Drug Addiction: A Complex Problem Requiring Complex Solutions

Every day, 91 Americans die from an opioid overdose. This shocking statistic is a clear signal that we are currently in the midst of the worst drug crisis in US history, according to the National Institute on Drug Abuse. Drug overdose is the leading cause of death for Americans under the age of 50, largely attributed to the rapidly worsening rates of opioid abuse. How this opioid epidemic spread across the nation is complex; similarly, treating the affected, preventing more deaths, and stopping the spread of this epidemic requires complex solutions.

Though the problem is widespread, so are the efforts to stop it. This year at TEDMED, we will hear the stories of three individuals leading the fight against the opioid crisis, and drug addiction more broadly. These Speakers come from West Virginia, which has the highest overdose rate in the country, a community library in Pennsylvania that sits next to an open space referred to as “Needle Park”, and British Columbia, Canada, home of the first legally-sanctioned supervised safe injection site in North America. By innovatively engaging their communities to combat the devastating opioid crisis, the TEDMED Speakers highlighted below are implementing promising new strategies to help stem the tide of this epidemic.

One of those individuals is Jim Johnson, the Director of the Mayor’s Office of Drug Control Policy in Huntington, West Virginia—a city with 10% of its 50,000 residents addicted to opioids. In Huntington, like in many cities and towns all across America, people from all walks of life—the young mother, the retired steelworker, the teenager—are affected by opioids, and the entire community bears the weight of addiction. One strategy that Huntington has used to deal with the drug crisis is incarceration. However, recent analyses have found that while state and federal prisons across the US house nearly 300,000 prisoners for violating drug laws, strict prison terms have not been correlated with decreases in drug use or drug related crime. As a former police chief and jail administrator, Jim realized that alternatives to incarceration were needed to effectively tackle addiction in his community. In his role at the Mayor’s Office, instead of solely working to curb the supply of illicit drugs, Jim chose to focus on decreasing demand. He’s partnered with diverse community organizations to help divert people addicted to opioids away from the prison system and to assist them in gaining access to treatment and reclaiming their health.

Huntington, West Virginia

The toll of addiction also reaches into schools, and tens of thousands of US children are affected by the opioid crisis. Like many of the children in Huntington, West Virginia, Chera Kowalski grew up exposed to drug abuse through her parents, who have been in recovery for over twenty years. Today, Chera is the Adult/Teen Librarian at the McPherson Square branch of the Free Library of Philadelphia, located in a neighborhood heavily affected by opioid abuse. Chera views the opioid crisis as a community issue, driven not just by individual behavior but by social determinants including limited employment, lack of housing, inadequate mental health treatment, and poor education.

Viewing the library as a public resource for her neighborhood, Chera sees her role, and the role of all public libraries, as one of community support and responsiveness. When Chera goes to work, she is there to help whoever comes through the library doors with whatever they need, to the best of her ability, at any time. Due to the library’s proximity to “Needle Park,” she is often involved in direct intervention with Naloxone—the injectable or nasal spray that blocks the effects of opioids—when someone overdoses outside the library. Other times, her role comes in the form of providing a supportive space for the young people in her community. Chera encourages kids affected by the opioid crisis to come to her for advice that often extends far beyond summer book recommendations and instead revolves around how to navigate difficult realities in their lives.

The Free Library of Philadelphia, McPherson Square Branch

Like Chera, Mark Tyndall, the Executive Medical Director for the British Columbia Centre for Disease Control, understands the importance of diverse types of community support for people and families battling drug addiction. Focused primarily on developing and implementing harm reduction models, Mark works closely with InSite, the first legally-sanctioned supervised injection facility in North America, which offers a clean location where people using illicit drugs can be treated with dignity. InSite also provides researchers with a valuable platform for data collection, enabling them to better understand the driving forces behind addiction. One such driving force is underlying trauma, as patients often use drugs to self-medicate. Mark believes that the best way to combat opioid addiction is by treating these underlying drivers and, in doing so, decrease demand for drugs.

The opioid crisis is complicated, and it demands intervention on multiple levels. These three TEDMED 2017 Speakers are pursuing solutions that help those affected across this spectrum. They are not alone, and a number of TEDMED’s Partner organizations are also working to combat this epidemic. Dr. Patrice Harris, head of the American Medical Association’s task force on opioid abuse will also be attending TEDMED this year, and she is calling for greater attention on treatment, saying that, “Until treatment for substance-abuse disorders is fully funded, I worry we won’t be able to reduce the number of overdose deaths.”

Given the severity of the opioid epidemic, we are looking forward to convening with these individuals and hearing their insights about this pressing health issue at this year’s TEDMED event. Their evidence-based health policy efforts, alongside their innovative and collaborative initiatives, are mobilizing communities to treat the underlying causes of the opioid epidemic, but there’s still more to be done. Join us this November to engage with these Speakers and to hear from them first-hand.

Now is the time to face the truth about drug use – Q&A with Carl Hart

In his TEDMED talk, Carl Hart offered a highly provocative but evidence based view of drug addiction and its links with crime. Carl speaks from personal experience; he grew up in a poor neighborhood in Miami, where he himself engaged in petty crime and drug use. Today, Carl is an Associate Professor of Psychiatry and Psychology at Columbia University, and a self-professed advocate for social justice and science.  

"I was unprepared for what I would learn as I went about making my contribution to the study of the neurobiology of addiction." - Carl Hart, TEDMED 2014 [Photo: Kevosk Djansezian]

“I was unprepared for what I would learn as I went about making my contribution to the study of the neurobiology of addiction.” – Carl Hart, TEDMED 2014 [Photo: Kevosk Djansezian]

We reached out to Carl to learn more about why his talk is particularly timely today. Here was his response:

Today – May 19 –  would have been Malcolm X’s 90th birthday, had he not been assassinated fifty years ago. Malcolm X’s influence on human rights, social justice activists, and me is increasingly apparent as society becomes more concerned about issues of over-policing in certain communities. My TEDMED talk, “Let’s quit abusing drug users,” is particularly important today because it illustrates the detrimental impact of aggressive selective drug law enforcement on communities of color.

In recent months, the issue of hostile, militarized policing has been pushed to the national forefront in response to the killing of the black, unarmed teenager, Michael Brown, by a white police officer in Ferguson, MO. Similar types of killings have occurred too often under the guise of the war on drugs. Eric Garner, Ramarley Graham, Kathryn Johnston, Trayvon Martin, and Tarika Wilson are just a few examples. In all of these cases, authorities suspected that the deceased individual was either intoxicated from or selling an illicit substance. This talk shows that dangers of drugs have been exaggerated, and that this has helped to created an environment where unjustified police killings are more likely to occur.

The importance of my talk is even further enhanced because too many people misattribute societal ills to drug problems. For example, the majority of people who use drugs – 80-90% – don’t have a drug problem. They are responsible members of our society. They are employed; they pay their taxes; they take care of their families; and in some cases, they even become President of the United States. Our three most recent Presidents all reported using illegal drugs when they were younger. In my talk, I clearly show that the real problems faced by society are not drugs but are poverty, unemployment, ignorance and the dismissal of science that surrounds drugs.

In my TEDMED talk, I also present intriguing results from my own research, during which we brought crack users into the laboratory and offered them $5 cash, or a hit of crack worth more than $5. We repeated this many times with each person over several days in the laboratory.  The drug users chose the drug about half of the time, and the $5 the other half. Even a nominal amount of money was enough to deter them from taking the drug at least half of the time. These findings are inconsistent with the notion that crack users display the insane, “anything for a hit” behavior that I had been previously taught. They also demonstrate how attractive alternatives, such as viable economic opportunities, can go a long way in decreasing societal problems, including drug abuse.

Watch Carl’s TEDMED 2014 talk, “Let’s quit abusing drug users,” here: