Heroin Essay Titles

Michael Barrett and Jenna Mulligan, emergency paramedics in Berkeley County, West Virginia, recently got a call that sent them to the youth softball field in a tiny town called Hedgesville. It was the first practice of the season for the girls’ Little League team, and dusk was descending. Barrett and Mulligan drove past a clubhouse with a blue-and-yellow sign that read “Home of the Lady Eagles,” and stopped near a scrubby set of bleachers, where parents had gathered to watch their daughters bat and field.

Two of the parents were lying on the ground, unconscious, several yards apart. As Barrett later recalled, the couple’s thirteen-year-old daughter was sitting behind a chain-link backstop with her teammates, who were hugging her and comforting her. The couple’s younger children, aged ten and seven, were running back and forth between their parents, screaming, “Wake up! Wake up!” When Barrett and Mulligan knelt down to administer Narcan, a drug that reverses heroin overdoses, some of the other parents got angry. “You know, saying, ‘This is bullcrap,’ ” Barrett told me. “ ‘Why’s my kid gotta see this? Just let ’em lay there.’ ” After a few minutes, the couple began to groan as they revived. Adults ushered the younger kids away. From the other side of the backstop, the older kids asked Barrett if the parents had overdosed. “I was, like, ‘I’m not gonna say.’ The kids aren’t stupid. They know people don’t just pass out for no reason.” During the chaos, someone made a call to Child Protective Services.

At this stage of the American opioid epidemic, many addicts are collapsing in public—in gas stations, in restaurant bathrooms, in the aisles of big-box stores. Brian Costello, a former Army medic who is the director of the Berkeley County Emergency Medical Services, believes that more overdoses are occurring in this way because users figure that somebody will find them before they die. “To people who don’t have that addiction, that sounds crazy,” he said. “But, from a health-care provider’s standpoint, you say to yourself, ‘No, this is survival to them.’ They’re struggling with using but not wanting to die.”

A month after the incident, the couple from the softball field, Angel Dawn Holt, who is thirty-five, and her boyfriend, Christopher Schildt, who is thirty-three, were arraigned on felony charges of child neglect. (Schildt is not the biological father of Holt’s kids.) A local newspaper, the Martinsburg Journal, ran an article about the charges, noting that the couple’s children, who had been “crying when law enforcement arrived,” had been “turned over to their grandfather.”

West Virginia has the highest overdose death rate in the country, and heroin has devastated the state’s Eastern Panhandle, which includes Hedgesville and the larger town of Martinsburg. Like the vast majority of residents there, nearly all the addicts are white, were born in the area, and have modest incomes. Because they can’t be dismissed as outsiders, some locals view them with empathy. Other residents regard addicts as community embarrassments. Many people in the Panhandle have embraced the idea of addiction as a disease, but a vocal cohort dismisses this as a fantasy disseminated by urban liberals.

These tensions were aired in online comments that amassed beneath the Journal article. A waitress named Sandy wrote, “Omgsh, How sad!! Shouldnt be able to have there kids back! Seems the heroin was more important to them, than watchn there kids have fun play ball, and have there parents proud of them!!” A poster named Valerie wrote, “Stop giving them Narcan! At the tax payers expense.” Such views were countered by a reader named Diana: “I’m sure the parents didn’t get up that morning and say hey let’s scar the kids for life. I’m sure they wished they could sit through the kids practice without having to get high. The only way to understand it is to have lived it. The children need to be in a safe home and the adults need help. They are sick, i know from the outside it looks like a choice but its not. Shaming and judging will not help anyone.”

One day, Angel Holt started posting comments. “I don’t neglect,” she wrote. “Had a bad judgment I love my kids and my kids love me there honor roll students my oldest son is about to graduate they play sports and have a ruff over there head that I own and food, and things they just want I messed up give me a chance to prove my self I don’t have to prove shit to none of u just my children n they know who I am and who I’m not.”

A few weeks later, I spoke to Holt on the phone. “Where it happened was really horrible,” she said. “I can’t sit here and say different.” But, she said, it had been almost impossible to find help for her addiction. On the day of the softball practice, she ingested a small portion of a package of heroin that she and Schildt had just bought, figuring that she’d be able to keep it together at the field; she had promised her daughter that she’d be there. But the heroin had a strange purple tint—it must have been cut with something nasty. She started feeling weird, and passed out. She knew that she shouldn’t have touched heroin that was so obviously adulterated. But, she added, “if you’re an addict, and if you have the stuff, you do it.”

In Berkeley County, which has a population of a hundred and fourteen thousand, when someone under sixty dies, and the cause of death isn’t mentioned in the paper, locals assume that it was an overdose. It’s becoming the default explanation when an ambulance stops outside a neighbor’s house, and the best guess for why someone is sitting in his car on the side of the road in the middle of the afternoon. On January 18th, county officials started using a new app to record overdoses. According to this data, during the next two and a half months emergency medical personnel responded to a hundred and forty-five overdoses, eighteen of which were fatal. This underestimates the scale of the epidemic, because many overdoses do not prompt 911 calls. Last year, the county’s annual budget for emergency medication was twenty-seven thousand dollars. Narcan, which costs fifty dollars a dose, consumed two-thirds of that allotment. The medication was administered two hundred and twenty-three times in 2014, and four hundred and three times in 2016.

One Thursday in March, a few weeks before Michael Barrett responded to Angel Holt’s overdose, I rode with him in his paramedic vehicle, a specially equipped S.U.V. He started his day as he often does, with bacon and eggs at the Olde Country Diner, in Martinsburg. Barrett, who is thirty-three, with a russet-colored beard and mustache, works two twenty-four-hour shifts a week, starting at 7 a.m. The diner shares a strip mall with the E.M.T. station, and, if he has to leave on a call before he can finish eating, the servers will box up his food in a hurry. Barrett’s father and his uncles were volunteer firemen in the area, and, growing up, he often accompanied them in the fire truck. As they’d pull people from crumpled cars or burning buildings, he’d say to himself, “Man, they doing stuff—they’re awesome.” When Barrett became a paramedic, in his twenties, he knew that he could make a lot more money “going down the road,” as people around here say, referring to Baltimore or Washington, D.C. But he liked it when older colleagues told him, “I used to hold you at the fire department when you were a baby.”

Barrett’s first overdose call of the day came at 8 a.m., for a twenty-year-old woman. Several family members were present at the home, and while Barrett and his colleagues worked on her they cried and blamed one another, and themselves, for not watching her more closely. The woman was given Narcan, but she was too far gone; she died after arriving at the hospital.

We stopped by a local fire station, where the men and women on duty talked about all the O.D. calls they took each week. Sometimes they knew the person from high school, or were related to the person. Barrett said that in such cases you tended “to get more angry at them—you’re, like, ‘Man, you got a kid, what the hell’s wrong with you?’ ”

Barrett sometimes had to return several times in one day to the same house—once, a father, a mother, and a teen-age daughter overdosed on heroin in succession. Such stories seemed like twisted variations on the small-town generational solidarity he admired; as Barrett put it, even if one family member wanted to get clean, it would be next to impossible unless the others did, too. He was used to O.D. calls by now, except for the ones in which kids were around. He once arrived at a home to find a seven-year-old and a five-year-old following the instructions of a 911 operator and performing C.P.R. on their parents. (They survived.)

Around three o’clock, the dispatcher reported that a man in Hedgesville was slumped over the steering wheel of a jeep. By the time we got there, the man, who appeared to be in his early thirties, had been helped out of his vehicle and into an ambulance. A skinny young sheriff’s deputy on the scene showed us a half-filled syringe: the contents resembled clean sand, which suggested pure heroin. That was a good thing—these days, the narcotic is often cut with synthetic painkillers such as fentanyl, which is fifty times as powerful as heroin.

The man had floppy brown hair and a handsome face; he was wearing jeans, work boots, and a black windbreaker. He’d been revived with oxygen—he hadn’t needed Narcan—but as he sat in the ambulance his eyes were only partly opened, and his pupils, when I could catch a glimpse of them, were constricted to pinpoints. Barrett asked him, “Did you take a half syringe? ’Cause there’s half a syringe left.” The man looked up briefly and said, “Yeah? I was trying to take it all.” He said that he was sorry—he’d been clean for a month. Then he mumbled something about having a headache. “Well, sure you do,” another paramedic said. “You weren’t breathing there for a while. Your brain didn’t have any oxygen.”

The man’s jeep sat, dead still, in the middle of a street that sloped sharply downhill. A woman introduced herself to me as Ethel. She had been driving behind the man when he lost consciousness. “I just rolled up, saw he was slumped over the wheel,” she said. “I knew what it was right away.” She beeped her horn, but he didn’t move. She called 911 and stayed until the first responders showed up, “in case he started to roll forward, and maybe I could stop traffic—and to make sure he was O.K.” I asked if the man’s jeep had been running during this time. “Oh, yeah,” she said. “He just happened to stop with his foot on the brake.” Barrett shared some protocol: whenever he came across people passed out in a car, he put the transmission in park and took their keys, in case they abruptly revived. He’d heard of people driving off with E.M.T. personnel halfway inside.

The sky was a dazzling blue, with fluffy white clouds scudding overhead. The man took a sobriety test, wobbling across the neat lawn of a Methodist church. “That guy’s still high as a kite,” somebody said.

We were driving away from Hedgesville when the third overdose call of the day came, for a twenty-nine-year-old male. Inside a nicely kept house in a modern subdivision, the man was lying unconscious on the bathroom floor, taking intermittent gasps. He was pale, though not yet the blue-tinged gray that people turn when they’ve been breathing poorly for a while. Opioid overdoses usually kill people by inhibiting respiration: breathing slows and starts to sound labored, then stops altogether. Barrett began preparing a Narcan dose. Generally, the goal was to get people breathing well again, not necessarily to wake them completely. A full dose of Narcan is two milligrams, and in Berkeley County the medics administer 0.4 milligrams at a time, so as not to snatch patients’ high away too abruptly: you didn’t want them to go into instant withdrawal, feel terribly sick, and become belligerent. Barrett crouched next to the man and started an I.V. A minute later, the man sat up, looking bewildered and resentful. He threw up. Barrett said, “Couple more minutes and you would have died, buddy.”

“Thank you,” the man said.

“You’re welcome—but now you need to go to the hospital.”

The man’s girlfriend was standing nearby, her hair in a loose bun. She responded calmly to questions: “Yeah, he does heroin”; “Yeah, he just ate.” The family dog was snuffling at the front door, and one of the sheriff’s deputies asked if he could let it outside. The girlfriend said, “Sure.” Brian Costello had told me that family members had grown oddly comfortable with E.M.T. visits: “That’s the scary part—that it’s becoming the norm.” The man stood up, and then, swaying in the doorway, vomited a second time.

“We’re gonna take him to the hospital,” Barrett told the girlfriend. “He could stop breathing again.”

As we drove away, Barrett predicted that the man would check himself out of the hospital as soon as he could; most O.D. patients refused further treatment. Even a brush with death was rarely a turning point for an addict. “It’s kind of hard to feel good about it,” Barrett said of the intervention. “Though he did say, ‘Thanks for waking me up.’ Well, that’s our job. But do you feel like you’re really making a difference? Ninety-nine per cent of the time, no.” The next week, Barrett’s crew was called back to the same house repeatedly. The man overdosed three times; his girlfriend, once.

It was getting dark, and Barrett stopped at a convenience store for a snack—chocolate milk and a beef stick. That evening, he dealt with one more O.D. A young woman had passed out in her car in the parking lot of a 7-Eleven, with her little girl squirming in a car seat. An older woman who happened on the scene had taken the girl, a four-year-old, into the store and bought her some hot chocolate and Skittles. After the young woman received Narcan, Barrett told her that she could have killed her daughter, and she started sobbing hysterically. Meanwhile, several guys in the parking lot were becoming agitated. They had given the woman C.P.R., but someone had called 911 and suggested that they had supplied her with the heroin. The men were black and everybody else—the overdosing woman, the older woman, the cops, the ambulance crew—was white. The men were told to remain at the scene while the cops did background checks. Barrett attempted to defuse the tension by saying, “Hey, you guys gave her C.P.R.? Thanks. We really appreciate that.” The criminal checks turned up nothing; there was no reason to suspect that the men were anything but Good Samaritans. The cops let the men go, the young woman went to the E.R., and the little girl was retrieved by her father.

Heroin is an alluringly cheap alternative to prescription pain medication. In 1996, Purdue Pharma introduced OxyContin, marketing it as a safer form of opiate—the class of painkillers derived from the poppy plant. (The term “opioids” encompasses synthetic versions of opiates as well.) Opiates such as morphine block pain but also produce a dreamy euphoria, and over time they cause physical cravings. OxyContin was sold in time-release capsules that levelled out the high and, supposedly, diminished the risk of addiction, but people soon discovered that the capsules could be crushed into powder and then injected or snorted. Between 2000 and 2014, the number of overdose deaths in the United States jumped by a hundred and thirty-seven per cent.

Some states became inundated with opiates. According to the Charleston Gazette-Mail, between 2007 and 2012 drug wholesalers shipped to West Virginia seven hundred and eighty million pills of hydrocodone (the generic name for Vicodin) and oxycodone (the generic name for OxyContin). That was enough to give each resident four hundred and thirty-three pills. The state has a disproportionate number of people who have jobs that cause physical pain, such as coal mining. It also has high levels of poverty and joblessness, which cause psychic pain. Mental-health services, meanwhile, are scant. Chess Yellott, a retired family practitioner in Martinsburg, told me that many West Virginians self-medicate to mute depression, anxiety, and post-traumatic stress from sexual assault or childhood abuse. “Those things are treatable, and upper-middle-class parents generally get their kids treated,” he said. “But, in families with a lot of chaos and money problems, kids don’t get help.”

In 2010, Purdue introduced a reformulated capsule that is harder to crush or dissolve. The Centers for Disease Control subsequently issued new guidelines stipulating that doctors should not routinely treat chronic pain with opioids, and instead should try approaches such as exercise and behavioral therapy. The number of prescriptions for opioids began to drop.

But when prescription opioids became scarcer their street price went up. Drug cartels sensed an opportunity, and began flooding rural America with heroin. Daniel Ciccarone, a professor at the U.C.-San Francisco School of Medicine, studies the heroin market. He said of the cartels, “They’re multinational, savvy, borderless entities. They worked very hard to move high-quality heroin into places like rural Vermont.” They also kept the price low. In West Virginia, many addicts told me, an oxycodone pill now sells for about eighty dollars; a dose of heroin can be bought for about ten.

A recent paper from the National Bureau of Economic Research concludes, “Following the OxyContin reformulation in 2010, abuse of prescription opioid medications and overdose deaths decreased for the first time since 1990. However, this drop coincided with an unprecedented rise in heroin overdoses.” According to the Centers for Disease Control, three out of four new heroin users report having first abused opioids.

“The Changing Face of Heroin Use in the United States,” a 2014 study led by Theodore Cicero, of Washington University in St. Louis, looked at some three thousand heroin addicts in substance-abuse programs. Half of those who began using heroin before 1980 were white; nearly ninety per cent of those who began using in the past decade were white. This demographic shift may be connected to prescribing patterns. A 2012 study by a University of Pennsylvania researcher found that black patients were thirty-four per cent less likely than white patients to be prescribed opioids for such chronic conditions as back pain and migraines, and fourteen per cent less likely to receive such prescriptions after surgery or traumatic injury.

But a larger factor, it seems, was the despair of white people in struggling small towns. Judith Feinberg, a professor at West Virginia University who studies drug addiction, described opioids as “the ultimate escape drugs.” She told me, “Boredom and a sense of uselessness and inadequacy—these are human failings that lead you to just want to withdraw. On heroin, you curl up in a corner and blank out the world. It’s an extremely seductive drug for dead-end towns, because it makes the world’s problems go away. Much more so than coke or meth, where you want to run around and do things—you get aggressive, razzed and jazzed.”

Peter Callahan, a psychotherapist in Martinsburg, said that heroin “is a very tough drug to get off of, because, while it was meant to numb physical pain, it numbs emotional pain as well—quickly and intensely.” In tight-knit Appalachian towns, heroin has become a social contagion. Nearly everyone I met in Martinsburg has ties to someone—a child, a sibling, a girlfriend, an in-law, an old high-school coach—who has struggled with opioids. As Callahan put it, “If the lady next door is using, and so are other neighbors, and people in your family are, too, the odds are good that you’re going to join in.”

In 2015, Berkeley County created a new position, recovery-services coördinator, to connect residents with rehab. Yet there is a chronic shortage of beds in the state for addicts who want help. Kevin Knowles, who was appointed to the job, told me, “If they have private insurance, I can hook them right up. If they’re on Medicaid—and ninety-five per cent of the people I work with are—it’s going to be a long wait for them. Weeks, months.” He said, “The number of beds would have to increase by a factor of three or four to make any impact.”

West Virginia has an overdose death rate of 41.5 per hundred thousand people. (New Hampshire has the second-highest rate: 34.3 per hundred thousand.) This year, for the sixth straight year, West Virginia’s indigent burial fund, which helps families who can’t afford a funeral pay for one, ran out of money. Fred Kitchen, the president of the West Virginia Funeral Directors Association, told me that, in the funeral business, “we know the reason for that was the increase in overdose deaths.” He added, “Families take out second mortgages, cash in 401(k)s, and go broke to try and save a son or daughter, who then overdoses and dies.” Without the help of the burial fund, funeral directors must either give away caskets, plots, and cremation services—and risk going out of business—or, Kitchen said, look “mothers, fathers, husbands, wives, and children in the eye while they’re saying, ‘You have nothing to help us?’ ”

Martinsburg, which has a population of seventeen thousand, is a hilly town filled with brick and clapboard row houses. It was founded in 1778, by Adam Stephen, a Revolutionary War general. The town became a depot for the B. & O. Railroad and grew into an industrial center dominated by woollen mills. Interwoven, established in the eighteen-nineties, was the first electric-powered textile plant in the U.S. The company became the largest men’s-sock manufacturer in the world, and at its height, in the nineteen-fifties, it employed three thousand people in Martinsburg. The Interwoven factory whistle could be heard all over town, summoning workers every morning at a quarter to seven. In 1971, when the mill closed, an editorial in the Martinsburg Journal mourned the passing of “what was once this community’s greatest pride.” In 2004, the last woollen mill in town, Royce Hosiery, ceased operations.

It’s simplistic to trace the town’s opioid epidemic directly to the loss of industrial jobs. Nevertheless, many residents I met brought up this history, as part of a larger story of lost purpose that has made the town vulnerable to the opioid onslaught. In 2012, Macy’s opened a distribution center in the Martinsburg area, but, Knowles said, the company has found it difficult to hire longtime residents, because so many fail the required drug test. (The void has been filled, only partially, by people from neighboring states.) Knowles wonders if Procter & Gamble, which is opening a manufacturing plant in the area this fall, will have a similar problem.

The Eastern Panhandle is one of the wealthier parts of a poor state. (The most destitute counties depend on coal mining.) Berkeley County is close enough to D.C. and Baltimore that many residents commute for work. Nevertheless, Martinsburg feels isolated. Several people I met there expressed surprise, or sympathy, when I told them that I live in D.C., or politely said that they’d like to visit the capital one of these days. Like every other county in West Virginia, Berkeley County voted for Donald Trump.

Michael Chalmers is the publisher of an Eastern Panhandle newspaper, the Observer. It is based in Shepherdstown, a picturesque college town near the Maryland border which has not succumbed to heroin. Chalmers, who is forty-two, grew up in Martinsburg, and in 2014 he lost his younger brother, Jason, to an overdose. I asked him why he thought that Martinsburg was struggling so much with drugs. “In my opinion, the desperation in the Panhandle, and places like it, is a social vacancy,” he said. “People don’t feel they have a purpose.” There was a “shame element in small-town culture.” Many drug addicts, he explained, are “trying to escape the reality that this place doesn’t give them anything.” He added, “That’s really hard to live with—when you look around and you see that seven out of ten of your friends from high school are still here, and nobody makes more than thirty-six thousand a year, and everybody’s just bitching about bills and watching these crazy shows on reality TV and not doing anything.”

The Interwoven mill, derelict and grand, still dominates the center of Martinsburg. One corner of it has been turned into a restaurant, but the rest sits empty. Lately, there’s been talk of an ambitious renovation. A police officer named Andrew Garcia has a plan, called Martinsburg Renew, which would turn most of the mill into a rehab facility. Todd Funkhouser, who runs the Berkeley County Historical Society, showed me around one day. “Martinsburg is an industrial town,” he said. “That’s its identity. But what’s the industry now? Maybe it will be drug rehab.”

In the past several months, I have returned to Martinsburg many times, and spoken with many addicts there. I learned the most about the crisis, however, from residents who weren’t drug users, but whose lives had been irrevocably altered by others’ addiction.

Lori Swadley is a portrait and wedding photographer in Martinsburg. When I looked at her Web site, she seemed to be in demand all over the area, and her photographs were lovely: her brides glowed in afternoon light, her high-school seniors looked polished and confident. But what drew me to her was a side project she had been pursuing, called 52 Addicts—a series of portraits that called attention to the drug epidemic in and around Martinsburg. It was clear that Swadley had a full life: her husband, Jon, worked with her in the photography business, and they had three small children, Juniper, Bastian, and Bodhi. Her Web site noted that she loved fashion and gardening, and included this declaration: “I’m happy that you’ve stumbled upon our little slice of heaven!” The 52 Addicts series seemed like a surprising project for someone so busy and cheerful.

We met one day at Mugs & Muffins, a cozy coffee shop on Queen Street. Swadley is thirty-nine, tall and slender, and she looked elegant in jeans, a charcoal-colored turtleneck, and high boots. She and her husband had moved to Martinsburg in 2010, she told me, looking for an affordable place to raise children close to where she had grown up, in the Shenandoah Valley. Soon after they arrived, they settled into a subdivision outside town, and Swadley started reading the Martinsburg Journal online. She told me, “I’d see these stories about addiction—whether it was somebody who’d passed away, and the family wanted to tell their story, or it was the overdose statistics, or whatever.” Many of the stories were written by the same reporter, Jenni Vincent. “She was very persistent, and—I don’t know what the word for it is—very in your face,” Swadley said. “You could tell she wanted the problem to be known. Because at that time it seemed like everybody else wanted to hide it. And, to me, that seemed like the worst thing you could do.”

Next, show this two-minute film (above) about how one woman has survived four overdoses and now hopes to build a new life with her young daughter. Ask students: What are your thoughts and reactions?

Reading and Questions

Before continuing, make sure students understand what we’re talking about when we discuss heroin and prescription opioids. If you think students don’t have enough prior knowledge, you can have them read this description:

What is heroin?

According to the National Institute on Drug Abuse, heroin is an illegal and highly addictive opioid drug made from morphine, a natural substance taken from the seed pod of the Asian opium poppy plant. Heroin can be a white or brown powder, or a black sticky substance. People inject, snort, or smoke heroin, or even mix heroin with crack cocaine. Heroin rapidly enters the brain, where it changes back into morphine, and then binds to opioid receptors on brain cells, especially those involved in feelings of pain and pleasure.

What are opioids?

Opioids are a class of drugs that include heroin as well as powerful pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, fentanyl and many others.

Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but they are frequently misused — taken in a different way or in a greater quantity than prescribed, or taken without a doctor’s prescription — because they can produce euphoria in addition to pain relief. Regular use, even as prescribed by a doctor, can produce dependence, and when misused or abused, opioid pain relievers can lead to fatal overdose.

In 2015 alone, prescription opioids and heroin killed more than 33,000 people.

For the main activity, students should work in pairs or groups and read one of these three recent Times articles about the opioid epidemic. You can find two-page excerpts from the articles here in this PDF. If you want your students to read the unabridged articles, here are the links:

• A Death on Staten Island Highlights Heroin’s Place in ‘Mainstream Society’
• In Heroin Crisis, White Families Seek Gentler War on Drugs
• Drug Linked to Ohio Overdoses Can Kill in Doses Smaller than a Snowflake

After reading their article, students should answer the following questions:

1. What is the “heroin and prescription opioid epidemic,” and just how bad is it? Explain the magnitude of the crisis and the damage caused by it in your own words. Provide at least one example from your article.

2. What does the article state about the causes of this epidemic?

3. What does the article state about possible solutions to the epidemic?

4. What is your personal reaction to this article and to the opioid epidemic in general?

Discussing Possible Solutions

All three articles acknowledge a tension between the role that law enforcement should play in addressing the opioid crisis, and the role that health professionals should play. Is this epidemic primarily a criminal issue to be dealt with by the police, or is it a health issue to be dealt with by the medical community?

Place two signs on opposite ends of the classroom: “Criminal Issue for Police” and “Health Issue for Medical Professionals.” Ask students to stand up and move toward the sign that they think best summarizes the problem. Then ask students to explain the reasoning for their decision to stand where they did, and to use evidence from the articles to support their answers. Alternatively, you can hold this discussion without moving around the room.

At the end of class, students should answer the question on an exit ticket or as a homework assignment.

See the Going Further Teaching Ideas below for more resources related to the “war on drugs” as well as different approaches to prevention and treatment.

_________

Going Further Teaching Ideas

1. How did we get to this point? The stories behind the nation’s opioid crisis.

In a special report, “Inside a Killer Drug Epidemic: A Look at America’s Opioid Crisis,” The New York Times writes:

Opioid addiction is America’s 50-state epidemic. It courses along Interstate highways in the form of cheap smuggled heroin, and flows out of “pill mill” clinics where pain medicine is handed out like candy. It has ripped through New England towns, where people overdose in the aisles of dollar stores, and it has ravaged coal country, where addicts speed-dial the sole doctor in town licensed to prescribe a medication.

Public health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 33,000 people in 2015. Overdose deaths were nearly equal to the number of deaths from car crashes. In 2015, for the first time, deaths from heroin alone surpassed gun homicides.

And there’s no sign it’s letting up, a team of New York Times reporters found as they examined the epidemic on the ground in states across the country. From New England to “safe injection” areas in the Pacific Northwest, communities are searching for a way out of a problem that can feel inescapable.

Have students choose one of the seven stories in the article (organized by state: Massachusetts, Iowa, etc.) to read with a partner. Then, have them summarize the story and explain what it reveals about the opioid crisis. Students can then share what they learned with the class.

Alternatively, students can read one or more of these readers’ stories about painkillers, heroin and addiction — or watch one of these videos about second chances or life after a heroin overdose — and then share what they learned with the class.

2. Rethinking the War on Drugs

What role should the government, including law enforcement, play in trying to solve problems of drug abuse and addiction? Should illegal drugs like heroin and misused prescription opioids be primarily treated as a health crisis or a criminal problem?

Have students watch the 14-minute Retro Report film above, which details how drug policy has evolved from the early 1970s to today. Have them take notes on what is the nation’s “war on drugs,” and how and why attitudes have changed about it since President Richard Nixon first used that term in 1971. Suggest they pay attention to the role that race seems to play in evolving attitudes about drug abuse and prevention, and ask students what they think: Should the government emphasize treatment and rehabilitation or punishment and deterrence when it comes to addressing drug addiction and abuse?

Then have students write an editorial about the war on drugs. For inspiration, you might have students watch this Op-Ed video by Jay Z in which he makes the argument that “the war on drugs is an epic fail.” For suggestions on how to write an editorial, see this Learning Network lesson on editorial writing.

3. Approaches to Prevention and Treatment

New approaches to prevention and treatment are continually researched and implemented to stem the tide of heroin and opioid addiction, and to reverse the tragic effects of the national epidemic in human, emotional and economic costs. For example, one emergency room in a New Jersey hospital now treats many pain patients with alternatives like laughing gas, trigger-point injections and a therapy harp. Some cities are experimenting with creating safe consumption facilities, where addicts would receive clean needles and syringes and would be permitted to inject heroin, smoke crack cocaine and take other addictive drugs under the supervision of trained authorities. What ideas will be most effective in stemming this crisis?

Have students break into small groups, and assign each group one of the articles or Opinion pieces below about opioid addiction, prevention and treatment.

• An E.R. Kicks the Habit of Opioids for Pain
• Seattle’s Potential Solution for Heroin Epidemic: Places for Legal Drug Use
• Can You Get Over an Addiction?
• Vancouver Prescriptions for Addicts Gain Attention as Heroin and Opioid Use Rises
• In School Nurse’s Room: Tylenol, Bandages and an Antidote to Heroin
• At the Frontline of the Opioid Epidemic, but Unable to Help

Have each group write a summary of the article or Opinion piece and then report the pertinent details to the rest of the class. Students can take notes on the presentations and then vote as a class on what methods and treatment approaches they think work best. Which should be researched further? Which should be followed by medical doctors, and which should be supported by government assistance? Students should follow up with statements about why they voted the way they did.

4. A Global Problem

Most of the world’s heroin supply comes from southern Asia, with Afghanistan being the world’s largest producer of the opium poppy plant used to make heroin. The Times reports:

The United States spent more than $7 billion in the past 14 years to fight the runaway poppy production that has made Afghan opium the world’s biggest brand. Tens of billions more went to governance programs to stem corruption and train a credible police force. Countless more dollars and thousands of lives were lost on the main thrust of the war: to put the Afghan government in charge of district centers and to instill rule of law.

Yet, despite all that American money and effort, government officials in Afghanistan and the Taliban insurgents they are fighting both profit from the drug trade. The country faces its own addiction problem as well.

In the United States today, however, much of the heroin supply is derived from Mexico and South America, which are closer to the U.S., and have easier modes of transportation. To have students learn why many Mexican farmers have decided to cultivate opium poppies, they should read the 2015 article “Young Hands in Mexico Feed Growing U.S. Demand for Heroin.” While reading, they can consider the following questions:

1. Why are many Mexican farmers and their children growing and harvesting opium poppies? What factors go into their decision making?

2. How does the problem of drug addiction and abuse in the United States affect them? How does the “war on drugs” affect them?

3. Azam Ahmed writes in the article, “As heroin addiction soars in the United States, a boom is underway south of the border, reflecting the two nations’ troubled symbiosis.” What does that sentence mean, particularly the phrase “the two nations’ troubled symbiosis”?

4. As demand for heroin has grown sharply in the United States, supply has also increased. The farmers profiled in this article, along with farmers in Colombia, Myanmar, Afghanistan and other countries, have switched to opium poppy production because the crop earns them more money than other crops they might plant. How do you think the United States, and the world in general, should turn the tide, so that worldwide opium poppy production shrinks instead of grows?

As a follow-up activity, the class can then discuss their answers to the last question.

_________

Learning Network Resources

Reader Idea | Students Talk to Students About Drug and Alcohol Use

Equality Under the Law? Investigating Race and the Justice System

Resources Outside The Times

Scientific American | The Addictive Personality Isn't What You Think It Is

National Institute on Drug Abuse | America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

The Atlantic | A Brief History of Opioids

Scientific American | Opioid Addiction is a Huge Problem, but Pain Prescriptions Are Not the Cause

FiveThirtyEight | What Science Says To Say If Your Loved One Has An Opioid Addiction

PBS Videos | Learning About Opioids

National Institute on Drug Abuse Lessons for Teens

Scholastic | The Science of Addiction

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