“FRONTLINE investigates America’s heroin crisis in a searing two-hour special that premieres Tuesday, February 23,” trumpeted PBS. I saw the show’s producer on MSNBC’s Morning Joe, where everyone amen-ed the importance of Frontline’s heroin panic portrayal.
Unfortunately, every single major principle presented by Frontline was false, and adherence to them will likely cause more addiction and drug deaths.
I’ll limit myself to a half-dozen of the dangerous shibboleths they purveyed:
1. “Widespread use of narcotics automatically means greater addiction rates.”
Opiate use was near-universal in the 19th century, with no recognition that such drug use was particularly addictive. No one can read Virginia Berridge’s Opium and the People and think about narcotic addiction the same way again. Nineteenth-century Brits used opiates daily—gave them to babies—with none of the appearance of what we today would label “addiction.” Berridge’s book is the antidote to the American vision of the same phenomenon, David Courtwright’s Dark Paradise, which—myopically viewing the same period through contemporary lenses—says millions of 19th-century Americans were addicted to narcotics, only they didn’t know it. If only they were as smart as we are!
2. “Painkiller use should be feared because it leads to heroin addiction.”
Painkiller addiction and poisoning deaths hit record levels along with heroin addiction and poisoning deaths in 2014, according to CDC data and analyses. People addicted to painkillers are 40 times more likely to be addicted simultaneously to heroin. So it’s simply not true that painkiller use and addiction, on the one hand, leads downstream to heroin addiction, on the other. And what does it matter whether people are addicted to one versus the other? Being addicted to either is awful—heroin addiction is not inherently worse.
(Remember, the drug involved in Chris Christie’s viral video about the horror of drug addiction—in which his law school friend gave up his job, his family and, ultimately, his life—was Percocet.)
3. “We are just realizing that we give out painkillers too freely.”
Americans have feared painkiller prescriptions, along with all opioid use, since the beginning of the last century. US medicine is famous for underutilization of analgesics, both in hospitals and outside of them, leading to periodic reports like the Institute of Medicine’s—headlined in Influence columnist Maia Szalavitz’s Time article as “Chronic, Undertreated Pain Affects 116 Million Americans.”
Thus the US was slow to introduce self-regulated narcotic titration in hospitals, which leads to uniformly less painkiller use by patients. And, of course, fear of painkillers led to restrictive prescribing practices…which are now recognized as a major cause of the surge in heroin use!
Yet now comes the bipartisan effort to impose greater restrictions on painkiller prescriptions. Great: Let’s do more of what got us here in the first place!
One politician, albeit one no longer facing re-election, sensibly rejects these proposals. Not everyone is totally crazed. Barack Obama rejects the plan, because:
“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said during his meeting with the governors Monday. “In some cases, addiction is already there.”
Unfortunately Obama is leaving office before he can implement such a sound understanding (one which has not been evident in his administration’s drug policies to date).
We grow too soon old and too late smart.
4. “Heroin overdose is the primary source of drug deaths.”
As I have been noting for decades, and as Influence contributor Kenneth Anderson has recently taken up, heroin overdose is a myth—a dangerous one. The CDC now refers to narcotic-related deaths as drug poisonings. Hardly anyone dies from taking too much heroin alone.
The ratio of a fatal to a normal dose of heroin is almost 75-to-1. Heroin purity has been declining just as poisoning deaths have been increasing in the US. New York City, which has the best data on such deaths, finds that over 90% involve use of multiple depressant substances, including tranquilizers and alcohol along with painkillers and/or heroin. Telling people not to take pure narcotics increases their likelihood of using other drugs to “take the edge off,” which leads to more deaths.
5. “People can’t control their narcotics use.”
Every profile of narcotics users shows that they regulate their intake of drugs. As I recently pointed out in The Influence, a Super Bowl ad ran for opioid-based constipation—because tens of millions of Americans take prescription opioids and an estimated eight million suffer constipation as a result, although very few become addicted.
Nearly every one of us has used powerful narcotic painkillers. The reason we don’t believe these drugs are really addictive (like heroin) is because we ceased taking them when our pain ceased—the usual course of events.
But heroin is little different in the inconstancy of its use. In 2014, 1.8% of Americans had used heroin in their lifetimes. In the past month, 0.2% had done so. In other words, a little over a tenth of lifetime heroin users have used the drug in the past month.
6. “We must focus on narcotics to avoid addiction.”
As always, focusing on a specific drug causes us to take our eye off of the ball of addiction in all its forms. So we now read alarmist accounts of tranquilizer deaths, which are likewise at record levels, and which comprise about a third of all drug poisonings.
Why are we unaware of them? “With public attention focused primarily on opioid painkillers,” a Times piece posits, “the role of anti-anxiety drugs ‘fell under the radar’.”
So how would you keep your own children from becoming addicted if, say, they broke a leg, or had their appendix removed, or had a wisdom tooth extracted and required a painkiller prescription?
Of course, it is valuable to be mindful of what pain is about and how to relieve it, along with potential dangers from painkilling drugs. But the single best antidote to addiction is that your kids have enough concern for themselves, appreciation for keeping a clear mind, and purpose in life that they will instantly reject continued narcotic use as being inconsistent with who they are—as I describe in Addiction-Proof Your Child.
Instead of misleading people about the inherent danger and addictiveness of heroin, and secondarily painkillers, we need to tell everyone, even children, that opioid use—like masturbation—has been ubiquitous throughout history: everyone does it; and, in itself, it is not a dangerous practice.
Rather, we should provide for them and expect them to adopt, which nearly all do, the life options that make addiction unlikely.
Stanton Peele is a columnist for The Influence. He has been at the cutting-edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has since written numerous other books and developed the online Life Process Program. His latest book, with Ilse Thompson, is Recover!: An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life. His website is Peele.net. Dr. Peele has won career achievement awards from the Rutgers Center of Alcohol Studies and the Drug Policy Alliance. You can follow him on Twitter: @