“In the middle of us continuing mass incarceration and a tough war on drugs we are having the worst drug epidemic in US history. If these policies actually worked we would never had this epidemic, let alone the worst one ever. Yet here we are….” – German Lopez, Vox

It is estimated by STAT that in the next decade up to 650,000 Americans will have died due to an opiate overdose. This loss of life is equivalent to that of the entire city of Baltimore. A horrendous figure which brings to light the seriousness of the opiate crisis facing the US. To find out more I spoke to German Lopez, a journalist for Vox, who recently wrote this excellent piece on the growing opiate crisis and the US policy response.

The story German told me was one of contradiction and hypocrisy. Despite gentler language being used to describe users of opiates in the media and Government, actual policy has remained rooted in the 1980s. German explained to me how the stigma associated with opiates is very different for a number of reasons.

“Since the 1980s advocates for addiction have been really good at getting people to think about it (addiction) as a medical issue. But to be honest a lot of this change in rhetoric has been due to race. The victims in this crisis are much more likely to be white, while the victims in the crack epidemic were more likely to be black. It is also important to not understate how the crack epidemic had a strong association with violence. Crack dealers were actually shooting each other in the street, and homicide rates in the 80’s were much higher than they are today. Now, people don’t have to onto the street to get drugs, they can message someone online to get what they need. So, this has meant the media are reporting this in a much different way.” – German Lopez, Vox

This changing nature of drug procurement and the media’s increased empathy for white American’s has appeared to change to rhetoric around opiate use. Even President Trump speaks of addiction as a health issue, although this could be in part due to the alleged loss of his brother to alcoholism.

With the media and Government viewing the issue as a health crisis, what has the policy response been from the US? German examined this issue in detail and found that despite a change in understanding of addiction, the front-line policy response remained largely the same as the 1980’s.

“I think some of these law makers in general do think that treatment is the answer, but when it comes to actually paying for it…..well that is always going to be the tricky part, because politicians don’t want to raise taxes, increase spending and add to existing debt. I think the risk here is that if you keep talking about how bad the crisis is, and how you are approaching it as a public health response, but the crisis keeps going worse, then people are going to get and more desperate for an answer. So, they will then rely more and more on the criminal justice side of things and they see it as a more affordable option. With all the rhetoric, it makes it seem like addiction services are getting the help they need, when actually they are not.” – German Lopez, Vox

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German raises a fascinating point with dangerous consequences for policy. If the media continue to talk positively about addiction, and the rhetoric is focused on making sure people get help, but the resources are not implemented and the crisis continues to get worse, in terrible irony, public opinion could further reinforce the exact interventions that are failing. This highlights the importance of holding Governments accountable for their rhetoric, and ensuring it is in line with actual policy.

German did find that while the rhetoric has improved around drug users, the way in which the media and Government are discussing drug dealers has remained firmly rooted in the 1980’s. In practice, the line between drug user and drug dealer is exceptionally blurred, but in the eyes of the law and Government things are very different. German told me this is how the hypocrisy is justified, by vilifying the stereotype and image of a ‘dealer’.

“One thing I found interesting which you see a lot at the state level is that they try to drive this wedge between drug dealers and drug users. They frame it as though the actual users need addiction treatment and public health support, and drug dealers need prison time because they are peddling poison in our communities. If you look at the stats it’s just not that clear, many or even most drug dealers are people who use drugs and are supporting their habit by selling drugs, but that is one way in which people have tried to make it seem like they are not contradicting themselves when they say it’s a public health problem while passing tough on crime laws. It doesn’t really hold up.” – German Lopez, Vox

It is this distinction in rhetoric that allows for a more punitive approach in practice, and validates actions which are taken in courts around the US. The complexity of drug use and distinction between users and dealer is not widely understood in society, but in the eyes of the law things are much more black and white. German described to me how this clamping down on drug dealers is actually persecuting users of the drug more than anyone else and that policy is still focused on the 1980s crack epidemic.

“People still have these images of a drug dealer as someone from the 80’s, with a gun going around shooting people — that still exists to some degree in some places, but it’s really not as common as it used to be. The stereotype people have of drug dealers now it just totally off. Normally it’s just a group of friends who want to get drugs. The problem now is that prosecutors essentially blame someone for an overdose, so anyone who sells or shares drugs to someone who overdoses will be charged with homicide. This type of prosecution is being really encouraged by the US Attorney General Jeff Sessions.” – German Lopez, Vox

German told me how Jeff Sessions has been encouraging prosecutors to ensure someone is held accountable, and often it is just the luck of the draw if someone happens to OD in a group, everyone gets charged with homicide. This duality of rhetoric in which users are given empathy and dealers vilified allows for a continued failing of policy, as many in society do not understand that the two groups are often one and the same. The context of drug use might have progressed but its policies and understanding in wider society certainly hasn’t.

In the process of exploring the crisis in detail German looked for places of good practice and improvement. I asked him what might help to stop the US hitting the shocking target of 650,000 opiate deaths in the next ten years. The evidence for German appeared clear. Treatment for those who want help, and access to medical grade heroin for those who continue to use seems to be the most sensible way of tackling the problem. German also told me how integration with health care services appears to be working well.

“The state of Vermont is an interesting case. They have basically integrated their addiction services with the rest of the health care system and had a really positive response. They are one of the few states that have no waiting time for addiction treatment. Although the state is still hit hard by the crisis they are doing much better than neighboring states and should in theory have had more deaths.” – German Lopez, Vox

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The biggest problem in the US opiate crisis, and the one which German was most concerned about, appears to be the way in which the drug is understood by society. While the duality of rhetoric that clearly exists around users is certainly contributing to the problem, fears and exaggeration of the drug could be doing more damage, and resulting in a continued ‘war on drugs’ rather than reform.

“One of the big things here right now is that people just don’t know that much about what fentanyl really is, they think of it as the crack of opioids and really it’s just a more potent opioid. One of my bigger concerns going forward is that people view it as a new uniquely dangerous drug, and it is dangerous, I don’t want to understate that, but I am worried that people will view it in the same way as they did crack as some uniquely evil thing which might result in them encouraging a tough on crime stance.” – German Lopez, Vox

In many ways German is reframing how we should look at and understand the war on drugs. No-one in the US wants to lose an entire city’s worth of lives in one decade to opiates. The reality though is in the complex and ever-changing field of drugs, simple messages and rhetoric strikes home. Past epidemics have warped our current understanding of the opiate crisis, and the vilification of the drug simply pushes people to turn to enforcement, which is clearly not working. The war on drug continues due to misleading rhetoric, continued vilification of drug dealing and a lack of understanding around the drug itself.

In the UK, we could be on the verge of a devastating opiate crisis as fentanyl begins to make its way into street heroin. The message from the US appears clear; continued punitive measures makes the crisis worse. Treatment clearly needs to be well funded, the Government should be proactive, and wider society needs to be carefully educated on a complex issue.

The UK has the resources to do this, although the current landscape may spell difficulties in doing so. Treatment services are facing heavy cuts across the UK, and the Government has so far taken no steps to address the record number of opiate deaths last year. Despite the challenges, the pending crisis in the UK does present an opportunity for us to not make the same mistakes. The evidence is overwhelmingly clear. The answer to the opiate crisis lies in treating it as a public health issue, and not resorting to further punishment and incarceration.

The key to facilitating such an approach is through careful and responsible rhetoric which provides education on the issue, rather than creating more fear and misunderstanding. Everyone can play a role in doing this. It might be easier said than done, but the price is too high to ignore. If you don’t believe me, just picture the bustling metropolis of Baltimore and imagine what 650,000 people looks like…

 

Paul North is an Addiction and Treatment Advisor at Volteface. Tweets @Paul_North

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