By John Klar
America is reeling from an opioid crisis that truly is epidemic and growing: The CDC estimates that 130 Americans die each day from opioid overdose, exceeding deaths from automobile accidents. Vermont’s death rate from overdose continues to climb, especially from fentanyl. This is not the ’80s drug war, and we must understand the causes if we are to fashion effective solutions. Our collective house is ablaze, and we need water more than blame.
And let’s start with blame, because that blame (stigma) thing is really key. I represented numerous drug offenders in the 1990s, mostly as a special public defender under contract in Connecticut. The arrests came in so fast there weren’t enough attorneys to guarantee due process. (Those who scorn attorneys for representing unsavory defendants fail to recognize that without us the entire judicial system would instantly seize up.)
My clients included many dealers with large quantities of heroin and/or crack cocaine. Willimantic, Connecticut, was at that time a major heroin hub — perhaps the largest on the East Coast. I had a client who was arrested in possession of 400 bags of heroin … while out on bail for possession of a previous (alleged) 400 bags of heroin. I had clients with numerous hand-to-hand sales to undercover police officers, who faced life in prison in consecutive sentences if convicted.
Harshly penalizing drug possession and distribution fails in part because of good old economics. Increasing penalties sharply for “dealing” (the stigmatized term for what on the street is just another business — a person “in sales”) does several things. It causes some dealers to drop out (like any illegal black market), decreasing supply and thus increasing prices (and profits, as remaining dealers command higher prices in order to undertake the higher risks — basic market theory). A good thing is that overall, dealer and user numbers fall. But, this revised, smaller pool of dealers has been modified by that well-intentioned drug policy: These dealers take higher risks, and the profits are now higher. They carry guns, organize in profitable gangs, kill rivals, and will fight to the death against law enforcement, take hostages or kidnap and execute informants. Of course, this necessitates more law enforcement, and the cycle continues. This inevitable (market/behavioral) failure is seen easily in alcohol Prohibition, which gave rise to both Al Capone and Eliot Ness.
But even worse are effects on users. In Prohibition, Americans shifted from beer to liquor (for obvious reasons). People ended up drinking more, and became criminals to do so. It was a disaster, as is the narcotics war. When users are addicted and pay $100 daily to get a maintenance dose, they rob and break into homes. When that same dose is $6 (as today, in Vermont), it is cheaper than (drinkable) beer — and most people who drink beer do so without house burglary. Higher prices motivate higher crime rates which add to stigma, fear and alienation — which all add fuel to the proverbial fire. Society deteriorates.
This epidemic is different, even as our society today is different. This epidemic arose from pharmaceuticals overprescribed (the first wave of spiked deaths: 2000-2016). In our nation’s drug war, we have never succeeded in prohibiting an illicit drug. Our best success is that, after failing to shield patients from opioids, the government can effectively shut down the pharmaceutical dope pushers. That is a disgrace, and the stigma should be on corporate profiteers, not on beguiled sick people and their deceived physicians.
The second wave (2010-2016) arose from a flood of cheap heroin, stimulated by increased U.S. demand as opioid prescriptions declined and those with “substance abuse disorder” moved to street (black market) suppliers. The third wave has been the sudden influx of illicit fentanyl from China, largely diverted through our Mexican border, where cartels now dominate some 90% of the U.S. heroin market, and offer a new, more refined product called “Mexican White.”
These are just a few of the extremely informative (though horrifying) facts reflected in the Sept. 6, 2018, testimony of UCal professor Daniel Ciccarone, M.D., before the U.S. House Committee on Foreign Affairs, entitled “The Triple Wave Epidemic: Opioids, Heroin and Fentanyl: Supply Issues and Public Health Consequences.”
We have not seen the crime wave of earlier prohibition efforts because this entire scourge was initiated by cheap legal pharmaceuticals. The global shift in heroin production from Asia to Mexico was enabled in part by millions of displaced Mexican corn farmers who (like free-market Afghan poppy growers who need to feed their children too) turned resourcefully to heroin and marijuana cultivation/production en masse. (This was amplified, if not caused, by NAFTA policies and U.S. corn industry subsidies — such policies often come home to roost, with unintended consequences.)
The mass production of heroin kept prices low as American consumers switched from their pharmacies to their dealers, and so the epidemic has grown without the usual symptoms of stolen cars, hold-ups, bank heists and gang wars. This is a quiet, unobtrusive, yet insidious destruction. And now comes fentanyl — unregulated, tainted, available in new compounds of various strengths, mixed with new synthetic opioids. Those “addicts” that our society once so thoughtlessly dismissed like lepers are truly victims — of drug companies that openly lied about degree of addictiveness; of drug cartels who filled the void when the U.S. drug company pushers got crushed like the Mexican maize market; of Chinese manufacturers of the lowest “market” scruples. Soon the now-growing flood of cheap methamphetamine (also from Mexico) will make its presence known — American dealers no longer manufacture it here, it is so cheap.
I do not dismiss personal responsibility among those who struggle with substance abuse — I praise and encourage it. But there ought to be personal responsibility and commitment from the rest of us, no? Should we as a society own our past biases that have stigmatized neighbors and relatives, alienating them further by our judgment instead of nurturing them into recovery? Because we are all in recovery together — if we cannot recover those lost to addiction, our society will gradually decline. Or perhaps it will crash like a court system where all the defense attorneys just quit and stayed home, having decided they were fed up with the stigma — sacrificing themselves for society‘s most downtrodden, while society condemned them as somehow complicit or tainted by association.
Here’s a modest proposal. Let’s stop judging people who suffer from addictions — including even pornography, or kleptomania, or gambling. Let’s start helping them. Dr. Ciccarone reported that “(t)he most compelling structural determinants include economic hardship and social and psychological malaise that may have led an at-risk population to seek opioids in the first place.” This is common sense — the same economic anxiety which is shaping the rural rebellion against urban dominance (and which fueled Donald Trump’s success), is creating isolation and social anxieties, and people (being human) turn to artificial support when human nurturing withers. This is also borne out by Vermont’s own opioid death rates, which demographically (by county) reflect pretty well the urban/economic hardship pattern. (Nationally, the urban socio-economic disintegration of community linked to narcotics is evident.)
Which means that we must prevent, treat, and encourage: not condemn. To engage this fight means to embrace love rather than fear — and not as mere platitude. The government cannot do this while we sit back with part-time legislators and underfunded “programs” that delay real action. This cannot be delegated to bureaucracy, when bureaucracy itself contributes to alienation and frustration. The country — and Vermont — now require community members’ collective personal responsibility.
Individual Vermonters must get informed, train as recovery coaches or counselors, and come along supportively in prevention, counseling, or for those in recovery. The time for ignorant stigma is past. We must shift tack, by shifting “tact”: “adroitness and sensitivity in dealing with others or with difficult issues.” As Dr. Ciccarone curtly summarizes: “This is a crisis that requires crisis level response.” We are not doing that when we blame people instead of helping them regain their lives.
Please get involved yesterday. Visit Vermont Recovery Network’s website to learn more.
John Klar is an attorney and farmer residing in Brookfield, and pastor of the First Congregational Church of Westfield.