The landscape of despair

Here in the Catskills, we all live in the shadow of the opioid trade. A little more than an hour’s drive from Woodstock, in the little Delaware County village of Hobart, is the Mallinckrodt factory, where hundreds of uniformed workers make generic oxycodone for one of the nation’s largest suppliers.

I don’t know what Alanis Morissette would make of an Oxy factory in the middle of a county with a raging opioid problem, but “ironic” doesn’t quite do it justice. It’s shameless, is what it is. And it’s been nagging at local writer Emily Popek for years.

A few months ago, Popek did some reporting about Mallinckrodt and the village that surrounds it, for the 100 Days In Appalachia project out of West Virginia University. Locals had plenty to say to her.

“When we ask people, ‘What do you think is the future of Hobart?’ it’s this kind of magical, wishful thinking, of some deus ex machina that’s going to come in and fix all the problems,” another local writer, Kristina Zill, told Popek. “There’s a kind of helplessness, and a kind of despair.”

The eyes of the nation are on the opioid epidemic, and Mallinckrodt’s factory in Hobart is being watched. A few years ago, local law enforcement broke up an oxycodone powder smuggling ring run by several of the plant’s employees. Last July, the company settled with federal prosecutors to the tune of $35 million, after a six-year investigation into the suspiciously outsize flow of millions of Mallinckrodt’s oxycodone pills into the state of Florida. [The company admitted no guilt in the settlement.] The company is now facing another lawsuit over alleged pill-pushing, this time by Missouri Attorney General Josh Hawley.

It’s satisfying to watch Mallinckrodt pay the piper, but none of this has put a dent in local opiate overdose deaths. In this, we are America writ small.

In a landmark 2015 paper, Princeton economists Anne Case and Angus Deaton found that after decades of decline across diverse categories of age, race, sex and class, mortality is stubbornly on the rise among one group of Americans: middle-aged non-Hispanic white people without a college degree. The authors lay the blame for this recent spike on “diseases of despair”:  a Venn diagram of human misery that spans the overlapping territories of suicide, alcoholism and drug overdose.

The Case and Deaton paper landed with a mighty thud, both in the scientific world and in the popular consciousness. Last year, they followed up on it with a look at more recent data, which show that mortality for black Americans without a college degree, which until recently had been decreasing, is beginning to tick upward as well.

Case and Deaton see the trends in worsening outcomes for broad groups of less-educated Americans as a symptom of “the long-term decline of working class lives.” It’s a profoundly pessimistic outlook, and one that — like most deep-rooted American problems — resists quick-fix approaches.

In the wake of Case and Deaton’s research, a spate of recent papers has explored the relationship between so-called “diseases of despair” and the geographic landscape of American life. Their conclusions are, quite literally, all over the map.

Earlier this month, in a National Bureau of Economic Research paper that made a splash in national media, economist Christopher Ruhm took aim at the whole concept of “diseases of despair,” arguing that the uptick in opioid overdoses was better explained by drug supply than by rurality or economic malaise.

Ruhm’s study was music to the ears of Bill Bishop, co-editor of the rural news website The Daily Yonder. Like most of the rest of the country, Bishop is apparently tired of reading endless feature stories on the perilous, drug-riddled rural habitat of that newly-discovered creature, Voterus americanus subsp. trumpii.

“Maybe we can call an end to the stories that try to show that addiction is related to where you live or who you vote for,” Bishop wrote in a recent editorial. “America has a drug problem. Everywhere.”

It’s hard to argue with that conclusion. Still, other reports have bolstered the connection between despair and geography. A March 2017 report from the CDC found that while U.S. suicides have increased across the board since 2000, they have been increasing faster in rural areas, where they were higher to begin with.

The link between landscape and despair appears particularly strong in Appalachia, a region whose northeastern tip extends to our own backyard — or mine, anyway; Delaware County is inside the Appalachian line. Last August, the Appalachian Regional Commission released a report that illustrated just how dramatic the impact of “diseases of despair” has been on the region in recent years: In 2015, the mortality rate from suicide, alcohol and drug overdose was 37 percent higher in Appalachia than in the rest of the nation.

Whatever the root cause — or, more likely, causes — despair lies heavy on the Catskills.

According to data from the New York State Department of Health, opioid overdose deaths have been on a steady rise in Ulster County in recent years. In 2010, that rate stood at 5.5 per 100,000; by 2015, the rate had risen to 15 per 100,000.

In neighboring Sullivan County, the opioid-related overdose death rate was 25.4 per 100,000 in 2015. That’s nearly double the statewide average of 13.5.

The deeper social and economic forces driving the opioid epidemic are probably beyond our local capacity to fight, even if we could somehow draw a clear line of causality between a place and its endemic disease. What we can do, we are beginning to do: local law enforcement, healthcare and social service providers, politicians and nonprofits are collaborating in new ways in an effort to stem the tide.

For their part, Mallinckrodt has tightened up security at the Hobart plant, and company brass will gladly tout their “anti-diversion” efforts to regulators and the press.

We can’t count on them to solve our problems. As I write this column, residents of St. Louis County in Missouri are waiting with bated breath for the EPA to decide what to do about their own local public health nightmare: thousands of tons of radioactive waste at West Lake Landfill, abandoned in secret after the end of the Manhattan Project and left to contaminate groundwater deep below the surface.

The uranium processor that created the waste? Mallinckrodt.

Note: An earlier version of this story stated that Mallinckrodt “abandoned” the waste at West Lake. Mallinckrodt did not directly deposit any radioactive material in the West Lake landfill. According to news accounts, after World War II, Mallinckrodt transported radioactive waste into the St. Louis suburbs in uncovered trucks and dumped it in open pits, with help from the federal government and under cover of national security. Much of this waste was eventually transported to the West Lake landfill by another company. Mallinckrodt has been the subject of dozens of federal lawsuits filed on behalf of St. Louis residents who have developed cancer while living and working near sites contaminated with waste produced by the company.

Responding to that version of the story, the company sent us the following:

Mallinckrodt has never had involvement with the West Lake Landfill, and we request you correct the mistake.

Shortly after the attack on Pearl Harbor, the U.S. Government approached Mallinckrodt Chemical Works to refine uranium ore as part of America’s nuclear program, and Mallinckrodt did so. Mallinckrodt’s work on this government program ended in the 1960s. At all times, the company worked under the direction of the U.S. Government, as did other contractors, and at no time did Mallinckrodt own any uranium or its byproducts. The U.S. Government owned all the uranium raw materials, in-process product, byproducts and residues and determined site locations where work was performed. Further, for decades, the U.S. Department of Energy and the U.S. Army Corps of Engineers have been responsible for and are handling all clean-up efforts on these sites.

Mallinckrodt has never had involvement with the West Lake Landfill, which is being overseen by the U.S. EPA. The U.S. Government sold the residue to a private third party, and some of that material was disposed of at the West Lake Landfill by another third party, according to reports.