On Thursday during a press conference, President Trump declared the country’s opioid crisis a “national emergency” and promised to spend a lot of “time, a lot of effort and a lot of money” on the problem.
And while many families, treatment providers and suffering addicts cheered the fact that a sitting American President finally spoke so forcefully about addiction and its treatment, it does raise a very important question: We have already devoted a lot of time, effort and money on the opioid epidemic — yet still the death toll is on the rise. What are we missing?
Perhaps we have to reexamine our view of addiction and, by extension, how we treat it and all of the misguided notions of the “war on drugs.” As we are discovering more and more, addiction is less about the substances and more about a person’s need for the substances. Thus the opioid epidemic is less about opiates and more a byproduct of certain very complex social, cultural, biological and economic factors that make a person vulnerable to the addictive escape of pain pills.
And unless we address those underlying causal factors, we will never make a meaningful dent to the opiate crisis because we will have, effectively, been looking at the telescope through the wrong end. We can analogize it with heart disease: Is it the heart attack that kills someone or the lifestyle and hereditary predispositions that led to the heart attack that are the ultimate culprit?
Here’s what we know: The U.S has an estimated 2.6 million opioid addicts, and drug overdoses (of all types) kill more people than car crashes and gun homicides combined; over 140 people a day and over 52,000 people died of overdoses in 2015 — and we’re on pace for 60,000 this year. By comparison, 58,000 American troops died during the entire 10 years of the Vietnam War.
And we know that there are more pain meds flooding our medicine cabinets. Fact: According to the National Institute of Drug Abuse (NIDA), in 1990 there were 75 million opiate pain med prescriptions written in the U.S. By 2010, that number had risen to a whopping 210 million prescriptions — an almost three-fold increase.
Why? Are we in more pain as a society over that 20-year period? Hardly. But many psychologists and sociologists do feel that our ability to tolerate discomfort has diminished exponentially in the modern, instant-gratification digital age. We have become less patient with both physical and emotional pain. Feeling a little blue? Pop a pill. Feeling a tad anxious. Pill. Don’t like your life? Pill.
As a psychologist, I am certainly not saying that there isn’t a time and place for appropriate medication. But let’s face it: Big Pharma has definitely been very accommodating in letting us know that we can take certain pharmaceutical shortcuts — very addictive shortcuts — to get through our discomforts, both large and small.
The fastest rise in the opiate epidemic has been in young people and the white “Rust Belt” middle class. The theory goes something like this: If a person feels trapped economically without viable job prospects (which also applies to inner city poverty and people of color who have also been crushed by addiction), then a person tends to look for some kind of escape from a daily reality that is untenable.
With many of the Millennial “Failure to Launch” generation, stuck in their parents’ proverbial basement, that addictive escape can include video games, pain pills, marijuana … just about anything. What’s happened with the opiate epidemic is that opiates have become much, much more powerful and readily available. Fentanyl — once used for end-stage cancer victims — and Oxycodone are very strong analgesic opiates. But now teens are popping them like yesterday’s candy.
In the 1970s, a very innovative Canadian professor named Dr. Bruce Alexander performed a series of groundbreaking experiments that were colorfully named the “Rat Park experiments.” In prior laboratory research with rats and morphine, isolated rats in cages invariably chose morphine water over food until they overdosed.
Dr. Alexander theorized that this had less to do with how addictive the morphine was and more to do with how miserable the isolated, caged rats were. So he set them free in “Rat Park” where they had space to run around in, wheels to frolic in — and other rats to socialize with. He also gave them access to both food and morphine water. What he found was that these “happier” and less trapped rats didn’t go for the morphine water like the caged rats. Indeed, none of the “Rat Park” rats overdosed while almost 100% of the caged rats overdosed.
He concluded that people can also feel trapped — even without being in a cage. The antidote for addiction became having people feeling free and a sense of meaning and purpose in their lives. Indeed, Portugal has adopted this perspective and has focused on giving addicts job training, micro-loans to start businesses and connections with other people — and they have seen their addiction rates plummet.
There have been many recent, wonderful initiatives that have saved lives, like providing Narcan — an opioid blocker that can literally bring a person back from near-fatal overdoses — to first responders. But just as we can’t arrest our way out of the opioid epidemic, we can’t Narcan our way out of it either. Emergency room doctors tell horror stories of addicts being revived by Narcan time and time again, only to keep using and overdosing again.
President Trump should follow the lead of Portugal and provide meaningful economic, social and treatment opportunities for our young people if we want the opioid fatalities to decline.
Dr. Nicholas Kardaras is Executive Director of the Dunes in East Hampton, former Clinical Professor at Stony Brook Medicine and a recovering opiate addict.