Mark Twain is reputed to have quipped, “Denial ain’t just a river in Egypt.”

The opioid epidemic has its roots in greed, deceit and exploitation. Twenty years ago, Purdue Pharmaceuticals sold the Federal Drug Administration on the notion that OxyContin, the opioid they wanted to sell to an unsuspecting public, was not really that addictive. Following the trail blazed earlier by the Big Pharma companies that sell the anti-depressants and anti-psychotics, Purdue foisted on the FDA a shoddy and soon-disproved study regarding the non-addicting qualities of opioids and persuaded the all-too-willing FDA to grant them the exclusive patent to market OxyContin until 2013.

Purdue then turned to the next group it had to bring on board, the medical doctors most likely to prescribe painkillers, and convinced them – another none-too-difficult feat – that its time-release formulation of the drug made it significantly less addictive than they might ordinarily suspect. Of course, within a few years and after the supply of OxyContin got tight, those addicted to the drug learned they could break down the time-release mechanism by cooking it and diluting it with water so it could be injected.

By 2000, the epidemic was on and people began dying. By 2014, according to the Centers for Disease Control, nearly 29,000 people had died nationwide from opioid overdoses, and the number kept going up. New York state began monitoring the number of opioid prescriptions filled by individual pharmacies with its I-Stop law passed in 2012 and, in a law passed earlier this year, began limiting the actual number of pills that can be prescribed to patients at one any time. Despite a 32 percent reduction in the number of opioid prescriptions being written, New Yorkers continue dying at higher rates.

By 2010, as the supply of OxyContin began to tighten, addicted persons turned to heroin, and when the Drug Enforcement Agency began confiscating large quantities of heroin at the U.S.-Mexican border, opioid users discovered fentanyl, an opioid manufactured in Mexico and China and claimed by researchers to be 50 times more powerful than heroin. From 2008 to 2013, deaths from OxyContin overdoses increased four-fold and heroin/fentanyl overdose deaths three-fold. A more telling illustration is that Staten Island’s annual death rate per 100,000 – 14.2, with 74 deaths in 2014, third highest among New York counties – is expected to double by the end of this year. In the North Country, by 2014, 34 residents per year were dying from opioid overdoses at an annual rate of 7 per 100,000. Both the number of deaths and the death rate are likely to have risen since then.

And what has been state government’s response? To their credit, the governor and the legislature eased access to treatment by adding $189 million to the state’s opioid treatment budget, creating several thousand new treatment slots and opening new opioid addiction treatment centers throughout the state. The latter feature medication assisted treatment (MAT) programs, which utilize suboxone, a combination of buprenorphine, an opioid believed to inhibit drug craving, and naloxone, popularly known as Narcan, an opioid agonist used to prevent opioid overdose deaths. A good start, but an approach reliant on questionable medical practices and one with too many programmatic holes.

Suboxone, for starters, is known to be effective in drug detox, but its use in long-term drug rehab and recovery remains unproven. Further, many opioid addicts in recovery have complained of being obliged to swap one opioid, OxyContin or heroin, for another, buprenorphine. The net outcome is that they remain addicted, which interferes with their ability to work, maintain personal relationships and rejoin their home communities and families as full-fledged members.

Here in the North Country, the state neglected to account for the Adirondacks’ unique geography and widespread population. In an area 200 miles wide, the state located our area’s lone opioid treatment program in Plattsburgh, at the North Country’s northeast rim. Further, there’s only one authorized needle exchange program, also located in Plattsburgh. Needle exchanges are key to preventing outbreaks of HIV and hepatitis. They’re also essential to outreach since addicted persons rarely volunteer for treatment. With the overdose rate so high and going higher, outreach is crucial if those addicted are to be engaged and the epidemic’s spread checked. The state’s plan contains no money for outreach. It also has no money for jobs – real jobs – or stable housing, each of which is essential for addicted persons’ rehab and reintegration back into the community.

Where is the money to come from to fund and establish effective rehab programs? New York state alone does not have deep enough pockets to pay for them. The cash-rich Drug Enforcement Agency, with a 2017 budget of $30 billion, earmarks most of its monies for law enforcement and only 46 percent for treatment, more than half of which goes to criminal justice not community-based programs. This past June, Congress passed a much-ballyhooed law allocating $400 million over four years to law enforcement, a coals-to-Newcastle remedy since U.S. law enforcement agencies already receive generous DEA funding for policing and armaments. In July, a treatment-oriented bill was passed by both houses but has stalled in the joint congressional reconciliation process as Democrats and Republicans squabble over funding. House Republicans are sticking to the $500 million contained in the House bill while Senate Democrats are advocating for the $1 billion requested by the president.

How to break this logjam? In such circumstances, I always turn to the wisdom of Joe Hill, the old IWW organizer, whose dying words were said to be, “Don’t mourn, organize.” Translated into practice, they mean that the epidemic’s biggest stakeholders – the persons opioid-addicted, their families and their families’ friends and supporters – have to come together, talk, plan and advocate for needed change and resources. They have to organize. Ironically, families are invariably excluded when these issues are discussed in the venues of power. Families are even excluded from all aspects of their addicted family members’ treatment.

There are no family advocacy organizations in the North Country to promote an opioid treatment agenda. One is sorely needed to untap the wisdom and ideas for effective solutions that families and addicted persons in recovery have accumulated over many years of pain and suffering. Organizing and confronting the barriers blocking change will help families and persons in recovery come to grips with and appreciate the power they have in their hands.

And I’ll make you an offer. I’ll make myself available to come and talk with any group of Adirondack residents that wants to initiate the discussion I’m suggesting. If you’d like additional information about me and how to reach me, and about the issues I’ve been raising, visit my website, www.paddlingupstream.org, and take a look at the article I wrote a month or so ago which contains a thorough analysis of the epidemic – its causes and possible remedies: “America & Addiction: From the War on Drugs to the Opioid Epidemic.” The direct link is www.paddlingupstream.org/america-addiction-a-primer-from-the-war-on-drugs-to-the-opioid-epidemic.

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Jack Carney, DSW (Doctor of Social Work), lives in Long Lake.

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Suggested Readings:

Hari, Johann, “Chasing the Scream: The First and Last Days of the War on Drugs,” 2015

Hinton, Elizabeth, “From the War on Poverty to the War on Crime: The Making of Mass Incarceration in America,” 2016

Junger, Sebastian, “Tribes: On Homecoming and Belonging,” 2016

Szalavitz, Maia, “Unbroken Brain: A Revolutionary New Way of Understanding Addiction,” 2016