Huntington, Heroin, and Hope

I was saddened to read about the rash of overdoses in Huntington, WV earlier this week. Twenty-six overdoses took place within the span of 4 hours on Monday, all within a few blocks of one another, all presumably from heroin laced with fentanyl or its even deadlier opiate relative carfentanil. Huntington figures prominently in Sam Quinones’ excellent book Dreamland about the new wave of customer-friendly drug dealers moving into small American cities to exploit markets primed by years of opioid over-prescription. Hundreds of cities like Huntington face a seemingly insurmountable challenge responding to a crisis of this scale, which strains the institutional capacity of even much larger, well-resourced municipalities.

Indeed, in my view it will be impossible for small cities acting alone to adequately address the social plague of opiate addiction. Success, which will never be better than partial, will first require rethinking the way in which America deals with addiction, followed by coordinated action across multiple types of institutions. It will also require a broad consensus agreeing to turn away from several non-solutions with small but vocal constituencies.

Non-Solutions

The most overtly malign approach to the opiate addiction epidemic (one I regret even needing to list) can be summarized simply as “let them die.” By this view spending on narcan, a drug that can save the life of someone undergoing a heroin overdose, is entirely wasteful. Addicts use by choice. They steal, possess character flaws, and are likely beyond hope, anyway. In the comment threads regarding Monday’s incident in Huntington, such views were expressed with alarming regularity.

It seems tempting to dismiss such arguments simply because they sound heartless and inhumane (which they are). However, I think it’s important to acknowledge the sense of exasperation that lies beneath these sorts of comments. Efforts to get clean do most often fail. Heroin users do resort to crime to support their addiction and impose various other social costs upon their communities. There will never be unanimous agreement as to which groups or individuals are “worthy” of assistance, but establishing a consensus regarding boundaries for reciprocal altruism is one of the most important ways in which a society expresses its values.

When one considers the many paths to opiate addiction, often beginning at the hospital or doctor’s office, the argument that addicts possess fundamental character flaws begins to look ridiculous. As the biochemistry of addiction becomes increasingly better understood, the evidence strongly suggests genetic predispositions toward addiction which can be exacerbated by environmental factors, such as prescribed use of opioid medications. Addicted parents, likewise, pass on a disposition toward addiction and often also provide an environment where drugs are easily accessible, increasing the chance of first use.

Should the confluence of these factors (and many others, such as mental health) yield a death sentence, or at best a social response of “you’re on your own?” Some (unfortunately) will say yes; I disagree, and hope a broad consensus forms around smart, coordinated action to help individuals and communities cope with opiate addiction. Worst of all, the “do nothing” alternative does nothing to reduce harm.

Some also suggest that building a wall along the Mexican border or otherwise increasing border enforcement through more practical means would reduce the consumption of heroin in the United States. This argument has been thoroughly debunked elsewhere, in part because most heroin entering the US comes through legal border crossings, but more generally by the last 35 years of the drug war, when repeated efforts to blunt supply did nothing to reduce demand. Drug entrepreneurs will always find a way to bring their product to a willing buyer. The “Xalisco boys” that Quinones documents so well in Dreamland rely upon relatively small quantities of smuggled black tar heroin, amounts that can easily and cost effectively enter the country via commercial air. Building a wall, in short, would do nothing to address the problem of opiate addiction.

Elements of a Solution

A real solution to address the heroin epidemic should focus on reducing the harm addiction causes to individuals and communities. Doing so will require new approaches to how society deals with addiction, including coordinated action by multiple types of social institutions.

Fortunately, there are places we as Americans can look for best practices, such as Switzerland, which has seen great success in reducing crime, disease, and drug overdose fatalities. A key component of the Swiss program allows doctors to prescribe heroin as part of treatment plans for heroin addiction. While some would argue that this is the very definition of a non-solution, the practical benefits in reducing crime (60% reduction in felony crime by program participants) as well as success in eliminating overdoses from spiked heroin are compelling. Since the drug is provided by a doctor (and covered under national health insurance), drug dealing and the violence associated with it have also been reduced.

To be successful in returning the largest possible number of people to clean, healthy lifestyles, harm reduction programs such as Switzerland’s need to be accompanied by access to recovery resources, mental health treatment, and employment assistance for those ready and able to work. Especially across Appalachia, places like Huntington face a confluence of factors — deindustrialization, the collapse of coal, low rates of educational attainment, lack of economic opportunity— that exacerbate the heroin problem by feeding into a sense of hopelessness about the future. Addressing each of these many dimensions will require not only government action, but also the engagement of community, faith-based, and secular organizations, as well as neighbors and families.

Where I Find Hope

I was born in Huntington and through a series of unlikely events now find myself nearly 50 years later living in Seattle, fortunate beyond words to be working in technology industry doing a job I love in a city I adore. Huntington seems a million miles from Seattle, further culturally than geographically in many ways, yet both places face similar challenges with opiate addiction. Earlier this year, just down the street from my house, a homeless man died in an alley from a heroin overdose. This followed an incident just a few months earlier in which a group of addicts abandoned an OD’d “friend” to die in a shopping cart beneath a bridge.

Troubled by hearing these local stories as well as deeply saddened by reading many accounts (such as this) about the situation in my old home, I was fortunate to be given an opportunity to help in a small way. A young man named Eric, a friend of my son’s, found himself struggling with addiction. Eric wanted to get clean, but had no place to live except an apartment filled with other users — hardly an ideal environment for getting on the path to recovery. He was also failing to comply with his medication schedule for a neurological condition, resulting not only in a risk to his physical health but also causing psychological side effects, such as paranoia and anxiety.

Luckily, Eric really wanted to get clean and had been off heroin for 2 months before asking if he could stay with us. Now, living with us he’s approaching 11 months clean, complies with his meds, and is in great shape both mentally and physically. After about 3 months, Eric’s natural intellectual curiosity seemed to return after being suppressed by years of drug use. He started digging into Python and teaching himself how to code, and reading books like The Zero Marginal Cost Society about the impact of technological change on the economy. Eric will be starting at community college this fall, looking to pursue a career in information technology using his prodigious intellectual gifts now unclouded by opiates.

Of course, these things are never over. Who knows what next year may bring, but to let fear of failure foreclose the opportunity to maybe — just maybe — make a dent in the machinery of despair that drives opiate addiction would be to give up on hope itself. For Huntington, and a thousand places like it; for Eric, and a million people like him, hope is something we cannot afford to lose.

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