A memorial in Huntington, West Virginia, the city often portrayed as the epicenter of the opioid crisis.
When it comes to killing people in America, drugs are top guns. Some 64,000 people died of a drug overdose last year. More than were killed in the entire Vietnam War. More than from gun violence and car crashes. More than at the peak of the AIDS epidemic.
The worst offenders are pharmaceutical opiates — dispensed by doctors, not dealers — so widely used that opioid addiction has become the worst epidemic in the nation’s history. When opiate addicts run out of money for pills, they turn to the street. Dirt-cheap and abundantly available, a bag of heroin is comparable in cost to a six-pack of craft beer.
More than 33,000 people died of heroin overdose last year. One of them could easily have been my daughter.
I found your daughter on the street. That’s what the unknown caller on my cell phone told me on New Year’s Eve 2007 — a moment seared into memory as my entry point into a subterranean nightmare world. My brain couldn’t find an image for my beautiful, gifted, college-educated daughter, working as a cook at a 4-star restaurant in the city, on the street somewhere in midtown Manhattan. On the street with what?
The one-word answer: Heroin.
That single word branded a scarlet H on my heart. Shame was my closest companion. Stigma was the leper colony of junkies and their families in which I was sequestered
Since then, epidemic numbers of parents have received some version of The Call, heard the same horrifying word, and entered the same nightmare world. Our children are dying, 100 every day. Those who survive are shooting up in McDonald’s bathrooms, wandering the streets, packing homeless shelters and prisons. Some are begging for detox and treatment that is still largely unavailable.
When there is nothing left for you to want for your child but survival, the world contracts to the size of a room strewed with needles and blackened spoons. A cell phone transmitting her voice — barely recognizable with its heroin slur, begging for money — rips your heart to pieces but, in this topsy-turvy world, is a relief, indicating that she’s still breathing.
I left a 35-year psychotherapy practice and turned all my force to trying to save my child’s life. It took me years to accept that I could take care of her at home, bar her from my house, have the court mandate her into residential treatment, pay for one rehab after another, go to family meetings in Intensive Outpatient Programs, consult Harvard-educated addiction experts, stalk her to keep her in my sights, love her unconditionally — and none of this would stop her from destroying herself.
In the end, she chose to save herself. She’s been clean for two years and is trying to rebuild her life from the ground up. The answer to the question Why? that haunts every mother of an addict is just as mysterious for why she stopped using heroin as why she started.
But I do know this: my daughter’s choice for recovery had something to do with spending time in treatment centers where she was exposed to the idea of seeing herself as someone with a treatable disease. Also, getting herself on methadone and knowing her family wasn’t giving up on her. Perhaps most importantly, finding someone who helped her kick the habit beneath the habit—the habit of thinking that she was irreparably damaged goods.
To make the choice for recovery, she had to get out from under the shame and stigma that kept her in the stranglehold of addiction.
The same is true for me. For years, I saw myself as a Bad Mother and failed human being — I’d raised a junkie. I became adept at re-routing friendly questions about what my girl was up to. I sank into the abyss of secrecy, unable to say the word heroin to anyone but my husband, one friend, and members of groups sworn to confidentiality who shared the same shameful secret.
To break through the stigma, I had to find a way to speak the unspeakable.
Stigma=Death
Heroin deaths quadrupled in the decade between 2002 and 2013 and have risen sharply every year since then. Statistics on overdose deaths tend to be underreported. The chief medical examiner of Milwaukee recently described the volume of autopsies as a “tsunami.”
The corpses are mounting. So many that they have overwhelmed the capacity of officials in many cities to count them and of coroner’s morgues to house them. So many that coroners have started to rely on “mobile morgue trailers,” currently being used for the overflow of the dead in cities in Ohio.
The consensus among experts is that half a million people will die of opioid addiction in the coming decade — a number equivalent to the entire city of Baltimore.
The fact is: we are letting them die because they’re junkies.
Is there a word in the English language that better conveys the essence of stigma than the word junkie?
In Boston, junkies have been confined to their own ghetto—a mile of treeless streets, methadone clinics, homeless shelters, and a treatment center. Methadone Mile belongs to the addicts. They shoot up on the sidewalks, nod out on the benches, walk the streets with the signature slow-motion shuffle of the smack addict. The Mile is what stigma looks like geographically. It’s where my daughter has gone every morning for the past eight years to get her methadone dose, an area she leaves as quickly as possible to avoid meeting up with the dealers. On the Mile, the smell of stigma is palpable and it’s the smell of despair.
I’m old enough to remember gay activists carrying signs saying Silence=Death during the AIDS epidemic. Eventually they got the government and the CDC to pay attention. In the trenches of the opiate epidemic, Stigma=Death. The bigotry that condemned gay men to death — if faggots are dying, they are bringing it on themselves with their disgusting behavior — is the way many people think about junkies.
In the grip of their addiction, drug addicts do reprehensible things. They lie. They steal. They rob their grandmothers. They forge checks and sell their mothers’ jewelry for a few bags of dope. A brain hijacked by heroin will do these things and worse. My daughter was no exception. The only line she drew, one she wouldn’t cross even when completely strung out, was not stealing her sister’s disability money.
But that doesn’t mean that addicts don’t have remorse or are without conscience. Nobody is harder on an addict than the addict. They will not forgive themselves for what they are doing to those they love — which only fortifies the stigma and fuels the addiction.
Stigma is the lynchpin that keeps addiction in place. The toxic core of stigma — shame, secrecy, and silence — guarantees continuous relapse and makes death more likely for the addict because it freezes all possibility of change.
De-stigmatizing and Treating the Disease of Addiction
Addiction is a disease. That’s what the science tells us. But culturally, addiction is still largely viewed as a visible stamp of depravity.
It took Obama almost his entire presidency to cozy up to the idea that addicts deserve treatment. In his last year of office, he put forth a bill recognizing addiction as a public health issue and recommending 1.1 billion dollars in funding for prevention, treatment and recovery. The Congressional allotment of funding for this bill so far? Nada.
Trump weighed in a few weeks ago, declaring the opioid epidemic a public health emergency — again, without a penny to fund disaster relief for addicts. In fact, Trump has done his best to propel the Republican agenda that would drastically reduce Medicaid monies to the states and further decimate the pathetically inadequate funding for treatment, condemning addicts without insurance to sickness without hope. And Attorney General Sessions has re-affirmed the failed policies of the past ‘Drug War’ in which the fundamental approach is incarceration.
Currently, only about 10 percent of addicts make it into treatment while over 50 percent of people in federal prison are there for drug offenses. Any mother of an opiate addict knows that when the addict is ready for treatment and there’s none available, the missed opportunity is tragic. With addiction treatment, readiness is all. Turned away from detox and treatment, addicts are encouraged to give up.
The stigma of addiction comes largely from treating addicts like criminals. We make them pariahs and then use their outlier status as proof that they aren’t like anyone else who needs help.
Junkies are seen as the lowest of the low, basically unredeemable. Shooting up isn’t like drinking Grey Goose martinis or snorting lines of cocaine at high-end parties. Heroin is pumped into collapsed veins in dark rooms full of garbage and bloody needles.
What kind of person would do this? As it turns out, anyone with a genetic predisposition who is at high risk for addiction because of other factors, like chronic pain or trauma. The childhood sex abuse survivor. The teenager who downed oxycontin as a party drug. The injured college athlete who took the standard medication prescribed by a doctor who was encouraged by Purdue Pharma to write scripts for what it claimed was the best ‘non-addictive’ pain-reliever available.
Through the lens of stigma, one line of thought has been: why bother treating heroin addicts when they only relapse after treatment? The reigning approach to drug addiction treatment in this country appears to concur that addicts don’t deserve to be treated unless they are already well enough to renounce the drug they’re addicted to. Most treatment centers insist that those who enter maintain total sobriety or be thrown out. The lung cancer patient who smoked two packs a day for forty years is not told at the hospital door Sorry, no treatment for you because you brought it on yourself and you’re still smoking. The diabetes patient addicted to Entenmann’s chocolate cake is not told to come back for treatment when she’s serious about giving up sugar. The workaholic CEO on his third heart attack is not admonished by his doctor I’ll treat you when you stop working.
The culture that stigmatizes addicts stigmatizes all people with mental illness. Seen as ‘Other,’ it’s easy to ostracize them. But given the demographic sweep of the epidemic, this is getting harder. Addicts are everywhere, in every geographic, racial, gender, ethnic, religious, and economic group. Though they live their lives in extremis, opioid addicts now comprise a vast population of folks familiar to us.
The new face of heroin is young, well-educated, and white. The idea of addiction as a disease has made some cultural headway precisely because we have seen the addicts and they are us.
Breaking the Stigma
Increasingly, it is family members of addicts, particularly mothers, who have been challenging the stigma and breaking the silence about opiate addiction. We are writing our children’s obituaries and openly revealing overdose as the cause. We are supporting one another to speak out without shame in online groups like The Addict’s Mother. We are marching in Washington with groups like Fed Up!, demanding a rational public health policy for addiction and the long-overdue dignity of adequate funding for treatment of this deadly disease.
The culture of treating junkies like dispensable sub-humans is beginning to change. But not enough. Not nearly enough. Perhaps when we stop stigmatizing addicts, we’ll stop letting them die.
From my professional and personal experience, I know that shame isn’t healed in silence. No recovery is possible under stigma’s deadly weight. I write to add my name to the long list of people affected by the opioid epidemic. To attest to the fact that my brave, kind-hearted daughter is no less kind-hearted because she used heroin. I write to say that I’m proud of her, proud of her courage to choose recovery — a mountainous road steeper than anything most of us will ever have to climb. I write to break through the stigma in the culture and in myself. In my small way, I write to reclaim the voices of those silenced by the shame of heroin addiction.
You Too?
If you have a story about addiction and stigma, please contact me through my website so that I can bring your story to light in future blogs: www.miriamgreenspan.com