Flashback, 2007: Absence of outrage, and our collective unwillingness to treat addiction:

Introduction: With over 60,000 drug overdose deaths estimated to have occurred in 2016, at least 19,000 of which involved fentanyl, it may seem odd to remark that this is not the first time we have had a run of fentanyl deaths. It is also not the first time we have seen a public response that continues to foot-drag on delivering the addiction treatment that so many need, and that recent reports (as of 12/2017) suggest will not be forthcoming. Why not? What would it take to do better?

I want to share something I wrote in 2006, and submitted to newspaper and broadcast venues for the next year, and which was uniformly rejected. It was my attempt to understand why no one seemed to care about a bunch of drug users dying. We should not not ignore their fate, I argued. Does my assessment of our passivity resonate today?

At the time, in 2006 and 2007 “bad heroin” (i.e. fentanyl-contaminated heroin) caused a run of overdose deaths, in batches. First it was 150, then 250, then 600. By the end, the CDC estimated a little over 1000 deaths transpired over two years.

What troubled me was why no one was willing to stand up and express anger on behalf of Americans dying from a treatable problem. Today we are faced with many more overdoses and a much larger problem. There is greater interest in addiction across the US. And I remain worried that when it comes to offering real care for addiction, we are falling grievously short.

The article below is the version I sent to the New York Times but I sent nearly identical pieces to almost every newspaper in the country, and many radio programs. Perhaps it was poorly written. But perhaps those rejections accurately captured precisely what I was trying to describe, an “absence of outrage.”

Absence of Outrage (February 5, 2007):

What 500 Quiet Deaths Teach Us About the Nation’s Drug Problem

The deaths began in October of last year, first in Detroit, then other places like Camden, Philadelphia and New York, and from modest towns like Tamaqua, Pennsylvania and Kalamazoo, Michigan. Sometimes they occur in gruesome clusters, as many as 12 in one day in Detroit. The killing agent is heroin laced with fentanyl, a lethal combination that has appeared in drug markets across the country. A few months ago the estimated toll was 250 lives. More recently that figure doubled to 500, a fact buried on page A19 of the New York Times (8/30/06).

Five hundred is 10 times the number who lost their lives at a Kentucky airport accident on August 27. Five hundred is 55 times the number who lost their lives from poisoned Tylenol in 1982, an event that occasioned outrage and front-page coverage across the country. Five hundred Americans have rarely died with so little public attention.

The obvious question is this: why are these 500 deaths not really news at all?

Two widespread misperceptions about substance abuse explain our collective lack of outrage. Both stymie national progress on substance abuse:

First, as with anything that appears both frightening and inexplicable, there’s a temptation to regard addiction tragedies as befalling only others. The facts say otherwise. In 2004, 22.5 million Americans abused or were dependent on alcohol or drugs. A Gallup/USA Today survey found that 20% of Americans report having family member with addiction problems, a figure that creeps above 50% in more rigorous national surveys.

Second, popular notions of addiction ascribe culpability to the drug user (who breaks the law) and even the uncontrolled drinker (who doesn’t), in ways that are not extended to persons struggling with heart disease or diabetes. But the differences between addiction and other chronic health conditions are not so vast. Most chronic ailments, from diabetes to drug abuse, reflect the impact of behavioral choices in the context of environment and genetics.

People remain, as always, responsible for their choices. What one ingests, be it a donut or a hit of cocaine, affects health. But why should we be more sympathetic to a former President with a heart attack (and a fast food problem) than to a Congressional Representative with a drug problem? Where behavioral choices are relevant to both, assigning differential culpability to the addicted person is rooted more in prejudice than in science.

Addiction deaths are particularly tragic because many are preventable through treatment. For heroin addiction, noneuphoric substitutes like methadone reduce drug use, criminal activity, and mortality. A few years ago, the commercial drug Suboxone was approved for the treatment of heroin addiction. Now even the federal government is concerned that too few people are getting it. For alcohol, new medications (like Vivitrex, which is just now hitting the market), behavioral treatment, and groups like Alcoholics Anonymous are beneficial.

Effective treatment should be available to all who need it. Sadly the nation has not risen to this challenge. National survey data show that fewer than 1 in 5 substance abusers obtain treatment, a figure that’s worrisomely low.

Many factors help to account for why individuals don’t seek formal help for addiction. Some people may not need treatment, and achieve positive change on their own. Others are unready, perhaps in denial. Still others are shy of the stigma associated with “rehab,” or are unable to handle its financial costs.

Addiction certainly needs to be destigmatized. With several new addiction treatment drugs now on the market, advertisers for the pharmaceutical industry should take a leading role. Consider how many Americans stopped “denying” their need for depression care after seeing those smiling, tribble-like neurotransmitters on television, brought to you by Zoloft. The lack of similar promotions for drugs like Vivitrex and Suboxone suggests surprising shyness on Madison Avenue. Is addiction an even bigger taboo than genital herpes and erectile dysfunction?

Aside from stigma, the cost of treatment poses a challenge. Health insurers tend to offer only short-term coverage, often through subcontractors whose incentives are to limit care. Unsurprisingly, addiction is one of the few domains where private health insurers now spend less per patient than they did a decade ago.

Neither stigma nor cost, however, are insurmountable barriers to progress on addiction. Our greatest stumbling block remains a national reluctance to speak with outrage, and with love, about the lives that have been lost.

Note: this is the version I sent to the New York Times on February 5, 2007. I sent it to roughly 20 outlets, sometimes multiple times to the same outlet with subtle edits and corrections. None took it.