BY MATTHEW HERBERT

In the last edition of “Nothing to See Here, Folks,” we noted that U.S government officials had ordered the U.S. Department of Agriculture to suppress a scientific article showing how climate change was sapping the nutrients from rice.

This week, E&E News reported that government officials also censored the U.S. Geological Service’s press release of a climate change study in March focusing on the California Coast. It found that “California, the world’s fifth-largest economy, would face more than $100 billion in damages related to climate change and sea-level rise by the end of the century.” The USGS’s political bosses doctored the press release to remove any mention of climate change, making the report sound like a routine look at upcoming infrastructure requirements.

Both incidents fit a pattern of government censorship of science. “It’s been made clear to us that we’re not supposed to use climate change in press releases anymore,” said one USGS scientist.

Americans are still doing key missionary work across the Atlantic, it turns out. We’ve known for several months now that Steve Bannon doesn’t think the Pope is reactionary enough and has set up shop in Italy to try to mobilize the European right against him. Open Democracy published a report recently showing that fundamentalist Christian groups in the U.S. have been funneled $50 million of dark money to nativist groups across Europe.

The parties receiving this money are good white Christians who have had it with being marginalized and disrespected. If you don’t want to read the full study, the New York Review of Books gives a nice summary here.

My two cents: From Italy’s Matteo Salvini to Hungary’s Viktor Orban (I could go on–message me if you want me to), the new nativist strongmen in Europe read from the same a script as Vladimir Putin–that other victimized white guy who has had it with Pride Parades, working women and the free press.

Finally, we can rest assured that women are still being effectively censored and alienated by the established powers. An in-depth article in the Atlantic Monthly revealed an “epidemic of disbelief” among police assigned to investigate rape cases. Police systematically fail–and likely refuse–to conduct rape investigations, as evidenced by the hundreds thousands of rape kits that sit sealed and untested in evidence rooms across the USA. When a group of crusading prosecutors pressed for these kits to be tested in Detroit, they found that many convictable serial rapists had been walking free for decades. For the most part, the DNA evidence that could have put them away had sat untested because police disbelieved the victims’ rape claims to begin with.

BY MATTHEW HERBERT

Everything that was politically formative for me happened between 1989 and 1995. Much of it was war.

In November 1989 the Berlin Wall came down, and the Cold War ended. Or at least it started to end. The real end came fast and furious.

The Romanians lynched Ceausescu on Christmas day of 1989. The other anti-communist revolutions in central Europe happened more peacefully, but they were still world-rocking events. Masses gathered in the streets all across the countries of the Warsaw Pact–the band of buffer states forcibly aligned with the Soviet Union since 1945–and demanded their freedom. They got it. By the next summer, there was not a communist government left in Europe.

Then, without anything to guard, the Soviet Red Army picked up and went home.

Two Christmases later, in 1991, the Soviet Union itself ceased to exist. The war that I had grown up thinking would end the world was over. And it ended because the idea that the Soviet Union had been fighting for just disappeared. For me, this was as jarring as if a color had been expunged from the spectrum of visible light.

Not everyone gets to witness an epochal change of that order right in front of their nose, but in the bloom of my youth I watched the complete and sudden extinction of a political ideology. Krushchev had said Soviet communism would bury us, and in the heat of the contest, it seemed like it might. That anxiety had defined my consciousness for the better part of 25 years. And now its root cause was just gone.

In 1992 I earnestly believed the explanation proffered by the political scientist Francis Fukuyama as to why this momentous change was happening. History, he said, had come to an end. The people of the world had had a fair chance to view democracy and authoritarianism side by side, and they chose democracy. Communism–the most common form of authoritarianism–collapsed, Fukuyama said, because it was an unsustainable idea, which had had to be propped up by force, propaganda and central planning for 70 years.

Democracy, on the other hand, was inevitable. Its supremacy, Fukuyama argued, could be summed up in the following observation: once a people became free and democratic, it was unthinkable that they would return to authoritarianism of any stripe, communist or otherwise. This bold claim certainly seemed to reflect the irreversible direction of the times. The Berlin Wall was not going to be rebuilt once it was torn down.

I suppose I found Fukuyama easy to believe because I believed the same thing he did about the gravitational pull of American power. I believed we were on top of the world because we had superior ideas, and anyone with any sense wanted to share in them and be like us.

As the Cold War came to a dramatic end in Europe, I went off to a different war, which I thought was unrelated but actually wasn’t. A week after Iraq invaded tiny, oil-rich Kuwait in August of 1990, I deployed to Saudi Arabia with the Air Force. In liberating Kuwait and defeating the fifth largest army in the world, we proceeded to demonstrate a “revolution in military affairs.”

For 43 days we put bombs on whatever (fixed) target we chose (mobile targets, especially the infamous SCUDs, were a different story), so softening up Iraq’s ground forces that when the time came to fight, most of the Iraqis simply couldn’t do it. They were starving, cut off from Baghdad, lice eaten, half dead. In dropping their weapons and running out of their foxholes to surrender to us in droves, they seemed like all those central Europeans, rushing, glad and relieved, it appeared, toward the side with the better ideas.

So the rest of the world watched as the U.S. military surgically prepared Saddam Hussein’s forces for defeat and then unceremoniously incapacitated them. The Iraqis lost 100,000 soldiers; we lost 383. If you were a recent Cold War enemy of the United States, you probably felt that this seemed like a good time to be our friend. Even our bombs were smart.

The American Moment was such a towering one, it didn’t even need an outsized leader to personify it. Indeed in lacking memorable traits, the faceless patrician George H. W. Bush was arguably just the man for the job. He was proof that American power was institutional. Our ideas were so strong, they did not need a charismatic leader to actuate them. The cult of personality belonged to the age of dictators, now a thing of the past.

But just as Pax Americana was rushing over Kuwait and central Europe, a small eddy of tribal war broke out in the Balkans, in June 1991. Slovenia, the small, northernmost republic of Yugoslavia, declared independence from the Serbs, Croats, Bosnians, Montenegrins, Macedonians and Albanians who ran the rest of the country. A ten-day war ensued; fewer than 100 people died as Slovenia became its own country. But the rest of Yugoslavia then fatefully followed suit, plunging into a series of ethnic wars that lasted five years and killed 140,000 people. Massacres and concentration camps even made a comeback.

When the wars were over, Yugoslavia had split into five new countries.

I witnessed much of Yugoslavia’s bloody breakup from as up-close as an outsider could get. Still in the Air Force, I was stationed in Germany and Italy from 1991 to 1995. I planned the air reconnaissance missions that were supposed to help the United Nations set up safe zones and determine if the warring factions on the ground were violating the latest ceasefire.

I hitched a ride on a UN supply plane and flew into Sarajevo in the winter of 1993, for no good military reason. I was simply drawn to the awful spectacle of a European army training its artillery down on a European capital city, shelling its citizens, trying to starve them to death. Every building in Sarajevo was pockmarked. This wasn’t supposed to happen. The American Moment was supposed to cancel out the possibility of this old European madness for war. So I pictured the world.

Ultimately, the United States was instrumental in bringing Yugoslavia’s wars to an end. After European powers repeatedly failed to conclude a peace deal at talks set up in their grand palaces, the American diplomat Richard Holbrooke sequestered the warring parties in the drab, cut-rate quarters of an unglamorous Air Force base in Dayton, Ohio. There he wooed, threatened and cajoled them for 20 days, and on 21 November 1995, Yugoslavia’s wars ended.

Although the end was messy, I still believed I was witnessing American power at its zenith. We were using the allure of liberal democracy and the tacit threat of military supremacy to guide the warring Europeans out of old, discredited patterns of conflict and toward a new order.

—

So I spent the years between 1989 and 1995 believing that history was coming to an end. Mankind had reached a point at which it would no longer be oppressed, because individual men would have to choose this fate. I held to this high-flown theory because of the concrete facts that appeared right before my eyes. The Wall really had come down. A liberal playwright had been elected president of Czechoslovakia. U.S. power had shown itself to be an insuprable force for democracy. Things were different now, and better.

I was mistaken, of course, but at least I was in good company. The acclaimed Oxford historian Timothy Garton Ash was gripped by the same delusion I was, which he phrased in this way: “The world of Nineteen Eighty-Four ended in 1989.” Liberal democrats like Garton Ash believed Orwell’s dire warning had worked, and humanity was now out of the woods.

Of course we are not out of the woods. And although I revere Orwell, it is with ruefulness that I admit his writing is not just masterful and brilliant, but once again useful.

In his wonderful new book, The Ministry of Truth: The Biography of George Orwell’s 1984, Dorian Lynskey makes a powerful case that Orwell’s best-known novel “remains the book we turn to when truth is mutilated, language is distorted, power is abused, and we want to know how bad things can get.” Written about an imagined future, it is also a guide to the present.

The Ministry of Truth undertakes two broad tasks. First it analyzes the literary sources of Nineteen Eighty-Four and locates Orwell’s thought among them. Second it illustrates what Lynskey calls the “afterlife” of Nineteen Eighty-Four, showing how it has thrived since its publication in 1949 as an ongoing, highly mutable response to mass culture and reactionary politics. Many of its memes and phrases, such as Big Brother, Room 101, and doublethink, are now known by millions, even if they have never read the book.

Lynskey makes no bones of the fact that his point of departure is the current, post-truth moment of  Trumpism. Sales of Nineteen Eighty-Four, he observes, shot up 10,000 percent in the four days after Trump’s spokesman Sean Spicer was marched before the world’s news cameras to tell flagrant, demonstrable lies about crowd size in 2017. That said, though, Lynskey delivers a work of wide-ranging literary criticism, which does an admirable job of “not repeatedly dig[ging] the reader in the ribs” when advancing an interpretation of Orwell that clearly applies to “our present rulers.” It’s an interpretation of Orwell that should stand up well for years to come.

Lynskey’s main political moral is that the societal horrors that Orwell hated, feared and diagnosed with such precision will continue to resurface in new outbreaks of authoritarianism. A book that fixated on the present rightward turn toward yokel fascism would have lamed itself for the future. Orwell, grimly, will go on being useful, and Lynskey’s interpretation of his highly useful book will go on expanding our understanding of it.

The first half of The Ministry of Truth is a magisterial work of scholarship, but delivered with a pleasingly light touch. In it, Lynskey refutes the simplistic notion that Nineteen Eighty-Four and Huxley’s Brave New World should be seen as “rival prophecies, as if both authors were, at the same point in time, given the same brief to predict the future, and we now have to decide which was the more accurate.”

Lynskey guides us through a whole Zeitgeist of utopian and dystopian writing spurred by the Industrial Age, unearthing a trove of fascinating connections.

Huxley, it turns out, had been Orwell’s teacher at Eton in 1918. Both men revered and drew inspiration from H.G. Wells. In one aspect, the course of Orwell’s thought can be traced as a reaction to  Wells’s evolving ideas on politics, technology, and human nature. Wells, for his part, had already mined sources of progressivism derived from earlier utopian visions produced in Gilded Age America. These sources would be passed along as part of Orwell’s genetic makeup as an artist.

One of the visions that inspired Wells was Edward Bellamy’s now forgotten utopian novel of 1887, Looking Backward 2000-1887, which was fabulously popular on release. In it, Bellamy feverishly claimed that history was approaching a rupture point that could only be averted by a socialist revolution. The actuating crisis had been brought on by the vast income inequalities produced by the industrial revolution. The economist Henry George had argued his landmark 1979 treatise Progress and Poverty that such huge disparities were neither sustainable nor desirable. George’s idea that society could be deliberately improved by bold visionaries was Wells’s second American inspiration.

So when Orwell has Winston Smith mutter that the proles were the only hope for the future–a line that belongs unimpeachably to Orwell–it nonetheless reflects a line of thought than can be traced back through Wells’s literary sources to ideas that germinated in progressive America. (FDR not only knew of Bellamy’s books, but included Bellamy’s biographer as part of the New Deal administration.)

Lynskey also dispenses expertly with the accusation that Orwell plagiarized parts of Nineteen Eighty-Four. From the 1880s onward, utopian visions and dystopian countervisions were coming so thick and fast (at least a dozen from Wells alone!) that their narrative elements would have been part of the air that any politically-minded writer was breathing.

There are, of course, a handful of striking similarities between Nineteen Eighty-Four and the dystopian 1921 novel We, in which the Russian author Yevgeny Zamatyin projects the failures of the communist revolution a thousand years into a totalitarian future. But does that mean any novel about a totalitarian future is a “copy” of We?

As Lynskey shows, Orwell the literary critic dissected practically every possible antecedent of Nineteen Eighty-Four, from Gulliver’s Travels to the dystopian 1920 play R.U.R., in which the Czech author Karel Capek makes the first use of the word robot. Subjecting these works to exacting, and often appreciative, criticism would have been an odd way for Orwell (or anyone else) to prepare an act of literary thievery from them. Furthermore, Orwell promoted the publication of We in English before he finished Nineteen Eighty-Four. Enthusiastically saying “Read this book” would have been another unusual move for a plagiarist concerned to cover his tracks.

In some cases it is hard, and perhaps pointless, to say which came first–the literary development of some minatory idea by one of Orwell’s forerunners or its occurrence in real life. H.G. Wells featured a deliberately pared-down English vocabulary as the official language of the 21st century in The Shape of Things to Come. As Orwell had read (and commented extensively) on Wells, it is clear that he modeled Newspeak on this idea. But it was in real life that such a thing actually happened. Churchill’s Minister of Information Brendan Bracken promoted an 850-word vocabulary he called Basic English to simplify government press releases. Wells and Orwell were both cognizant of this and incorporated it into their writing.

Zamyatin’s We features secret police who are a lot like Orwell’s. Neither man could have reflected on this menace, Lynskey argues, without knowledge of the Soviet secret police’s methods.

It is he literary act of synthesis, together with a political point of view, that makes Orwell original, just as it will for future novelists writing about dystopia. One of Orwell’s schoolfriends recalled him saying of Wells’s A Modern Utopia in approximately 1919 that he (Orwell) “might write that kind of book himself” someday. In 1984, as Margaret Atwood sat down to write The Handmaid’s Tale, she drew self-consciously from Orwell, Wells, and the broad dystopian literary stream in which they had swum. Atwood  tells Lynskey that she decided to write The Handmaid’s Tale in part because she identified so closely with Winston Smith.

Politically, Orwell is such a consequential writer that his authority has become the object of strenuous competition in the decades since Nineteen Eighty-Four was published. Almost all of the book’s early critics (including Pravda) read Nineteen Eighty-Four as a straightforward repudiation of all leftist thought. Indeed the consummate neocon Norman Podhoretz argued barefaced in 1983 that, had Orwell survived to see Ronald Reagan stare down the USSR, he would have championed the righteous cause of the right.

This is not at all what Orwell intended. The anti-left interpretation of Nineteen Eighty-Four, Lynskey points out, does not comport with Orwell’s own words or lifelong political loyalties. When an official of the United Automobile Workers in Detroit wrote Orwell asking whether good union members should read Nineteen Eighty-Four, Orwell wrote back that his novel was “‘NOT intended as an attack on socialism, or on the British Labour Party (of which I am a supporter)’ but a warning that ‘totalitarianism, if not fought against, could triumph anywhere.'”

Orwell reserved his hottest vitriol for the left because he was so outraged at how socialists could (and did) turn on their own adherents with the most horrific methods of the totalitarian right–fabrications, propaganda, show trials and executions. 

Indeed the formative political experience for Orwell came in 1936, the year he fought for the Worker’s Party of Marxist Unification (POUM). The POUM was a Trotskyite militia making common cause with the Russian-backed Communist Party in the Republican forces in the Spanish Civil War. The flagrant dishonesty with which the Soviet puppetmasters smeared the POUM and the blank cruelty with which it turned on them in 1936 outraged Orwell. He never forgot the horrible power Moscow wielded in its ability to erase plain facts about his comrades with blatant propaganda, branding them as “capitalist gangsters” even as they fought for the republic. The POUM’s executioners knew they were acting on outrageous lies when they ruthlessly suppressed their former comrades, but they treated those lies as rock-solid truth. The Spanish Communists believed, in effect, that 2+2=5, because that was what Moscow ordered them to believe.

Orwell’s special genius was his ability to imagine how desperate life could become for the common man once a standing government discovered how to scale up Moscow’s mutilation of the truth and impose it on all of society.

Indeed Orwell had the harrowing world of Nineteen Eighty-Four coming all along, and hinted at it darkly in all his earlier books. In Coming Up For Air he envisions:

The world we’re going down into, the kind of hate-world, slogan world. The coloured shirts. The barbed wire. The rubber truncheons. The secret cells where the electric light burns night and day, and the detectives watching you while you sleep. And the processions and the posters with enormous faces, and the crowds of a million people all cheering for the leader till they deafen themselves into thinking that they really worship him . . .

This is sharpest aspect of Orwell, the part that warns, as he did in a press statement just after the release of Nineteen Eighty-Four: “Don’t let it happen. It depends on you.” Honesty is not the property of the right or the left. It belongs to each individual, and it will fade if not guarded and actively looked after.

Orwell is so memorable at his most dire, it is too easy to forget why he cared about outrages against human decency to begin with. The Ministry of Truth is a valuable book because it captures, not just the fears and warnings behind Nineteen Eighty-Four, but its motivating hope as well. Orwell was an optimist about humanity. Lynskey recalls Orwell’s analysis of Swift’s abiding pessimism in Gulliver’s Travels:

Perhaps Orwell was using Swift to personify his own grimmest impulses, so that he could mount a case against them. However pessimistic he became, he didn’t believe that humans were grubby, worthless, self-defeating creatures. “[Swift] couldn’t see what the simplest person sees,” Orwell concluded, . . . “that life is worth living and human beings, even if they are dirty and ridiculous, are mostly decent.”

 

 

 

BY MATTHEW HERBERT

In 2016, the first time Tess Henry’s mother, Patricia, tracks her down in the throes of heroin addiction, Tess is using a social media app to advertise herself as a prostitute. “Sweet Sultry 26” is her handle. Out of jail and off her second attempt at rehab, Tess needs money for her next heroin fix. She is feeding a habit of six shots a day.

After two years of watching her daughter’s downward spiral into dopesickness, Patricia feared the worst when Tess disappeared from her Roanoke, Virginia home, leaving behind her toddler son. After weeks being gone, Tess was surely dead, thought Patricia. Patricia is so relieved to find even a trace of her daughter still alive, she monitors “Sweet Sultry 26” for weeks, sleeping with her cell phone. Even the picture of Tess scarred, pale and emaciated gives her hope.

Such is a parent’s love for her child.

In 2012, there had been nothing especially worrisome about Tess Henry’s life. Too the contrary, she had been a track star and honor roll student in high school. She was two years into college, studying French, gliding along on the invisible privileges that came from growing up in her wealthy suburb of Roanoke. Then, after having her wisdom teeth pulled, a doctor prescribed Tess a 30-day supply of Oxycodone.

Today, with the opioid epidemic finally in front page news, most of us would know that prescribing 30 days of Oxy for post-op tooth extraction pain would be like giving someone a bazooka to go deer hunting. When I got my wisdom teeth out 22 years ago, I got an Advil, not a month’s worth of powerful narcotics.

The path from popping prescribed Oxy pills to injecting heroin was a short one for Tess, as it has been for millions of other Americans. That first, magical euphoria of an opioid high, often experienced courtesy of a doctor’s prescription, is a feeling that rewires the brain and subjugates a person’s entire will to seeking the next fix.

These days drug dealers use this knowledge. They lace common street drugs like marijuana with powerful opioids to instantly hook the unwitting user. It’s called heatpacking.

 

But about those doctors: their role in America’s opioid crisis is where Macy’s story begins.

The technical term for drug addiction enabled by doctors is iatrogenic addiction. The first wave of iatrogenic drug abuse, Macy tells us, happened in post-Civil War America. Hundreds of thousands of American soldiers and veterans were treated for pain by doctors who would “leave behind both morphine and hypodermic needles, with instructions to use as needed.” The resulting effects of widespread addiction were tragic and disastrous. Dopesickness that time around was called “Soldiers’ Disease.”

All opioids are derived from the the morphine molecule, the same compound found in heroin. Morphine bathes the brain in a lightness and ecstasy which, in sufficient dosage, can override the most excruciating pain. Everyone is different, but the chemical-neurological configuration of almost anyone’s brain is acutely susceptible to this feeling of rapture. Once you’ve had it, you need it again and again. You abandon everything you once held dear to seek the next fix. If you don’t, you’ll become dopesick, violently ill with fever, nausea, and pain that will not subside because the synthetic opioid you’d been using effectively shut down your brain’s receptors of natural opioids such as endorphins. You’ll wish you were dead if you can’t get more morphine.

One of the main effects of opioids is to slow down respiration. This is what users die of; when they take too much, they simply stop breathing.

In 2017, the last year for which figures have been fully analyzed, more than 70,000 Americans died of drug overdoses, most of these from opioids. For perspective, “only” 58,000 Americans died in the Vietnam War. Now we lose more than that each year to drug overdoses, and the trend is poised to climb further before it begins to subside. This is the new normal.

What unleashed such a pitiless beast on American society in the 21st century? Five factors, according to Macy’s compelling narrative.

The major push factor was the aggressive and, as it turns out, fraudulent marketing of opioids by big pharmaceutical companies, particularly Purdue, starting in the 1990s. It was an historically opportune moment for big pharma. Doctors were beginning to regard pain as “the fifth vital sign” and to treat pain seriously in its own right.

Purdue released its flagship drug Oxycontin in 1996. It was supposed to relieve severe pain without being addictive, due to its time-release property (“contin” being shorthand for “continuous”). Around the same time, the FDA loosened rules on the TV advertisement of potent drugs, and in 1998 the pharmaceutical industry’s total spending on ads surged from $360 million to $1.3 billion. Purdue pushed Oxy to doctors around the country, offering its sales reps incentive bonuses in the tens of thousands of dollars and luring doctors with Las Vegas getaways and luxury cruises. Sales reps unironically pushed Oxy on doctors as a great way to pay for their children’s college education.

Although Purdue courted doctors everywhere, they found their biggest markets in rural, poor, white America. Appalachia became Ground Zero for the opioid crisis, followed closely by de-industrialized Ohio. When globalization began to take away these regions’ jobs in the 1990s, the widespread alienation and the unemployed people’s loss of a sense of purpose created a major pull factor for opioids.

It was not just an abstract state of despair that threw former coalminers and factory workers into the maw of opioid addiction. One of Macy’s major journalistic achievements in Dopesick is to have sleuthed out the pathway that systemic unemployment took toward widespread addiction. After Appalachia’s main employers cast off the people who had done decades of hard labor in mines and factories, these newly unemployed pursued medical disability as a means of survival. It was as natural for doctors to use the new wave of pain management techniques to treat them as it was for the people to seek them.

This pattern of disability-seeking dovetailed with an increasingly dominant American narrative, that there is a pill for every complaint. Again, though, there were concrete factors at work behind this abstract attitude. A major environmental factor leading to the opioid crisis was the fact that so many Americans were already on pills. This factor (1) helped normalize the idea of medicating almost anything, and, more importantly (2) enabled millions of Americans to trade their old, legal drugs for new, illegal ones, a criminal transaction known as diversion.

As we increasingly medicate a myriad of life-long conditions starting in childhood, we should note a sobering fact which Macy observes: “Almost to a person, the addicted twentysomethings I met had taken attention-deficit medication medication as children, prescribed pills that as they entered adolescence morphed from study aid to party aid.” Some traded Adderol for marijuana, Ritalin for cocaine. A doctor Macy interviewed reported how normalized prescription drug use by children has become in recent years. As a YMCA camp doctor in the 1970s, about one percent of the kids he saw came to camp with prescribed meds. This figure jumped to 10 percent in the 1990s, and by 2012, a third of his campers were showing up with prescriptions, “mostly ADHD medications, antidepressants, and antipsychotics.”

The decisive factor in Macy’s narrative is the widespread determination to see drug addiction as a sin, which calls for cathartic forgiveness and total abstinence, rather than a sickness which calls for evidence-based treatment. We are now far enough into the opioid epidemic to understand its defining statistics. The main one staring us in the face, Macy tells us, is the effectiveness of medically assisted treatment of addition, which means the use of prescribed proxy drugs (such as methadone or suboxone) which, in a supervised setting of addiction treatment offers the best hope for recovery.

Critics of MAT object that it basically replaces one opioid addiction with another, and furthermore, addicts can, and often do, divert their prescriptions for heroin or other narcotics. The pitiless statistics of recovery, however, indicate nonetheless that MAT offers the only viable path toward recovery. It replaces an untreatable addiction with a treatable one.

Moralistic Americans, including some members of the medical, legal, and law enforcement communities, are fixated on the emotionally-satisfying image of a short detox program followed by lifelong sobriety–a road to Tarsus conversion. But this model simply doesn’t work. A Harvard research tells Macy, “What happens is, it takes about eight years on average, after people start [detox] treatment, to get one year of sobriety . . . and four to five different episodes of treatment” to achieve durable sobriety.

Advocate of MAT tout not its higher success rate (closer to 50 percent), but also its overall effectiveness in harm reduction. Any of the dozens of parents of dead addicts in Dopesick would tell you they would prefer even a lifelong protocol of supervised suboxone use by their recovering children to the callous, lethal ideology of cold-turkey detox.

Lurking beneath the facts, trends and statistics that Macy lays bare is the sinister suggestion that America’s power elite regard those dying of drugs as disposable people, and that their disappearance is a positive good. This admittedly outlandish-sounding conclusion actually springs from the confluence of three common ideologies that remain stubbornly popular in America.

The free-market ideology says consumers want whatever they want–good or bad, right or wrong–and that an efficient market simply responds to their demand signal. If the demand happens to run fundamentally counter to the consumers’ interest, it will eventually cancel itself out. We see this ruthless market correction in the 70,000 plus who die annually of drug overdoses. The irrationality of poor consumer choices is simply extinguishing itself.

All-out libertarianism tells us each individual must be protected in his right to make the choices that suit him. It is wrong to intervene politically in such basic decisions. Nannying free people away from free choice is the thin end of an authoritarian wedge, which we should not tolerate. In a country where we imprint on our license plates “Live free or die,” we must be prepared to accept that some people will die as a result of exercising their freedoms.

Finally, religious fundamentalism says we get what we deserve based on the way we live our lives before a divine judge and that, in any case our god(s) will set things right in the long run. If we deserve comfort in an afterlife, we will get it.

Tess Henry died of blunt-force head trauma and was thrown into a Las Vegas trash dumpster. The proximal cause of her death, as nearly as the police could determine it, was a blow delivered by her pimp/dealer. After weeks shooting up on the streets of Vegas, Tess owed more for her heroin supply than she could make turning tricks.

But the way Macy tells the whole story of opioid addiction in America, I can’t help but comment on a more distal cause of Tess Henry’s death. It was, to my mind, a confluence of bad ideas–the three just mentioned. We have so brutalized the idea of human worth in our society that, to stay true to our ideas, we must believe that Tess got what she deserved, and that her mother, Patricia, sleeping with her cell phone when she got the call on December 30th, 2017, got what she deserved. The perfect forces of a free market at work delivered up this result, and it is not for us to call the result good or bad, still less to ask our government to get involved in parenting our children to prevent this kind of outcome. If there is a right or wrong to be adjudicated in the system of free, individual choices that led to Tess’s death, we surrender that task to God in his wisdom.