Our Misunderstanding of the Opioid Epidemic: Loneliness in America

By Ryan Pelosky ’21

Should the US rethink its response to the opioid crisis? (Photo Credit: Op-Med)
Should the US rethink its response to the opioid crisis? (Photo Credit: Op-Med)

In the 1970s, Canadian Dr. Bruce Alexander conducted a series of experiments that proved that our historical understanding of drug addiction—as a chemical dependency on particular drugs like heroin or cocaine—was, with few exceptions, completely misheld. These experiments are aptly named “the Rat Park experiments.”


For decades, doctors convinced Americans—and their politicians—that drug addiction derived completely from a chemical dependency through experiments on rats. Such experiments were conducted as rats were placed into dark, gloomy, and empty laboratory cages with two bottles of water: one filled with tap water and another with a water-morphine solution. Nearly all of the tested rats quickly became addicted to the morphine solution and died soon thereafter.


Dr. Alexander’s Rat Park was a large cage—200 times larger than normal lab rat cages—with between sixteen and twenty rats of both sexes, toys, food, and space for mating. Like the original experiments that claimed to have proven that addiction was a result of chemical dependency, there were two bottles of water in the Rat Park cages: one bottle of tap water and one bottle of tap water laced with a morphine solution, which was sweetened to ameliorate the poor taste of pure morphine.


In contrast, the environments of previous rat addiction experiments were crammed, gloomy, and lonely. Dr. Alexander’s control group rats were placed into the same environment: they lived alone in smaller cages, which did not have toys, food, or other rats. These rats consumed nineteen times more morphine solution than the rats in Rat Park.


Similarly, another group of rats was raised in normal laboratory cages and transferred to Rat Park, where they rejected the morphine solution completely. Only when Dr. Alexander added Naloxone—a drug that negates the effects of opioids—to the solution did the Rat Park rats begin to drink the morphine solution. In sum, all Rat Park rats rejected the morphine solution unless its psychological effects were dulled completely.


The Rat Park experiments yielded results that defied the false narrative of chemical-dependency addiction to opioids in America; rats that lived in Rat Park—with toys, light, and other rats—never once demonstrated dependency, addiction, or even a liking to the morphine-induced solution. Rats that were first placed into independent, control-group cages that had become addicted and were subsequently transferred to Rat Park quickly dropped their addiction to the morphine solution. While Dr. Alexander noted that these rats showed “minor withdrawal signs, twitching, what have you," "there were none of the mythic seizures and sweats you so often hear about.”


These results, which are to be assumed true for humans, are extraordinary. They demonstrate that addiction to opioids—Oxycontin, Percocet, heroin, fentanyl—arises as a result of one’s mental state—which itself is most often a product of their environment—more so than their dependency on the chemical makeup of the underlying opioid.


The current state of opioid addiction in the United States should warrant it a national health emergency. If made its own statistic (it is currently hidden under the guise of “Unintentional Injury” in ranking lists), drug overdoses would have been the seventh-leading cause of death in the United States in 2017 with more than 70,000 deaths—more than the wars in Vietnam, Afghanistan, and Iraq combined. The rate of overdose deaths from synthetic opioids that do not contain methadone (fentanyl, fentanyl analogs, tramadol) increased on average by 8 percent per year from 1999 to 2013 and 71 percent per year from 2013 through 2017, according to the Centers for Disease Control and Prevention (CDC).


Currently, the United States’ War on Drugs makes sure that heroin, fentanyl, and other opioid possessions are punishable by harsh sentences and crippling fines. Mandatory minimum sentencing makes narcotic possession and trafficking sentences extremely harsh in some states; for example, for possession of any amount of heroin in Washington is punishable by up to five years in prison, and possession of more than ⅛ of an ounce of heroin is punishable by one to five and a half years in prison for first-time offenders. Such sentences affect low-level users rather than cog-in-the-system traffickers. The far harsher sentences—between eight and twenty years in New York for possession of eight ounces of any narcotic—that are handed down to such traffickers will ruin one life only for another trafficker to be sent to take his/her place the following week, pumping drugs into neighborhoods and towns at the same rate as their predecessor.


After a 71 percent average increase year-over-year in non-methadone overdoses from 2013 to 2017, it’s evident that our current dealing with the opioid crisis is woefully uninformed, unsuccessful, and unsustainable. Instead of tasking politicians who see such criminals as “super-predators” with constructing a system to ameliorate such issues, we should assemble a board of scientists, psychologists, and researchers to find a proper remedy. Thankfully, this may not even be necessary, as we have models and large-scale human trials to model our new policies off of: those in Portugal and Switzerland.


At the turn of the 21st century, Portugal was enduring a daunting opioid crisis. One percent of its population was addicted to opioids, which, for reference, would total 3.3 million people in the United States. They had the highest HIV infection rates in the European Union. Their prime minister and opposition leader met and agreed to assemble a board of Portugal’s most distinguished doctors, psychologists, and experts in the field, who eventually arrived at the conclusion that full decriminalization of all drugs would be Portugal’s best step forward.


Decriminalization of such drugs, the Portuguese understood, is useless without offering a social structure and scaffolding to each recovering addict’s life. In turn, the Portuguese government commenced a wide-scale jobs program for all addicts, offered housing, and paired each with a therapist to help them reintegrate and restart their lives.


Since comprehensive decriminalization in 2001, Portugal’s overdose rate per 100,000 people is one-fifth of the European Union’s and one-fiftieth of the United States’. Their HIV infection rate has fallen by 96 percent. Incarceration rates have fallen precipitously as well, as those found with less than a ten-day supply are sent to rehabilitation centers, and higher-level traffickers, of which there are very few, are sent to jail.


Switzerland, which saw an opioid epidemic similar to ours or Portugal’s, decided in 1994 to dispense heroin at sites across the country. Addicts could go to dispensaries, which provided and supervised their use of free, medical-grade, clean heroin. At the same time, those who entered the dispensaries were paired with social workers and therapists who, like in Portugal, found jobs and housing for addicts as part of a government-sponsored works and housing program. Within three years, a referendum pushed by the opposition demonstrated popular support for the new measures: 70 percent of the Swiss populace voted in favor of keeping the same policies, largely because they all saw positive changes in daily life. Street crime dropped significantly, addicts were taken off the streets, and the new measures were far cheaper than paying for police and incarceration. In the last two decades, overdose deaths have fallen 64 percent, HIV infections have fallen more than 80 percent, drug-related crimes are down 75 percent, and theft is down 98 percent. As a result, spending on policing and incarceration dropped significantly, proving that decriminalization and structural support cost less than the War on Drugs.


It’s now time that we adopt such policies in the United States. The research has been done, and large scale trials in countries with similar epidemics have brought about a truth that many politicians do not want to hear: victimization, punishment, and shaming of addicts who have little control over their addiction does not work. Decriminalization of such drugs and structural, social, and emotional support of these addicts does work. We don’t become addicts that seek to numb the pain of reality when we have a loving family, strong relationships with friends, and a home and job. Americans become addicts as a result of their environments, turning to a substance that helps them escape their lonely, dark, hopeless reality.


In a society that is increasingly pushing its citizens into solitude, loneliness, and isolation, depression will only rise, and addiction worsen. Automation and artificial intelligence are destroying millions’ sense of self-worth as members of society—who wants to see their job taken and done better by a robot? Technology and social media trick us into believing falsehoods that pose a serious threat to our mental health. The friends whom we’ve met on social media won’t help us if we enter a period of struggle or hardship; we’ll only see what they choose to post and share—only things that reflect well upon them, things that make us feel worse. We won’t want to embarrass ourselves by reaching to them for help. As humans, we’re wired to value physical connection with others. Only our flesh-and-blood friends and family will notice what’s wrong and offer to help. We have to realize that.