This essay began as a poem in which I was trying to explore correlations between the opioid epidemic, gun violence in the United States, and fundamentalist religion.

“As of August 31, 2019, 297 mass shootings have occurred in 2019 that fit the inclusion criteria of this article. This averages out to 1.2 shootings per day. In these shootings, 1,219 people were injured and 335 died (for a total of 1,554 victims).”—Wikipedia

Thoughts and prayers or medicine?

Where is the pain?

It starts near the top of my head
and runs down to the soles of my feet.

Here and here.

As a native Texan I carry a both a complicated heritage and a complex relationship with the Texas of today. I am of course appalled and pained deeply by every mass shooting that manages to get media attention, but the incident in El Paso in early August followed by the one in Odessa exactly one month later hit me very hard.

How would you describe the pain?

Like being shot 297 times. A sort of dull ache

with occasional throbs.

On the pain scale 1-10, how bad?

Toward infinity. Varies from 3-10 depending.

Depending on what?

On how much I think about thousands
of gunshots and bullet holes.

I don’t know. How tired I am or if I’ve eaten.

Or how deeply I remember El Paso and Odessa
and wonder if Dallas is next.

The pain, of course, is both physical and psychic. I’ve had some slight experience with opioid painkillers, but fortunately have never been drawn to using them for anything other than physical pain relief. Given some of my tendencies and past behavior, this restraint sometimes seems miraculous.

“The body that has developed a tolerance for opioids demands more, and seasoned opioid users will take fentanyl even if they see someone overdose from it right before their eyes.” —Dr. Adam Bisaga, “Overcoming Opioid Addiction”

Would you like something for the pain?

Nothing that will increase my tolerance.

Tylenol, maybe?

My meditations on these questions led me to Beth Macy’s amazing book Dopesick. A reporter for the Roanoke (VA) Times, Macy chronicles in meticulous and unsparing detail the ravages of first, overprescribed opioids, then heroin when belated regulations forced pharmaceutical manufacturers to weaken their products and add blockers to limit the “highs” that users experienced, causing addicts to seek out even more illicit means to maintain their addiction and avoid dopesickness. Her region, a land where factories closed and jobs were shipped overseas and where the declining coal industry shut down mines, leaving thousands of sick and injured workers to fend for themselves, is Ground Zero for the opioid and heroin crisis. It also happens to be the heart of what is sometimes called Trump Country, where not only drugs proliferate, but also guns and fundamentalist religion.

Although extensively researched and massively documented with reams of data, Dopesick often reads like a very compelling novel. We meet the promising children of blue-collar and middle class families cut down by drugs licit and illicit, grieving parents and siblings, and harried and overworked medical and law enforcement professionals struggling to limit the flow of drugs and save lives. The book as a whole presents an unflinching indictment of greed-driven Big Pharma, a horrendously inadequate health care system, and a political establishment that can’t decide whether the epidemic is a health problem or a criminal one and is seemingly incapable of dealing adequately with either.

I am not, of course, positing a causal connection between opioid addiction and the urge to commit a mass shooting. In fact, a gun in the hands of an addict is more likely to be turned on him- or herself. There’s a cruel irony in the fact that guns do not provide adequate defense against the physical pain left after years of exacting, backbreaking labor nor do they mitigate the sense of displacement brought on by being marginalized as decently paying jobs with benefits disappear.

“[Religion] is the opiate of the masses.”—Marx

So where does religion fit in here? Again, I am asserting no causality, simply noting that strong religious faith provides no better defense against addiction and despair than guns. Is the strong emphasis on sin problematic in dealing with a disease that still carries a moral stigma for many? Twelve-Step programs with their emphasis on spiritual transformation also all too often fall short, especially when they oppose medication-assisted treatment.

I have no answers, only a strong concern for the waste of human potential and the personal and social wreckage wrought by opioid addiction and the crime and degradation associated with it. Dopesick provides an intense and necessary examination of the opioid epidemic in its many aspects and even offers a few glimmers of hope along with strong recommendations for both expansion of and improvements in treatment options and prescriptions for addressing the larger societal and political issues that have lead to the crisis in the first place. I highly recommend you read it.