Those who work to address the overdose crisis know that stigma impedes reform. The barriers to implementing needed initiatives—those backed by ample scientific research and proven to save lives—don’t otherwise make any sense. To overcome this public health epidemic is to somehow undo the deep-seated stigma that has tainted public support and, in turn, constrained policymakers from the collective response that is called for.
Sadly, the coordinated effort to shift societal attitudes seems out of reach in a nation where drug use is a crime. After all, it is nearly impossible to shed the stigma associated with any behavior that incurs incarceration or other legal consequences. Years in the making, this dyed-in-the-wool mindset continues to be nurtured by existing laws that further challenge the way out of this vicious cycle.
Let’s look at prohibition and the war on drugs.
By 1915, drugs such as morphine and cocaine, which had formerly been used freely for ailments as well as recreation, were made illegal. It wasn’t too many years before alcohol and then marijuana joined the ranks with any usage deemed a punishable crime. As a result, people were arrested and incarcerated for continuing established practices, and organized crime flourished, feeding widespread corruption, violence, and the dangers of the underground market. Recognition of this massive failure brought on a repeal of alcohol prohibition, permitting its use and establishing standards for its quality and potency.
But the war on drugs was just heating up as were the strategies to eradicate the supply of prohibited drugs and penalize people who use them.
According to statistics from the Department of Justice, over 2 million people in the US are currently incarcerated. With just 5 percent of the world’s population, but 25 percent of its inmates, the US has the highest prison population in the world, with more people behind bars than any other country, including those with a totalitarian regime. Over 300,000 of these people are locked up for nonviolent drug offenses, a number representing a sharp rise from the 25,000 of 1980 and an explosion in facility costs to the tune of $80 billion annually, an expenditure that exceeds the Department of Education budget by $12 billion, and one that benefits a murky private-equity network of financiers.
In addition to massive incarceration and scores of ruined lives, prohibition ushered in the black market and its many perils. Intent on ridding the nation of illegal substances, law enforcement works to block entry points and confiscate illicit drugs. Yet evidence demonstrates that for every shipment seized, hundreds more get through. Clever cartels inevitably develop new strategies, smuggling smaller amounts but with higher potency, escalating the dangers of drug use and stoking the spike in accidental fatalities.
The biggest beneficiaries of prohibition are the drug cartels who make billions every year without any accountability, regulations, or taxation. In essence, our prohibitionist approach has emboldened lucrative trafficking with increasingly deadly drugs, while we simultaneously criminalize its victims, compounding problems such as poverty, hopelessness, and stigma.
Recent years have brought the Drug Enforcement Administration (DEA)—a police agency—into surveillance of prescription drugs and government involvement in dosage and prescribing limits, undermining doctors’ expertise in pain management, eroding the rights of chronic pain sufferers, and creating a new set of victims many of whom have been driven to street drugs or suicide.
Yes, the pharmaceutical companies' greedy and profit-driven practices have been shameful, and clipping their wings is a good thing. But the onset of addiction among recipients of prescribed medication has been 10 percent and, for those without previous illicit drug use, less than 1 percent. Opioid misuse that did involve prescription drugs was due to people using medication that wasn’t prescribed to them, obtained from a friend or a dealer. While this suggests that some reductions have been sensible, the black market quickly filled the void with more deadly drugs. Regardless, taking needed medication from those with chronic pain, who do not miss a dose or share their medication, makes no sense.
Predicting a continued rise in overdose fatalities from now through 2025, a scientific study published in JAMA Network Open and conducted by experts from Harvard Medical School and Massachusetts General Hospital, concluded: "Prevention of prescription opioid misuse alone is projected to have a modest effect [3.8 percent] on lowering opioid overdose deaths.” But prescription surveillance continues despite its lack of effect on the overdose epidemic that continues to claim more lives than gun violence and car accidents combined. The killer is illicit fentanyl; not prescribed medication.
The DEA also regulates the prescribing of methadone and buprenorphine, medications that effectively treat opioid addiction, saving from 50 to 70 percent more lives in comparison to treatment that doesn’t include medication. Even so, needless controls on these two medications limit the doctors that can prescribe them and cap the number of patients they can serve, making access difficult for some and impossible for others. Any doctor, even those fresh out of medical school, can prescribe oxycodone without the special license or other hurdles involved in prescribing buprenorphine, a far safer drug and one that has transformative effects in the treatment of addiction. It makes no sense.
Costing a trillion taxpayer dollars, the war on drugs has failed to thwart the thriving underground drug market, failed to prevent the demand for drugs, failed to reverse the growing number of overdose deaths, and failed to help those in need. Leaving heartache and destruction in its wake, the war on drugs has brought mass incarceration, inhumane treatment, an overwrought judicial system, ruined lives, erosion of human rights, a staggering number of preventable deaths, and the suffering of innocent bystanders—people with chronic pain conditions. In short, it has destroyed more lives than drug use itself, as suggested in a Pew Charitable Trust examination that found no statistical relationship between drug imprisonment rates and drug use or overdose deaths.
Attempts to initiate programs that have saved countless lives in peer countries are met with resistance from the federal government whose warriors reason that their interpretation of a legal technicality trumps saving lives. If we could move the oversight of drug policy to the Department of Health, and drop the military approach, we could champion health care and ensure the human rights and the dignity of our people, providing much needed clean needle programs, overdose prevention sites, and the gold standard of addiction treatment that is free of government interference. Rather than compounding the misery of addiction, we could replace the war on drugs and put an end to its harms.
An article in American Consequences titled “The Hidden Costs of Drug Prohibition” by Trevor Burrus—a research fellow in the Cato Institute’s Robert A. Levy Center for Constitutional Studies and in the Center for the Study of Science—begins with a question he’d posed as a teenager: “Why do heroin addicts get cages and alcoholics get treatment?”
Full of wisdom and compassion, Burrus’ analysis includes: “The drug war, like so many legal prohibitions on vices and private behavior, is rooted in the dehumanization of the drug users usually based on racial stereotypes and moralistic class warfare. Due to drug prohibition, illicit drug users get dangerous and overly potent drugs...and we all get a hostile and increasingly ineffective system of law enforcement.” In elaborating on the “insidious and invidious costs of prohibition” that are often unknown and surely under-discussed, he makes a compelling case for prohibition as the biggest cause of accidental overdose deaths.
In conclusion, Burrus says, “We need to do more. Treating drug users like human beings is a good first step.”
His words give me hope, but then I remember the stigma.