The band is still playing

and_the_band_played_onMissteps, politics, and controversy hampered AIDS research and prevention in the 1980s – costing us literally thousands of lives.  “And the Band Played On”, Randy Shilts’s excellent account of the early days of AIDS,  would be less disheartening if we weren’t repeating the same mistakes today with a different disease.

Look at the parallels between AIDS in the 1980s and opiate addiction in the 2000s:

Patient group

  • AIDS was first identified in homosexual men, “a group that already suffered social stigma and inspired fear.” (And the Band Played On)
  • Opiate addicts are nothing if not socially stigmatized. Case in point: Olympic gymnast Simone Biles’s birth mother gave up parental rights because of substance abuse.  The mother was irate when the press found out.  I doubt she would have been angry if she had given up Simone due to cancer or multiple sclerosis, diseases that don’t spark shame.

Patients are being punished

  • The conservatives of the day proclaimed AIDS as God’s retribution for the homosexual lifestyle. Even for those who did not consider it a divine message, AIDS was generally considered to be the patient’s fault.
  • Opiate addiction is considered an illness only in certain circles, such as substance abuse treatment professionals. By nearly everyone else – including many patients, it is considered to be a weakness of character or lack of will. Is there any other illness where one describes himself as “a completely different person back then”, the way Biles’s mother (and countless other recovering addicts) do?  This implies that changing one’s fundamental person is the cure, which leads to the next parallel.

“Rational thought” as treatment

  • If the disease is the result of the patient’s own willful behavior, the only treatment is changing the patient’s behavior. The 1980s and even later saw many proprietors “curing” homosexuality.
  • When you think “buck up” is the answer for opiate addiction, then funding methadone clinics seems superfluous. A study of heroin addicts found that the patient’s family’s support (or lack of support) was an important predictor of whether the patient would continue treatment.  Imagine if diabetics gave up insulin because their family told them they should just lose weight.

Treatment centers are shunned

  • “[New York] city’s hospitals were petrified of being identified as an ‘AIDS hospital’, which would surely lose them patients . . .” (And the Band Played On)
  • The largest obstacle to opening a methadone clinic is finding a location where the neighbors do not protest. No one wants to live near a place that treats addicts.  Google “protest new methadone clinic” and you will find groups protesting everywhere from Philadelphia, Pennsylvania to Monument, Colorado.

1980s vintage blinders seem to be shaping our approach to opiate addiction.  I hope that opiate addiction does not follow the slow, torturous path that AIDS attitudes and treatment did.  The longer we reject addiction as a health problem, the more human potential we waste from people dying young.

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