We all live in glass houses


Life expectancy has gone down in the United States for each of the last three years.  After decades of steady increases in lifespan, this is the first such period of sustained decline in longevity since World War I.  The primary culprit is the opioid epidemic that has been sweeping the country in the last 25 years, or so.  The number of opioid-related deaths more than quadrupled between 1999 and 2016.  Over 115 Americans die every day from an overdose of opioids, either prescribed or illicit.  That’s more than 72,000 people.  Kentucky has been particularly hard-hit.  The opioid-related death rate in Kentucky is more than twice the national rate.  1,565 Kentuckians died from opioid overdoses in 2017.

The factors that contributed to the current epidemic are not what most people would think.  The people affected are also mostly not who most people would think.  The current epidemic bears little resemblance to the drug culture of the 1960’s.  Most of today’s victims did not become addicted due to recreational use.  Most of today’s victims are also in their 30’s and 40’s, not in their teens and twenties.

Today’s epidemic has its roots in a change in medical practices in the 1980’s and 90’s.  Pharmaceutical companies played a key role, as did changing public attitudes toward medical management.  People started to believe that modern medicine should be able to provide relief from almost all disease and injury-related pain.  Pharmaceutical companies told physicians that there were new formulations of pain-relieving medications that practically eliminated the potential for addiction, so that doctors should feel comfortable, indeed obligated, to prescribe these new narcotic pain relievers to patients experiencing pain.  The first big problem with that was that it wasn’t true.  There was still a high likelihood of addiction, even when the drugs were used as prescribed.  The second big problem was that the huge increase in the availability of opioids massively increased the potential for diversion of prescribed pills and abuse. 

That vast expansion of the availability of very powerful narcotics was the part of our current problem.  In 2017, there were 58 opioid prescriptions written for every 100 people in the country.  Almost 20% of the entire population of the US had at least one opiate prescription written for them in that year.  “Pill mills” became commonplace. 

Eventually, it was determined that over-prescribing of opiates was causing harm, prescribing standards were changed and providers started to cut back or stop providing narcotic prescriptions at all.  Most states developed prescription registries so that opiate prescriptions could be tracked to prevent people from getting prescriptions from multiple providers.  These changes made it more difficult to get prescriptions for opiates, which is a good thing for everyone not already addicted, but very problematic for those already addicted, either to legitimately prescribed drugs or otherwise.  As the supply of “legitimate” pills dried up, both for those taking prescriptions and for those using diverted prescriptions, they had to turn to another source, which is the illicit drug trade.

Lest you think that these people should have just stopped taking the opiates, you should understand that it is often not possible, physically or psychologically, for addicts to “just stop”.  “Just stopping” some drugs will kill you.  These drugs produce real, physical changes in those who take them over the long term, making “just stopping” extremely dangerous and difficult.  It’s not a choice.

While we are certainly taking the right steps to reduce prescription opiate abuse in the future, we still have to deal with the problem that has already been created.  The opioid epidemic has laid waste to large swaths of America, particularly in eastern Kentucky, West Virginia and southern Ohio.

Addiction is not a crime–it’s a disease. The vast majority of addicts are not degenerate criminals who deserve what they get. They are humans with potential to live productive, happy lives if they can get out from under their addiction. They are husbands, wives, mothers and fathers, sons and daughters. Most of them are in their 30’s and 40’s. They aren’t “kids”. They don’t want to be addicts and most of them don’t want to be living the lives they are. There are many pathways that lead to addiction, many of which began completely innocuously. I know people with chronic pain from injuries and disease who are addicted to prescription narcotics and have been for years. Professional people. If they suddenly couldn’t get their medications, I have little doubt that many of them would be forced to turn to street drugs, rather than deal with withdrawal and a return of their intractable pain. You might well sit next of one of these folks at church. You might work in the office next to one.

By no means is every addict reachable. Some are beyond help, but I don’t know anyone who is qualified to make that determination. I know I’m not, and I’d a whole lot rather be disappointed that someone didn’t take or benefit from help that was offered than to watch them die because there was no hand reached out. Nobody wakes up one day and says to themselves, “I think I’ll become a drug addict today, since the police are carrying Narcan (an opiate overdose reversal treatment) and I won’t have to worry as much about ODing” Nobody says to themselves, “Wow! I think I’ll start injecting heroin today, since there is a needle exchange opening up!” Fighting against addiction and doing everything that can be done to mitigate the consequences of addiction, like the spread of HIV and hepatitis, is what decent people should all want to do. Yes, one person might OD 6 times and be saved by Narcan each time. It’s not a failure. It’s not a waste. What if after the sixth time, the person actually makes it through rehab and becomes a counselor? Or a pastor? Or a health care worker? It’s not always going to end that way. It’s probably not even often going to end that way. But how many times does it need to end that way to make all the times it doesn’t work worth the trying?

At some time, probably thanks to our Puritan roots, we, as a society, determined that we preferred to deal with the consequences of what people who don’t experience them call “failure” or “weakness”.  It somehow seems more just to let people stew in the consequences of their situations than to spend the resources to fix the issues. It doesn’t work. It’s never worked. It’s never going to work. Putting an addict in jail is just as effective as putting someone with congestive heart failure in jail. Why do we think the person with congestive heart failure has value as a human and as a member of our society and the addict doesn’t? It is entirely possible that the person with congestive heart failure has the disease because of the life choices they made, in terms of diet, exercise, managing their health and so on. They might have willingly destroyed their health with pizza, beer, cigarettes and sloth. What makes them somehow more virtuous in the eyes of their neighbors than the heroin addict who might have been set on the path of addiction by prescription narcotics prescribed for them by a well-meaning physician after a car wreck?

It seems to me that if we just paid a little more attention to two simple ideas which are part of every religion on Earth, we’d be so much happier and healthier. One of these ideas is “don’t try to judge someone until you’ve walked a mile in their shoes”. The other is “Do unto others as you would have them do unto you”. Why is that so hard? Maybe it’s because another of those universal truths that people tend to ignore is “don’t criticize the splinter in your neighbor’s eye when you have a beam in your own”. Also expressed as “people who live in glass houses shouldn’t throw stones”.

I’m not particularly religious and nobody would accuse me of being particularly liberal but I am pragmatic and like to think I have some sense of right and wrong. What I do know is that it is both wrong and foolish to waste human potential. It is vastly more expensive, both in terms of treasure and in terms of lost human potential, to continue to deal with the consequences of issues like addiction than it is to deal with addiction itself. Why do we keep getting these things so wrong?