When recent headlines marked a spike in drug overdoses for white, middle-class Americans, the news saddened but did not surprise Deacon Timothy Flanigan, an HIV specialist at Brown University medical school in Providence, R.I.
Beyond the classroom, Flanigan has directed the HIV care program at the Rhode Island state prison for two decades. He knows better than most Americans that no group is immune from the ravages of drug addiction and that controversial medical protocols for treating pain have brought this scourge to bedrock communities as well as inner-city neighborhoods.
“Many of my old patients have died of drug overdoses,” said Deacon Flanigan, a physician and a professor of medicine and of health services, policy and practice at Brown’s Warren Alpert Medical School.
“Opioid addiction is very common in Rhode Island, where more young persons die of opioid addiction than car accidents,” Dr. Flanigan told the Register, as he somberly recounted a story of one patient who was slated to speak at an international AIDS conference but was found dead in a dumpster a week before the event.
“She died of a drug overdose, like so many other people who are abandoned in alleyways to die alone. It is so tragic for the patients and their families.”
That haunting story is hardly an isolated case. The nation is struggling with a new wave of drug addiction that is hitting all sectors of society, but especially young whites.
While drug abuse has plagued poor urban areas for decades, this new development has been partly fueled by prescription painkillers, like OxyContin, that pack highly addictive opioids.
The prescription drugs are used to treat acute and chronic pain, and when patients become addicted, they may eventually switch to street heroin, which is less expensive and easier to secure, at least for the young.
Deacon Flanigan confirmed that the recent surge in overdoses among young whites have been linked to controversial medical guidelines that called for a more aggressive approach to treating both acute and chronic pain.
In 2013, the Food and Drug Administration reacted to the increase in deaths from drug overdoses by announcing new guidelines that restricted prescriptions for OxyContin and similar drugs.
While these drugs had been recommended for patients with “moderate to severe” pain, the FDA now stipulates that they should be “reserved” for patients “for whom alternative treatment options are ineffective, not tolerated or would be otherwise inadequate to provide sufficient management of pain.”
The news of the spate of drug overdoses among the middle class has helped to spark a reassessment of federal policies that sent many drug offenders to prison, rather than into treatment programs. Meanwhile, proposed federal legislation, like the Comprehensive Addiction and Recovery Act, seeks to broaden and promote access to drug-treatment services
It may be too soon to say whether the FDA’s tougher guidelines will have an impact on medical practices, but the surge of white deaths caused by drug overdoses has yet to abate.
“Death rates for black and Hispanic adults have fallen since 1999, but have increased for whites, particularly women and young adults. The rise in deaths has been largely driven by drug overdoses,” stated a Jan. 16 article in The New York Times that summarized the paper’s analysis of 60 million death certificates collected by the Centers for Disease Control and Prevention between 1999 and 2014.
“For young non-Hispanic whites, the death rate from accidental poisoning — which is mostly drug overdoses — rose to 30 per 100,000 from six over the years 1999 to 2014, and the suicide rate rose to 19.5 per 100,000 from 15,” the article also noted.
Different From the ’70s
Andrew Kolodny, a senior scientist at the Heller School for Social Policy and Management at Brandeis University, contrasted the heroin epidemic of the 1970s with the present crisis.
“The previous crisis affected poor, non-white communities,” Kolodny told the Register.
“Users started very young and put a needle in their arms to inject the drug. Typically, they were juvenile delinquents, and it was part of the culture.”
Kolodny also serves as the chief medical officer for Phoenix House Foundation, which offers a therapeutic community model for treating drug and alcohol addiction. And he noted that decades earlier Phoenix House was “focused on working with folks who had no structure in their lives” and suffered from the failing schools in their community.
“Today, when you look at young people who are heroin users, they [did not start off as] juvenile delinquents. They were the star of the sports team; they were headed to college.”
Kolodny places much of blame for the present surge in drug addiction on physicians overprescribing painkillers like OxyContin, a practice that began more than a decade ago.
Many patients who are prescribed OxyContin don’t realize the drug is an opioid. And that means, according to Kolodny, its effect on the brain is virtually indistinguishable from heroin.
“If you repeatedly use a highly addictive drug, you can easily get addicted, especially if you are young,” he said.
Asked to explain why prescription painkillers have had a greater impact on young whites, Kolodny argued that many physicians had accepted societal stereotypes that presented minority groups as more likely to become drug addicted, so the medical community was more cautious about prescribing such drugs to black and Hispanic patients.
But while some patients get hooked on drugs prescribed to address legitimate medical needs, others develop an addiction by experimenting with painkillers shared by their friends or bought on the black market.
Cheryl Chou, 31, a graduate of a small Jesuit college, was given painkillers by her roommate. Struggling with unresolved issues of childhood abandonment and abuse, the high-achieving student found the medication helped to anesthetize her emotions.
“I had broken up with a boyfriend because he was using weed. But my roommate told me, ‘OxyContin is not illegal — doctors give it to you when you get your teeth pulled,’” Chou told the Register.
Within three months, Chou was stealing from her roommate’s stash of painkillers.
“The moment I found my drug of choice I felt instant relief. I was no longer terrified all the time and didn’t worry about what people thought of me.
“I checked out: No problems were running through my head.”
The drug use continued after Chou started her accounting job, and, over time, she headed on a downward spiral, as she began experimenting with other drugs. Visits to emergency rooms, stints in drug-rehabilitation programs, job loss, suicide attempts and homelessness followed.
The lowest point came when the young woman found herself “sitting outside of the police department, hoping God would have someone arrest me.
“I realized this would be the rest of my life — burning bridges every day and starting over the following day.”
Her prayer was answered: Chou was arrested and eventually served time in Marin County Jail north of San Francisco.
In 2014, she got her life back on track after she was released from Marin County Jail and was accepted to Catherine Center, a restorative-justice program for women like her who have served time for drug convictions and related offenses. Sponsored by St. Vincent de Paul Society of San Mateo, Calif., in alliance with the Sisters of Mercy West Midwest, Catherine Center takes no government funds so it can provide a comprehensive faith-based program for women who face daunting challenges as they prepare to re-enter society and commit to staying clean and sober.
Over the past year and a half, Chou has participated in a 12-step program, made restitution, received counseling and taken part in structured spiritual reflection and prayer. More recently, she has mentored new arrivals to the program, as she holds a job and hones the skills she will need this fall, when she begins a program to earn a master's degree in business administration. But she believes the spiritual transformation she has undergone at Catherine Center, where she learned to hand over to God all the anxieties that have shadowed her life, is equally important.
People dealing with addiction need “constant help and accompaniment to help them remember that God loves them. They will encounter suffering, but they don’t walk alone,” Lorraine Moriarty, the executive director of St. Vincent de Paul Society of San Mateo, told the Register.
As Moriarty sees it, the recent epidemic of drug addiction can only be partly explained by the overuse of addictive painkillers. Other factors include a plague of loneliness and social isolation and the furious “pace” of modern life that fosters deep anxiety and leads some to treat emotional wounds with drugs.
Sociologists who have researched the broader social context of the nation’s new drug crisis confirm Moriarty’s judgment.
“Stressors such as poverty, divorce and economic insecurity are playing a role in people’s response” to the seductive appeal of drug use, Mark Hayward, a professor of sociology at the University of Texas at Austin, told the Register.
As economic changes erode manufacturing jobs that once supported an entire family, the sharp rise in mortality rates for whites underscore the fact that in recent years “this group has lost more than other groups in society,” said Haywood, yet their struggles have received little attention.
Whites who do not finish high school are much more likely to die from a drug overdose than college graduates, according to data published in this month’s New York Times story. But this same demographic, the influential sociologist and best-selling author Charles Murray has pointed out earlier, is also less likely to marry, attend church or take part in other forms of civic engagement, and that leaves them more vulnerable to the ravages of drug addiction.
“The breakdown of the family and declining rates of marriage today disproportionately impacts lower-income individuals and those with less education,” agreed Dr. Aaron Kheriaty, a psychiatrist at the University of California-Irvine Medical Center, who noted the intertwined rise in drug overdoses and suicides.
Kheriaty is a Catholic and has worked closely with the Diocese of Orange on mental-health initiatives. So when asked for suggestions on how local parishes should respond to the crisis, he pointed to “the corporal and spiritual works of mercy that have always had a central place in Catholic life.”
A Catholic Response
Back in Providence, Deacon Flanigan identifies another factor that breeds drug dependency in 21st-century America: a culture of consumerism that encourages people to believe they have a right to “feel good.”
“There is an existential crisis in our culture: We see this more clearly among our youth, but it affects all ages. I am speaking as a doctor and a deacon,” he said.
“Society is so good at promoting consumerism, and we are told, ‘Do what makes you feel good.’ And it really does feel good to go shopping and get a hotshot car and have a really great alcoholic drink.”
Yet the “false promise” of consumerism, he noted, leads people away from the path of a challenging, but ultimately fulfilling, life rooted in self-sacrifice for the sake of loved ones and to sustain the common good.
His words echo Pope Francis’ critique of the West’s “throwaway culture” and his call for the Church to be a “field hospital” for sinners.
Thus, while experts seek further restrictions on the use of drugs like OxyContin, and Catholic agencies work to expand access to treatment programs, Flanigan also wants to see more parishes acknowledge the reality of drug abuse and offer 12-step programs for Catholics and others in the community.
If the Church admits there is a problem, he suggested, it will encourage individuals and families who often struggle alone, too filled with shame to ask for help.
“The clientele for your 12-step meeting may not be the same as the clientele for your parish finance committee — though there may be overlap, and you don’t know it,” he said.
“We need to address the reality of drug addiction and tell those who are dealing with it that we are there to help them get the help they need.”