Today I learned that America’s opiate abuse problem is, to all intents and purposes, sponsored by the major pharmaceutical companies, who are also substantial donors to presidential campaigns of both colours.

I wish I’d gone with my first instinct and watched Susan Calman on Strictly instead.

Perhaps you knew all this before Louis Theroux spelled it out in his latest foray into the hinterland of hopelessness. It’s not a state secret; if you google “drug addiction big pharma” 2,880,000 results appear in less than a second. Articles, investigations and information by drug abuse charities and prestigious international media outlets including The Washington Post, salon.com and CBS are front and centre. Indeed, that’s probably how they get away with it. Hiding in plain sight certainly worked for Harvey Weinstein.

Maybe you didn’t know about it. We’re a bit disconnected from all that in the UK. We have the NHS, possibly the most underappreciated service freely available to everyone at the point of delivery in the world, and one we abuse with the ferocity and regularity that would be better directed towards our politicians.

The thing with the NHS is that while its principal function is to diagnose and treat patients, its mere presence insulates us from the dangers of private healthcare; specifically ourselves. What we like to refer to on phone-ins as ‘the nanny state’ tacitly acknowledges that human beings don’t make good choices in the free market and our access to drugs should be controlled by someone who isn’t subject to market forces.

Louis has helpfully outlined the alternative with assistance from the residents of Huntington, West Virginia, a town so blighted by addiction that ‘one in ten babies born [is] dependent on opiates and the fatal overdose rate [is] 13 times the national average’.

I don’t need to tell you what that looks like. Since emerging onto our screens in 1998, Louis Theroux’s schtick hasn’t changed dramatically. He might look marginally less startled upon inserting himself into people’s narratives, but his presence as a conduit through which we can view the humanity beneath the stereotypes remains as powerful as it was the first time, and is as yet unparalleled.

His delicate balancing act of journalistic curiosity and humanity came as close as I’ve ever seen to tipping during Heroin Town though. Hunched on the floor of a drug house, he watches Katillia – a young woman whose spirit is so strong it shines through her deadening addiction like the sun through thick fog – preparing to inject herself. He’s at one with his audience in his helplessness. When he asks her if there’s anything he can say to stop her, he’s asking for us all.

But he knows, as we all do, that Katillia, her allegedly abusive supplier/partner Alvin and everyone else we meet are beyond help because the drug they’re addicted to is so powerful, its grip so unremitting, that the physiological need for it overwhelms the need for anything else.

Of course, we can carry on condemning and punishing users and fighting the ‘War on Drugs’, but while criminalising heroin has been wonderful for the bottom lines of privately run prisons, it’s done little to improve life chances for those who find themselves addicted. As Theroux points out, the vast majority of users found their way to opiates via pain medication prescribed by doctors and turn to street heroin when their supply runs out.

Yes, personal responsibility is a thing. You can’t legislate for kids going through their parents medicine cabinets and taking discarded pills any more than you can train the desensitisation out of the medical professionals who resuscitate the same people in garbage strewn alley ways week after week. You can’t persuade someone whose physiological need for a drug is stronger than a family bond not to steal to feed their habit, make poor judgements or involve themselves in abusive relationships.

If you were really motivated to make a difference, you could legislate to improve rehabilitation and education. To prohibit or at least limit the incentives offered to medical practitioners in the United States to prescribe highly addictive medications in quantities sufficient to create the overflow.

But while the American Society of Addiction Medicine figures claim in 2015 “2 million people had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin,“, their voices will not be heard. The rarified air in and around Washington is instead filled with the hushed whispers lobbyists who pay for the privilege of proximity to lawmakers and the resulting legislation.

I hope they’re as excited and happy when that pen signs off an amendment as Katillia is when Alvin announces he’s expecting an extra special batch of product. For a few hours, she won’t remember that no one cares enough to look beyond her pallor to the smart, intelligent human being beneath, or that to all intents and purposes she’s Alvin’s prisoner, to use and discard as and when he wishes.

In a cost/benefit analysis, she’s merely natural wastage in an hugely profitable industry. A loss that is factored in and deemed acceptable. That’s the real reason why neither you, nor I, nor Louis Theroux can look her in the eye.

At least he had the balls to try though. Do we have the balls to stand up to our politicians while we still have the NHS?

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by Kelly Welles.