By Lloyd I. Sederer, MD, author of The Addiction Solution: Treating Our Dependence on Opioids and Other Drugs (out now on Simon & Schuster)
It’s clear to me, as a public health doctor and journalist, that there have been fewer news stories on the opioid epidemic in recent months, in print, online, and on the radio and TV. While I don’t have a major survey to point to, my work demands that I pay attention to this epidemic and the stories written about it — and that I encourage others to take it seriously as well.
Have we grown numb to the people who are dying every day? To the families thrown into the pain addiction creates? To the hellish financial and social consequences in many communities, especially in epicenters of the epidemic?
Numbness is well known to happen in the face of persistent and horrific information, especially when no real hope is in sight. Numbness is a central symptom, an enveloping experience, for people who have been traumatized. I’m not arguing that the reading public suffers from collective PTSD – with its constellation of symptoms like nightmares, flashbacks, and being easily startled – but I fear that our numbness, nevertheless, may close us off from taking action as a country to rein in the deaths and destruction caused by disease.
Numbness can be protective. It’s natural for us to want to defend ourselves from circumstances that seem overwhelming and without evident solution. Some say that this attitude toward addiction can best be described as “compassion fatigue,” but I suspect there is more than that at play. It is not our compassion that’s being tested: it is our capacity for hope.
It has been eight months since the President declared the opioid epidemic a public health emergency. Yet it is frankly hard to imagine anything but higher overdose rates and more addiction in the foreseeable future, if current trends continue. At the federal level, the money allocated so far to fight the epidemic was called a “pittance” by the New York Times Editorial Board on April 21st. Talk of non-opioid analgesics, while perhaps helpful for current and future pain sufferers, is hardly a solution for the millions of people already addicted. Criminal justice approaches, like border interdiction, arrest and maximally sentencing drug dealers — even “executing” some — has never, in the long history of the War on Drugs, been successful. Moreover, these approaches towards drug use are part of why our country has the greatest number of prisoners on earth, a good proportion for non-violent drug offenses. Clearly criminalizing addiction has not worked, ever — and, of course, this approach also disproportionately falls on people of color and those living in poverty.
Numbness makes sense when there is a grave problem, like this epidemic, coupled with big talk and little substantive action. The news must begin to accent solutions, ones that work.
We have a remarkable history of overcoming epidemics by using public health strategies. Think of polio, diphtheria, Ebola. Consider how infectious diseases have been massively curbed by sanitation, vaccines, and clean water. Take a look at our falling levels of cigarette addiction.
The epidemic of opioid use, and the use of other psychoactive drugs, has proven public health solutions. And that is undoubtedly welcome news.
We have successful, workable prevention strategies with youth as early as elementary school. We have tools to reach parents and provide them with the skills to protect their kids amidst their huge access to drugs. We know that much of our efforts must be in screening for drug and alcohol problems early, in primary care doctors’ offices and at schools, because early detection and intervention are much more effective than trying to treat a disease after it’s already taken root. And we must work to provide ample access to affordable, proven treatments – through insurance, not just privately paid – and programs that combine psychological, medical and support approaches, for the legions already under the powerful grip of addiction. We have all of these solutions, yet their availability remains scarce. That’s why there is no horizon yet for this epidemic.
A well-known maxim, attributed to Churchill in the darkest days of WWII, is that “You can always count on Americans to do the right thing … after they’ve tried everything else.”
We can succeed. The news can be worth seeing and hearing, not becoming numb to, once we close the gap between what we know and what we do. That will be difficult, costly, and take time — though it certainly won’t be as costly or time-intensive as failing. That means the sooner we start, the better.
Lloyd I. Sederer, MD, is a psychiatrist, public health doctor, and medical journalist. He is also an adjunct professor at the Columbia/Mailman School of Public Health and a monthly regular on Tell Me Everything, the SiriusXM radio show hosted by John Fugelsang. His recent books include The Addiction Solution; Improving Mental Health: Four Secrets in Plain Sight; and Controversies in Mental Health and the Addictions.