Last Call

Emily Campbell, who is chronicling the start and evolution of the opioid crisis

Veer Mudambi

Worcester Magazine USA TODAY NETWORK

The new Hulu mini series, "Dopesick," is based largely on the 2018 book by Beth Macy, and shows how the now dissolved Purdue Pharma, owned by the Sackler family, along with lax regulations, pushed OxyContin in the 1990s. OxyContin’s introduction is now viewed as the start of the opioid epidemic, which has killed hundreds of thousands of people nationwide and addicted millions more. With this resonating in the public memory, Last Call sat down with local expert Emily Campbell, a professor of sociology at The College of the Holy Cross, whose current research is on the social, political and cultural implications of drug overdose death. In the last two decades, over 800,000 Americans have died of drug overdose, and her book project, tentatively titled "Grieving Overdose," tells the story of those left behind.

Why do you think that drugs have become as much a part of American culture as they have?

One piece of why we have the overdose crisis of such proportions and why it’s gotten worse in the last 20 years, is prohibition and the criminalization of drug use. What has been shown by political economists is that drugs become cheaper and more potent over time. Their use becomes more widespread and what we’ve seen is a snowball effect of the illicit market responding to ongoing prohibition. The war on drugs made them illegal and hard to find but that had the effect of driving down the price, so it was easier to afford drugs.

Wouldn’t supply and demand mean that prices would increase?

Demand over time draws more people into the illicit drug trade and that has the effect of depressing prices over time, not the opposite. It’s been dropping for decades now. It is counterintuitive in some ways.

Is there a medical solution that’s being underutilized?

Challenges on the medical end of being able to prescribe buprenorphine, some of which have been lifted but data shows that doctors continue to underprescribe this medicine. Buprenorphine is normally prescribed as part of a comprehensive treatment plan that includes counseling and other behavioral therapies to provide patients with a whole-person approach. These are very important measures that could streamline people into recovery. What we see with buprenorphine is that once people are prescribed and have access to care, they do extremely well and are able to get their lives together and no longer have the pain and suffering associated with chaotic drug use.

What is chaotic drug use?

It is drug use that has taken over somebody’s life, in a way that they can no longer maintain their basic wellbeing, and ordinary tasks are no longer as easy for them to complete because they are in a pattern of compulsive drug use. On the ground, in terms of preventing fatal overdoses, there are a number of other harm reduction methods being embraced, in particular naloxone, a nasal spray, which is designed to reverse overdoses to counteract life-threatening situations.

Would you say combatting chaotic drug use is a better first step than what we have now?

Yes, and ending the risks of consuming from a drug supply that is unpredictable, especially with the contamination of fentanyl. This is a very dangerous moment.

Fentanyl is 50 to 100 times stronger than morphine and accounts for 50% of the drug overdose deaths in Massachusetts. In terms of solutions, people need access to longterm treatment options which are currently very difficult to obtain due to the cost of drug

Emily Campbell, visiting assistant professor of sociology at the College of the Holy Cross. COLLEGE OF THE HOLY CROSS

treatment. People should be able to spend weeks getting care and just not a few days.

Fentanyl is the contaminant?

Yes, it has grown precipitously since 2013 when it started contaminating heroin but now it’s a very long list of drugs and people need to be aware of that.

In some of your other work, you comment how sobriety is always considered the end goal and how that’s not always the best way to do it. Expand?

It comes with a model of abstinence which is very prevalent in the United States. There are some that stigmatize medicine like buprenorphine, saying you’re not truly sober if you’re using it, which can be very damaging. Sobriety doesn’t work for everyone and once we can be honest about this, we can ask questions of how we can reduce the harm of drug use overall. We need to begin by humanizing people who use drugs. More pathways to recovery have to be expanded and be honest that some people will use drugs and we don’t want that to be a death sentence.

So sobriety is not the only form of recovery, you could say?

Yes, and when they have the choice of what to do with their body is when they begin to move away from chaotic drug use. Clean needle sites and safe injections are a form of recovery.

Anything to add? It has been said that the "Dopesick" mini-series could help Americans see that the drug abusers are not the problem but are often portrayed as culprits.

It is true that the stigma is something that affects recovery — it is spoken about a lot in the recovery community and people who have gone through the challenges of addiction in their families and lives. People need access to long-term treatment but stigma is very much about our cultural belief system and plays out in interpersonal dynamics in how we treat one another. All people are deserving of dignity and shouldn’t be ashamed to seek help and when they do, be treated with the dignity they deserve.