America’s opioid plague: “The only way to understand it is to have lived it.”
No ongoing fight offers a more visceral and urgent explanation for white working class anger than the opioid epidemic.
The following article was originally published in our June 8, 2017 issue of “What I Learned This Week.” To learn more about 13D’s investment research, please visit our website.
Earlier this week, The New York Times released the first preliminary estimates of 2016 drug overdoses: between 59,000 and 65,000 people died, or a minimum increase of 19% over 2015 — the single biggest year-over-year jump in American history. Drug overdoses are now the leading cause of death for Americans under 50.
With opioid abuse driving the spike, the blame game has begun. From the State of Ohio and the State of Mississippi to the City of Chicago and counties in New York, West Virginia, and California, governments are seeking compensation from drug companies seen as predatory architects of the opioid burden. As we explored in WILTW March 9, 2017, governments may have a case — clear evidence drug giants systematically put bottom-line above human life. If any of the cases succeed, it could trigger a nationwide civil litigation movement not seen since the tobacco industry paid out more than $200 billion in the 1990s.
Yet, regardless of drug company greed, fixating on their culpability neglects the complexity and cultural intractability of the problem. In an article published by The New Yorker last week, Margaret Talbot paints a heartbreaking portrait of Berkeley County, West Virginia. By exploring the lives of those on the front lines — both the addicts and the people dedicated to saving them — she pinpoints the systemic and societal failures underlying the crisis.
Over the past 18 months, we have dedicated ourselves to understanding working-class anger in America — how it led to Donald Trump and what it could mean for America’s future. No ongoing fight offers a more visceral and urgent explanation than the opioid epidemic.
West Virginia has the highest overdose death rate in the country — 41.5 per 100,000 people as of 2015, roughly seven more than New Hampshire, which ranks second. The state’s Eastern Panhandle, where Berkley County sits along the Maryland border, has been hit particularly hard. As Talbot writes:
“In Berkeley County, which has a population of a hundred and fourteen thousand, when someone under sixty dies, and the cause of death isn’t mentioned in the paper, locals assume that it was an overdose. It’s becoming the default explanation when an ambulance stops outside a neighbor’s house, and the best guess for why someone is sitting in his car on the side of the road in the middle of the afternoon. On January 18th, county officials started using a new app to record overdoses. According to this data, during the next two and a half months emergency medical personnel responded to a hundred and forty-five overdoses, eighteen of which were fatal. This underestimates the scale of the epidemic, because many overdoses do not prompt 911 calls. Last year, the county’s annual budget for emergency medication was $27,000. Narcan, [an overdose-reversing drug] which costs fifty dollars a dose, consumed two-thirds of that allotment. The medication was administered two hundred and twenty-three times in 2014, and four hundred and three times in 2016.”
The roots of the problem can no doubt be traced to prescription pills. Between 2007 and 2012, drug wholesalers shipped 780 million hydrocodone and oxycodone pills to West Virginia — or 433 pills per resident. After Purdue Pharma pled guilty in 2007 and the CDC subsequently issued new guidelines for opioid prescription, the supply of pills on West Virginia streets plummeted and black-market pill prices spiked. Drug cartels stepped in to meet demand, flooding West Virginia with cheap powdered heroin.
However, when Talbot asked why heroin infected their towns, Berkeley County residents rarely pointed to drug companies, instead looking inward, to the psychological toll the area’s industrial decline has taken. As Talbot writes: “It’s simplistic to trace the town’s opioid epidemic directly to the loss of industrial jobs. Nevertheless, many residents I met brought up this history, as part of a larger story of lost purpose that has made the town vulnerable to the opioid onslaught.”
Talking to Talbot, Michael Chalmers, publisher of an Eastern Panhandle newspaper and a lifelong resident of Berkeley County who lost his brother to an overdose in 2014, put the problem in greater detail:
“I asked him why he thought that Martinsburg was struggling so much with drugs. “In my opinion, the desperation in the Panhandle, and places like it, is a social vacancy,” he said. “People don’t feel they have a purpose.” There was a “shame element in small-town culture.” Many drug addicts, he explained, are “trying to escape the reality that this place doesn’t give them anything.”
What Chalmers describes has a striking resemblance to J.D. Vance’s depiction of Middletown, Ohio in Hillbilly Elegy (WILTW August 25, 2016). As Vance writes, “There was something almost spiritual about the cynicism of the community at large.” Decades of watching a small town decay — economically, physically, and emotionally — had created a culture of “learned helplessness.” And in the Panhandle, as Vance found in Middletown, endemic cynicism became a self- fulfilling prophecy.
In 2012, Macy’s opened a distribution center in Martinsburg, the Panhandle’s biggest city at roughly 17,000 people. Berkeley County’s recovery services coordinator, Kevin Knowles, told Talbot that Macy’s has been unable to fill positions with in-state residents due to failed drug tests. So the company recruits from neighboring states. Knowles believes P&G, which opens a manufacturing plant in Martinsburg this fall, will likely face the same problem. Jobs alone are not the solution when the crisis becomes cultural.
This is evident not only in the roots of the opioid epidemic, but also its intractability. Family and community dependence is at the core of working- class culture. J.D. Vance details this in his description of Middletown and his Kentucky coal-country family. Joan C. Williams explores this in her book White Working Class (WILTW May 18, 2017) — how the elite’s stress on higher education and job-driven relocation has neglected, and in turn, insulted working-class community reliance. In terms of the opioid crisis, this community dependence has proved a killer. As Talbot writes about a conversation with Peter Callahan, a psychotherapist in Martinsburg:
“In tight-knit Appalachian towns, heroin has become a social contagion. Nearly everyone I met in Martinsburg has ties to someone — a child, a sibling, a girlfriend, an in-law, an old high-school coach — who has struggled with opioids. As Callahan put it, “If the lady next door is using, and so are other neighbors, and people in your family are, too, the odds are good that you’re going to join in.”
Which is not to say the problem’s virality and intractability is exclusively cultural. The government has underserved the epicenters of the crisis. Most in the Panhandle are on Medicaid or have no insurance at all. This means those seeking to get clean must get care in West Virginia. The closest detox facility to Martinsburg is more than two hours away. Rehab is an even greater challenge — the state has a chronic shortage of beds. As Knowles told Talbot: “If they’re on Medicaid — and 95% of the people I work with are — it’s going to be a long wait for them. Weeks, months. The number of beds would have to increase by a factor of three or four to make any impact.” This certifies the endemic of learned helplessness: those seeking to get clean turned away by the government at a moment of unimaginable desperation.
As The Times reported when releasing its 2016 overdose statistics, it appears the problem is only escalating in 2017. A court may decide drug companies are culpable, but that does not mean the crisis’ roots don’t run much deeper — solutions hinging on cultural repair as much as financial funding. The problem can’t be solved with jobs alone. Or law enforcement. It reflects the dislocation of working class culture in America. Diagnosing and confronting the epidemic is essential to not only the health of small town communities, but to repairing the class divide ever-deepening national instability.
This article was originally published in “What I Learned This Week” on June 8, 2017. To subscribe to our weekly newsletter, visit 13D.com or find us on Twitter @WhatILearnedTW.
