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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
An old saw: “Senator Robert Byrd is moving Washington DC to West Virginia, one building at a time.”
Numerous states now have prescription tracking programs, which require prescribers to query them every time they write for a controlled substance. No more, “my dog ate the prescription chit.” I am very curious to see how this works out. I suspect that doctor shopping to obtain drugs will be replaced – as an unintended consequence (as with most government coercions) – by a sharp increase in robberies and muggings, to finance the substitution by many addicts of street drugs for the cut off of their prescription drugs..
Sorry. Which social structures do I decry?
So smoking meth and crack are up with IV Heroin, but not on the chart. I think this chart underates harm of Ecstasy, based on the brain slides I have seen on monkeys given mild does. There appears to be long term seritonin loss with mild Ecstasy use.
Also, they left out the #1 Drug of Choice for billions of people: caffeine. :) It is my drug of choice for sure, and there is no doubt I am addicted.
Legalizing something will tend to make it less taboo. Coors has lost its mystique from the 1970’s in the East because it is not longer bootlegging to bring it East of Texas.
However, legalizing something does not mean it has no taboo at all. Gang Bangs are still pretty taboo to go about in polite society, despite the fact they are legal. Images of gang bangs are much less taboo than they used to be, since being made more legal.
All of that being said, I think you are doing Fred a disservice here. He is giving an honest stance on why he thinks drugs should be made legal, and in no way is claiming it will be a perfect solution.
What you say may be true in the cases of LSD and peyote, for example, though some effects of peyote exhibit tolerance (probably one of the phenomena involved in addiction) and it has been observed that “psychological dependence” develops; it used to be believed that cannabis only produced “psychological dependence” but it is now known that physical dependence can also develop and the mechanisms are consistent with other addictive substances.
True, some people are more susceptible to the addicting properties of certain drugs than other people are, but with the possible exception of some hallucinogens, drugs of abuse are almost all addictive to some degree or another.
This of course doesn’t automatically make them all bad. Caffeine, for example, is addicting, but unless you’re LDS or SDA or have accepted a religious precept of not exogenously modifying your consciousness, that doesn’t seem to be too much of a social problem.
What constitutes a social problem also varies. The fact that signs like “I don’t have a drinking problem! I drink, I fall down, no problem” are considered humorous does indicate a certain social tolerance to alcohol abuse; the fact that they are much less tolerated today than when I saw them 45 years ago in places like the towel cage of the men’s locker room or behind the parts counter at a plumbing supply shop indicates that mores change much quicker than psychopharmacology.
The social (e.g. cocaine as a prestigious social drug, crack cocaine as a low life social drug) or even official sanction of addictive drugs (often in extreme circumstances; this could range from cigarettes being sold at low cost or even issued in field rations to troops in WWII to amphetamines and other stimulants being issued to soldiers:
comes from a pretty good overview of the use of drugs in modern military service in the Daily Mail (!). The Nazi use of drugs, particularly amphetamines, was detailed in Blitzed, a fascinating book by Norman Ohler.
But returning to our muttons.
First of all, alcohol and other addictive substances don’t act by the same brain mechanisms. Alcohol is globally toxic, and doesn’t have specific receptors in the nervous system.
Other drugs interact directly with brain receptors. Opioids and cannabinoids are two major examples.
That said, pleasure/pain/motivation pathways seem to be involved in the brain mechanisms of addiction.
Social approval/disapproval is probably most universally utilitarian: Does using a particular substance interfere with someone’s ability to support himself and his family, to have constructive relationships including appropriately rearing children, and the like.
[continued]
All of them. You’re an anarchist, remember?
Hush, I’m teasing Fred.
You misunderstand. I decry government structures. I have no problem with voluntary social structures so long as they’re non violent.
This point hits too close to home for me to joke about it, or tease Fred about it.
In college, my sister was one of a team of observers trained to categorize social interactions (observed both live and from videotapes) in a colony of Rhesus macaques.
After a baseline of behavior including mother/infant interactions was developed, some of the monkeys were given regular doses of marijuana edibles in doses that were considered equivalent to those used by serious dopers at the time (by today’s standards, the weed was much weaker than what is used today.)
In a confirmation of centuries of observations of human populations, (one Egyptian physician of my late stepfather’s acquaintance told him something to the effect of “Yes, people have been using hashish for a long time in Egypt, but it’s generally known which villages and which families are involved, and nobody outside of those circles would want their son or daughter to marry into them”) monkeys who were “using” exhibited serious degradation of their ability to read social cues, and users’ mothering behavior was badly disrupted, even to the point of neglect.
When the social cost of such disruption is pretty much limited to fellaheen starving to death but there are plenty more where they came from to grow the food and dig the ditches, that’s one thing. When society is expected to provide a universal safety net, it’s a whole nother ball game.
Tao Te Ching §18, Legge translation.
We are far down that road, and it is not merely stuff happening. It’s not enough to say “laws don’t work.” Law/regulation and social (including religious) sanctions are needed to some degree to restrain all of us, or at any rate (perhaps) all but the most saintly.
Entire sectors of society – academia, advertising, the entertainment media – are working hard and skillfully to break down traditional social strictures. Bad laws and ill advise regulations certainly don’t help, but economic disincentives and moral strictures are not sufficient in a modern or postmodern society.
The kind of distinctions that @bryangstephens mentions in #87 are very important.
That explains a lot.
I’m not sure what that means.
Unattributed, and it smelled like old information. TinEye brought me to Wikipedia, which supported it with information at least a decade old, (a long time in this field.)
Yeah. But it’s not like khat is going to become more addictive or something. There aren’t gonna be big changes.
However, if you have a more recent chart with different information, you’re invited to present it.
The physical damage side is going to change as we learn more.