Opioids in a painful spotlight
President Donald Trump deserves credit for ringing the alarm bell on the crisis of opioid abuse. In 2016, more Americans died of opioid overdoses than were killed in the Vietnam War. This appalling statistic is a key factor in the recent, shocking decline in U.S. life expectancy.
I would quibble, however, with Trump's decision to launch a global trade war on the same day he convened a White House summit to highlight the opioid emergency. That's not what folks normally mean by "highlight." Where is the laser focus and message discipline that allowed a younger Trump to leverage his 1990 garden-variety divorce into a New York tabloid sensation? These days, we're lucky if he can stay on topic for an hour.
And I feel it's my duty (since his lawyers are otherwise occupied) to break the news to the president that mandatory death sentences for drug dealers – Trump's latest solution to the crisis – would violate the Constitution, according to multiple Supreme Court rulings joined by conservative and liberal justices over the past 42 years. Can such long-standing precedents be overturned?
Highly unlikely – and certainly not on Trump's timetable.
Trump should go back to the track he was on before visions of Singapore's draconian justice system began dancing in his head. Last year, when the president declared opioid abuse a "public health emergency," he directed compassionate attention to the heart of the problem: the suffering addict in need of help, as well as the potential addict in need of prevention.
"I learned myself," the president said during a speech at the White House. "I had a brother, Fred. Great guy, best-looking guy, best personality - much better than mine. But he had a problem. He had a problem with alcohol. And he would tell me: 'Don't drink. Don't drink.'”
The human essence of the opioid crisis is laid bare in photographer James Nachtwey's astonishing essay in the March 5 issue of Time. Never before in Time's 95-year history has an entire magazine issue been devoted to a single photo essay; the result is a masterwork by one of the world's greatest photojournalists.
Along with editor Paul Moakley, Nachtwey – a veteran of wars and famines the world over – spent a year traveling the United States, from the streets of Boston and San Francisco to the hot zones of Ohio, Appalachia and New Hampshire. In prisons and back alleys, in hospitals and graveyards, he trained his fearless eye on pain that is difficult to look at but impossible to ignore.
“It's not just the guy who's never worked a day in his life," a deputy sheriff on the front lines of the epidemic told Nachtwey and Moakley in one of some 200 interviews they conducted. "It's airline pilots. It's teachers. I'm sure there's law enforcement, firemen out there hooked on it. It's Joe Citizen that's dying.”
That quote doesn't immediately square with the debased condition in which Nachtwey found many of his subjects: huddled in a snowbank trying to find a vein, catatonic and skeletal on a makeshift stretcher, dead in a roadside field. But by turning abstract statistics into human beings, the photographer points us to the person who preceded the addiction – and who, given enough chances and support, might survive it.
Any family that has struggled with an addiction, as the president's family has, can tell you that it's easy to fall into one but very hard to climb out.
That's what baffles me about the opioid crisis: With the possible exception of alcohol, no substance on earth has a longer track record of disastrous addiction than opium and its derivatives – laudanum, morphine, heroin, codeine – and synthetic relatives such as fentanyl and carfentanil.
Yet despite centuries of hard-won knowledge, pharmaceutical companies and prescribing physicians were allowed to make such opioids as Percocet and OxyContin widely available as treatments not just for acute pain, but for chronic discomfort. Their fantasy of benign long-term opioid use is the root of the epidemic. Nearly 80 percent of heroin users report that prescription pain relievers were their gateway drugs, according to the National Institute on Drug Abuse.
Such a failure of epic proportions by a generation of public-health officials merits a major congressional investigation to reduce the chance that anything like it ever happens again.
In the meantime, this is not a problem we can kill our way out of. Time, citing a recommendation from the president's own opioid task force, urges the immediate lifting of Medicaid limits on reimbursements for drug treatment. Another pressing need: ramped-up research on safe alternatives for managing chronic pain.