H(O)me: Understanding Opioid Addiction and Housing Consequences

Earlier this month, an unlikely pair, President Barack Obama and rapper Macklemore, teamed up to address an increasingly dire issue in America: opioid addiction. The two appeared on the South Lawn in promotion of an MTV documentary, “Prescription for Change: Ending America’s Opioid Crisis,” that addresses the overwhelming epidemic of opioid drug abuse in the US today, which ranges from the abuse of pain killers to heroin to Fentanyl (Sandra Gonzales, CNN). Within the film, the pair and recovering addicts share their own experiences with drug use in hopes of educating millennials about the consequences of addiction and to dissuade all of opioid abuse.

This new documentary and presidential focus on opioid addiction stems from the increasing abuse of opioids in the past 10 to 12 years. Since 2000 there has been a 200% increase in opioid related drug overdoses across the country. In certain regions, including Appalachia, New England, and the Southwest, these numbers are even more dramatic. For instance, based on a New York Times inquiry, New Mexico has been dramatically hit by the issue, where there were 27.3 opioid related deaths per 100,000 in 2014. This figure compares to the national average of 14.7 opioid related deaths per 100,000 in the same year. What’s most shocking however, is perhaps how both of these numbers contrast to the figures we saw only ten years ago: opioid related overdose deaths have increased more than 2 times since 2003, when there were only 6.2 opioid related deaths per 100,000 (cdc.gov).

Not only has abuse increased, but the demographics surrounding opioid addiction has dramatically changed. In the 1980s and 1990s opioid use was equally split between racial minorities and whites and was often focused in urban, inner city areas. Today, use has morphed—as President Obama highlights, “the opioids crisis is getting into communities that are suburban, that are relatively well to do, rural communities, white communities” (Sandra Gonzales, CNN). The new faces of opioid and heroin addiction are mostly suburban and rural whites from lower-middle class to upper-middle class families.

The overall increase and shift in demographics leads many to conclude that prescription pain-killers are to blame. Often easily offered to middle class suburbanites, drugs like Hydrocodone and Oxycodone have become over-prescribed. This over-access to narcotics has provided a stepping stone to addiction and possibly spurred the opioid epidemic as a whole. As Surgeon General Dr. Vivek Murthy has highlighted, “prescriptions for powerful painkillers have risen to the point that there’s enough for every American adult to have a bottle of pills” (Alexandra Sifferlin, TIME). This is astounding, especially when considering that other countries—where drugs like Vicodin are not readily prescribed—tend to witness lower opioid abuse levels. In the United States around 6% of Americans practice opioid use while countries with more restrictive practices (where only 0.5% of the population has a prescription to use) see a mere 2% use level. In fact, the US, which constitutes only 5% of the world population, receives a whopping 80% of the world’s prescription opioid supply (Michael Zennie, The Daily Mail). The prescription levels of narcotics also correlates to increased abuse of opioids on the state level.  For example, states like West Virginia and Tennessee in Appalachia and Nevada and Utah in the Southwest see both above average narcotic prescription rates and large amounts of opioid abuse and overdose (Haeyoun Park and Matthew Bloch, The New York Times). In West Virginia, for instance, there were around 120 prescriptions written for opioids in 2014 for every 100 people; meanwhile, in Minnesota, a state that has remained largely removed from the opioid epidemic, there were only 60 prescriptions per 100 (cdc.gov).

Outside the data, average Americans are taking notice of the opioid epidemic, too. In recent years, the drug abuse issue has become more visible to the public both in terms of neighborhood visibility and national media coverage. For instance, most millennials today are able to identify a friend or relative that has abused opioids in some capacity. Nationally, much attention was given to the premature passing of pop star Prince, who overdosed on Fentanyl this summer. This increasing visibility has been quite acute for my own hometown of Chanhassen, Minnesota, where within a year the community grieved the loss of both a beloved classmate and a local leader, Prince, to opioid overdose.

The visibility of opioid use itself has reached previously unprecedented levels, especially with heroin. The New York Times notes users openly abusing heroin in public spaces, like on city buses or even in fast food bathrooms, while leaving children unattended (Katharine Q. Seelye, The New York Times). Many average Americans are experiencing opioid addiction and abuse right before their eyes.

The opioid epidemic is also recognized in our own community in Wisconsin. As the Badger Herald explored last winter, many UW-Madison community members have struggled with opioid addiction and the state as a whole has witnessed increased opioid use and overdose in recent years. As the graphics below demonstrate, heroin cases in Wisconsin have increased from 2009 to 2014 in over half of the state’s counties; the number of counties with 30 or more cases related to heroin has jumped from a mere 4 in 2009 to a whopping 11 counties in 2014.

As the Herald explains, often times abuse can have serious and unexpected consequences, affecting almost every aspect of one’s life. Mentally, addiction can lead to depression, and possibly brain damage. If untreated, these debilitating outcomes of abuse can influence a wide range of important life factors, including the ability to keep employment, sustain personal relationships, or attend school. Meanwhile, on the flip side, the instability of addiction often leads many to lose their income and the support of friends and family members. Frequently this loss of financial and emotional support comes at the worst time, plummeting many further into addiction. One can see how these factors create a vicious and debilitating cycle of abuse. Other consequences of addiction include family dissolution and the removal of children from the home, aggression and violence, lack of appropriate diet and nutrition, and the establishment of unstable and toxic drug-based relationships.

However, one particularly serious consequence of opioid addiction is housing instability and homelessness. Often times many users are left without the proper income to maintain their home, pay utility costs, or pay their often unjustly high rent costs. This consequence of opioid addiction was seen first hand in Evicted, this year’s Go Big Read book by Matthew Desmond. The portrait of Scott demonstrated the debilitating consequences of drug abuse—his opioid addiction led him, like many others, to housing instability.

Scott started off his opioid problem like many Americans: with a prescription to Percocet after an injury. Wisconsin, like a majority of states, has a middle of the road opioid prescription level, with roughly 75 narcotics prescriptions per 100 people (cdc.gov). It was standard enough for Scott to receive the opioids, but unfortunately, he was soon hooked. Within the first few weeks of taking the medication, he started to look at the doctor as a “treasure […], like a bartender who pours to the rim”(Evicted, p. 83). He returned often to refill. However, once the M.D. announced his retirement, Scott went into a panic; he needed Percocet to cope with both his physical and emotional pain and he didn’t know what he would do without it. As the Badger Herald explains, this progression of use to abuse is common. Painkillers like Percocet can be extra addictive because they not only create a euphoric and relaxed feeling, but cause the body to stop producing natural levels of dopamine, the “happiness” chemical. For people who are taking a prescription for a few weeks, like Scott, “the body stops producing dopamine and the medication ends up as the body’s only source” of the needed chemical (Emma Palasz, The Badger Herald). The body ends up requiring the opioid to produce any dopamine. Thus Scott, depressed and in need, turned to alternatives: he first purchased painkillers from his nursing home patients and eventually abused Fentanyl, the same drug that killed Prince.

His Fentanyl addiction became all consuming and came with consequences—Scott lost his nursing licence and thus flow of income. He was then evicted from his upscale apartment on the East Side of Milwaukee. Discouraged and hopeless, Scott checked into The Lodge, a shelter, and eventually moved into the mobile home park with his friend Teddy (Evicted, p. 84). In the park, he found many fellow addicts and began abusing methadone pills and later heroin. Upon eviction from the park, he continued on a road of temporary and unstable housing and the cycle of sobriety, relapse, and addiction.

It was only after Scott was able to find a permanent and stable residence that he was able to kick his drug addiction completely, highlighting the strong connection between opioid abuse and housing precariousness. Although he still did not have his nursing license or a set income, he was able to find assistance through the Guest House, a shelter, that provided him with $600 a month for rent and furnishings for his new apartment. As he explains, in the trailer park in his sub-standard housing, he felt stuck, like there was no hope. In his new space, “[he] felt affirmed, deserving of something better” (Evicted, p. 280). Scott was able to get back on track, writing out a 5 year plan that included getting his nursing license back.

As the story of Scott and Evicted demonstrates, the opioid epidemic and housing instability go hand in hand. Although Scott’s story began with opioid abuse, which later led to eviction, often times eviction itself can lead to a string of terrible consequences that pushes many to drug abuse. Either way, eviction is a painful and destabilizing reality that many face. Those that have been evicted have a 15% higher chance of being laid off than workers without displacement. Those that have experienced eviction face 20% higher levels of material hardship than those that have not. Those that have been forced to move are 25% more likely to experience future housing instability (Evicted, p.294-5). It is apparent that eviction has dire consequences for many that lead to severe instability and possibly homelessness. As such, whether an opioid abuser or not, home displacement contributes to the desire for escape and fosters an environment that is conducive to addiction. Unfortunately, both opioid abuse and eviction in a sense play into one another.

However, hopefully with increasing measures to curb both the opioid epidemic and eviction levels in America, needed changes with both abuse and displacement are to come. It was recently announced that MARS, Desmond’s own innovative and effective survey for measuring eviction, will be integrated into HUD’s national American Housing Survey, providing meaningful understanding about eviction on a national level. Meanwhile, President Obama and legislators have been pushing strongly in the past year to combat opioid addiction, passing major legislation last spring to help curb the epidemic. Hopefully, change will come on both fronts.

Morgan Olsen

Student Assistant, Go Big Read Program