Contesting Deaths’ Despair: Local Public Religion, Radical Welcome and Community Health in the Overdose Crisis, Massachusetts, USA

1.1 Deaths of Despair

Deaths of Despair, coined by Anne Case and Angus Deaton,^[3] describes an increase in deaths due to suicide, drug overdose and cirrhosis of the liver in the United States. Explanations as to the causes of this uptick are multipronged but most readily attributed to growing inequality, ongoing deindustrialization and a broken healthcare system.^[4] The demographic group that experienced the sharpest decline in life expectancy to such deaths are white, working-class people with only a high school diploma.^[5] In recent decades, quality of life between those with and without a college degree has grown starker with major divergences in not just life expectancy but also other social and health indicators like marriage rates and disability. Both as a cause and consequence of the shift, broader civic life has suffered for this group with declines in civic engagement, union membership and religious participation.^[6] Some point to a broader spirit of despair and loss of hope as characteristic of rising mortality.^[7]

1.2 Religious and civic decline

The decline of American civic life has been bemoaned by scholars for decades.^[8] In terms of religious participation, though the United States has proved an exception to secularization^[9] in comparison to its European counterparts,^[10] those not affiliated with a religion, termed “nones,” continues to grow.^[11] Religious participation has also become more stratified, with working-class whites less likely to participate in religion than their middle and upper middle class counterparts, a chasm that was not present for the majority of the twentieth century.^[12]

The stratification of religious participation is significant because projects of social uplift often have a religious bent or origin.^[13] Religious communities also present the opportunity for the transmission of social capital.^[14] Health outcomes are also positively linked to religious participation.^[15] Research shows persons in communities with stronger ties to institutions do indeed experience protective effects, leaning on the social and cultural capital institutions provide to weather life’s storms.^[16] For example, geospatial research analyzing drug overdose with community markers of positive social capital, like religious participation and union membership, found communities with more social capital to experience lower rates of fatal overdose and medical distress than adjacent communities with less social capital.^[17]

As the American working class has little social safety net and experiences increasingly precarious work conditions, religious institutions, as Wilcox and co-authors assert, “might be one of the few institutional sectors working class Americans can turn to for social, economic, and emotional support in the face of today’s tough times.”^[18] As such, understanding the work of religious groups to strengthen ties with their community and respond to despair is needed.

1.3 The American overdose crisis

The overdose crisis itself is complex and understood as having occurred in four waves of fatal overdose death with each subsequent wave building on the former. The first uptick in fatal overdose started in the late 1990s and occurred with the introduction of highly addictive pharmaceutical opioid OxyContin. Manufactured and mass marketed by Purdue Pharma,^[19] OxyContin was touted as a less-addictive pain relief treatment and was widely embraced by the medical profession for the treatment of a broad range of pain-related issues. Many who were prescribed OxyContin became addicted causing demand to grow for off-label or diverted pills.^[20] With increased scrutiny on both the pharmaceutical industry and prescription practices, the drug was reformulated to an “abuse deterrent” form in 2010.^[21] In the second wave, the reformulation coupled with tightening prescription practices led many to turn to heroin as a cheaper, more readily available alternative.^[22] This caused an overall rise in overdose death due to a combination of pharmaceutical opioids and heroin.^[23]

Since 2013, the third wave, fentanyl and illicitly manufactured fentanyl, an opioid 50–100 times stronger than morphine, began to contaminate the American heroin supply. The adulteration of heroin with fentanyl led to a surge in fatal overdose in both recreational and experienced heroin users. Since 2018, fentanyl has contaminated the American drug supply and is found in not just heroin, but cocaine, MDMA or Molly and counterfeit prescription pills.^[24] This, coupled with an increase in polydrug fatal overdose, has led to a fourth wave.^[25] Polydrug overdose frequently involves some combination of fentanyl, heroin, cocaine, methamphetamine and alcohol.^[26] Since the onset of the COVID-19 pandemic, attributed to the ubiquity of fentanyl and challenges wrought by the pandemic, drug overdose has risen precipitously.^[27] The 12-month period from November 2020 to November 2021 was the worst on record with 106,000 Americans dying of drug overdose.^[28]

Despite the large amount of literature on the opioid crisis, little research has engaged how religious institutions have responded^[29] and none that is based on original ethnographic research. This research asks: How have faith communities responded to the overdose crisis?

3.1 No Shame: Erasing the Stigma

In conjunction with the #2069 campaign, Trinity hosted a rally on Wrentham’s town common, “No Shame: Erasing the Stigma” on October 28, 2017. Held on an unseasonably warm fall Saturday morning, information tables hosted by public, private and nonprofit services related to addiction lined the town common. The stage offered an amped mic to project the voices of faith, community and political leaders. The crowd sprawled across the grassy common with many seated in folding chairs or reclined on blankets. The event was attended by 175 people.^[39]

Tibbetts opened the rally with a welcome and then a moment of silence to remember those lost to overdose, saying: “If you have a picture of a loved one you’ve lost, hold it up. If you need to cry, cry. If sadness weighs you down, let others raise you up. I ask you to join me in this time of remembering.”^[40] Many held up photographs and some held one another during the long period of silence.

The first to take the stage after Tibbetts was a husband and wife, parishioners at Trinity. Their son passed away by drug overdose that February at the age of 33. The mother explained that they wanted to, “let people know they’re not alone.” Her husband followed by saying, “It’s a journey of despair and sometimes of economic disaster. Substance use disorder is completely beyond our control. People handle grief differently. We found solace and comfort. Our grief will never fully end. It may sound strange, but we don’t want our pain to go away. We are not the same as we were before our son died.”^[41]

A number of speakers followed: another family who had lost loved ones, first responders, including ambulance workers and Emergency Medical Technicians, State Representatives Republican Shawn Dooley and Democrat Jeffery N. Roy, founder of support group nonprofit Learn to Cope Joanne Peterson, founder of nonprofit support organization the SAFE Coalition Jim Derick and staff member from Teen Challenge of Brockton, a Christian recovery organization, Sean Merrill. Before leaving the stage, speakers were given flowers and, prompted by the facilitator, the crowd echoed in unison, “We stand as one, the voice of change.” Tibbetts offered a short sermon, “Moving Towards Hope: Erasing the Stigma.” The event was emotionally charged, as many told stories of loss with some speakers crying openly and embracing one another.^[42]

3.2 Public health outreach

A key feature of the campaign was linking people to needed social services utilizing a coalition model that coordinated with local nonprofits, medical professionals and the local police department. The SAFE Coalition, founded by Derick after struggling to support his son through addiction, links people with support services related to addiction recovery, bereavement and social support groups. One of its key features is a volunteer-run telephone support hotline that helps people navigate the bureaucratic maze of addiction support services in the state. The hotline served 268 people in 2017.^[43] SAFE also authored a support manual that features general education on substance misuse and outlines institutional pathways for support and practical knowledge, such as how to negotiate with health insurance. The support manual is kept on hand inside the police cars of eight local towns and is given to families as part of drug overdose response.^[44]

For the campaign, signs printed by Trinity were delivered personally to those who requested them. Tibbetts recounted, “When I deliver a sign, and I offer to help plant the sign, they say they are putting it out to remember their loved one in memory as an affirmation that they are not forgotten.”^[45] Beyond memorial, the signs facilitated personalized outreach and support. Derick explained,

Ron delivered a sign to a woman that he ended up knowing, and she was putting it up to commemorate her brother. Her daughter was in the hospital from an overdose [at the time], and we at the SAFE project deployed people. She just got out of detox and is now in a long-term facility [for addiction treatment]. Her parents are now attending a local support group.^[46]

3.3 Online support, organizing, information sharing

In tandem with the #2069 lawn sign campaign, Tibbetts established a public Facebook group. The group, which remains active as of April 2022, has over 15,000 members. The online group serves a number of functions, chief among them different types of information sharing. Upcoming local resources and events are frequently shared on the page related to addiction recovery, memorial events, political and community forums. Frequently, volunteer opportunities are advertised on the page with organizations and individuals soliciting donations and collaboration for meals, food and clothing for people in addiction recovery and locally unhoused people.

Through the page, Tibbetts communicates to the group offering messages of encouragement and shares information about upcoming protest and rallies. For example, the page was used to encourage people to attend protests outside the Massachusetts State House in 2018 and 2020, and in 2019, to protest outside Suffolk County Superior Court in Boston for a court hearing against the Sackler family owners of Purdue Pharma, the maker of OxyContin.^[47]

A daily feature of the page is the posting of the “Massachusetts Daily Detox Bed List.” The post, shared on a number of regional groups related to drug addiction, lists all facilities currently accepting people for detox^[48] or medically supervised withdrawal, the first step in an acute addiction recovery program. This is significant because within the state there is a chronic shortage of available detox beds for people who want them. As such, the list serves a vital community function in offering an updated daily list of current facilities along with their corresponding phone numbers and contact information. The list itself is voluntarily run by a woman from Boston who lost her husband and daughter to drug overdose.^[49] Each day, the list is dedicated to one to four people that lost their lives to drug overdose. The dedication writes, “Today’s list is in memory of.” Photographs are included of the deceased, often accompanied by their name, date of birth and date of death, along with their age at the time of death. For example: Greg, “Forever 34.”

The group serves as a source of solace and support for its members. Tibbetts^[50] explained,

My friend lost her son after years of struggle. I asked one member if they would send cards to her: she received 200 cards. She feels so strong in the face of the loss of her son. She has been in recovery herself for many years. She felt a little afraid and isolated, but it opened up that opportunity. They are all connected to the signs.

3.4 Memorial, protest and action

Annually since 2018, Trinity has observed Black Balloon Day on March 6. Founded by a mother and daughter of Peabody, Massachusetts, in remembrance of their son/brother, the day is for memorialization of those lost to drug overdose. In observance, people display black balloons outside their homes and in public areas. In 2018, Trinity and others observed the day by protesting outside the Massachusetts State House in Boston carrying pictures of their deceased loved ones and holding black balloons.^[51] Though the protest received minimal press coverage, and no one from the State House came outside to meet them, protesters socialized, recounted personal stories of loss, cried and embraced one another. Those in attendance that I spoke with expressed feeling ignored and forgotten by politicians of both political parties.^[52] In 2019, Trinity observed the day by handing out black balloons on the town common in Wrentham. In tandem, a week prior, they hosted a Naloxone^[53] opioid overdose reversal response training and distribution at the church as well.

International Overdose Awareness Day, celebrated annually on August 31, is also significant. Founded in 2001 in Australia, the day is marked by vigils and protests internationally. In 2020, members of Trinity, along with other civil society advocacy groups, protested outside the Massachusetts State House in Boston demanding that American flags in the state be lowered to half-staff to honor those lost to fatal drug overdose, a custom traditionally reserved to memorialize war dead.^[54] Masked because of the pandemic, many carried signs of deceased loved ones. State officials did not head their request. In 2021, President Joe Biden acknowledged the day and signed into law that the week be federally designated as Overdose Awareness Week.^[55]

The group, like many concerned with the opioid crisis, has followed litigation against Purdue Pharma, makers of OxyContin, closely. On June 18, 2018, Attorney General Maura Healey on behalf of the state of Massachusetts filed a suit against Purdue Pharma and members of the Sackler family, owners of Purdue Pharma.^[56] The state was the first in the nation to name members of the Sackler family explicitly. The following summer, for a hearing that was anticipated to be attended personally by the Sacklers, roughly a hundred people, including members of Trinity, gathered outside Suffolk County Superior Court in Boston holding large photographs of deceased loved ones and handmade signs with messages like, “Sack the Sacklers.”^[57]

Though no major decisions were made and the Sackler family was not in attendance, instead represented by their legal team, Attorney General Healey connected personally with protesters. Outside the courthouse, she spoke with families, offering hugs and at one moment, even wiping the tears away from a bereft woman’s eyes. The moment was captured by the press, later shared on Healey’s Facebook page with the message, “I’m with them — always. A deeply moving moment outside Suffolk Superior Court yesterday before a hearing in our lawsuits against Purdue Pharma, its executives and its directors. These families deserve answers.”^[58]

Rev. Tibbetts was in attendance with members of Trinity and later reflected to the #2069 Facebook group,^[59]

Ok so today is August 5th. Just 3 days ago on August 2nd I joined a group of about 100 people outside the Suffolk Superior Court House as they gathered to remind others of the human cost of the epidemic called Substance Use Disorder.

2 things remain with me as I reflect on that gathering that I think transcend the day.

1. My oh My how they love one another!!! [sic]

2. I stood close by as Maura Healey wiped away the tears from the cheeks of a grieving woman and couldn’t help but know that this wiping away of tears is what we all should be doing, always.

As part of a broader settlement, in 2021, Massachusetts tenuously settled with Purdue for $90 million dollars.^[60]

3.5 Contesting despair with community and radial welcome

Faith communities’ efforts in the #2069 campaign demonstrate religious institutions’ ongoing role as a source of community in an increasingly atomized and fragmented society.^[61]

Though the #2069 project was initiated by Trinity, its impact and engagement went beyond the church in a number of ways. Principally, this was through facilitating a coalition model in collaboration with local nonprofits, support groups, local police and public health and government officials. Events hosted by Trinity were frequently held on the town common, a public community gathering space in the center of the town. When asked about the broader meaning of the project, Tibbetts^[62] framed #2069 as building community partnership between religious and secular worlds:

There are some [parish members] that are excited and energized, and some participate and are more connected to people in the community. This campaign has invited folks in [from the community], to experience the liturgy style of Trinity. It has helped challenge us to ask, what does it mean to welcome people? And it’s given us the language of radical welcome. It helps you stretch out your hand to someone that is in a crisis that you didn’t understand.

The challenge that confronts our society is to tear down the wall that divides the faith based from the secular communities. So many nonprofits don’t reach out to faith based [communities] because of whatever their notions are. But there are issues that are greater than our individual identities and we really need to practice more bridging between those two worlds and that is one of the challenges.

As a campaign, the community building element is significant in light of the indignities and isolation characterized by deaths of despair. The group created avenues for social support by facilitating conversations among people previously afraid to publicly disclose their personal challenges. Derick^[63] offered his experience as a father of an adult son with substance use disorder within the parish:

As a person impacted by this, it’s a very isolating illness. It affects the family and friends. When you drove by the signs and you see them out in front of houses, you no longer feel alone. I want to punctuate that for at least 25 years, I ushered and sat on vestry with a man. For all of those years, our sons were both battling the same illness. We socialized, went to barbeques, never did we know we were bearing the same cross. He lost his son, I only found out six months before his death [about his addiction]. We never spoke to each other about our sons’ illnesses.

We were able to come together and literally embrace each other, albeit it late. It has allowed us to come out of the weeds and given us permission. They are people like me, people like you, they want to let people know that there is a problem. That’s the call. That’s the power. It’s an indelible mark that it’s left on my life.

4.1 Faith partnerships as expanded public health opportunity

Within the field of public health, faith institutions are acknowledged as important but often underutilized spaces to support well-being, facilitate social services and allow for information sharing to communities.^[64] The scope of the overdose crisis – found in virtually every community in the United States – and the presence of faith institutions presents an important potential avenue for expanded partnership. This could include faith institutions distributing Naloxone, providing overdose response trainings, education and connection with services as well as more acute harm reduction support such as needle exchanges and safe injection sites.^[65] Public health officials should take note of faith institutions as partners, as they know the challenges of their members intimately and can provide not just basic health information but the spiritual, emotional and community support needed to endure the challenges wrought by chaotic drug use.

Trinity did engage directly in public health work in a number of ways. First, they offered overdose response training and distribution of Naloxone to the public. On their Facebook group page, the “Daily Detox Bed” is an ongoing service that facilitates access to treatment in an overburdened and inadequate healthcare system. More, the SAFE Coalition also represents a community response and volunteer-led effort to support people emotionally and pragmatically with the challenges of chaotic drug use and drug addiction. Their volunteer-run support hotline serves a social work role for those who seek their services and their detailed handbook on services and support groups throughout the state facilitates education on what services are available locally. Such efforts can be understood as filling the gap of an inadequate and confusing state healthcare bureaucracy.

It should be noted, a potential challenge to religious and public health partnerships is the possibility of abstinence-only programming and emphasis over harm reduction.^[66] In some ways, as an enduring legacy of the Temperance movement,^[67] abstinence-only models present serious barriers to harm reduction approaches that are understood to prevent fatal overdose significantly.^[68] For example, groups that consider Medically Assisted Treatment, the benchmark medical treatment for opioid use disorder, as “not being sober” can have the effect of pushing people away from treatment and community.^[69] Tensions between harm reduction and religious communities predate the overdose crisis^[70] and contemporary science and faith-based world views can diverge substantially.^[71] In spite of this, survey data reveal broad heterogeneity in faith communities’ attitudes on how to best address the overdose crisis.^[72] As such, longer-term partnerships between faith communities and public health initiatives will need to engage in site-specific negotiation and collaboration to best address the needs of the community.^[73]

4.2 Racial justice and interfaith collaboration opportunity

Though initially characterized as a white social problem,^[74] overdose death has increased precipitously in communities of color since 2013 – mostly attributed to the contamination of heroin and the American drug supply with fentanyl.^[75] Though this article offers a case study of a predominately white faith community, the role of religious institutions in African American and Latinx communities is significant as in many instances these communities surpass whites in terms of religiosity.^[76] They are also shown to be less stratified along class lines than their white counterparts.^[77] In these communities, public health officials should collaborate with faith leaders as key stakeholders.^[78] Current trends of increasing fatal overdose rates among Black in Latinx men, in particular, highlight to the urgency of such collaborations.^[79]

An opportunity exists for interracial and interfaith partnerships that work to address this issue and support the diverse but interconnected challenges of their respective communities in particular long-standing racial disparities in drug sentencing, mass incarceration^[80] and displacement caused drug war–related violence in Latin America.^[81] This would need to be couched in an approach that embraces pluralism^[82] and is sensitive to longstanding issues of racism,^[83] racial discrimination and persistent racial segregation.

In Massachusetts, some notable interfaith efforts have occurred in respect to the opioid crisis. For example, Natick, Massachusetts, has held the Interfaith Vigil in Memory of All Lost and Who Still Struggle with Substance Use Disorder annually since 2013.^[84] Public vigils with no explicit religious bent also feature faith leaders. For example, on International Overdose Awareness Day 2021 in Worcester, Massachusetts, a public vigil was held outside City Hall. The vigil was opened and closed in prayer led by Catholic pastor and a Jewish Reform Rabbi, respectively.^[85]

4.3 Countering despair, public religion

This article demonstrates that deaths of despair have been met with civic response, including faith-based responses that have sought to alleviate the overdose crisis and the conditions precipitating it. Through a case study of the campaign #2069 led by Trinity Church of Wrentham, Massachusetts, I have shown how the campaign bridged religious and secular worlds through a coalition model of relevant public and private institutions. Engaging those personally impacted by addiction and fatal drug overdose, both online and in person, the campaign offered a space for people to share their struggles, to give and to receive spiritual and emotional support. As such, Trinity’s campaign can be seen as an example of localized, public religion.

Public religion encourages the broader civic engagement of its members.^[86] As a campaign and movement, #2069 evaded partisanship while engaging politically. They protested outside the Massachusetts State House, engaged local political leaders from both major parties, all while calling for increased visibility, expanded funding for treatment options in the state and demanding accountability from Purdue Pharma and their role in the crisis. The characterization of #2069 as an example of local, public religion shows that in spite of overall membership decline from mainline Protestant denominations and other traditionally progressive faiths,^[87] that they remain active in politics and local, civic life.^[88] As such, scholars of religion should remain attentive to local developments and faith-led community engagement efforts.

To close, those troubled by deaths of despair and the decline of American civic life should take note of faith-led efforts to contest these conditions. As the #2069 campaign shows, communities have not simply mourned and memorialized their dead. Rather, they have engaged in coalition building to support those most impacted, demanded political action and offered community to those isolated by the challenges of addiction, chaotic drug use and fatal drug overdose. In the face of conditions marked by “death, drugs and despair,”^[89] the #2069 campaign offers a powerful counternarrative of hope.