The Truths We Hold

by Kamala Harris

  It started in 1995, when the FDA approved OxyContin and allowed its manufacturer, Purdue Pharma, to make the claim that, unlike previous opioids (Percocet and Vicodin), OxyContin was “believed to reduce” appeal to drug abusers because it was longer acting. Purdue Pharma seized on this claim and, in 1996, began the largest marketing campaign in pharmaceutical history based on the idea that OxyContin wasn’t addictive. The company’s executives testified in Congress to this effect and ran a whole program to convince doctors and patients that pain should be treated more aggressively than in the past, and that it could be done with little fear of addiction, as long as that pain pill was OxyContin. This despite the fact that company officials had received information that pills were being crushed and snorted, and that doctors were being criminally charged with selling prescriptions to patients.

  According to a time line developed by Mother Jones, by 2002, doctors in the United States were prescribing twenty-three times more OxyContin than they had in 1996. By 2004, the Federation of State Medical Boards actually recommended sanctions against doctors who undertreated pain.

  Pill mills started to pop up all over the country, where doctors would sell prescriptions and pills for cash. Between 2007 and 2012, three major drug distributors—McKesson, Cardinal Health, and AmerisourceBergen—made $17 billion by saturating West Virginia with opioids. By 2009, the United States was consuming more than 90 percent of the world’s hydrocodone and more than 80 percent of its oxycodone. By 2012, sixteen years after OxyContin reached the market, health care providers had written 259 million prescriptions for opioids. For perspective, there are about 126 million households in America.

  By the late 1990s, heroin use in the United States had declined quite dramatically from its 1960s and ’70s peak. But as opioid addictions skyrocketed in the early 2000s, heroin traffickers found a highly motivated consumer base for their product, which was significantly cheaper and easier to obtain than prescription medication. According to the National Institutes of Health, roughly 80 percent of Americans who become addicted to heroin start with a prescription for opioids.

  The danger worsened in 2013 as fentanyl, an exceptionally deadly synthetic opioid with fifty times the strength of heroin, made its way from China into the American heroin supply. The CDC estimates that there were 72,000 drug overdose deaths in America in 2017 alone. That’s nearly twice what it was ten years earlier. And in 2018, the CDC released a report finding that opioid deaths are still rising in nearly every segment of the country.

  When I was attorney general, I made the fight against opioids one of my highest priorities. We took down a large-scale transnational drug-trafficking organization in 2011 while sponsoring legislation to make it more difficult to print fraudulent prescription pads. We went after pill mills and shut down so-called recovery centers that were overprescribing, leading to patient deaths. When funding to my department’s drug-monitoring program was cut, we fought tooth and nail until I got the budget restored. The system allowed prescribers and pharmacists to quickly access a patient’s prescription history and make sure the patient wasn’t seeking the same painkillers from different doctors simultaneously. We went after criminals who were selling opioids on Craigslist and filed a lawsuit against a pharmaceutical company for inflating prices for opioid addiction treatment.

  How has the federal government responded? Not in the way one would hope. According to a joint investigation by 60 Minutes and The Washington Post in 2017, Congress “effectively stripped the DEA of its most potent weapon against large drug companies suspected of spilling prescription narcotics onto the nation’s streets. . . . The law was the crowning achievement of a multifaceted campaign by the drug industry to weaken aggressive DEA enforcement efforts against drug distribution companies that were supplying corrupt doctors and pharmacists who peddled narcotics on the black market.”

  In 2017, the administration declared the opioid crisis a public health emergency, but the fund they used to deal with it had only—I kid you not—$57,000 in it. That represents less than one dollar for each person who died of a drug overdose that year. It’s unconscionable. And if Republicans had succeeded in repealing the Affordable Care Act, they would have taken addiction treatment coverage away from three million Americans.

  This is a crisis that deserves a major federal mobilization. We need to declare a national state of emergency, which would provide more funding, right away, to help combat this disease—giving places like Chillicothe, Ohio, more resources to pay for addiction treatment, hospital services, skills training, and more.

  We need to address the challenge at every point along the spectrum, beginning with providing supportive treatment programs for those whom experts call “pre-contemplators”—that is, people who are not yet ready to commit to treatment.

  We need to make sure that people who are addicted have access to medication-assisted treatment (MAT)—drugs like buprenorphine, which prevents withdrawal symptoms and cravings without producing the kind of high that heroin or OxyContin does. Many insurance companies will cover the cost of opioids while charging more than $200 a month for buprenorphine. That has to change. We have to change it.

  At the same time, we need to create a federal standard for substance use disorder treatment. Right now, in many states across the country, it’s possible to open an addiction treatment center without being qualified to do so. There are no requirements for proper training or evidence-based treatment. As a result, too many Americans who have worked up the courage and strength to go to rehab arrive only to find that, for all the expense, they are not getting proper care and the treatment doesn’t work.

  We also need to reinstate the DEA’s authority to go after the major pharmaceutical manufacturers and distributors for their role in creating and sustaining the crisis. And we need to invest resources in law enforcement efforts to cut off the supply of fentanyl from China.

  Finally, we need to understand that, at its core, this is a public health issue, not a criminal justice issue. We can’t keep repeating the mistakes of the failed war on drugs that put so many people addicted to crack in prison. It is normal human behavior to want to stop feeling pain, whether physical or emotional, and people will find ways to do so. Sometimes that will mean getting help, and sometimes it will mean getting hooked on heroin. Our job is not to punish our friends and family members and neighbors by throwing them in prison. It is to put them on a sustainable path to better manage their pain.

  * * *

  • • •

  As my mother’s condition worsened, she needed more care than we could provide her. We wanted to hire a home health care aide to help her—and me. But my mother didn’t want help.

  “I’m fine. I don’t need anybody,” she would say, even though she could barely get out of bed. There was a fight to be had about it, but I didn’t want to have it. Cancer—the disease she’d devoted her life to defeating—was now wreaking its havoc on her. Her body was giving out. The medication was making it difficult for her to function—to be herself. I didn’t want to be the one who took her dignity away.

  So we muddled through. I cooked elaborate meals for her, filling the house with the smells of childhood, which reminded us both of happier times. When I wasn’t at the office, I was most often with her, telling stories, holding hands, helping her through the misery of chemotherapy. I bought her hats after she lost her hair, and soft clothes to make her as comfortable as I could.

  There isn’t a smooth, steady decline, I would learn. The process isn’t gradual. My mother would reach a plateau and stay there for weeks or months, then, seemingly overnight, fall to the plateau beneath it. During one especially hard spell, I convinced her to spend two weeks at the Jewish Home for the Aged—a place known for some of the kindest and best care—where she could get the round-the-clock care she needed. We packed her up and drove over to the home. The staff was incredibly kind to our family. They gave my mother a tour of the facility, s
howed her to her room, introduced her to the doctors and nurses, and explained the routine of her care.

  At one point, one of the doctors pulled me aside. “How’s my DA?” she asked. The question caught me off guard. I had been so focused on my mother’s well-being I hadn’t made room for anything else, but the question cracked through the strength I had mustered and hadn’t wanted to betray. I started to choke up. I was scared. I was sad. Most of all, I wasn’t ready.

  She asked me if I had heard of “anticipatory grief.” I hadn’t, but the term made perfect sense. So much of me was in denial. I couldn’t bring myself to believe that I was going to have to say goodbye. But underneath it, I was aware. And I had started grieving my mother’s loss already. There was something validating about that, about understanding what was happening to me. Putting a label on things can help you cope with them, I’ve learned. It doesn’t make you stop feeling your emotion, but you can put it somewhere if you can name it. And now I could.

  When the tour was over, I unzipped my mother’s suitcase so that I could help her move in. But she had other plans. She was sitting cross-legged on the bed, all five feet of her, when she said firmly, “Okay, this was nice. Let’s leave.”

  “Mommy, you’re going to stay here for two weeks, remember?”

  “No, I’m not. Nn-nnn. I’m not staying for two weeks.” She turned to the medical team, who were still in the room. “This has been great. Thank you. We’re leaving.”

  And so we did.

  She ended up in the hospital not long after that. That was when I started to see another change. For as long as I could remember, my mother loved to watch the news and read the newspaper. When Maya and I were kids, she’d insist we sit down in front of Walter Cronkite each night before dinner. She loved to digest everything that was happening in the world. But suddenly, she had no interest. Her mighty brain had decided it had had enough. Though she still had room for us.

  I remember that I had just gotten into the attorney general’s race and she asked me how it was going.

  “Mommy, these guys are saying they’re gonna kick my ass.”

  My mother had been lying on her side. She rolled over, looked at me, and just unveiled the biggest smile. She knew who she had raised. She knew her fighting spirit was alive and well inside me.

  When it was time for hospice care, we took her home and, finally, she let a hospice nurse come with us. Maya and I still didn’t believe that she could die, to the point that when she said she wanted to go to India, we booked plane tickets and started planning. We worked out how we could get her on a plane, and made arrangements for a nurse to come with us. We were all in a great state of delusion—especially me. I couldn’t bear to tell my mother no—not because she couldn’t take it, but because I couldn’t. Whether it was a question of bringing a nurse home or staying in the nursing home or going to India, I didn’t want to accept what saying no to her meant. I didn’t want to accept that she was running out of time.

  One night, Maya, Tony, Meena, and I were all at my mother’s house when Aunt Mary and Aunt Lenore, who had flown into town, came for a visit. I decided to cook again. I’ll never forget that night—I was making Alice Waters’s recipe for beef stew. I had browned the cubes of beef and they were cooking down in red wine, and all of a sudden my brain figured out what was happening around me. I started to hyperventilate—short breaths in and out. I felt like I might faint. All of a sudden, the delusion was gone. I had to face reality. I was going to lose my mother and there was nothing I could do.

  We had called our uncle in India to let him know that she was too sick to make it. He got on a plane from Delhi to see her. I now realize that she waited for his arrival, waited to say goodbye. She passed away the very next morning.

  One of the last questions she asked the hospice nurse, the last concern on her mind, was “Are my daughters going to be okay?” She was focused on being our mother until the very end.

  And though I miss her every day, I carry her with me wherever I go. I think of her all the time. Sometimes I look up and talk to her. I love her so much. And there is no title or honor on earth I’ll treasure more than to say I am Shyamala Gopalan Harris’s daughter. That is the truth I hold dearest of all.

  Eight

  THE COST OF LIVING

  When I was getting ready to write this book, I spent a good deal of time going through photo albums, reminiscing with Maya, and unpacking old boxes, including things my mother had saved. It’s been a blessing. I’ve had the chance to sit with good memories that don’t always make it to the front of my mind.

  When we were growing up, our mother always made chiles rellenos around Christmas. After she died, I wanted so badly to find the recipe. I searched everywhere I could, including online, but nothing matched my mother’s version. I felt so defeated, as though I’d lost more than just the flavor of her cooking. And then, while I was digging through my cookbooks, I found a notebook, and as soon as I opened it, the recipe fell right out of the pages and onto the floor. I was transported just by reading my mother’s handwriting. It was like she was there with me, still responding to my needs.

  I also found a couple of pot holders that Maya and I had woven on plastic looms. Any reader who grew up in the 1970s probably knows just what I mean. Our mother made sure our hands were never idle, especially in front of the television. That’s where I perfected my crochet shell stitch.

  Our mother loved to talk with her hands, and she was always using her hands—to cook, to clean, to comfort. She was always busy. Work itself was something to value—hard work especially; and she made sure that we, her daughters, internalized that message and the importance of working with purpose.

  She also showed us, in so many ways, how much she valued all work, not just her own. When something good would happen at the lab, my mother would come home with flowers for our babysitter.

  “I wouldn’t have been able to do what I did if you didn’t do what you do,” she would say. “Thank you for everything.”

  She saw the dignity in the work that society requires to function. She believed that everyone deserves respect for the work they do, and that hard effort should be rewarded and honored.

  I’d hear the same thing at Rainbow Sign, where speakers would talk about Dr. King’s Poor People’s Campaign, about his belief that “all labor has dignity,” and his effort to make it so.

  As part of that effort, Dr. King had gone to Memphis in 1968 to join black sanitation workers in their fight for basic decency. Day in and day out, these workers rode the trucks that hauled away the city’s garbage. The city didn’t provide uniforms; instead, workers were forced to befoul their own clothes on the job. They worked long hours without water to drink or a place to wash their hands. “Most of the tubs had holes in them,” one sanitation worker recounted. “Garbage leaking all over you.” He described how, when the workers got home in the evening, they’d remove their shoes and clothes at the door and maggots would fall out.

  For this hard, indispensable work, they received little more than minimum wage. They didn’t get overtime pay. They had no sick leave. If they were injured at work and needed time to mend—as happened often—they were likely to be fired. And if bad weather made trash collection impossible, they were sent home without pay. Many needed government assistance to feed their families.

  When the city refused to compensate the families of two sanitation workers who were crushed to death by their trash compactor, it became too much for the others to bear. With great courage, 1,300 Memphis sanitation workers went on strike, demanding safer conditions, better pay and benefits, and recognition of their union. They were on strike for their families, for their children, and for themselves. It was, above all else, a battle for dignity. The signs they held at marches said simply I AM A MAN.

  When King arrived at Bishop Charles Mason Temple, in Memphis, on March 18, 1968, a crowd of 25,000 people had gathered to hear him speak.


  “So often we overlook the work and the significance of those who are not in professional jobs, of those who are not in the so-called big jobs,” he said. “But let me say to you tonight, that whenever you are engaged in work that serves humanity and is for the building of humanity, it has dignity and it has worth.”

  “We are tired,” King said to the audience in Memphis. “We are tired of our children having to attend overcrowded, inferior, quality-less schools. We are tired of having to live in dilapidated substandard housing conditions. . . . We are tired of walking the streets in search of jobs that do not exist . . . of working our hands off and laboring every day and not even making a wage adequate to get the basic necessities of life.”

  Sixteen days later, King returned to Memphis to march on behalf of the strikers—speaking again at Bishop Charles Mason Temple, where he declared, “I’ve been to the mountaintop.” The next evening, April 4, 1968, he was killed by an assassin. Two months after that, on June 5, Robert F. Kennedy was murdered as well. The nation’s clearest voices and strongest leaders in the fight for economic justice had been suddenly, irrevocably silenced.

  That was half a century ago. In some ways, we have come so far since then. And in others, we have barely budged. I remind people that when you adjust for inflation, the federal minimum wage is actually lower now than when Dr. King spoke of “starvation wages” in 1968. What does that say about how our country values the sanctity and dignity of work?

  Americans are a hardworking bunch. We pride ourselves on our work ethic. And for generations, most of us have been raised to believe that there are few things more honorable than putting in an honest day’s work to take care of our family. We grew up trusting that when we worked hard and did well, we would be rewarded for our effort. But the truth is, for most Americans, it hasn’t been that way for an awfully long time.