Chris Caldwell: American Carnage

There have always been drug addicts in need of help, but the scale of the present wave of heroin and opioid abuse is unprecedented. Fifty-two thousand Americans died of overdoses in 2015—about four times as many as died from gun homicides and half again as many as died in car accidents. Pawtucket is a small place, and yet 5,400 addicts are members at Anchor. Six hundred visit every day. Rhode Island is a small place, too. It has just over a million people. One Brown University epidemiologist estimates that 20,000 of them are opioid addicts—2 percent of the population.

Salisbury, Massachusetts (pop. 8,000), was founded in 1638, and the opium crisis is the worst thing that has ever happened to it. The town lost one young person in the decade-long Vietnam War. It has lost fifteen to heroin in the last two years. Last summer, Huntington, West Virginia (pop. 49,000), saw twenty-eight overdoses in four hours. Episodes like these played a role in the decline in U.S. life expectancy in 2015. The death toll far eclipses those of all previous drug crises.

And yet, after five decades of alarm over threats that were small by comparison, politicians and the media have offered only a muted response. A willingness at least to talk about opioid deaths (among other taboo subjects) surely helped Donald Trump win last November’s election. In his inaugural address, President Trump referred to the drug epidemic (among other problems) as “carnage.” Those who call the word an irresponsible exaggeration are wrong.

From: American Carnage by Christopher Caldwell | Articles | First Things

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25 thoughts on “Chris Caldwell: American Carnage

  1. I wonder how much of the epidemic is related to the way the DEA, etc. deal with both treatments for overdose/addiction (methadone, narcan, etc.) as well as how they treat doctors whose patients get addicted (a doctor who suspects their patient might be addicted would have a powerful incentive to remain ignorant if s/he is worried that reporting it would put them under suspicion as well).

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    • I have had recurring back pain since I was 21. Most of the time I can manage it with stretching and rest and maybe a couple of Aleve, but every once in a while it gets bad enough that I have to call the doctor. The amount of interrogation I have to go through to get anything stronger is intense, but I also appreciate him looking out for his patients.

      With that said, I had my share of fun in my 20s and nothing was as enjoyable as being prescribed opioids for back pain, when doctors didn’t really know better. I agree with the article that the high is unlike anything else. Luckily for me, I have always had a strong resistance to addictive substances. I quit smoking very easily. I can have one beer and not even be interested in another for months. But if I had been very unlucky, my occasional enjoyment of prescribed pain medication could have turned into an addiction.

      So I’m pretty concerned about all of this, but man, I have NO IDEA how to fix it. I can’t help but wonder if heroin is getting pushed harder because weed is becoming legal and then it makes me wonder if I should change my position on legalization. All I know is this is really scary, especially when my kids are out there in the world.

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      • Heroin is getting pushed to people already addicted to narcotics (or narcotic-like things) because it’s a cheaper, more available alternative. Totally orthogonal to pot.

        But anyone who things that all drugs should be legalized, because freedom, needs to give this situation some thought.

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        • Not exactly true.
          There is an incentive built-in to the illegality of it.
          The more difficult it is to smuggle, the greater the incentive to ensure potency.
          Same reason that whiskey was so popular during Prohibition, but beer came back well enough after Repeal.

          One of the many fascinating things I learned from Johann Hari’s Chasing the Scream: The First and Last Days of the War on Drugs. (It was required reading for a public policy course.)
          One of the few books that I can say truly changed my mind on a long-held position.
          I highly recommend it.

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        • ” anyone who things that all drugs should be legalized, because freedom, needs to give this situation some thought.”

          Yeah, it’s just like how legalizing alcohol led to a massive wave of deaths from methanol poisoning.

          oh wait, that didn’t happen at all.

          But at least there was a total failure by society to provide any form of addiction counseling and support, right?

          oh wait, there’s a vast array of programs both private and public.

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      • I had my share of fun in my 20s and nothing was as enjoyable as being prescribed opioids for back pain, when doctors didn’t really know better. I agree with the article that the high is unlike anything else.

        I had a moderately bad case of pleurisy the summer I was 16 — felt like someone had started a 20d nail between a couple of my ribs, and every time I inhaled or exhaled it was like they gave it a good rap. Don’t know which of the narcotics the doc gave me, but I lost whole chunks of the three days I was on it. Scared me enough to put me off recreational use of anything but mild intoxicants forever. (Also left me with enough scarring to show up on every chest x-ray since, which is a different sort of pain.)

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      • Do the areas with the worst opioid problem overlap with those where weed is legal? Npt a rhetorical question, I really don’t know.
        I’d be inclined to say the correlation isn’t strong enough to support causation, but that’s just an uninformed gut reaction.

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        • Roughly speaking — I don’t keep a list of cites handy — the experience so far is that legal recreational weed results in a small but significant decrease in opioid prescriptions and a similar decline in opiod overdose deaths. The most common assumption about the cause is that self-prescribed cannibinoids are effective in some cases of chronic pain. Might be a placebo effect; might be a “yeah it still hurts but I don’t care as much” effect; might actually work in some cases. The statistics are convincing enough that the big-buck campaign contributions against legalization in California last year came from a pharma company that holds the patents on a bunch of the synthetic opiods. Also, the NFLPA is looking at trying controlled studies to see if they want to push the owners to approve marijuana as an alternative to opioids in the states that have legalized medical marijuana.

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        • I really don’t know either, however I read/heard somewhere some speculation that drug dealers switched to pushing heroin in areas where people could now legally purchase marijuana. I don’t know that i agree with that logic though, since it basically goes, “People were buying weed legally less for the high and more for the rush of doing something naughty…and so they are now buying heroin because buying legal weed doesn’t scratch that itch.” It just doesn’t really compute for me.

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  2. Any discussion of this needs to deal with availability of drug treatment. That is what an addict needs today assuming they are willing. Trump may have moved his pie hole about it but where has the money been for drug treatment. Who has resisted paying for it and who has pushed for more treatment?

    Certainly those for drug legislation need to face this head on. Some drugs are highly addictive and dangerous. That is the real deal. Ignoring that goes no where.

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  3. I wonder if this article would read different if the author suffered from intense chronic pain? Which is to say, we should certainly look at the human cost of addiction, but we should not ignore how utterly horrible pain is, and what a miracle it is that we can mitigate it.

    He calls “politically correct” language “unscientific,” but that is hogwash. None of the examples he provide are any less accurate or coherent than the more judgemental alternatives that he evidently prefers.

    The implicit accusation is that only now that whites are involved have racist authorities been roused to act. This is false in two ways. First, authorities have not been roused to act. Second, when they do, they will have epidemiological, and not just tribal, grounds for doing so. A plague afflicting an entire country, across ethnic groups, is by definition more devastating than a plague afflicting only part of it.

    This is a poor application of utilitarianism, and at odds with how society actually works. Sure, I would be eager to accept that one life is worth one life, but you have to be deeply stupid to believe that (for example) the federal government would have sat on their hands during the AIDS crisis, had it affected upscale str8 folks in equal measure to how it affected gays. So it goes for addiction. If this were concentrated in minorities communities, this article would have a different tone.

    I was around for the crack epidemic. The narrative played out quite differently, with blacks presented at dangerous, predatory thugs, whereas powder cocaine was just good, clean fun for posh white professionals. So it goes for his writeup, where he presents narratives of white victims engaging in petty graft and shoplifting to afford their high, whereas during crack, black “crackheads” were always presented as violent predators who would kill you for a ten dollar bill.

    In any case, it’s a curious argument, pointing out that people who cannot get cheap drugs in pharmaceutical-grade pill form instead turn to street drugs that kill them, and thus we should make it even harder to get the safer versions.

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  4. I was around for the crack epidemic. The narrative played out quite differently, with blacks presented at dangerous, predatory thugs, whereas powder cocaine was just good, clean fun for posh white professionals. So it goes for his writeup, where he presents narratives of white victims engaging in petty graft and shoplifting to afford their high, whereas during crack, black “crackheads” were always presented as violent predators who would kill you for a ten dollar bill.

    If you were around for the crack epidemic, you were around for the violent crime epidemic. While there was some violent crime everywhere, the worst of it was in the cities. Particularly in poor black neighborhoods. Which was also where the crack was. I’m not sure I’d call it “good, clean fun,” but by and large powder cocaine was not associated with crime in the way crack was. OWS rhetoric aside, stock brokers were not shooting people in the streets.

    Same deal with opioids. The crack epidemic occurred at the peak of a major violent crime wave, in the urban areas where that violent crime was concentrated. The opioid epidemic is occurring when violent crime is at 50-year lows, in rural and suburban areas where violent crime has always been fairly low anyway. The reason there’s no stereotype of opioid addicts as violent criminals is that they aren’t. West Virginia has the highest rate of drug overdose deaths in the US by a wide margin, but its homicide rate is slightly below the national average.

    Interesting fact about that 1986 drug bill that created the sentencing disparity between crack and powder cocaine: Several months ago I went back and cross-checked the vote on that bill against the membership of the Congressional Black Congress. Something 80% of the CBC members voted for that bill. It wasn’t just white suburban racists. Black people were afraid, too, because they were the ones bearing the brunt of the crime wave.

    Note that I’m not saying that crack actually caused the crime wave. It may have contributed a bit, but it certainly wasn’t the primary cause. I’m just saying that these stereotypes weren’t born out of the fever dreams of a bunch of white racists. The correlation was absolutely there, and a lot of people, black and white, jumped to the conclusion that there was a causal relationship.

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    • “Something 80% of the CBC members voted for that bill. It wasn’t just white suburban racists. Black people were afraid, too, because they were the ones bearing the brunt of the crime wave.”

      It’s also the case that, for all that conservatives in 2016 tried mightily to tie Clinton to the mid-Nineties crime bills that put so many more black men in jail, black people who were actually around at the time were not particularly bothered by the idea.

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  5. We have a lot of ghosts haunting us from our puritan days.

    We have no problem with drug treatments that don’t feel good.
    It’s the ones that feel good that get everybody to start screaming for intervention. Even when given to the terminally ill.

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    • Depending on where you stand with how you deal with your pleasure/reward centres, the puritans may have had a point. I know exactly the kind of person I am, if you hooked me up to that button and I could push that button, I would push it until I wasted away from starvation.

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      • Oh, I understand the point of the the War on Drugs. I understand the point of Prohibition. I totally understand what they were shooting for and I can see the upsides of having that sort of thing around.

        That said, (insert conversation we’ve had a million times about Prohibiton/WoD here).

        Given the above, I’m still unclear on why pain management for even terminal patients is so FUBARed.

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  6. Contra above, when I injured my back they handed out Narco* like it was candy. Now, this might have been due to it being a workers comp injury (and not one that stretching was going to help) but I must have a good 5-6 vials of it sitting in the med cabinet. Due to the length of time it took to quite smoking and an awareness of issues with alcohol (something I need to be very careful with) I have always shied away from pain killers. I have also lost a couple friends to opioid addiction, then again, but I know a few people who have died from alcohol also.

    *Hydrocodone

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  7. Trumpcare has bigly cuts for substance abuse treatment. If you surprised you are naive. A nice solid kick in the balls of the people in those towns ravaged by drug abuse.

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