Moving Beyond Caring "A Little More"

Medieval scholarly theologians, while contemplating the notion of “being,” speculated how many angels might be able to stand on the head of a needle. Seventeenth century theologians mocked such mental gymnastics. I will admit that the thought of such speculation is a bit humorous to me. Here's something, however, that is no laughing matter.

How much fentanyl may be placed on a pin before it becomes deadly? According to pharmacologists, 2 milligrams of the synthetic drug Carfentanyl, an analog of the drug fentanyl, will just fit on the head of a pin and is lethal (Cf. image above). Safely handling of any amount requires the full protection of hazmat suits! I assure you that few, if any, are laughing at the trail of grief left behind by fentanyl abuse. Mother’s Day will be observed on May 12 and, tragically, too many mothers will grieve the untimely and unnecessary deaths of their children due to the pervasive use of this deadly drug. All Christians have much to consider and act upon, even though this dangerous drug may not have touched their lives yet in a personal way.

This drug was created for its medicinal value. It was fashioned as a pharmaceutical agent in 1959 by a physician (Paul Janssen) to be used as an intravenous surgical analgesic. Due to its exceptional strength, 50-100 times more potent than morphine, it was rarely used except in hospital operating rooms or on large animals. Doctors have used it to treat severe pain following surgery and for advanced-stage cancers. Not all intent or use, however, has been beneficent. Criminal manufacturing of the drug began in the 1990s, soon after a transdermal patch was developed to treat chronic pain. “Lozenge, lollipop, tablet, and nasal spray versions soon followed” (PNNL). Illegal varieties of the drug quickly emerged in liquid and powder form.[1]

Most of the illegal fentanyl is transported into the United States by two Mexico-based cartels. The first point of entry is El Paso, Texas, where the drug is then transported East and West across the country. The chemicals used to make Fentanyl are brought from China to Mexico, where they are manufactured. The drug is easily distributed using a mobile phone and social media (e.g., Snapchat).
 
Cartels have begun targeting young children by producing colored-coded pills, made to look like candy, or crafted to simulate chips or cookies, or foods they would normally eat. In addition, drugs like cocaine, heroin, methamphetamine, and counterfeit pills are often laced with fentanyl, which makes them more potent. Many people have no idea they are ingesting the drug that can lead to accidental poisoning. The motivation of the cartels is simply to make a profit, and human life is not a concern. Five people, for example, die each day in my state of Texas from fentanyl-related overdoses (155 Americans die each day in this way). This drug plays no favorites, and anyone, anyplace, and at any time, may become a victim. This reality holds key ethical implications.

The moral implications of fentanyl production, distribution, and use are highly significant. First, governmental protection of citizens is an essential element in an orderly society. The illegal production, sale, and distribution of illegal drugs like fentanyl hold implications for rights of citizens to live securely. Fifty-five thousand Americans die each year from overdoses. Citizens are not being protected adequately.

Secondly, studies also indicate that African Americans of both genders are several times more likely to die of fentanyl overdose than Whites.[2] Fentanyl is certainly no respecter of persons, but minorities are impacted at a greater level. The issue is highly complex, but layers of social injustice contribute to what I will term “generational cycles of despair” (see below: "Steps to become aware and care a little more").[3]

Thirdly, the lack of concern at a core level for the value and dignity of human lives exhibited by the cartels, for example, is of grave moral concern. The lack of concern for value and dignity of human life extends in other directions as well. Research indicates that Black/African Americans with opioid use disorder experience limited access to the full range of medication-assisted treatment when compared to Whites. While the latter lack of gateways to medical care is not criminally negligent, it may be morally negligent, certainly ethically tragic. We will consider our Christian responsibility in a bit.

The story of a young child who died needlessly in February of this year encapsulates all the painful ethical realities of this deadly drug. A two-year-old African American daughter of a mother living here in the North Texas area died from a fentanyl overdose. The woman states that the death of her baby from fentanyl poisoning was “entirely preventable.” The toddler was staying at her father’s house when she encountered a single M30 pill on the floor. The counterfeit tablet resembled oxycodone, but had been laced with fentanyl. The heartbreak unfolded when a simple 911 call was delayed for two hours. Had the child been able to receive an emergency injection of naloxone, a rapidly reversing opioid overdose medicine, the results would likely have been different. The child’s grieving mother says she just wants parents to “be aware and care a little more.” Her words are saturated with moral meaning.

This heartbreak invites Christians to consider our lack of awareness of and failure to care for communities in despair. I confess that I often do more hand wringing about moral problems, like rampant drug abuse and addiction, than community engagement. The fentanyl epidemic and the tragic loss of life stated above exposes two basic layers of need that call for a unified Christian response.
 
First, illegal drug sales and addiction impact the security of every community, but especially the impoverished ones. Some of the universal needs, like affordable, accessible, and quality healthcare that many people take for granted, are unmet in “poor and oppressed communities.” Other core goods include “the need to be significant and important, and the need for a reasonable amount of security.” Our culture preaches that the removal of economic and political oppression will enable the generational poor to rise above their misery.[4] In some cases this works to enable people to leave behind their lives of poverty, but in many other instances the despair and hopelessness runs too deep. It is in these communities that people are most vulnerable to great evils like this drug crisis. Christians know the essential need for community security, but often use ineffective means to reach neighborhoods in a transformational way. The poor do not long for or need our “telescoping charity” or “drive-by philanthropy.” Instead, they need Christians to join hands in creating a web of connection that brings them into the fellowship of the Christian family and the presence of God (cf. John 1:14; Acts 6:1-6). Our benevolent ministries should do better to securely connect isolated homes and lives to the wider family of faith.
 
Secondly, our impoverished communities need to know they possess intrinsic value. Darrel Amundsen writes a probing chapter in On Moral Medicine describing the approach of the ancient world to the birth of defective children. The chapter holds broader ethical implications for children like the one I mention above and for entire impoverished communities. He decries a society where an individual's absolute value is always seen through the grid of social value. Medicine flourishes through a strain of utilitarian thinking where the maxim concerns the greatest good for the greatest number.[5] It may seem cynical, but the “greatest number” too often represents a summation of individuals who have the resources necessary to make helpful medical choices.[6] However, one in ten Americans do not have health insurance because the burden of making healthcare payments is greatest among those with the lowest incomes. I do not know what caused the above-stated two-hour delay in calling for emergency medical help, but I do know that the wider reality in poor communities includes a cluster of issues related to non-trust in the medical community, medical deserts where emergency care is not close by, and the lack of health insurance to pay for emergencies. This reality severely limits the power of choice.

The practice of Christian presence means that we will leave the comfort of our own gated communities to live among the poor through our consistent practices of hospitality. We will regularly serve in soup kitchens, food banks, offer housing assistance, open the way to drug treatment programs, and halfway houses (Matthew 25). The church my family attends consistently does these things. The organization I lead along with others strives to practice this type of presence. However, there must be more. We also need to be one unified voice speaking prophetically to the secular powers, holding them accountable to provide meaningful responses to these crisis, roots and all.

Mothers who face tragedies like fentanyl overdose and death of their children need us to stand with them and their wider communities. Abiding with them through their need practices the presence of Christ in transformational ways.

Larry C. Ashlock

Notes:
1. “In its liquid form, IMF can be found in nasal sprays, eye drops, and dropped onto paper or small candies.”

2. Pew Research. Between 2015-2020, the death rate from overdose has risen 213% for black men and 144% for Black women. One reason for the spike in deaths may be related to the lack of access to treatment during the pandemic and a rise in mental health problems.
 
3. Ibid. Blacks and Hispanics are more likely to say that drug addiction is a “major problem” in their communities where heroin and cocaine use have been an issue in low-income neighborhoods since the 1960s and 1970s. These drugs have become even deadlier since they are often laced with fentanyl. The issue is complex, but inter-generational substance misuse is passed from generation to generation. High poverty rates, economic disinvestment, and inter-generational substance use is a trifecta of deadly misery in these communities where a “means of survival.” Drugs are used and sold by community members as a means of survival.

4. M. Therese Lysaught & Joseph J. Kotva Jr. On Moral Medicine: Theological Perspectives on Medical Ethics (p. 160). Wm. B. Eerdmans Publishing Co., Kindle Edition.
 
5. Ibid., p. 788.
 
6. Ibid., p. 160.