What polite company avoids at our peril

So far, our discourse about the opioid crisis that’s gripping our state and nation has been discussed in strict isolation from the socio-economic conditions that set the stage for this tsunami that shows no sign of ebbing. Invariably, an overdose is framed as the individual succumbing to addiction, but there is a broader societal context that these deaths are occurring in that we ignore at our peril.

US opioid deaths, now well above 59,000 a year, have now overtaken auto crashes and gun related fatalities. The impact is being felt throughout the country but has been most felt in states like Ohio, Michigan. Pennsylvania and West Virginia. Yet in just one year between 2013-14 New Hampshire saw a 75 percent spike while North Dakota saw a 125 percent increase that same year.

This is a wide scale enough national problem that at the end of last year the Centers for Disease Control and Prevention reported that for the first time since 1993 that America’s life expectancy had actually declined. The surge in suicide, alcohol and opioid linked over doses was particularly pronounced for young and middle aged white men. 

According to a study from the University of New Hampshire  Cursey School of Public Policy in 2014 in New Jersey 55.5 percent of deaths of young white male adults  were related to drugs, alcohol and suicide, making it the fifth highest in the nation. 

So often these events are so steeped in societal shame, grief and remorse that the families and friends close to a victim continue to suffer the very same isolation that their lost loved endured before they died. And, thus the cycle continues. 

The public policy conversation has been about better restricting access to opioids and increasing access to drug treatment. But there has been precious little in the way of a broader critical look at what societal circumstances are setting the stage for people to turn to opioids in the first place. 

Perhaps, we are afraid the answers to these self-critical questions could up end our near religious notion that mankind is on an unbending trajectory of progress. From that perch we view those that fall into the abyss of addiction and suicide as a reflection of their own weakness rather than exposing gapping flaws in the broader society. 

Dr. Joseph Fennelly, has practiced medicine in New Jersey for over 50 years and co-chaired the Bio-ethics Committee of the New Jersey Medical Society for over thirty years. He sees the opioid overdose epidemic as the tragic, but logical outgrowth of a multi-faceted crisis that includes how medicine itself is practiced and the steady deterioration of community, family and faith based supports society wide. 

“Let’s start with the nature of what has become of the usual patient/ physician interaction where the doctor has 12 minutes to get the relevant information from the patient and 13 minutes to enter all of that into the computer,” he said during a phone interview. “A patient complains of pain and before you know it they have a five day script for percocet. What’s missing in that whole interaction is the time to sit in a chair across from one and another and figure out does this kid have a predilection to addiction?”

“We also can’t look at these statistics without acknowledging the psycho-social isolation that is happening for more and more Americans,” said Fennelly who added that this isolation is manifesting itself at the same time so many people lack the community, familial or faith based emotional supports that were once common place. 

This unraveling extends, he says, to basic interpersonal interaction between people, when they  chose to engage their iPhones, rather than members of their own family, whose physical company they are in. “You have heard the call that we need to take the iPhones from the kids? What about taking it from the adults?” 

While the spike in overdose deaths for young people  gets much of the media attention, data from the Henry J. Kaiser Foundation shows that here in New Jersey this crisis is hitting all age cohorts.  According to Kaiser, here in our state in 2010 58 people 24 years and younger died from an opioid overdose. In 2015 that number went up to 105. In the 25-34 age cohort over that same five years deaths spike from 71 to 257. For adults ages 35-44 it went from 38 in 2010 to 178 in 2015. For 45 to 54 year olds the rise was equally dramatic spiking from 38 to 2010 to 210 in 2015. New Jersey residents 55 years old and older saw the number of such death go from 29 in 2010 to 118 five years later.

The University of New Hampshire researchers that flagged  alcohol/opioid related deaths and suicide as the leading cause of death for New Jersey’s young white males, saw  economic dislocation and anxiety about the future as a possible contributing factor for the spike.  “Recent academic and journalist work also suggests ties to declining social supports and rising income inequality, economic distress, and instability that followed decades of declines in secure and livable wage jobs for those in the working class,” the researchers wrote. “Although there are political and economic constraints to implementing comprehensive policies that address the underlying causes of high rates of drug, alcohol, and suicide mortality, such policies are likely to provide the best chance for reducing these deaths.”

Official data on opioid deaths and household economic well being both lag by at least a year to two years behind.  According to the 2015 report from New Jersey’s Office of the Medical Examiner  the six top counties with the highest body count were Camden 191, Ocean 157, Essex 146 Monmouth 122, Hudson 107, and Middlesex 106. 

Earlier this year the United Way released its update of its ALICE report which tracks the status of New Jersey’s poor and near poor. The acronym ALICE stands for asset limited, income constrained but employed. The United Way data analysis, which has now been utilized around the country, differs from federal poverty data because it looks at the local cost of essentials like housing, daycare, taxes as well as the actual wages earned by households.

From 2007 to 2014 the United Way found that in Camden County the percentage of families living below poverty or paycheck to paycheck went from 23 percent of all households to 44 percent. In Ocean, which started in 2007 with 39 percent struggling, it went up by just one percent to 40 percent.  Essex County had  36 percent of its households struggling in 2007. By 2014 that was up to 44 percent.

Monmouth in 2007 was in comparatively good shape with just 22 percent of families in financial distress. By 2014 it hit 31 percent. Hudson went from 35 percent in 2007 to 40 percent that were having trouble making ends meet. Middlesex saw a six percent spike from 28 percent in 2007 to 34 percent recent in 2014.

If you are looking at New Jersey’s aggregate economic numbers, like statewide unemployment, your missing the granular reality at the local level where people live or decide to kill themselves. There is a lot of economic dislocation flying below Trenton’s radar that is  defining more and more of New Jersey’s long term realty.    

For Dr. Harriet Fraad, whose New York City mental health practice helps families and individuals cope with job loss and financial reversals, says there is a direct link between the opioid crisis and the ongoing fallout from the Great Recession that the ALICE numbers document.

“This used to be an inner city African-American problem but this is now a consequence of what’s happened across the country where there was never a recovery, where wages did not rebound and good paying jobs with benefits actually became harder to find,” Fraad said in phone interview. “It is a testimony that for many people the hope that the economic setback was just temporary is gone.”

Fraad says that families facing prolonged economic hardship are further isolated because the mass market media fixates on Wall Street, wealth accumulation. and the selling of luxury goods and vacations. 

She continued. “In so many households there is the sense that the children of those families are not going to do better than their parents did and that the stability of a home life as defined by the American Dream is increasingly beyond their grasp.”

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  1. Poverty is certainly a factor, but for the families I personally know, timely treatment access is the key issue. Boils down to finding a bed when a patient needs treatment, not some time later.

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