Maia Szalavitz: There’s Been a Secret Safe Injection Site in the US for Three Years (Vice)
Why do sites that apparently condone drug injection actually encourage recovery? The paradox dissolves if you understand the real drivers of unsafe drug use and addiction: stigma, criminalization, mental illness, despair, and trauma. When people with addiction are provided with a safe, caring, and nonjudgmental atmosphere, they can slow down and engage in practices that allow safer injection, they have better access to clean equipment, and basically, time to think.
Zachary Siegel: Hating Big Pharma Is Good, But Supply-Side Epidemic Theory Is Killing People (Longreads)
New books about the opioid crisis — “Dopesick,” “Fight for Space” and “American Fix” — have different ideas about who’s to blame and what to do next. Our critic says regulating supply can have deadly consequences, and we need to address users' pain.
Purdue Pharma did not invent addiction in America. Especially true in Appalachia, where families have generations of substance use. Meth and alcohol have long had a grip on rural America. Opioids are merely the newest iteration in the pursuit of oblivion, a more effective reliever of emotional and physical pain. As reprehensible as it is, Purdue exploited, profited, and even targeted this vulnerability. To be sure, growing up in a financially stable and supportive family didn’t immunize me from addiction. It’s not just poor people in despair who get addicted. Opioids muted the harsh voice in my head, a relentless critic attacking me from within, that told me I was undeserving of love. I quickly learned that I could synthesize and manufacture warmth and connection by self-administering opioids.
This company is no doubt both culpable and rotten. But the effect of their patent maneuver (that activists advocated for!) meant that the reformulation forced those of us addicted to OxyContin to start using much more dangerous heroin, which has lately been spiked with super potent, illicit fentanyl — often referred to as the third wave of the opioid crisis. The mass exodus of users from black market pharmaceuticals to black market heroin was documented in a 2017 study by the RAND Corporation and the University of Pennsylvania’s Wharton School of Finance, which connected the reformulation to thousands of heroin overdoses. The researchers conclude that supply-side efforts are not achieving their intended effects, chief among them: reducing overdose deaths.
Unfocused anger at Big Pharma also winds up harming a different vulnerable group, one that’s typically an afterthought in stories about opioids: chronic pain patients. In the name of “battling the epidemic,” patients who need opioids are being abandoned by their doctors. With Jeff Sessions and the DEA breathing down their necks, they’re afraid of prescribing any narcotic. In response to the opioid crisis, the prescribing pendulum has rapidly swung. Doctors who treat pain are receiving threatening letters to prescribe fewer opioids, patient outcomes be damned. As a result, some of these patients are killing themselves, which has caught the interest of investigators at the Human Rights Watch, who are documenting patient abandonment in the new, restrictive climate. A sweeping package of opioid legislation recently passed by the Senate will also be studying whether opioid prescribing limits have led to patient suicide.
America’s cold, hyper individualistic culture of “personal responsibility” might be slowly melting. Sympathy for addiction (partially thanks to American society’s greater credulousness when it comes to white, rural victimhood) is growing. Drug users and recovery activists are finally being seen in this country, and their needs are being heard. Cities like San Francisco, Philadelphia, and Seattle are close to opening supervised injection facilities. Family physicians practicing rural medicine are obtaining waivers to prescribe buprenorphine, and doctors are convincing their field to treat addiction like any other chronic illness they see everyday. Cops are saying, “we cannot arrest our way out of this epidemic,” and activists like Hampton are holding them to their word. America’s drug crisis hasn’t reached its peak. But the activists, families, and the people supporting them, who are fighting for space, are just getting warmed up. Policy and political will lag far behind knowledge. Do 72,000 more people have to die before it catches up?