Addiction does not discriminate.
My relationship with my hometown is complicated. Like much of the rural Western Maryland, West Virginia, Southern Pennsylvania area, it’s hardly a spearhead of social progressivism: Our neighborhood Moose Lodge denied membership to a black man in the 1990s, and Confederate flags dot the landscape as naturally as the cornfields. It was a town I had to leave in order to learn more about the world and about myself, albeit now a sanctuary from the D.C. frenzy in its misty Appalachians and winding Potomac.
There is sanctuary in memory too as I drive past my old high school where, instruments in our sweaty hands, we marched under the August sun. But that sanctuary is interrupted today. I think of the little blonde girl whose gap-toothed smile flashed whenever she turned around to question our tempo or help me move a field marker. I think of her freckles, her laugh, because she is now dead. The rest of us band kids are out there making our way as teachers and musicians and business owners, left wondering why her life diverged so drastically from ours.
The opioid epidemic sweeping America took our classmate last month, and, a year earlier, my friend’s teenage sister. According to the CDC, the national amount of drug overdoses reached a record high in 2014. Opioid overdoses—which include heroin and its prescription derivatives—have nearly quadrupled in the past 15 years. And still, those of us who imagine the horrors of Trainspotting and Requiem for a Dream as fictional worlds away regard opioid addiction as a personal, criminal lifestyle rather than a public health problem.
Our first impulse may be to ask, “What about personal accountability?” We choose to take the pill or to not—though that choice is sometimes guided by physicians we trust. There is certainly a distinction between addictions spawned from conscious action rather than chronic disease—though these two brands of affliction often influence one another. The continued condemnation of drug abuse as spawning from one decision made in a vacuum, that is now solely your problem, is more than an oversimplification. It is the wrong way to frame addiction if we want to stop those statistics from climbing and for addicts to feel supported.
After my wisdom teeth were extracted at 17, I was sent home, sedated and swollen, with a mouth of bloody gauze and a bottle of hydrocodone. The pain was manageable, but I wanted to follow the doctor’s instructions. What followed was a mental emptiness and lethargy that I had never known. I stared into my bedroom mirror for hours, rocking back and forth like a child, drooling. As much as I wanted to cry, I couldn’t. Once the medication wore off, I flushed the rest of the pills and decided to tolerate the pain.
I didn’t understand why anyone would voluntarily take a drug that made the world so blank and terrifying. Part of this is because I don’t have an “addictive personality” and have always been able to moderate my indulgences. My life was also smooth sailing at this time, free of personal hardship or chronic illness that could have propelled me toward such a vice.
Like me, Emily from Rochester, New York, is white, grew up in upper-middle-class suburbia, and holds a graduate degree. Unlike me, she has dealt with persistent pain from fibromyalgia and arthritis: conditions that prompted her doctor to prescribe narcotics. “One day, [my doctor] decided to stop writing the prescriptions without any instruction or attempts to wean me off even though I had been taking opiates for years. Physically dependent, I had no choice but to either be sick or self-medicate,” Emily shared with Frontline, a PBS documentary series. “I was not going to suffer through a withdrawal so bad that I thought I was dying as well. So I bought pills on the streets…I turned to heroin. I am a perfect example of how addiction does not discriminate.”
Opioid use can similarly be driven by emotional pain. Chelsea from Rutland, Vermont, described herself to Frontline as an honors student with dreams of becoming a veterinarian. But after her rape and subsequent multiple abusive relationships, she found that alcohol was no longer enough to dull the agony. At the onset of post-partum depression, she turned to opioids. “People become addicted because they lack other coping skills to deal with [mental illness],” Chelsea explained. “The only way to stop this epidemic is for people to show compassion and understanding…because [addicts] will not come forward for help for fear of being judged and rejected.” Like drug addiction, mental illness is highly stigmatized, and those who suffer (6.7% of Americans live with major depression) may find a quiet refuge in self-medicating rather than coming forward to family, friends, or health professionals.
The stigmatization of addicts neglects a critical part of the epidemic equation: Big Pharma’s role in downplaying the dangers of opioids while peddling them to the public. OxyContin’s market release in 1996 coincided with medical trends to “push to do a better job of treating pain,” according to Kimberly Johnson, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration. OxyContin differs from other opioids in its extended 12-hour release, and its creators at Purdue Pharma urged doctors to prescribe it over shorter-acting medicines. An L.A. Times investigation concluded that many physicians, upon hearing from patients that the drug’s effects wore off before 12 hours, were simply encouraged to prescribe higher doses. In a Frontline testimonial, Carol cautions other parents to “watch out if your child is prescribed pain medication at an early age.” Carol’s son, who was prescribed opioids following a high school football injury, died from a heroin overdose in 2015.
When my D.C. co-workers hit the road for an Appalachian weekend getaway, they soak up the beauty of rivers and mountains and a sky free of light pollution, unbroken by angry grey edifices. They return to the office feeling replenished with the stuff of life that the urban trudge drains from our hearts. But they do not see the parade of obituaries in our local paper: 24, died at home; 30, died at home; 27, died at home. They do not see the recent flood victims in West Virginia who would rather let black mold grow in their homes than leave their opioid supply open to looters.
As my classmates mourn one of our own, remembering the championship our marching band was elated to win, the Senate passes legislation to reframe opioid addiction as a crisis of public health. Supporters of the bill hope that it will help expand access to mental health treatment and drugs that reverse opioid overdoses. Alison Kodjak of NPR deems this emphasis of treatment over jail time “a big reversal from the ‘war on drugs’ campaigns of a few decades ago.”
I think of the tiny flutist dead at 30 because her brain, on a raging hunt for dopamine, had overridden the vibrant personality we all knew and loved.
It could have been any of us.
It could be any of us.
Chelsea Cristene is a communications associate and English professor based in Washington, DC. She has been published by the Good Men Project, Salon, xoJane, and MamaMia, and runs a film review blog, Catch Up, with fellow Role Reboot contributor Telaina Eriksen. Find her on Twitter.