Tag Archives: public health

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.