“The first thing people need to know is that these drugs take over the survival center. I don’t call it ‘the pleasure center.’ It’s the survival center.”
Vice’s 2016 documentary Fentanyl: The Drug Deadlier than Heroin is full of disturbing scenes, but one moment early in the movie is especially memorable.
In this scene, a young man has come into a publicly funded treatment center asking for help with his addiction. His desire to get sober seems genuine and urgent. A staffer explains to him, however, that before he can begin the program, he must stay sober for at least five days: he has to find the “willpower” to go through withdrawal while he’s alone, broke, and possibly homeless.
After he pleads his case and loses—”five days” is a strict requirement—he seems to check out of the conversation, to give up on the idea of entering treatment, at least for now. (In the next scene, a different person tells the filmmakers that he would “rather die than go through the pain of the withdrawals of these pills.”)
“But it’s only five days,” you can imagine somebody complaining. “How hard could it be to not take pills for five days?”
***
I asked Driftwood’s Medical Director, Dr. Rey Ximenes, to explain why a person addicted to a drug like fentanyl often won’t just do the prudent thing and lay off for a while.
“I have a favorite analogy, actually. So there’s this cup of coffee on the table here. Let’s imagine that I told you to take a sip of that coffee, and you didn’t want to. If you felt strongly about it, you’d refuse.”
“Now—what if I took a .45 out and pointed it at your head and said: ‘drink the coffee?’ What are you going to do?”
“That’s what the addict is experiencing during acute withdrawal. ‘If I don’t drink that, if I don’t snort that, if I don’t shoot that, I’m going to die.’ The person might know that they don’t really need the substance. But they feel that they do. And that’s the trap.”
I asked Dr. Ximenes how easy it might be to kick fentanyl alone, while squatting in an empty house or sleeping under a bridge in cold temperatures.
“It would be like five days of re-enacting The Deer Hunter. Click. Click. Click. Five days of that? No. That’s where supervised detox becomes crucial.”
Dr. Ximenes takes exception to the idea that opioids like fentanyl hijack the brain’s “pleasure center.” “The first thing people need to know is that these drugs take over the survival center. I don’t call it the pleasure center. It’s the survival center.”
***
The question “why don’t you just quit” implies, subtly, that drug dependency is fun—that people addicted to fentanyl or OxyContin are indulging. If they wanted to get sober, they’d find the willpower to deal with a week or two of “dysphoria, insomnia, pupillary dilation, piloerection, yawning, muscle aches, lacrimation, rhinorrhea, nausea, fever, sweating,” and life-threatening “vomiting and diarrhea.”—and then independently solve all of the problems that had made them susceptible to addiction.
But the world we glimpse in that Vice documentary—of young people wandering around in the autumn cold begging strangers for spare change, living in tents and under bridges, obsessively looking for the next pill—doesn’t seem like such a fun place to be. It’s easy to see why the glassy-eyed young man at the treatment facility in Calgary wants to free himself from his addiction. It can be harder to see why he doesn’t “just do it.”