Warning: This Drug May Kill You
An HBO Documentary on the Opioid Epidemic, directed by Perri Peltz
Debuts on May 1, 2017 (10 PM, EST)
Review by Lloyd I. Sederer, MD
Who dies from drug overdoses? Teenage and twenty-something youth, children to their parents – the greatest loss a mother and father can try to endure. Parents of children, as well as spouses and siblings. Friends, neighbors and co-workers. 91 every day in the United States, and the numbers continue to grow.
An epidemic of opioid drug use, abuse, dependence, overdoses and death has seized the United States.
Opioids are derivatives of the poppy plant, like opium, morphine and heroin. They are also synthetic drugs like OxyContin, Vicodin, Percocet, and Fentanyl. All target the mu-receptor in our brain (a natural neurotransmission site in us all) and produce pain relief (physical and psychic), a wondrous sense of bliss and peace, and can transport us away from the everyday and mundane. Opioids have a number of side-effects, the most dangerous being that they depress our breathing, producing respiratory arrest and death when too much is consumed – often inadvertently.
In this beautiful and sorrowful HBO documentary, directed by Perri Peltz (a journalist and documentary filmmaker) and produced by Sascha Weiss, we crisscross this country to meet families who represent today’s victims of the opioid epidemic. All the families we see have suffered the loss of a loved one to an opioid overdose, and some still struggle with the disease of addiction, a relapsing disorder, in one of their loved ones. They also are all white, and of middle or better income. White families are representative of how the epidemic, over the past 15 years, has had significantly greater impact on whites as opposed to people of color. The drug epidemic is no longer among the inner city poor and people of color. The epidemic is at all of our doorsteps.
In this film, we learn about the progression that so commonly occurs. A youth (adults too) suffers an injury, undergoes a dental procedure or surgery, has a painful medical condition and is given a sizable quantity of opioid pain pills, more than needed for acute pain yet more than enough to foster tolerance and dependence. The former means needing more to achieve the same effect and the latter means that the person using will experience craving for the drug and the awfulness of withdrawal when blood levels begin to fall. Both can happen in a week or two, with daily use. We see this in the people with addiction in this film; and it is how the great singer/entertainer Prince become first addicted to opioids and, later, died from them.
We meet, for example, two beautiful sisters, one who at about 15 began to have kidney stones, which were treated with opioid pain pills. Soon she was dependent and using great quantities of pills, not for her kidney stones but to achieve intoxication, and later to quiet withdrawal. Her younger sister followed in her footsteps, seeing the initial wonders of the drug effect. 80% of people addicted to heroin in recent years began in the same way, by being prescribed opioid pain pills by their doctors.
After weeks or months, a person dependent may need 20 or more pills a day to get high and prevent withdrawal. Their access to this large quantity of drug is foreclosed, especially today with state prescription drug monitoring programs (PDMPs, or data bases that track which doctor prescribes which medications, and at what doses), which are sensitizing doctors to not so liberally prescribe opioids because the “state” is watching.
With a habit costing hundreds of dollars a day, and increasing difficulty obtaining an opioid, the solution is readily available: a more potent, far cheaper and highly effective opioid called heroin. At first, the mode of administration is snorting. But that too soon wears thin, and the ‘solution’ is the delivery of the heroin by a syringe. A precious, enchanting young girl or boy becomes hooked on heroin, unimaginable in the past and commonplace today.
We meet, as well, the mother of three whose family can afford Betty Ford or a Malibu rehab facility, yet cannot stay clean after 11 admissions. She is found dead of an overdose by two of her teenage sons. The pain is all too palpable. Yet we also see how families can be resilient in the wake of tragedy and enormous grief, by both turning to support and offering support themselves, sometimes in well-organized community programs they develop and sustain. Addiction does not stop with the person using, it consumes every member of a family, and can take over a community.
There is a great deal of scientific evidence of what can work, what can help a person dependent on opioids (or alcohol or other drugs) get clean and sober, and stay that way. We need to decriminalize minor drug possession, and engage the police as allies as we also witness in this film. Doctors need to be far more prudent in their prescribing, and that is now happening throughout this country. Prevention is possible but not by adults trying to scare youth; in fact, instead, youth teaching other youth about not just the dangers of drugs but also skills about how to manage stress and distress, and how to say no to the power of peer pressure. Treatment works, not always right away, and needs to be comprehensive – not a singular reliance on 12-Step programs (like NA and AA). Instead, 12-Step complemented by Cognitive-Behavior Therapy (CBT), which reduces the power of cues to stimulate a person to use; relapse prevention groups; alternatives like sports, exercise, artistic expression, and a variety of mind body activities (like yoga, meditation, mindfulness and slow (Yogic) breathing; and by MAT – Medication Assisted Treatment – agents that reduce craving, block the action of opioids on the mu-receptor, or fill the receptor with safer, legal and more stabilizing agents like buprenorphine (Suboxone) or methadone. We have so much farther to go in this country to adopt the strategies that work, rather than hewing to persistent puritanical, punitive and criminalizing ideologies that don’t.
If you want to understand our country’s opioid epidemic, the one that is rampant in middle-America, watch this film. It will touch your heart and open your mind to appreciating that no one is immune to becoming dependent on these deadly drugs.
Dr. Lloyd Sederer is a psychiatrist and public health doctor. The opinions offered here are entirely his own.
His latest books are Improving Mental Health; Four Secrets in Plain Sight (2017) and Controversies in Mental Health and the Addictions (2017). His book on drugs in America will be published by Scribner in early 2018.