What happened in Ohio, Kentucky, and West Virginia was not an isolated incident—and those outside peering in on rural Appalachia need to take off their judgmental hats. In 2017, President Donald Trump declared the opioid epidemic a national public health emergency.
Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones (published in 2015 by Bloomsbury Press) is a reminder etched in paper and in our memories about the history of the catastrophic opioid epidemic that devastated Portsmouth, Ohio (a town in Scioto County and southern Appalachia Ohio) and other rural and urban towns in Appalachia Ohio as well as across the plains of America. Quinones’ book provides a timeline and explains the progression of events that lead to the opioid addiction crisis.
“Dreamland, the three-pronged story of how heroin addiction became epidemic in small-town America,” summarized the author. Quinones’ book has won numerous awards. Visit www.samquinones.com/books/dreamland/.
And we need to reread Quinones account often; lest the cycle of ruinous addiction is repeated. The philosopher and poet, George Santayana, proclaimed, “Those who cannot remember the past are condemned to repeat it.”
The press has labeled prescription opioids and heroin as “twin addictions” because 3 out of 4 new heroin users reported they abused prescription painkillers prior to black tar heroin.
The Food and Drug Administration (FDA) approved Oxycontin in 1995; a drug almost chemically identical to heroin. Purdue Pharma, based in Stamford, Connecticut, owned the patent to Oxycontin (oxycodone controlled-release) medication that allowed dosing every 12 hours instead of every 4 to 6 hours. Visit www.fda.gov/Drugs/.
Quinones examines and tries to explain the causes of the epidemic as he interviews a gamut of individuals: both abusing and recovering addicted people, the drug dealers, the doctors, the prosecutors, and the parents. He goes back to the opium poppy fields to the manufacturers in Mexico to drug rings to drug dealers. Dreamland also tells the stories of survivors. There is help, hope, and healing, but it takes individual, family, community, state, and national perseverance.
Nonetheless, history tells of the psychedelic drug-using counterculture in the 60s; the heroin crisis in the 70’s; and the crack calamity in the 90’s. But, history’s warning was not heeded.
Janis Joplin, Jim Morrison, Jimi Hendrix, and many other celebrities have died from drug overdoses. Elvis Presley died in 1977, and it was reported the underlying cause was addiction to codeine, Valium, morphine, Demerol, amphetamine and Phenobarbital. In her book, Elvis and Me, Priscilla notes the use of prescription drugs from the fist time she visited him in America.
John Belushi and Whitney Houston died from cocaine-related overdoses. So the rich and famous as well as the poor and unknown die from addictions.
According to The Drug Enforcement Administration (DEA) “During the 1980s there was a tremendous increase in the clandestine production of controlled substances, particularly methamphetamine.” Law enforcement starting shutting down meth labs. When ephedrine became regulated, meth cookers and traffickers turned to pseudoephedrin. Visit www.dea.gov/.
However, when we go way back, history tells us the earliest cultivation of opium poppies comes from Mesopotamia around 3,400 B.C. Visit www.history.com and read more about the opiates of yesteryear.
In 1908, President Teddy Roosevelt appointed Hamilton Wright, a doctor from Ohio, as the nation’s first Opium Commissioner. “The habit has this nation in its grip to an astonishing extent,” Roosevelt told the New York Times in 1911 in regard to opiates. President Donald Trump declared the opioid epidemic a national public health emergency in 2017.
What is different about the recent opioid-heroin crisis? Unlike previous drug epidemics, this one witnessed more abusers and more deaths from overdosing and the users lived in nice communities in small towns instead of slums and drug houses, according to the news media. Again I write what George Santayana proclaimed, “Those who cannot remember the past are condemned to repeat it.”
Is the current opioid-heroin crisis so different from the past? In my opinion, this topic needs more exploration and discussion.
Back to Dreamland. Quinones notes that OxyContin “has legitimate medical uses, and has assuaged the pain of many Americans, for whom life would otherwise be torture.” I can agree by my experience of providing mental health counseling piece for several Workers’ Compensation individuals from accidents and injuries at worksites; hard-working people who desperately wanted to return to work but chronic permanent pain would not allow it.
Is the prescribing of mega opiates by licensed physicians for patients with legitimate pain and without legitimate pain what makes this current epidemic different? Or is it the mixture of fentanyl with the heroin that increases accidental overdoses. Or is it greedy drug companies? Or is it the place you live? Or lack of jobs?
Or an increase in drug cartels, drug trafficking, and dealers? Or is it because humans want a mood-altering drug because they do not know how to manage emotional pain, distressful events, and being in relationships with each other? Perhaps multiple factors came together to create the “perfect opiate-heroin storm.”
Many years ago when I worked as a clinical director and licensed independent chemical dependency counselor (LICDC-S) for two chemical dependency treatment centers in Ohio, I found that drug addiction can accompany clinical depression, severe anxiety, and other diagnosable disorders as well as a history of childhood sexual abuse. According to
Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2014 National Survey on Drug Use and Health, “20.2 million adults (8.4%) had a substance use disorder. Of these, 7.9 million people had both a mental disorder and substance use disorder, also known as co-occurring mental and substance use disorders.” Visit www.samhsa.gov/disorders. So, when we look for causes or precursors of opioid addiction, co-occurring mental and substance use disorders need a place at the discussion table.
Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones is an eye-opening book that needs further discussion in Appalachia as well as the nation. Again I write what George Santayana proclaimed, “Those who cannot remember the past are condemned to repeat it.”
Melissa Martin, Ph.D, is an author, columnist, educator, and therapist. She resides in Scioto County, Ohio. www.melissamartinchildrensauthor.com.