Every day, 91 Americans die from opioid overdose, the CDC reports. From 2000 to 2015, half a million people lost their lives to drugs. In Ohio, they’re are killing so many people that cold storage trailers are being used as morgues. In West Virginia, the annual state fund for families who couldn’t afford funerals ran out by March, the fifth consecutive year it did so. Two questions emerge: why is this plague happening, and why is the deadliest crisis facing the country getting so little attention?

“The terrorist threat families in America see is not in the streets of Aleppo,” said Massachusetts Senator Ed Markey at a recent summit on drug abuse. “It’s fentanyl coming down your street,” he added, referring to the synthetic opioid 50 times stronger than heroin that’s both widely prescribed and available on the black market. “We lose a Vietnam War every single year to drug overdoses,” added Tom Price, the Secretary of Health and Human Services.

The pills are certainly profitable — OxyContin, America’s most popular painkiller, has reportedly made $31 billion in sales since launch. They’re also plentiful: from 2007 to 2012, 780 million pain pills were shipped to West Virginia alone.

What’s frustrating and bewildering is why painkillers, in their prescription and street drug forms, have devastated so many American lives. Margaret Talbot tackles that question in a lengthy new feature for the New Yorker on West Virginia, the state with the most overdoses per person. A huge factor, she says, is “the despair of white people in struggling small towns.”

Judith Feinberg, a drug addiction researcher at the University of West Virginia, describes opioids as the “ultimate escape drugs.” They are a way of not feeling what you feel: “Boredom and a sense of uselessness and inadequacy — these are human failings that lead you to just want to withdraw,” she tells Talbot. “On heroin, you curl up in a corner and blank out the world. It’s an extremely seductive drug for dead-end towns, because it makes the world’s problems go away.” Michael Chalmers, publisher of The Observer newspaper in Jefferson County, West Virginia, added that the desperation in these towns comes from “a social vacancy,” and that “people don’t feel they have a purpose.”

In blue collar communities, identity is largely tied to work, Penn State sociologist Shannon Monnat explained to Thrive Global. “For men who grew up in these communities, where men did physically demanding jobs, there was satisfaction in doing physically difficult work, even if the paychecks weren’t huge,” she says. But now, there’s a collision between what it means to be a masculine in the traditional sense and hold a job in the practical sense. Relatedly, University of Massachusetts sociologist Ofer Sharone has found that while Israelis think the system is flawed when they can’t find a job, Americans see themselves as flawed when they can’t find work. It’s less surprising, given all this, that half of unemployed men in the U.S. are on some sort of painkiller. That desperation has consequences, both in public health and in politics.

According to University of Maryland psychologist Arie Kruglanski, when people feel like their lives are unstable, they’re more attracted to populist leaders who can point to a common enemy they can lay their problems on. In line with that, demographic data suggests that counties that had the most “deaths of despair” — from overdoses, suicides, and liver disease — were most likely to see Donald Trump outperform Mitt Romney from 2012 to 2016. It’s all evidence that when people don’t feel existentially insecure, they’ll turn to substances that make them feel better, or leaders who promise to make their problems go away. This is a public health crisis not only in the medical sense — but in opportunity, identity, purpose and meaning, too.

Originally published at medium.com


  • DRAKE BAER is a deputy editor at Business Insider, where he leads a team of 20+ journalists in covering the shifting nature of organizations, wealth, and demographics in the United States. He has been a senior writer at New York Magazine, a contributing writer at Fast Company, and the director of content for a human resources consultancy. A speaker at the Aspen Ideas Festival and other conferences, he circumnavigated the globe before turning 25. Perception is his second book.