The State: The Opioid Epidemic

Welcome to The State. This column looks at a few of the more noteworthy stories making waves in the psychedelic and reform spheres, and when appropriate, examines how they fit into a larger context.

On Thursday, October 26, President Trump declared America’s opioid crisis a national emergency, on par with hurricanes, wildfires, and other natural disasters requiring serious and immediate action for relief.

The numbers around US opioid use are stark and damning. Americans consume more opioids than any other nation on earth. OD deaths have mushroomed and abuse dings the economy to the tune of billions per year. The human stories are wrenching.

Opioids are strong and versatile instruments that demand respect. The damage done defies simple explanation. The American opioid situation involves worldwide factors and implications, from Chinese manufactures of fentanyl to Mexican gangs eager to make up for the losses they’ve suffered thanks to legalized weed.

But most of the evidence points straight toward the pharmaceutical industry.

Starting decades ago, those in the healthcare business undertook a rethinking of pain and pain treatment. (“Pain is the fifth vital sign!”) Since then, big pharma has pumped pills into poor communities, kneecapped the DEA in its attempts to stop the spread and saturation, and gave rise to a sleazy new business niche.


Taxpayers and governments are lashing out legally, under the assumption that the private companies who exacerbated the problem should take some ownership of the check. The state of West Virginia provides a useful case study. Big pharma invested millions to plague WV with painkillers. When it’s time to clean up the mess, should the police and the people do all the work?

For anyone who remembers the Reagan Administration’s awesome response to the ’80s crack epidemic, the Trump plan may prompt discouraging deja vu. Writer Steve Chapman poetically describes the White House approach as “mostly a form of yoga: lots of posturing while staying in one place.” Trump has an array of incentives to protect big pharma. There’s little reason to believe a punitive broken-window approach will soothe root causes, but that’s what we’re likely to get from a DOJ under Jeff Sessions, who has expressed his readiness to crack down hard… on marijuana use.

“Really tough, really big, really great advertising” has been tried before, and the results spoke for themselves. Chapman continues: “More innovative remedies will be needed to actually turn back the relentless onslaught of overdose fatalities.”



What sort of treatment might move that needle?

Well, there’s Naloxone, the emergency fix that reverses 93% of overdoses. But treatment for opioid addiction is not a one-and-done endeavor. Most abusers don’t get clean and find themselves suddenly cured. Addiction isn’t a hero’s journey with a clear beginning, middle, and end—effective treatments take time and go on, for life, in some cases.

Methadone or buprenorphin are widely considered the most useful for helping addicts become functional citizens. There’s proof: long-term treatment involving these medications makes patients less likely to relapse. But they’re heavily stigmatized, and it will take some time and effort for society to soften toward them.

The controversial herbal supplement kratom has long been a darling of Reddit and other electronic enclaves. It has been used as a home remedy for the symptoms of opiate withdrawal, and may garner more mainstream attention in a bull market for answers.

Through all this, the problem of pain remains and persists.


In a provocative piece, the libertarian Jacob Sullum cautions that a strict, prohibitive law-and-order approach will hurt not just addicts, but pain patients using these medicines for their intended purpose. Sifting through NSDUH numbers, Sullum questions the dominant narrative of drug distributors as witting profiteers of misery. The overwhelming majority of opiate users aren’t abusers or addicts, and the majority of addicts have issues outside of opioids. When experts originally suggested that there was too much paranoia around the potential for abuse, they weren’t wrong, or at least they weren’t lying. Cutting the supply, in lieu of a cleaner panacea, will threaten patients who depend on these drugs for their comfort and sanity.

We need to go deeper. Let’s start the conversation where it starts.

What is pain? How does it work? When a person is suffering, should you focus on the suffering, or the person?

At Cedars-Sinai, Brennan Spiegel sees some promise in using virtual reality to mitigate the psychological turmoil associated with physical trauma. Psychedelic solutions such as ibogaine therapy may be effective not just as chemical agents, but as transformative journeys of psychological inquiry.

Pain is, in part, a creature of the mind. America’s opioid situation demands smart, creative, and rational remedies.


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