In an April 2018 post (Gender, Race, Class and the Root Causes of the Opioid Crisis) I laid out data indicating that the opioid crisis has not impacted all communities to the same extent. Nationally, rates of opioid abuse trend higher among white men in working class neighborhoods than among other demographics. At the end of that post I called for deeper investigation into the reasons for these disparities and promised to launch a study focusing on the root causes of the opioid crisis at the community level.
Since that time I have carried out ethnographic fieldwork in Weymouth, a well-established, suburban town located south of Boston. According to data gathered by the Massachusetts Department of Public Health, Weymouth is one of the Massachusetts towns hit hardest by the opioid crisis. With a majority white population, Weymouth’s per capita income is $36,174.
I was encouraged to select Weymouth as a research site by the warm welcome with which my inquiries were met by residents and by the cooperation extended by town officials and municipal employees. Over the past months I spoke with young and old people, teachers and parents, blue collar workers and health care professionals, law enforcement officials and religious leaders, local business owners and people looking for work, bereaved parents and former opioid users in Weymouth. Turning to the people who know their community first-hand, I sought local explanations for opioid abuse in Weymouth.
Bit by bit, residents described the past twenty years as a period in which virtually all major institutions – economic, religious, medical and military – let them down. Good jobs disappeared, the Church turned a blind eye to priests’ crimes against children and even military service failed to provide a sense of pride and accomplishment. In this environment, pills that take away pain could almost sell themselves, with, of course, full-court advertising campaigns by pharmaceutical companies.
“Pharmaceutical companies put [people] in the frame of mind [to ask for drugs.]” – Former opioid addict, Weymouth
The advent of direct-to-consumer advertising by pharmaceutical companies in the mid-1980’s, followed by the production of increasingly potent formulae during the 1990s, provided impetus for the current opioid crisis. Interviewees pinpointed the years in which the problem exploded. “2004. That’s when pills pills pills came around.” According to a local health care professional, “It’s a US thing, a national mind set – you need a pill, an MRI, for everything … I think there was a culture that more medication is better. Let’s make sure no one is in pain.”
By the 2010s, as stories of overdoses in suburban communities were featured in newspapers across the country, federal and state governments began to clamp down on profligate prescribing of pain pills. Hooked on opiates, some people – particularly young adults – turned from pills to heroin, which had become cheaper and more easily available. According to several interviewees, opiate use was not really seen as a problem in Weymouth until people began dying from heroin laced with fentanyl or other toxic chemicals.
“In Weymouth a lot of it [the substance abuse problem] is economic. People here don’t have a lot of hope.” – Weymouth educator
Weymouth residents are proud of their blue collar heritage. One resident explains, “Weymouth is big with construction, many sheet metal workers and pipefitters. These are physically difficult jobs.” Another elucidates, “In working class communities people get injured on the job [and then are] overprescribed pills. If they don’t go to work they don’t get paid so they fight through injuries. And then one thing leads to the next and the next.”
The rigors of blue collar work contributed to the availability of opioids in Weymouth. But younger and older residents alike relate the current crisis to more recent “lack of hope for decent [blue collar] jobs,” especially among young men, many of whom had planned on following their fathers into the trade unions. (Young women are more likely to attend college and find satisfying jobs in the education and health care sectors.)
Over the course of half a century, most of the large employers of blue collar workers in Weymouth shut down. And then, when the Great Recession hit, “The job market dried up for young people especially. There was no alternative, nothing else to do. A twenty-two year old living at home, your parents have to buy you a car. How does that work for your self-esteem?” In the words of another resident who has worked with teenagers and young adults, “A lot of the overdoses are kids still living with their parents – middle / working class families. Kids still are living with their parents into their 30s.” These young adults find themselves working strings of part-time, dead-end jobs.
Young adults and teachers commented on the gap between what white, suburban kids are promised in school – “you can be anything you want to be,” with the post-high school reality. According to a local educator, “Many of the kids were fine in high school and then got out there [into the work world] and felt ‘this is it? This job? This much money?’ So in their twenties they began floundering. … Many students who did start college dropped out and are now saddled with loans that they have little hope of ever being able to clear.”
“They don’t trust institutions.” – Weymouth clergy member
In the heavily Catholic town of Weymouth, reports of sexual abuse by priests undermined what had been the single most important source of social cohesion. An interviewee who moved to Weymouth two decades ago recalls that when she first came to town people described where they lived in terms of the Catholic parish to which they belonged. Through the 19th and 20th centuries, priests in towns like Weymouth found jobs for parishioners, intervened with the police when kids got into trouble, mediated family and neighborhood quarrels, provided counseling, arranged for kids to go to Catholic schools, represented their parish’s needs to politicians, and were present at every major and minor life event.
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According to a member of the clergy, “There is institutional anger towards the church because of the bishops’ behavior. They don’t like institutions in general. They don’t trust institutions.”
“The VA used to give out pills like candy.” – Weymouth business owner
The Church is not the only institution that has let down the people of Weymouth. Weymouth consistently sends higher than average numbers of young people — especially young men — to various branches of the military. Although military service can be a path out of poverty and a source of self-confidence and self-esteem for many Americans, military service also is associated with pain, trauma, and high rates of exposure to substance abuse.
In the era of the wars in Iraq and Afghanistan, veterans struggle to find good jobs, to settle into civilian life, and to access the funds to buy homes. A town official muses “People give lip service to ‘our heroes’ but there’s not a lot of concrete policy to back that up.” People in town read and hear news stories about long waits and substandard conditions at VA medical facilities. Acknowledging that things have improved recently, veterans expressed particular frustration with the VA’s mishandling or over-medicating of PTSD, head injuries and chronic pain.
“Families here cope with trauma with substance abuse.” – Local health care provider
According to residents of Weymouth, long before OxyContin or Percocet showed up in town, the scene for the opioid crisis had been set in the culture of excessive alcohol consumption. Residents of all ages explain that drinking starts early in Weymouth. In the words of one young adult recounted, “Everyone was drinking in the woods at [age] 15.”
One interviewee now in her forties recalled, “There was a lot of alcohol and alcoholism when we were younger. … Parents, uncles, grandmother — they’d drink, get drunk.” A local social service provider elaborates, “There are high rates of domestic violence in this community. It goes hand in hand with alcohol. [A] violent raging alcoholic beats his son and the son eventually becomes violent himself.” These dynamics, according to residents, create a cyclical culture of trauma in which people turn to alcohol as a coping mechanism and eventually perpetuate the trauma that led to their own substance abuse.
An educator confided, “Speaking personally – substance abuse in the town has a lot to do with lack of communication … sweeping everything under the rug.” More broadly, residents explained that the local culture does not encourage people to seek professional help with mental health challenges or government help with financial challenges. As one local civic leader, “They don’t like government handouts!”.
The Good News?
The warmth with which Weymouth residents received me and the extraordinary level of cooperation shown to me by town officials made it clear that this is a community ready and eager to do what it takes to address the opioid crisis at its roots.
According to data provided by the Weymouth Police Department, the number of opioid overdose deaths has declined dramatically in the past year, though it is not yet known whether that decline reflects actual reduction in opioid abuse or only wider availability of Narcan (an opioid antagonist that counters the effects of opioid overdose).
Whatever the reason, the reduction in overdose deaths is good news. At the same time, the structural conditions that allowed opioids to gain a rapid and deep foothold need to be addressed so that communities like Weymouth will be less vulnerable to the next wave of mood altering substances, whether that is cocaine or methamphetamines (both currently seeing a precipitous rise in use), alcohol, or some new elixir dreamed up by drug cartels, pharmaceutical companies, or by regular Americans looking for relief from bodily, emotional or social pain.
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