In a recent blog post, ‘Anne Amnesia’ sparked a discussion about an emerging subsection of society in the United States, made up of those people who have been left behind in the race towards the future[i]. She names this group the ‘Unnecessariat’.
The Unnecessariat’s loose membership can be found predominantly spread across the rural U.S. but its membership is bound not by geography, but by a shared hopelessness, an apathy, and a feeling of having become unnecessary to an economy which no longer values nor demands low-skilled labour.
Importantly for this discussion paper, Anne argues that the conceptual birth of the Unnecessariat is closely linked to the very real and growing death of its membership through opioid addiction, overdose and suicide.
The current epidemic
It took a long time for the US to admit that it had a drug problem, but the facts around opioid[ii] addiction and overdose have become difficult to ignore:
The first step is admitting that you have a problem, and in U.S. government’s case that acceptance has indeed come in steps; Congress committed $100m to tackling the issue in 2014, $400m in 2015 and in May 2016 President Obama asked Congress for $1.1bn of funding for the treatment and prevention of opioid abuse. Importantly, the White House now deliberately and clearly refers to these worrying levels of opioid misuse as an ‘epidemic’[v].
The future epidemic
This epidemic is real and it is complicated. When discussing the likely future developments of such a multi-faceted phenomenon we have to be careful not to oversimplify the picture. It’s easy, for example, to simply blame the relaxed prescription of opioid painkillers in the U.S. (the number of opioids prescribed in the U.S. since 1999 has nearly quadrupled, despite there being no observable change in the amount of pain being reported[vi]), but this remains one among many important factors.
This is equally true when discussing the potential future development of the Unnecessariat, a disparate group of Americans whose shared despondency has been forged haphazardly through decades of lazy policy, global trends and overt neglect.
However, thankfully, there do remain a few clear strands that we can pull at. These are trends and shifts that we are able to predict with some degree of certainty, and which may offer some guidance when considering the future of the U.S. opioid epidemic.
Automation, globalisation and a reduced labour requirement
Technological change will, in all likelihood, continue to reduce the costs and increase the benefits associated with automation[vii]. This will affect businesses in all sectors of the economy, increasing efficiency but reducing the amount of human labour that they require – particularly for low-skilled labour[viii]. At the same time, globalisation and rapid economic growth across the global south will make it less profitable for multinational corporations to base low-skilled production activities in the U.S.[ix]. Shifts in the balance of power in setting the terms of trade will further exacerbate both of these movements.
In short, one change that we can predict with some certainty is that low-skilled labour in the U.S. will become less important to the economy over the coming decades. This will leave a growing number people with nothing to offer and very little ability to direct their own path; the Unnecessariat will continue to grow.
The available evidence shows that people living in these circumstances, with no jobs, hope, or control of their destiny, are more vulnerable to addiction and, once addicted, will be less able to find a path out of addiction[x]. The important distinction here is that the Unnecessariat pose a very different challenge for policy makers than the challenges seen under traditional models of unemployment or underemployment. The members of the Unnecessariat cannot be motivated to find a job because there will be no jobs. From here, increased vulnerability will become a permanent factor.
Tackling the problem – the government’s approach
The government’s most recently promised $1.1bn of spending sends a clear statement of intent and represents an awareness of the scale of the problem faced. A deeper look into the specifics of this proposed funding reveals two key points.
Firstly, that the government’s priority is (quite understandably) on tackling the problem in the short term, with $920 million of the $1.1bn put towards funding current treatment centres and strategies.
Secondly, the government’s funding leans heavily on medication-based treatment. Medication has been shown to be highly successful when applied well, however future policy will have to take care not to:
It is becoming clear that this is not a problem that can be solved sustainably just by throwing around money or medication. Effective and sustainable solutions will need to be relatively cheap, and will need to stand-up over a very long time, possibly even supporting individuals indefinitely.
For these reasons we will increasingly see success in solutions that manage to integrate innovative treatment within existing community networks. In other words, solutions will increasingly be designed to work through those ‘Alcoholics Anonymous’ style community groups which have been a feature in many of the most affected communities for decades. This might mean that the future of treatment could be found in more unconventional sources. For example:
An emerging innovation in treatment – virtual reality
At the University of Houston, a government-funded research team have developed a novel form of heroin addiction treatment, which uses what the team call ‘virtual heroin caves’[xii]. These computer rendered scenes realistically simulate real-world scenarios in which the user might face the temptation to turn to heroin. This allows the user to practice facing real world challenges in a safe and controlled environment, alongside a trained therapist[xiii].
Although the system is not yet fully developed, early reaction has been positive and the benefits of creating a safe-but-realistic environment in which a patient and their therapist can work through challenges has the potential to significantly disrupt current methods of addiction treatment.
Such a technology-heavy approach would have traditionally been high cost and difficult to implement at scale. However, this is unlikely to be the case in future as the resurgence of Virtual Reality in the video games industry will significantly reduce the cost and increase the availability of Virtual Reality systems over the next decade.
As a non-medical solution there would likely be likely no insurmountable legal requirement to have a trained therapist administer this Virtual Reality treatment. As such, it would be possible to incorporate Virtual Reality treatment directly into non-medical treatment groups in town halls, community centres, practically anywhere that could house a PlayStation and a VR headset.
A changing landscape
The opioid epidemic is causing untold pain and grief, and it is difficult to blame the U.S. government for prioritising short-term solutions. However, this blog presents the conclusion that although money and medication are central parts of the solution, the deepening opioid epidemic will take place in a very different future landscape, with large numbers of long term unemployed and unengaged citizens spread disparately across predominantly rural areas. This should promote a different kind of treatment and innovative solutions.
The eventual answer may or may not be Virtual Reality: the end (or avoidance of the end) is more important than the specific means. What is clear is that it will become increasingly important to identify cheap solutions which can be deployed across a large area. Again, this will likely mean utilising the existing non-medical networks that are already in place, to build resilient networks that are integrated deep within communities, in order to support treatments that may need to last entire lifetimes.
The U.S. (as other countries in a similar position) would be wise to prepare for large numbers of people becoming lost, with no hope of being found. In the past, governments have tended to hand out medication to addicts, to help them get clean so that they can go out and get a steady job. For the Unnecessariat of the future, that tune may no longer ring true.
Image via Flickr