One morning not long ago, I was contacted by an old friend from a town I no longer live in and a circle of friends I no longer see. It was good to hear from her. After some brief catching up, she asked me, “did you hear about Ezra?
“Dead. Overdose. Last month.”
Our friend Ezra died of a heroin overdose, he was only 24. I’d known him since he was about 16, and even then he was struggling with addiction. For a while we were neighbours on an old estate in East London, when he was around 19 or 20. He was off heroin then, mostly, and taking a lot of ketamine.
It is a well-known fact that drug dependency is a product of hard social conditions
In the past few years I had seen him go clean and then relapse, clean and then relapse, over and over. I had seen the same pattern in many places, not just drug addiction. Someone would be doing well, really well, getting their life on track; then a bad week would strike with one fuck-up after another, day after day, and they would relapse. Sometimes the relapse was heroin, sometimes anorexia, sometimes self-harm. But the result was always the same: they would spend weeks climbing back out of that hole, rebuilding their life, cleaning out their bodies and their minds, strengthening their resolve until the next bad week.
When Ezra died, he had had a shitty week. I do not know exactly what made it shitty, or why he decided to score, or what he was feeling when he was preparing the hit. But he was clean for months and his tolerance was low; the dose was too strong and he died. People do not speak ill of the dead, instead they always say things like “What a kind soul he was” or “He was so intelligent, it was such a waste,” whether it was true or not. Ezra was kind, he was intelligent, and he was a critical and sceptical thinker. But even if he were not, his death would still be a waste, a tragedy, a loss for society.
It is a well-known fact, among those interested in the pathology of addiction, that drug dependency is a product of hard social conditions. In the 1970s, Professor Lee Robins studied the use of heroin and morphine among American troops in Vietnam, and among those returning to civilian life. She found that nearly half of all US soldiers had tried heroin or opium at least once, and that 20% had become addicted to it during their time there. Her study of soldiers returning from active duty found that of those who reported addiction in Vietnam, only 5% relapsed within 10 months of returning, and 12% within 3 years. That is, out of the 20% group of addicts, only one in twenty ever used again when they returned home. Moreover, it was found that such relapses did not necessarily lead to re-addiction, with reports of infrequent use but not always addiction (though this may be due to variation in heroin quality, a factor which could not be investigated).
Ezra did not live in the “enriched environmental conditions” that safeguard against drug addiction
At first, it was thought that these results were due to successful treatment. However, as only half of the addicted men received treatment, and as both the treated and untreated groups each had 4% re-addiction rates within the first year back, it was concluded that treatment is not always necessary for remission.
More recent studies on mice and rats go some way to explaining how addiction and remission appear to be directly related to social conditions. In 2006, at the Beijing Institute of Radiation Medicine, research led by Chenggang Zhang found that “enriched environmental conditions” cause a decreased use of morphine as reward. What enriches the environment of mice? Unsurprisingly for a social mammal, it is a lot of the same stuff humans need to be comfortable; free access to food and water, lots of space, a house, nesting materials, a running wheel, rubber balls and other toys. This study was undertaken on the back of similar ones, such as that of Smith et al in 1997 which looked at addiction-inducing environments using cocaine and amphetamine or the now-famous Rat Park experiments of the 1970s. The conclusion of these studies is clear: drug addiction is a product of intolerable social and economic conditions. At least in rodents.
Though his family wasn’t poor, Ezra spent a long time being homeless, from the age of 13 in fact. His parents were far from supportive, due to what could only be put lightly as “spiritual differences.” They were born-again Christians, he was not, and they would not accept him until he accepted Jesus. Growing up and living in London is difficult, the capital is a hard place to make ends meet while staying sane, even when you have class on your side. I could go on at length about the details of Ezra’s difficult life, but they are not necessary, as his story is all too common and I would like to maintain his anonymity. Suffice to say that, between Robins’ human observation studies and the various experimental animal studies, Ezra did not live in the “enriched environmental conditions” that safeguard against drug addiction.
A social welfare institution informed by the latest scientific knowledge knew better; it investigated, learned the pathology of the disease and found a treatment
Now for a brief tangent, the point of which will become clear. If you watch the excellent BBC drama Call The Midwife, then you deserve a spoiler alert. It’s not Game of Thrones, nobody dies, but I am going to reveal the plot of one of the episodes:
On the evening after the morning in which I received the awful news, I was watching Call The Midwife in bed. Set in 1950s East London, it told of two young brothers who were very ill. They presented with respiratory symptoms, thick phlegm and tiredness, but neither the nurses nor the doctor could diagnose them. Eventually an old nun, a walking repository of book knowledge, heard about the children and informed the nurses that the disease has no name, and is described in a Renaissance-era medical tome she had lying around here somewhere. “The sufferers of this disease would not live past the age of 5,” she quoted, “and their skin has a salty taste.” This gave the doctor an idea about a newly-characterized disease he had recently read about. By the end of the episode, both brothers were receiving treatment for cystic fibrosis, for free, on the fledgling NHS.
The old understanding of the disease gave no hope, resigning the children to a premature death from circumstances beyond anyone’s control. But a social welfare institution informed by the latest scientific knowledge knew better; it investigated, learned the pathology of the disease and found a treatment. It gave the children long lives, their parents the chance to see their children grow and to fill their lives with love. A death that conventional knowledge deemed fateful was shown to be preventable by a then-radical notion of free healthcare for all who need it.
Society and policy-makers still cling to the old understanding of addiction
This was another safeguard this that Ezra lacked. He tried continuously to get clean, fighting for his life on a daily basis. He went through rehab, attended Narcotics Anonymous meetings regularly, did everything that medical professional asked of him. And this showed, as over time the clean periods in-between relapses were longer and longer. But just like other addictions, just like smoking, quitting is often a temporary thing and has to be done several times before it sticks. We may have the NHS, but society and policy-makers still cling to the old understanding of addiction. It does not fit into our conventional understanding of disease being a set of symptoms caused by microbes, requiring a chemical medicine as cure (or in the case of cystic fibrosis, genetics and medical treatment). However, addiction works in the same way, it is simply that the causes are macro, not micro:
Had Ezra’s family been able to support him; or had he lived in economic conditions that fostered community and social cohesion rather than atomisation and selfish struggle; had society afforded him “enriched environmental conditions,” he would have probably avoided addiction altogether. Had Ezra been rich, or had the NHS been properly able to provide rehab away from the impoverished environmental conditions that kept him in a state of relapse-remission flux, he would still be alive and fighting.
That our society has these tools but fails to use them makes Ezra’s addiction preventable
Science and scientifically-informed social welfare institutions mean that we have the technology and the know-how to establish these “enriched environmental conditions” that prevent addiction, and that we could provide the treatments necessary for long-term remission. That our society has these tools but fails to use them makes Ezra’s addiction preventable. It makes many “macro” diseases preventable: every junkie, every homeless person, every rough-sleeper, every OAP shivering in their unheated home, every malnutritioned child. They are all victims of a society and economic system that will not use the tools available to prevent death and alleviate suffering.
Society is hard on junkies – no one cares enough to understand. Addicts are blamed and told that they are responsible for their own addictions, leading people to believe that they don’t truly deserve help. Even in the most liberal or progressive sections of society, the people who are able to see sufferers of HIV or morbid obesity as victims of environmental conditions continue to devalue the lives of drug addicts, refusing to acknowledge that economic conditions create addiction.
This is what upsets me so much about Ezra’s death. If it was preventable, there is someone out there who could have prevented it. Ezra – like the millions of others floundering in the murky waters of poverty – was a drowning boy whose society stood on a pier bedecked with life-rings and tutted sadly about the inevitability of a death he made for himself. And so I cannot shake the feeling that my friend Ezra was murdered.