How to Create a Crisis

Edmund was such a bratty kid the first time I read The Lion, the Witch and the Wardrobe.  I loved Lucy, since I was a girl her age, but his relentless effort to embarrass her only made him half villain.  What I found repulsive was his ignorance to temptation; he didn’t even try to defend himself against White Witch. How could a person so shamelessly seek after evil, trudging through snow with no coat, to sell out his siblings for candy?  I understood that he represented me as a sinner, but I couldn’t bear being lumped in with someone so oblivious to an evil plot.

That same feeling is rampant where I live in the Appalachians. People’s resentment builds as heroin bashes away at the infrastructure of rural life. It’s not that they’re unfamiliar with addiction, or the depression that leads people to it. They’re just tired of the unrelenting pain the heroin version brings, and of lacking the resources to fight back.  People wonder, why can’t these addicts just say ‘no’? They did DARE in school like everyone else, so how could they be so helpless against such an obvious evil?  Maybe if addicts just thought about their choices, money wouldn’t be wasted on Narcan, social services and jail.  Someone in a crowd will always suggest we save our resources by just letting them overdose and die.  It’s callous and simplistic, but people are so annoyed that heroin is even an issue.

It took 30 years and raising 4 little boys for me to appreciate Edmund as a universal character.  My boys didn’t see him as a spiteful bully, but as an emotional little boy, frightened by the war and annoyed by his seemingly perfect siblings.  As a parent I was finally able to see the wounds caused by circumstance, separated from his parents and scared for their safety.  Every day I referee squabbles created by a child who’s been squashed by his place in the birth order, trying to undo the resentment that it brings.  Adding to Edmund’s plight, he’s sacrificing joys he’s been entitled to since birth- sugar, chocolate, even new shoes and socks.  He wasn’t wandering Narnia seeking fortune or dominance, they just found him cold and lonely in the woods with an unsettled heart and offered themselves as solutions.  All it took was a small choice of food, and suddenly his greed was insatiable. 

The enchanted treats perverted Edmund’s character similar to the way heroin would.  The more of the treat he ate, the less remained of his virtue.  Reality became distorted to the point he could no longer decipher the good from evil, or truth from lie. His disposition became increasingly combative, even when he was obviously wrong.  Of the Turkish Delight, Lewis says, “…anyone who had tasted it would want more and more of it, and would even, if they were allowed to, go on eating it until they killed themselves.” His greed for it left Edmund with an empty container, making promises he couldn’t keep, to a woman he couldn’t trust, all to dominate his siblings and live in a fantasy.   We scoff at people who fall prey to addiction, the same way we do at Edmund, but truthfully we know more about this scenario than we’d care to admit.  

The creation of today’s Heroin crisis is rooted in the same oblivion as Edmund’s.  He didn’t know that the Witch’s treats were enchanted.  He’d probably eaten Turkish Delight before without feeling the urge to sell his soul, so why should he suspect danger? The Witch may have been exuding evil, but it was just candy.  The increase in heroin use today is attributed to the mass abuse of OxyContin that began about 20 years ago. The pill was first marketed as non habit-forming, and for a decade doctors were encouraged to prescribe it to anyone with chronic pain.  It didn’t matter if you were prescribed pills from your doctor or bought them on the street, the lie was pervasive and convincing: there have been studies, it’s not habit forming, it’s FDA approved for all your pain.  Maybe we should have been more wary, but doctors prescribe all kinds of drugs that heal and help, so why should this be different? Even after 1000’s of years of experience with opium and its derivatives, we never stopped to question if these claims were true.

In the time that it has taken OxyContin and its generic oxycodone to rise and level off in popularity, our culture has seen an abundance of fraudulent schemes fail. Our economy imploded as the housing market crashed.  Record breaking athletes almost all turned out to be bogus, and our olive oil was fake.  We wanted so much, we even ruined kindergarten in an attempt to have smarter kids.  Ignoring fraud and then being horrified at the consequences is just about our new national pastime.  It’s in this way we know Edmund and the addicts on the street. We know them through our blinding greed.  

The story of how we legalized drug dealing reveals that greed as the real epidemic, and our opioid abuse as a symptom of it.  It would seem, according to the arrest records, that the White Witch villain of this story are the people operating pain clinics. To an extent this is true, Jeff and Chris George were like this, They were twin brothers from Florida who were both housing contractors and felons, but from 2008 to 2010 they owned and operated the U.S.’s  largest chain of pill mills, profiting $40 million in just two and a half years.  They hired desperate doctors who were bankrupt, either literally or morally, and told them if they wrote a lot of prescriptions they could make $2 million a year.  As soon as patients realized how easy it was to obtain drugs without getting arrested, their business exploded.   People drove down by the van full from as far away as West Virginia and Kentucky.  Each patient needed an MRI (done for $50 in a trailer behind a nearby strip club) and a clean cup of urine (didn’t have to be yours), but as long as someone followed the procedure they could go home with a month’s worth of pills.

Since pain is relative and mostly invisible, you can’t prove someone is lying, which made it difficult for the DEA to build a case. It wasn’t until the brothers violently threatened people that agents were allowed to wiretap their phones and prove the clinic was a sham.  At any point before that, the George’s certainly could have walked away with a fortune, but when recounting the story they said their love for profits and power became insatiable.  By the time the clinics were shut down and everyone involved was arrested, the DEA estimated that 20 million doses of oxycodone had been prescribed, an average of about 10,000 per day.

Most doctors, however, were less villainous than the Witch and as blinded as both Edmund and addicts alike. Dr. William Hurwitz, star of the documentary “Dr. Feelgood: Dealer or Healer”, had an impressive resume compared to the George brothers.  He was educated at Columbia and Stanford, and then volunteered with the Peace Corp in Brazil. When he came back to the States, he specialized in chronic pain, became an expert in the field, and opened his own clinic in an affluent D.C. suburb.  His patients were people whose pain was so crippling they were unable to do basic things, like walk or get out of bed. They were grateful for his support, but traditional treatment involved multiple types of surgeries and therapies in addition to some meager medication.  It was a long, expensive road with lined with tiresome insurance battles, and no promise of relief.  Everyone was desperate for an easier answer to the problem of chronic pain.

In 1996, sales reps from a company called Purdue Pharma showed up in doctor offices across the country, and a ‘hallelujah’ rang out.  They promised their new pill, OxyContin,  was the first non-addictive opioid, thanks to its fancy, new time release capsule. They wooed doctors during special conferences at fancy resorts, and cited a few loosely applied studies to substantiate their claims.  At these conferences they promised even a primary care physician could prescribe it safely.  It’s so harmless, people could use it after a tooth extraction.  Purdue trained its sales team to ingrain the message that the risk of addiction was “less than one percent.” They even made up a term to describe skeptics: ‘opiophobic.’

Hurwitz was so enamored with the idea of the pill that he became blind to its power. After years of repeated appointments with little progress, his patients were finally happy, and he was overjoyed. “It’s like a miracle from heaven,” they’d tell their friends.  They can go back to work, walk without a cane, and play with their grandchildren again.  But soon they would become tolerant and ask for a higher dose, and Hurwitz became as addicted to prescribing OxyContin as they were to taking it.  He started to ignore signs that his patients were abusing the drug.  When a nurse would point an addict out, he claimed they still felt chronic pain, so who was he to deny them relief?  If a patient ran out of pills before their prescription ended, Hurwitz would assume the patient was developing a tolerance and increased their dosage.  After two of his patients overdosed and died, the DEA opened an investigation. His abundance of patients taking abnormally large doses led them to shut his practice down.  Soon after the medical board revoked his license, and eventually he went to jail.

Even after losing everything, including his marriage and career, he still thought OxyContin was the answer for chronic pain.  When they interviewed his ex-patients, ones who were lucky enough to have recovered from their habit, they all regretted their addiction and understood how needing the pills had made them suffer more.  Hurwitz showed remorse for the people who had died, but was unwilling to assume any blame. He was sad that people had taken the drug incorrectly, mostly because it ruined the chance for others to use it for relief.  In his post jail interviews, he still did not feel that large doses, extended use, or increasing tolerance had anything to do with creating epidemic addiction. He shows we can be greedy with excellent motives, and what’s scary is that will blind us all the same.

Closer to the White Witch in this story is Purdue Pharma.  In the early 90’s they were still a small company, whose primary product was a painkiller called MS Contin given mainly to dying cancer patients. It was profitable, but the patent was about to expire, and with it’s limited market it wouldn’t be able to compete with its generic versions. The company needed something new to keep them afloat, preferably something with a bigger market so they wouldn’t be in the same position ten years later. OxyContin, was their answer and chronic pain patients would be their market.  Soon enough, its popularity turned them into superstars, and opioids became a billion dollar a year industry in just a few years.  Today their reach is global, and the Sackler family who owns the brand, is the 16th richest in the nation according to Forbes.

It’s unclear what their original intention was other than trying to stay in business. Did they create their product to help people or did they know they had found a way to legalize heroin? Probably the truth is somewhere in between.  By 2000, people began to realize that OxyContin actually was addictive, and started filing lawsuits.  In 2007 The U.S. Attorney General’s office took up the case, and Purdue Pharma pleaded guilty to criminal   ‘misbranding’, for mislabeling theb drug, fraudulently promoting it, and marketing for an unapproved use.  They paid $635 million dollars in fines to stay out of jail, which was the biggest pemalty at the time, but has lost its meaning compared to the $35 billion in revenue that ; earned from OxyContin to date.  Several other affected places have successfully filed for damages since, including Kentucky, New York, Ohio, West Virginia and Canada.  Most recently the town of Everett, Washington has filed a new lawsuit, this time claiming the company purposely fueled the black market in order to increase profits.  

Why did it take almost a decade for Purdue to admit their guilt or do anything about it? Could they really not see that their product was destructive? Their actions have created a state of unending winter without Christmas for large chunks of our country, just like in Narnia. As satisfying as it would be to see every CEO responsible in jail, it’s difficult to judge where the distinction between evil intention and ignorance lies.  The CEO’s themselves were so caught up in the success of their product, it’s possible they didn’t understand the long term consequences of their actions.  Even once the effects became undeniable, they were still too blinded by profits to admit the pill was causing problems.  29 claims for damages were fought off before a single case was settled.  With bank accounts growing into the billions, their morals became more polluted than those addicted to the drug they were selling.

When Peter confesses that he was partially to blame for Edmund’s actions, Aslan doesn’t deny it.  The contributing sin is in my soul as much as it is that of addicts, over-prescribing doctors and Purdue Pharma’s.  Living with four little boys helps me see how deeply embedded in our human nature greed is.  Every day begins a new challenge to shepherd them through their desires, trying to teach them to see others needs before their own, and to be content with what they already have.  Everything else, from their friends to our junk mail, teaches them they need more: more activities, brains, ambition, muscles, toys, fun, food, gifts and then also more money, to pay for it all.

In the aftermath of OxyContin we find ourselves like Edmund, standing alone in a frigid castle, desperate for hope and lamenting the greed of our actions.  Heroin addicts may receive the worst of our scorn, but those that can find recovery are the most blessed, for they’ll have seen their sin clearly enough to be freed from it.  Unfortunately, the epidemic of greed pushes us to behave like headstrong teenagers.  We suffer the consequences for a while, but when they’ve run their course, we’ve learned nothing.  If freedom is to be found, we must see our problem as clearly as an addict at rock-bottom, with an awareness of the disasters we’re causing, humility to admit our imperfection, and acceptance of contentment with our reality.

After Purdue Pharma was convicted, their profits and the rates of pill abuse continued to increase for 3 more years.  Even with the landmark court case, opioids were not a top news story in 2007, or listed in the top 10 headlines for any year before or after.  Most headlines were about elections and their related issues, the war on terrorism, sports or celebrity gossip.  The housing crisis and the ensuing recession have been a top story almost every year since 2008 because of the mayhem it caused, but opioids have devastated almost as many.  It’s estimated that 7 million have struggled with dependency since the release of OxyContin, many cases resulting in death.  On the surface this seems about equal to recession unemployment or foreclosures, but the statistic grows exponentially when we realize that addiction is a family problem.  For every dependent person counted, there are several more suffering the consequences, like kids in foster care, babies in withdrawal, and/or relatives spending a fortune on their loved ones in rehab.

After such a traumatic experience, you would think we would make an elaborate effort to keep history from repeating.  Some progress has been made; OxyContin now has a tamper resistant coating, and databases have been formed to track prescriptions and prevent abuse.  Doctors now have strict guidelines for prescribing opioids for chronic pain. Rates of abuse have leveled off, but at the same time so have profits.  Instead of being satisfied with the money that’s been made, there is now a global campaign for OxyContin, using the same misleading and aggressive marketing techniques that proved so successful in the U.S. In a terrifying quote from a promotional video, the company claims, “We’re only just getting started.” 

After we finished our trip to Narnia, the boys and I read The Blessing Cup by Patricia Polacco.  It tells the true story of a poor Russian Jewish family that had been gifted a beautiful  tea set for their wedding.  The set came with a note saying, “Anyone who drinks from this will have blessings from God. They will never know a day of hunger. Their lives will always have flavor. They will know love and joy and they will never be poor.” The mom pours the family tea in it every week, while reciting the blessing, and pointing out all the ways it has come true. Though they are meager peasants, fleeing persecution, fighting off pneumonia and living as refugees, they believe her.  The persecution has given life flavor in the form of crazy stories and new friends who help them along the way.  They may not have always had enough to eat, but they were never hungry for love.  They may not have had sufficient money to provide for their needs and yet they were still rich in family, even in through the three generations the tradition continued after the first blessing was recited.  

May we, as individuals and a culture, have that blessing too, that we can preserve one another for generations. Let us be so full of contentment and thanksgiving that we could clearly see the temptation set before us.  The heroin epidemic probably won’t be a catalyst for lasting change. History would indicate that it won’t, since our policies created this same exact problem when heroin was released by Bayer Pharmaceutical in the early 1900’s.  But it might, and we should pray that it will.  For now, our power against the greed is in choice as individuals to be satisfied, and our ability to teach our kids, friends, and neighbors to do the same.  May these values be the heritage we cherish above all, not ease, fortune, power or fame.

“Dreamland”: Parenting Lessons From a Drug Epidemic

I have found that being a stay at home mom enables tunnel vision.  Are the kids learning and are they healthy? Am I still sane?  These are the questions that dominate domestic conversations.  The lifestyle is wholesome and protected for the kids, but the danger is that you too become sheltered.  It’s tempting to forget about the tragedy in the world, since it’s depressing and out of control, so instead we focus on problems that could possibly have solutions. Hence the abundance of articles about, “10 things to do in a healthy marriage” or, “Cleaning Your House in 5 Simple Steps.”

The world is out there, whether we’re ready to be aware or not, and ignoring it will leave us and our kids unable to handle it.  When we moved to the Shenandoah, I heard people complaining about heroin, and how they were finding needles around the playground, and seeing drug deals in parking lots.  I vaguely knew that people were using more heroin again, but I greatly underestimated the extent of the epidemic, especially in the Appalachians.  It’s not just me though, many people don’t see this problem until they’re living with it.  

The book Dreamland:The True Tale of America’s Opiate Epidemic by Sam Quinones helps the oblivious public understand how the overflow pain pills collided with a well run heroin distribution system to create the epidemic that’s growing today.  I’ve read a lot on this topic, but I recommend this book because in addition to the facts and stories that led up to the epidemic, he also addresses the cultural trends that made our country susceptible.  Among these trends are several things for parents to consider, definite lessons, possible influences, and some just philosophical questions we should consider.  

Definite Lessons

Be aware of what’s in a pill bottle.   Do your research on what a doctor prescribes your child,  especially if something is possibly habit forming. Even if big pharma or your doctor tells you an opioid, benzo or amphetamine is not addictive, that it has a special time release formula or some other mechanism to keep people from abusing it, assume that it is still is addictive, because that’s the nature of these drugs.  

Shame intensifies the problem. In Portsmouth Ohio, the city that Quinones identifies as ‘ground zero’ of the epidemic, parents didn’t speak out about what was happening because they were embarrassed. They were trying to navigate things they knew nothing about: rehabs, prison systems, probation, but silently, without help.  They were too ashamed to ask for it, which was silly, because their friends and neighbors were going through the exact same things, but also silently and no one knew.  It took 10 years before a parent in town was able to speak up about it, and form a support group.  If one good thing comes from the opiate epidemic, it’s that there’s a light shining into the hidden worlds of middle and upper class addiction. Because it’s heroin, you can’t just send a kid to rehab silently and expect when they return, life will go back to normal.  Heroin is not just bad behavior at parties and DUI’s, it’s cops, multiple stints in jail, and ambulances in front of your house. You have to have help to support a person through recovery; knowledge and honesty from a community are essential. And since addicts are overdosing more often than people are dying in car crashes, there is no longer time for any parent to shame or be ashamed.

Possible Influences

Kids had their own rooms. Because of our increased affluence and the real estate boom, many kids had their own rooms, which was less common in previous generations.  Kids said that their room was the perfect sanctuary to get high in, away from the cops, nosy neighbors, tattling siblings and any other person who could tell their parents what they were doing.  

And their own cars.  Having a car gave suburban teens easy access to drugs.  You call a number, like you’re ordering pizza, you drive somewhere and meet another driver, and exchange money for drugs. Quinones mentions that the cars also had the added benefit of becoming a place to live when the parents wised up, and kicked their kids out of the house.  

Sports.  I hate to mess with something that has become sacred to so many people. I’m not denying that athletics can be beneficial for children, but that it can be overdone. Quinones noticed that in the middle and upper class communities he was studying youth athletics had been elevated to the point where the problems began outweighing the benefits.  After interviewing an addict in one upper-middle class town he said,  

“It was a place of gleaming mansions, but he felt no sense that education was of value in providing choices for life, much less a love of learning. These kids’ futures were assured. So sports were what mattered. Dads would brag to friends about their sons’ athletic exploits, then berate their boys for poor play, urging greater sacrifice. From the athletic director down to parents and teachers they heard, ‘you need good grades so you can play…’”(291)

Quinones saw that sports were becoming a gateway to opiate abuse because of the pressure and the injuries.  Because of how important sports had become, kids were playing year round starting in early elementary school, and were then more likely to have chronic injuries by the time they reached high school.  And because of the pressure to succeed, they were encouraged to play through their injuries and ignore their pain. They were often prescribed painkillers just so they could finish a season and Quinones noticed that the local football star was quietly becoming the face of teenage opioid abuse. Medicating injuries has always been done, but with oxycodone being prescribed for chronic pain, many sports teams, (and football especially since the players are prone to injury) were developing their own addictions.

Philosophical Questions

What are the consequences  of isolation?  The book is named for the community pool in Portsmouth, Ohio, where generations of kids would hang out all day every day over the summer, surrounded by their neighbors and elders.  It closed in the early 90’s because people began installing their own pools, tucked away neatly in their backyards. People stopped meeting their neighbors and letting their kids roam the streets until dinnertime.  The lack of neighborhood made it easier to hide a drug addiction, away from the watchful eyes and accountability of the community.  Quinones sees this as a metaphor, because it wasn’t just Dreamland that closed, people everywhere started staying in their homes and becoming more isolated. Closed doors made it easier for people to pretend they were perfect, which fueled secrecy and shame about all of their hidden defects.

What happens when we have too much stuff? Maybe not so coincidentally, the peak business years of pill mills coincided with the boom and bust of the housing market.  Quinones theorized that our increasing consumerism created a culture that was fertile for an opiate epidemic.  Unfortunately, parenting has not been immune to this, and the increase in teenage heroin addiction shows the consequence. In an interview with a man running a rehab clinic, the man explained,

“‘Spoiled rich kid syndrome’ seeped into America’s middle classes. Parents shielded their kids from complications and hardships, and praised them for minor accomplishments-all as they had less time for their kids….’You have a lot of kids who have everything and look good, but they don’t have any self-esteem. And you put an opiate addiction in the middle of that?’” (p.293)

Is it possible that minimalism could be an antidote to rampant drug use?  If we wanted less and were satisfied more would we still crave chemicals to fill the gap? While we all know that spoiling children is detrimental to their behavior, maybe we don’t understand the gravity of that consequence.  I tend to think of the consequences as behavioral.

What do we lose when we stop accepting pain as part of life? Our culture has also become less tolerant of pain, not just chronic pain, but any pain.  People started getting oxy prescriptions for things that Tylenol would normally take care of.  Quinones said,

“In heroin addicts I had seen the debasement that comes from the loss of free will and enslavement to what amounts to an idea: permanent pleasure, numbness, and the avoidance of pain. But man’s decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior.” (p.37)

This idea has also trickled into parenting, because we can’t even handle watching our children feel pain, physical or emotional. The man Quinones interviewed from the rehab clinic thought that parents today are making recovery even more difficult than usual.  He believed there was a simultaneous epidemic of parents addicted to rescuing their children, and that their kids maturity was stunted because of it.  He had seen too many parents enable addictions by rushing to their kids aid with money, food and shelter when they should’ve been capable of providing it for themselves. People do this because its been their habit since birth, every time a child cries from a scraped knee or because someone was mean to them, we jump to their aid.  He warned, “I tell parents it’s real important to say no, but say no way back when they’re young.” (p.293)

I think most people have heard this before, but have not thought about it in this context.  Whose pain are we really medicating when we come to our children’s rescue, and could the consequences not only lead to irresponsibility, but also to their demise? Is it possible to walk the line of being compassionate toward our children without enabling them, starting when they’re still young?

I wish I could offer you a parenting guide, and not just a book review. My kids are still in elementary school still and not addicted to heroin, so I’m no authority, but I do know there’s no foolproof way to keep your kids from trying drugs.  I also know enough about addiction, to know that it’s usually not a parents fault, and as the book shows, the epidemic has many influences that are beyond parental control.  I’m sure there are many kids who had their own rooms, drove their own cars, played sports year round, had lots of stuff, and still grew up to be healthy adults. Just as I know there are kids who grew up with none of these privileges that are still battling addiction.  The influences above are just observations that the book brings to light, with the hope that history won’t repeat itself, and I share them here in case there’s any possibility that our behavior can help curb this trend.

Although you could never place the blame all on one influence, I do think the epidemic shows that it’s important to have conversations about the long term consequences of parenting trends. What do you think of his warnings? Have you seen these things enable addiction in our culture? Will you debate the consequences with your friends? I know it’s even less comfortable to talk about than marital problems, but we owe it to the parents who have suffered already, to respect the education they earned, and the pain they have endured.