Greetings. It seems that somebody’s passing is the only thing that will stir me sufficiently to write about what’s going on in this benighted country.
I had anticipated writing this a week or two ago but I got sidetracked. It’s certainly not too late, since Hoffman’s death by heroin overdose is still being discussed in the media and by folks I run into. Yes, I know, he only died 5 weeks ago – February 2, to be precise – but our attention spans tend to be not too long.
Hoffman’s death was dramatic – found dead with a needle stuck in his arm with bags of heroin strewn nearby, a famous actor at the top of his craft with artistic heights still to climb. His death has been portrayed as a benchmark event and has drawn attention to the opioid abuse and addiction that has seemed to sweep the country. If it can happen to a man with everything to live for, it can happen to anyone in Vermont and Staten Island, to name two locales portrayed in two recent New York Times articles.
I never got to meet Hoffman, and I saw him in person on only two occasions: at the Public Theater’s production of Idiot Savant, starring Willem Dafoe, in December, 2009; and on Broadway in Death of a Salesman, in April, 2012. At the Public, he came in alone, no entourage, just another, non-descript member of a typical New York Sunday matinee audience. Yet everyone knew who he was, and we all probably figured he had come to see Dafoe. For us, Hoffman was, like Dafoe, a New York actor, not a celebrity. In Death of a Salesman, different story – you couldn’t take your eyes off him when he was onstage. He made Willie Loman real today, another middle-aged working stiff betrayed and humiliated by the corporate bosses to whom he had been loyal his entire working life. He reminded me and my wife and anybody paying attention why Miller’s play is still America’s greatest.
I knew nothing of Hoffman’s private life until I read Anthony Lane’s beautiful tribute to him in The New Yorker (“Postscript,” Feb. 17 & 24, 2014). I learned he was a family man, living with his partner, Mimi O’Donnell, and their three kids – boy, 10; two girls, 7 and 5 — in the West Village, often seen there when not working strolling the streets with them or running errands. He was only 46 when he died; and I was struck by the absence of speculation about the role his break-up with O’Donnell a few months prior might have played in his relapse and eventual overdose. How respectful of the media, I thought; or how dumb.
I was much more disappointed by the immediate zoom-in on Hoffman’s heroin addiction and the immediate and zealous search for villains, for the evil dealer. Soon enough, he and his compatriots had been arrested and their stash seized. How simplistic, but since when do the media and the general public want complexity? Those of us who have at least a rudimentary appreciation of human behavior know that addictions just don’t happen. Something must have occurred in Hoffman’s life that contributed to his relapse after twenty-plus years of sobriety – we might never know. We can speculate that his relapse led to his and O’Donnell’s break-up; again, we might never know whether other factors were involved. We do know, as Hoffman, himself, seems to have known, that once drug addiction takes hold of your body and your life, it can kill you.
The focus on heroin served to avoid consideration of these issues. It also diverted attention from oxycodone, the increasingly notorious pain-killing opioid, that re-opened the door for Hoffman and pushed him down the stairs. Reports in the media, particularly The Times (3/1/14), noted that Hoffman had begun using oxycodone several months earlier. The toxicology report completed after his death led the New York City medical examiner to conclude that he had been “killed by a poisonous mix of drugs that included … heroin … cocaine, amphetamines and sedatives…”
Yet, no outcry against Big Pharma for producing these drugs – the amphetamines, sedatives and the oxycodone – in the first place. Against the FDA for allowing them willy-nilly in the marketplace with little regulation. Nor against the GP’s who dispense these drugs like M&Ms.
Readers of the recent series of articles published by The Times since Hoffman died (2/11; 2/16; 3/6/14), can only conclude that oxycodone is the new “gateway” drug; that millions of Americans have been prescribed it and become addicted; or have raided Aunt Sylvia’s medicine cabinet and discovered the soothing effects of an opioid. Once hooked, oxycodone can become expensive, particularly if you can’t wangle a prescription from some indifferent medico. In New York State, individual prescribers’ scrips are tracked, particularly when addictive substances – the benzos and opioids – are prescribed. It’s not clear whether the new state regulations are deterring the facile prescription of these meds or whether they’ll eventually become a bureaucratic “feel-good” for the state’s politicians. And not all states – for example, neighboring New Jersey – are even doing that much.
Heroin is the next step for oxycodone abusers because it’s cheap — $4 a bag in Staten Island, New York City’s southernmost borough and the 19th century abode of Walt Whitman. Surprisingly, given the media hype, heroin is much less deadly than oxycodone. National statistics reported in one of The Times articles (2/11/14) showed that, in 2010, more than 19,000 persons suffered opioid-related drug deaths, 3,000 of which were from heroin. Oxycodone by a 5 to 1 margin. Given that more than half of those who died were younger than 34 and almost one-fifth were between the ages of 15 and 24, that margin could well shift. So long as heroin stays cheap and oxycodone so readily available, the number of deaths from heroin and from all opioids is certain to rise. At present, approximately 6 million Americans are believed to be opioid-addicted.
Of course, no one’s thought to ask, at least not in the media, why so many folks, particularly young “selfies”, are “tuning out and turning on.”
An old phrase, to be sure, and one which dates the writer, but unfortunately apt once again. It’s beginning to remind me of what happened in the latter half of the Vietnam War, when American draftees got strung out on the heroin they injected while on “r & r” in Bangkok and the U.S. Army began falling apart. That was the “smack” manufactured in the nearby “Golden Triangle” – Burma (Mynamar), Cambodia and Thailand – by the remnants of Chiang Kai Chek’s Nationalist Chinese army, those that didn’t make it to Taiwan, whose drug manufacture and smuggling was aided and abetted by the CIA and those conservative die-hards who still believed we could “save” China. Bangkok might have been the first stop for their “product;” Harlem and other black communities in the U.S. were the next. Don’t take my word for it. Read Peter Dale Scott’s several books on the subject (1991, 1998, 2003, 2009, 2010); and take a look at Ridley Scott’s American Gangster (2007), starring Denzel Washington and Russell Crowe, which nicely depicts what I just wrote.
So what do you do when you’re disillusioned from fighting — or opposing — a futile war? Why not drugs when you can’t find a decent paying job and can’t support yourself or your family? Is the situation any different now than it was forty years ago? Nixon, of course, isn’t around. But his legacy remains: the “War on Drugs (1971); the end of the military draft (1973); and welfare reform (1972). The first two initiatives were designed to strengthen the National Security State; the third, with all categorical income maintenance programs for the elderly and the disabled consolidated into SSI, became another brick in the foundation of what has now become known as the Therapeutic State.
Kirk, Gomori and Cohen provide a thorough description of the Therapeutic State in Mad Science … (2013). It’s the public mental health system writ large – the “Bigs”: Big Government, Big Pharma, Big University, Big Insurance; the acronyms: NIH, NIMH, APA, DSM, NAMI; the professionals: who earn their living there; the users of service: who get their treatment, i.e., meds, there. Follow the money – the pharmaceutical research funding; SSI, SSD, Medicaid, Medicare – and you’ll see that the Federal Government, with its “big” and “alphabet” partners, pretty much controls everything. The Therapeutic State.
Originally designed as an adjunct to the National Security State – c.f., Jonathan Metzl’s The Protest Psychosis … (2009) – the Therapeutic State has grown into its own entity within the national security apparatus. Its principal task, particularly since the advent of the DSM-III in 1980, has been to promote a neurobiological explanation of human behavior.
No job or prospects of one; beaten up by your partner; feeling down, despondent, maybe suicidal. You’re depressed; your brain is messed up – take a pill, preferably an SSRI.
Yes, its complementary task is to sell the psychoactive solution. Any evidence to support the theory and its remedies? No, but take your pill anyway and keep quiet. And get yourself on SSI.
Bottom line, the Therapeutic State is peddling what Kirk, et al, call “mad” science. I call it “faux” or “phony” science. Either way, it’s just one big shell game. What brought that home to me was when Obama, in the wake of the Newtown massacre and his failure to get any gun control measures through Congress, suddenly fastened on to the explanation proffered by the NRA — Adam Lanza (Newtown), James Holmes (Aurora) and Jared Loughner (Tucson) were simply crazy and E. Fuller Torrey had the answer. Psychoactive medication. Without it, persons diagnosed with serious mental illnesses, particularly schizophrenia were dangerous and capable of murder. Again, there’s no data to support this contention, but those in authority, starting with Obama, grabbed hold. Easier than butting heads with the NRA. So did the Congress. Increased funding for mental health services was the only gun control-related legislation enacted by Congress during 2013.
Same deal with the use of the heroin card in reporting Philip Seymour Hoffman’s death – another diversion in the shell game. Don’t ask about oxycodone. More importantly, don’t ask what difference actually exists between heroin and oxycodone. After all, both are opioid-based; both relieve pain; both are psychoactive medications that scramble your brains. The big difference, of course, is that heroin is illegal, another target of the “War on Drugs.” All profits go the Mexican cartels. As for oxycodone – no easy answer. One minute, provided you have a prescription for it, it’s legal, with profits to the Big Pharma company that holds the patent. The next, no prescription, buy it on the streets, provided you can afford it, profits to the dealer who sold it and his/her suppliers.
Marijuana’s getting even more complicated. Increasingly legal, for personal use – Colorado and Washington – or medicinal purposes – 20 states and growing, the DEA doesn’t know whom to arrest any more. The line between legal and illegal, “good” and “bad”, keeps on moving, confusing the hell out of the DEA and the FDA. What’s the solution? Continue the woeful “War on Drugs”, keep the DEA occupied, the prisons full and the proprietors of the for-profit “prison-industrial complex” in business? Or legalize everything and double or triple the size and responsibilities of the FDA? Just imagine – Big Pharma growing weed in its own aquaponic nurseries, investing in the Afghan poppy market; the Mexican cartels and California pot growers incorporating and going public on Wall Street.
Fun, even funny to think of, but actually just a much larger shell game. If we get caught up in such a debate or find ourselves obliged to bear witness to it, what of the poverty, the racism and the exploitation and misery that cause some folks to seek psychoactive escapes, whether illegal or not, and force others, even more vulnerable, into psychoactive shackles? I’m reasonably certain that Philip Seymour Hoffman and his family and friends do not want him and his death to be dragged into the middle of such a debate, to be used as a symbol to characterize the mad or phony choices I depicted above. He was a man whose time to die had simply come. As the Zen Buddhists are wont to say, “The world is perfect as it is.”
I’ll remember him as a great New York actor, who was able to bring to life on stage and screen men very much like me and others – honest and deceitful; happy and unhappy; brave and frightened; in love and in pain.
I’ll miss him.
As consolation, remember the spirit of Joe Hill is always available to us. Just conjure him up, continue to struggle, and organize.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
I have been reading your stuff religiously ever since I discovered you were a fellow disillusioned social worker. Actually, in the state of Ohio, I am no longer allowed to call myself a social worker. But, I digress.
Here, I just want to underscore a couple of your points, and open up the question of addiction to the Movement at large. At the very end of my imploding clinical career, I did about an 18 month stint as a drug counselor. I am the worst drug counselor on the planet. I cannot even keep myself clean and sober. Again, I digress. My point is that addiction CAN happen to anyone and it DOES kill. I believe I lost 6 individuals in 18 months. They were not movie stars. They were not at the height of their prowess in any professional field. Most had been effectively thrown away by our positive thinking obsessed culture, dying broke and alone. I’m not glad Hoffman is dead; but, I confess, I am much more indifferent to his death than to the deaths of the individuals I worked with in treatment every day. And, I think it is good and right that someone still stands for them. There are many others who need attention, help and compassion. They lack even 1/10 of 1% of Hoffman’s resources and supports.
I hear very little about addiction in the Movement that is not addiction to Benzos or some other equally heinous psychiatric medication. Yet addiction is a part of the DSM we oppose, and like other categories covered in the DSM, big pHarma is making “substitute” drugs all the time and the government is funding community treatment centers to push them. “Don’t take Heroin, take Methodone…”
Unbelievably enough, some people still ask me for advice on getting clean. I like to tell them, if you are going to do drugs, find something you enjoy and just do it. But take your drugs. Don’t take “their” drugs. Any other thoughts on these ramblings from Movement folks?
Sharon Cretsinger, XLISW
Founder, Kent Empowerment Center, Kent, Ohio
I can’t comment on your ability as a drugs counselor. How could I? I only know you online. I do not know your past clients, what was going on in their lives, the quality of support you were able to offer as limited by the agency you were employed by, what other support was on offer to them or the other factors that effect what happens to people who regularly take drugs and alcohol in potentially dangerous amounts.
I can tell you about the drug and alcohol work in the UK though because a friend was a drug counselor in several different services for a few years. Here in the UK these agencies are businesses who are commissioned on results. The tick-box approach to measuring success and the way business managers, often from retail, have been bought into run these business has resulted in a distortion in the way these businesses run. This is bad for clients and stressful for workers, though profitable for the private companies that run the businesses.
My friend told me about, “Cream skimming,” where managers tell the workers to mainly work with the easy to work with clients, the ones who are motivated to change, and then select one or two really hard clients for the workers job satisfaction. This looks good for the business as they get good results that way and keep the funders happy. I think the easy to work with clients might have turned their lives around anyway, they just needed a bit of encouragement and a lot of people can find that from friends.
My friend also told me about an agency he worked for that triaged drug and alcohol clients. He was expected to see about 80 clients a week, assess them, pass them onto the methodone clinic and refer them to counselling which might happen in six months. A lot of clients disclosed traumatic histories which had driven them to drink and drugs. They also disclosed histories of suicide attempts and serious self harm. He asked his manager, someone who had a business background and no experience of working with distressed people and who knew very little about why people drink and drug to dangerous amounts, what to do about this? They said that he needed to ignore the clients, pass them onto counselling, with the waiting list of six months, and get onto the next client.
My friend asked people who worked in commissioning services if what he was told was true? The commissioner said it was not true and that a service had a duty if someone was at serious risk to continue supporting the person until they got ongoing support from the counselling team.
No commissioner seemed to be checking up on this service, or several others.
My friend resigned with a letter, which he copied to the commissioners, saying that the practice of the agency was dangerous and fraudulent.
The agency lost that contract but then got another one.
So in my opinion competitive tendering and a business model for providing drug and alcohol services serves private business more than it serves the client.
I agree about the use of psychiatric drugs for drug and alcohol clients though. I know someone who has been on so called anti-depressants for years after coming off heroin. His hands shake constantly due to them. No one seems interested in sorting out why he used these drugs in the first place or why he feels he needs anti-depressants now.
Recent articles and sources listed on this website have reported evidence that in at least 30% of all opiate overdose deaths, bendodiazapines were found in the victim’s bloodstream. It is likely that the decisive ingredient in the drug cocktail leading to Philip Seymour Hoffman’s death was a benzo. Biological Psychiatrists and other doctors, with all their reckless prescribing patterns, are flying way below the radar in these prescription drug/opiate related deaths.
just a couple of additional puzzle pieces from a fellow (former) NYC social worker and street worker: Over fifty years worth of federal funding for research has failed to find evidence of damaging effects of pot use, but has inadvertently managed to provide support for claims of a variety of therapeutic effects. And though there has never been evidence that pot is in any way associated with violence, American jails are still filled with consumers and small dealers. And let’s not forget that Americans who have been jailed, lose their right to vote among others (but that is another issue). In the late 70’s M. Duncan Stanton did some very interesting NIDA (National Institute of Drug Abuse) funded research into returning Vietnam veterans and found that of those who were heavy users of heroin in Vietnam, more than 80% returned home and spntaneously stopped using heroin WITHOUT treatment of any kind! They simply didn’t know that they were supposed to be “addicted”!
Drug testing and the War on Drugs have been used by Dick Nixon and a number of other presidents since to police the work force (your employer can legally require you to pee in a cup on demand and fire you if you refuse!) , expand police powers, control “unruly” minorities, illegally intervene or invade third world countries, and on and on.
But back to the 1st world: In the late 70’s and early 80’s a drug researcher in Vancouver did some studies that called the dominant paradigm of “physical addiction” into question. By showing that rats, when provided with a rodent-friendly environment, will avoid drugs like heroin or cocaine even after heavy ingestion over several weeks time, the research exposed gaping holes in biological models of addiction, while proposing a more complex ecosystemic model. This research was so compelling that it was even presented before the Canadian parliament. But alas, we must forgive the researchers their naivete in underestimating the power of the international (aka American) war on drugs- their funding was simply cut.
A psychiatrist in Liverpool prescribed heroin, cocaine, amphetamines and various other illicit substances for over 10 years. The overdose death rate dropped to zero, there was a significant decrease in new HIV infections, criminality decreased, and many of those receiving drugs via prescription sought and found employment. Within a month after 60 Minutes had done a report about this wonderful program, the DEA applied enough pressure upon their English colleagues that the program was dismantled and turned into a methadone-maintenance clinic.
I could go on and on, but I’ll stop here with the words of the late great Gil Scott-Heron “makes you wanna holler…!!”
Methinks the war on drugs was never, ever about the drugs! It certainly has a lot to do with trying to control minorities.
Well where to begin…… a discussion of drug use, and especially Opiate use, could fill many volumes. But, our space and time here is limited.
When drugs like Oxycontin were approved by the FDA, it was well understood that they had a high abuse potential.. In fact one of the pharmaceutical companies, lied to the FDA about this during the approval process. This resulted in a fine. When those drugs began to be abused in gargantuan amounts instead of taking them off the market they were supposedly reformulated to keep them from being as easily abused. Needless to say that didn’t work.
These drugs should never have been approved. Why were they? Because the pharmaceutical companies and the FDA, enable each other, and because there are large profits to be made from their sale, either legally or illegally.
The other side of the story, is treatment. While we are in a prescription drug death epidemic, the insurance companies have decided they don’t want to pay for drug detox, and drug treatment. So many drug users can’t get help.
They would rather prescribe yet more drugs, like Suboxne, which are cheaper for them. (Suboxone, costs are much less then residential care which can run up to $1000 dollars a day.)
But sadly treatment is oriented because of how insures pay, toward prescribing legal medications, that do the same thing as street drugs do. But are often drugs of abuse themselves, much as Suboxone is now entering street markets as a drug of abuse.
Prescribing drugs to cure drug use is never gong to work. Its the exact wrong approach, but its the most profitable one. In fact success rates are much higher for people who quit drugs on their own without any help. There are good reasons for this, because they are unlikely to get prescription medications, that further depress their bodies natural endorphin system.
Forget, the NDA, and the FDA, our medical system is now controlled by those that believe treatment should consist of prescribing dangerous medications, and they will continue to ignore the evidence that it is a total and abysmal failure, because their goal is to protect the profits of the insurance companies and the pharmaceutical companies. Nothing else matters to them.