Popping Pills with Presidential Candidates

How has the abuse of narcotics gone mainstream? And what void in mainstream life do narcotics fill?

A question to the governor of Virginia: “Why is there no Narcan in the school system where we live?”  This came out during a “CNN Townhall.”  These televised productions feature non-random questions from non-randomly selected members of the public.

The person who posed the question about Narcan was the mother of a 15-year old boy who had succumbed to a fentanyl overdose.  The suggestion seems to be that this handsome young fellow was at school when he had ingested fentanyl.  One might inquire about whether he had wittingly ingested fentanyl—we hear much about drugs laced with potentially fatal concentrations of fentanyl—or whether ingesting fentanyl, other synthetic opioids, or natural opioids (“opiates”) has become both common and commonly accepted among younger people.

The Narcan question matters for at least three reasons.  First, there is a general understanding that the governor, Glenn Youngkin, is contemplating a run for the 2024 Republican nomination for President.  The governor is using such video content to brand himself to the electorate.  Second, the content reflects (it seems) the normalization of drug use and ready access to pharmaceuticals…  among children.  Why is that, and how did that happen?  Finally, I would suggest that the Narcan question reveals something about healthcare in America: The healthcare sector actively exploits what I would argue are the latent demands of consumers to medicalize everything.  Medicalizing everything fits into a larger ethos of victimization: health conditions are things that just happen; there is nothing to be done about them other than take “life-saving pharmaceuticals.”  Got a problem?  Take a pill.    

Let me take up these three matters in turn.  But, first, what is Narcan?  “Narcan” is a commercial name for a Naloxone.  “Naloxone is a life-saving medication that can reverse an overdose from opioids—including heroin, fentanyl, and prescription opioid medications—when given in time…There are two forms of naloxone that anyone can use without medical training or authorization: prefilled nasal spray and injectable.”  So says the CDC.

Now, about the governor’s politics: 

He took up the question of Narcan access in schools like a political pro.  I listened to his unfolding answer with some question of whether he would actually address the question or merely redirect it.  He did answer it, but first he did a very good job of commiserating with an aggrieved and grieving mother.  He demonstrated empathy, a quantity, a currency much appreciated since at least Bill Clinton’s 1996 victory in that year’s Presidential election.  (“I feel your pain.”)

Youngkin then proceeded to offer a direct and affirmative answer to the question: There had been federal monies directed to the supply of Narcan in schools (true?).  Those monies had been withdrawn, but the governor was in the process of supplanting those federal resources with state funds (true?).

The governor answered the question.  The answer may have been nonsense, but the governor managed to do what he has demonstrated great capacity to do: Come in to an inquisition heavily prepared to role out scripted answers to scripted questions.  There’s nothing spontaneous about it.

There is nothing spontaneous about this would-be presidential candidate.  He prevailed in the 2021 gubernatorial election in Virginia.  To do that, he had to overtake “Trump in heels” (state senator Amanda Chase), a self-anointed “Disruptor” and tech guru (Pete Snyder), as well as a Virginia establishment snoozer (Kirk Cox).  Youngkin presented himself as … I don’t know. He was the guy from the Carlyle Group about whom one could find Youtube videos of him doing for the Carlyle Group what he did throughout his campaign: confidently say a lot nothing about nothing. 

His gubernatorial campaign was not enterprising.  But a funny thing happened on the way to election day.  The gods of electioneering tossed a fob into the path of his campaign team—the path of least resistance—and his team had the good sense to pick it up and make something of it.  Parents of high-school-age children in Loudon County—a wealthy county right outside of Washington DC—had started showing up in appreciable numbers at school board meetings to complain about the school district’s mishandling of a sequence of sexual assaults on school grounds.  A young fellow had assaulted a fellow student in a girls’ bathroom.  This school district afforded the young man ready access to the girls’ bathroom, because he identified as a girl.  But, rather than deal with the assault, the school district endeavored to bury the matter. It transferred the young man to another school… where he proceeded to assault another female classmate.

A randomly selected sample of parents in Loudon County would likely yield a group of voters who had heavily favored Joe Biden in the 2020 Presidential election.  These parents would include federal employees as well as people who work for IT companies and defense contractors who maintain heavy presences just outside of DC in Northern Virginia.  These parents would likely be the kind of people who watch television news and buy into the concept of “Our Democracy.”  But, in the 2021 election, there was a 10-point swing in Loudon county from the 2020 vote for Democratic candidate for President (Joe Biden) to the vote for Republican candidate for governor (Glenn Youngkin).  That ten-point swing comprised Youngkin’s entire, state-wide winning margin.  So, yes.  Youngkin secured an “upset” win over the heavily-favored Clinton crony Terry McAuliffe, but the margin was very tight.  The win did not reflect a Republican resurgence so much as “a close-run thing” that could have tilted either direction.  Absent the ten-point swing in Loudon County, Youngkin would have lost.

Some establishment Republicans and Democrats seem to be hopeful that Youngkin will run for President, Because Orange Man:

Youngkin attracted national notice for one main reason: He showed that he could harness the coalition of voters who like Donald Trump without having his own reputation and candidacy be hijacked by the former president. His success seemed fueled in significant measure by the national political climate and the self-inflicted wounds of his normally skilled opponent, former Gov. Terry McAuliffe.

That’s the reliably left-authoritarian John Harris in Politico in a piece titled “Why Glenn Youngkin Would Be Crazy Not to Run for President: The Virginia governor offers two things Republicans need: A non-hostile alternative to Trump and a compelling centrist challenge to Biden.”

In terms of political skills, he is plainly as talented as other Republicans hoping to halt Trump’s return as the party’s nominee next year — but talented in different ways.

The Establishment loves “centrists,” because centrists do nothing.  They follow the path of least resistance.

About casual drug use among children:

What is the path of least resistance with respect to pharmaceuticals?  One dare not stray from the political message that the job of government is to secure “lower costs for life-saving pharmaceuticals.”  Further, the job of government is to affirm—or, at least, not question—the benefits of pharmaceuticals aimed at people of all ages, including children.  Indeed, children in the United States are more likely to be labeled with the condition “Attention-Deficit / Hyperactivity Disorder” (ADHD).  The CDC tells us that ADHD is “one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood.”

A child with ADHD might:

daydream a lot

forget or lose things a lot

squirm or fidget

talk too much

make careless mistakes or take unnecessary risks

have a hard time resisting temptation

have trouble taking turns

have difficulty getting along with others

Basically, being a kid qualifies one for the scarlet ADHD, and a common solution, evidently, is to prescribe kids amphetamines (“speed”) with commercial names like Adderall.

Speed supposedly helps people concentrate and perform better in school.  Performing better in school increases the prospect of a young person securing a place at an ostensibly prestigious college.  And a college degree, parents have been told for generations now, is a ticket to a financially secure life.

Basically, a college degree causes success.  A problem with such a proposition, however, is that it does not account for self-selection.  Historically, there may have been a correlation between college education and financial performance, but it is not obvious that just sending a random person to college would improve that person’s long-term financial prospects.  Indeed, that person’s prospects might decline given that that person will have given up time and energies that could have been devoted to other, productive pursuits.  Then there is the matter of financing.  Going in to debt to go to college might not suit everyone well.  We know that, for why else would “cancelling college debt” emerge as a potent political issue?

I pose the race to get kids into college as a misguided “arms race” by which parents and their kids waste enormous resources.  “Arms race” might not constitute the perfect metaphor here, but it does suggest a game that has no equilibrium in that players engage more and more resources for the pursuit of illusory gains.  That arms race, meanwhile, has attracted the predatory attentions of the pharmaceuticals industry.  It’s been happy to medicalize childhood into conditions worthy of pharmacological interventions.  So, we have more and more children identified with “learning disorders” and behavioral problems.  Pumping up children with speed, evidently, amounts to a responsible intervention. Then there is the burgeoning business of “gender-affirming care” …

So, what does this have to do with opioid use and abuse?  I merely speculate that a few decades of turning childhood into a medical problem demanding pill-popping solutions has engendered a culture of casual pill-popping.  Taking speed went mainstream.  Taking narcotics has become mainstream.

I have no direct insights into the mainstreaming of drug abuse—I do not have kids in high school, for example—but one can’t help but wonder why the virtual mainstreaming of narcotics, marijuana and speed has not motivated more discussion about what to do about it.  Indeed, the best a governor and the governed can do is puzzle about emergency pharmacological remedies to drug overdoses.  Solve drug problems with more drugs.  That was the demand put to the governor in his “CNN Townhall,” and that was the remedy the governor promised to provide.  But what of the fundamental problem of people, whether young or old, popping pills for the fun of it?

Hence the last point: Everyone is a victim.  No one can exercise agency.

Opioid abuse has been medicalized into “opioid use disorder (OUD)”.  According to the CDC, “OUD is a treatable, chronic disease that can affect anyone – regardless of race, gender, income level, or social class.”  So, opioid abuse is just something someone can casually fall into through no effort of one’s own?

The account of the opioid phenomenon in Beth Macy’s Dopesick (2018) does suggest at least one way that people really can just fall into the bad, addictive equilibrium that is OUD.  The Pharma industry made an effort to market pain relief as not a band-aid solution to serious injuries and chronic conditions but as a definitive solution to serious injuries and chronic conditions.  Pharmaceuticals companies encouraged physicians to place injured lumberjacks and coal miners—or anyone with “severe to moderate pain”—on potentially long-running opioid regimens.  Under-documented and underappreciated was the fact that these opioid treatment regimens really could suck people into the vortex of addiction, of dopesickness, of OUD.

One thing I get from Dopesick is the fact that the opioid phenomenon has not altogether involved the recreational abuse of narcotics.  It was the kind of thing that really did victimize the kind of people who would have been least likely to get hooked on drugs.  Those people had been employed people.  Those people are people working hard to pay the rent and make things happen for themselves.  Those people have demonstrated some capacity to exercise agency.  Which brings this idea to mind: One might be skeptical of easy demands for “drug treatment programs” to deal with addiction.  Indeed, insofar as drug abuse really is “recreational” in that it conforms to a kind of escapism, then what can a program achieve if it does not directly address demands for escapism?  But people who had demonstrated a capacity and desire to work and take of themselves—these people might make for better candidates for rehabilitation through the course of program.  So, I will pose that hypothesis: There really are people who can be identified as better candidates for drug treatment.  Relatedly, the best treatment program is an economy that produces a serious volume of serious jobs. People who have something to work for have less to escape from. But, what do the data say?  Have actionable data been systematically recorded?

I will have to look into it, but one thing I can say is that Dopesick (2018) motivated the miniseries Dopesick (2021).  The script, especially over the course of the opening two episodes, is impressive and believable.  It gave me the impression of being back on the inside (inside the federal government) talking to outside parties and conferring with colleagues on the inside.  More than that, the story aligns with all of the evidence of promiscuous relationships between government and big business that we have yet witnessed over the last few years.  Revolving door between Big Pharma and the FDA?  There it is.  Is it like the revolving door between the Pentagon and “defense contractors”?  It certainly is.  Does it involve the distortion of public policy to suit the demands of big private interests?  Yes.  But, the problems are more extensive than that.  I look back on the governor’s “CNN Townhall” and can’t help but marvel at the willing participation of the pill-popping public in its own immiseration.  Getting injured working people hooked on drugs is a bad business.  But the casual mainstreaming of drug use …  Where are the adults?

People have been victimized. They were the kind of people least likely to perceive themselves as victims, but they got led down a bad path.  But, are there not also those who perceive strategic advantages to identifying as a victim?  Does status as a victim, formally recognized by the educational authorities, facilitate passage through the narrow door to college admission?  Is victimhood self-anointed, and does it relieve one of having to exercise agency?