I recently got into a discussion on FB about rising heroin use and attendant ODs in the middle class. Some of the commenters had very personal and painful histories of losing family and the thread threatened to turn into a flame war. I dropped out, but the experience got me thinking and I decided to collect my thoughts on the matter in one place.
To begin with, where I’m coming from:
I very seldom use pain killers. I seem to have a rather high threshold for pain. Broken bones, muscle injuries, etc. don’t seem to hurt me as much as they seem to hurt others. That is undoubtedly the luck of good genetics. I also seem to have a very high tolerance for pain killers or psychoactive chemicals. I once broke two ribs and an arm and was in what I would call minor pain. The doctor prescribed 2 Percocet per dose and that pretty much made the pain disappear. I could drive, work, function normally. (It was actually a danger in that I would forget I was injured and would over-exert and re-injure myself). If my wife had taken 2 Percocet at that time she would have been in la-la-land. Different genetics.
Back in my Greewich Village days I discovered it was possible to drop Acid and have no effect; I found that it took a lot of pot plus a bit of hash to get me even mildly stoned (and I didn’t like it, so it never happened again). Genetics again. I’ve known people to take the strongest painkiller they can get their hands on when they have a headache. They cannot tolerate ANY pain. (Or at least they act that way – I don’t know if they’re wimps or just hypersensitive). I know people who have lived with chronic pain for decades and are happy if medication makes the pain tolerable. My wife has spent the last 37+ years in chronic pain, often at a level of 7-10 on the 1-10 scale. She’s happy if her pain meds get the pain down to 5.
People take drugs for various reasons; entertainment, relief from pain, escape from the harsh realities of their circumstances. Drug usage may or may not lead to addiction, depending on the person, the drug(s) and the circumstances. Handling addiction is a related but separate matter.
Medicine has failed:
Chronic pain is badly under-diagnosed and under-medicated in this country. For one thing, pain diagnosis is largely subjective. Although recent fMRI studies show the possibility of firm ‘proof’ of pain, the equipment and methodology is still experimental and not ready for ‘prime time’ as a diagnostic tool. Untold amounts of Vicodan, Percocet and Oxycodone have been ladled out in relief of low back pain until it has become somewhat of a joke, albeit rather black humor. For a second thing, many MDs who practice ‘pain management’ do so as a adjunct to their specialty – anesthesiology or orthopedics. Those focused entirely on pain management are few and far between, and like any group, some are better or worse than others. A third issue is that the ‘drug war’ has scared many MDs away from treating pain aggressively and made even the true specialists very careful and meticulous with prescribing strong pain medication.
There are people in genuine pain who cannot get the relief they need through legal medical channels, particularly if the pain is chronic. They therefore turn to illegal channels. There are three problems with this. First, the purity/dosage of illegal drugs is always questionable and whenever a particularly potent batch hits the streets, we have lots of ODs. Second, being unmonitored and therefore uncontrolled, the danger of addiction rises significantly. Third, the illegality creates possible jail time, a felony record and severe reduction in the odds of getting one’s life back together.
The nature, cause and treatment of addiction (of any sort) have been the subject of speculation, research, theories, practices, methodologies and wild guesses for at least the last 100 years if not more. Some programs work or appear to work, though sometimes it turns out they have no more effectiveness than a placebo. Psychiatrists prescribe Zoloft, Prozac and Cymbalta without asking if the patient’s life circumstances are depressing; Xanax, Klonopin and Valium without investigating the causes of a patient’s stress. Being in constant pain, being unable to work to or do anything which gives pleasure or satisfaction, being in poverty and always on the edge of financial disaster – maybe depression and anxiety are normal responses rather than mental illnesses. Maybe medicine (and society) should seek the cures elsewhere.
Society has failed:
The Rat Park Experiment from the ’70s was declared a proof that addiction is basically social, although it seems to me an over-simplification of the situation, as such initial breakthroughs often are. Its critics have chipped away around the edges but it remains clear that the social environment (in the broadest context) of individuals has a huge influence on whether or not they get addicted and their chances of successfully beating the addiction. And treatment methods which do not succeed in significantly changing the patient’s environment face a more difficult task and a higher failure rate. Sometimes a program is a blend of actions – AA meetings, buddy-system, half-way-houses, rehab centers – and it is difficult to determine exactly which victory or defeat is due to which particular ingredient of the process. Unfortunately, this leads to some very sloppy pseudo-science in evaluating various programs.
Drug use for recreation has been around a long time – since we discovered alcohol and various esoteric plants. Initially viewed as a blessing from the Gods or a connection to Them, we moderns have taken out most of the inherent value of such gifts of nature and reduced them to mere relief from existential ennui. We get drunk because we’re unhappy or bored; snort a line of coke because we’ve got nothing better to do. Whether we become addicted or not depends largely – IMO – on how fucked up our lives are.
Drug use for Escape-From-Hell is another thing altogether. In many segments of society, there is a deep and abiding pain. It comes from recognizing that you have no power over your life, no brighter future, no way to find satisfaction or joy or establish a meaningful life. This occurs in urban ghettos, in rural backwaters, in broken cities and countries and families. Drugs are an escape, and – unlike recreational users – these users are more likely to recognize the possibility of addiction – and be less likely to care. And much less likely to have access to ways of treating addiction. In all too many cases, treatment consists of jail rather than rehab at a luxurious center in Southern California.
Recently re-reading Joe Bageant’s essays and his memoir, it is struck me how and why the underclass – white and black – is ravaged by drug use and abuse. It is also notable in his description of his youth ‘down on the farm’ that the conditions were not ‘ripe’ for such widespread drug use. There were undoubtedly a drunk or two, perhaps an occasional joint smoked in certain places, but by and large, drugs were not a social or community problem.
Why not? In my view, because they had a community – people who understood and valued their world and their place in it, who valued themselves as part of that community and found pleasure and satisfaction in daily life and interactions with others, who felt what they did was meaningful and important. Their lives had purpose and meaning.
Contrast that with the fragmented lives of so many people in the modern world. How many can actually say they do meaningful work? That their lives have purpose? That they are part of a community of shared values and goals? And as the economy tanks, debt rises and the empire crumbles, the once-secure Middle Class finds itself teetering on the edge of disaster. Fear and anxiety rise, futures vanish. Is it any wonder people escape into alternate realities when the view out their windows is so dismal?
One other point is worth mentioning here. Drug use and sometimes addiction has been common in the military since Vietnam. Heroin production is up in Afghanistan since the Taliban lost control. Vets are coming home with PTSD, inadequate treatment through the VA, unemployment, homelessness. By sending an entire generation to war where they see – and often do – terrible things on a regular basis, we should not be surprised to find a lot of people whose lives have been effectively destroyed.