“I believe everyone's born with a hole in them,” the lady owner of a Christian coffee shop in Utah told me. "People try and fill it with relationships or alcohol or drugs, but the only thing that can really make you complete is God."
People like to ask me about the lessons I learned while traveling to the geographic center of every state in America. It's not their fault that I hate this question, but it means I always have to think of something to say other than “We grow a fuck-tonne of corn and do a fuck-tonne of meth.”
The meth thing, in particular, surprised me; I thought we had moved on to opioids—like, as a nation. Just one day everyone switched from meth over to Oxy, I thought. Some people told me, when I made this observation to them, that people were turning back to meth in the absence of opioids, which didn't quite feel right to me, but who am I to doubt the people with actual experience, you know?
The thing about meth, though, is that it isn't advertised to anyone, or prescribed to anyone. Your oral surgeon doesn't cook you up some crystal after they've removed your wisdom teeth; you aren't bombarded with ads that tell you meth can help you handle your chronic pain. Billion-dollar corporations are not extremely invested in you doing meth. (Well. Some are.)
Opioids, now. There was a lot of legal money to be made with opioids. And Purdue Pharma, which brought OxyContin to market in 1996, made sure it would make as much of that money as possible. It did this first by lying about OxyContin's safety and efficacy, then by selling a newer, more expensive reformulation that drove its users to heroin.
We are still learning just how invested not just regular shitheel corporations, but a single family was in hooking as many Americans as possible onto opioids. Damning reporting on the subject has come from The New Yorker and other outlets, but New York Attorney General Tish James is now bringing suit against the Sacklers, the main beneficiaries of this blood money, and she is unsparing in the 269-page document laying out the charges. A variety of other shitty garbage pharma companies are also named in the suit, but the Sackler part is of particular note to me because there is perhaps no better example of rapacious greed wreaking havoc on an entire society.
I learned about the opioid crisis as I learn about a lot of things beyond my ken—through scripted television. Justified hung its third season on it, back in 2012, bringing in a carpetbagger villain whose ambition was to set up a pill mill in Harlan County. But there's a nagging sense that I should have known, even before it came up on Justified.
See, in 2009, I was desperately searching for a full-time job in the aftermath of the financial crisis. Pharmaceutical Executive, a trade magazine whose audience was, yes, executives of pharmaceutical companies, offered me a job as an Associate Editor for an in-hindsight paltry $32,000 per year because I'd interned with them for a summer in college. PharmExec had a sister publication, Pharmaceutical Representative, for which I had written a couple pieces before getting the PharmExec job, stories about how to best comply with sunshine laws about visits to doctors.
I solicited columns from marketing executives, encouraging them to tout their big campaigns, all the creative ways they tried to get around marketing regulations. I cannot honestly recall, in the six months I was there—nor in the two years that followed, when I worked at a management consulting firm that worked with pharma companies—hearing much about an opioid addiction epidemic. I merely thought it odd that an urgent care doctor prescribed me oxycodone in 2010 for pain from an ear infection. I just wasn't paying attention.
I did hear a lot at PharmExec about "KOL"s (Key Opinion Leaders) and "CMS" (Continuing Medical Studies), concepts that were presented to me as unqualified goods. They were some of the mechanisms by which Purdue buried physician dissent against its precious OxyContin.
Graphic via U.S. Department of Health and Human Services
As usual, the poor got especially fucked by these greedheads. The explosion in opioid and meth addiction is highly correlated with poverty, unemployment rates, and the employment-to-population ratio. "On average, counties with worse economic prospects are more likely to have higher rates of opioid prescriptions, opioid-related hospitalizations, and drug overdose deaths," the U.S. Department of Health and Human Services concluded.
The way we talk about addiction as a society is slowly moving in a direction that more correctly understands it as a disease or condition that requires treatment, and that’s certainly not a bad thing. But I worry sometimes that in these conversations, we focus solely on the disease, the individual, and ignore the fact that life absolutely sucks shit most of the time for most people: Their dad just died after the family RV crushed him while he was working on it. They can't afford insurance—car, health; you name it, it’s unattainable. Their child died of cancer. Their husband's family is crazy. The plant shut down. Monsanto is Bigfooting them off the family farm. They're completely burned out. No one ever listens to them, really listens. Holes, everywhere.
These specific situations aren't the reason Timmy in OKC died during a meth-fueled episode of psychosis a few years after his doctor prescribed him Oxy for a broken collarbone (ATV accident). But they do induce despair—real despair, the kind that can't be fixed by simply having a better outlook on life, and the kind that sure as shit isn't conducive to recovery.
And with that despair come all those hundreds of thousands of deaths that some researchers attribute to “diseases of despair,”* suicides and drug overdoses and alcohol-related fatalities. Up up up the death rates in these categories have climbed over the last 20 years—and not just for aggrieved, middle-aged white people who think their way of life is being taken from them, but for groups like Native American men, who in the Midwest have had their suicide rate nearly double from 1999 to 2016. (Somehow, the 40 percent increase in the suicide rate among white men has gotten more attention.) The rate of drug poisoning deaths increased from 4 per 100,000 Americans in 1999 to 18.8 per 100,000 in 2017.** Across our entire society, the crushing indignity of daily life is clearly becoming untenable, and no amount of individual counseling is going to undo that.
You're never going to completely eradicate addiction or substance abuse. But I guess at least we can wring the Sacklers for all they're fuckin' worth.
Hugs and puppies,
*One guy refutes the "deaths of despair" claim by saying that a lot of people in areas of America that aren't economically depressed are also dying from drug overdoses at similar rates and that the key factor in a lot of these deaths seems to be that a whole bunch of people were, y'know, prescribed extremely addictive medications, and he's got a good point there. Opioid receptors do not give a shit how much money you do or do not have. But there's next to no mention of social or public health factors in his study, his economic factors didn't include percent of income spent on housing or debt levels of any kind, settling instead on “housing prices” and “median household income;” and he doesn't explain the increase in deaths from suicides and alcoholism-related conditions. It's hard to quantify despair.
**I swear this information used to be easier to look up and link to. I had to do searches and comparison using the CDC's WONDER data portal.