Tag Archives: opioids

A Floor for the Stool to Stand On

1 Apr

Last Monday, I attend committee of the whole meeting, a soiree in which the Duluth city councilors all gather together to hear a presentation, often from a city staffer or some contracted party. Monday’s topic was the recent spate of heroin-related deaths, overdoses, and arrests in Duluth. (Though city officials use it, I am going to shy away from using the term “epidemic,” for reasons I will explain later.) It showed a proactive city response, one that has already heard Mayor Emily Larson’s call to fight back.  Duluth is basically doing everything right. And yet it still may not matter.

Mike Tusken, the city’s Chief of Police, gave the presentation. Duluth is lucky to have Tusken, who is on the forefront of tackling issues like opioids, and has worked with many partners to develop a comprehensive strategy. He continues a long tradition of creative, community-minded policing in this city. He repeated himself several times: Duluth cannot arrest its way out of this problem.

Not that it can’t try. The city has been remarkably proactive to date. Its arrest and seizure rates far exceed other parts of the state, even when accounting for the higher addiction rates. They’ve overheard arrested dealers saying they have no desire to ever return to Duluth, as the police are all over them here.  Paradoxically,  with a crackdown on the supply and no change in demand, the price only rises, and increases the incentives for dealers to try their hand in this market. Without a change in demand, there will always be a reason for people to try to match the supply and make money off of it.

Tusken spoke of a three-legged stool necessary to combat the opiod surge, and spent plenty of time on the second leg, treatment. The opioid task force has an embedded social worker on hand to help with outreach. Needle exchanges, methadone clinics, drug court, treatment programs: there are a wide range of options available to people at various stages of addiction recovery, though in some cases, long wait times leads to people slipping through the cracks. When these programs are effective, expanding them only makes sense, and the police appear to be doing a good job of tracking data.

Finally, there is an education component, and once again, Duluth is staying as close to the cutting edge as it can in making sure the education leg of the stool relies on serious research and study. The city dropped its old DARE program for fifth graders because studies found it ineffective; now, with a new curriculum that has shown some initial promise, DPD is ramping it up again, recognizing that middle school health class is often too late to make this connection.

In short, combatting opioids requires a comprehensive strategy, and Duluth has built a comprehensive strategy. And yet I still find myself taking a skeptical bent. The opioid crisis is much more than a public health issue. Hence my misgivings over the word “epidemic,” which makes it sound like an outbreak of some virus. Treating it as such misses out on yet another element at play, and may mistake the symptoms for the disease.

Chief Tusken was at pains to emphasize how opioids affect everyone. Yes, at times these addictions can hit people who’ve been on them for, say, a sports injury. And yes, as with any drug, there are no doubt plenty of people from wealthier backgrounds who end up on them, whether due to peer pressure or ennui or an effort to escape dysfunction in some less material sphere of life. But let’s not bury the lede here: this particular crisis grew out of a particular class of people. Those who are toward the bottom of the economic ladder, even if they do not necessarily use drugs more than those toward the top, are much more likely to suffer its negative effects. The increase in middle-aged white mortality in the United States—a stunning reversal in recent years, one that runs counter to trends in other first-world countries and even other racial and ethnic groups in this one—is among the non-college educated.

This implies that the problem is socioeconomic, which in turn implies a need for socioeconomic solutions. Better education, more reliable careers for those who don’t have an education: we’ve heard all of these before, and it adds up to the fourth leg of a stool. The stories from later that evening make it clear how declining economic station can lead to feedback loops and greater struggles. This sort of crisis is a call to find solutions, and this is, I suppose, why I work in economic development. We have a lot to learn about how to adapt to an economy that looks drastically different from the one that made Duluth a powerhouse of the industrial era. Even with this city’s relative success when compared to many of its Rust Belt brethren, there are a lot of people who don’t have obvious long-term roles to play in the economy. Regardless, stable incomes and meaningful work are part of the solution.

But for all these pieces coming together, for all the scholarly rigor in making sure they work, this approach can’t quite go all the way. Take it from the pioneers of the first study to document the dying white non-college-grad trend have just come out and said it: the crisis goes much deeper than opioids.  Call it psychological, moral, spiritual: without an underlying belief system that informs a conception of what a complete human life looks like, all the policy tools in the book can’t turn the tide. Perhaps we can learn a thing or two from the Mormons; whatever one may think of their faith, they’re keeping the American Dream alive better than anyone else out there. Perhaps we just need to do a much better job of thinking holistically, especially when it comes to an honest accounting of the more troubled portions of individuals’ minds that we can’t just legislate away. People who have fought addictions and won know this better than anyone. Without a solid floor to stand on, it doesn’t matter how many legs there are on a stool.

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Progress Uber Alles: Duluth City Council Notes, 3/27/17

29 Mar

Oh no, the black hole is sucking me back in: I’m writing about Duluth City Council meetings again. Perhaps I’m out of practice after a few years away, but Monday’s edition certainly ranked among the most uncomfortable public meetings I’ve ever witnessed. I attended mostly for the pre-meeting Committee of the Whole about opioid abuse issues in the Duluth area, a topic about which I know little and am somewhat curious, especially after just reading a book on how they can consume a post-industrial town. I did, however, stick around for the more memorable part of the night: a debate over “Transportation Network Companies,” or TNCs, which is legalese for Uber and Lyft.

My caveats before I start: I rarely take taxis, in Duluth or anywhere else. My handful of experiences with cabs in Duluth have been fine, though I’ve also had a couple of nights where they were unreachable, and had another ride in a memorably dented cab. I have used Uber and Lyft with some regularity in larger cities and enjoyed those experiences, mostly because of the convenience and ease of the platform they operate on. Being able to request a ride with a few touches of a screen, see how far away that ride is, know the fare beforehand, and easily divide fares among riders makes life easier, especially for more spontaneous trips. The nicer vehicles don’t hurt, either. I’m aware that Uber has some ethical issues and implications for existing cab companies, but hadn’t given them much thought until Monday night. One can only fight our Silicon Valley overlords on so many fronts.

While the council chamber was filled with cab drivers and their various allies, only four came forward to speak. All expressed worry about the damage TNCs could cause to their business; many expected to be done. It was a hardscrabble crowd. Unlike many large cities, where immigrants have come to dominate the cab industry, this group’s membership was almost entirely from that category we’ve come to call “white working class” this past election cycle. They came out in numbers, they were angry, and they were largely resigned to yet another defeat.

Councilor comments began with Councilor Noah Hobbs, the author of the resolution, explaining his many efforts to regulate TNCs in a fair way that imposed standards without being onerous. He pointed to stringent insurance requirements and a clear permitting process, even if certain fees were somewhat lower that with cabs. Councilors Barb Russ, Zack Filipovich, and Howie Hanson lined up to support the resolution, all thanking Hobbs’ work and acknowledging the complexity of the issue. They all hinted at a certain inevitability when it came to TNCs; while none of them expressed much of an interest in using them, they said they knew which way the world was going, and had little choice.

With four ‘yes’ votes in the books, Council President Joel Sipress took the microphone, and began a lengthy discourse on his concerns about TNCs. He worried about their effects on existing cab companies, lamented the practice of employing drivers as contract employees (thereby skirting labor laws), and expressed disappointment in seeing money from local transportation swallowed up by a large outside company instead staying in the community. He then asked CAO Montgomery to elaborate on the city’s regulation mechanisms, who allowed the entire council chamber an opportunity to nap through this lengthy recitation. Satisfied, Sipress then announced that, for all his reservations, he would support the resolution, as he knew it was going to pass anyway and wanted to acknowledge the hard work done by Hobbs and city staff to find something workable. With a fifth ‘yes’ vote in hand, the cabbies all marched toward the exit, some adding choice words on their way; one announced that his Superior-based cabs wouldn’t cross the bridge again. The measure ultimately passed by a 7-1 margin, with Councilor Jay Fosle as the lone ‘no’ vote. (Councilor Elissa Hansen was absent.)

In the councilor comments following the meeting, Fosle politely rebuked Sipress’s intimation that his no vote wouldn’t have mattered: “Voting no matters to the people who it affects.” As a frequent lone ‘no’ vote, Fosle would certainly know. In opposition to the ordinance, he mounted a defense of threatened individuals and businesses in the here and now rather than relying on vague hopes it would all work out, and promises to revisit the issue if it didn’t. Fosle is a conservative in the truest sense of the word: he is here to conserve what exists, to protect people from changes in regulation no matter their station. He consistently speaks for people who do not have it easy and who are not at ease in these stately halls, even if they are not a majority, and if their plight goes far beyond the control of this little city council.

Howie Hanson, sounding as eloquent as I have ever heard him, pushed back. “I’m not sure our role is to protect businesses; it’s to level the playing field,” he said, hoping the regulations would do that. He pointed out how much the internet has changed things in countless fields: “you have to change or die.” As someone in the publishing industry, he would have some knowledge of this. “It’s scary. It’s hard to know what’s our role,” he concluded, sounding a very fair philosophical question.

The counterpoint comes from Celia Scheer, one of the cab drivers who spoke. It was difficult for her to come to this meeting, she said: it was the birthday of her late son, who had died of a heroin overdose in the past year. That might seem coincidental with the committee meeting on opioids at the start of the night, but the parallels here are all too real. She blamed government regulation for this and a previous job loss, though I think she misses the degree to which politicians are responding to market forces (on this issue, at the very least). Still, it is difficult not to see Ms. Scheer and her fellow drivers as victims of a changing world beyond their control, the poster children for the white working class that has been battered time and again by economic and social disruptions of recent decades.

The cab drivers are among the people with no safe home in a knowledge and technology-driven economy, and for whom even our most creative theories on community and economic development do little. If we’ve learned anything from the past few decades in politics and urban development, it is that decline and loss have particularly harsh effects. They linger, affect different generations, and can trap large swaths of the country in different worlds from its more successful enclaves. Nor is the political party typically associated with support for the downtrodden much of a voice here: all of the DFL-endorsed councilors supported this resolution, while the lone holdout is its most frequent critic. A more rigid partisan than I might use this as an opportunity to blast the direction of the Democratic Party, but I’m not sure that would be right, either. The emotional, raw side of politics has had a good run over the past year and a half, and while I do think we need that rawness to get beyond platitudes and fully understand people’s humanity, we also need to be able to step back and see the big picture.

As Councilor Hanson suggested, it’s hard to justify keeping a struggling industry alive for the sake of propping up the status quo. One speaker mentioned how he and other cabbies could have days where they earned little to no money. If that’s reality, frankly, it’s a sign that the market has too many drivers and not enough riders, and could also benefit from a near-universal real-time app that better matches supply to demand. Regulations might just be propping up a bad business model that distorts the market and passes off costs on consumers, who struggle to organize in response. Sure, the city could continue to prop up the cabs if it wanted to, much as the national government does with, say, the steel industry, another local economic driver that has had its share of misery in recent years. But this is a practice that can quickly grow out of hand and overly political, and with real service improvements from TNCs, comparatively few jobs at stake, and none of the geopolitical or national security implications of something like the steel industry, it’s hard to make a coherent case for the cabbies. If these jobs are on their way out the door, there’s no reason for the council to give false hope, when in reality we may just need to bite the bullet and admit that certain ways of life might just not be sustainable anymore. The city council just finds itself in the unenviable position of needing to deliver that message from on high.

Fortunately, we do have some evidence on the effects of TNCs beyond Duluth. Stories from some major cities point to clear drops in cab drivers, while the most recent and rigorous academic paper I can find on the topic points to no loss in employment, though there is some decline in income among traditional cab driver income only partially offset by the gains in the non-traditional sector. Many of the cabs will survive, though a number of the drivers will likely migrate over to TNCs, and overall options for transportation in Duluth will get better.

This is, however, little consolation to the people who stayed to plot their next moves alongside a row of cabs parked on Government Plaza, their alienation evident even from a distance as I trudged past to my car after the meeting. Even as I look forward to my first Uber ride in Duluth, this night will linger.