?
I don’t know the answer, but I suspect that he probably hasn’t read the report (it’s well known that he doesn’t read) and even if he has read the report, these recommendations don’t fit his agenda.
What can we do?
So, if you’re like me (and I don’t just mean someone in recovery), you may be wondering what you can do. Here are two recommendations.
- Sign this petition asking that the President follow his own commission’s recommendation and declare a national emergency.
- Contact your representatives make your voice heard. Tell them that you want to see the opioid crisis addressed in a meaningful way and that the president’s reiteration of the last 40 years of two failed policies isn’t the answer.
- A.A. World Services Inc. Alcoholics Anonymous, 4th Edition (Kindle Locations 265-266). A.A. World Services, Inc.. Kindle Edition. ↩︎
- ”Trump Clearly Has No Clue How to Stop the Opioid Epidemic” (http://fortune.com/2017/08/09/trump-opioid-briefing-speech-crisis-epidemic-war-on-drugs/) ↩︎
- “White House Panel Recommends Declaring National Emergency on Opioids” (https://www.nytimes.com/2017/07/31/health/opioid-crisis-trump-commission.html)