The spiritual agony behind America's opioid crisis
Let's try and actually understand drug addicts' complicated quest for happiness
America is beset by an opioid epidemic ruining far too many lives in communities across the country.
Many Americans have become increasingly aware of this drug problem over the last year. And that attention is welcome. But it's unlikely to do much to change the ghastly trends.
That's in part because, as with so much else these days, our response to the facts is mainly a function of our prior political commitments. Conservative Republicans point to economic despair brought about by liberalism's fondness for big government (burdensome taxes and regulations). Democrats point to rising economic inequality and insecurity and blame both on the cold-hearted refusal of conservatives to support policies that would give struggling people the help and support they so desperately need. President Trump, meanwhile, prefers a populist approach, denouncing trade deals for driving jobs overseas and illegal immigrants for stealing the remaining jobs from "our people."
There may well be some truth to each of these explanations, but they aren't likely to make a big difference in combating the opioid epidemic — and not only because each of them conflicts with the others and is supported by only a portion of the electorate. The deeper reason why they are unlikely to make much of a difference is that all of them see the opioid problem as rooted in economic circumstances when we have ample cause to believe its sources run much deeper.
One might even call them spiritual.
Imagine, for a moment, that addiction is a response to spiritual agony. Then consider the role of substance abuse in our lives.
A 2015 study showed that 32 million Americans (one out of every seven adults) struggled with a serious alcohol problem during the previous year — and that nearly a third of all Americans will exhibit signs of an alcohol-use disorder at some point in their lives. That's an astonishingly high rate of alcohol abuse. Consider how it compares to other drug-related public health crises. As Christopher Caldwell notes in an important essay on the opioid epidemic, the spike in heroin addiction during the mid-1970s reached a high of 1.5 overdose deaths per 100,000. The crack epidemic of the mid-to-late 1980s was worse, hitting a peak of two per 100,000. As of the end of 2015, the rate of fatal opioid overdoses was more than five times higher than that — 10.3 per 100,000. That's bad. But rates of death from alcohol (even without counting fatalities from drunk driving and alcohol-related violence) are nearly as high, at 9.6 per 100,000.
Then there are prescription medications for depression and anxiety. The United States leads the world in per capita consumption of these drugs, with roughly 11 percent of the population over the age of 12 using them. If we assume that rates of depression and anxiety are a given, then this figure sounds like a good thing: People who crave relief from suffering are receiving it, which sounds like progress over a world without such medications, in which they would be consigned to lives of misery without relief.
But are rates or depression and anxiety a given? Constant across time and place? Those questions are most likely impossible to answer — because the human experiences of melancholy and angst only became medicalized over the past century or so, because they only became treatable with pharmaceuticals over the past few decades, and because the drive to quantify such experiences and treatments only got underway during this period as well.
What is clear is that the United States is filled with people pursuing various forms of relief from various forms of profound unhappiness, discontent, malaise, agitation, and emotional and/or physical pain.
Which brings us back to the recent surge in opioid addiction and overdose. What makes this class of drugs unique is that they are extremely addictive and they produce an experience of intense euphoria or joy. They are, as we commonly refer to them, "painkillers."
Americans must be suffering from an awful lot of pain. The national fatal overdose rate for opioids was 10.3 per 100,000 in 2015. But it's far higher in some states. (According to Caldwell, the rate is over 30 per 100,000 in New Hampshire and over 40 in West Virginia.) Perhaps most astonishing of all is the fact that more than one-in-three Americans are prescribed painkillers every year.
That stunning statistic raises a range of important questions — about why doctors are filling so many prescriptions for such powerful and dangerous drugs, and about the motives of the pharmaceutical companies that market and sell them. But the most troubling and most needful questions need to be directed at the millions of Americans who seek out these drugs to relieve one or another form of pain and allow themselves to become addicted.
Some will object to this way of putting it: How dare I insinuate that these men and women exercise agency in becoming ensnared by addiction. But I'm not casting blame or judgment. I'm trying to understand the very real allure of such drugs and the experiences they facilitate. Not just the experience of drug-induced euphoria — but the experience of intense addiction itself, which can have its own attractions.
Our national creed frees us to pursue happiness as we wish. But who among us really knows how to be happy — especially in an age of declining religious observance and the weakening of other communal institutions? If happiness requires a pursuit of purposes, of setting and realizing a set of rewarding goals, then what could be happier than a life devoted to scoring the next pill and enjoying the flood of pleasure and release that follows from taking it, one after another after another? Yes, the happiness is self-destructive, ultimately incompatible with any purposes beyond the self, and for some it's even life-destroying. But what's worse: A life of painful and pointless sobriety? Or one dedicated to the purposeful release from personal pain and the (temporary but repeatable) achievement of joy, elation, and completion?
That, I suspect, is how the choice appears to many of those who end up ensnared in opioid addiction.
There are many forms of pain, many kinds of suffering. Opioids are just the latest and perhaps the most intense and dangerous way in which Americans have sought relief from the spiritual agonies that seem to accompany a life of freedom. It's unlikely to be the last.