Summary
Highlights
McDowell County, West Virginia, once a thriving coal community, faced severe economic decline. Drug companies flooded the state with highly addictive pain pills, leading to a surge in addiction. Jasen Edwards, a former miner, recounts how easy it was to obtain pain pills for work-related injuries, eventually leading to his addiction, fueled by doctor shopping and an inability to stop due to withdrawal.
Addiction is understood as a brain disorder where the brain changes in response to drugs. Robert Malenka explains how the brain's reward system, primarily controlled by dopamine, is exquisitely evolved to seek rewards. Drugs cause an unnatural surge in dopamine, leading to strong cravings and altering brain connections. Dr. Nora Volkow's research shows that addictive drugs, including opioids, reduce dopamine D2 receptors, impairing motivation and decision-making.
Fentanyl, a synthetic opiate 50 times stronger than heroin, has exacerbated the overdose crisis. Darwin Fisher describes its extreme toxicity, leading to rapid deaths. Dr. Rahul Gupta in West Virginia tracks overdose occurrences, noting that many overdose victims do not receive treatment. The potency of fentanyl makes the risk of fatal overdose extremely high.
Jonathan Winnefeld battled anxiety and depression, leading to substance use. Despite 15 months of expensive abstinence-based treatment, he tragically died from a heroin and fentanyl overdose. This highlights the scientific flaws of abstinence-only approaches for opioid use disorder, as they set people up for relapse, especially given the high risk of death with each opioid use.
Dr. James Berry in West Virginia found success with buprenorphine (Suboxone) for opioid addiction. Medications like methadone and Suboxone combat cravings and normalize brain function without causing euphoria. These treatments significantly cut mortality rates and help patients reclaim their lives, allowing them to engage in therapies that address underlying issues.
Trauma, such as childhood abuse or neglect, can predispose individuals to addiction. Marie's story illustrates this link; she became addicted to OxyContin after experiencing a difficult childhood and faced the loss of her children to Child Protective Services due to her addiction. The lack of affordable and accessible treatment options, especially medication, perpetuates the cycle for many.
Vancouver, Canada, implemented Insite, North America's first legal supervised injection site. This program provides clean needles, overdose reversal drugs, and access to treatment, significantly reducing overdoses and HIV rates. The Overdose Prevention Society also helps users test drugs for fentanyl, demonstrating that harm reduction keeps people alive and connected to services.
Addiction is a disease that has been stigmatized and criminalized, hindering effective solutions. Experts advocate for treating addiction like any other disease, integrating it into mainstream medicine. The documentary concludes with stories of successful recovery from Jasen, Mark, Casey, and Marie, all utilizing various forms of support and treatment, emphasizing that recovery is possible for everyone, given proper support and resources.