Wednesday, February 24, 2016

Frontline: “Chasing Heroin” (WGBH/PBS-TV, aired February 23, 2016)

by Mark Gabrish Conlan • Copyright © 2016 by Mark Gabrish Conlan • All rights reserved

My “feature” last night was a two-hour Frontline special, “Chasing Heroin,” based on an epidemic of heroin abuse that has grown to such proportions it has even made the Presidential campaign (it’s been mentioned in the Republican and Democratic Presidential debates, from which this show features clips of Carly Fiorina, Chris Christie — remember them? — and Hillary Clinton discussing it). Written, produced and directed by Marcela Gaviria, and narrated in the usual comforting tones of Will Lyman (PBS’s go-to narrator when he isn’t doing BMW commercials), “Chasing Heroin” is a peculiarly schizoid show. The first half is a relatively conventional exposé documentary about how Purdue Pharmaceuticals, the inventor of Oxycontin (its root drug, oxycodone, is not new but they patented a time-release version that they claimed would make it more difficult to become addicted), marketed the drug with a big-time campaign that told doctors they were undermedicating people with severe cancers and other diseases that caused chronic pain. A large part of that was due to the U.S.’s “War on Drugs” mentality and the belief that even people who were terminally ill shouldn’t be put on opioid pain medications for fear that they would become addicts. So under the lash of Purdue’s ad campaign (including a video filmed with a doctor who’s since had second thoughts), prescriptions for Oxycontin, Vicodin and other easily abused painkillers went up. Then people started noticing that folks were offing themselves on these drugs, and even when they weren’t O.D.’ing they were buying or selling pills on an illegal black market and “doctor-shopping” (seeing more than one physician at once) to get more of these drugs, while some doctors were setting up “pain mills” in which prescribing opioids had become their main business and source of income. So, partly because as expensive as pharmaceutical drugs are in the U.S. they cost even more when you have to get them illegally; partly because the Mexican drug cartels were looking for new markets and finding them in the nice white suburbanites who had become addicted to opioid pills; and partly because the “hard stuff” was actually cheaper and had lost much of its stigma, many people who’d become opioid addicts through pain pills turned instead to illegal but easily obtainable heroin.

The result was that heroin has leaped out of the communities of color that are the first people most Americans think of as being vulnerable to illegal drugs (never mind that in the real world whites are just as likely per capita, if not more so, to become drug abusers) and not only into white communities, but white suburban communities whose members (the ones who weren’t using, anyway) had long thought of their towns as safe havens from all the evils of the inner city, including drugs. The second half of the show dealt with a pioneering program in Seattle (our friend Garry Hobbs, who lives there, watched the first hour and 15 minutes of the program with us and recognized a lot of the locations; he also noticed that he’s personally seen discarded needles in areas where none existed just two years ago) called LEAD (which stands for Law Enforcement Assisted Diversion), whose mantra is harm reduction. Specifically, under LEAD the cops involve social workers who not only assist addicts in finding treatment programs and other kinds of help (including housing, since a lot of drug users end up on the streets) but are willing to work with them even if they’re still using, knowing that you can’t expect a heroin addict to quit cold turkey until they actually are admitted to treatment and can detox and go through withdrawal with professional help. What’s more, the treatment can include methadone, suboxone, buprenorphine or some other opioid substitute drug — the cops and staff of LEAD aren’t insisting that people live a totally drug-free life — even though methadone treatments are hard to come by because there’s been a lot of NIMBY’ism towards where they’re located, which means a lot of people on methadone have to start their day by driving (or having someone drive them) three or four hours just to get to the treatment center. (Federal law prohibits doctors from simply prescribing methadone for use at home; if you’re on it, you have to get it at a licensed clinic so professional staff can see you’re taking it and not abusing it or taking it off premises to sell it — which may be why it’s generally dispensed as a liquid, much like those old vending machines that sold soda by dropping a paper cup into place and then automatically pouring soda into it.)

We follow three people in the LEAD program: Johnny Bousquet, who used to be a successful music producer in Seattle until he got hooked first on pills and then heroin following his breakup with his wife (and his addiction has meant he hasn’t been allowed to see their kids in years), ultimately ending up on the streets; Cari Creasia, a heavy-set, black-haired suburban wife and mother who got hooked on pills, eventually started using heroin, and ended up in a filthy drug den where she and 20 other people slept in a small house and lived in squalor; and Kristina Block, a 20-year-old who’s been on heroin for about three years, makes $1,000 a week (which is considerably better than I’m doing these days!) stealing and turning tricks, and of course shoots virtually all of it into her arms, since one of the cruelest effects of heroin is you totally lose all interest in anything else, including food. (That’s the main reason heroin users generally — though not always — become incredibly thin: both the drug itself and the constant struggle to make enough money to score kill off any normal appetites, not only for food but sex as well. The Andy Warhol-Paul Morrissey film Trash dramatized this quite well in its opening scene of the addict couple, played by Joe Dallessandro and Holly Woodlawn, at home alone and interested in nothing else but their next score.) Eventually the LEAD officials get Johnny into treatment — after a 40-mile journey to a facility in which he’s been promised a bed, only to be turned down once he arrives because there’s no room (“at the inn,” I couldn’t help but joke) — only he relapses after he’s apparently got clean, not on heroin but on methamphetamine (an even worse drug from what I’ve heard of it, including users I’ve known), and gets kicked out of the sober living facility he was in just when it looked like he was getting on his feet and starting to play music again (his room at the sober living facility contained a guitar and an electronic keyboard). Cari gets busted for small-time dealing (a lot of users, like Amway distributors, sell in order to finance their own supplies) just a few days before her scheduled “graduation” from drug court, so her release is delayed four months. At the end Kristina tells the LEAD people she’s finally ready for treatment — though if nothing else the show has demonstrated that “treatment” is hardly the panacea it’s often depicted as in the media; people are constantly getting “treated” and then going back to drugs, and it seems that once you become addicted there will be a tug-of-war between you and the substance for the rest of your life, whether that’s drug-shortened or not.

The film offers a mixed view of 12-step programs, saying they work for some people but not for others (I remember reading once that for alcoholics — not drug addicts, though the numbers may be similar — AA had only a 25 percent success rate, and the only reason the program is held in such high repute is every alternative method does even worse), and to me the most chilling scene was an interview with researcher Dr. Nora Volkow, who claims that vulnerability to opioid addiction is 50 percent genetically determined. “Fifty percent of our vulnerability to become addicted is genetically determined,” Dr. Volkow says. “And the other 50 percent relates to multiple factors, including the age at which you start taking the drugs or the alcohol. The younger you are, the greater the likelihood that you will become addicted.” Dr. Volkow also claims that drugs — not only opioids but other commonly abused substances, like cocaine — literally change the shape of your brain: “All of these drugs will with repeated administration erode the function of the frontal cortex. The easiest metaphor is driving a car without brakes. You may very well want to stop. If you don’t have brakes, you will not be able to do it.” She even showed colored X-rays of brains, comparing those of drug abusers with those of non-using controls, and the grim sight of certain parts of the brain literally lighting up more in users than non-users was chilling to me: if your likelihood of becoming addiction is largely genetically determined and the drugs physically alter your brain to make it harder to function without them, the future of people who get hooked is grim indeed. The one thing I was hoping for on this show and didn’t see was any ideas on anti-drug education, on how to get people never to use opioids or other addictive substances in the first place — as much as she was ridiculed at the time (and as hard as it would be for the already addicted to follow her advice), Nancy Reagan seems to have been on the right track when she advised people, “Just say no!” (Then again, maybe that’s easy for me to say because I’ve been saying “no” to potentially addictive substances all my life: I gave up drinking alcohol in 1978, I’ve never smoked tobacco, and my whole experience with illegal drugs is having tried marijuana as a teenager twice and feeling nothing except intense nausea. I’m sure that was a physiological reaction because to this day I get queasy when I’m around marijuana smoke.)

I’m becoming convinced that we won’t conquer the illegal drug problem until we start conquering the legal drug problem — and one thing I would strongly favor is reinstating the ban on advertising prescription drugs directly to consumers. I was amused when after the Super Bowl there were people complaining about the commercial for a new drug designed to reduce the constipation frequently associated with use of prescription opioids (though one person I know said that when he was prescribed opioids for pain, the constipating effects of the opioids and the diarrhea-producing effects of his anti-HIV medications canceled each other out and rendered his bowel function normal for the first time in years), and some of the anti-drug types had their usual hissy-fits to the effect that the CBS network should be using the Super Bowl to advertise the dangers of prescription opiates rather than to hawk a product to control their unpleasant but not life-threatening side effects. What amused me about that is I’d been watching that commercial on various programs for weeks — it’s only when it was put on during the Super Bowl that enough people saw it to engender a negative public reaction, just as one could argue that all the current attention towards the heroin epidemic is a function of its spreading to white people. Just as I was grimly amused when, after Ebola has been endemic in Africa for decades, it was suddenly hailed as “the greatest health threat on earth!” once two white people got it, so the unconscious (and sometimes conscious) racism which seems to affect everything we say or do about each other has led to the sudden “discovery” of heroin as a major social problem now that white people — and nice white suburbanites instead of countercultural or Bohemian white people, at that — are getting addicted and dying from it.