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The Addicts Next Door
I’m not sure if everyone will be able to read this; it isn’t paywalled for me, but I think that’s because you’re allowed to read a certain number of New Yorker articles for free every month, and I haven’t hit that limit yet. If you can read it, I recommend it. It’s called The Addicts Next Door, by Margaret Talbot, and It’s the best journalism I’ve read about the opioid epidemic:
One Thursday in March, a few weeks before Michael Barrett responded to Angel Holt’s overdose, I rode with him in his paramedic vehicle, a specially equipped S.U.V. He started his day as he often does, with bacon and eggs at the Olde Country Diner, in Martinsburg. Barrett, who is thirty-three, with a russet-colored beard and mustache, works two twenty-four-hour shifts a week, starting at 7 a.m. The diner shares a strip mall with the E.M.T. station, and, if he has to leave on a call before he can finish eating, the servers will box up his food in a hurry. Barrett’s father and his uncles were volunteer firemen in the area, and, growing up, he often accompanied them in the fire truck. As they’d pull people from crumpled cars or burning buildings, he’d say to himself, “Man, they doing stuff—they’re awesome.” When Barrett became a paramedic, in his twenties, he knew that he could make a lot more money “going down the road,” as people around here say, referring to Baltimore or Washington, D.C. But he liked it when older colleagues told him, “I used to hold you at the fire department when you were a baby.”
Barrett’s first overdose call of the day came at 8 a.m., for a twenty-year-old woman. Several family members were present at the home, and while Barrett and his colleagues worked on her they cried and blamed one another, and themselves, for not watching her more closely. The woman was given Narcan, but she was too far gone; she died after arriving at the hospital.
We stopped by a local fire station, where the men and women on duty talked about all the O.D. calls they took each week. Sometimes they knew the person from high school, or were related to the person. Barrett said that in such cases you tended “to get more angry at them—you’re, like, ‘Man, you got a kid, what the hell’s wrong with you?’ ”
Barrett sometimes had to return several times in one day to the same house—once, a father, a mother, and a teen-age daughter overdosed on heroin in succession. Such stories seemed like twisted variations on the small-town generational solidarity he admired; as Barrett put it, even if one family member wanted to get clean, it would be next to impossible unless the others did, too. He was used to O.D. calls by now, except for the ones in which kids were around. He once arrived at a home to find a seven-year-old and a five-year-old following the instructions of a 911 operator and performing C.P.R. on their parents. (They survived.)
I don’t think I have anything of wisdom to add to it, beyond encouraging you to read it. It’s what journalism ought to be. I’ve of course read hundreds of articles about opiate addiction crisis, and read the statistics, but I’ve never before been able to visualize how completely devastating this is to American small towns.
Some passages struck me, particularly:
Michael Chalmers is the publisher of an Eastern Panhandle newspaper, the Observer. It is based in Shepherdstown, a picturesque college town near the Maryland border which has not succumbed to heroin. Chalmers, who is forty-two, grew up in Martinsburg, and in 2014 he lost his younger brother, Jason, to an overdose. I asked him why he thought that Martinsburg was struggling so much with drugs. “In my opinion, the desperation in the Panhandle, and places like it, is a social vacancy,” he said. “People don’t feel they have a purpose.” There was a “shame element in small-town culture.” Many drug addicts, he explained, are “trying to escape the reality that this place doesn’t give them anything.” He added, “That’s really hard to live with—when you look around and you see that seven out of ten of your friends from high school are still here, and nobody makes more than thirty-six thousand a year, and everybody’s just bitching about bills and watching these crazy shows on reality TV and not doing anything.”
And this leaves me with questions. Why exactly do people in Martinsburg feel they have no purpose? What’s so shameful about making less than thirty-six thousand a year? (I consider that a “pretty good year,” personally.) Why do people stay there if they feel the place doesn’t given them anything? Why are they watching crazy shows on reality TV and not doing anything when they’re citizens of a superpower, free to go anywhere in the country — and to many other countries, too, if they feel like it — to start new lives?
What’s keeping people, in other words, in a mental prison?
So many questions come to my mind: Talbot intimates, but doesn’t explicitly state, that this is a disease of industrial decline. Do the data really confirm this? If we map towns and cities to regions that have experienced de-industrialization, do we see an invariable connection? Or do we see that some towns stay clean? If so, why?
The word “epidemic” is a metaphor. Obviously, opiate addiction isn’t contagious the way chickenpox is contagious — you don’t catch it through a virus or a similar physical vector; you can’t catch it just from being in physical contact with the afflicted person or their bodily secretions. But it does seem to behave, in some important ways, like a contagious disease: Being around addicts does seem to make you much more likely to become one; some cities and towns experience “outbreaks” — and your risk is much higher if you’re in a place that’s having an “outbreak.”
Shepherdson, Talbot says, “has not succumbed to heroin,” but that’s all she says about it, apart from noting that it’s “a picturesque college town.” (I found a photo of Shepherdson and posted it on the right.) I looked it up: It’s a tiny town with a population of 1,734. (The population of Martinsburg is 17,227.) Based on what she says, it’s hard readily to pronounce people in Martinsburg characterologically or even spiritually flawed, because it seems clear that if they were living in Shepherdstown, instead of Martinsburg, they wouldn’t be addicts.
It sure doesn’t sound as if there’s much more to do in Shepherdson than there is in Martinsburg, or as if life is in any obvious way more full of promise and hope. It really does sound as if heroin addiction is more like a standard epidemic disease than a spiritual one: If you’re around it, you catch it.
When I looked up Martinsburg, I saw that it, too, is “picturesque,” which made me abandon my first thought — that perhaps something about a town being “picturesque” is really important here, that perhaps seeing ugliness around you rots your soul and robs you of hope. Martinsburg is shown above, on the left. The photo of the derelict Interwoven mill in the New Yorker made me think the town itself must look like an abandoned wasteland, but to judge from other photos of the place, it’s only the mill that’s depressing to look at. The rest of the town looks very attractive. Martinsburg has four colleges and universities, which means it too could have just as easily been, and been described as, a “picturesque college town.”
The author and the people she interviews seem strongly to suspect that it’s the loss of industrial jobs that’s causing this. But I’m not sure what the mechanism is. The Interwoven mill closed in 1971. Most of the people who are now addicts were born long after the mill closed. I’m not saying they’re wrong to think there’s a connection: I trust that they’re the experts about what’s wrong with their town. I’m just wondering how it works, exactly, and why it takes so long for a town to go from de-industrialization to heroin addiction.
I find it mystifying: It is like a disease, but it isn’t really a disease. I personally wouldn’t be afraid of catching heroin addiction if I went to Martinsburg. It’s connected to something about contemporary American life, but it skips over towns like Shepherdson. Almost everyone who talks about it describes it as an affliction of hopelessness, yet it’s hard for me to see any objective reason for such hopelessness: People in Shepherdson, obviously, don’t find their lives so hopeless. No one is bombing Martinsburg. There’s no war, no famine. No one is preventing people from making friendships, falling in love, starting families, going to church, starting new businesses — and above all, no one is keeping them from leaving.
Yet unquestionably, something is keeping them there — and it’s killing them, in numbers you’d associate with war or famine.
It’s so depressing and dystopian that it’s hard to believe it could be happening: It’s like something out of the Twilight Zone.
What do you think is really going on?
Published in General
Great discussion!
I blame The Great Society. If you subsidize bad life habits, you get more bad life habits.
The older charity based safety nets could discriminate and saved those that could be saved, and encouraged the rest not to tempt fate by starting bad habits.
Government welfare by definition cannot discriminate among applicants, which means all applicants are subsidized regardless of their ability or desire to maintain good life habits.
I am sorry for the destruction of Ann’s life and the pain it must have caused you. Thank you for this. Drugs destroy real poeple’s lives.
No, the observation is that societies that execute drug dealers (ie, inevitable multiple-level manslaughter criminals) don’t have a drug use epidemic. Societies that take no serious steps against them and who blithely import narcocriminals from Mexico and the Dominican Republic, do have a problem.
The fallacy is of a society so committed to preserving life that it fails to protect it. Hang a dozen drug importers tomorrow and two more a day every day, and the opioid crisis will end in about a month.
As Manny noted above, drugs hurt real people.
America is the most violent western nation, in general, if you discount the Islamic stuff, maybe even if you include it. It is part of our “shadow”. Violence is part of the American character.
A few extra things to consider:
One of Senator Sasse’s frequent talking points is that there are 4 things researchers have found correlate with happiness:
All of these have been in decline for a century, and to some extent heroin is one of many drugs we turn to to mask our pain.
Another thing to consider: welfare prevents “ghost towns” but enables “zombie towns”. Ghost towns, aka towns where industry had once thrived but were now uninhabited, were frequent in pre-Great Depression America. Thanks to Social Security, Medicare/Medicaid, disability insurance, police to fight the war on drugs, government-backed rehab facilities, etc, many towns can still struggle on despite there being no profitable industry in their location, aka “zombie towns”. Consider when a Reason writer went to his grandparent’s old town, which had shrunk over the years from 100k people to 20k. The writer never asks why the population hadn’t just gone to zero, but the answer seems to be: because government sends checks and has employees there. The town survives, but doesn’t have many opportunities for advancement.
I’d guess the university towns have far more opportunities for advancement than non-university towns.
And when there are no opportunities for advancement, people start looking into welfare. That link is to a heartbreaking portrait of a man considering going on welfare. And welfare is poison [trigger warning: Williamson]. When the 90’s welfare reform required people to look for work, it made an exemption for the disabled. Suddenly, instances of “back pain” went up. And back pain was treated with prescription opioids, but eventually the federal and state governments started cracking down on those. And there was heroin, the black-market substitute.
I suspect that a certain type of person, and their descendants, are more inclined to risk-taking behavior. Immigrating across an ocean to an unknown land for a fresh start is a big risk. So is starting a business. So is robbing a convenience store.
Yes. Most people who came here, choose too.
There’s also the self-selection inherent in comparing the USA (descendents of European immigrants) to European countries (the people who stayed behind).
As for the difference of Martinsburg and Shepherdson, I am guessing that it is mostly a fluke and that for reasons of history and chance the socio-economic demographics in Shepherdson are less conducive to heroin addiction.
I would be skeptical of any attempt at using genetics to explain anything about American culture.
Iran has pretty awful addiction problem as well.
You’re one of the writers I most respect. I’m disappointed to see this unthinking mimcry of a faddish abuse of the English language, in fact, of logic itself.
Yes, I’m confused by that, too, or at least, the article I cited didn’t help me better to understand this.
You’ve trained yourself to flinch whenever you see someone use the phrase, “beg the question” — to the point that you didn’t realize mine was a rare correct usage. When I said it begged the question, I didn’t mean, “raise the question.” I meant that the argument included the conclusion to be proven within its premises.
You were quite right to think I’d never use that phrase incorrectly. Keep your faith in me.
I thought that, too, but (I learned this from Wikipedia, so cum grano salis etc.) Martinsburg has four colleges and universities, which isn’t quite as many per capita as Shepherdson, but depending on their size, might also be enough to provide a lot of employment opportunities.
I’d like to visit both towns and see for myself what’s going on. It might be much more obvious if I visited and looked for myself.
Are they? Seriously?
Another important factor in the high fatality rate is the tainted nature of the drug supply right now.
They are so strong and deadly around our area that the police can follow the trail of a drug dealer by following the trail of bodies as addicts take the drugs, lose the ability to breath, and just die. The emergency services quickly become overwhelmed and traumatized.
To give you an idea of the strength of these drugs, a week or so ago a policeman nearly died from using his bare hand to brush off some drugs which were left on his clothes after searching a car. They can be absorbed through the skin. The drug is called carfentanil and is 10,000 times more potent than morphine.
What once might have been a short term recreational relationship with narcotics that most people would grow out of has quickly become a deadly game of Russian roulette.
Thanks so much for sharing this article. I’ve been learning a lot about drug culture as my sister has taken that road, the first in our family (she doesn’t fit the demographic in which the epidemic is raging…she graduated from Pepperdine and had a great job, but she has chosen that community since the onset of her addiction). As the article suggested, what seems unbelievably irrational, foolish, and even evil to those who have not either been addicts or forced to live in close proximity to the world that addiction creates, is the norm for those within the insanity of the addiction cycle. As I have tried to understand and help my sister, I’ve had a lot of conversations with recovered addicts who basically scold me about doing any of the normal things one does to show love and care for a loved one because it will only prolong their descent to the place where they might start to seek help. A woman who my sister helped when she was caught in homelessness and addiction and is now recovered told me, “Your sister is either going to die, go to jail, or end up in a rehab facility, and there is nothing you can do about which road she will take. She has to make that decision. There is nothing we can do.” So as to the question of the current American situation and why it is so dire, I think the simple but incredibly painful and difficult answer is that once that addiction has taken hold, it has an evil and insidious nature that humanity in general has not the strength to overcome…AA and NA would say it literally requires a higher power…which matches remarkably with the scripture of Judeo-Christianity. In that sense, it is a spiritual issue, but I still wonder of the cultural factors that lead to our current problem. Up until a few decades ago in American culture, there was a deep sense of honor for anyone who worked hard and cared for their duties (such as family). I think of The Blacksmith by Henry Wordsworth Longfellow…a poem that wasn’t likely to have been written in European or Hellenistic cultures that primarily gave favor and honor to aristocracy. Our media’s contempt for white males, the lost of the sense of the spiritual and the hand of God in our circumstances, the loss of a robust faith tradition in the blue collar world, the open acceptance and even celebration of the “party” lifestyle in our music that validates and even shows honor to those who choose drugs as if it some kind of courageous rebellion…the lie that sleeping around and having kids without the commitments of marriage…relationships that end in STD’s, abortions, and emotional chaos…I would suggest that a significant factor is that these communities bought into what the pop culture told them and abandoned their spiritual and cultural roots.
One more point…I worked at one of the largest homeless shelters in L.A. when cocaine and crack were significant problems in the African American community in the mid 90s. I remember reading an article where an interviewee declared something to the effect of, “Ain’t nothing could keep a black woman away from her child until cocaine.” Different decade, different drug, and different demographic, but the issues of leaving spiritual roots, being shamed by their own culture, and perceived lack of opportunities for a better life were all the same…as was the prevalence of the opportunity in the community making access almost constant.
For six months last year, I lived less than 1/2 a mile from Heritage Park Mall, which Kevin Williamson wrote about this week. Midwest City seemed to be in pretty good shape overall. It was doing better than Peoria or Cedar Rapids, anyway. Things are hollowing out. It’s even happening here. Obama did no favors for Illinois. When I said that according to the yard signs, both Hillary and Donald were losing to Coldwell Banker and Baird & Warner, that was not a joke.
Swedish psychiatrist Nils Bejerot (he’s the guy who coined the term “Stockholm Syndrome) at one point did classic epidemiological contagious disease contact tracing the spread of addiction through social circles and beyond. He extended this model and noted that an exclusion and isolation strategy is appropriate when you are trying to keep a rare infectious disease from establishing itself in a population, but that that once the disease has become endemic, that is no longer useful. While his policy recommendations are not viable approaches to the widely used addictive substances in the US, his observations of addiction, which include the following risk factors, are still useful.
I’d also like to clarify something @claire wrote: “None of these drugs are legal.”
Heroin isn’t legal, some of the designer variations of drugs such as Fentanyl have not yet made it to the federal schedules, and some of them, for example Norco, Vicodin, Oxycodone and its preparations, and Fentanyl, are, while controlled, legally available through prescription. Unless prescription tracking methods are in place, it is common for addicts to obtain multiple prescriptions from multiple doctors. Stanford psychiatrist Anna Lembke found this out in her own practice once California’s tracking system came online and wrote about it in Drug Dealer, M.D.
But not all the people involved on the legal side of the supply chain were well meaning. Purdue Pharma had to pay out over $600,000 due to its “misbranding” of Oxycontin. In case you didn’t know what that means Purdue did, the NYT wrote that
Purdue’s other methods included industry funded astroturf “patient advocacy” groups.
Unless they’ve moved in the last few years.
I recently talked with the mother of a young adult (whom I’ll call Lindsay (not the real name)) who has been dealing with Lyme disease – definitively diagnosed – and multiple coinfections for years. Lindsay has been in a lot of pain, and had been on one or another opioid for years. Lindsay recently noticed that if changing the patch was delayed by so much as an hour or two, the pain got much worse.
That prompted some consultations with Dr. Google, the question: “Is this pain at least partly due to narcotic withdrawal,” the desire to test this by withdrawing, an argument with an ultimately cooperative physician who very gradually tapered the dose down, and, after being clean for a month about the same amount of pain as while on the meds.
Fortune called Oxycontin a “breakthrough of marketing, not medicine;” the marketing included coupons which made the first month free. With their marketing budget, they could go beyond the street corner guy’s first dose for free.
Via deceptive marketing to doctors, astroturfing and lobbying, Purdue pretty much created the boom in opioid prescriptions.
The American Journal of Public Health:
Fortune:
Having contributed to the creation of this catastrophe, it doesn’t seem right for the Federal government to institute policies that call for treatment without funding programs. Why, if you didn’t know better, you’d think that people would turn to totally illegal drugs if the supply of diverted prescription drugs dries up.
In some ways this all reminds me of Pohl and Kornbluth’s classic The Space Merchants.
I am sorry your family is having to live through this. I think much of what you say is true.
Okay, so a few things about this comment:
Look, I know this is an unpopular thing to say, but not all illegal drugs are addictive and not all users are addicts. Just as some people can have a glass of wine at the end of the day without becoming alcoholics, some people can handle their high.
I hasted to add that the way our government regulates and handles drug laws has everything to do with fearmongering and racism and nothing to do with rationality.
And now we’ve had decades of government propaganda to rationalize those laws, backed these days by entrenched interests.
This is true. All drugs can be addictive. Not all users of a given substance will become addicted. Alcohol is around a 10% rate. Cocaine is 30%.
Pathways matter. Smoking Crack or Meth is 100%. Cigarettes are 100%. All cause immediate pleasure via direct brain stimulation. I imagine what IV Heroin is close to 100% for similar reasons. Snorting Heroin is not 100%.
LSD is not addictive at all.
I am really sceptical about addiction as primarily a function of the drug and method of ingestion rather than the vulnerabilities in the addict’s life.
I find this chart very useful:
If that’s cut off, the one axis says “Dependence” and the other says “Physical Harm.”
Oh, Fred … you decry the social structures that serve to make some things taboo, then you rely on taboos to limit behavior?
I admire the chutzpah.