Governments around the globe and their citizens routinely respond to ecological disasters. Think Exxon Valdez or Love Canal in the U.S.; Chernobyl in the Soviet Union; Bhopal in India; and far too many others. The responses, though not always immediate or thorough, at least tend to be multifaceted. We are currently in the midst of a human-made ecological disaster, the opioid crisis, that isn’t recognized as such, but that can benefit from the same sorts of responses made to ecological disasters.
Like an oil spill, the opioid disaster is emerging from the saturation of the environment with a single family of substances. Like a tornado or typhoon, it crosses state and international boundaries with abandon, whether that’s the shipment of synthetic opioids from China or global marketing of opioids by multinational pharmaceutical corporations. Like a chemical or radioactive spill, its impact will persist through generations, in the thousands of children who must live with the repercussions of neonatal abstinence syndrome and the growing number of grandparents caring for grandchildren after the overdose deaths of their own children.
Treating the opioid epidemic as an ecological disaster could set important precedents for cleanup and prevention that can be particularly useful in areas where effective responses have been lagging. Such efforts are relatively easy to visualize when the disaster is a pollutant like mercury. But what does a cleanup look like when the offending substance is, for some people, a medically essential resource?
Close to 2 million Americans live with opioid use disorder. Twenty-five times that number, or about 50 million Americans, live each day with chronic pain. Despite studies that question opioids’ effectiveness in treating chronic pain, anecdotal evidence from these individuals and their doctors strongly supports the view that opioids are essential for helping some people live with and manage their pain effectively. That is certainly true for me.
The dual nature of opioids as licit medications and illicit street drugs makes “cleanup” a challenge. Simply choking off the supply or restricting access, which may already be underway, would endanger people living with chronic pain. Even so, containment is still possible for the opioid disaster. There is a big difference between a legitimately prescribed opioid medication given to a patient in chronic pain and a shipment of fentanyl FedEx’d into the U.S., a difference that is lost when focus is on restricting access to opioids above all else. Blocking access to honestly and ethically prescribed opioid medications will not save lives; shutting down opioid “pill mills” and access to illegal opioids will. To provide a fair and effective response to the opioid disaster, law enforcement and medical governing bodies need to recognize and better act on this difference.
Perhaps the most important effect of viewing the opioid crisis as a multigenerational ecological disaster is that it offers a series of useful guidelines. In the litigation against BP after the Deepwater Horizon oil spill, for example, we saw corporate accountability. Although steps toward corporate accountability for the opioid disaster are now underway in some states, where litigation is being pursued against opioid manufacturers, we should support a broader understanding of accountability, one that holds drug makers responsible for developing new, non-opioid treatments for acute and chronic pain.
In nearly all ecological disasters, government-backed relief programs are ramped up at local, state, and national levels. Emergency management signals that everyone, from the federal government and local councils to individual families, should be prepared. For the opioid disaster, that means stronger initiatives to educate Americans about the hazards of illicit opioids and the availability of existing resources, such as medication-assisted treatment, and also equipping communities with the tools they need to address the epidemic as they see it and live through it. Responses can range from easier access to overdose-reversal medications and support groups to in-community job training programs for people in recovery.
The opioid disaster is occurring simultaneously on so many levels and affecting so many lives in ways that other disasters may not. It can be viewed through many different lenses. I see the opioid disaster as an individual living with chronic pain who depends on opioid medications to manage each day. But I also acknowledge and suffer with members of my community who are experiencing substance abuse themselves, or are in recovery from it, or who have lost family members or friends to opioid overdoses.
Even now, nearly 30 years after the Exxon Valdez struck a reef and spilled nearly 11 million gallons of crude oil into Prince William Sound, some of that oil persists in Alaskan soil and water, breaking down minutely year by year. The opioid disaster will continue to saturate our environment for the near future, but it should not need to take three decades for us to break it down.
Maia Dolphin-Krute is a writer and artist based in Boston. Her most recent book is “Opioids: Addiction, Narrative, Freedom” (Punctum Books, October 2018).