A tough pill to swallow

In the past three decades, we’ve seen the face of opiate addiction change drastically. The stereotypical heroin junkie used to fit a mold. They were dropouts and hippies, they were Vietnam veterans self-medicating to treat their PTSD, they were impoverished inner-city dwellers with little to lose but much to gain from a warm opium buzz. They were easily identifiable and even easier to forget about. If they didn’t overdose, they hung around long enough to get a hefty prison sentence, and then it was out of sight, out of mind.

Back then, there was little to no compassion for the junkie. This was before the cultural rebranding of opiate addiction that took place in the past decade. Nobody cared about compassion when the crack epidemic plagued the Black community in the 1980s. It’s only when middle-class white people started dying that we really made a fuss.

Compassion, within the context of contemporary rehab centers, drug court, and 12-step programs, is only awarded to addicts who actively want to quit. Only once an addict has displayed this desire, which I can assure you, is very tough for a heroin addict to even imagine doing, will he be offered entrance into the compassion club of mainstream recovery. This model excludes a large portion of opiate addicts who will probably never seek the help they truly need, because it doesn’t exist.

So what does compassion look like for the junkie that doesn’t want to change? There seems to be this belief that all opiate addicts would choose recovery if given the resources to change, but people aren’t addicted to heroin for the same reasons as they used to be. The quick rise of over-prescribed and cheap prescription opiates in the early 2000s has given birth to a generation in constant withdrawal. Percocet is a party drug. Smokeable black tar heroin plagued the community I grew up in. Benzodiazepines such as Xanax and club drugs like MDMA and Ketamine are continually found containing heroin or synthetic opiates like Fentanyl. It’s no longer associated with poverty and beatniks. It’s associated with the white middle class and suburbia, as well as the smaller towns that make up large portions of middle America.

Vancouver, British Columbia has the only clinic in North America that offers prescription grade heroin. According to an interview Scott Macdonald, the head physician at the Providence Crosstown Clinic, had with Vox in 2017, of the 200 patients treated at the Providence Crosstown they’ve had, not one single person has died while in their care. The heroin these patients receive is of a consistent purity, thus making overdose considerably less likely. Vancouver isn’t the first city to implement what is known on the streets as “shooting galleries.” Switzerland embraced these kinds of treatments in the 1990s, following a rapid rise in heroin use during the 1970s and 1980s, culminating in a full-blown public health crisis concerning the spread of HIV and AIDS. According to The Swiss Federal Policy on Public Health, overdoses have steadily declined since the programs were introduced in the 1990s.

In Oregon, we have free needle exchange programs to help avoid the spread of disease. These same programs also offer injectable Narcan, a drug administered during an overdose that reverses the effects of opiates, to anybody willing to sit through a ten-minute class. These programs that save lives recognize the inevitability of opiate addiction. However, this is only a Band-aid for the much larger issue surrounding impurities in the street heroin that addicts are unwittingly overdosing on daily. Legalizing heroin and controlling it the same way we control pharmaceuticals is a logical solution to helping “junkies” navigate their addictions without landing on a “hot shot.”

This is what compassion looks like for the modern day opiate addict. The epidemic is vast enough to warrant a new approach. We can’t simply push treatment on every addict. There aren’t enough resources available. We can’t simply lock everybody up. There aren’t enough jail cells. There isn’t a “one size fits all” solution to treating opiate addicts and recovery can look different depending on the person. Choosing a faith-based, 12-step program isn’t any more admirable than the person visiting the Methadone clinic for opiate maintenance treatment. It’s time we show compassion to all addicts, not just those who we deem worthy of it.