(Translation into most languages at tab to the right)
“We were trying, all of us, so hard, and he just wanted to live.” (1)
Ursula Rauh said this about her brother, Tommy, after his death from a fentanyl overdose and a dozen stints in rehab in ten years. He became addicted to Oxy’s at 23 after being prescribed an unlimited amount for tendinitis and a year later, another prescription for wisdom teeth extraction. Sam Quinones retells the family story in The Least of Us: True Tales of America and Hope in the Times of Fentanyl and Meth. “The tragedy wasn’t just the death of her brother; it was all the time, effort, love, and pain that the family traversed, the hoping and living for the smallest encouragement.” (1)
When my husband, John, and I returned from Australia in May, we decided that we needed to address the decades of files we had saved and ‘stuff’ we had accumulated and ‘stuffed’ away in closets. We have shredded and recycled dozens of boxes of documents, cleared out half the books in our library, and now I have moved on to scanning and sorting thousands of photos. While I was pulling bins of photos and albums out of closets, I came upon a few more file bins. I sighed out loud to John, “Oh boy…more of JL’s file’s I’d forgotten about.”
(Translation into most languages at tab to the right)
It’s hard to know where to start in delving in to Sam Quinones new book, The Least of Us. The more I read, the more I want to say in the hope of convincing everyone to read this insightful and comprehensive treatise on how we ended up where we are today in American society and why he finds reasons for hope even amid such despair.
When Sam wrote Dreamland in 2015, he was truly an anthropologist documenting the origins, development and cultural characteristics of the Opioid Epidemic. But Quinones saw beyond the opioid epidemic and warned us of the dangers of synthetic designer drugs and the kingpins who made their products in Magic Bullet blenders and illicit labs. With cheap fentanyl, 100 times more powerful than morphine, traffickers laced it into every other street drug causing tens of thousands of deaths in America. At the same time, they made Meth more potent and cheaper, causing its own epidemic of mental illness, violence, and homelessness. It presents “the rawest face of living addiction. Meth users dragged themselves through the nighttime streets, howling, hysterical, starving.”
When he continued his investigations in The Least of Us, he came to realize that, “In a time when drug traffickers act like corporations and corporations like drug traffickers, the forces looking to manipulate our brains for profit are frightening to behold. So many more synthetic blasts compete for our brain receptors–from chicken nuggets and soda to cell phones and social media apps, methamphetamine and fentanyl.” (1) This is not news to any of us and yet we seem strangely mesmerized to our own state – and that of our children – as we continue to acquiesce to the lure of pervasive consumerism.
Big Dope – like Big Tech, Big Pharma and Big Finance – is Big Business aimed at the voracious consumer market in Western society where traffickers are producing illegal synthetic drugs of abuse year-round. No more having to wait for two or three poppy crops every year. They have easy access to world chemical markets, global banks to wash their money, and weapons to enforce their will. Blood Gun Money: How America Arms Gangs and Cartels written by journalist Ioan Grillo in Mexico, documents the ways guns are easily bought in the US and smuggled south to arm drug gangs in Latin America. Seventy percent of firearms the Mexican military seized in 2018 were made or bought in the US. But Quinones is clear that Mexico, China, and the US all share responsibility for the worldwide addiction crises.
Although the Law of Supply and Demand is commonly associated with economics, it is also part of our daily lives. When the supply of something decreases (making it rarer) or when the demand for that good increases (making it more sought after) the price goes up. Conversely, goods will decline in price when they become more widely available (less rare). This is never truer than in the world of illicit drugs.
Sam Quinones lived and worked in Mexico for 10 years and he believes “solutions will come only when Mexico and the US work together. This is crucial because walls don’t stop dope. Not in an era of free trade.” (2) He stresses that drug demand is important, but the drug epidemic begins with supply. Remember how the opioid epidemic started? Purdue Pharma – Big Pharma – and their relentless marketing (pushing, trafficking, peddling) and unlimited supply of prescription opioids? (3) They were the initial ‘dope dealers’ of the opioid epidemic. Or go back in time to the Opium Wars and British trade merchants. (4) And how about sugar-laced breakfast foods, snacks, drinks? (5) Did we demand them for our children or were they supplied and pushed via relentless advertising by multi-national corporations? And the motivation for all these actions? Money, and lots of it.
Next time, I will share the hope Quinones gained as he traveled the country and listened to stories from those affected by the addiction crisis. I hope that I have piqued your interest sufficiently so you will buy a copy of The Least of Us (6), read it, and pass it on to friends and family.
Laudanum––an opium tincture that contains almost all of the opium alkaloids, including morphine and codeine––was developed in the 16th century. Many Puritan wives of the whaling merchants used it daily. By the 18th century, the medicinal properties of opium and laudanum were well known. The Chinese knew it was addictive when the idle rich used it “recreationally”, and so they banned it in the 1720’s. But the British trade merchants (some of the early ‘corporations’) saw it as a source for additional income from their colonies. In 1839 the first wars were fought––The Opium Wars––that succeeded in opening up trade with opium from India. Those increased supplies created what we’ve all heard about – Opium Dens – that plagued China for a century.
As I was driving home in 105-degree heat last week, I noticed a young man carrying a plastic bag stumble to a bus stop bench and sit down. It was clear he was homeless and it was equally clear that he was on drugs. I felt compelled to pull over. I rolled down the window and asked, “Are you ok?” He said, “No.” I asked if he needed help, and he wept and said “Yes.” When he came over to the truck, I asked if he was on drugs, and he said “No.” I said “I think you are on drugs and you don’t need to be ashamed.” He said he was, so I asked if I could sit with him and talk.
As we sat on the bench in the heat I asked what drug Julian (not his real name) was using. Fentanyl in the form of street Oxy’s that sell for $2 and come from Mexico. He is homeless, has never known his father, his mother is out of state and done with him. He is 23 years old and has been struggling with alcohol and addiction for 5 years – fentanyl for the past 1½ years. I told him about my son and said Julian was on the same path to the morgue unless he could get clean. He had gone to rehab in March with a predictably miserable 5-day detox and then was supposed to go to a sober home, but said they never got him there – probably not true. I offered to take Julian for something to eat and to try to connect him with a program to help him. While I drove and he nodded off, I called a few of the directors I knew from programs our son went to, but had to leave messages. I decided to take him home for a shower and a rest as we tried to find him a place.
My husband John prayed with this sweet and troubled young man and encouraged him to know there was hope and that he wasn’t a bad person, or less-than, but had a powerful war waging in his brain that needed medical help and emotional support. We drove him to the public behavioral health service, where he had gone in March, and got him signed in. It was an hour wait for him to go through intake again, so we left him with our names and phone numbers to give as his contacts for help so that we could follow up on how he was doing.
When we tried to follow up the next day, we found he had done a runner and never went through the intake. I would guess the fear of excruciating withdrawal was stronger than the fear of a potential or eventual death. This is so common, especially for those who have tried many times to get clean. Addiction specialist, Dr. Richard Whitney said, “Once people get addicted, they really lose the power of choice.” (1) Even with medication, the drugs need to be out of your system first. On average, it takes 4-5 recovery attempts and 8 years to achieve one year of sobriety. After another 5 years in recovery, the relapse rate drops to 15%.(2)That is 13 years to try to undo what most commonly started as trying something fun as a young person. The chemistry in our brains needs more time to recover than a few weeks or months from the damage done by opiates.
In 2015, Sam Quinones released his award-winning book Dreamland: The True Tale of America’s Opiate Epidemic documenting how Purdue Pharma – with a monopoly on the market on pain in the 1990’s with its new highly addictive drug, Oxycontin – deceptively promoted it as a non-addictive solution for every ache and pain. Then, with the lure of easy money, young men in Mexico, independent of the drug cartels, trafficked black-tar heroin to neighborhoods in America as a cheap alternative to Oxy’s. Its powerful long-lasting high then became the go-to drug for millions of young people who could heat and smoke it – our son included. Quinones states that the perfect storm was created when the pursuit of prosperity, pain avoidance, and the breakdown of close-knit family and community life, beginning in the 1960’s, created the void that those easily available opiates filled.
Quinones has recently released The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. It is the second most important book written on addiction and American society. In my next blog, I will delve into this new book and discuss where we are in the drug epidemic and where we can go from here. I personally need some hope as I see the thousands of homeless young people on the streets of my city and struggle with the tension of wanting to help prevent one more life from a literal “dead end” and feeling frustrated with the lack of effective programs to help these addicted individuals get the long-term recovery care they need. This – in a country where the majority of people seem to think that health care is a privilege for those who can afford it instead of a basic service for all Americans, including the least of us.
(Translation into most languages is available to the right.)
When I am doing research for an upcoming blog post, I can get lost. There is so much information now on drug addiction and the opioid epidemic that I suddenly look at the clock and realize I’ve been wandering virtually around the world and becoming more discouraged with each new article or report: Scotland has more drug overdose deaths per capita than any European country (1); Fentanyl is flooding California with overdose deaths skyrocketing (2); the use of over-the-counter codeine (an opiate) cough medicine among eighth graders in the US has increased (3); and, Australia now has the eighth-highest per-capita opioid consumption in the world (4).
(Thirty-fifth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
This week’s Story of Hope is from a friend of JL’s, Peter (not his real name). Here are some excerpts from his story in Opiate Nation (5 min read):
My name is Peter and I’m an alcoholic and addict. This is how I introduce myself at the AA meetings I attend several times every week, as I have done for over 10 years. I am from a fairly affluent family, raised with high moral standards, and attended the best schools. So how is it that I became an alcoholic by the time I was a senior in high school and an opioid addict and dealer by the time I was 20?
The first time I used alcohol was in my junior year in high school. I was new to the school and I felt like I didn’t get the playbook for how to be a part of the group. I had been raised with strong values against using drugs and alcohol – but I wanted to fit in with the popular kids.
I tried a capful of vodka—that was it. I hated the way it tasted. The next day I was sick—not so much from the alcohol, but with guilt. This would be a consistent theme in my drinking and using: I always felt guilt and the consequences of doing something soul-crushing and bending the moral line I had deep within me. Once that barrier had been crossed, then anything was permissible. Initially I only drank on weekends at parties so that I wouldn’t be the outsider.
(Eighteenth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
In 1735, Benjamin Franklin wrote a letter to his own newspaper, The Pennsylvania Gazette, where he used this now-famous phrase: An ounce of prevention is worth a pound of cure. He wasn’t referring to a pandemic or keeping your roof in good condition so it won’t leak or changing the oil in your car so you won’t ruin your engine or, my personal example, brushing your teeth to avoid tooth decay and gum disease.
When I was growing up in the 1960’s, brushing our teeth every day was a new habit for most Americans. Even though the toothbrush was invented in 1857, it wasn’t until after WWII that we got in the habit of regularly brushing our teeth. When I was young, I didn’t give much thought to personal care and it seems I didn’t brush my teeth often – I was too busy living life – which is why my two older sisters gave me the endearing nick-name “moss-mouth”. (FYI, I must have good teeth genetics because I didn’t have my first cavity until I was 30.)
(Ninth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
Shells are beautiful and fascinating to me. Each and every one is unique, differing from others just like our fingerprints. John and I just spent time at the central eastern coast of Australia and on our daily walks on the beach I just couldn’t stop picking up shells – especially the Nautilus shells with their logarithmic spirals of every size, shape, and color. These are empty shells that were once the home of a sea creature.
The exoskeleton of mollusks is the hard, outer layer that protects the tender creature inside. As the creature grows, layers are added to accommodate it. One day, as I was picking up shells in the surf, the inhabitant was still inside. It immediately retreated as far back into its shell as possible.
(Seventh in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
When public health is at risk, one can only wonder about the motives behind politicians’ decisions – our “public servants” as they used to be referred to – regardless of what they may say. But we don’t have to guess their motives because actions speak louder than words and the actions of the US Department of Justice (DOJ) this week regarding Purdue Pharma and the Sackler family are unconscionable. This deal is not justice for the victims and their families for this pervasive and criminal corporate greed.
(Second in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right. If you feel this blog is important, please repost to your social media using the buttons below. Thank You!)
When our 25 yr old son died of a heroin overdose in 2014, the statistics for the average life-span of a heroin addict was 5 years. Five years. Not very long if you are 15 or 20 or even 30, the age when most young adults’ nowadays are just getting in gear with their career, a long-term relationship, and planning a family. To have your life swept away before you have a chance to experience some of the most wonderful years of living on this earth is painful to consider.
(Today begins a series of topical blogs based on excerpts from Opiate Nation, chapter by chapter, that will run for 28 weeks. Translation into most languages is available to the right.)
It’s a bit ironic that as I begin blogging through Opiate Nation we are in the midst of a pandemic. Ironic in several significant ways.
Opiate Nationwas written because of the opioid epidemic – which, in reality, is a pandemic. Every industrialized nation, and many emerging and third-world nations too, are dealing with the results from the ease of availability of opioids, whether natural and home-grown, or synthetic and imported. Or both, as is the case in America.
And like the Coronavirus pandemic that crept up on us so gradually that it’s deadliness caught us by surprise and mostly unprepared as nations, the opioid epidemic crept up on us too. In both cases, certain international players were unscrupulous for various reasons, causing delays in awareness when there might have been a chance for all of us to not be caught off balance.
The “inoculation” that should have happened, especially in the United States, by way of accurate scientific information disseminated by responsible leaders, didn’t happen. Instead, false information fueled by political agendas and financial motivation created a scenario that so crippled a timely public health response that, for many nations, it became too little too late.
The Ohio Society of Addiction Medicine is a chapter of ASAM - A professional society actively seeking to define and expand the field of addiction medicine.
Opiate Nation 