Opioid Overdoses: A 9/11 Attack Every 2.5 Weeks
2,753 innocent civilians losing their lives when the World Trade Center towers fell was a watershed moment in American history. It drove civic engagement across the country, shifted long held cultural views on liberties and privacy, and spurred military action across the globe. Almost 17 years later, the United States has spent an estimated $5,600,000,000,000 (trillion) fighting terrorism in Iraq, Afghanistan, Syria, and Pakistan as a direct result of the 9/11 attacks.
The victims who died in the World Trade Center were mostly middle and middle-upper class ‘average’ Americans. More men than women were killed. Their ages ranged between 2 and 85 with most being between 35–39. The majority were white men and more than 60% were college graduates.
The 9/11 Commission Report found “the most important failure” leading to the attacks was “one of imagination” and it concluded “we do not believe leaders understood the gravity of the threat.” Tom Kean, the chairman of the 9/11 Commission, said “they penetrated the defenses of the most powerful nation in the world. They inflicted unbearable trauma on our people.”
Today we are facing a crisis that dwarfs the collapsing towers — last year, 64,000 people died of opioid overdoes — causing a loss of life equivalent to 9/11 every 2.5 weeks. This week, the CDC reported that opioid overdoses have increased 30% in the last 14 months. Opioid overdoses are now the leading cause of death for Americans under 50 and have caused the US life expectancy to drop over the last two years. The demographics are eerily similar to 9/11 victims. The statistics show that the majority are 35–44 year old white, middle-class, increasingly educated males with remaining victims having a representative group of differing ages and ethnic backgrounds.
Rapidly increasing deaths and plummeting life expectancy are staggering numbers that point to a new failure of imagination as our leaders misunderstand the gravity of our nation’s most significant homeland security threat.
Trends Point to a Big Problem
The analysis of the 9/11 attacks showed that government officials failed to put the pieces together. The 9/11 Commission Report specifically cites immigration authorities, the FBI, CIA, State Department, and the Pentagon for failing to form a coherent policy against al-Qa’eda. The principal recommendation was to unify more than a dozen intelligence agencies that individually failed to foresee the attacks.
The opioid crisis mirrors the same set of failures leading up to 9/11. All of the trends point to a major crisis but national efforts are not unified and government agencies lack a coherent policy. At the federal level, the CDC, FDA, SAMHSA, and NIH all share some level of responsibility while implementation of programs falls to 50 different state health departments and hundreds of local health agencies. In response to the opioid crisis, HHS is focusing its efforts on five major priorities:
- Better addiction prevention, treatment and recovery services
- Better targeting of overdose reversing drugs
- Better data
- Better pain management
- Better research
These broad brush concepts do not align to the severity of the problem based on the data. Imagine if President Bush announced after the 9/11 attacks that the CIA would focus on “better data” and “better research”. There would be public outrage and it does not take an expert to see that opioid related deaths are dramatically increasing based on the available data and research.
The number of opioid related deaths have increased every year since 2002.
Opioid related deaths are concentrated in the most economically depressed areas of the country where traditionally middle-class manufacturing jobs have disappeared.
Opioid deaths have increased every year since 2002 while the rate has grown dramatically over the last five years having the highest impact on the economically depressed middle class.
This is not a novel situation. At the height of the arms race, the collapsing Soviet Union faced a strikingly similar crisis with alcohol.
Learning from the Soviets
The Soviet middle class was crushed by a combination of social and economic factors in the 1970’s and 80’s. Drinking cheap vodka (less than a $1 a bottle) became the only escape for many as soaring rates of alcoholism and alcohol related deaths paced the economic decline of the USSR.
The Atlantic details How Alcohol Conquered Russia: A history of the country’s struggle with alcoholism, and why the government has done so little about it:
According to the World Health Organization, one-in-five men in the Russian Federation die due to alcohol-related causes, compared with 6.2 percent of all men globally. It’s estimated that some 20 million Russians are alcoholics in a nation of just 144 million.
“The Kremlin’s own addiction to liquor revenues has overturned many efforts to wean Russians from the tipple,” as Mark Lawrence Schrad wrote in the The New York Times last year. “Ivan the Terrible encouraged his subjects to drink their last kopecks away in state-owned taverns” to help pad the emperor’s purse.
“Before Mikhail Gorbachev rose to power in the 1980s, Soviet leaders welcomed alcohol sales as a source of state revenue and did not view heavy drinking as a significant social problem,” as Critchlow put it. In 2010, Russia’s finance minister, Aleksei L. Kudrin, explained that the best thing Russians can do to help, “the country’s flaccid national economy was to smoke and drink more, thereby paying more in taxes.”
Times have changed in the past 30 years since the Soviet Union fell and Russia is back on the rise as a global power. The government’s priorities and Russians’ social views on drinking are changing as the economy has grown over the past decade:
Russia’s middle class is becoming increasingly health conscious and switching to lower-alcohol drinks, such as wine and beer. “The government has become increasingly concerned about the public’s health, as it has realized that population decline is a serious threat to the long-term development of the economy.”
Many Russians’ incomes have continued to rise since the 2008 economic crisis, due to high energy revenues and increased government spending, and while overall vodka consumption has been falling.
Action from the government, economic development, and social behavior has pulled Russia out of the public health crisis caused by excessive drinking. Without all three factors, it is unlikely the trends would have changed.
Just like the USSR before its collapse, the United States has several factors that together are creating a perfect storm for substance abuse.
- Economically depressed middle class that is growing poorer
- Lack of meaningful government policies to combat opioid addiction
- Systemic overprescription by healthcare providers (e.g., OxyContin to treat everyday pain, the annual amount of opioids prescribed in the U.S. was enough for every American to be continuously medicated for 3-weeks)
- Culture of maladaptive addiction treatment (e.g., access to illegal drugs, lack of drug enforcement, social stigma against addition treatment)
We Need a Leader to Take Action
Following 9/11, President Bush said in his 2002 State of the Union Address “we’ll be deliberate, yet time is not on our side. I will not wait on events while dangers gather. I will not stand by as peril draws closer and closer.”
In the same manner that the nation mobilized against the perceived threat from terrorism, time is not on our side with the opioid crisis. Each month, opioid overdoses are killing more Americans than died in the 9/11 attacks and each new study proves the situation to become exponentially worse.
Until we demand action from our government, the perils draw closer.
David Riedman is an expert in critical infrastructure protection, homeland security policy, and emergency management. He is a co-founder of the Center for Homeland Defense and Security’s Advanced Thinking and Experimentation (HSx) Program at the Naval Postgraduate School.
