Greetings, and I hope that you and yours are healthy and safe – and can stay that way.

As part of being careful to stay safe, the “Friday Lunch,” a CWRU tradition since 1989, continues on Zoom. We work to present experts from campus and sometimes beyond to discuss important issues for the university, local community, nation or the international stage.

This Week’s Program

Once upon a time, basically from 1999 to 2011, somewhat naïve and mainly well-meaning physicians, especially those who specialized in pain management, combined with rather rapacious pharmaceutical manufacturers, and a variety of other forces (such as some dishonest pharmacy owners) to push prescription painkillers in a way that led to much greater use, addiction, and what was termed an “epidemic” of deadly overdoses.

Around 2010, overdoses from prescription opioids became so obvious that there was some policy response but, perhaps more important, change in medical practice that made it more difficult for people who had become addicted to prescription medicines to get the drugs. Unfortunately, many people were able to switch to a cheaper and more accessible product: heroin. So as deaths from prescription opioids leveled off, deaths from the traditional products took off over the following five years. At the same time, deaths from “cocaine and psychostimulants with abuse potential” also began to increase. The epidemic seemed to have entered a second wave.

The first decade or more of the opioid crisis disproportionately affected lower-income, more rural and less educated whites – people whose economic hopes and social networks were eroding as their communities shriveled. Overdoses could be grouped with suicides and alcoholic liver disease as “deaths of despair” growing from that social decline.

A third wave began in 2013, became particularly visible around 2015 and has yet to crest. Part of it involved more and more deaths from cocaine and its equivalents. But the largest impact was from growing use of fentanyl, much of it unintentional as people thought they were buying heroin or black-market prescription opioids. Fentanyl and its various analogues are far more powerful and so overdosing is far more likely. Moreover, illegally manufactured fentanyl began showing up not only in products sold as opioids but in drugs sold as cocaine or methamphetamine. Fentanyl has not only increased the death toll but changed the profile of victims. Since 2013 or so the impact of the epidemic has been less concentrated on whites without a college education, and instead been concentrated on all groups without a B.A.

The COVID-19 pandemic has only made the opioid epidemic worse. Total overdose deaths in 2020 appear to have reached 93,000, more than 30% higher than in 2019. Overdose deaths “spiked at the start of the pandemic.” The total in 2020 was around 93,000, more than 30% higher than in 2019.

So what’s going on now, and what’s likely to come next? The origins of the epidemic should be blamed on people and institutions that are not pushing the products that mostly are killing people now. Logical policy responses to over-prescribing of legal opioids don’t seem likely to protect people who know they are buying something illegal but don’t know they are getting fentanyl.

Lee Hoffer has worked on many dimensions of the opioid crisis. His book, Junkie Business, is a deep ethnographic study of the heroin market in Denver at the turn of the millennium. While he has continued studying heroin markets, he has been deeply involved in other topics, including the 2017 National Academies Study of policies for pain management. He joins us to discuss what he has seen over more than two decades of studying use of illegal drugs, abuse of legal drugs, drug markets, and interventions addressing both individuals and the communities in which they live.

Signing In

This semester’s discussions will begin at 12:30 p.m., the usual time. The meeting will be set up as from Noon to 2:00 p.m., so people are not all signing in at the same time and to allow for the discussion to run a bit long. Each week we will send out this newsletter with information about the topic. It will also include a link to register (for free) for the discussion. Every Monday the same information will be posted on our website: fridaylunch.case.edu.

If you register, you will automatically receive from the Zoom system the link to join the meeting. This week’s link for registration is:

https://cwru.zoom.us/meeting/register/tJwucuCuqj0sE9ZLUGnszipLkCncjcTW7yDy

After registering, you will receive a confirmation email containing information about joining the meeting.

Please e-mail padg@case.edu if you have questions about how the Zoom version of the Friday Lunch will work or any other suggestions. Or call at 216 368-2426 and we’ll try to get back to you. We are very pleased to be partnering this semester with the Siegal Lifelong Learning Program to share information about the discussions.

Best wishes for safety and security for you and yours,

Joe White
Luxenberg Family Professor of Public Policy and Director, Center for Policy Studies

About Our Guest

Lee Hoffer is a cultural and medical anthropologist who does research on illegal drug use and substance use disorder. His work has informed a range of topics, including; HIV risk behaviors of drug injectors, understanding the misuse of medications, the diagnosis of substance use disorders, drug policy and community-based intervention studies. His research currently focuses on understanding, monitoring, and predicting trends in drug use, as well as studying how illicit drug markets, and drug acquisition, influences the lives of people who use drugs. In addition to his research endeavors, Dr. Hoffer has on-going collaborations with and provides technical support services to local community health care providers seeking to reduce the harms associated with drug use.

Schedule of Friday Lunch Upcoming Topics and Speakers:

November 5: Redeveloping Buckeye/Woodhill. With Taryn Gress, MSSA, Strategic Director, and Debbie Wilber, Assistant Director, National Initiative on Mixed-Income Communities.

November 12: Can India Survive as a Secular Democracy? With Ananya DasGupta, Ph.D., Assistant Professor of History.

November 19: Hospital Boom and Busts. With J.B. Silvers, Ph.D., Associate Dean of Finance and Professor of Banking and Finance.

December 3: President Biden’s Trade Policy: Continuity and Change. With Juscelino Colares, J.D., Schott-van den Eynden Professor of Business Law.