Drugs: they’re everywhere. In our medicine cabinets, the books we read, the movies we watch, and the communities in which we live. What isn’t common: reliable and accurate information about drug use and addiction.
In the latest edition of Breaking News Consumer’s Handbook, we confront the most pervasive myths about drug use, addiction, and prescription. Bob talks to Debbie Dowell of the Centers for Disease Control; Dr. Carl Hart of Columbia University and author of High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society; and finally, Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction.
“ON THE MEDIA"/SENIOR PRODUCER: KATYA ROGERS
AUGUST 25, 2017
[PROMOS/MUSIC UP & UNDER]
BROOKE GLADSTONE: From WNYC in New York, this is On the Media. I’m Brooke Gladstone.
BOB GARFIELD: And I’m Bob Garfield.
[CLIPS]:
ATTORNEY GENERAL JEFF SESSIONS: We have too much of a tolerance for drug use, psychologically, politically, morally. We need to say, as Nancy Reagan said, “Just say no.” Don’t do it!
BOB GARFIELD: That was Attorney General Jeff Sessions earlier this year, voicing his long-held, hardline view on drugs and drug users. In May, he signaled his eagerness to rejoin the nation's old-style “war on drugs” with a memo that orders federal prosecutors to pursue the harshest possible punishment against drug offenders, including mandatory minimum sentences.
ATTORNEY GENERAL SESSIONS: We are returning to the enforcement of the laws as passed by Congress, plain and simple. If you are a drug trafficker, we will not look the other way.
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BOB GARFIELD: On the premise that big prison populations keep our nation safer, Sessions’ memo cancels an Obama era policy that reduced sentences for non-violent drug offenders. This initiative flies in the face of data that suggests that the criminal justice system disproportionately penalizes black and Latino drug offenders and utterly rejects the idea that the nation has lost its $1-trillion war on drugs, this, despite the fact that there is an ongoing opioid catastrophe in America.
DEBBIE DOWELL: It would be hard to overestimate the magnitude of this problem.
BOB GARFIELD: Debbie Dowell is a senior medical advisor at the Centers for Disease Control.
DEBBIE DOWELL: We saw drug overdose in the United States more than double and opioid-related overdose more than triple.
BOB GARFIELD: On average, 91 Americans overdose on heroin or prescription painkillers like Percocet and OxyContin every day. That is clear. What is not clear, amid conflicting narratives, ideologies, medical protocols and laws, is the very nature of the abuse or even of drug addiction, itself. The government defines it as a chronic brain disease of compulsive use, quote, “despite harmful consequences.” But the overwhelming majority of illegal drug users do not meet that standard.
This week, we devote the show to media depictions of drugs and drug users because, as you’ll hear, in politics and journalism the drug thread often stands in for fear of the “other.” In pop culture, there's less ambiguity. Drugs are merely vehicles for comedy or drama.
[PINEAPPLE EXPRESS CLIP]:
DALE DENTON: Ah, you can smoke this?
SAUL: Hell yeah, man.
DALE DENTON: No.
SAUL: What you do is you light all three ends at the same
time -
DALE DENTON: Really?
SAUL: - and then the smoke converges, creating a trifecta of joint-smoking power.
[END CLIP]
[BREAKING BAD CLIP]:
WALTER WHITE: You produce a meth that’s 70 percent pure, if you’re lucky. What I produce is 99.1 percent pure.
[END CLIP]
[TRAINSPOTTING CLIP]:
MARK "RENT-BOY" RENTON: Take the best orgasm you ever had, multiply it by a thousand and you're still nowhere near it. When you're on junk you have only one worry, scoring.
[END CLIP]
BOB GARFIELD: As I said, it’s not hard to susS out distortions of drug use and drug users in pop culture. It's a lot trickier in political pronouncements and news coverage. So we begin with the latest in our series of Breaking News Consumer’s Handbooks: Drugs Edition.
FEMALE CORRESPONDENT: As the heroin problem continues to get worse, so do the crimes associated with it.
MALE CORRESPONDENT: Most shocking, many new users are turning to heroin because they became addicted to legally-prescribed painkillers.
MALE CORRESPONDENT: In so many communities across this country, the needles are everywhere.
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BOB GARFIELD: Ah, heroin, H, horse, smack. In the ‘60s, we were told, it was an inner-city African American drug, now, a white rural drug. Did you know that at least half of heroin users nowadays inhale it, instead of injecting it? Probably not because the image of the needle on the ground or in the arm is so arresting, so familiar. But the current heroin epidemic, a headline-grabbing subject, deserves a closer look. So we’ll correct a few assumptions.
Point 1. Heroin use has certainly increased but, contrary to what you may have seen or heard, it is used far less than, say, marijuana or cocaine, Ecstasy or prescription painkillers. The alarming news is the sharp rise in heroin overdose deaths since the 2000s. That's what troubles and perplexes public health officials the most. Debbie Dowell of the Centers for Disease Control.
DEBBIE DOWELL: In 2015, the last year for which we have numbers, we saw 12,989 deaths related to heroin in the United States.
BOB GARFIELD: Note that Dowell said “related to heroin.” Point 2. Overdose deaths don't usually stem from just one drug. The majority involve multiple substances, like heroin and alcohol or OxyContin and alcohol and Tylenol. Public health officials and journalists could offer news consumers a little more clarity. So beware reports like this.
[CLIPS]:
MALE CORRESPONDENT: It's the one drug that police officers dread above all others, not crack, heroin or even prescription pills. We’re talking about PCP.
FEMALE CORRESPONDENT: People used to buy the powdered form called angel dust. Now, 70 bucks gets you a vial filled with liquid to make dippers, marijuana and cigarettes dipped into a potent cocktail, including ether and embalming fluid.
[END CLIP]
BOB GARFIELD: Point 3. Most new drugs are not new. Often, they're just slight variations on or combinations of substances we already knew about, with maybe a slangy new name. Think powder cocaine and crack or Molly, the now popular purer form of the ‘80s party drug, Ecstasy. The novelty offers the media a chance to claim the drug is making a more potent comeback, which is sometimes true, often not. Remember the hysteria over so-called “bath salts.” This new class of drugs triggered paranoia in a small number of users and a large number of news organizations.
[CLIPS]:
FEMALE CORRESPONDENT: Bath salts look like their name but are a strong concoction similar to amphetamines or cocaine. The effects are like no drug on earth.
[SOUND OF SOMEONE SCREAMING]
MALE CORRESPONDENT: And we have new video out tonight from that bizarre attack in Miami where a man, high on bath salts, eats a homeless man's face.
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DR. CARL HART: People believed that bath salts caused this guy to eat the face off of this other guy when, in fact, bath salts had nothing to do with it.
BOB GARFIELD: Dr. Carl Hart is chair of the Psychology Department at Columbia University and author of High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.
DR. CARL HART: The only thing that was in the guy’s system was THC, but the THC could have been there for some longer period of time so we're not even clear if the guy was intoxicated from marijuana. These kind of stories create mythologies around drugs and they seep into our drug education and law enforcement education, and we wonder why police officers think that someone on bath salts or PCP is so dangerous or unaffected by bullets. It’s because of this misinformation. When you start to see those kind of buzz words - “a few hits and you’re addicted” - put down the article because either the author is an idiot or the author thinks that you are an idiot.
BOB GARFIELD: Thus, Point 4. Remember “The Boy Who Cried Wolf.” Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, has written about addiction and drug policy for almost 30 years.
MAIA SZALAVITZ: If you take an illegal drug that you have been told is the most horrifying bad thing and that you will become a terrible person overnight if you do this and that doesn't happen, then you will be much more skeptical of the messages about the drugs that are actually a lot more harmful.
BOB GARFIELD: Such as fentanyl, a synthetic opioid often used as an anesthetic.
[CLIP]:
MALE CORRESPONDENT: Fentanyl, the powerful painkiller that officially killed Prince, 100 times more powerful than morphine.
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BOB GARFIELD: This, the media, have right. From 2014 to 2015, the death rate by synthetic opioids like fentanyl increased by 72.2 percent, but when the media depict every drug as extremely lethal, the real killers get short shrift.
So why are we awash in so much imprecise hyperbolic coverage? Which brings us to Point 5, one that appears in every edition of our News Consumer’s Guides. Consider the source. For instance, be wary of stories that rely heavily on law enforcement quotes, unless they're talking about police work.
MAIA SZALAVITZ: Police are not pharmacologists. They are not experts in statistics or in addiction. If we had a MD talking about, here is the best way to police this particular precinct, I think people would have a problem [LAUGHS] with that.
The other problem with looking at addiction through the police's view is that police see people who are having problems with drugs. This is a minority among people who use drugs and it gives a perception that all people who use drugs are criminals, all people who use drugs are violent, all people who use drugs become addicted. And this is actually a sampling bias, basically.
BOB GARFIELD: Likewise, just because someone has experience with addiction does not necessarily make them an expert on addiction.
MAIA SZALAVITZ: People with addiction should certainly be seen as experts on their own addiction and their own experience of addiction but, unfortunately, the addictions field has had this idea that if you've got 90 days free of drugs you are an expert and you can go on the media and talk about this as though you speak for everybody with addiction. And we wouldn't do that with any other group of people.
BOB GARFIELD: Point 6: As always, be suspicious of simplistic finger-pointing narratives.
[CLIP]:
MALE CORRESPONDENT: The medical community has been overprescribing opioid pain medicines and it led to parallel increases in rates of addiction and overdose.
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BOB GARFIELD: In recent years, much of the blame for the overdose crisis has been heaped on doctors, portrayed as negligent “Dr. Feelgoods” indiscriminately pushing painkillers, which, for one thing, obscures the role of Big Pharma and of the simple shortcomings of medical education. With data provided by drug makers, doctors were misled to believe that the addictive rate of opioids for certain patients was less than 1 percent. Recent studies have found that risk to be 8 to 24 times greater. Furthermore, says Szalavitz, the genesis of addiction is seldom in the doctor's office.
MAIA SZALAVITZ: Ninety percent of all addiction starts in the teens and twenties. And, thankfully, most people in their teens and twenties don't tend to have back pain. So, yes, it is possible for teens to get exposed via medical use, and that certainly happens, but what typically happens is about two- thirds of them are using someone else's prescription. They are getting it out of their parents’ medicine cabinet. They're getting it from a friend. They're getting it from a drug dealer. They are not getting it from a doctor. And so, the idea that doctors directly cause this is a little more complicated.
BOB GARFIELD: All of which leads to the final, most fundamental caution, Point 7: Demonizing the drug alone ignores the underlying problems.
MAIA SZALAVITZ: We can't talk about the opioid problem without talking about the way the middle class in America, itself, is threatened, the way people feel a real sense of despair and hopelessness.
BOB GARFIELD: Szalavitz points out that two-thirds of the people who use painkillers generally don't enjoy the experience, but among the third that do feel the euphoric effects of opioids those with stable lives tend to weigh the risks against the rewards, and they choose friendships, family time and professional ambition over the drug.
MAIA SZALAVITZ: That's what happens if your life is in a good place when you get exposed to these drugs. If your life isn't in a good place, if you have a history of childhood trauma, which about two-thirds of people with addiction do, if you have mental illness, which about 50 percent of people with addiction do, if you have some combination of that and some type of despair or you’re unemployed, that's when opioids become a risk.
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BOB GARFIELD: Despair, alas, like illegal drugs, themselves, is not in short supply. What is in short supply is nuance, context and restraint in telling the story of a plague and its grim toll. You can find a one-page printable version of our Breaking News Consumer’s Handbook: Drugs Edition at onthemedia.org.
BROOKE GLADSTONE: Coming up, who started the drug war? A guy named Harry.
BOB GARFIELD: This is On the Media.
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