(Forgive me for light posting. I’m dealing with some family health issues — nothing urgent, but time-consuming all the same.)
In his new encyclical, Pope Francis says repeatedly that “everything is connected,” and argues that a big part of our problem is that we err in seeing phenomena in isolation. As a result, he says, our approaches to addressing these problems are partial and insufficient.
An acute, deeply depressing example of this can be found in the recent nonfiction book Dreamland, by Sam Quinones. A writer friend e-mailed me the other day and said it’s the most important book he’s read in years, and that he can’t get it out of his head. I literally have four different books going right now, books I need to read for the Benedict Option book I’m starting on. But the way my friend talked about Dreamland, I ordered it immediately on the Kindle and read it in a day or two. It really was hard to put down.
It’s the story of the contemporary heroin epidemic nationwide, especially in small cities and towns that had never known the presence of heroin until now. What it’s really about, though, is a culture that opened the door for this catastrophe, in complicated but all too familiar ways.
The suppliers are not, as you might have thought, ruthless members of Mexican drug gangs, but a sprawling network of farm boys from the tiny Mexican state of Nayarit — and specifically, from one town, Xalisco (pron. ha-LEES-co). They got tired of doing extremely hard work raising sugarcane, and being dirt poor and looked down on by Mexican society. Indians in the nearby mountains grew poppies. The townspeople learned how to process it into a thick, dark goo that looked like Tootsie Rolls. And through marketing and distribution genius, people in the town developed a system for getting this “black tar heroin” into parts of America that the conventional drug gangs had overlooked. They figured out how to tap family and friend networks from Xalisco, and mobile phone technology, to set up a hard-to-police system of reliable local dealers who distributed heroin like pizza.
No guns, no threat of violence. The dealer comes to you. Customer service is the No. 1 priority. It’s a diabolical scheme, but looked at from a pure business perspective, a brilliant one.
How did the “Xalisco Boys,” as Quinones calls them, pull it off? They only used people from back home that they could trust. They insisted that nobody involved in selling could use the drug — and in fact, there was a taboo back home against it. All the local dealers were salaried, so there was no incentive to cut the drug. They provided consistent quality, which earned customer loyalty. They would not use guns, and avoided violence to keep the cops from noticing. In fact, they had a rule against selling heroin to black customers, on the belief that blacks are likely to be violent in drug deals. They kept their client base restricted to whites. Maintaining these disciplines helped their business expand tremendously.
And the Xalisco Boys tracked where prescription opiate use — OxyContin, mostly — was big, and moved into those markets. Oxy is expensive, but once people are hooked, they’ll do anything for the pill. Black tar heroin — chiva, they call it — gives the same kind of high as Oxy, only more intense, and at a much lower price. Every OxyContin addict was a potential chiva customer. And there were a lot of Oxy addicts.
It turns out that in the 1990s, there was in US medical circles a revolution in pain management. The story is complicated, but boiled down, junk medical science came to be widely accepted as true. Doctors came to believe that opiates used in treating pain were not addictive. There were never any solid data to support that conclusion, but a single letter to the editor of the New England Journal of Medicine was seized on and repeated in medical circles as a “study” that showed opiates were non-addictive in pain treatment.
According to the story Quinones tells, this was what doctors wanted to hear. They were eager to help suffering patients. Plus, Purdue Pharma, the drug company that invented OxyContin, pushed the stuff hard. It was supposed to be a painkiller limited to cancer patients, who were dealing with the most severe pain, but doctors, falsely thinking it was safe, began prescribing it for all kinds of pain, including much more minor issues. Health insurance companies preferred to reimburse for prescriptions, versus non-drug pain therapies, providing a greater incentive for doctors to rely on Oxy.
People quickly became hooked. OxyContin is a form of morphine, and therefore extremely addictive. Unscrupulous doctors set up so-called “pill mills,” which wrote Oxy prescriptions for anybody who wanted one. Soon, huge numbers of people were strung out on the stuff — poor and working-class people, but also middle-class and wealthy people. Anybody who had Oxy prescribed to them was at serious risk of addiction. Using Oxy was so pleasurable that when those pills became widely available, teenagers started taking them recreationally. When the pills ran out, or became too hard to get, or too expensive as one’s dependence built up, there were the Xalisco Boys with black tar heroin.
This is how heroin went from being the kind of scary big-city drug that only lowlifes used in the Seventies to being a drug of choice for Mayberry.
The most fascinating part of Dreamland is how Quinones examines the cultural roots of the opiate epidemic. He writes:
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.
In fact, the United States achieved something like this state of affairs … in the last decade of the twentieth century and the first decade of the twenty-first century. When I returned home from Mexico in those years, I noticed a scary obesity emerging. It wasn’t just the people. Everything seemed obese and excessive. Massive Hummers and SUVs were cars on steroids. In some of the Southern California suburbs near where I grew up, on plots laid out with three-bedroom houses in the 1950s, seven-thousand-square-foot mansions barely squeezed between the lot lines, leaving no place in which to enjoy the California sun.
Excess contaminated the best of America. Caltech churned out brilliant students, yet too many of them now went not to science but to Wall Street to create financial gimmicks that paid off handsomely and produced nothing. Exorbitant salaries, meanwhile, were paid to Wall Street and corporate executives, no matter how poorly they did. Banks packaged rolls of bad mortgages and we believed Standard & Poor’s when they called them AAA. Well-off parents no longer asked their children to work when they became teenagers.
In Mexico, I gained a new appreciation of what America means to a poor person limited by his own humble origins. I took great pride that America had turned more poor Mexicans into members of the middle class than had Mexico. Then I would return home and see too much of the country turning on this legacy in pursuit of comfort, living on credit, attempting to achieve happiness through more stuff. And I saw no coincidence that this was also when great numbers of these same kids — most of them well-off and white — began consuming huge quantities of the morphine molecule, doping up and tuning out.
Quinones tells a story about how the drug trade, on both ends, comes from a deep human desire to avoid pain — physical, emotional, psychological, spiritual. This is a normal thing, wanting to avoid pain, but when the desire to avoid pain becomes so disordered that you will do so no matter what the cost, you destroy lives, and destroy society. At one point in the 1980s, the World Health Organization, says Quinones, in its protocols, formally “claimed freedom from pain as a universal human right.” Theirs was a health policy decision, but it tracks with a deep moral belief of the rich, therapeutic, consumerist society.
Healthcare standards were changing to give patients more autonomy. If a patient said he was in pain, the doctor was directed to trust him. Besides, if opiates really weren’t addictive to those in pain, why not prescribe? Result: “Worldwide morphine consumption began to climb, rising thirtyfold between 1980 and 2011.”
Here’s the thing: the wealthiest countries, with only 20 percent of the world’s population, came to consume 90 percent of the global morphine supply. Partly this was due to irrational anti-opiate prejudices in poor countries. But there was something else going on.
In Xalisco, the poorest of the poor were sick and tired of material want and social humiliation that comes with living in cardboard shacks. When they discovered a way to lift themselves out of that pain — by selling locally-grown and processed heroin to Americans — they took it. When the money started pouring in, and the poor began living in nicer houses, and young men returned home with lots of money in their pockets, and the status that purchased them, the euphoria of all that became an addiction. Quinones:
Only the self-centeredness of addiction, she said, explained how farm boys from a traditional and conservative small town could sell a product, anathema to their parents, to sad-eyed, vulnerable junkies and not be tormented.
He quotes one former Mexican heroin dealer saying that when he arrived in the US, the older manager who introduced him to the business warned him not to think about what the drug was doing to other people’s children. If you do, he said, you will think about your own children, and you won’t be able to do this job. The drug dealers distanced themselves emotionally from the consequences of their labors, focusing instead on all the good things they could provide for their families back home in Xalisco, and the way that money elevated them from social outcasts to men of status. They refused to allow the human cost to American families and communities get to them. In time, even the people back home who knew better than to think that selling dope in America was respectable work came to ignore the moral implications, because it felt good to have money.
Meanwhile, in the US, patients came to accept that they were entitled to live without pain, and to do so without having to do anything more than take a pill. On top of that, OxyContin — and after it, heroin — really did take away more than physical pain. People in the Rust Belt who were losing jobs to outsourcing, and who had poor prospects for gainful employment, got hooked on the feeling the drug gave them. One homeless addict tells Quinones that his first heroin high “made him feel like the President of Everything.” The widespread use and abuse of OxyContin corrupted everything it touched. One doctor tells Quinones how the culture of medicine contributed to the corruption by throwing out “ten thousand years of reality” — that is, the knowledge that opiates are extremely addictive — by citing bogus science. Doctors wanted to believe that, not because they were bad people, but because they wanted to heal people’s pain. They convinced themselves that this time, it would be different.
And Purdue Pharma exploited this. It was good for business. And it was only business.
Reading Dreamland, you can see why unemployed former mill workers could fall into this kind of addiction, but it’s harder to see why the kids of the rich do. Quinones shows that the specific motivations may be different, but the basic motivation is the same: wanting relief from the perceived pain of living. For the middle class and the well-off, it’s a matter of boredom, of believing that life should be pleasurable all the time, and that instant gratification is their birthright as Americans.
The book is full of sad stories, but the saddest is the tale of Russian Pentecostals in Portland, Oregon. Massive number of these persecuted Christians emigrated from the Soviet Union to the US, and settled mostly on the West Coast. They were religious, conservative, and strict churchgoers. But their kids went to school with other Americans, and came to see church life as boring and too restrictive. They tried OxyContin, and moved into heroin. Hundreds of these Russian Pentecostal kids became addicts. Their parents did not know what to do. In one family’s case:
Two decades after Anatoly and Nina left the Soviet Union for the freedoms of America, each of their three oldest children was quietly addicted to black tar heroin from Xalisco, Nayarit. … [T]heir American dreamland contained hazards they hadn’t imagined. Remaining Christian in America, where everything was permitted, was harder than maintaining the faith in the Soviet Union where nothing was allowed. Churches were everywhere. But so were distractions and sin: television, sexualized and permissive pop culture, and wealth.
Think of it: these Pentecostals were better off in the USSR than in America, because American freedom led to extreme decadence.
I had no idea how bad this opiate epidemic was. According to statistics from the State of Ohio, which was especially hard-hit, the number of Ohioans who died from drug overdoses from between 2003 and 2008 was fifty percent higher than all the American soldiers who died in the Iraq War. Three times as many people died of prescription pill overdoses between 1999 and 2008 as died in the eight peak years of the crack cocaine epidemic.
And almost all of those pills were legally prescribed, and legally obtained.
One pain specialist tells Quinones:
Cahana believe that what insurance companies reimbursed for distilled many unfortunate values of the country. “We overtest, perform surgery, stick needles; these people are worse off,” he said. “If we work on their nutrition, diet, sleep habits, smoke habits, helping [them] find work — then they improve. You have to be accountable. If you give a treatment that kills people or makes people worse, you gotta stop. You can’t continue making money on stuff that doesn’t work.” Cahana saw “stuff” as the problem. Our reverence for technology blinded us to more holistic solutions. “We got to the moon, invented the Internet. We can do anything. It’s inconceivable to think there are problems that don’t have a technological solution. To go from ‘I can to anything’ to ‘I deserve everything’ is very quick.
“All of a sudden, we can’t go to college without Adderall; you can’t do athletics without testosterone; you can’t have intimacy without Viagra. We’re all the time focused on the stuff and not on the people. …”
In the end, Quinones believes that the loss of community, purpose, social responsibility, and a sense of moral reality have all contributed to this problem. One doctor tells him that morphine is a great metaphor for the way we Americans approach life today:
“The bad effects of morphine act to minimize the use of the drug, which is a good thing. There are people born without pain receptors. [Living without pain] is a horrible thing. They die young because pain is the greatest signaling mechanism we have.”
Lord have mercy. Think of the truth in that. We have worked so hard as a culture to minimize pain, and to train ourselves to think of comfort and pleasure as our birthright, that we have left ourselves and our children vulnerable to this addiction. This false religion of Moralistic Therapeutic Deism is part of the package.
When Russell Moore talks about how it’s as easy to go to hell out of Mayberry as out of Sodom, this is the kind of thing he’s talking about, in part. I talked to a local physician friend of mine, asking him if we had this problem around here. Heroin, not so much, he said, but he said I would be startled by the number of people — respectable people, even older people — who are dealing with a pill addiction — and from pills that no doctor in town prescribed. Addicts find a way, even here in Mayberry.
As far as I can remember, Pope Francis doesn’t once mention drug addiction in Laudato Si, but the forces he talks about in that encyclical all manifest in the story Quinones tells in Dreamland. Everybody should read this book. Everybody. The writer friend who turned me on to it said:
It’s hard to imagine a better metaphor for the destructive power of an culture that has lost its spiritual moorings. When people talk about the BenOp some are terrified of repeating the mistake of the fundamentalist withdrawal. I understand why. I also understand that what Lenin, Stalin, et. al. could not do the Russian Pentecostals in 74 years, American libertine culture came close to pulling off in a few decades, if that long.
Who needs secret policemen when you have the unfiltered Internet? I don’t what the balance is or should be. I know that the Russian Pentecostals are not the only Christian families whose kids were swept up in the epidemic.
Quinones’ book barely if ever mentions religion, but my friend said that reading Dreamland and contemplating the deeper spiritual message in its pages has led him to this conclusion: the question is no longer ‘Do we need the Benedict Option?’ but rather, ‘What form will the Benedict Option take?’
UPDATE: From a reader:
I am living this nightmare right now. One of my children is a heroin addict who quite possibly is on his way to prison for a long time. My other children struggle with other drugs.
I know other families, nice middle class all-american families, who have had children overdose, be imprisoned and die from their drug use. Most of the time, these kids started on marihuana and moved on to pain pills they got from friends. Often, they have untreated emotional or mental issues and they use drugs to avoid the pain.
Nothing can prepare you for the nightmare of parenting a drug addict- particularly if they use heroin. The toll on the family is devastating. Nothing is left untouched. All relationships are poisoned, finances devastated, and marriages are often ruined.
Yet, resources available to addicts and their families are almost non-existent. All the while, in some states, more people are dying from opiate overdoses than car wrecks.
But what about rehab, you ask? A decent rehab typically costs around $25,000-$30,000 for one month of in-patient treatment. And your insurance will NOT pay for it. And only one month of in-patient treatment is usually a waste of time. Heroin addicts typically require 18 months of some level of active treatment, not necessarily at $30k per month, but at a cost most people cannot afford.
Who can do this?
I laughed at the recent national hysteria over the Ebola “crisis”. More kids are dying every day from opiate/heroin overdose than died in the entire Ebola outbreak in the US. Yet, where is the proportionate response?
Constantly grieving for your lost child and wondering if he may die on any given day is pure anguish. And like I said, for the most part, the family is ruined and alone. It’s indescribable.
How I wish we could somehow as a society attack this problem with all the relish we reserve for other, less lethal concerns.
As far as the culture is concerned, I discovered as a parent, that you’re on your own. There’s precious little support for parents trying to teach the values required for a child to navigate the cess pit they must wade through in order to reach maturity in the USA. Everything shouts you down, whether it’s TV, music, politicians, or the schools. And now, I guess the pharmaceutical companies.
UPDATE.2: Mike W. writes:
I was talking with a friend at work who is just bewildered at the kinds of issues his 14-year-old teens are dealing with. His daughter, in particular, has multiple friends in the hospital over failed suicide attempts, other friends who are cutting themselves, someone else who has decided to be gender neutral, and on and on. He lives, by the way, in the suburbs around the Microsoft campus in Redmond, Wa — so we’re talking about kids who are the products of the best that money, power and affluence can buy. He is at a loss of what to do and how to help his daughter. I suggested that he send his daughter to a convent. He thought I was kidding. I wasn’t. These kids have everything and yet they have nothing. No wonder they gravitate towards zombies and end of the world scenarios. There are no hard edges to their existence, no bottom lines, no safe places they can hold fast to, everything is negotiable and open to interpretation, and so they are flailing around, trying to find something solid, and their high functioning uber-educated parents are no help because they’re not doing any better.
So, “Dreamland” is now on my list. I’m still working through Crawford’s new book, and slowly reading “Christ the Eternal Tao,” and finding passage after passage where Crawford and the Ancient Sage and the Way echo one another.