New county-level data from the CDC highlight the extreme geographic variation in opioid prescription rates, with some areas showing average morphine equivalents per capita 10 times greater than those of less-impacted counties. As seen in the map below, Appalachia appeared to be one giant hot spot. But every state had at least one county with a high per-capita rate of prescribed opioid use.
Do you think that the individual counties with high levels of opioid use were the wealthiest county in their state (say West Chester, in New York?)
If you guessed (wrongly) the wealthiest county, you would be perfectly following disease logic: "Since everyone is equally susceptible, then the wealthiest people are most able to afford the drugs."
In my long, peripatetic career journey, I lectured once at the greatest university center of brain = addiction, Concordia University, in Montreal (home to Roy Wise, the supposed discoverer that rats love cocaine so much they will stimulate their brains, cocaine like, until they die).
When I quizzed this group about how smoking patterns had been changing, one bright-eyed researcher shot his hand up and answered: "richer people smoke more, since prices have risen so much." Correct answer: smoking as a habit has become ensconced among the least well-off, least-educated Americans.
So you think:
So those of you who answered "people are equally susceptible to opioid addiction, and in fact the better-off are worse off since they have more money," believe that the Obama daughters are equally likely to become addicted to people living in Appalachia with generations of social welfare status and family dysfunction?
Why this matters:
Aside from its always being worthwhile to know the truth, since it points to the well-springs of addiction in people's lives rather than to the mythical addictive properties of drugs, the anti-addiction crusade, armed with the truth (if they could accept it) would focus on inequity, social opportunity, people's life situations rather than on drug supplies, which are endless.
One sidelight of CDC opioid report:
Opioid use has, in fact, been declining nationally, while drug-related deaths (incorrectly labelled overdoses) have been skyrocketing, extending even beyond the 2015 data in the CDC's current report.
What you can do at home:
When you join your local opioid crisis group, and someone states the "addiction-is-an-equal-opportunity-destroyer" view, ask questions such as,
My seating in the addiction section of my international flight:
One last tall tale. Returning from London this past Monday, I found myself seated next to a doctor who ran an alternative pain clinic in a poor Virginia county bordering on West Virginia and near Southern Ohio. He vehemently opposed painkiller use, and lashed out at other doctors for prescribing too many of the drugs. (He assumed that I felt the same way when he found out I had been lecturing about addiction in England.)
I finally asked, "Have you had an impact on opioid deaths in your county?"
He looked at me, surprised, "We're a small clinic with under a hundred patients."
I quickly reassured him, "Yes, yours is a valuable mission, to assist any people who want to quit using drugs for their chronic pain."
He responded, "We often have to sell them hard. It's not their natural disposition."
Then he added, "Of course, when we turn people down for pills, they can go anywhere in the streets of the county and find them."
I then moved to sit next to the heavily tattooed woman in the next row to talk about how she got drunk every night to go to sleep. (I told you I was in the addiction section of the aircraft.)
One last reflection:
If people aren't getting pain killers distributed through a licensed provider, but picking their drugs up on the street, are they more or less likely to end up dead? (Hint: the ratio isn't even close, more than 100 to 1.)
Greatest quote on crisis from an American president:
Then-outgoing president Barack Obama (who selected a disease guy to be his drug czar, despite his own contradictory life experiences), delivered after a unanimous decision by American governors to curtail opioid prescriptions:
“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said during his meeting with the governors Monday. “In some cases, addiction is already there.”