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Dying to Entertain Us: Celebrities Keep ODing on Opioids and No One Cares

When mid-century matinee idol Rock Hudson appeared alongside Doris Day at a press conference in July 1985 looking glassy-eyed and skeletal, the scattered members of the early AIDS activism movement cautiously rejoiced.

“We were thrilled, in a really kind of awful way, because we thought maybe this is it, maybe this is AIDS,” says David France, director of How to Survive a Plague, the Oscar-nominated documentary about the influential New York City–based AIDS activist group AIDS Coalition to Unleash Power (ACT UP) that would form in 1987.

Early AIDS activists such as France certainly weren’t celebrating the prospect that Hudson might suffer from a highly stigmatized disease and face a swift and horrific death. Rather, in their desperation, as they watched fast-increasing numbers of their friends and lovers suffer such a fate, they had been praying for the power of celebrity to finally thrust AIDS into the national conversation.

They got their wish. After Hudson disclosed he had AIDS later that summer, the nation finally woke up to an epidemic that had been ravaging gay communities in major urban areas. During the short remainder of Hudson’s life, the beloved movie star and friend of first lady Nancy Reagan took to the activist pulpit, praising the sudden surge of public interest in tackling the burgeoning epidemic.

“That death began research,” France recalls of Hudson’s passing in October 1985.

The next year, the notoriously parsimonious President Ronald Reagan allowed a significant increase in the National Institutes of Health’s budget — for research into AIDS, a disease about which Centers for Disease Control and Prevention (CDC) scientists had first sounded the alarm five years earlier.

Flash forward three decades: Thanks in large part to a massive, sustained governmental investment, currently to the tune of more than $26 billion in annual federal dollars, the U.S. HIV epidemic is now increasingly being brought under control. At the same time, several city and state governments, such as those in San Francisco, Seattle, and New York City and State, have waged expensive, multifaceted campaigns to help control their own local epidemics.

Consequently, HIV is effectively crossing paths with the contemporary opioid epidemic, as that particular scourge follows a devastating upward trajectory and the governmental response remains woefully inadequate.

According to CDC estimates, the number of new annual transmissions of HIV declined by 14.8 percent between 2008 and 2015, from 45,200 to 38,500, while during that same period annual deaths among people diagnosed with AIDS declined from about 16,000 to 12,800; approximately 1.1 million people now live with the virus. Meanwhile, at least 2.1 million U.S. residents have an opioid addiction, according to government estimates, with those recently struggling with the condition including a long roster of boldfaced names: Macklemore, Demi Lovato, Rush Limbaugh, Cindy McCain, Matthew Perry, Jamie Lee Curtis, Eminem, Charlie Sheen (whose 2015 disclosure about his HIV status led to soaring testing rates), Courtney Love, and Steven Tyler. Some 42,000 Americans died from an opioid overdose in 2016, a rate that has soared fivefold since 1999. During the current century, opioids have already cut short the lives of more than 350,000 Americans, including such celebrities as Glee’s Cory Monteith.

This year, the federal government is ponying up some $27 billion for overall drug control efforts, including $16 billion for enforcement and interdiction and $11 billion for treatment and prevention. Much of this spending is earmarked for tackling the opioid epidemic. But public health experts believe such figures remain paltry given the scope of the opioid crisis, particularly because of insufficient support for what an increasingly widespread consensus says should be at the core of the U.S. response: evidence-based addiction treatment.

“We’re spending too little to address the epidemic, and you get what you pay for,” Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, says of the federal government’s “anemic” efforts so far. Looking to the future, he says, “Treatment costs are going to be enormous, but so is the cost of inaction.”

***

In April 2016, the legendary musician Prince died of what was eventually revealed as an accidental overdose of fentanyl, the extraordinarily powerful synthetic opioid painkiller that has swept through the U.S. drug supply in recent years. Eighteen months later, the same drug killed singer Tom Petty. Both entertainers fell prey to opioid use disorder the same way many Americans do: They were prescribed painkillers in this class — or in Prince’s case, he apparently got at least one physician to write prescriptions for him in someone else’s name — to treat chronic pain resulting from workplace-based physical trauma. For Prince, who had weathered long-term hip pain, dancing in heels for decades was his rarified version of a factory worker’s repetitive strain injury. Petty had recently concluded a nationwide tour he carried on with despite a hip fracture, on top of knee issues and emphysema.

These men’s awesome celebrity notwithstanding, the overall reaction to Prince and Petty’s overdoses — and to the opioid-driven losses before them of such other popular performers as Philip Seymour Hoffman and Heath Ledger — has amounted to nothing much when it comes to awakening Americans to the scope of the national crisis. By comparison, Rock Hudson’s death, as well as Magic Johnson’s announcement in 1991 that he had HIV, utterly jolted the national conversation about that epidemic.

Melissa Moore, deputy state director in the New York office of the national advocacy group Drug Policy Alliance, reasons that Americans are disinclined to file a celebrity overdose in the same mental folder where they place personal worries that addiction, or HIV, may hit them where they live. Such drug-driven deaths are “looked at as a part of the fast and quick lifestyle of celebrities that isn’t for an average person,” Moore says.

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The public’s perception of the HIV and opioid epidemics — which do, of course, overlap given that injection drug use is a major risk factor for HIV transmission — have historically diverged in various other key ways. “People aren’t shocked by drug deaths or overdoses in a way that they are about a new and emerging infectious disease that they don’t understand,” says Kenyon Farrow, the former U.S. health policy director at the ACT UP offshoot nonprofit Treatment Action Group.

While AIDS was brand new during the Reagan era, the nation’s ebbs and flows of mass addiction to opioids date back more than 150 years. Today’s epidemic was brought on in part by excessive prescription of opioid painkillers after Purdue Pharma brought OxyContin to the market in 1995 and then aggressively promoted the drug as a pain-relieving godsend that boasted a low risk of addiction.

The current crisis actually represents history repeating itself. Following the Civil War, the United States saw a surge in the prescription of opioids such as morphine, codeine, and heroin, in part for battle wounds. The advent of modern chemistry in the early nineteenth century had given rise to the synthesis of such drugs, and the advent of hypodermic injection use for medications later that century fanned the flames of the epidemic. By 1900, 1 in 200 Americans were addicted to opioids, about the same rate as seen today.

Better training of the younger generation of physicians — older doctors were notorious for overprescribing opioids for a wide swath of conditions, from pain to diarrhea — helped contain that early epidemic, as did a series of major acts of Congress passed between 1890 and 1924 that progressively taxed opium and eventually banned its importation, required manufacturers to identify the components of medicinal products, and ultimately regulated opioids.

During the first few decades after World War II, addiction to opioids — particularly heroin — largely afflicted inner-city populations, in particular New York City’s. Throughout this period, occasional entertainer overdoses helped remind the general public of the dangers of opioids. Hank Williams, who suffered chronic pain due to a spinal condition, accidentally overdosed on morphine in 1953. During the post-counterculture era, heroin was behind the deaths of Janis Joplin and John Belushi.

***

Today, the stigmas associated with each epidemic powerfully mediate how people react to news of either HIV or opioid addiction. These involve not only deeply ingrained attitudes regarding race and class, but also by the question of whether individuals are seen to have brought HIV or addiction on themselves, and the perceived degree to which free will dictated their high-risk behaviors.

Early HIV activists moved mountains to combat the hostile attitudes society initially levied against those living with the virus. Media reports of celebrities such as Magic Johnson or Ryan White, the HIV-positive boy whose harsh discrimination at the hands of his middle-American town propelled him into the national spotlight, helped lend humanity to those living with the virus. White, in particular, seemed custom-made to inspire a more caring attitude toward people with AIDS: a sweet-faced boy who had contracted HIV “blamelessly” through hemophilia treatments and whose poetic last name, in tandem with his pale skin tone, projected a nonthreatening image of angelic purity to the nation’s racial majority.

Stigma toward those with HIV is generally driven by two main factors: fear of contagion, and judgment about what stigmatized behaviors an individual may have engaged in to contract HIV, including various forms of condomless, non-missionary-position, non-heterosexual sex, as well as injection drug use. Sex between men is, of course, much less stigmatized today than in the 1980s, when it was still illegal in half the states. But ignorance still abounds about how HIV is and is not transmitted, and that ignorance certainly drives people’s fear of contact with those living with the virus.

The predominantly white face of the opioid epidemic has helped drive a more forgiving public reaction to that crisis — a fact that invites painful historical parallels, given the harshly punitive response to people of color affected by the the heroin scourge of the 1960s and 1970s and the crack epidemic of the 1980s.

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Additionally, the American public may be more sympathetic toward those addicted to opioids because they tend to perceive the epidemic as largely driven by doctors prescribing painkillers to individuals with legitimate medical conditions. The truth is, most of those who misuse opioid pills obtain them without a prescription. Additionally, droves of those who initially became addicted to prescription painkillers have migrated to heroin, which can be cheaper and easier to obtain.

All this said, drug addiction remains one of the most highly stigmatized human conditions, a fact that significantly limits the ability for celebrity narratives to help inspire the nation’s reaction to the opioid epidemic.

“Katie Couric getting a colonoscopy and everyone going to check their colon is not the same as Katie Couric coming out and saying she struggles with heroin addiction,” says Kassandra Frederique, New York State director at Drug Policy Alliance. “Celebrity can only carry you so far when it comes to stigmatizing behaviors.”

***

Perhaps the most crucial difference between the AIDS and opioid epidemics lies in how each has inspired troops of activists to fight for the respective causes. David France notes that, compared with today’s population of individuals addicted to opioids, gay men provided a much richer pool for potential activist foot soldiers during the 15-year crisis period of the AIDS epidemic, because such men were often either facing death themselves or thought they were.

“My study of ACT UP has led me to believe that self-interest was [AIDS activism’s] major component and major driving influence,” France says.

By comparison, those addicted to drugs like heroin or Vicodin, France argues, may not see overdose as a clear and present danger — and so may be less inclined to fight for their lives and those of others by, say, joining an activist movement or howling at their elected representatives. Additionally, the everyday lives of those in the throes of addiction may be so chaotic or otherwise compromised that these individuals lack the wherewithal to commit themselves to activism and political organizing.

Oftentimes, however, family members are indeed motivated to advocate for change. According to France, it’s such moms, sisters, daughters, and nieces who contact him pleading him to make a documentary about the opioid crisis. 

“But they’re also not leaving their ordinary life to go full bore in the opioid movement,” he adds.

The comedian Russell Brand is one of the rare celebrities who has a history of opioid addiction and has thrown himself into advocacy work — although his is quite a problematic voice. In Brand’s 2012 documentary on addiction treatment, he is sharply critical of opioid substitution therapy such as methadone or buprenorphine. In the face of competing scientific evidence that supports such medically based treatment as an effective, if imperfect, means of reducing the risk of opioid-use relapse and overdose, Brand clings stubbornly to the abstinence-centered dogma of Narcotics and Alcoholics Anonymous as the preferred route to fighting the opioid crisis.

Celebrated photographer Nan Goldin, who suffered a recent bout of active opioid addiction that took hold after she was prescribed OxyContin for chronic wrist pain, has waged a vociferous and creative activist campaign against the Sackler family, the wealthy owners of Purdue Pharma. Calling for nonprofits to refuse donations from the highly philanthropic dynasty, she has orchestrated colorful, headline-grabbing protests at various art institutions, including in the Metropolitan Museum of Art’s Sackler Wing.

Having started her own opioid-addiction-related advocacy group, Goldin is among those pushing for a massive, multipronged federal investment in combating the opioid epidemic, to the tune of $100 billion over the next decade. Called the Comprehensive Addiction Resources Emergency Act, or CARE, the proposed legislation is not as pie-in-the-sky utopic as the extraordinary price tag may make it sound. Importantly, CARE is modeled after the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, itself a multipronged federal program that passed with bipartisan zeal in 1990 — during a Republican presidency — and which has been reauthorized enthusiastically ever since. Today, that legislation provides about $2.3 billion annually in vital healthcare-based response to the HIV epidemic.

Repeating the success of the Ryan White Act on the opioid front would require a massive advocacy movement in the coming years. Longtime activist Jennifer Flynn Walker, director of mobilization and advocacy at the Center for Popular Democracy, argues that with a continued accumulation of grassroots organizing against the epidemic, such a corps of foot soldiers could harness the publicity generated by a future celebrity overdose and channel it into considerable progress.

“If Prince died next year, I think you would see the same kind of response,” she says, referring to the kind of impact that Rock Hudson and Magic Johnson had on the HIV movement, with “everybody going wearing overdose ribbons to the Oscars.”

If Walker is right, the next famous person to overdose on opioids could yield a tipping point. “The celebrity death,” she says, “only becomes the watershed moment because there was the base organizing happening first.”

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NEWS & POLITICS ARCHIVES THE FRONT ARCHIVES

Staten Island Law Enforcement Won’t Stop Fighting the War on Drugs

After using heroin for a year and a half and trying unsuccessfully to quit on her own, Jenna was confident she was on the right path. She had checked herself into a methadone clinic on Staten Island’s Seguine Avenue, deciding it was time to try in earnest to get clean.

“I had a really normal and good life prior to trying heroin,” the 29-year-old Staten Island native, who asked to be identified only by a pseudonym as her case is still pending, tells the Voice. While she’d been able to maintain her job at a construction company as her addiction worsened, she eventually became unable to take care of her son, and sent him to live with her mother. The clinic offered a chance to turn things around.

But on her third morning at the clinic, less than five minutes after she drove out of the brick hospital complex’s parking lot, she was pulled over by an unmarked police minivan. As is often the case for people struggling with addiction, Jenna was still using heroin during the early days of methadone treatment to stave off sickness from withdrawal, and had several glassine bags of the drug on her.

Jenna was cuffed and taken to the precinct where her arresting officer, Mathew Reich, told her about a drug diversion program called HOPE (Heroin Overdose Prevention & Education) that could wipe the potential misdemeanor possession charge from her record. But, he later informed her, an old felony theft charge on her record that had been dismissed actually made her ineligible for the program.

HOPE was the brainchild of Richmond County District Attorney Michael McMahon, who launched the program in February 2017 to redirect people with “little to no criminal record” who were arrested on low-level drug charges away from jail and prosecution and into community-based health and treatment services, instead of jail and prosecution. McMahon said at the time that he hoped the program would “shift the Staten Island paradigm — no longer will we be Heroin Island, but rather HOPE Island.”

But while HOPE has since expanded to Brooklyn and is set to expand this year to Manhattan and the Bronx, public defenders say the overall number of people on Staten Island being admitted to treatment diversion programs — for both felony and misdemeanor drug offenses — has actually gone down on McMahon’s watch.

Christopher Pisciotta, attorney-in-charge of Staten Island Legal Aid’s criminal practice, calls HOPE “a great program,” but notes that for every person offered a place in the program since its inception, two more have been denied. Since HOPE’s inception, 468 people have been offered admission, according to Ryan Lavis, a spokesperson for McMahon’s office, and 361 of those people have completed the program and had their cases withdrawn. Lavis says 5 percent of people directed to HOPE by the arresting officers are then turned away.

But these numbers don’t account for first-time low-level drug offenders like Jenna, who are never directed to the program by the police in the first place. And other programs, such as Staten Island Treatment Court (SITC) and Treatment Alternatives to Street Crime (TASC), have seen their numbers decline; in 2014, 434 people were referred to SITC by the D.A.’s office, a number that fell to 201 in 2016, one year into McMahon’s term. (The director of TASC, which is partially funded through the D.A.’s office, declined to comment on admissions to the program.)

“We are in the midst of an opioid abuse health crisis,” says Pisciotta. “Yet we see fewer and fewer offers for people to receive drug treatment through our Staten Island Treatment Court.”  

***

In 2016, the number of overdose deaths on Staten Island rose by 66 percent, leaving the borough with the highest overdose rate in New York City. The crisis of opioid use — which includes synthetic painkillers such as oxycodone and fentanyl as well as heroin — cuts across demographics, affecting young and old, black and white, poor and middle-class Staten Islanders.

Fentanyl, a highly addictive synthetic opioid painkiller that is significantly stronger than morphine, has exacerbated Staten Island’s overdose death rate, especially as dealers mix it with heroin to increase its potency, making it easier to overdose. In 2017, 40 percent of overdose cases on the island involved fentanyl, according to a spokesperson for McMahon’s office.

A self-described “Democrat-Independent” and a former city councilperson and congressional representative for Staten Island’s north shore, McMahon was elected as the opioid crisis on the island kicked into full gear. During his successful 2015 campaign for D.A., McMahon trumpeted plans to tackle Staten Island’s opioid crisis, both by locking up drug dealers and by expanding treatment options for opioid users.

“We have the worst drug problem in the state of New York,” McMahon told NY 1 News just after his win. “We’ve got to work together with the law enforcement, to get to drug dealers, but also we’ve got to find the treatment and prevention that we need. That was the message of my campaign.”

Since McMahon won office that November, though, tough-on-crime tactics — such as leveling homicide charges against people who sell opioids to users who later overdose — remain center stage at the district attorney’s office.

In addition to launching a public awareness campaign last summer, which includes yard signs that read “Staten Islanders Against Drug Abuse,” a school education program reminiscent of DARE, and a website with resources for those or their loved ones struggling with addiction, McMahon has centered his approach on his Overdose Response Initiative. Launched in February 2016, the initiative entails police calling prosecutors to the scene of any death suspected to be an overdose, which is immediately treated as a crime scene. The goal? “Hunting down drug dealers, aggressively prosecuting them, and sending them to prison,” said McMahon when introducing the program.

Targeting those who supply drugs is an understandable goal for any D.A., but with opioid use, the line between addicted user and seller is often blurry. Those grappling with addiction who may benefit from treatment programs are often the same people being prosecuted for sharing or selling drugs with people who overdose — not just the “kingpins.” Yet someone who unintentionally shares a lethal dose with another user can be charged with homicide, even if they’re battling addiction themselves.

Further, there is little evidence that pursuing harsh sentences — particularly when it comes to drugs — actually deters their use. A recent investigation by the New York Times illustrated the often devastating and counterproductive consequences of approaching overdoses as homicides using drug-induced homicide laws.

“We have seen how families and partners trying to come to grips with the immediate death of a loved one then become the target of law enforcement,” says Pisciotta. “We can save more lives by addressing this crisis for what it is: a public health crisis and not a war on drugs.”

It’s concerns like these that led Mayor Bill de Blasio to endorse a plan to open four pilot safe injection sites around the city — places where opioid users will be able to inject and use drugs under the supervision of trained staff in clean, safe facilities, both to stem the rise in overdose death rates and to prevent the spread of communicable diseases through needle sharing. In late May at an American College of Emergency Physicians Forum in D.C., U.S. Surgeon General Dr. Jerome Adams, a Trump nominee, voiced his support for harm reduction methods including safe injection sites.

But though Staten Island is neck and neck with the Bronx as the borough with the highest rate of overdose deaths, only the Bronx, Brooklyn, and Manhattan would receive safe injection sites. That’s largely because McMahon is opposed to their introduction, stating that instituting safer-injection sites “undermines prevention and treatment efforts, and only serves to normalize” opioid use.

When asked whether McMahon might change his stance if pilot sites in other boroughs proved to save lives, the spokesperson repeated that “the D.A. has said he opposes supervised injection sites,” and referred to a statement issued following de Blasio’s announcement, in which McMahon says the creation of the sites “poses a serious risk to public safety and creates difficult challenges for law enforcement to overcome.”

***

When Detective Mathew Reich pulled over Jenna and her boyfriend, he initially told them it was for stopping too abruptly at a traffic light. (This is not recorded on the formal charging documents Reich filed — he didn’t include any reason for the stop, which is not typical police protocol.) “As soon as he pulled us over, he was cursing, yelling, telling me I was a stupid driver,” says Jenna.

Reich then mentioned that he had seen the couple exiting the methadone clinic and followed them. Jenna says that after her arrest, she and her boyfriend, who is also receiving methadone treatment, were placed in the back of a van with tinted windows. Shortly after that, they were joined by two other handcuffed people who had been at the methadone clinic as well.

When Jenna returned to the clinic for her next dose following the arrest, she says, her counselor wasn’t surprised at her story, telling her that his clients were often arrested outside the clinic.

Staking out methadone clinics for arrests is common nationwide: In a methadone Reddit thread, clinic patients around the country report routinely seeing police sitting in the parking lots of treatment centers. In some instances, undercover officers pose as dope-sick addicts, wait outside clinics, and beg patients to sell portions of their methadone to ease their alleged illness. If patients sell the drug, they are arrested.

“This [tactic] is horrific,” said Dr. Sarah Wakeman, an addiction medicine specialist at Massachusetts General Hospital who is co-chair of the hospital’s Opioid Task Force. “We should be encouraging people to access treatment, not frightening them away with the threat of arrest.”

Neither McMahon’s spokesperson nor the NYPD responded to requests for comment on this stakeout method, and a FOIL request filed by the Voice for further information about arrests made by Reich outside the clinic was denied. But the pursuit and prosecution of such cases suggests at least a tacit endorsement by the Staten Island D.A.

***

After being told she was ineligible for the HOPE program, Jenna was offered a different deal by the D.A.’s office: Plead guilty to misdemeanor possession, and participate in TASC, a twelve- to eighteen-month program that pre-dates McMahon. If Jenna successfully completed the program, her misdemeanor would be vacated and replaced with a guilty plea to disorderly conduct, which is not technically classified as a crime and would be sealed after a year. But if she slipped up once during the TASC program with a dirty urine sample or other transgression, she could face up to a year in jail.

The district attorney’s office is eager to share success stories from HOPE, which is soon to be replicated in the Bronx and Brooklyn. “We have seen tremendous success with our HOPE program, which has served as a guide for other D.A.’s offices across the city,” says McMahon in a statement to the Voice. “To date, HOPE has connected more than 400 people on Staten Island with treatment services…. These are people who may otherwise be one more use of the toxic drugs out there away from deadly overdose.”

But the program remains out of reach for many prospective participants who, like Jenna, are instead pressured to immediately plead guilty with a distant possibility of having their record wiped clean.

At the same time, Staten Island Treatment Court, the county’s drug diversion court, has seen a marked decrease in admitted participants over the past two years, according to Pisciotta. And a special court for narcotics cases called Part N, which McMahon launched in October 2016 ostensibly in part to allow judges to better assess who needed to be diverted into drug treatment, was shuttered fifteen months after it opened, in which time not a single defendant was diverted. It has since reopened, and Pisciotta says he’s hopeful that it will have better treatment outcomes this time.

Jenna, too, is hopeful about her own future, thanks to the methadone clinic that ultimately led to her arrest. Her cravings for heroin were gone, she said three weeks into her treatment, and she was working to keep her methadone dose low, so it would be easier to ease off it when the time comes.

“The methadone really helps; I don’t feel sick anymore,” she says. The clinic “is a pretty good support system.”

Still, she says she watches her back during her daily visits to the clinic. She’s nervous now, and tries to avoid leaving through the main entrance or exit.

“I’m at fault; I did have drugs on me,” she says. “I get that there has to be accountability. But people are going there for help.”