Rural Americans now more afraid of opioids than cancer

The opening monologue in the Neil Simon play, “Brighton Beach Memoirs,” set in 1937 Brooklyn, introduces teenager Eugene Jerome explaining his idiosyncratic family. “I’d better explain what [my mom] meant by Aunt Blanche’s ‘situation,’” he begins. “You see, her husband, Uncle Dave, died six years ago from (he looks around) this thing... they never say the word. They always whisper it. It was (he whispers)— cancer!”

Fortunately, our collective attitudes toward cancer have progressed substantially over the past several decades. And though we are still struggling to combat its ravaging effects, the perceived stigma associated with the disease has long been erased.

I recalled Jerome’s whispered words while reading the recent NPR poll that reveals the extent that rural Americans are now worried about opioid addiction. Here’s a sobering statistic: 41% of residents of Appalachia cite drug addiction, including opioids, as the biggest problem in their communities. The opioid epidemic has grown so overwhelming in rural America that it is now more frightening than cancer (12%) and access to health care (11%).

And the concern is growing each year. Nearly half of those surveyed say opioid addiction has gotten worse over the past five years. This is no doubt a reflection of opioid-related deaths in America—nearly 200 people each day in 2017.

These devastating results show no signs of abating:

• Opioid overdose deaths have increased four-fold in the past 15 years.
• Overall life expectancy in the U.S. has declined for the past two years, driven by the surge in fatal opioid overdoses.
• Opioid overdoses, numbering 42,000 in 2016, killed more Americans than car crashes (37,400), gun violence (38,000) and breast cancer (40,000).

Think about that last statistic; it cannot be overstated: Opioid overdoses kill more people in the U.S. each year than breast cancer.

While health care access is no doubt contributing to this crisis, more pressing is the pervasive, public stigma associated with opioids, whose effects are far-reaching:

In addition to inhibiting patients from seeking treatment, it is preventing them, once in recovery, from assimilating back into their personal and professional lives. This produces dramatic, long-term effects that foster additional physical and mental degradation, an endless cycle of decay where the damage may be irreparable.

I was driving to work recently and NPR’s Morning Edition touched on this subject, interviewing a husband and wife whose 34-year-old daughter, Alicia, died overdosing on fentanyl. During their daughter’s struggle, they said people would look down on her, calling her a junkie or a thief – devastating condemnation that continues to inflict injury.

Since her death, “Nobody from my immediate family has called us, stopped in to say ‘How are you doing? Can I help you?’” said Peter Troxell, Alicia’s father. “Not one phone call, not one visit from my immediate family.”

The Troxell’s story is all too familiar. I see it play out daily in Acadia’s network of treatment centers. Every intake specialist and healthcare professional has encountered patients — dozens and dozens of patients — with advanced stages of opioid addiction, whose common excuse for delaying treatment stems from shame and embarrassment. And these are the people who make it into treatment. Many more end up like Alicia, addicted and overdosing, without ever seeking help.

Opioid use disorder leads to profound and grave physical destruction. But it is eminently treatable. And therein lies the most disheartening facet of the disease. We must educate the public and ourselves that opioid use disorder is a mental illness fully deserving of compassion, not scorn or shame.

Just as millions each year adorn pink ribbons to raise awareness and much-needed funds for breast cancer education, research and treatment, so too must we adopt a collective effort to address opioid use disorder, bringing it to the forefront of our attention, not neglecting it with the hope that it won’t impact our own lives.

Opioid use disorder is not a choice. It is not a moral failing. It is a deadly, deadly disease. Like cardiac disease or even (whisper) cancer, it deserves our unmitigated attention on a local and very personal level. And until we understand that, it will continue to fester as a calamitous disease that destroys our communities — every one of our communities — one family member at a time.