How Opiate Use Disorder Made Our World "The Leftovers"
It's a public health nightmare, and we are all guilty remnants.
We have had our sense of normalcy ripped away. Cataclysms and whatever the plural of apocalypse would be have a long place in our mythology. They don't have an easy place in our day-to-day life.
Fiction writers have tried to approach the problem of grief, at unimaginable scales, before.
We have ancient stories to warn us—the flood! Modern mythologists, prior to the death of HBO1, presented unimaginable lost as the show, “The Leftovers.” Our current relentless grief is moving closer to that fiction. Those writers imagined enough loss would drive us mad.
I suspect they are correct. We are not prepared. We have lost our ability to mourn at scale.
I will focus, here, on drug related deaths. I’m skipping death by suicide. This omission is to allow narrative focus. However, the specter of death by suicide can and should loom behind everything you read.
The total death rate in the US for every cause in 2020, in the middle of a global pandemic, was 835 per 100,000 people according to the CDC. The final data for 2020 show over 350,000 deaths from COVID-19. In these cases, the novel virus was the underlying cause of death.
The Leftovers was a TV show about overwhelming grief:
In a global cataclysm, "The Sudden Departure," 140 million people disappeared without a trace. …three years later, the equilibrium when the notion of "normal" no longer applies.
Intense grief has divided families and turned faith to cynicism, paranoia and madness, leading some of the traumatized to join the Guilty Remnant, a cultlike group.
For reference, people in the US know about 600 people.
The leftovers magic number was 2%. When we’re looking at population health numbers, it is 2000/100,000.
The difference between global apocalypse in which everybody goes insane and joins cults, in the minds of TV writers? It is only 2.4x the current annual rate.
It’s likely that the “indiscriminate” nature of a rapture is the issue, in creating a sense of horror with loss. There is an emotional correction factor we do for death, I suspect. The more we can say “they lived a good life,” the less we find the loss deviating.
Enter Drugs
The war on drugs ruined drugs. Drugs used to require scaremongering, because, to be clear, they weren’t scary enough. I’m not saying addiction is good, or not scary. There is a difference between your brain figuratively being a cracked egg:
And not breathing till one is dead after a single use of any given drug because of pervasive contamination of the supply of recreational drugs.
Drugs used to be “fun,” and would lead, eventually, to serious consequences. Drugs could ruin your life. But almost by definition, if you're alive to be warned about how bad it is, you're not dead yet.
The war on drugs media effort had to work to make them scarier. Perdue Pharma had the opposite mission: opioids were “dangerous”—thanks to the War On Drugs. Big Pharma? They worked very hard to make them acceptable and “safe enough.”
Ironically, recreational drugs are now sometimes immediately and unpredictably fatal. It’s not that drugs will “ruin your life,” which was always true for a subset of recreational users who became addicted. Recreational drug use has become so absurdly Russian Roulette that any one-off use can leave casual users dead. The more regular the use, the more likely the death.
Let’s review the data behind my assertions. As a harm-reduction enthusiast, I take both the role of drug use seriously, in the lives of people who make those choices, and the harm seriously.
Prior to 1980, the numbers were, in a study from Northern California:
In the period 1974 - 1981, based on the analyses of 35 drugs in biological samples taken in autopsies… Ethanol and phencyclidine were, however, more frequently found in drug-related cases of death….There was a slight overall increase from 1947 (7.9/100,000) to 1970 (19.3/100,000)
19.3 per 100,000 was the maximum prior to 1979. By 2020, it was 28.3 per 100,000. These are population risk numbers, and are terrifying but abstract.
It’s a problem, and it’s getting worse.
That messaging sounds suspiciously like the messaging we used to get in the 80s. And 90s. With enough screaming “the sky is falling,” it becomes hard to respond with sense when the sky is actually falling.
There were 91,799 Drug Overdose Deaths (aka abrupt death from drugs) in the same year. Here is the trend from the CDC related to death from overdose over time:
These drug overdose deaths kill people who are young, and they kill people are old.
We had massive increases in death. These deaths have been across kinds of drugs, because nothing that people get on the street is what they think it is anymore.
According to data from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, 106,699 people lost their lives to an overdose in 2021. Fentanyl remains the primary driver of these rising overdose trends with fentanyl-related overdose deaths increasing 22 percent between 2020 and 2021.
Among the young, the qa numbers are horrifying, as the CDC data from 2022 in those between 10 and 19 dying from overdose suggest:
Among 1,871 overdose deaths in 43 jurisdictions with available data on circumstances, 1,090 (60.4%) occurred at the decedent’s home. Potential bystanders††† were present in 1,252 (66.9%) deaths, and 1,089 (59.4%) decedents had no pulse when first responders arrived. Among deaths with one or more potential bystanders present, no documented bystander response was reported for 849 (67.8%), primarily because of spatial separation from decedents (52.9%) and lack of awareness that decedents were using drugs (22.4%). Naloxone administration was documented in 563 (30.3%) deaths.
That last line there hints at a pending horror augmentation: xylazine, a veterinary anesthetic about which I have written before, getting into the drug supply. Its street name is Tranq. Like tranquilizer. Get it?
The drug, when added to fentanyl, means that naloxone, a.k.a. Narcan, can't aways wake you up anymore. It makes the rate of abrupt death worse, because even EMS or Narcan can't save that child between 10 and 19.
I'm going to illustrate that number, with the following images in which each child is represented by a doll left behind:
This is a nightmare. It is a nightmare for EMS—who have to pick up the bodies they couldn't save. It is a nightmare for me, and my family. My sister Alison died, on the floor of her bathroom, after years of her opiate use disorder.
It's not just the other people who are dying. It is 1090 children, dead, in their own parents’ homes.
That was just last year. Everyone of those families know 600 people on average. So just among children 10-19, we have 600,000 child leftovers. More every year.
If we're looking at the personal connections of all drug related death, It was 55 million in 2020 from CDC listed overdose alone. It is 64 million 2021.
The characters on The Leftovers2 had tragedy happen all at once. They didn't actually have to keep going through it over and over again.
It's a Relentless Departure. It is indiscriminate. The grief can and will drive us mad. It feels like our current approach— simply repeat the term crisis over and over again like that solves anything— is the worst of all worlds. To quote the show, what we lack is a way to make sense:
“a regimen of hardship and humiliation that at least offered you the dignity of feeling like your existence bore some sort of relationship to reality, that you were no longer engaged in a game of make-believe”
—The Leftovers
Or, more simply:
A Call to Action:
Narcan is now over the counter. That is the change that is coming. It saves lives. As soon as it’s available: Have it at home. Have it at parties. Have it, and know how to administer it. It won't be long now …until you have a chance to save somebody's life.
—Owen Scott Muir, M.D.
And it's subsequent rebirth into the butterfly that is “Max”
Disclaimer: many images featured in this article, which explores themes of death and loss, are sourced from the HBO TV show "The Leftovers." The use of these images is intended as an homage to the program, which also deals with similar themes. The images remain the property of their respective copyright holders, including but not limited to HBO. We do not claim ownership or copyright over these images, and we acknowledge the creators and copyright holders of "The Leftovers." If you are the owner of any of these images and would like them removed, please contact us, and we will promptly comply with your request.