The hypocrisy of the opioid debate

Posted on April 25, 2018

Days ago, the U.S. Senate Health, Education, Labor and Pensions Committee unanimously approved a bill called the “Opioid Crisis Response Act of 2018.” Since this is a bipartisan measure, it’s no surprise that the bill is a catchall of small ideas. Sure, we should enact the bill. But it’s more PR than solution.

Let’s address one slice of that PR. Why is it called an “opioid crisis”?

Since when did we start using the word “opioid”? When did we stop calling it a “drug crisis,” or as I will explain, a “heroin and fentanyl crisis”? When did we start focusing on the narcotics instead of the people abusing them? When did we start shifting the blame from drug “addicts” to prescribers? And when did we stop talking about the “war on drugs”?

When the addicts were perceived as white.

But (perhaps you are thinking), isn’t the situation now different from the 1980s and 90s because the drug users are mostly dying from prescription drugs?

No. That is political spin promoted by both parties and all of the media.

First, understand that “opioid” includes four different types of drugs: (1) illegal opium products (mostly heroin), (2) illegal synthetic opium products (mostly fentanyl), (3) prescribed methadone, and (4) all other prescribed semi-synthetic opium products (like oxycodone).

According to the Centers for Disease Control, in 2016 there were 34,882 deaths from illegal opioid products and only 17,860 from opioid prescriptions. Illegal opioids caused twice as much harm.

But even more crucial, look at the trends.

The number of deaths from methadone overdoses have steadily declined from 5,518 in 2007 to 3,373 in 2016. There is no methadone crisis.

The number of deaths from all other opioid prescriptions—the type of medicine that politicians and the media are hysterical about—increased from 10,943 in 2010 to 14,487 in 2016. This represents a 32 percent increase, which is sad. But…

Deaths from heroin jumped from 3,036 in 2010 to 15,469 in 2016—a five-fold increase. And deaths from fentanyl skyrocketed from 3,007 in 2010 to 19,413 in 2016—greater than a six-fold increase.

Now that’s a crisis.

White folks are dying, but today’s emergency is overwhelmingly a matter of illegal drugs, not prescriptions. Why the phony spin?

Think about America’s political history when it comes to drugs. You already know some of it.

According to journalist Dan Baum who was writing a book about politics and drug restrictions, former Nixon domestic affairs adviser John Ehrlichman said in a 1994 interview:

The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.

That was just the beginning. Ronald Reagan announced a “war on drugs” in 1982, Nancy Reagan launched the “Just Say No” campaign in 1984, and Congress enacted mandatory minimum sentencing in 1986, focusing attention and the harshest sentences on crack rather than powder cocaine—because crack users tended to be (or be perceived as) people of color while cocaine users were white.

The strategy continued. In his first televised address as president in 1989, George H.W. Bush held up a bag of crack cocaine and called it “the greatest domestic threat facing our nation today.” The bag had been taken from a black 18-year-old novice dealer who was lured by the Drug Enforcement Administration to Lafayette Park (next to the White House) specifically for Bush’s speech.

Without belaboring the point, for the past half-century conservatives have used drug addiction as a white-against-black political banner, rather like the confederate battle flag. It’s been a racial dog whistle. Now that drug users are perceived as white, conservatives decided to join progressives** in reframing drug abuse as a public health issue. (See Washington Post columnist Petula Dvorak’s story for a more colorful discussion of this phenomenon.)

Yes, we should treat drug abuse as a healthcare rather than a criminal justice issue. Yes, today’s drug users—no matter their race—deserve sympathy and help. But no, today’s addicts are nothing new and the change in language is pure hypocrisy.


**As an example of progressive reframing, see this White House directive released in the last days of the Obama Administration called “Changing the Language of Addiction.”