With rising overdose death rates driven by heroin and fentanyl, most indicators suggest that the worst of the crisis has yet to pass. Early 2016 data suggest that fentanyl has surpassed heroin in overdose deaths, skyrocketing 540 percent in three years to 20,100 deaths. Heroin abuse continues to rise. Abuse of prescription opioids appears to be falling, along with opioid prescription rates, but slowly, and deaths from the category of opioids that includes prescription pain relievers continue to rise.
Beyond the proximal factors contributing to the opioid crisis, there is the question of why some people succumb to addiction and some do not. As we have seen, there are regular patterns in the national picture of opioid use, abuse, and death; some people and places are more vulnerable to addiction than others. This is true of other forms of despair as well. The special evilness of opioids is that they offer practically no quarter to those who are most vulnerable to addiction. For opioid addicts, compared to others dependent on drugs, “the recovery period is longer and the chance of relapse is higher.” One study interviewed 109 patients following discharge from residential addiction treatment and found that over nine in ten reported a relapse, with nearly six in ten of those occurring in the first week.
Successfully combatting the opioid crisis will require that we better understand the sources of despair and vulnerability that lead to addiction. As Christopher Caldwell poignantly notes:
Calling addiction a disease usefully describes certain measurable aspects of the problem—particularly tolerance and withdrawal. It fails to capture what is special and dangerous about the way drugs bind with people’s minds. Almost every known disease is something people wish to be rid of. Addiction is different. Addicts resist known cures—even to the point of death. If you do not reckon with why addicts go to such lengths to continue suffering, you are unlikely to figure out how to treat them. This turns out to be an intensely personal matter.