Barbara Andraka-Christou - The Opioid Fix: Americas Addiction Crisis and the Solution They Dont Want You to Have

THE OPIOID FIX

2020 Johns Hopkins University Press

All rights reserved. Published 2020

Printed in the United States of America on acid-free paper

9 8 7 6 5 4 3 2 1

Johns Hopkins University Press

2715 North Charles Street

Baltimore, Maryland 21218-4363

www.press.jhu.edu

Library of Congress Cataloging-in-Publication Data

Names: Andraka-Christou, Barbara, 1988 author.

Title: The opioid fix : Americas addiction crisis and the solution they dont want you to have / Barbara Andraka-Christou.

Description: Baltimore : Johns Hopkins University Press, 2020. | Includes bibliographical references and index.

Identifiers: LCCN 2019028033 | ISBN 9781421437651 (hardcover ; alk. paper) | ISBN 9781421437668 (ebook)

Subjects: MESH: Opioid-Related Disordersdrug therapy | Opiate Substitution Treatment | Health Policy | Opioid-Related Disordersepidemiology | United Statesepidemiology

Classification: LCC RC568.O45 | NLM WM 284 | DDC 362.29/3dc23

LC record available at https://lccn.loc.gov/2019028033

A catalog record for this book is available from the British Library.

Special discounts are available for bulk purchases of this book. For more information, please contact Special Sales at .

Johns Hopkins University Press uses environmentally friendly book materials, including recycled text paper that is composed of at least 30 percent post-consumer waste, whenever possible.

To the dozens of courageous people recovering from opioid addiction who have shared their stories with me

And to my husband, Alex, who has supported all my dreams

The best time to plant a tree was 20 years ago.

The second-best time is now.

CHINESE PROVERB

THE OPIOID FIX

DO YOU THINK YOU CAN handle the whole story? Or do you want the PG version? Jackson asked me over the phone.

Just tell me as much or as little as you feel comfortable sharing, I responded.

By now I have heard many gritty stories of opioid addiction, which is the compulsive use of opioids despite negative consequences. For the past three years I have spent a significant portion of my time interviewing people in recovery, their families, health care providers, criminal justice system employees, and policy makers. I have conducted more than 120 in-depth interviews and analyzed hundreds of hours of interview transcripts. Not to mention the numerous informal discussions with concerned people, ranging from police officers to twelve-step group leaders to other public health researchers like me.

I wish I could say that the story Jackson went on to tell me was an anomalythat few Americans experience the kind of early childhood trauma he faced prior to regularly misusing drugs. But according to a world-famous series of studies on adverse childhood experiences,

From a scientific standpoint, the relationship between adverse childhood experiences and addiction is unsurprising for two reasons. First, adverse childhood events may cause mental illness, such as post-traumatic stress disorder, anxiety disorder, or depression, and people with mental illness may self-medicate with drugs,

For many people, drugs become a coping mechanism for post-traumatic stress disorder or depression. Others experience opioid addiction after repeated exposure to prescription pain medications, such as oxycodone or hydrocodone, following an injury. The latter is called iatrogenic addiction, meaning caused by medical treatment. In the past two decades, the number of opioid prescriptions written by physicians quadrupled for conditions such as chronic pain. This increase reflected a response to unethical marketing by pharmaceutical companies and pressure from the US government to alleviate

The United States is facing a health crisis in which more than 115 Americans die daily from opioid overdoses, Prescription pain medications, opium, heroin, and fentanyl are all opioids and affect the brain in essentially the same way.

Despite the medias focus on upper-middle-class families exposed to Oxycontin following an injury, most people whom I have interviewed come from a lower socioeconomic background, often with parents struggling with their own addiction, unemployment, or mental health issues. Opioid addiction is often called an equal opportunity problem because it can affect anyone of any background. According to the National Institute on Drug Abuse, however, such terminology obscures the fact that the hardest hit populations have been those from lower socioeconomic backgrounds as well as people in rural areas, such as Appalachia. Combine such social disparity with untreated mental health disorders and an influx of opioids and youve got a full-blown public health crisis.

Regardless of how addiction starts, the National Institute on Drug Abuse and other scientific institutions call opioid addiction a biopsychosocial brain disease.Many other less stigmatized chronic diseases likewise result from these factors, including diabetes, depression, chronic hypertension, and asthma.

Jacksons story is one of the more harrowing ones Ive heard. It really starts with his mothers story, as do many narratives of multigenerational drug addiction. Jacksons mother, Kelly, was a victim of incest, repeatedly raped by her father in a small Midwestern town in 1970s America, a time when police preferred to look the other way and stay out of family matters. At the age of fifteen, she gave birth to Jackson. By then she was already using crack cocaine.

When she was pregnant with Jackson, Kelly moved in with her boyfriend, though the relationship was neither healthy nor stable. The boyfriend also used crack cocaine, along with alcohol and marijuana. Jacksons first memory of drugs was at the age of three. His mom was throwing a party in their rundown apartment. Lines of cocaine lay ready for snorting on the living room coffee table. Seeking refuge, Jackson climbed over passed-out bodies on the living room floor to reach his mother. Kelly grabbed him and forced a marijuana joint in his mouth, clamping his nose with her fingers, while her friends looked on and laughed at the three-year-old getting high. Jacksons mother then poured an entire bottle of beer into his mouth, with more laughter ensuing. Its not hard to understand why Jackson was regularly smoking marijuana and drinking by the age of seven.

When he was six years old, Jackson was raped for the first time. It was his next-door neighbor, who was also his babysitter. Kelly found her son sobbing later that evening. After Jackson told her what the neighbor had done, she marched over to the neighbors house demanding an explanation and an apology. She got what she wanted, and the neighbor promised to never rape Jackson again. The next time Jacksons mother went out and needed a babysitter, she hired the same neighbor.

By the age of ten, Jackson was so neglected that the states Department of Child Services took him away and placed him with a foster family. That family was okaystable but not particularly kind toward the melancholy boy who would sometimes start shaking for no reason. But as often happens to foster children, Jackson was eventually sent to a new family. This family had a blond man who asked Jackson to call him Dad. Then, like the old next-door neighbor, Dad proceeded to regularly sexually assault Jackson. So, Jackson ran away.

By fifteen, Jacksons home consisted of homeless shelters or friends sofas. He was also using every drug he could get his hands on. He had never been to a counselor, let alone a dentist. He hated his life, regularly skipped school, and felt miserable. More than once he thought of killing himself. Arguably, the best thing that ever happened to him was when his girlfriend, Diana, got pregnant at the age of seventeen.