Project Opioid: A Call to Action
The “Opioid Crisis” can be a too-big-to-process, blurry topic. Are we talking about Purdue Pharma and other drug makers pushing pills? Doctors prescribing too loosely and getting patients hooked? People buying and dying from street drugs laced with fentanyl? Young people sharing party drugs?
Yes, yes, yes, and yes. I entitled my book The United States of Opioids not because opioids explain everything, but because they have commanded national attention in a different way than any other drug ever has. They represent a massive, complicated problem: a slow-moving mass casualty event; a public health disaster wrought by our health system; a nightmare in which teenagers go to bed feeling fine and die in their sleep. The waves of overdose deaths across the country, the multi-billion dollar settlement negotiation, the surging demand for addiction treatment, have all forced opioids to the front and center of our consciousness.
But the problem is deeper than just this one class of drugs. One of the central messages of The United States of Opioids is that, while both prescription and street opioids have driven the surge in overdose deaths over the past two decades, the data reveals a much longer 40-year cycle of steadily increasing overdose deaths across all types of drugs. Each time we crack down on one drug, people move to another—and keep dying in ever greater numbers.
This makes the “Overdose Crisis” a better (though less catchy) description than the “Opioid Crisis.” I argue in the book that, when you compare the data on alcohol-related deaths and suicide, along with the rising and profound levels of pain, trauma, and untreated anxiety, depression, and other mental health conditions, the crisis is best described—in the words of Dr. Steve Grinstead, author of Thank You Adversity for Yet Another Test—as a “syndemic”; series of overlapping epidemics that are synergistic with each other. The overdoses and suicides are only the visible outgrowth of a deep well of suffering that has roots in unaddressed trauma, untreated mental health conditions, and a pervasive social crisis of isolation and stress.
Whatever we choose to call this massive problem—and, for simplicity, I am sticking with “Opioid Crisis ”—the more important question is: What are we going to do about it? My argument has been that the shared root causes also mean that we will find common solutions. This is not to say that there are not distinct elements. We need a multi-pronged and comprehensive approach that focuses on reducing the death toll, improving access to treatment, and implementing early intervention and prevention strategies.
One of the most disheartening observations that led me to write The United States of Opioids was the extent to which the discussion over solutions gets nowhere near this bigger conversation. Political leaders, policy experts, and researchers are comfortable talking about narrowly focused steps where we can see immediate improvement, like deploying Narcan, the overdose reversal drug, or offer Medication Assisted Treatment (MAT). These are positive steps and commendable. But they address only opioids.
The conversation about the social crisis tends to make people uncomfortable. It goes to the heart of some difficult questions: to what extent is the profound isolation a byproduct of profound social changes that advanced the value of the “sovereign self” but eroded socially connective (but repressive) institutions like religion, family, community, and culture? To what extent is the wondrous technology of the smartphone undermining the resilience that develops through face-to-face human interaction? What changes could we make that would address these issues? What new skills and resources do we need?
While these are big questions, the reluctance to tackle them makes no sense in the face of a crisis that touches every part of our society, with implications for how we parent, live, educate, and raise children. They also have implications for our law enforcement and policing, the front lines of drug trafficking and accidental and intentional self-harm. They have implications for the American workforce.
As a consequence, it stands to reason that, if we are going to address the crisis comprehensively, we need to think holistically about a “community partnership” model in which we bring visionary leaders from all sectors of our society together to think through the problems and the solutions. We have so much unexplored terrain to address the crisis in the workplace, in schools, and in civic and faith communities. Personally, I have found that the way that I think about and manage my own anxiety and stress has been transformed by the privilege of exploring these issues with researchers, innovative clinicians, and thought leaders who share my preoccupation with these issues.
In October, I had the privilege to give a keynote address to Project Opioid, an initiative launched in Central Florida, that brings together leaders to coordinate a regional response that leverages a community partnership model.
My message there and here is that we stand at a pivotal moment in time. In the coming year, billions of dollars will be paid out in the opioid litigation. Even as we have a long way to go to identify let alone implement solutions, we need to ensure that these resources are not squandered. We need to be thinking about and answering big questions: How will we bring down the death toll from not only prescribed, but illegal opioids? How will we provide access to evidence-based, effective treatment to people who are addicted? What are we going to do to address the 50 million Americans for whom chronic pain is a daily reality? How will we address the social crisis we are living through?
Nothing makes me more hopeful than projects that not only recognize the need to address the crisis in new ways and new settings, along with the urgency to implement practical solutions. We have work to do.
Harry Nelson is the Founder of Nelson Hardiman, the leading law firm in America addressing behavioral health challenges. He is the author of The United States of Opioids: A Prescription for Liberating a Nation in Pain, recent winner of the Spirit Award from Clare-Matrix and the Davis Direction Foundation Prize.