Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.

This statistic provided by Beth Macy in Dopesick: Dealers, Doctors, and the Drug Company that Addicted America sheds light on the extent of the opioid epidemic in the United States. No other nation uses opioids as much as the United States does, relative to its population. A set of virulent circumstances particular to American life—a medical establishment that often stands to profit from opioid use by having doctors eagerly prescribe heavy doses of painkillers, an ability for illegal drug dealers to cheaply to produce and import opioids, a bleak mental environment in areas of the US with high levels of unemployment, weak relationships between family members that allow vulnerable drug users to feel alone, among other factors—has caused a particularly American crisis.

Whatever rules you make, you better stick to them. Your son or daughter depends on it. They will call your bluff on everything. Don't you budge. Changing the rules only confuses a young, developing mind.

Macy’s parenting advice highlights her belief that children need an even, consistent enforcement of rules and expectations in order to grow up safely. Her contention corroborates popular advice for how teachers can manage a classroom effectively. At home or in school, children benefit from knowing exactly what they should or shouldn’t do and what the consequences are for obeying or disobeying one’s parents. Behavioral consistency helps maintain a sense of morality among one’s family and community. Such safety is a basic need for a child’s motivation to learn, according to theorists like Abraham Maslow. Only when children are able to learn safely can they independently understand the danger of abusing opioids and make choices that avoid opioid use and dispersal.

If my own child were turning tricks on the streets, enslaved not only by the drug but also criminal dealers and pimps, I would want her to have the benefit of maintenance drugs, even if she sometimes misused them or otherwise figured out how to glean a subtle high from the experience. If my child's fear of dopesickness was so outsized that she refused even MAT, I would want her to have access to clean needles that prevented her from getting HIV and/or hepatitis C and potentially spreading them to others.

Macy offers a hypothetical about addiction that helps substantiate her recommendation for mitigating the US opioid crisis: promote legal, safe access to maintenance drugs and medication-assisted therapy. Too often, Macy argues, a dangerous, criminal environment worsens the effects of opioid use. When opioid users aren’t treated as victims suffering from a disease but as criminals, drug dealers and pimps stand to financially benefit from keeping opioid users hooked on illegal drugs and illegal means to support their drug addictions.