We’re seeing a significant increase in substance abuse these days. There are the usual suspects — marijuana, pain pills and sedatives. But heroin is up, and so, sadly, is the use of the synthetic opioid fentanyl. Physicians are routinely prescribing the antidote, naloxone (Narcan), to those who overdose and are discharged home. While the reasons for this have to do with ease of manufacture and transport, another important issue is simply, “Why are people using?”

Time and experience, and hopefully some sanctification, have softened my view. I’m coming to understand a couple of things.