What can we learn from the opioid and spice epidemics?

by Oliver Callaghan

If there is a lesson to be learnt from the opioid and spice epidemics, it is that substance abuse isn’t solely about drugs and the underlying legal and political framework. Instead, it starts and ends with the socioeconomic climate and vulnerable populations affected most by it.

History has consistently demonstrated that drug abuse epidemics are cyclical, and often have nothing to do with the legal status of a drug. Rather, they are driven by the human desire to use and abuse substances to escape pain and trauma. 

Over the past 15 years, there have been a number of socioeconomic disasters which have been neglected, inflicting devastating ramifications on substance abuse as a consequence. 

A shift in job market focus driving unemployment and a lack of purpose, a mental health crisis, and a technological and cultural shift are just a few of these issues aggravating substance abuse in society.

When reflecting on previous crises in history; during wars, financial hardship, or cultural revolutions, drug use has almost always existed synonymously as a way to enhance or protect us from the extremes of human experience.

During the World Wars for instance, morphine was quintessential for aiding soldiers as a painkiller. Once their pain had healed, morphine no longer had a purpose for them outside of the battlefield.

However, if these veterans returned to a society which was maladapted to equip them with the tools to reintegrate into society, the use of these drugs often continued if the mental trauma of war could not be addressed, or the sense of purpose provided by service could not be replicated.

It is worth noting that this is a vast generalisation of a large cohort of individuals with differing socioeconomic backgrounds, and many veterans of war return without the need to continue use. This reinforces the importance of the set and setting of drug use, better demonstrating the kind of relationship veterans had with a substance, indicating whether it was use or abuse.

If we look at the history of financial crashes; the Great Depression for instance, we can see a similar relationship emerge between an individual’s set and setting in determining their use of substances. 

In the 1930s, the Federal Bureau of Narcotics was set up to counteract the sweeping reports of opioid abuse from a range of socioeconomic classes. Widespread unemployment, financial deprivation and homelessness fuelled a setting which provided a need for opioid use.

The impact of the rapid cultural change should also be examined. The Bolshevik Revolution for instance demonstrated how a rapid shift in the morals and values of society can also drive substance abuse due to a sense of communal alienation and deprivation.

If we analyse the model of Rozenshtein’s “Active Psychiatry” from 1914 we can see that he determined that a key role in preventative care in mental health and substance abuse was centralised around social work in the community. While notions of stigmatisation and hysteria around “Narkomania” were circulating, he argued that the individual’s wellbeing is crucial in understanding the rationale behind the use and abuse of substances.

So what does this historical context provide about our current climate? What insights can we draw from these snapshots in time? These examples highlight the importance of psychosocial wellbeing in determining the purpose of drug use, showcasing why in fact abuse is so common within contemporary society.

We are currently in the midst of a mental health crisis, an economic crisis, and a cultural revolution, all of which pose individual challenges and compound the issues further. 

Facilities to support mental health have been declining for years, the balance of wealth has been magnified more than ever since the Covid-19 pandemic, and a cultural and technological shift has posed a sense of dissonance, which I believe we will be tackling for many years to come. 

This brings me to the problem of spice in the UK and opioid abuse in the US. While the chemical compounds of these drugs are different, I believe that the issues underpinning these crises run parallel to one another. 

Spice represents a novel advancement in the chemical development of drugs, as it was produced to bypass legal roadblocks. Despite changes to the Misuse of Drugs Act in 2009 and 2013, and a more comprehensive Psychoactive Substance Act, spice persisted and adapted to become more potent and distributable than any other drug. 

This results in a drug that can cause fatal overdoses easily, can be distributed to prison populations efficiently, and rapidly provide the intended outcome of escapism in a more prominent display than ever before.

While opioid abuse in America originated from legal Oxycontin use prescribed by doctors, the natural progression of the production of opioids has followed a similar path to the production of Spice. We can see this best when looking at the advancement of Fentanyl, which shares many of the same properties of spice listed above.

Although the legal framework for these drugs are different, they are both being used to address a deep sense of pain caused by the day to day trauma of vulnerable people’s lives. 

In Manchester, people living on the streets use spice to take away the cold, ruthless way of living they have to endure. The negative properties of this drug are irrelevant to them if it means they have a way of separating them from physical and mental trauma.

In Huntingdon, people who originally used Oxycontin were and still are in an almost identical socioeconomic situation to those in Manchester. What started as a simple prescription for pain or an escape from trauma often developed into a pursuit for cheaper, and more effective ways to achieve the physiological effects of these drugs at detriment to their wellbeing.

This emphasises the point that the legality of these drugs play virtually no role in vulnerable socioeconomic populations’ decisions on whether or not to consume these drugs.

We have been trying to address these problems by asking how we can stop these drugs from being distributed and used, rather than asking why they are being used in the first place.

So, where are we now? And how do we work towards integrating harm reduction?

Well, the war on drugs has indicated that prohibiting these drugs only enhances potency, optimises distribution (just look at the use rates of fentanyl and spice in prisons) and obscures the road to recovery for those suffering.

Instead, we should aim to empathise with those in situations of trauma and recognise the longstanding socioeconomic problems contributing to these decisions.

Rather than prosecute or stigmatise, we should fund mental health programmes, support harm reduction policies, and take advantage of the rising research on the functionality of substances such as cannabis or psychedelics in a medicinal capacity.

Substance abuse needs to be spoken about as a human issue rather than a political or legal one.

Oliver Callaghan is an Intern at Volteface. Follow him on X @Oliver1331556

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