A bigger killer than car crashes

kw: book reviews, nonfiction, opioids, opiates, addictions, polemics

For most years I remember, the number of people killed in auto accidents in America was about 50,000. Then after about 2000 it got down into the low 40's, and since 2008 has usually been in the mid-to-low 30's. From 2005 until the end of 2018, just over half a million deaths in America have been auto fatalities. Yet, car deaths are on the rise since 2014, with a 10% increase from 2017 to 2018, and I'll get back to that.  But first:

This chart shows data only from 2005 onward, to better focus attention to the crossing trends: In 2009, for the first time, deaths in America from drug overdoses exceeded those from car crashes. Since then, this trend has increased dramatically.

Figures aren't complete for 2018, and they may not have risen as fast as they did the prior year or two. But the fact remains that, from 2005 to 2017, one year less than the sum in the prior paragraph, drug overdose deaths have exceeded 570,000. These two causes together come to about 1.1 million untimely deaths in America in fifteen years.

Ryan Hampton, for one, wants to do something about that, at least the drug overdose part, as he writes in American Fix: Inside the Opioid Addiction Crisis—and How to End it. While I call this book a polemic, in this case I mean that in a very positive way! Nothing short of loud Jeremiads seems able to get through the thick skulls of not just policy makers but the majority of the public.

I must confess that, while Mr. Hampton is a very good writer, it was quite an exercise for me to read through the book. His aim is to pluck heart strings, and he does it masterfully. He is in recovery himself, and pulls no punches about his path from an "innocent" pain prescription, to doctor-shopping (because the "safe" medication he was given wasn't safe after all), to heroin use, and then through several recovery programs to one that has been working for him. Two messages underlie this paragraph:

1. The pharmaceutical companies have tragically underplayed the addictive potential of popular pain-killers. Criminally so.
2. The public and political view of drug abusers is dramatically wrong, and increases their suffering greatly and needlessly.

Americans need to face that fact that drug addiction is a disease. It doesn't resemble other diseases such as cancer or tuberculosis, because the causes are more hidden. They are buried in brain chemistry and the way it is so easily hijacked by certain chemicals. We are also somewhat jaded by hearing numerous radio ads that mention "the disease of addiction", in which it is applied properly no more than half the time. It is not proper to speak of compulsions toward sex, gambling, or chocolate as "addictions", and particularly not proper to treat them as diseases. They are in a different category, even though they do affect the reward circuitry of the brain. Yes, they do so, but not nearly as powerfully.

Let me mention at this point my musing about the 10% rise in traffic deaths last year, and a similar rise a couple of years earlier. How much of it is because the current recreational drug of choice, marijuana, is being legalized?

When I was actively involved in drug rehabilitation programs, some 45-50 years ago, heroin and its relatives was being pushed into the background by psychedelic drugs. LSD was popular, followed by PCP and Meth. Kids I worked with weren't all that likely to OD on LSD. They were more likely to walk out a 4th floor window thinking it was a door to paradise, or fall into a creek and drown, or to have a bad trip or even a flashback and find a way to kill themselves. I was never involved in heroin recovery efforts. And there is a new factor in the OD picture. Heroin is no longer the strongest drug (closely followed by cocaine). Its synthetic cousin Fentanyl is therapeutically effective as a painkiller at doses of around 1-1.5 mg, compared to 2.5-5 mg for morphine; however, its therapeutic range is narrow; 3-4 mg of Fentanyl can kill. There are much worse versions out there, such as Carfentanil. A few mg of that can kill an elephant or rhino.

Thus, I can't really speak intelligently about the author's experiences in recovery. He did not overstate the case. It is grim. If you aren't rich, you can't afford rehab. It's still rare for insurance to cover any part of such programs. The "affordable" rehab programs are so inadequate that they actually set people up for overdose. It works this way. A single heroin dose of 30 mg will usually kill someone who has never used it. The therapeutic dose of morphine (heroin is metabolized into morphine) is single doses in the 2.5-5 mg range, and no more than 30 mg/day. Someone who has abused heroin for a couple of years is using 60-100 mg per "hit", and a total of between 500 mg and one gram daily.

Suppose you are such a user and want to get rehabbed, and you manage to get into a program. It typically ends in four weeks, and you are returned to the street with no more than a "Good luck". If you have at least a little emotional support from peers or parents, you may hold out for a few weeks or months. Then you enter a low spot, emotionally, and go for "just one more hit". But much of the habituation to the drug has been lost. The "nickel bag" you were used to using is now enough to kill you. Many OD deaths are recently rehabbed young people, found with the needle still stuck in, they died so fast.

In a later chapter of the book, the author describes a few programs he found that are working better, because they abandoned old thinking and old ways of treating drug abusers. I think it better to leave it to you at this point. Read this book.

Count yourself lucky if there is absolutely nobody among your family, friends, and acquaintances who has not used a hard drug. We have a lady friend in her late 70's who was successfully weaned from prescription painkillers, just barely! It was costly and pretty hard on her and her husband. Luckily, she had not graduated to heroin!! It is likely that you do know someone, even if you don't know about it yet. So, get this book and read it. Consider Mr. Hampton's call to action in the last chapter. Our voices are needed by those whom society formerly forced into silence.