Anatomy of an epidemic

In ‘Opium,’ David Blistein looks at how heroin went from wonder drug to street menace

BRATTLEBORO — Award-winning author David Blistein doesn't consider his upcoming presentation at Next Stage so much a reading as a community conversation about the local opioid crisis.

On Thursday, Dec. 5, at 7:30 p.m., Next Stage Arts Project will host Blistein, who will be reading from his new book Opium: How an Ancient Flower Shaped and Poisoned Our World, which tells the extraordinary and at times harrowing tale of how we arrived at today's crisis.

“I will read a fairly short excerpt from my book on the history of opium, perhaps how the Boston Brahmins in the 1880s used profits from the opium trade to finance the Museum of Fine Arts,” Blistein says.

“Then, with the assistance of John Halpern, open up a conversation with the audience about our opioid problem in Southern Vermont. I suspect that almost everyone in our community has been touched by someone struggling with opioid addiction, and each has something significant to say on the subject.”

Admission is $5 to $35, sliding scale, with 100 percent of ticket sales supporting Groundworks Collaborative and Next Stage.

Blistein will be joined by his collaborator and co-author Dr. John Halpern and the pair will facilitate a Q&A with the audience following the reading. Signed copies of the book will be available for sale.

In Opium, Halpern and Blistein reveal the fascinating role that opium has played in building our modern world, from trade networks to medical protocols to drug enforcement policies. They disentangle how crucial misjudgments, patterns of greed, and racial stereotypes served to transform one of nature's most effective painkillers into a source of unspeakable pain.

Blistein wrote the award-winning PBS documentary The Mayo Clinic: Faith - Hope - Science and is currently working on a three-part series on brain disorders and mental health as well as a documentary on Henry David Thoreau.

He also co-wrote the films Cancer: The Emperor of All Maladies and The Gene for PBS and is the author of David's Inferno, a book that combines personal anecdotes with insights into manic-depression and descriptions of how it is diagnosed and treated.

Halpern, a psychiatrist in private practice, previously served as medical director of the Boston Center for Addiction Treatment, the largest substance-use disorder hospital in New England.

He completed his residency and a fellowship in addiction research at Harvard Medical School, where he spent over 20 years on the faculty and served as the director of his own research laboratory at McLean Hospital, supported by private grants and National Institute on Drug Abuse funding.

“In a time when there are a lot of unanswered questions around the opioid epidemic, David and John's book asks a lot of interesting questions that are poignant and add depth to this complex and difficult topic,” says Groundworks Executive Director Josh Davis.

A deadly problem

Opioid addiction has swiftly become one of the most deadly crises in American history. In 2017, opioid overdoses claimed nearly 50,000 lives in the U.S. - more than gunshots or car crashes, and almost as many Americans as were killed in the entire Vietnam war.

Blistein and Halperin write, ”Estimates are that 200,000 Americans have died from OxyContin-related [opioid] overdoses since 1999. Countless other addicts have been given long, if not lifetime, sentences for opioid sales and use.”

In an article “Unwinnable War” that Halpern and Blistein wrote for The Commons last September, they explored how a perfect storm of overmarketing and overprescribing opioids, combined with the ease of adulteration and the ingenuity of drug cartels, created today's crisis.

As nearly everyone in the community now realizes, the opioid crisis and homelessness (which are related concerns) have transformed Brattleboro in the past few years.

Blistein believes we need to face up to the reality of the situation. “Communities like ours must direct their energies on the specific problems at a community level,” he says.

Various strategies to control the opioid problem, through legislation, insurance, and specific harm-reduction programs, have been proven to be only partially successful. Blistein believes that you can't do just one thing and solve the problem.

“It is a multi-prong issue, and there is no simple solution to it,” he says. “On top of that, fine strategies are hampered by laws too often based on misleading or incorrect assumptions about drug addiction.”

In writing Opium, Blistein and Halpern worked to challenge those assumptions.

“In our book, John and I tried to disentangle the science and reality from the myths surrounding the history of opium,” says Blistein. “In the crisis here in Southern Vermont, we can see the same mistakes that were made throughout time.

“By examining the past, we can discover how history keeps repeating itself. The strategies to win the war on drugs through drug eradication, developing better opioids that were less addictive, and decriminalization of users, in and of themselves have failed.

“Even if there weren't a single poppy growing in Afghanistan, America would still be awash in opiates. The even more inconvenient truth is that heroin's long reign as the primary addictive 'hard' street opiate is coming to an end, regardless of where it's being grown.

“Free from the ingredients within the opium flower, opioid analogs are synthesized rather than grown and can be hundreds of times stronger than heroin.”

Geographic variations

So far, opioid addiction seems to have remained, to some extent, a regional issue.

“While the entire country is grappling with drug related concerns, strangely enough opioids are the drug problem here in New England and the Mid-Atlantic states, while in the West, the crisis centers around methamphetamine, which is a very different kind of drug than opioids,” says Blistein, who has no easy answers as to why this is happening.

Blistein points out that it is very hard to know what causes one person to become addicted and another not.

“It seems to be related to such diverse facts as generics, the environment, and lack of education,” he says. “But to make a blanket characterization about your typical drug addict is virtually impossible.”

Blistein suggest numerous factors have contributed to Brattleboro's opioid and homeless crisis.

“Addicts are formed from people who had been prescribed powerful opioid drugs like Oxycontin for substantial pain relief, and when doctors curtailed their treatment, or when they found that they could get it cheaper on the street, they turn to heroin,” Blistein says.

“Brattleboro is often considered the first stop on the illegal drug dealers' trail as they carry heroin throughout the state. The effect of this can be devastating, and Windham County has become the first or second in the state in drug-related deaths per capita.

“Another factor for having so many addicts here may be that patients are released in the community from mental health treatments like the Brattleboro Retreat without enough support, and so end up resorting to illegal drugs to deal with their often difficult lives.”

Nonetheless, Blistein believes that Brattleboro is doing admirable work attempting to deal with this crisis in an enlightened and humane manner.

“Here social services and law enforcement work with and listen to what each has to offer to try and deal with the crisis,” he says.

That doesn't mean that this is a crisis that can be resolved. Blistein believes the drug problem will never completely go away.

“The reality is that no matter what the community tries, we can't wrestle everyone from the stranglehold of drugs,” Blistein states bluntly. “Not everyone can be saved.”

But things can be done.

“As a community, we must work together,” says Blistein. “Much of this is already happening here. We need to make treatment more effective, by understanding what works well and what doesn't.

“We must learn methods to keep people from overdosing. We must reduce the stigmatization of the addict, so he or she is not forced into the shadows and remaining out of reach from treatment and help.

“Finally, we must learn from history. That is why David and I wrote Opium in the first place: to document the long history of this social problem. We need to remember just how complex it is, and give up the delusion that a simple solution can be discovered. Nonetheless, that need not lead us into the hopeless despair that progress can not be made. I believe it can.”

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