Enlightenment Now: The Case for Reason, Science, Humanism, and Progress

Figure 12-6 shows an apparent exception to the conquest of accidents: the category called “Poison (solid or liquid).” The steep rise starting in the 1990s is anomalous in a society that is increasingly latched, alarmed, padded, guard-railed, and warning-stickered, and at first I could not understand why more Americans were apparently eating roach powder or drinking bleach. Then I realized that the category of accidental poisonings includes drug overdoses. (I should have recalled that Leonard Cohen’s song based on the Yom Kippur prayer contains the lines “Who in her lonely slip / Who by barbiturate.”) In 2013, 98 percent of the “Poison” deaths were from drugs (92 percent) or alcohol (6 percent), and almost all the others were from gases and vapors (mostly carbon monoxide). Household and occupational hazards like solvents, detergents, insecticides, and lighter fluid were responsible for less than a half of one percent of the poisoning deaths, and would scrape the bottom of figure 12-6.⁵³ Though small children still rummage under sinks, taste the offerings, and get rushed to poison control centers, few of them die.

So the single rising curve in figure 12-6 is not a counterexample to humanity’s progress in reducing environmental hazards, though it certainly is a step backward with respect to a different kind of hazard, drug abuse. The curve begins to rise in the psychedelic 1960s, jerks up again during the crack cocaine epidemic of the 1980s, and blasts off during the far graver epidemic of opioid addiction in the 21st century. Starting in the 1990s, doctors overprescribed synthetic opioid painkillers like oxycodone, hydrocodone, and fentanyl, which are not just addictive but gateway drugs to heroin. Overdoses of both the legal and illegal opioids have become a major menace, killing more than 40,000 a year and lifting “poison” into the largest category of accidental death, exceeding even traffic accidents.⁵⁴

Drug overdoses clearly are a different kind of phenomenon from car crashes, falls, fires, drownings, and gassings. People don’t get addicted to carbon monoxide, or crave taller and taller ladders, so the kinds of mechanical safeguards that worked so well for environmental hazards will not be enough to end the opioid epidemic. Politicians and public health officials are coming to grips with the enormity of the problem, and countermeasures are being implemented: monitoring prescriptions, encouraging the use of safer analgesics, shaming or punishing pharma companies that recklessly promote the drugs, making the antidote naloxone more available, and treating addicts with opiate antagonists and cognitive behavior therapy.⁵⁵ A sign that the measures might be effective is that the number of overdoses of prescription opioids (though not of illicit heroin and fentanyl) peaked in 2010 and may be starting to come down.⁵⁶

Also noteworthy is that opioid overdoses are largely an epidemic of the druggy Baby Boomer cohort reaching middle age. The peak age of poisoning deaths in 2011 was around fifty, up from the low forties in 2003, the late thirties in 1993, the early thirties in 1983, and the early twenties in 1973.⁵⁷ Do the subtractions and you find that in every decade it’s the members of the generation born between 1953 and 1963 who are drugging themselves to death. Despite perennial panic about teenagers, today’s kids are, relatively speaking, all right, or at least better. According to a major longitudinal study of teenagers called Monitoring the Future, high schoolers’ use of alcohol, cigarettes, and drugs (other than marijuana and vaping) have dropped to the lowest levels since the survey began in 1976.⁵⁸

With the shift from a manufacturing to a service economy, many social critics have expressed nostalgia for the era of factories, mines, and mills, probably because they never worked in one. On top of all the lethal hazards we’ve examined, industrial workplaces add countless others, because whatever a machine can do to its raw materials—sawing, crushing, baking, rendering, stamping, threshing, or butchering them—it can also do to the workers tending it. In 1892 President Benjamin Harrison noted that “American workmen are subjected to peril of life and limb as great as a soldier in time of war.” Bettmann comments on some of the gruesome pictures and captions he collected from the era: