A 12-Step Program to Opioid Justice

By Mattea Kramer, TomDispatch

20 November 19

 

---

[Note for TomDispatch Readers: It’s your last chance! The offer of a signed, personalized copy of Michael Klare’s new book, All Hell Breaking Loose: The Pentagon’s Perspective on Climate Change, in return for a donation of $100 ($125 if you live outside the U.S.) still stands, but only for a few more days. Of the book, the Huffington Post writes, “Outstanding... Exhaustively researched, beautifully written, and convincingly argued.” Go to our donation page and check out the details -- and many thanks to those of you who already donated for Klare’s book! Tom]

As a website, TomDispatch has long focused on one great twenty-first-century American addiction: our endless wars. Eighteen years after the 9/11 attacks, from Afghanistan to Syria, Yemen to Somalia, those conflicts only continue. In the process, ever more people die or are displaced; the world becomes more unsettled; governments totter or fail; and victory, by any definition, remains beyond some unimaginable horizon. And yet the addiction continues, largely unexamined (except in places like this). Only recently, for instance, one of those addicts, Chairman of the Joint Chiefs of Staff General Mark Milley, spoke about the necessity of the U.S. military remaining in Afghanistan for “several more years” since the “mission” there “is not yet complete.” In similar fashion, he added that perhaps 600 American troops (replacing those supposedly sent “home” by President Trump in early October), along with tanks and Bradley Armored Vehicles, are being sent to northeastern Syria to protect... well, oil, or something valuable to this country anyway.

Meanwhile, here at home, another kind of endless war rages. Think of it as the modern equivalent of a nineteenth-century opium war. Only in this case, the drugs, addictive opioids, aren’t being sent thousands of miles away by an imperial power. The companies producing them have instead found a far simpler formula for their distribution. They just essentially send them to your trusted local doctor, wherever in this country you happen to live. The casualty figures since 1999 are horrific -- nearly 400,000 dead, an estimated 218,000 of whom perished from prescription opioids. And the wounded, often in jails, are beyond counting. It’s a nightmare that this site has rarely covered, but that TomDispatch regular Mattea Kramer explores today in a particularly vivid way.

-Tom Engelhardt, TomDispatch

---

t was evening and we were in a windowless room in a Massachusetts jail. We had just finished a class -- on job interview skills -- and, with only a few minutes remaining, the women began voicing their shared fear. Upon their release, would someone really hire them? Beneath that concern lurked another one: Would they be able to avoid the seductively anesthetizing drugs that put them in jail in the first place?

Their disquiet was reasonable. Everyone with me around that grey plastic table, along with the vast majority of other prisoners in the jail, was addicted to opioids. On the cinderblock wall, a laminated sign read: “We take stock of all the suffering we have experienced and caused as addicts.”

Thousands of lawsuits are making their way through the court system in an effort to force some kind of repayment from the corporations that manufactured, distributed, and dispensed billions of doses of prescription opioids. Those drugs, including OxyContin and fentanyl, have killed hundreds of thousands of Americans, while entangling untold numbers of others in addiction (and, often, in illegal activities like larceny to pay for the drugs they then craved). The pharmaceutical companies involved have, unsurprisingly, been eager to deny their culpability, which has led to a vast blame game that’s routine in our republic of finger pointing.

When a surge of opioid addiction transformed my small New England hometown, I began to write about what was happening and follow local efforts to combat the scourge. This, in turn, led me to that jail, first as a writer on assignment and eventually to the front of that ad-hoc classroom. At the same time, over the course of two years, I interviewed dozens of people in recovery. What I learned was that, nestled within this crisis (if you knew where to look), people were taking responsibility for what had happened to them and doing so in a transformative way. They had discovered that blaming others -- even the worst of those drug companies -- was a quick path to the bottom, while taking responsibility turns out to be a race to the top.

The “Scum of the Earth”

On a sunny fall morning, I pulled off Route 2 in central Massachusetts and into the parking lot of what used to be the Wachusett Village Inn. It still looks like a picturesque country hotel, but today it’s a detox facility and recovery center. I’m here to meet the friend of a friend. When she greets me at the front atrium, I notice that she has a lanyard around her neck with an ID indicating that she’s on staff. Years ago, though, Anna Du Puis could have been a patient here. Before she got sober, she went through detox for opioid addiction so many times she lost count.

“I’m a story of perseverance,” she assures me -- and, when she says it, she seems to glow with energy.

It’s only recently that Anna has had this full-time job helping others who are, as she once was, in early recovery. Before that she sold insurance, telling no one she had been an addict and regularly hearing coworkers and others dismiss addiction as a choice and treatment as a waste of taxpayer dollars.

Thought about a certain way, the pharmaceutical companies that produced those opioids pulled off the perfect crime. They peddled addictive products that were prescribed by trusted physicians, while those who became addicted gained scant sympathy. After all, once they were hooked, they were, by definition, drug addicts. Richard Sackler, former president of Purdue Pharma and mastermind behind the marketing campaign that launched OxyContin and remade opioid prescribing practices in this country, is now infamous for referring to those who became addicted to his blockbuster drug as the “scum of the earth.”

For this we vilify Sackler -- what he did was deplorable -- but it’s also true that every time any of us has accepted drug addict as an unsavory epithet, we’ve given an assist to him, to Purdue, and to the rest of the pharmaceutical industry that profited not only from addiction but from our prejudice toward it. By looking down on those afflicted with this disease, we, the public, helped insulate corporate perpetrators from responsibility.

In the process, we have also missed the chance to witness something incredible.

“A Searching and Fearless Moral Inventory”

On another night in the county jail, our little group strategized together. These women would soon have to explain their criminal records to prospective employers who increasingly run background checks on applicants. So, quietly at first and then with more confidence, they practiced reflecting on their pockmarked pasts, affirming how much they had learned (a lot) and their efforts (herculean) to regain control of their lives. All of them referenced the importance of embarking on a 12-step program to recovery.

This is something I heard again and again from people in long-term recovery. Beginning with an admission of powerlessness over addiction, 12-step programs are so often transformational in part because they involve radical responsibility-taking. Even when something is someone else’s fault, the steps encourage you to look inward and ask: What was my own role? What responsibility do I have in all this? A pivotal moment comes in step four, which calls for “a searching and fearless moral inventory” of oneself. This is a breathtakingly tall order -- and one that pays commensurately large dividends for those with the courage to undertake it.

“I accept myself wholly for who I am and every single thing that I’ve done in my life,” says Raj Aggarwal, who became addicted to OxyContin in the 1990s and subsequently switched to heroin. When he made that switch, he told almost no one. Whereas Oxy, which was widely prescribed by doctors, was socially acceptable, heroin was not. Like so many others, the deeper Raj waded into addiction, the more isolated he became.

Today, he has been sober for more than 15 years, and his enviable self-acceptance has liberated him to be a force for good in the world. Raj is the founder and president of Provoc, a Washington, D.C.-based organization that helps businesses create positive social change. Provoc has designed successful campaigns in areas ranging from expanding clean energy and combatting racism to boosting voter participation. Over video chat he told me that he used to think addiction was the worst thing ever to happen to him. Now, he says, “My greatest challenge has turned into a tremendous source of strength.”

The soul-searching that Raj and others engage in as part of their recovery process is not only applicable to addiction. Let’s say you’re angry about something devastating a family member said, or a colleague’s poor behavior, or maybe you’re despondent -- who isn’t? -- over our broken democracy. Consider the 12-step approach to investigating your own role in the situation. This doesn’t mean other people aren’t responsible, too. It just gives you a shot at seeing your actions (or your lack of them) with greater clarity. In other words, it allows us to own our shit -- and then, perhaps, to take the next right step forward.

This is largely a foreign concept in our culture, at least to people who aren’t in recovery, but its promise is bottomless. As one example, it’s relevant to the problematic way the media have covered the current opioid crisis. When addiction is rampant in communities of color, the subject tends to draw minimal attention. But in recent years, as great numbers of white people have been afflicted, the media have zoomed in with stories of blue-eyed kids dying untimely deaths. And this is a place where I bear responsibility. I took up the subject of addiction only after it enveloped my overwhelmingly white hometown. In other words, I initially focused on (and so privileged) the concerns of people white like me. In retrospect, 12-step-style, I see what I did and that it reinforced the white supremacy that drenches our American world.

Maybe you’ve heard this one from the visionary novelist James Baldwin: “Not everything that is faced can be changed. But nothing can be changed until it is faced.” Here lies the key to overcoming the opioid crisis: that people in recovery are teachers for how to face the hardest things of all.

“As Long As You’re Breathing, There’s Hope”

When he filed his complaint against Purdue Pharma, Minnesota Attorney General Keith Ellison said, “The Sackler defendants were motivated not by human dignity or the value of human life, but by unlimited greed above all else.” Billionaire Richard Sackler unrelentingly pushed addictive drugs that destroyed lives and pulled at the threads of unraveling communities. Why? To make yet more money, of course. It turns out that, in this story, there are many kinds of addiction, and if money is your drug of choice, then (as the recent responses of multi-billionaires to the possibility of a wealth tax suggest) you’ll never have enough, no matter how much you’ve amassed.

And so, while we malign the Sackler family and other corporate executives for what really does appear to be jaw-dropping greed, their condition is instructive. At a more modest level, many of us are skating along, feeding ongoing cravings for electronic devices or wine or work or money or just fill in the blank yourself. Like minor versions of those billionaires, we, too, are often chasing a high -- a brief sense of euphoria to distract us from something underneath.

Anna Du Puis told me that her drug use was a search to fill an “internal barren place of desolation.” Raj said OxyContin offered him blissful relief from his difficult childhood as an immigrant in a white neighborhood. In many thousands of cases, opioid addiction resulted from people in chronic pain searching for an answer. Yet there are many kinds of chronic pain, including despair, or a crushing sense of emptiness. Maybe the Sacklers, nightmares of greed as they have been, are in some deeper sense more like us than we’d care to think.

There is now a growing call to put them and other pharmaceutical executives in jail. After all, why should people who committed low-level crimes thanks to their addiction to the very drugs the Sacklers peddled, like the women in my class, get locked up, while they walk away with blood on their hands and billions stuffed away in bank accounts? The answer mostly has to do with who has good lawyers. Just as in the financial and foreclosure crises of 2007-2008, when corporations inflicted widespread devastation, we are unlikely to see executives behind bars for what their companies did.

And yet, as Sam Quinones, author of the remarkable book Dreamland about the roots of the opioid crisis, points out, the public has already won important victories. Back in 2014 when he was finishing his book, he says, Purdue was “untouchable.”

In the years since then, individuals and families have rejected isolation and spoken out about drug addiction. Their outcry, in turn, has transformed the problem from something taboo into a priority for local governments -- and thousands of lawsuits have been the result. Quinones acknowledged that pharmaceutical companies will likely never pay anything close to the full cost of what they’ve done. And yet, as he told me by phone, “We have probably seen the last of Purdue Pharma the way it once looked, and that right there is stunning.” He’s right: that is no small feat.

Still, there’s something else that future settlements could require, something that Raj Aggarwal sees as a potentially just approach. What if a team of people in recovery from drug addiction were enlisted to teach the pharmaceutical executives what it really means to take responsibility? It’s an idea that honors those whom they most victimized, while giving the perpetrators a framework for grappling with what they’ve done and beginning to make amends.

Imagine the Sacklers embarking on a searching 12-step moral inventory of themselves. (I, at least, fantasize about this.) Cynicism tells us that, even if this were to come to pass, a group of white-collar criminals would never listen, but Anna Du Puis takes a more charitable view. “As long as you’re breathing, there’s hope,” she told me.

I learn so much from people in recovery that sometimes I think my head will explode. Instead what happens is that my heart grows.

At the county jail, we finish our final class in that windowless room and the women file back to their cells. They will soon be released. Even though I know the odds are against them, I allow myself a tiny serving of optimism. Maybe, eventually, they will be viewed as true teachers among us.

---

Mattea Kramer, a TomDispatch regular, is at work on a novel about a waitress’s love affair with a prescription pill.

Follow TomDispatch on Twitter and join us on Facebook. Check out the newest Dispatch Books, John Feffer’s new dystopian novel (the second in the Splinterlands series) Frostlands, Beverly Gologorsky's novel Every Body Has a Story, and Tom Engelhardt's A Nation Unmade by War, as well as Alfred McCoy's In the Shadows of the American Century: The Rise and Decline of U.S. Global Power and John Dower's The Violent American Century: War and Terror Since World War II.

Colin Kaepernick's Contested Workout and the Power Plays of the NFL

By Louisa Thomas, The New Yorker

19 November 19

 

or the past three years, Colin Kaepernick’s absence from the N.F.L. has made him a nearly constant presence in the broader culture. Kaepernick, who, six years ago, led the San Francisco 49ers to the Super Bowl, began kneeling during pregame performances of the national anthem in 2016, in protest of racial injustice. He became a free agent after that season, and no team would touch him. But no one could ignore him, either. Other players were protesting during the anthem, citing his example. Donald Trump dangled the bogeyman of Kaepernick at his rallies, whipping up racist resentment. Many blamed the movement that Kaepernick started for driving down the league’s ratings. Kaepernick, through all of this, mostly stayed silent and out of view. When he was named GQ’s Man of the Year, in November, 2017, he showed up for the photoshoot but declined to be interviewed. He attracted more than two million followers on Twitter but primarily used the platform to retweet others. He rarely appeared in public, and, when he did, it was usually in a controlled setting: he gave a few speeches, and, in 2018, starred in a popular Nike commercial.

By then, Kaepernick and his former teammate Eric Reid, who had joined Kaepernick’s protest early on, had filed a grievance with the N.F.L., alleging that teams had colluded to keep them out of the league. The N.F.L. settled the complaint in February, reportedly paying between one and ten million dollars. In the years since they first knelt, Reid has played for the Carolina Panthers. Kaepernick still hasn’t played for anyone. He said that he wanted to play, and, in theory, teams were free to sign him. Other quarterbacks got injured, and some healthy quarterbacks played terribly. Kaepernick remained out of sight—in some ways, arguably, more powerful for it.

Then, on Tuesday, word broke that the N.F.L. had invited Kaepernick to work out for league teams on Saturday, in Atlanta. He was reportedly given two hours to accept the invitation. Kaepernick’s camp wanted to know the names of who would be there; the N.F.L. declined to give him a list. He wanted to know the receivers the N.F.L. planned to provide; the league refused to tell him. (He decided to fly in his own.) In addition to these initial points of conflict, there were unanswered questions surrounding the whole event. Why was Kaepernick given so little time to prepare? Why was the invitation sent now, when ratings were up and the anthem controversy had died down? Why was it sent in the middle of the season, when teams would generally be less interested in signing a new quarterback—especially one who would invite as much scrutiny from the press and from fans as Kaepernick would? Why was the workout happening on a Saturday, when most head coaches and general managers would be busy preparing for their Sunday games, unable to make the trip, rather than on a Tuesday, when most free-agent workouts are held? Why was the league setting it up at all, given that individual teams were free to invite him to work out on their own?

Various answers to these questions were floated online and in the media, some of them based on reporting and others anchored only in speculation. Perhaps the N.F.L. commissioner, Roger Goodell, had sprouted a conscience. Perhaps Jay-Z had put him up to it. Perhaps it was just an ill-conceived publicity stunt. Perhaps some teams were legitimately interested in signing Kaepernick but didn’t want to deal with the sure-to-ensue Fox News segments that would accuse, say, the Detroit Lions of being insufficiently patriotic. Perhaps the league’s lawyers were trying to get Kaepernick to sign a waiver that would entail forfeiting his labor rights. (Reid focussed on the waiver, which was obtained by multiple media outlets, in an interview over the weekend.)

Regardless of whether the N.F.L. was up to something with that waiver—the league insists it was a “standard liability waiver,” and that the rewritten one offered by Kaepernick’s camp was “insufficient”—the document seems to have contributed to the last-minute breakdown in negotiations, on Saturday afternoon. It wasn’t the only issue. Another was the question of who would get to see Kaepernick throw, and how. Kaepernick wanted the media to be allowed in; the league did not. Kaepernick wanted to bring his own video crew to film the workout, possibly out of concern that the one provided by the Atlanta Falcons would not portray him fairly in the tape that the league would subsequently send to all thirty-two teams. (The league agreed to let the quarterback’s representatives watch the filming but would not let him bring his own cameras.) Hours before Kaepernick was set to take the field, his people announced that the previously announced workout was off, and that he would be holding his own workout at Charles R. Drew High School, south of Atlanta. Of more than twenty teams that had planned to have representatives at the workout, only eight ultimately sent scouts. Jay-Z was reportedly disappointed.

But this new setup turned the event from a private tryout into something else: now the rest of the world could be there, too. Hundreds of people watched through a chain-link fence behind one of the field’s end zones. Hundreds of thousands watched footage of the workout on YouTube. A band held Kaepernick’s Afro back from his face. He moved lightly on his feet. He wore black shorts and a black tank top, showing off shoulders that appeared more muscular than they were when he last played in an N.F.L. game. The ball came out of his hand fast and easily; long bombs landed accurately. He threw for about forty minutes and completed fifty-three of sixty throws. His arm strength, one N.F.L. executive present told ESPN, was “élite.”

But we knew that already. Even after three years out of the league, there is little question that Colin Kaepernick is better than a number of quarterbacks who have seen playing time this season. There may be team owners who remain put off by the political stands that Kaepernick has taken—there are surely owners who fear that signing Kaepernick would alienate some significant portion of their fans. In this view, whether Kaepernick is a force for good in the world for the United States is beside the point if he is bad for the bottom line. They are quite possibly wrong about this: despite a lot of noise about boycotts in the wake of Nike’s Kaepernick commercial, the company has done just fine in the year since the ad was released. And there is an obvious and easy argument to make for an owner who steps up to do the right thing—which could very well help his team. But the N.F.L., first and foremost, is a business. Winning isn’t the only thing. It’s not even the main thing.

Kaepernick’s decision not to accept the N.F.L.’s conditions, and to host his own workout instead, has prompted some prominent commentators to declare that he never wanted to come back in the first place. But one could as easily look at all the peculiarities of the setup and conclude that the N.F.L. was determined to discourage him from returning. Or perhaps the N.F.L. just wanted Kaepernick to demonstrate that, should he return, he would be willing to submit to the league’s authority. If that’s the case, then what went down on Saturday would surely be seen as his refusal to do so. Maybe Kaepernick sees himself as representing something bigger than the game of football now—if he does, he’d be right. Still, he clearly wanted people to see him play. And, on his own terms, he insured that they did, even if it meant that, on any given Sunday, he may not be seen again.