Is There Really a Growing Epidemic? No and yes.
No, there has not been an increase in drug use overall, with the exception of marijuana (which is not implicated in drug deaths).
But yes, there has been an increase in the number of drug-related, and particularly opioid-related, deaths.
At this time, it is unclear to what extent that uptick is caused by bad drugs, stronger drugs, lower tolerances in people who cycle in and out of detox, or other factors entirely.
What we do know is that, according to researchers at the CDC, the primary culprits are prescription pain medication and poly-drug use:
[Our study highlights] the predominant role opioid analgesics play in pharmaceutical overdose deaths, either alone or in combination with other drugs. It also, however, highlights the frequent involvement of drugs typically prescribed for mental health conditions such as benzodiazepines, antidepressants, and antipsychotics in overdose deaths.
The issue, then, is not more drug users but rather higher rates of death from particular drugs and drug combinations.
That distinction should be critical in terms of policy, yet typically is overlooked. Take for instance, an article in the Boston Globe: “Boston Globe Game Changers: Four Innovative Ideas for Fixing the Opioid Crisis.”
Three out of the four “innovative ideas” are aimed at helping individuals stop using drugs and assume that “treatment” (whatever that means) is effective—an assumption that, as I have argued on The Influence, has little basis in evidence-based research.
Follow the Money
There are huge profits to be made in drug treatment, though there is very little rigorous evidence showing that addiction treatment of any sort actually works.
Not so much money, however, to be made in changing social values.
Given the public consensus that addiction is a manageable yet essentially incurable disease (“once an addict, always an addict” is a mantra promulgated by the 12-step movement; there is no actual evidence for this notion), the treatment-industrial complex stands to be even more profitable than the prison-industrial complex.
Prison sentences and parole eventually end, in most cases; the treatment of chronic disease can go on forever.
Fortunately for their stockholders, private prison companies are moving into the lucrative treatment field.
Take a look at this excellent article by Deirdre Fernandes in the Boston Globe:
“The $35 billion-a-year addiction treatment industry is gaining more attention from investors of all sizes, including private equity giants like Boston-based Bain Capital, which owns the largest chain of detox clinics in Massachusetts.
Large investors are capitalizing on the increasing demand, changes in health care law, and opportunities to scoop up smaller facilities, reduce their costs, and sell them at a profit.
American Addiction Centers, a Nashville addiction treatment company, went public in late 2014, raising $75 million. Its profits climbed from $871,000 in 2011 to $11.2 million last year, a more than twelve-fold increase.
So it’s no surprise that individual investors are piling in, too, said Philip Levendusky, the director of psychology at McLean Hospital, an affiliate of Harvard Medical School. ‘Everybody is chasing the pot of gold at the end of the rainbow of the opioid issue,’ Levendusky said. ‘There’s an epidemic of opioid abuse, so there’s a tremendous demand.’”
A Real Response to an Epidemic
Imagine if efforts to stop the Zika virus were limited to offering individual treatment (the treatment consists of rest, water and Tylenol, since there is no known cure for the Zika virus) and counseling sufferers about the importance of staying away from mosquitoes (where exactly does one go to hide from mosquitoes in the tropics?)!
Imagine if there were no efforts to assist communities in removing stagnant water from yards and streets, or to encourage governments to build systems that distribute safe water (so as to minimize mosquito larvae survival as well as the need for households to store water in buckets and pools)!
Yet that essentially is how many states are tackling their “opioid epidemics.”
For instance, just a week ago, Marian Ryan, district attorney in Middlesex County, Massachusetts issued a press release addressing the epidemic by offering a list of resources for people struggling with addiction and for “their loved ones.”
The list turns out to be a hodge-podge of treatment and support agencies and organizations, many of which are not licensed by any local, state or federal office and some of which are for-profits corporations (LLCs or others).
Others still are entirely lay-led, quasi-religious 12-step groups. (The statuses of the agencies and organizations are not indicated on the list.)
Pools of Stagnant Water in Which Mosquitoes Breed
To be clear, I am not suggesting that drug users who wish to stop using should not receive appropriate, evidence-based support and treatment. I am, however, pointing out that giving people with drug issues the equivalent of rest, water and Tylenol will not protect them—or anyone else—from our stagnant pools of poverty, sexism, racism and hopelessness.