The United States is in the midst of an epidemic-level crisis of overdoses — one that is accelerating each year. Nationally, overdose rates have now surpassed motor vehicle accidents as the leading cause of injury-related death in the country.
In 2016, the overdose death toll in the U.S. surpassed American deaths during the entire Vietnam War and lives lost at the peak of the AIDS crisis, with an estimated 59,000 people succumbing to overdose.
{mosads}This is far from the first time that problematic substance use has had a devastating impact on communities across the country, but our response is distinctly different than during previous eras. Heroin, cocaine and other substances have never discriminated, but it’s clear our policy response certainly has.
Throughout the 1970s, heroin overdoses ravaged Harlem and other cities that were facing deindustrialization, disinvestment and demographic upheaval. The response was harsh policing and the Rockefeller Drug Laws in New York, which established draconian mandatory minimum sentences that were then adopted across the country. Absent from policymakers rubric was consideration of the well-being of people with substance use disorder.
In the 1980s and ’90s, communities that were decimated by lack of economic opportunity experienced the brunt of what became defined as the crack era. Again, our country deployed law enforcement and prisons to interact with people experiencing deep trauma and medical issues — negating any public health dimension within the response. Instead, the Senate enacted enhanced penalties for people who sell small amounts of drugs and sentencing disparities of 100:1 for crack versus powder cocaine.
Now, with the overdose crisis becoming a mainstream conversation, there has been a shift in the narrative. When prior “drug problems” were seen as affecting primarily communities of color, government intervention focused on increased policing and criminalization. Current policy responses — now that predominantly white, suburban or rural communities are perceived as the hardest hit by overdose — invoke a distinctly public health response, a “kinder, gentler approach” that has politicians proclaiming we “can’t arrest our way out of this problem.”
There is widespread and growing recognition that policies that deny people’s basic humanity, separate families, and rip apart communities do nothing to stem the tide of overdose or support public health. Yet the ripple effects of the criminalization approach — in terms of lack of infrastructure and frameworks for treatment — haunt us in the current crisis.
Naloxone, the drug that can reverse an opioid overdose, was approved by the FDA in the 1970s. But it wasn’t widely deployed until the mid-2000s and is just getting into the hands of first responders in the last several years. It is absolutely devastating to consider how many lives could have been saved over the last 40 years if the people who were dying of overdose in the 1970s had mattered enough to policymakers to elicit a compassionate response.
Likewise, rural and suburban communities are feeling the impact of opioids dramatically and reeling from lack of sufficient access to treatment programs. Because drug problems were seen as an issue that only affected other communities, methadone, buprenorphine and other gold-standard therapies for opioid use were seen as a stain on the community and programs to be blocked out. Now communities are clamoring for effective treatment options and providers are scrambling to establish caregiving facilities.
We cannot afford to let this moment of compassion remain skin deep. Parallel to the tide of compassionate response, across the country we’ve also seen a push for wrong-headed drug-induced homicide laws that again trade in dangerous stereotypes. We must be truly vigilant as this federal administration and policymakers in statehouses and city halls try to claw their way back to punitive approach of the war on drugs.
Caring rhetoric must be backed up by implementing the full range of evidence-based solutions that can save lives and ensuring that all communities have access to responsive treatment options.
The opioid epidemic has underscored what we have always known about drug use and misuse. Addiction is not specific to racial group or economic class, but the effects of supposedly “race-neutral” or colorblind drug policy have had a disparate impact on communities of color. Congress needs new thinking in drug policy that owns that truth and atones for the harm done.
Kassandra Frederique is New York State director at the Drug Policy Alliance. Melissa Moore is the New York State deputy director at the Drug Policy Alliance.