The Firefighter

Jan Rader is a fire department veteran with 23 years of experience. As Fire Chief in the small city of Huntington, West Virginia, she has risen from obscurity to be included in Time’s 100 Most Influential People of 2018 and prominently featured in the Oscar nominated Netflix documentary Heroin(e), for which she attended the Academy Awards ceremony. As a heroic Fire Chief, one may expect Rader to be celebrated for her firefighting prowess, but it has been her brave battle against America’s devastating opioid epidemic that has brought her international acclaim.

According to Time, “the opioid crisis is the worst addiction epidemic in American history,” with overdoses killing 63 600 US citizens in 2017 and significantly contributing to the decline in the nation’s life expectancy for two years in a row. According to the government regulated national health protection agency, the Centers for Disease Control and Prevention (CDC), overdoses in 2017 were responsible for more deaths than the 58 000 American soldiers that died in the Vietnam War, more than the 55 000 US citizens killed in car crashes at the statistic’s peak in 1972, more than HIV/AIDS’ most devastating year of 43 000 deaths in 1995, and more than the nearly 40 000 gun-related deaths in the worst ever recorded year of 1993. Yet, the opioid crisis seems to remain relatively hidden from the public eye, overshadowed by these more politically charged and fiercely debated issues.

And while the opioid health crisis has not yet captured the public’s imagination as vividly as the gun control debate, for example, those on the front line of this battle know just how real it is. As a first responder to emergency calls, Fire Chief Rader is often the first to arrive at the scene of an overdose – as are firefighters, paramedics and police officers across the US. Because of the rapidly spreading nature of the epidemic, Rader says that as many as one in every four calls to the fire department can now be attributed to opioid-related overdoses, with Huntington being at the very centre of the opioid crisis.

Underpinning this growing problem are the efforts of big pharmaceutical companies over the last 20 years to change the public perception toward opioid-based medications. Since the late 1990s, these pharmaceutical production and distribution companies have managed to convince and reassure medical practitioners that their prescription opioid pain relievers are non-addictive to patients, when used under the right circumstances. Subsequently, prescription rates for pills such as OxyContin and Vicodin soared, more than doubling from 112 million prescriptions in 1992 to a peak of 282 million in 2012. And while the problem has become more apparent to the government, which has attempted to limit prescriptions to only chronic pain sufferers since about 2012, opioids are still readily being given to patients for mild dental surgeries or qualitatively assessed back pain, and are often over-prescribed in batches of 30 or more, where five or six days’ worth of medication would suffice. In 2016 alone, five billion oxycodone (the active ingredient in medications such as Vicodin) tablets were distributed to patients in the US.

However, this is not the most distressing part of the problem. Since the peak of prescription opioid distribution in 2012, prescription opioid-related overdoses have begun to level off, with a slight but steady decline observed in the last few years – a statistic that can be attributed in part to the government’s attempted crackdown on the liberal distribution of prescriptions by medical practitioners. But during this same period, heroin-related deaths have sharply increased nationwide. As more and more people have become dependent on the pills distributed by the large pharmaceutical companies, the prices for these prescription opioids have skyrocketed. Once addicted, but no longer able to financially maintain their increasing dependence, it has been well documented that users turn to heroin as a cheaper and often more readily available opioid alternative.

So desperate and widespread has this epidemic become that it has started to significantly impact the economic landscape of America. In a research paper, Princeton University Professor of Economics and Public Affairs Alan Krueger outlines the intertwined nature of the declining labour force participation rate and the growing opioid epidemic. In the study, titled “Where Have All the Workers Gone?”, Krueger notes that along with an ageing population and the fact that young people are now choosing to study longer before entering the workforce, there is also a strong link between the increasing use of pain medication across the population and the decreasing rate at which unemployed individuals re-enter the labour market. This point is bolstered by statistics that show that up to half of all unemployed men in the US use pain medication daily, with two thirds of them routinely taking prescription pain medication. When this data is combined with Krueger’s survey results that determine that prime age men who are out of the labour force “experience notably low levels of emotional well-being throughout their days, and that they derive relatively little meaning from their daily activities,” the situation seems even bleaker, culminating in a 40-year low workforce participation rate when the study was concluded in 2015.

This sense of hopelessness and meaninglessness sets in motion a vicious cycle of dependence, with despondent individuals turning to the readily available, soul-numbing opioid-based medications pushed by pharmaceutical giants. There is something to be said ontologically about the human condition – and particularly about the adult worker – when we reflect upon how easily so many are so susceptible to these drugs that drown out reality. For if they lived-reality of today’s workers is so painful that only powerfully addictive medications can give them a sense of escape, it is perhaps time to reassess the status quo of our work environment.

And while it is disheartening to witness the slow and inadequate response by governmental powers, inevitably bogged down by their own sluggish bureaucracy, there is at least a semblance of hope that has emerged through the valiant efforts of brave people on the ground like Jan Rader. It is these individuals that manage to cut through the red tape to get to the heart of the matter – saving countless lives in the process – that should serve as inspiration in our work and daily lives. For to know one’s cause is meaningful and yet, if one does not act to make it a reality, there is no hope for change, only regret.