As the United States continues to reel from the opioid and heroin epidemic decade after decade and we try to reach at the root of the problem, it emerges that it has persisted not just for years or a couple of decades, but for well beyond that. According to Ekow N. Yankah, law professor at Yeshiva University’s Benjamin N. Cardozo School of Law in New York, “Thirty years ago, America was facing a similar wave of addiction, death and crime, and the response could not have been more different.”
“Television brought us endless images of thin, black, ravaged bodies, always with desperate, dried lips. We learned the words crack baby. Back then, when addiction was a black problem, there was no wave of national compassion. Instead, we were warned of super predators, young, faceless black men wearing bandannas and sagging jeans.”
These words of Yankah encapsulate the state of affairs in the 1980s and the early ’90s when the crack cocaine epidemic was sweeping across America, affecting predominantly the African American communities. This period was marked by thousands of overdoses annually, innumerable murders and violent crimes linked to illicit drug dealings. Instead of focusing on the public health aspect of the epidemic, America responded by criminalizing addiction.
The current opioid epidemic has been declared a national emergency by President Donald Trump and the emphasis now is on treatment and saving lives. As Yankah says, “Today, police chiefs facing heroin addiction are responding not by invoking war, but by trying to save lives and get people into rehab. Suddenly, crime is understood as a sign of underlying addiction, rather than a scourge to be eradicated.”
The prevalence of the opioid crisis owes its origins to the flawed responses to previous drug crises whose victims largely comprised African Americans and other racial minorities initially. Lack of addiction awareness, which was high in the 1980s, was further complicated by racial prejudices.
Inadequate addiction treatment system
In 2015, drug overdoses resulted in more than 52,000 deaths, of which 33,091 involved prescription or illegal opioids. Since 2000, over 300,000 Americans have died from an opioid overdose. Provisional data for 2016 indicates more than 64,000 drug overdose deaths for the year, and 2017 is expected to be worse due to lethal overdoses principally resulting from fentanyl-laced heroin, fentanyl, and its analogues.
Heather C. McGhee, president of the public policy organization Demos, says that due to racial prejudices, “we did not create the infrastructure and the policy understanding during the earlier drug epidemics.” Racially prejudiced perceptions are not only damaging to minorities; they affect the entire society. This is amply demonstrated by the failure of public health officials, policymakers and law enforcement agencies to curtail spiraling overdose deaths. Although there is consensus that opioid-addicted individuals need treatment, the existing drug addiction treatment system in America is significantly inadequate. More importantly, such infrastructure cannot be created overnight.
This “treatment gap” has been acknowledged in the Surgeon General’s Report on Alcohol, Drugs, and Health which highlights that “substance use disorder treatment in the United States remains largely segregated from the rest of health care and serves only a fraction of those in need of treatment.” In states, such as West Virginia and New Hampshire, which have been hit the hardest by the opioid epidemic, waiting periods for getting treatment can stretch to weeks, months or even years. Despite these interminable delays, there is no guarantee that treatment will be provided.
Irrelevant criminal justice system
Most experts agree that it is ineffective and costly to use criminal justice systems to deal with the opioid crisis. Several states, including Kentucky, Maryland, Louisiana and Indiana have, in recent years, passed various laws imposing new penalties or enhancing punitive action for possession or distribution of opioids. Although banning drugs increases their prices somewhat, there is no substantial evidence to show that increasing the severity of punishments or undertaking extensive efforts to eliminate the drug supply are more effective than lighter penalties.
Besides enacting new laws, police and prosecutors are turning to older laws to inflict harsher punishments, including mandatory minimum sentences, on opioid users and distributors. Some states are also charging suspected opioid dealers with homicide, undermining the “good Samaritan” laws passed by several other states.
In response to the crack epidemic, there was a limited treatment-focused response in terms of setting up drug courts. However, treating addiction as a public health issue and mainstreaming addiction treatment benefits into the Medicaid system in the ’80s, similar to what it is now, could have increased the affordability of treatment. This would have also increased the likelihood of health care providers expanding treatment modalities to match demand even before the opioid crisis worsened to its current levels.
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