Recovering from the opioid addiction crisis: Time for progressive strategies?

In this April 5, 2019, file photo, containers depicting OxyContin prescription pill bottles lie on the ground in front of the Department of Health and Human Services' headquarters in Washington as protesters demonstrate against the FDA's opioid prescription drug approval practices. | Patrick Semansky / AP

A major effort is underway in court rooms across the continent to prosecute Big Pharma companies that have irresponsibly promoted some of the medicines that have fueled the opioid epidemic and resulted in harm and death for many vulnerable people, such as OxyContin. Cases have been brought by more than 2,000 states, counties, municipalities, and Native American governments against Purdue Pharma and other opioid companies. On Sept. 16, Purdue Pharma, maker of OxyContin, filed for bankruptcy as part of its plan to settle litigation with dozens of states and and other plaintiffs who say the company fueled the opioid crisis.

Going after the corporate giants who are pushing doctors to prescribe more and more of these drugs is a positive development, but it won’t end the problem. North America is clearly in the middle of a severe addiction crisis. What is presently lacking, though, is a coherent approach to what can be done to prevent so many of us from dying. In 2018, for example, a reported 47,590 people died from opioid overdoses in the United States and another 4,460 in Canada.

Even though there are varied reasons why so many people die from addictions, predominant addiction and treatment models have, until recently, remained entrenched in approaches coming out of the 1930s.

Early psychological experiments used a caged rat that had the choice of drinking regular water or drug-laced water. In example after example, the rat chose the drugged water; often, it would die after becoming “hooked” on drugs. Based on these experiments, drug laws focused on the notion that drugs were “bad” and had to be stopped. This led to continued drug prohibition with severe criminal sanctions for users and sellers. Strict policing and corrections were seen as part of the (failed) “war on drugs.”

Approaches based on recovery from addiction were based on similar notions. The work of 12 step-based recovery organizations is well known. Alcoholics Anonymous, and other programs based on it, such as Narcotics Anonymous and Cocaine Anonymous, were started in the U.S. in the early to mid-1930s. Their goal is total abstinence for members, who are taught that recovery can begin once the drink or drug is put down. AA and the other fellowships have their advantages: membership is free, friendships and support can be easily built, and role-modelling can be very supportive. Membership and successes can be celebrated, and the recovering person can obtain some pride and satisfaction in a job well done and in success at recovery.

The potential problem with the 12-step approach is in the general philosophy of the “problem and the solution.” A quote from the Big Book, the basic text for Alcoholics Anonymous, reads:

“I need to concentrate not so much on what needs to be changed in the world as on what needs to be changed in me and in my attitudes.”

This small quote is significant, as it is often repeated in celebratory meetings when a recovering person reaches a milestone, such as a year of sobriety. The recovering person is taught that it is not society (or class exploitation or alienation or oppression), but rather their own adaptation to society that needs to change for recovery to be successful.

Is there an alternative to the war on drugs? Is there a new way to stay clean?

Newer rat studies have challenged the earlier ones. The problem with a rat in a cage that has two choices of beverage is that the rat doesn’t have much choice or freedom. The newer studies, referred to as “Rat Park,” provide the rat could have choice or freedom with a whole room to live in. The rat can choose to eat cheese, dig tunnels, interact with other rats, hide on its own, and so on. Rat Park also includes the water tube and the drugged water tube; but no rat has become dependent on the drug water. The rats all drink the drugs, and maybe even come back for another helping, but the big difference is that none of them developed a drug problem.

Are there approaches to recovery that take “Rat Park” into consideration?

For many years, Portugal had one of the worst drug problems in Europe. Several years ago, a decision was made to legalize all drugs. Money from enforcement and corrections was redirected to drug treatment and rehabilitation. Today, drug use in Portugal has declined significantly. Drug users can now get the help they need, if they want it, to thrive and move away from negativity in their life.

The “Harm Reduction” public health strategy has many adherents. Instead of having people die from addictions, governments can provide services like safe injection sites, needle exchanges, HIV and Hepatitis screening. Harm Reduction is person-centered, based on the notion that we can reduce the harm drugs can do so long as we put our fellow human first.

While many people find that 12-step recovery or “Rational Recovery” programs work for them, we need to develop a more progressive strategy for addiction and recovery. Such a strategy needs to be user-specific and based on notions of empowerment, love, and care for drug users, whether they choose to abstain or not (or not yet). Substance abuse care needs to be based on theories of social transformation and assistance to overcome experiences of alienation at the heart of capitalist society.

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CONTRIBUTOR

Brian W. Major

Brian Major has worked in the field of community mental health and addictions for 15 years, being clean and sober himself for over 23 years. Brian is a member of the Communist Party of Canada in Barrie, Ontario.