We've traced the etiology of America's opioid epidemic to the erosion of economic and social status of workers over several decades, with resultant diminution of dignity and hope.
This has created the vulnerability into which opportunistic pharmaceutical companies could foster a solution to the problem of psychological loss-induced pain that led to the crisis.
The solution to the crisis does not permit or exist in short-term fixes -- the law-and-order measures of the war on drugs. We are not going to arrest ourselves out of the problem and punitive policing drives the problem under ground -- for many, literally.
It was that attitude of an immediate answer that brought us here, as people in pain sought relief and it was offered in the form of a pill or a shot.
Now, faced with the many who are addicted we are forced to administer treatment which, if it is to be effective, will require much in the way of resources and a commitment to the long term.
It will also require a change in direction of treatment to include more than the individual addicted person but also their family and community. A big ask but a necessary one.
As in any epidemic, the most effective method is prevention. We need to use data accumulated through the social media to focus our efforts on those likely to be affected before they are.
As the final common pathway to opioids is the request to medical professionals for pain relief, we need to provide them with the means to treat that pain effectively without opioids.
To deal with pain we need a broad approach, one encompassing movement rather than stasis, and the range of such methods from yoga to mindfulness, massage and physical rehabilitation and altered temperature baths, and diet. For medication as an accessory, without creating further damage, muscle relaxants, anti-inflammatory meds, anti-depressants, and medical cannabis.
The time for medical cannabis has arrived. It's effectiveness in alleviating pain and psychic distress in illness is well known. Less known is its specific place in the preventive aspects of the opioid crisis.
Since 2011, three major academic studies -- one from the military-funded Rand Corporation -- have shown that in the several states which enacted medical cannabis, the rate of opioid-related deaths fell by anywhere from 16 per cent to 34 per cent.
Anti-cannabis campaigners have for years made the false claim that pot is a "gateway drug" leading users to move on to harder drugs. The new data suggests that cannabis does act like a "gateway drug" -- only in the opposite direction. As its use closes the door to the opioids.
The long-term solutions lie with the politics of restructuring economic and social factors that made the epidemic possible in the first place, something that will take decades and considerable courage and thought on the part of politicians (things seldom exhibited in that profession).
In the United States, the present temporary occupant of the White House calls for aggressive police action.
His attorney-general, eager to comply, lost his own former admiration for the KKK when he discovered the sheeted ones used pot, "because no good person would do that".
Here in New Zealand, we already have the beginnings of the crisis in our increasing inequality of opportunity and widening disparity of haves and have-littles.
Our current political groups have emphasised growth of cities over the economic wellbeing of the rural regions. The result -- in addition to actual gridlock -- is the growth of homelessness (the canary in the coal mine of social dissolution) and burgeoning desperation.
Add to that that New Zealand and the US are the only two countries permitting direct advertising to consumers of pharmaceuticals, and you're nearly there.
Two billboards are the bookends of this story.
One stands in Lawrence, Massachusetts, a post-industrial city, 30 miles from an epicentre of opioid use. It reads: "States that legalized marijuana had 25 per cent fewer opioid-related deaths."
The other appeared near Wellington's Basin Reserve in 2003 in response to the falsified basis for the US invasion of Iraq.
It was a Tui advert. One square read: "American intelligence"; the other read: "Yeah, right!"
Jay Kuten
Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.
