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The Opioid Epidemic: Nothing as Whole as a Broken Heart Parshas Mishpatim

As a very young child, I remember thinking that my family was part of a Chassidic dynasty. There is a Chassidic group known as Modzhitz; they’re most famous for their music; the many beautiful songs their Rebbes composed, such as the tune I use every month for Birkas Hachodesh. Well, Modzhitz, Motzen – they kind of sound similar, I knew I was named after the first Modzhitzer Rebbe, Rav Yisroel, and my father was a devout Modzhitzer chossid. So in my five-year-old brain, I just assumed that I was part of this great legacy.

Turns out, there is no connection whatsoever, and to top it off, my grandfather who was Chassidic growing up was part of an extremist group known as Satmar who probably saw the Polish Modzhitz as a bunch of heretics for their more moderate views.

Despite growing out of this thinking-I-was-the-next-Rebbe phase, there was one story of the Modzhitzer Rebbe that made a deep impression on me. My father told me the story numerous times, how in 1913, the Rebbe, who suffered from diabetes, traveled to a specialist in Berlin. The doctor declared that the only way to save the Rebbe’s life would be to amputate a part of his leg. And so the story goes that the Rebbe declined any form of anesthesia and instead, on the operating table, composed a beautiful song, a masterpiece known as Ezkera Elokim, a song that is sung in many shuls on Yom Kippur, and sang it to himself throughout the surgery.

That story made a very deep impact on me, and I think it’s a story that’s worth reflecting on in a time in which pain medication is administered like candy – actually more freely than candy. We Jews are very quick to call things a crisis. Everything seems to be in crisis when it’s really not. But when people describe our drug issue as an epidemic it is not hyperbole. Currently, the leading cause of death in America, more than illness, more than car accidents, more than gun violence, is drug overdose. And, here’s the scary part, over half of those deaths are from prescription drugs. In 1999, 4,000 people died from opioid overdose. In 2016, 64,000 people died from opioid overdose. Those deaths were caused by drugs like OxyContin and Percocet; items that many of us probably have sitting in our medicine cabinet.

The story behind this epidemic is a rather frightening one. Two doctors, read about a study in which the vast majority of patients who had received narcotics did not develop addictions, so these two doctors wrote a letter to the editor in the New England Journal of Medicine, a top medical journal, stating that, “We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”

This was not a paper, not a peer-reviewed study, but a letter to the editor; a letter that was so inconsequential that years later, one of the doctors claimed to have forgotten that he ever wrote it. But he did write it and this letter ended up being cited by a group that was advocating for more pain-medications to be administered by the medical world and they described it as a peer-reviewed article in the New England Journal of Medicine. And before you could say, “Doctor, my back hurts,” OxyContin’s and Percocet’s were being prescribed left and right. It has been cited as “a peer-reviewed article” in 900 publications since then.

As an aside, it turns out, surprise, surprise, that the advocacy groups were heavily funded by the drug companies. One way or another, new guidelines in the medical world, encouraged by the U.S. Department of Health and Human Services and the NIH, caused Oxycontin prescriptions to go from 316,000 prescriptions in 1996 to 7.2 million prescriptions six years later.

Let me share with you a personal story. About twenty years ago, I had my wisdom teeth pulled out. After a day or two, I realized something was wrong, so I went back to my dentist, and he informed me that my gums had gotten infected. To be clear, I came in because there was inflammation, not because I was in any pain. And yet, I left the dentist’s office with a pill bottle packed with Percocet’s that could have lasted me for around three weeks! The scariest part, was that on the way out, this dentist told me that if I had extras he could take them back because he would dispose of them for me. How nice.

That is one small anecdote that reflects the reckless prescribing of potentially addictive medication and, this specific story, also speaks to the prevalence of drug abuse. Dentists do not dispose of extra drugs! A dentist who is asking for your extra pills is either selling them or using them himself.

So yes, there is an epidemic and the question is, what is there to do about it? Is there anything to do about it?

Thankfully, a lot has already taken place. Doctors and legislatures across the country are taking action. And while there are still a few doctors lagging behind, many doctors are leading the way in preventing any further abuse of drugs and are working tirelessly to combat the misuse of opioids. Most of the change will have to take place on that level and I pray that they are successful in their endeavors.

But I believe that there is work to be done on a communal and on a personal level. The first and most obvious thing we can do is educate our children. And I’m speaking to parents because it is a parent’s responsibility to educate their children. So whether or not a school has an educational program about addictions, it is imperative that parents have such conversations with their children. And to bear in mind that children are experimenting with addictive substances at a much younger age.

Not too long ago, someone called me to let me know that at a Kiddush in our shul, a rental Kiddush in which there was a table packed with bottles of scotch, a young, a 12-year-old got himself completely intoxicated. (Since then, our rental policy has changed that for alcohol to be served at a Kiddush, there must be an adult overseeing the table.)

Policies aside. 12 years old. That’s quite young.

So yes, tell your children, when you feel they’re old enough to hear it, about the dangers of addiction; of what it looks like.

Role play and review with them how they could turn down an offer of drugs or alcohol. Give them the knowledge and the tools to not succumb to peer pressure and to do what’s right.

Beyond formal education, there is also informal education. As Jews, we have many opportunities for informal education. Whether it’s Pesach, Purim, Kiddush, or a Sunday night, Judaism is not opposed to a little indulgence. Those could be great opportunities to teach your children what is acceptable and what is unacceptable behavior.

And we need to ask ourselves some straightforward questions: How often are we drinking to the point that we are noticeably impacted by our alcohol? What message does that give our children? And what does that say about ourselves?

Because quite often, not always but often enough, there is some underlying pain that leads a person down that path. Substances are quite often an escape from a stressful life, a dark past, or a meaningless existence. One of the best preventative tools is making sure that our children are emotionally healthy, that we are emotionally healthy, and that we don’t feel the need to escape from our regular life.

And lastly, we also need to educate ourselves to appreciate that addictions are an illness. If we know someone with an addiction, to have sympathy towards them, to get them help; there are often boundaries we may need to create, but they should be enforced with sympathy and with love. If we, heaven forbid, have a child who is struggling with addiction, we need to not be ashamed to reach out to the many, many local qualified therapists or institutions that can guide you or your child.

Too often we take a whack-a-mole approach to these problems. If we don’t let our children go here or there then they won’t get access to drugs or alcohol. Kids are smarter than that. And so when we block access here, they find access somewhere else. Obviously, we need to keep them away from places where substances are readily available but we also need to dig deeper; we need to give them the tools to refuse, we need to give them love, and we need to build their self-esteem to make them not want substances because they’re happy with their life, and perhaps most importantly, we need to role model a healthy attitude of a balanced lifestyle.

And it’s that balanced lifestyle and attitude that I really want to focus on. Let’s go back to my visit with the dentist. I didn’t tell you what I did with those pills… Are you ready?

I took one pill. That’s it.

You see, I was a teenager when this happened and teenagers process everything through a ‘coolness calculator.’ A coolness calculator measures the coolness of every word that comes out of your mouth, every piece of clothing you wear, and how much of a swagger you walk around with. So my teenage coolness calculator came out with the following equation – it was far cooler to be stoic and to tell my friends that I only took one pill then it would been to be high and have taken the whole bottle.

That was how my coolness calculator processed things two decades ago.   But I don’t think a teenager in 2018 would come to the same conclusion. And that’s because, coolness aside, the ethos of our generation is to experience no pain. Stoicism, what does that even mean? Pharell William’s Happy song is our anthem. And if you want to get scientific, according to the World Database of Happiness, in the 1960’s, there were about five studies measuring people’s levels of happiness. Currently, there are over two thousand happiness studies being conducted yearly. That’s all we care about. How do I get happy? How do I live a pain-free life?!

Now it’s not politically correct to talk about morality when you talk about addictions. Addictions are a disease. I get that. But the prescribing of pills to preempt pain (!), the quickness that we go to the medicine cabinet, is part of a bigger MORAL problem. Our moral failing is that we want to live a stress-free, sadness-free, anxiety-free life.

There was a book that came out a while ago. It was about a drug addict whose mother, at one point started popping pills herself. In one chapter, he talks to his mother about it and he realizes that she’s doing this to herself because she hates her life and she’s so lonely. On his way home, in the cab, he reflects on the conversation and it dawns upon him that that’s exactly what he’s doing; he’s sad, he’s lonely, he feels empty inside, and he starts to cry.

He cries for ten seconds but he can’t handle the sadness. And so a moment later, in the back of his cab, he pulls out his needle, his eyes dilate, and he flies away into his happy place.

That scene symbolizes our generation’s mentality. It’s a pathetic moral failing and it’s also such a pity.

A pity not only for the 66,000 Americans that died from opioid use this past year, a pity not only for the countless tens of thousands of others who abuse drugs on a regular basis, and a pity not only for the countless others who do so recreationally. But it’s a pity for all of us to be striving for this pain-free life because in doing so, we miss out in so many ways from the beauty and the true joys of life.

Today we welcomed in the month of Adar, a month during which we are expected to increase our joy; Mishenichnas Adar marbim b’simcha. Today, and every year, immediately before the month of Adar, we read about the machatzis hashekel; the half-shekel that the Jews were expected to donate to the Bais HaMikdash. According to the Chassidic masters, the half or the broken shekel symbolically represents a broken self; a sense of existential loneliness, a sense of pain, a sense of anxiety, and a sense of not always knowing the answer – brokenness. I would suggest that we read this section deliberately before the month of Adar. We’ve been pursuing happiness for so many years and it hasn’t really worked out. We’ve been gratifying ourselves faster and faster and with more and more. But we’re even hungrier. Perhaps what we need is a little bit of brokenness.

The machtzis hashekel represents the ability to accept brokenness as a part of life; to not always be in a good mood, to cry and not run away from it, to not always feel so physically comfortable, to not have quick and shallow answers to existential questions. Spiritually, there is nothing more powerful than reaching out to G-d in prayer after feeling so down and distant from Him. Emotionally, there is nothing more cleansing than crying without restraint. And physically, while we don’t need to be masochists, we don’t need to sing a song to ourselves in the surgery room, there is a time and place for pain medication, I get it. But it’s probably not a bad thing to condition ourselves to being able to deal with some level of pain.

Brokenness leads the way to the joys of Adar and I would conjecture that it could lead the way to a healthier and happier society.

Legislation. Education. And perhaps adopting a new attitude, one that allows for some level pain; physical, emotional, and existential.  I hope and pray that as individuals and as a society, we can learn the true meaning of what a wise man once said, that “There is nothing as whole as a broken heart.”

 

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