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Opioid Addiction: A National Crisis in Slow Motion

How is it possible that a cataclysmic public health crisis which takes the lives of over 42,000 Americans and incurs economic costs of a half-trillion dollars each year so rarely garners a front-page headline? Maybe it is a function of “attention fatigue”—the mental overload felt by millions in these anything-but-normal times in North America circa 2018—or “not my problem.” But even as numerous troubling events (school shootings, revelations of police brutality, sexual predation, and the ethically troubling Trump missives) compete for every last ounce of the public’s concern, there is no satisfying explanation for why the opioid crisis gets lost in the shuffle.

Our nation’s response to an unprecedented spike in deaths caused by addictive painkillers has been both feeble and immoral. The crisis has so far sparked no large-scale social movement akin to Black Lives Matter, #MeToo, or March for Our Lives. While it is heartening to witness the upsurge in public support for people disadvantaged on account of gender, race and immigration status, perhaps we need a reminder that those suffering addiction also routinely encounter life-threatening experiences—the ultimate deficit of privilege. Ethicists may have much to say about the deep-seated reasons why the suffering of this particular group is grossly overlooked. However, the missed opportunities to address the symptoms and deep causes of the crisis reflect poorly on the ability of the American people to move beyond the familiar “blame-the-victim” responses and to mobilize public support for the resources to change the narrative and save lives.

But the first step on the path to effective action is simply to notice the elephant in the room. The lives of people addicted to heroin and other opium derivatives are chaotic and ugly; the easy thing to do is to avert our eyes and distance ourselves, as individuals, as congregations and as members of a polity. Occasional media coverage may force us to take notice of the “crisis in slow motion” unfolding in our midst. An outstanding example of such coverage is the March 5, 2018 issue of Time magazine. With not a single advertisement or ordinary department, this issue consists solely of a feature entitled “The Opioid Diaries.” This contribution of noted photojournalist James Nachtwey portrays vividly the squalor, agony and frequent violence associated with opioid addiction, all the more stark for the candidness of its close-ups in black-and-white. What Nachtwey offers in these pages is the chilling desperation of those who are addicted and the exasperation of first responders and law enforcement as they struggle to assist (and sometimes to restrain) the afflicted, often as they writhe in pain in beds, on floors of bathrooms or on parking lot blacktop. What we don’t see are the systemic causes of opioid abuse, such as legal over-prescription and distribution of opioids by irresponsible pharmaceutical companies and criminally in black markets at unprecedented levels. Disturbing as it is, the photo spread (and deliberately minimal accompanying commentary) is a tribute to the power of photojournalism (like art in general) to move us—at least to new individual appreciations of grim social realities and hopefully to collective action to halt the crisis. A letter to the editor of Time that appeared in the next (March 19) edition captured my own sentiment in saying simply: “Thank you for waking me up.”

The photo essay moves us to embrace the universal duty to look a deep social problem in the eye and take seriously the suffering of our neighbors whose lives have spiraled out of control. What ethicists are especially obligated and particularly well-positioned to do is to hold us all accountable to the standards of social responsibility. How may policymakers as well as ordinary citizens better match our actions to the values that guide us? What words and gestures can we ethicists employ to stir up the resolve that will effect needed changes in laws and practices to open up alternatives to the trap of opioid addiction?

Raising the public profile of this pressing issue is a necessary start, but merely calling attention to the problem is not sufficient. Human nature is such that shock soon fades and outrage fizzles amidst the rush of daily events that compete for our attention. The challenge for us is to find ways to sustain public energy and commitment after the shock of the staggering scale of this human tragedy in our midst has worn off. The challenge of fashioning an adequate response to this suffering includes a methodical application of resolve even as the news becomes a regular drumbeat rather than a startling trumpet blast.

In short, a problem as huge and profound as the opioid crisis requires a large-scale social response—a movement strong enough to organize and mobilize the public to halt the mounting death toll, approaching 100 victims each day (about the same as the daily body count from gun violence in the U.S.). Only genuine social movements have the power to turn shock and anger into hope and a constructive agenda for sustainable change. Organized responses so far constitute a tale of missed opportunities, including recent government studies and commissions that seem to go nowhere. Add to the woeful mix the recent Trump administration opioid plan that mixes outrageous posturing (a proposal to execute drug dealers) with a string of familiar platitudes, but ultimately pledges laughably few resources to programs for effective prevention and recovery. Real improvement will have to get beyond past approaches that tend to blame the afflicted, not to mention criminalizing and incarcerating them. Lasting change will require sustained investment in resources to counter the opioid epidemic, such as building up the capacity of treatment facilities and a more comprehensive system of therapeutic and social services adequate to the immense scale of the problem.

After the school shootings in Parkland, Florida, the students of Marjory Stoneman Douglas High School had every reason to feel immobilized and to shrink from the newsfeeds of the public eye to mourn their dead and wounded. To their everlasting credit, these courageous teenagers did the opposite by seeking out public attention to publicize the need for reform of laws and attitudes regarding gun violence and its causes. They received a remarkable public hearing because they possessed the authority that naturally attaches to those who suffer—they knew what they were talking about as few others could (or would ever so desire). Ideally, opioid sufferers would someday address the public in a similar way with their own stories of pain and ardent hope for reform. But until they do, those of us who have escaped the lethal grasp of addiction should step up and point out just as courageously how the suffering of our neighbors levies an obligation on each of us to face the problem head-on. Notice how the interplay of power and powerlessness (real and perceived) controls the narrative of desert and blame in this urgent social and public health issue—one which will require the wisdom, imagination, and collaborative commitment of all if improvement is to come.