Trump’s Opioid Response Ignores Real Solutions
President Trump has declared the opioid crisis a public health emergency, but his ‘Just Say No’-like approach ignores the roots of addiction and proven ways to address it, says best-selling author Johann Hari
AARON MATÉ: It’s The Real News. I’m Aaron Maté. Two months after saying he would take action President Trump has declared the opioid overdose crisis a public health emergency.
DONALD TRUMP: Beyond the shocking death toll, the terrible measure of the opioid crisis includes the families ripped apart and for many communities, a generation of lost potential and opportunity. This epidemic is a national health emergency. We cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction.
AARON MATÉ: Trump’s decision falls short of what his own commission recommended in August. The commission said a national emergency should be called, which would have freed up new federal resources. Instead, Trump’s designation only authorizes the use of existing resources.
Over 59,000 Americans died of opioid overdoses in 2016 and this year is on pace to top that record. Johann Hari is author of the best-selling book, Chasing the Scream, The First and Last Days of the War on Drugs. Johann, welcome. I guess my first question is, if Trump is not allocating new resources for this crisis, then is he really doing anything at all?
JOHANN HARI: If you want to understand Donald Trump’s approach towards addiction, look at what he did to his own brother. He talked today about his brother, Fred Trump, Jr., who was such a severe alcoholic, he drank himself to death in his 30s. It’s a tragic and awful case. Donald Trump’s response to his brother’s severe addiction was to take his brother’s widow and disabled baby to court to cut them out of the family estate.
Trump’s response to the nation’s addiction crisis is quite similar. It’s very disturbing. If you look through what he’s said, it’s really a catalog of errors, things that have been tried, things that are reported on in great detail for Chasing the Scream, and we know the results. “Just say no” is one of his approaches. We know what happens. There was a major study of the DARE program, the one which taught kids to just say no. The kids who went through it were slightly more likely to use drugs than the kids who hadn’t.
He says that the solution is to block supply from Mexico and build the wall. You will have noticed there are prisons in the United States which have walls around them. I’ve been in a lot of those prisons. You can get drugs in every damn one of them. If you can’t even keep drugs out of a small walled perimeter, it’s a good luck with a 3,000-mile border with Mexico, strained with racism.
The core problem here is that Trump and, I’m afraid, the wider American culture, is misunderstanding why this crisis is happening and therefore, we’re not finding the right solutions. This crisis is not happening because drugs are available. Very powerful intoxicants have been available every day the United States has existed. The reason there is a very severe crisis right now is because there’s an enormous amount of pain in the United States. Go the places I’ve been to where the crisis is worse, like Monadnock in New Hampshire or Cleveland, Ohio, and you’ll see this immediately. There’s a really interesting parallel, I think, and I’ve spent half my year in the U.S. but I’m in Britain at the moment. And in the history of this city, London, there’s a really important parallel that tells you what’s going on with the opioid crisis.
In the 18th century, huge numbers of people in Britain were driven out of the countryside into these disgusting urban slums. It was the birth of industrialization. They lost everything that gave their lives meaning. They lost their communities, they lost the kind of work they’d done, they lost their sense of themselves. What happened was something called the gin craze. It was an outbreak of mass alcoholism. It really did happen, there’s a famous painting from the time of a woman drinking a bottle of gin while her baby falls out a window. There really was this crisis.
At the time, what people said is what Donald Trump said today. Look at this evil drug, gin. Look at how it destroys people. If only we could get rid of this evil drug, then everything would be okay.
AARON MATÉ As you say, Trump’s policies are going to be hurting the very communities that voted for him, where this crisis has exploded. Let me ask you, though, even if we understand that, as you say, at the heart of addiction is pain, is a loss of connection, how do we apply that to policy?
JOHANN HARI: When you go to look at the plate, there’s nothing abstract about this answer to this question, which is exactly the right question to be asking. I’ve been to the places that have done it. I’ll give you an example. Switzerland had a massive opioid crisis in the 1990s. People might remember horrendous scenes from Switzerland of people in a mass outbreak of quite extreme heroin use, often in public. Catastrophe, they tried lots of different things and they solved that crisis. I’ve reported on it in depth. I’m also a Swiss citizen, as well as, obviously as you can tell from my voice, British depth.
Ruth Dreifuss, the President of Switzerland, explained to people, when you hear the word legalization, what you picture is like anarchy and chaos. What we have now is anarchy and chaos. We have unknown criminals selling unknown chemicals to unknown drug users, all in the dark, all filled with violence, disease and chaos. What she did is, she legalized heroin in a way that is radically different to what happens in the United States with prescription opioids or illegal heroin.
The way it works is, if you’ve got an opioid addiction, you’re assigned to a clinic. You go to that clinic, I went to the one in Geneva, you turn up at 7:00 o’clock in the morning, because Swiss people believe in doing things early. You turn up, you’re given your heroin or opioid there. You can’t take it out with you, you’ve got to use it there, a nurse will watch you. Then you leave to go your therapy and your job, because they give you really extensive care, psychological support, subsidized housing, subsidized work to really deal with the problem that was making you want to anesthetize yourself all the the time in the first place.
Think about this, because you want to contrast it with what’s happening in the U.S. at the moment. There are two prongs. The first prong is, give the person the drug. The second prong is really deal psychologically and environmentally with the reasons why they were using it in the first place. One of the things that fascinated me when I went to this clinic is you can stay on that program as long you want. There is never any pressure to cut back, and they will give you any dose you want, apart from a fatal one.
It really surprised me because I thought surely everyone will just stay on it forever, then. I spoke the psychiatrist there, Rita Mange, who explained to me. I said to her, why? In fact, she explained to me that there was virtually nobody who was still in the program ten years on who’d been on it at the start. Almost everyone chooses to cut back and stop over time. I said to her, “Why is that?” She said, “Well, because we look after them and their lives get better. Then as their lives get better, they don’t want to be anesthetized so much.”
Now contrast that to what’s happening in the U.S. and, I have to say, cheered on not just by Trump, but actually by a lot of people on our side who are good and decent people, who are really misunderstanding this crisis and actually recommending policies that are going to cause even more harm. What happens in the U.S. is, if your doctor is prescribing to you and your doctor realizes that you’re using not because of physical pain but because of psychological pain, your doctor is required by law to cut you off. That is a legal requirement, or they can go to prison as a drug dealer, which has happened to many doctors.
Then you’re on your own in an environment where it’s extremely expensive to buy these prescription drugs on the black market, whereas heroin is quite cheap for reasons I’m happy to explain if you want. What we get is you’re transferred, far from getting the support you get in Switzerland, you’re actually transferred into a criminal market where you become a criminal. Actually, you face imprisonment, stigmatization, punishment. We’re doing the exact opposite of the policy that worked in reducing opioid crisis.
If you want to know the results in Switzerland, just look at them. Do you know how many people have died of overdoses on the legal heroin program in Switzerland? The answer is zero, literally nobody. There remains an illegal market. It’s much smaller, very few people die in that, far fewer than died before the legalization. Switzerland is a very conservative country. My grandmother got the vote in 1974. This is not San Francisco. Yet, when they had a referendum on this program, once people had seen it in practice, they actually, there was an enormous support for it, 70 percent of Swiss people voted to keep opioids legal for precisely that reason.
AARON MATÉ: Why do you think we keep, as a society, rejecting the solutions that work? I wonder if you have any thoughts on the psychological dynamics at work in stigmatizing addicts, and as refusing to see them as people in pain?
JOHANN HARI: I think there’s kind of two parts to the answer to what you’re saying. One is the answer which I’m sure everyone watching The Real News Network knows, which is about the vested interests in the prison industrial complex and DEA and all of those people. That’s all very real. I’m not underestimating that for a moment. That’s a really significant part of the resistance to change.
There’s another factor, which is harder to talk about, which is, even though I know everything I just said to you and I believe it very deeply, with the people I love who have addictions, a lot of the time I’m really angry. I try not to act on that anger, it certainly doesn’t inform my how I think we should respond. I think it’s kind of natural if you’re looking at someone who’s got an addiction problem, I think about one of my relatives who has a child who I love very much, there’s a part of you that thinks, I don’t think it’s unnatural to think someone should just stop you, but I do think we can see the results. I’ve been to the societies that act on the approach which is someone should just stop you.
In Arizona, I went out on a chain gang with women who were made to wear T-shirts that said, “I was a drug addict” by that psychopath Joe Arpaio, who was pardoned by Trump for some of his other crimes. These women are humiliated and destroyed and, of course, when they leave prison, sometimes people say, “Oh, that doesn’t work in stopping addiction?” It’s much worse than that. That makes their addiction worse because it makes their pain and trauma deeper. I’ve been to the places that have tried that, I’ve seen the results. You will have noticed from looking out the window, in the United States the addiction crisis is massively growing. I’ve been to the places that acted on that other impulse. Just like we all have an angry impulse, I think almost all of us have a, clearly Trump is not one of them given how he treated his own brother, but almost all of us have a loving and compassionate response as well. I’ve been to the places that acted on those loving and compassionate responses.
Think about Portugal. In the year 2000, Portugal had one of the biggest heroin problems in the world. One percent of the population was addicted to heroin. Every year they tried the American way more and more and every year the problem got worse, until finally, they set up a scientific panel led by a wonderful man I got to know, called Dr. Joao Goulao, and the panel to solve the problem. The panel said decriminalize all drugs from cannabis to crack, but, and this is the crucial next step, take all the money we currently spend on screwing people lives up, and spend it instead of turning their lives around.
What they did is, they repurposed all that money for a program of meaning creation. Say you used to be a mechanic, they go to a garage and they’ll say, if you employ this guy for a year, we’ll pay half his wages. They set up a big program with micro-loans so people with addiction problems could set up and run businesses where they were their own bosses. Again, the results are super clear. Injecting drug use is down by 50% in Portugal, 5-0 percent. Virtually nobody in Portugal wants to go back.
At some point, we have to look at the evidence. The thing that worries me about the opioid crisis, there are many things that worry me about the opioid crisis, but one thing is the response of our side. People you and I admire, people who are natural allies, most people know, most people on our side of politics and actually, most Americans now would know, that the Nancy Reagan script about, say, the crack epidemic, was nonsense. Blame the drug dealer, say that it’s the fault of the people selling the drug, and just, if only we could stop the people selling the drugs, the problem would go away. Most people know that was a ridiculously simplistic and nonsensical way of thinking about the crack epidemic. But look at what our side is saying about the opioid crisis.
What they’re saying is, evil drug dealers, in this case, Big Pharma, who there are legitimate criticisms of and I’m critical of many other things, but evil drug dealers have caused this crisis and we need to stop the evil drug dealers from doing it. It’s really the return of a Reaganite script, just kind of repurposed. I hate Big Pharma as much as anyone. This crisis is not happening because of Big Pharma. Look at when the crisis ticks up. It ticks up in 2008. Is there anyone watching this program that can’t think of anything that happened in 2008? A lot more Americans were in a lot more distress.
At some point we have to look at, go to the places where the opioid crisis is highest. They’re also the places where the suicide crisis is highest, where the alcoholism crisis is highest. Actually, and this is a difficult thing to say, Marianne Faithfull, a lot of people will know. She was a rock star, had a heroin problem. In her memoir, she says this very challenging thing about heroin addiction. She says, at the point she was homeless, she says, “Heroin saved my life, because if it wasn’t the heroin, I would have killed myself.” She’s not saying that heroin is the solution, it’s clearly not.
It’s obvious to everyone it brings its own dangers and its own problems, but there’s a really important thing to understand. I spoke to a doctor in Oklahoma called Dr. Hal Vorse, who was very good on this. What happens is, if you just throw people who are addicted off of their prescription, what happens is some of them will go and get heroin on the streets and they’re far more likely to die, because street heroin is much more contaminated and heroin is any way more potent. Some of them will just kill themselves and some of them will just have terrible lives of really deep psychological pain.
The wider solution, and this can sound very big, but this is a big crisis so we should be talking about big solutions. The wider solution is to build a society people want to be present in, where we value people, where people’s psychological needs are met. There are such societies in the world. They have very low levels of addiction. The United States has, at various points in its history, been a society like that for a lot of people, not everyone.
What we’ve got to be doing is looking at the, Bruce Alexander, who did a great experiment and it taught us a lot about addiction, I’m happy to talk about if you want, said we talk all the time in addition about individual recovery, and that has real value, but we need to talk much more about social recovery. Something has gone wrong with us, not just as individuals, but as a group. It’s not just that the people of Monadnock in New Hampshire just happen to be mysteriously all malfunctioning at the same time, whereas people in a nice part of Vermont are not. We’ve got to understand the deep social causes of this pain. This is partly what my, a book I’ve written that’s out in January, it’s called Lost Connections, it’s all about this deeper social understanding of the crises we’re facing.
AARON MATÉ: Johann Hari, we have to leave it there. Just to spell out that 2008 reference for anybody who missed it, that was when the financial crisis hit around the world. Johann, I can’t wait to talk to you about your upcoming book, Lost Connections, which is about depression, right?
JOHANN HARI: Yeah, it’s about the deep malaise that’s happening in our culture, which is manifesting in all sorts of different ways, depression, anxiety, addiction, Trump, and what the real causes of this crisis are and how we can actually begin to solve them.
AARON MATÉ: Johann Hari is author of the best-selling book, Chasing the Scream, The First and Last Days of the War on Drugs. Johann, thank you and thank you for joining us on The Real News.