The Opioid conversation

The purpose of this post is to make the reader think and not to point the finger at anyone that has been or will be affected by opioid abuse.‍

This post will focus on My Common Sense behind why Opioid use has exploded and what to do about it; however, prior to getting started, I need to mention the following:

Since I was born in 1981, the United States has experienced 2 major drug use explosions, crack cocaine in the 1980’s and opioids, mostly in the 2010’s. In the 1980’s, the primary solution to the crisis was to incarcerate many of the affected individuals. In the 2010’s, the primary solutions have focused on funding research into a public-health crisis and enabling states to deal with its consequences on a more local level. This post will not focus on the comparisons between the crack cocaine and opioid differences; however, I would be irresponsible in failing to point out the stark differences in the political response and policies created in response to increases in drug abuse by different demographics of users. If you would like to read more about the differences, you can consult the following WSJ article and form your own opinion.‍

CRISIS vs PREDICAMENT

‍To better understand why the Opioid conversation should be classified as a predicament rather than a crisis, you must understand the meaning of both terms.

A “crisis” is defined as the turning point for better or worse; an unstable or crucial time; the state of affairs in which a decisive change is impending; a situation that has reached a critical phase. A crisis that gets worse and then improves can be depicted in the form of a bell curve. They peak of the curve can be described as the peak moment or the moment when the solution(s) were introduced. A crisis that only continues to worsen beyond the peak moment could give way to a new normal. Examples of a crisis are: the common illness (cold, the flu, strep throat, etc.), the World Wars, etc.

“Predicament” is defined as a difficult, perplexing, or trying situation. The primary difference between a crisis and a predicament is predicaments do not have solutions; they just have outcomes. Examples of predicaments are: climate change, the consumptive nature of society, etc.

Since I do not believe there is a realistic and/or easy solution(s) for the rapidly increasing reasons behind the explosion of opioid abuse, the Opioid conversation should be classified as a predicament until a potential solution(s) is introduced to convert it to a crisis. There have been proposed solutions, but none that has led to universal decreases in opioid abuse.

FACTS‍

This rise in opioid use and overdose deaths can be outlined in three distinct waves.

The 1st wave began with increased prescribing of opioids in the 1990’s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999. The 2nd wave began in 2010, with rapid increases in overdose deaths involving heroin. The 3rd wave began in 2013, with significant increases in overdose deaths involving synthetic opioids.

‍National

‍On average, 115 Americans die every day from an opioid overdose. Between 1999 to 2016, more than 630,000 people died from a drug overdose. Around 66% of the more than 63,600 drug overdose deaths in 2016 involved an opioid which is a rate that is 5 times higher than in 1999. Regardless of the website from which you gather data, they all show a sharp increase in opioid use over the past 15-20 years. According to the CEA (Council of Economic Advisors), the economic cost of the opioid crisis in 2015 was $504 billion and is only increasing.

‍Local

‍According to the ARC (Atlanta Regional Commission), there were 996 overdose deaths in 2016 caused by opioids. This represents 68.8% of all drug overdose deaths in the state and a 61% increase since 2013. Of those overdose deaths statewide, 595 involved prescription (legal) opioids, a more than tenfold increase since 1999. Overall, the geographical focus of opioid abuse in Georgia has been in the northern Atlanta suburbs. This area has been termed the “deadly triangle.” Imagine a triangle with I-20 as the lower line and the other 2 sides converging in the Hwy 400 area in northern Fulton County.

Demographics

‍Opioid abuse affects all demographics. According to The American Journal of Preventive Medicine, white American males face the greatest risk of death by opioid abuse. The rise in fatal drug overdoses is also mostly responsible for the growth in mortality rates for white, non-Hispanic people between the ages of 22 and 56 in recent years. It is my opinion that opioid use is having the greatest effect on 2 even smaller demographics than just white American males.

The first is white Americans that live in smaller towns and/or rural areas (think West Virginia and Ohio). During the writing of this post, this article was published by the Robert Wood Johnson Foundation showing that the economy and drug abuse are the primary concerns for rural America.

The second is affluent communities made up mostly of upper-middle to upper class residents where the average income is higher than the national average (think Roswell, East Cobb, Alpharetta, GA - the “deadly triangle” areas). This particular demographic was determined based on local evidence showing sharp increases in opioid use between 2006 and 2015 and I know the demographic makeup of these communities. I am assuming this demographic applies not only to Georgia, but for the United States.‍

DRUG USE

‍I believe that regular drug use is a symptom of a much larger problem. The problem could be physical, psychological, emotional, etc. or a combination of several factors. I can empathize with these individuals. In my late teens and early 20’s, I faced steep emotional challenges and high levels of anxiety regarding coming out to my family, friends, etc. During that period, I sought refuge in several drugs to mask the years of anxiety and depression that built up over many years. Fortunately, I was never attracted to any hardcore drugs, and never became addicted; however, I have lost several friends due to persistent drug use. Eventually, I took personal responsibility to change my life, and have thrived as a result.

People that use drugs should be able to get the help that they need to alleviate their addiction and then work on repairing the issue that caused the drug use. This help or treatment should never be funded by taxpayers. The financial responsibility should fall to the individual drug user, the responsible party(s) for the individual, nonprofits dedicated to helping addicted persons, religious groups, etc. Individuals that chose to use drugs should be held responsible for the consequences of their choices, including the financial costs of getting sober. Many Type 1 diabetics around the nation struggle with the costs of insulin (life sustaining medication). We can debate why insulin costs have skyrocketed, but the fact is insulin is incredibly expensive. Narcan (lifesaving medication), the reversing, anti-overdose drug is not as expensive… yet. That will change as demand increases and/or if governments begin to subsidize Narcan as part of interventionist policies to curb drug use.

‍If opioid abusers can receive free Narcan (lifesaving) every time they self-inflict an overdose, they why should Type 1 diabetics be expected to pay 5x as much for the insulin (life sustaining) they need to treat a condition that is not self-inflicted?

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‍SUICIDE

‍My Common Sense on suicide is simple. I do not believe that anyone should commit suicide. Life is beautiful yet very challenging and should be enjoyed at every opportunity. I support an individual's right to choose how to live their life and believe in personal responsibility. If someone is determined to off themselves, good luck. If I had a child, friend, family member, etc. that told me they had thoughts of suicide, I would be saddened and would do almost anything to get them help. However, I would never stand in the way of doing what they feel is best for their life because it is not my responsibility to decide what is or is not best for them. ‍

MY COMMON SENSE ON THE OPIOID CONVERSATION

I believe that the continued rise in opioid abuse may be associated to many individual’s inability to overcome the difficulty of living in a highly consumptive society that is growing at an exponential rate.

COMPELLING RATIONALE

‍GROWTH

‍If you have any question as to whether we are growing and consuming at an exponential rate, take an hour and watch Professor Albert Bartlett’s slightly old, but compelling explanation on the exponential function, population growth, and consumption. If you watch the video until around 14:55, a chart is reviewed that eerily displays things that should be encouraged if growth/consumption needs to be slowed. Fast forward to 2018, you can see many of the topics from the right-hand list on the nightly news. I do not believe that many Americans are even aware of the Exponential Growth Function; however, we all feel it every day. If you are not familiar with the “Lord of the Flies”, look at the consequences of attempting to maintain a large group of people with limited resources. As the overall population grows, so does the overall anxiety level. None of the items on the right side of the chart are happy or positive, they are horrible, but are happening as we speak. “...would you like more murder, more famine, more accidents?...”

‍CONSUMPTION

‍The United States has less than 5% of world's population yet it consumes ⅓ of the world’s paper, ¼ of the world’s oil, 23% of the coal, 27% of the aluminum, and 19% of the copper. Our per capita use of energy, metals, minerals, forest products, fish, grains, meat, and even freshwater dwarfs that of people living in the developing world. We are also consuming through debt as indicated on this recently published chart on Visual Capital.  This debt is allowing our society to further enable our consumption.

Several years ago, the “Occupy” movement took over Wall-Street and the headlines. Their goal was to “take down the 1%!” What the protesters failed to realize is if they earned more than $32,400 (the basic poverty level in the USA), they were part of the World’s 1%. I recently read an article where a smart individual pointed out to an Occupy Wall-Street protester that they were in the 1% and then cited the data. The protester then commented “.. no you don't understand the rich are those who have more money than me…”

The Occupy movement was and is at the core, a bunch of people complaining because they do not have the means to consume more than the top 0.1%.

Imagine the Cookie Monster from Sesame Street…

The more money you have, the more stuff you have the ability to buy. The United States has most of the world’s money, most of the debt and the highest rate of consumption, but how does that play out in the Opioid conversation for the 2 demographics mentioned above? Here’s how…

‍RURAL AMERICA

I believe that Rural America’s inability to consume has contributed to its increase in drug abuse.

‍According to the PEW Research Center, 95% of Americans have a cell phone and around 92% of Americans ages 18 to 49 have a smartphone. This means that the overwhelming majority of citizens in the United States have the ability to connect to Instagram, Facebook, Twitter, YouTube, Snapchat, and streaming media services like Netflix and Hulu. I also previously mentioned that 2 of Rural America’s greatest concerns are the economy and drug abuse.

Here is a basic explanation of what has taken place over the past 20 years in rural America: a large group of people (many “blue collar”) that relied on manufacturing had their factories closed. Then, a large percentage of them applied for and were placed on government assistance. With the corresponding rise in social media use, they have been blasted with media that depict the amazing lives of everyone living outside of their community and/or with media from their local connections that further promote their hopelessness. A large portion of this media is tied to consumption (the purchasing of goods and services).

My in-laws are from rural Ohio (just north of Dayton). They often comment that many of the residents in their small towns are on some form of government assistance. A cousin-in-law is also a police officer in one of these small towns. Every time we chat at a family gathering, he cites drug abuse as the main problem in their jurisdiction. To add insult to injury, another local police officer in the same area was recently arrested for OVI while driving his police car. Even though he was drunk and not high, what would drive a dedicated public servant to get so tanked while on duty that he wrecked his car?‍

AFFLUENT AMERICA

I believe that the anxiety and pressure to constantly consume (“keeping up with the Joneses” or the Kardashians) has contributed to the increase in drug use in affluent communities.

‍If you think that affluent communities have it easy, you’re right. They have it so easy that recent studies show that when younger affluent individuals face adversity (aka the real world), they experience high levels of anxiety and depression. There is also a rise in college students seeking therapy and a corresponding increase in hospitalization for self-harm and suicide. In their 2016 Annual Report, the Center for Collegiate Mental Health published research gathered from 139 college and university counseling centers.

The research noted that 150,483 college students sought mental health treatment during the 2015-2016 school term which represented a 50% increase from the previous year. I am making an assumption that the majority of college students are from affluent families living in affluent communities.

Consider the story of the Princess and the Pea. The princess, who is accustomed to sleeping on the most luxurious of mattresses is forced to sleep on a pea and hates it. She chooses to go back to the mattress after one night. What would happen if the princess was told that she might need to spend many nights on the pea? Would she think about numbing her pain with drug abuse after 1, 2,... 30 nights on the pea? That is unknown, but she would likely increase her chances of opioid abuse if all her friends were Instagramming about the amazing night’s sleep they got on their awesome mattresses. This story is representative of the modern affluent society and their inability to cope with the pressures of consumption. Individuals raised in affluent areas need something more purposeful for their lives than striving to achieve enough success to purchase their next Tempurpedic Mattress or iPhone.

We have friends that live in many areas of Atlanta. Two of our friends live locally in Roswell, GA. They live in one of the most upscale communities in the area, have multiple kids that attend a well-known private school, and have lived in several different states for work, etc. In my opinion, they have done a great job raising their kids. They are well behaved, are active in sports and life, are social and play well with others, and seem to be above average in their intellect. Recently, they told us the following… they decided to send their kids to a well-known private, middle school. At that point, they had NOT purchased cell phones for their kids. When their kids got to middle school, they were bullied, picked on, etc. for not having an iPhone like everyone else. After a week or so being tormented and coming home depressed, their dad went to his bedside table. He pulled out a few of his older iPhone's that were not connected to cell coverage but still had the ability for Wi-Fi, wiped them, and gave them to each kid to take with them to school. Over the next week or so, they came home even more anxious and depressed. They finally admitted that the kids in their school were bulling them even more because they did not have the latest and coolest iPhone like everyone else. I do not recall how the story ended because we got into an intense discussion about consumerism and how it plagues children.

Comparing yourself to others is never healthy and 99% of affluent customers spend at least 2 hours a day on social media websites. People should compare themselves to who they were the day prior to judge their own improvement. I am going to make the assumption that all social media platforms have the ability for intensive social comparison. I am also going to assume that excessive social media use, particularly related to social comparison, can be very harmful to people’s happiness. Imagine being in the worst aspects of junior high school 24 hours (or at least 2 hours) a day forever. That might drive most people to drug use… Stop trying to Keep up with the Kardashians and focus on bettering yourself… ‍

IDEAS BUT NO SOLUTIONS

‍As I mentioned above, crises have solutions, and predicaments have results. I believe the possible solutions that could convert the Opioid conversation from a Predicament to a Crisis are so complex and require such radical changes in societal behavior that any potential solutions are unrealistic. My only remotely realistic solution would be to decriminalize the use of all illegal drugs, encourage education, personal responsibility, and see what happens. Maybe if presented with the freedom of choice, people would choose not to use illegal drugs because psychologically, it is no longer “cool” to do so…

As long as we have an exponentially consumptive society that looks to substances to treat anxiety and depression, we will continue to have drug abuse and the correlated suicides as a societal issue.

If you want to have a constructive conversation about this or anything else, message me, and let's grab coffee or a beer.

Have a good one,

Dan