Comer Family Foundation

LEXINGTON, KY – Opioid epidemics have ravaged rural areas across the United States; in regions as different as Alaska on the one hand and Appalachia on the other.

Eastern Kentucky's epidemic has made it into the national discussion, was covered on '60 Minutes' and featured in the Harlan County-set TV drama, 'Justified'.

If you search 'hillbilly heroin' in the address bar in a Safari browser, the first suggested result is the Wikipedia page for oxycodone.

The drug

opium, made from the seeds of the opium poppy - a flower of unassuming, delicate beauty - has been used as a painkiller and recreational drug for millennia. The latex-like substance itself contains various 'opiates', such as codeine and morphine, which can be further processed into heroin and other analgesics.

Oxycodone is a semisynthetic 'opioid.' While not an opiate itself, it's still ultimately biologically-derived. In Eastern Kentucky, practically everybody knows somebody who has been victimized by this drug, oxycodone, and demonized by the public, lumped in with the nameless hordes of 'pill heads,' like zombies but somehow worse.

On a large scale, it's easy to watch entire regions consumed like villages during the Black Death, like paper in a fire, and blame it on the residents. But on a personal level, you know people as human beings, and you know they're not zombies. It was their choice to take the drug in the first place, but why did they? What brought them to it? And why do some people become addicted and others don't, even when they've had the same background and both made the choice to try it? All these questions are very complicated, bound up in the highly statistical science of public health and the nearly mystical one of neuroscience.

Let's look at the sociology of public health. Studies have shown unequivocally that both mortality from and use of opioids is higher in rural areas than urban ones. Why? We don't know. It's almost certainly a result of many mitigating factors, from the boredom and general oppression/depression associated with rural poverty, to the related possibility of the opportunity to earn money by participating in a tax-free illegal market.

One study even hypothesizes that the culture of painkiller use in Appalachia results from the heavy toll on the body by heavy labor industries such as mining, a culture now become a runaway freight rain with the increased ease of access to these drugs in recent decades.

And then there's the neuroscience of addiction. It's increasingly common in psychiatry to view drug addiction as a mental illness, rather than a character fault. A well-known epidemiologist and trained doctor I once spoke to, (who could be called 'conservative' in this respect), declared the 'war on drugs' to be the business of public health officials and medical practitioners rather than law enforcement. So the hard, material science of neurological biochemistry supports the idea of addiction to be very much a mental illness, and yet many refuse to consider it as such. 

People who have devoted their lives to this topic, who have seen nearly every possible case imaginable, and they see a mental illness, not just a crime. What do we lose by treating people like human beings, by assuming the best? We certainly don't lose those whose addiction is by all accounts, jury-tried, family-tested, not just their fault. We certainly don't lose ourselves.

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